AC 4411 (1) LEYTON LEY 43 Borough of Lenton. HEALTH REPORT FOR THE YEAR 1949. ANDREW W. FORREST, m.a., m.d., ch.b., d.p.h., Medical Officer of Health. CONTENTS. pages 1. Opening Remarks 3—6 2. Vital Statistics 8—18 3. Infectious Diseases 20—29 4. General (a) Food Poisoning 32 (b) Scabies 33 (c) Mortuary 33—35 (d) National Assistance Act, 1948 36—37 5. Sanitary Circumstances op the Area 40—54 6. National Health Service Act, 1946, Part III 56—87 (a) Sec. 21 Health Centres 56—57 (b) „ 22 Care of Mothers and Young Children 58—68 (c) ,, 23 Midwifery 69—71 (d) ,, 24 Health Visiting 71 (e) „ 25 Home Nursing 72 (/) ,, 26 Vaccination and Immunisation 73—75 (g) „ 28 Prevention of Illness and After Care 76—81 (h) ,, 29 Domestic Help 81—87 7. School Medical Service 90—112 3 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LEYTON. Mr. Mayor, Ladies and Gentlemen, I have the honour to present herewith my Annual Report on the health, sanitary circumstances and vital statistics of the Borough of Leyton during the year 1949. VITAL STATISTICS. The Registrar-General's estimate of the population of the Borough of Leyton during the year 1949 was 106,700 persons, an increase of 600 persons compared with the previous year. The last official census of population was taken in the year 1931, and arrangements are now being made for the taking of the next official census in 1951. Compared with the previous year, there has been a considerable decrease in the number of births per thousand of the population durine 1949. From the following figures it will be seen that the sudden post-war increase in births reached its maximum in 1947. Year. Births. Birth Rate. 1945 1,474 16.87 1946 2,223 21.81 1947 2,359 22.35 1948 1,810 17.06 1949 1,630 15.27 In my last Annual Report, while dealing with the exceptionally low death rate for the year 1948, I drew attention to the progressive increase in the expectation of life which has been taking place during this and the last generation, the great fall in the birth rate during the same period, and the consequent increase in the proportion of old people in the population. If unchecked, these factors—which have brought about such a fundamental change in the age constitution of the population—must inevitably give rise to an increase in the general death rate. to an increase in the general death rate. Deaths of Leyton residents certified during the year numbered 1,232, giving a death rate of 11.54 per thousand of tho population. 4 Year. Deaths. Death Rate. 1945 1,147 13.13 1946 1,181 11.58 1947 1,278 12.10 1948 1,118 10.53 1949 1,232 11.54 In my last Annual Report I had occasion to report that the infantile mortality rate for the year 1948 (20.99 deaths of infants under one year per thousand live births) was the lowest rate ever recorded since official figures became available. During 1949 the number of infant deaths under one year per thousand live births was 26.38; the corresponding figures being 29 for London, and 32 for England and Wales. Year. Births. Deaths under One Year of Age. Infantile Mortality Rate. 1945 1,474 52 35.27 1946 2,223 64 28.78 1947 2,359 78 33.06 1948 1,810 38 20.99 1949 1,630 43 26.38 During the year under review no Leyton woman died from diseases or accidents associated with pregnancy and childbirth. The maternal mortality rate is therefore nil. Additional vital statistical information is to be found in the body of the Report (pages 8 to 18). On page 18 there is a table showing annual comparative vital statistics in Leyton over a period of fifty years. INFECTIOUS DISEASES. One of the most outstanding features of the year is that not a single confirmed case of diphtheria was notified during the year. This is the first time in the history of Leyton, at least since official figures have been available, that the area has been quite free for a whole year from a disease which in the past has been one of the chief causes of death and lifelong disability. Of children attending Leyton schools, some 76 per cent. have been immunised against diphtheria. Scarlet fever remains mild in type. Since 1941 only one death in the Borough has been attributable to it. 5 Measles continued its epidemic prevalence but, for the second year in succession, no Leyton child died from measles. Another encouraging feature is that no child has died from whooping cough. On page 75 will be found information regarding a special investigation into the efficacy of whooping cough vaccines, which is being undertaken in collaboration with the Medical Research Council. During the summer of 1947 there occurred the most widespread and serious outbreak of acute poliomyelitis (commonly known as "infantile paralysis") we have ever had in this country. In that year 14 cases were notified in Leyton, and of these one was fatal. Fortunately there was no widespread occurrence of cases in 1948, when only two cases were notified ; but as early as April, 1949, the first case of the year was notified. During the year there were notified some 20 cases, of whom four were extra-district residents who were undergoing in-patient treatment in hospitals in the Borough. Further information regarding the outbreak, along with a table showing in summary form relevant information regarding individual cases, is shown on pages 23 to 24. Last year I had occasion to draw attention to the increase in the incidence of and mortality from tuberculosis during 1948. From the figures on page 27 it will be seen that in 1949 there has been a welcome decrease in both incidence and mortality. SANITARY CIRCUMSTANCES. During their inspections and surveys of dwelling houses in the area, your sanitary inspectors report that during recent years there has been a steady improvement in the standard of cleanliness of dwelling houses in the area, and in the general environmental conditions. Increasing attention continues to be paid to places where food is prepared, and there is a welcome improvement in the structural conditions, general cleanliness and utensils. As the result of advice given by your inspectors, there is increasing desire by both employers and employees to co-operate in the campaign for ensuring the cleanliness of catering establishments. SCHOOL MEDICAL SERVICE. From a perusal of the section of the report (and the statistical appendix) dealing with the school medical service, it will be seen that it was possible to carry out essential services in spite of shortage of staff. There are, however, two branches of the work in which staff shortage is responsible for virtual breakdown of the service. In 6 March, 1949, Miss Harris (Physiotherapist) left your service, and all attempts to fill the vacancy have failed. For nine months of the year under review it has therefore been necessary to curtail the physiotherapy service and to abandon the artificial sunlight clinic for pre-school and school children. In my last annual report I drew attention to the disastrous position in which mothers and children are now placed in consequence of the dental arrangements set up under the new National Health Service Act, and to the grievous harm which will be done to their dental welfare and future health unless something can be done at once to remove the anomaly. A year ago I felt that the position was so palpably serious that something would have to be done. Unfortunately, as will be seen from the report of your Senior Dental Surgeon (Mr. A. E. Hall) on pages 97 to 99 and my introductory observations thereon, the position has worsened to such a degree that it can now be regarded as a major tragedy. Leyton, which should have six full-time dental surgeons to carry out the pre-school and school dental services, has now only one ; and it is a source of gratification that there are still to be found dental surgeons in the service of local authorities who have been able and willing to resist the tempting remuneration of private practice. NATIONAL HEALTH SERVICE ACT PART III As explained in my last report, on 5th July, 1948, the Essex County Council took over from Leyton Council responsibility for local public health services connected with maternal and child welfare, home nursing, priority dental service, domestic help, vaccination and immunisation, after-care, ambulance service, blood transfusion and laboratory services. There is still a Leyton Health Area Sub-Committee, which is responsible to the County Council for certain aspects of these services, but the responsible official is the County Medical Officer. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, Vital Statistics 8 Extract from Vital Statistics for the year 1949. Population 106,700 Live Births.— Legitimate Males 829 Females 743 Illegitimate Males 34 Females 24 Totals 1.630 Birth Rate per 1,000 of population 15.27 Stillbirths:— Males 13 Females 21 Rate per 1,000 total (live and still) births ... 20.43 Deaths:— Males 578 Females 654 Totals 1,232 Death Rate per 1,000 11.54 Number of women dying from diseases and accidents of pregnancy and childbirth:— From Sepsis 0 From other causes 0 Rate per 1,000 total (live and still) births 0.00 Death rate of infants under one year of age:— All infants per 1,000 live births 26.38 Legitimate infants per 1,000 legitimate live births 25.45 Illegitimate infants per 1,000 illegitimate live births 51.71 Deaths from Cancer (all ages) 232 „ ,, Measles (all ages) 0 „ ,, Whooping Cough (all ages) 0 ,, ,, Diarrhoea (under 2 years of age) 4 9 TABLE 1. Birth-rate, Death-rate and Analysis of Mortality During the Year 1949 Birthrate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Births. Percentage or Total Deaths. All Causes. Enteric Fever. Smallpox. Tuberculosis. Pneumonia. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under 2 Years). Total Deaths under 1 Year. Certified by Registered Medical Practitioners. Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. Live Births. Still Births. England and Wales 16.7 0.39 11.7 0.00 0.00 0.45 0.51 0.01 0.00 0.15 3.0 32 ... ... ... ... 126 County Boroughs and Great Towns, including London 18.7 0.47 12.5 0.00 0.00 0.52 0.56 0.02 0.00 0.15 3.8 37 ... ... ... ... 148 Smaller Towns. Estimated Resident Populations 25,000 to 50,000 at Census, 1931 18.0 0.40 11.6 0.00 0.00 0.42 0.49 0.01 0.00 0.14 2.4 30 ... ... ... ... London 18.5 0.37 12.2 0.00 0.00 0.52 0.59 0.01 0.00 0.11 1.7 29 ... ... ... ... LEYTON 15.27 0.31 11.5 0.00 0.00 0.34 0.55 0.00 0.00 0.15 2.4 26 80.3 7.1 12.5 ... 10 INFANTILE MORTALITY RATES. (Per 1000 live births). 11 TABLE 2. Registered Births, 1949. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Total. January 4 8 4 3 3 5 5 1 2 3 38 February 5 8 1 o 9 3 5 4 4 5 46 March 6 3 2 4 5 4 4 2 4 — 34 April 3 6 5 7 10 7 2 10 5 4 59 May 5 10 3 1 8 3 — 1 4 4 39 June 4 5 9 4 8 7 4 — 5 7 53 July 3 3 2 2 9 3 3 3 3 1 32 August 5 8 4 4 9 4 6 3 3 2 48 September 4 3 9 5 6 5 6 5 6 6 55 October 1 5 4 4 9 2 2 4 7 4 42 November 9 6 3 6 1 2 3 4 3 37 December 4 7 4 2 4 2 6 4 2 3 38 Transferables 97 182 82 93 196 157 84 85 85 48 1,109 Totals 141 257 135 134 282 203 129 125 134 90 1,630 12 TABLE 3. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE BOROUGH OF LEYTON, 1949. Sex. All Ages. Ages at Death in Years. In Institutions in the District Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. Not belonging to District. Belonging to District. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1. Typhoid and paratyphoid fevers M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2. Cerebro-spinal fever. M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet fever M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping cough M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Diphtheria M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Tuberculosis of respiratory system M 20 ... ... ... ... ... 1 5 4 6 2 2 ... ... F 13 ... ... ... ... 2 3 2 2 4 ... ... ... ... 7. Other forms of tuberculosis M 4 ... ... 2 ... 1 ... ... ... 1 ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8. Syphilitic disease M 4 ... ... ... ... ... ... 1 ... 1 2 ... ... ... F 4 ... ... ... ... ... ... ... ... 1 ... 3 ... ... 9. Influenza M 7 ... ... ... ... ... ... 1 2 1 l 2 ... ... F 9 ... ... ... ... ... ... ... ... 1 3 5 ... ... 10. Measles M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Acute poliomyelitis and polioencephalitis M 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12. Acute infectious encephalitis M 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13. Cancer of buccal cavity and oesophagus (males only) M 6 ... ... ... ... ... ... ... ... 1 4 1 ... ... 13. Cancer of uterus F 7 ... ... ... ... ... ... 1 ... 2 1 3 ... ... 14. Cancer of stomach and duodenum M 26 ... ... ... ... ... ... ... 3 9 10 4 ... ... F 14 ... ... ... ... ... ... ... ... 4 3 7 ... ... 15. Cancer of breast M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 33 ... ... ... ... ... l 3 9 7 8 5 ... ... 13 15. Cancer of breast M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 33 ... ... ... ... ... 1 3 9 7 8 5 ... ... 16. Cancer of all other sites M 85 ... ... ... ... ... 2 5 14 22 28 14 ... ... F 61 ... ... ... ... ... ... 6 6 11 16 22 ... ... 17. Diabetes M 2 ... ... ... ... ... ... ... ... 1 1 ... ... ... F 4 ... ... ... ... ... ... 1 ... ... 3 ... ... ... 18. Intra-cranial vascular lesions M 59 ... ... ... ... ... ... ... 4 11 21 23 ... ... F 81 ... ... ... ... 1 ... 1 2 14 23 40 ... ... 19. Heart disease M 137 ... ... ... ... ... 1 3 6 16 46 65 ... ... F 224 ... ... ... ... ... ... 4 9 18 49 144 ... ... 20. Other diseases of circulatory system M 26 ... ... ... ... ... ... ... 1 4 9 12 ... ... F 17 ... ... ... ... ... ... ... 1 2 4 10 ... ... 21. Bronchitis M 63 1 ... ... ... ... 1 ... 5 12 25 19 ... ... F 47 2 ... ... ... ... ... 1 2 1 12 29 ... ... 22. Pneumonia M 28 1 ... ... ... 1 ... 2 2 6 8 8 ... ... F 31 3 ... ... ... ... ... 2 1 1 10 14 ... ... 23. Other respiratory diseases M 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... F 10 ... ... ... ... ... ... 1 1 3 3 2 ... ... 24. Ulceration of the stomach or duodenum M 12 ... ... ... ... ... 1 ... 3 3 5 ... ... ... F 5 ... ... ... ... ... ... ... 1 1 1 2 ... ... 25. Diarrhoea (under 2 years of age) M 1 1 ... ... ... ... ... ... ... ... ... ... ... ... F 3 3 ... ... ... ... ... ... ... ... ... ... ... ... 26. Appendicitis M 3 ... ... ... 1 ... 1 ... ... ... ... 1 ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27. Other digestive diseases M 7 ... ... ... ... 1 ... ... 3 1 1 1 ... ... F 15 1 ... ... ... ... ... ... 2 5 4 3 ... ... 28. Nephritis M 6 ... ... ... ... 1 ... 1 ... 3 ... 1 ... ... F 4 1 ... ... ... ... ... ... ... ... 1 2 ... ... 29. Puerperal and post-abortive sepsis. F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30. Other maternal causes F ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31. Premature birth M 6 6 ... ... ... ... ... ... ... ... ... ... ... ... F 4 4 ... ... ... ... ... ... ... ... ... ... ... ... 32. Congenital malformations M 9 8 ... ... ... ... ... ... ... 1 ... ... ... ... F 12 9 1 ... 2 ... ... ... ... ... ... ... ... ... 33. Suicide M 7 ... ... ... ... ... ... ... 2 5 ... ... ... ... F 6 ... ... ... ... ... 1 3 1 ... ... 1 ... ... 34. Road traffic accidents M 4 ... ... ... ... 1 ... 1 ... 1 ... 1 ... ... F 3 ... ... ... ... ... ... ... 1 ... 2 ... ... ... 35. Other violent causes M 11 ... ... ... 2 ... 1 ... 1 2 1 4 v ... F 6 ... ... ... ... 1 l ... ... ... 2 2 v ... 36. All other causes M 42 2 ... ... 1 2 4 3 5 6 6 13 v ... F 41 1 ... ... 1 2 ... 1 6 4 11 15 v ... Totals M 578 43 1 2 7 14 18 49 99 193 326 480 1,200 358 F 654 14 TABLE 4. DEATHS IN WARDS, 1949. CAUSES OF DEATH. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. 1 2 3 4 5 6 7 8 9 10 119 1. Typhoid and paratyphoid fevers ... ... ... ... ... ... ... ... ... ... 2. Cerebrospinal fever ... ... ... ... ... ... ... ... ... ... 3. Scarlet fever ... ... ... ... ... ... ... ... ... ... 4. Whooping cough ... ... ... ... ... ... ... ... ... ... 5. Diphtheria ... ... ... ... ... ... ... ... ... ... 6. Tuberculosis of respiratory system 2 5 5 2 6 3 2 ... 5 3 7. Other forms of tuberculosis ... 1 ... ... 2 ... ... ... ... 1 8. Syphilitic diseases ... 2 ... 1 4 1 ... ... ... ... 9. Influenza ... 2 ... 2 2 3 1 1 5 ... 10. Measles ... ... ... ... ... ... ... ... ... ... 11. Acute poliomyelitis and polio-encephalitis ... 1 ... ... ... ... ... ... ... ... 12. Acute infectious encephalitis ... ... ... ... ... ... ... ... ... 1 13. Cancer of buccal cavity and oesophagus (males only) ... 1 ... 1 ... ... 1 ... 2 1 13. Cancer of uterus ... ... 1 ... 5 ... ... ... ... 1 14. Cancer of stomach and duodenum 7 ... 5 10 4 2 3 5 2 2 15. Cancer of breast 4 5 2 1 5 4 6 1 4 1 16. Cancer of all other sites 15 30 13 18 22 16 5 10 9 8 17. Diabetes ... ... ... 2 3 1 ... ... ... ... 18. Intra-cranial vascular lesions 13 24 8 15 25 17 4 7 15 12 19. Heart disease 34 60 26 28 68 44 21 27 32 21 20. Other diseases of circulatory system 2 9 2 6 8 4 4 3 4 1 21. Bronchitis 10 25 8 15 9 7 4 g 16 8 22. Pneumonia 3 12 4 6 12 4 5 5 6 2 23. Other respiratory diseases ... 2 ... ... 4 2 ... ... 2 1 24. Ulcer of stomach or duodenum 4 3 1 1 2 ... 1 4 ... ... 25. Diarrhoea (under 2 years) ... ... ... ... ... 2 ... 2 ... 1 26. Appendicitis ... ... ... ... 3 ... ... ... ... ... 27. Other digestive diseases 1 4 ... 3 1 6 1 1 2 3 15 28. Nephritis ... 2 1 ... 3 1 2 ... 1 ... 29. Puerperal and post-abortive sepsis ... ... ... ... ... ... ... ... ... ... 30. Other maternal causes ... ... ... ... ... ... ... ... ... ... 31. Premature birth ... 2 1 2 2 1 2 ... ... ... 32. Congenital malformations 4 1 1 2 7 3 1 1 1 ... 33. Suicide 1 5 ... ... 4 1 1 1 ... ... 34. Road Traffic accidents ... 2 3 ... 1 ... 1 ... ... ... 35. Other violent causes 3 4 ... 1 3 2 1 ... ... 1 36. All other causes 5 15 7 6 12 15 2 6 8 7 Totals 108 217 88 122 217 139 68 82 116 75 16 TABLE 5. Vital Statistics of Whole District during 1949 and Previous Years. Year. Births. Total Deaths Registered in the Borough. Transferable Deaths Nett Deaths belonging to the Borough. Inward Transferases Nett. of Nonresidents registered in the Borough. of Residents not registered in the Borough. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. Number. Rate. 1 3 4 5 6 7 8 9 10 11 12 13 1934 819 1454 11.78 2864 23.2 1774 227 64 44.02 1317 10.67 1935 777 1493 12 26 2671 21.9 1789 243 60 40.18 1225 10.06 1936 661 1421 11.85 3028 25.2 2018 262 74 52.07 1272 10.61 1937 653 1420 12 02 3190 27.0 2104 263 75 52.81 1349 11.42 1938 656 1509 12.87 2934 25.0 1938 152 70 46.38 1148 9.79 1939 605 1499 12.90 2951 26.6 1987 278 46 31.65 1242 11.21 1940 645 1353 14.02 3865 40.0 2302 335 50 39.03 1563 16.2 1941 705 1129 13.31 2430 28.6 1288 341 37 38.30 1142 13.46 1942 814 1452 16.69 2373 27.3 1546 296 73 50.27 1123 12.91 1943 871 1595 18.14 2769 31.5 1810 289 57 35.73 1248 14.20 1944 1003 1613 18.87 2779 32.5 1778 284 68 42.15 1285 15.04 1945 971 1474 16.87 2644 30.3 1698 201 52 35.27 1147 13.13 1946 1260 2223 21.81 2617 25.6 1646 210 64 28.78 1181 11.58 1947 1328 2359 22.35 2595 24.6 1558 241 78 33.06 1278 12.10 1948 1172 1810 17.06 2152 20.2 1244 210 38 20.99 1118 10.53 1949 1109 1630 15.27 2162 20.2 1200 270 43 26.38 1232 11.54 17 TABLE & Infantile Mortality, Year 1949—Ages. CAUSES OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months. 9 Months and under 12 Months. Total Deaths under 1 Year. Smallpox ... ... ... ... ... ... ... ... ... ... Chickenpox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... ... ... ... ... ... Diphtheria and croup ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Tuberculous meningitis ... ... ... ... ... ... ... ... ... ... Abdominal tuberculosis ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 1 ... 1 3 Pneumonia (all forms) ... 1 ... ... 1 1 ... 1 1 4 Diarrhoea ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... 2 1 1 ... 4 Gastritis ... ... ... ... ... ... ... 1 ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 4 ... ... ... 4 ... ... ... ... 4 Congenital malformations 7 2 ... ... 9 1 1 1 ... 12 Premature birth 10 ... ... ... 10 ... ... ... ... 10 Atrophy, debility and marasmus ... ... ... ... ... ... ... ... ... ... Other causes 1 ... 1 ... 2 ... 1 1 ... 4 Totals 23 3 1 ... 27 5 4 5 2 43 Nett Births registered during the calendar year Legitimate 1,572 Illegitimate 58 Nett Deaths registered during the calendar year Legitimate infants 40 Illegitimate infants 3 18 TABLE 7. Comparative Statistics or Births, Mortality, Etc. LEYTON, 1900-1949. Year. Population. Births. Birth Rate. Deaths. Death Rate. Deaths under 1 year. lnlantile Death Rate. 1900 100000 2932 29.32 1179 11.8 410 140 1901 100000 2963 29.63 1243 12.4 404 136 1902 100000 3152 31.52 1183 11.8 336 106 1903 102000 3273 32.08 1112 10.9 322 99 1904 104000 3198 30.07 1370 13.1 444 138 1905 105000 3209 30.05 1177 11.2 303 94 1906 108000 3344 30.9 1327 12.2 382 114.5 1907 120000 3190 26.6 1269 10.6 182 86.6 1908 121200 3071 25.3 1185 9.8 242 78.8 1909 121200 2979 24.6 1208 9.9 244 81.9 1910 123300 3011 24.4 1112 9.0 191 63.4 1911 124736 2931 23.5 1473 11.8 327 116.6 1912 126700 2797 22.1 1343 10.6 223 79.7 1913 129366 2904 22.4 1336 10.3 242 83.3 1914 130847 2800 21.4 1363 10.4 219 78.2 1915 124497 2655 21.3 1510 12.1 225 84.7 1916 B132107* 2560 19.4 1471 12.1 197 76.9 D121420* 1917 B125352* 2005 16.0 1414 12.6 172 85.8 d112452* 1918 B125352* 1791 14.3 1723 15.3 161 89.9 d112452* 1919 B129062* 2195 17.0 1397 11.3 154 70.16 D123896 1920 128832* 3168 24.6 1330 10.3 207 65.34 1921 128432 2679 20.86 1290 10.04 182 67.94 1922 131600 2416 18.36 1420 10.79 155 64.16 1923 132800 2328 17.53 1228 9.25 106 45.53 1924 133500 2101 15.74 1325 9.92 110 52.36 1925 132700 2091 15.76 1349 10.16 114 54.51 1926 130000 2022 15.55 1261 9.7 131 64.79 1927 128920 1826 14.16 1322 10.25 80 43.81 1928 130300 1853 14.22 1290 9.90 91 49.10 1929 128300 1731 13.49 1510 11.76 100 57.77 1930 128300 1757 13.69 1222 9.52 81 46.09 1931 128600 1812 14.09 1365 10.61 71 39.18 1932 127140 1666 13.10 1341 10.54 89 53.43 1933 125700 1499 11.91 1468 11.67 76 50.70 1934 123430 1454 11.78 1317 10.67 64 44.02 1935 121690 1493 12.26 1225 10.06 60 40.18 1936 119900 1421 11.85 1272 10.61 74 52.07 1937 118100 1420 12.02 1349 11.42 75 52.81 1938 117200 1509 12.87 1148 9.79 70 46.38 B116100* 1939 D110800* 1499 12.90 1242 11.21 46 31.65 1940 96500 1353 14.02 1563 16.2 50 39.03 1941 84790 1129 13.31 1142 13.46 37 38.30 1942 86960 1452 16.69 1123 12.91 73 50.27 1943 87880 1595 18.14 1248 14.20 57 35.73 1944 85440 1613 18.87 1285 15.04 68 42.15 1945 87330 1474 16.87 1147 13.13 52 35.27 1946 101910 2223 21.81 1181 11.58 64 28.78 1947 105550 2359 22.35 1278 12.10 78 33.06 1948 106100 1810 17.06 1118 10.53 38 20.99 1949 106700 1630 15.27 1232 11.54 43 26.38 * Population as estimated for purposes of b, Birth Rate, d, Death Rate. Infectious Diseases 20 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Table showing the number of notified cases of infectious diseases and their disposal. Disease. Notifications Received. Removed to Hospital. Smallpox ... ... Diphtheria ... ... Erysipelas 37 3 Scarlet Fever 151 59 Pemphigus Neonatorum ... ... Pulmonary Tuberculosis 118 48 Tuberculosis, other forms 9 7 Pneumonia 241 102 Ophthalmia Neonatorum 2 ... Typhoid Fever ... ... Paratyphoid Fever 2 2 Puerperal Pyrexia 10 9 Cerebrospinal Meningitis 3 3 Poliomyelitis 18 17 Polioencephalitis 2 2 Encephalitis Lethargica ... ... Dysentery 4 4 Measles 1,031 56 Whooping Cough 316 18 Malaria ... ... Totals 1,944 275 21 SMALLPOX. During the year no case of smallpox was notified, and no case has occurred in the Borough since 1933. Since 5th July, 1948, the compulsory vaccination of infants as a protection against smallpox ceased to be compulsory. Routine medical inspection in schools shows that only 32.7 per cent. of Leyton school children are protected against smallpox by vaccination. DIPHTHERIA. During the year 1949, and for the first time since official figures became available, no case of confirmed diphtheria was notified. To those of us who remember diphtheria as one of the chief causes of death and lifelong disability and a severe drain on national and local expenditure, this welcome turn in the tide is most encouraging. In the year 1935 Leyton Corporation inaugurated a municipal clinic for the immunisation of children against diphtheria, and the work has gone on steadily ever since. These figures show the difference between the figures of diphtheria incidence and mortality in 1949 compared with those of the last year before municipal facilities for diphtheria immunisation became available. Year. Cases Notified. Deaths. Case Fatality per cent. 1934 257 11 4.28 1949 0 0 0.00 SCARLET FEVER. Scarlet fever has remained of the mild type to which we have become accustomed during recent years. Since 1941 only one death in the Borough has been attributable to scarlet fever, and this was a child who died from cardiac failure due to rheumatic carditis. 22 Year. Cases Notified. Deaths. Case Fatality per cent. 1943 386 0 0.00 1944 110 0 0.00 1945 312 0 0.00 1946 201 0 0.00 1947 221 0 0.00 1948 160 1 0.62 1949 151 0 0.00 MEASLES. Measles continued its epidemic prevalence. Of the 1,031 notified cases it was necessary to admit 56 to hospital. For the second year in succession no child in the area has died from measles. Year. No. Notified. Removed to Hospital. Deaths. 1948 1,088 33 0 1949 1,031 56 0 WHOOPING COUGH. Whooping cough has not been so prevalent as during the previous year. A significant and encouraging feature is that no child died from whooping cough during the year. Year. No. Notified. Removed to Hospital. Deaths. 1948 623 29 3 1949 316 18 0 23 POLIOMYELITIS ("INFANTILE PARALYSIS"). In the past poliomyelitis has had a well marked seasonal prevalence in the autumn. The first case in 1949 was notified in April, and on page 24 I submit a summary, in tabular form, of the cases notified during the year. In addition to the Leyton cases, notifications were received in respect of four non-Leyton cases which were diagnosed in hospital after admission there ; but these four extra-district cases are notifiable in this district. I addressed to all local medical practitioners information regarding the outbreak in general and the Leyton cases in particular. As there is no consensus of informed opinion with regard to the source of infection and spread of poliomyelitis, I did not consider it advisable to cause public alarm by suggesting the closure of such places as schools, day nurseries, cinemas and other public gatherings, public baths, etc. Nor, in consequence of the long waiting list of children awaiting operation for removal of tonsils and adenoids, have I endeavoured to interfere with the treatment for which they have been waiting so long. All notified cases, with the exception of one slight case, were admitted to hospital for treatment, and arrangements made for their subsequent supervision either as hospital out-patients or in connection with the health authority's orthopaedic scheme. One patient, a male aged 20 years suffering from acute polioencephalitis, died in hospital a few hours after admission. No case occurred of paralysis of respiratory muscles, necessitating treatment in a special respirator ("Iron Lung "). The following list shows the annual number of cases of acute poliomyelitis notified in this Borough during the last 10 years. Year. Cases Notified. Year. Cases Notified. 1940 0 1945 0 1941 0 1946 3 1942 5 1947 14 1943 0 1948 2 1944 0 1949 20 24 BOROUGH OF LEYTON. Summary of Notified Cases of Acute Poliomyelitis and Polio-Encephalitis, 1949. No. Date of Notification. Sex. Age. Hospital. Site of Initial Paralysis. Condition at end of Year. Admitted. Discharged. 1 29/4/49 M 11 29/4/49 20/5/49 Thigh muscles both legs. Complete recovery. *2 7/6/49 F 18 6/6/49 5/8/49 Extensor muscles right hip and thigh Slight weakness still present. 3 23/6/49 F 4 23/6/49 20/7/49 Right arm Paralysis still present. *4 23/6/49 F 5 23/6/49 11/7/49 No paralysis Complete recovery. 5 14/7/49 M 4 14/7/49 29/9/49 Left arm, left leg Weakness still present. 6 27/7/49 F 8 26/7/49 19/9/49 Both legs Slight weakness still present. 7 10/8/49 M 15 6/8/49 20/9/49 Face, palate, pharynx, right arm and right foot Some weakness still present. 8 15/8/49 M 7 6/8/49 29/8/49 No paralysis Complete recovery. *9 17/8/49 M 30 10/8/49 30/9/49 Left leg and right shoulder Slight weakness left foot. 10 6/9/49 M 2 6/9/49 13/10/49 Left leg Paralysis still present. 11 12/9/49 M 14 21/8/49 10/10/49 Weakness of leg Complete recovery. 12 19/9/49 M 20 17/9/49 1/11/49 Both legs Paralysis still present. 13 6/10/49 F 3 6/10/49 12/11/49 Right arm, right leg Weakness still present. *14 12/10/49 M 5 12/10/49 16/11/49 Right leg Weakness still present. 15 24/10/49 M 20 22/10/49 — Bulbar nerve centres Died 23/10/49. 16 1/11/49 M 14 1/11/49 — Right arm and left leg Still in hospital. 17 3/11/49 M 6 — — Right hand Making satisfactory progress. 18 3/11/49 M 35 2/11/49 29/11/49 Both arms. Weakness in both arms. 19 17/11/49 M 1 4/11/49 24/12/49 No paralysis (Abortive case) Making satisfactory progress. 20 17/11/49 F 5 3/11/49 — Back, abdomen, hips Still in hospital. *Extra district cases notified from hospitals within the area. 25 TUBERCULOSIS. Notifications.—One hundred and twenty-seven patients were notified for the first time in 1949 as suffering from tuberculosis. The number was made up as follows:— Males. Females. Total. Pulmonary Tuberculosis 69 49 118 Non-Pulmonary Tuberculosis 3 6 9 72 55 127 The following is a statement of particulars appearing in the Register of Notifications of Cases of Tuberculosis for the year ended 31st December, 1949 :— Pulmonary. Non-Pulmonary. total M. F. Total. m. F. Total. Number on Register at commencement of year 347 254 601 26 43 69 670 Number first notified during the year 69 49 118 3 6 9 127 Number of cases entered in Register otherwise than by Notification 12 9 21 1 — 1 22 Number removed from the Register during the year 56 34 90 6 6 12 102 Number remaining at the end of the year 372 278 650 24 43 67 717 Details of cases removed from the Register during the year:— Died 28 17 45 3 — 3 48 Removed from the district 20 15 35 1 2 3 38 De-notified 8 2 10 2 4 6 16 26 Deaths.—Thirty-seven deaths from tuberculosis were recorded. The following table gives particulars regarding the new cases which have occurred during the year:— Age Periods. New Cases. Pulmonary. Non-Pulmonary. M. F. M. F. 0 — — — — 1 1 2 1 1 5 3 3 1 — 10 3 1 — 2 15 8 7 — — 20 4 9 1 — 25 20 11 — 2 35 10 9 — 1 45 11 3 — — 55 6 4 — — 65 and upwards 3 — — — Totals 69 49 3 6 Statistical Summary. The following tables have been compiled to show the annual numbers of new cases and deaths over a period of ten years. 27 TUBERCULOSIS. NOTIFICATIONS. Year. Pulmonary. Non-Pulmonary. Total. M. F. Total. M. F. Total. 1940 49 33 82 11 13 24 106 1941 57 45 102 7 5 12 114 1942 64 27 91 7 6 13 104 1943 51 50 101 11 6 17 118 1944 43 41 84 11 10 21 105 1945 71 40 111 6 5 11 122 1946 61 30 91 6 11 17 108 1947 50 39 89 4 5 9 98 1948 60 70 130 9 5 14 144 1949 69 49 118 3 6 9 127 DEATHS. Year. Pulmonary. Non-Pulmonary. Total. M. F. Total. M. F. Total. 1940 44 18 62 7 4 11 73 1941 24 23 47 4 4 8 55 1942 40 27 67 6 2 8 75 1943 38 24 62 6 2 8 70 1944 30 26 56 4 4 8 64 1945 20 15 35 3 3 6 41 1946 27 17 44 2 1 3 47 1947 24 17 41 1 3 4 45 1948 23 24 47 3 2 5 52 1949 20 13 33 4 - 4 37 28 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1949. DISEASE. Total. Leyton. Lea Bridge. Central North. Centra] South. Forest. Leytonstone. Grove Green. Harrow Green Cann Hall. Wanstead Slip. Removed to Hospitals. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 37 3 3 2 5 7 8 3 2 1 3 3 Scarlet Fever 151 12 36 11 10 27 19 1 19 8 8 59 Pemphigus Neon. ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary T.B. 118 7 27 15 11 14 8 7 8 13 8 48 T.B. Others 9 2 1 ... 3 ... ... ... 2 1 7 Pneumonia 241 8 22 15 56 71 29 14 6 14 6 102 Ophthalmia Neon. 2 ... ... ... ... ... 1 1 ... ... ... ... Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... Paratyphoid Fever 2 ... ... 1 ... 1 ... ... ... ... ... 2 Puerperal Pyrexia 10 ... 1 2 1 2 2 ... 1 1 ... 9 Cerebrospinal Meningitis 3 1 ... ... ... 2 ... ... ... ... ... 3 Poliomyelitis 18 1 1 1 2 7 4 1 1 ... ... 17 Polioencephalitis 2 ... 1 ... ... ... 1 ... ... ... ... 2 Enc. Lethargica ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 4 ... ... ... ... 3 ... ... 1 ... ... 4 Measles 1031 52 218 48 86 226 173 71 57 67 33 56 Whooping Cough. 316 15 42 13 52 47 45 22 16 54 10 18 Malaria ... ... ... ... ... ... ... ... ... ... ... ... Totals 1944 99 353 109 223 410 290 120 111 160 69 275 29 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1949. DISEASE. At All Ages Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and up Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 37 ... ... ... ... ... 1 ... 1 4 4 19 8 Scarlet Fever 151 ... 1 ... 15 17 95 12 2 1 ... ... ... Pemphigus Neon. ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary T. B. 118 ... 1 ... 1 1 6 4 15 44 20 23 3 T.B. Others 9 ... ... ... 2 ... 1 2 ... 3 1 ... ... Pneumonia 241 7 2 8 6 6 30 2 4 31 22 74 49 Ophthalmia Neon. 2 2 ... ... ... ... ... ... ... ... ... ... ... Typhoid Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Paratyphoid Fever 2 ... ... ... ... ... ... 2 ... ... ... ... ... Puerperal Pyrexia 10 ... ... ... ... ... ... ... 1 7 2 ... ... Cerebrospinal Meningitis 3 ... ... 1 1 ... 1 ... ... ... ... ... ... Poliomyelitis 18 ... 1 1 1 2 6 3 1 2 1 ... ... Polioencephalitis 2 ... ... ... ... ... ... ... 1 1 ... ... ... Enc. Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 4 ... ... 1 ... 1 ... ... ... 2 ... ... ... Measles 1031 42 127 170 162 151 362 7 3 5 1 1 ... Whooping Cough 316 22 51 65 40 46 89 2 ... ... 1 ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1944 73 183 254 228 224 591 34 28 100 52 117 60 General FOOD POISONING. SCABIES CLINIC. PUBLIC MORTUARY. NATIONAL ASSISTANCE ACT, 1948. 32 FOOD POISONING. During the year 28 notifications of food poisoning were received. Of these, 27 were residents of the Borough and one an extra-district case notified from Whipps Cross Hospital. All the cases were investigated, the following being a summary of the findings. Food consumed. No. of Cases. Agent Causing Outbreak. Cockles 20 Not known. Raw fruit 2 Not known. Ducks eggs 2 Salmonella Typhi Murium. Whelks 1 Not known. Winkles 1 Not known. Unknown 2 1 Salmonella Newport. l Salmonella Typhi Murium. In addition to the cases mentioned above, it was ascertained that a large number of persons, who had eaten cockles at a popular seaside resort, suffered from mild gastro-enteritis. The attacks were so mild and so short-lived that many of the affected persons did not consult a doctor, the result being that the cases were never notified officially. Of the 20 cases due to cockles, the incubation period was 18 to 24 hours. The main symptoms were vomiting, abdominal pain and diarrhoea ; and the symptoms cleared in a few days. Owing to the short duration of illness no laboratory investigations were possible, and the causative agent was not discovered. In every case where the source of infection was discovered, full particulars were forwarded to the Medical Officer of Health of the district concerned. 33 SCABIES. In order to provide facilities for dealing with the increased prevalence of scabies and verminous conditions at that time, a Special Clinic and Cleansing Centre was established in Ruckholt Road School in the early part of 1942. The following figures show the work done at that Clinic since then. Year Cases Treated Total attendances for treatment Children Adults Total 1942 (10 mths.) — — 303 1291 1943 522 632 1154 2490 1944 328 517 845 1990 1945 302 454 756 1462 1946 261 402 663 1298 1947 91 156 247 495 1948 67 90 157 271 1949 18 25 43 105 Attendances during 1949. Number of patients treated 43 Children 18 Adults 25 Number of patients who had One routine treatment 43 Two „ „ 23 Three „ ,, 5 Local treatment, no bath 34 105 PUBLIC MORTUARY. In consequence of the land on which Leyton Public Mortuary is built being required for a building site in connection with the Council's Housing Scheme, the mortuary was closed on 28th September and the building and contents handed over to the Borough Engineer and Surveyor. On the same day the Mortuary Attendant (Mr. E. J. Miles) retired on superannuation after completing 16 years' service. On 29th September there was put into operation the provision of temporary public mortuary facilities in the mortuary of Whipps Cross Hospital in accordance with the arrangement entered into between the Council and the Hospital Management Committee (Leytonstone No. 10 Hospital Group). 34 Number of bodies deposited, death being due to:— Natural causes 42 Suicide 7 Accidents 8 Murder 1 58 Number of Post-mortem examinations performed 58 Number of Inquests held 16 In 42 instances no inquest was considered necessary in view of the post-mortem findings that death was due to natural causes. The causes of death in these cases were certified as follows:— Coronary thrombosis 8 ,, occlusion-atheroma 10 Myocardial degeneration 3 Mitral stenosis 1 Atelectasis 1 Epilepsy 1 Aneurysm of aorta—specific 2 Cerebral haemorrhage 2 Hypertension 5 Leukaemia 1 Suppurative bronchitis 2 Pulmonary tuberculosis 1 Emphysema 1 Strangulated hernia 1 Hyaline necrosis 1 Cancer 2 Inquests. The following verdicts on Leyton residents were recorded at inquests held during the year :— Accidental 23 Suicide 13 Natural causes 6 Open verdict ] Murder 1 35 Accidental. Knocked down by motor car 2 Knocked down by van 2 Knocked down by lorry 1 Collision between motor cycle and motor car 1 Collision between pedal cycle and motor car 1 Thrown out of motor car 1 Fall from tree 1 Drowning 2 Fractures and falls 6 Coal gas poisoning 1 Acute acetic acid poisoning 1 Crushed by goods lift 1 Burns 1 Forceps left in abdomen after operation 1 Electrocution 1 Suicides. Coal gas poisoning 8 Hanging 2 Fall from window 1 Ac. barbiturate poisoning 1 Multiple injuries. Run over by electric train 1 Murder. Strangulation 1 Open Verdict. Drowning 1 Natural Causes. Epilepsy 2 Sarcoma 1 Amoebic dysentery 1 Ac. pericarditis 1 Traumatic perforation of oesophagus 1 36 NATIONAL ASSISTANCE ACT, 1948. Section 47—Removal to suitable premises of persons in need of care and attention. No cases were dealt with under this section during the year. Section 50—Burial and Cremation of the Dead. Until May, 1949, Leyton Council continued to be responsible for the burial of all persons who died in the area and no suitable arrangements for the disposal of the body had been or were being made. In March, 1949, a Circular was issued by the Ministry of Health intimating that the Minister had decided to ask Hospital Management Committees to exercise their power to arrange and pay for the burial or cremation of certain categories of deceased patients, which included the great majority of patients dying in hospitals whose relatives did not themselves undertake to arrange for burial. In certain exceptional cases the Hospital Management Committees were advised to refer the matter to the Local Authorities upon whom the residual duty rests, under Sec. 50 of the Act, in view of the powers of recovery from the liable relative conferred upon Local Authorities. As a result of this Circular, the Hospital Management Committee made arrangements for the burial of certain categories of patients dying in Langthome and Whipps Cross Hospitals as from 1st May, 1949. The following table gives details of the work carried out under Sec. 50 since its inception. Period. No. of Burials. Where Death Occurred Whipps Cross Hospital. Langthorne Hospital. At Home. 1948. July to December 41 14 33 4 1949. January to April 47 9 36 2 May to December 2 1 ... 1 It will be seen from the above table that the majority of the cases dealt with were institutional. Since May 1st, when the 37 Hospital Management Committee accepted responsibility for institutional deaths, cases dealt with by the local authority are very small in comparison. When the Council became the responsible authority under the Act, steps were taken to invite funeral furnishers to tender to a specification drawn up by the Public Health Department. The tender laid down a specification for the coffin, linings and fittings and clauses inserted relating to the hearse, bearers and the general conduct of the funeral. In every case a senior member of the Public Health Department attended at the funeral and satisfied himself that the funeral was carried out according to the contract. It has been very gratifying to know, from the letters of appreciation received from relatives of the deceased and from the clergy and officials at the various cemeteries, that the services carried out under the Council's contract have been responsible for raising the standard of the old type " parish funeral ". Now that the responsibility for institutional public burials has passed to the Hospital Management Committee, it is to be hoped that no relaxation of the standard will be permitted. Sanitary Circumstances of the Area 40 SANITARY CIRCUMSTANCES OF THE AREA. SANITARY INSPECTIONS OF THE AREA. Inspections. The table below gives a summary of the Inspections made by the Sanitary Inspectors:— Number of dwelling-houses inspected 3,296 Miscellaneous inspections 1,726 Re-inspections 12,102 Places of entertainment 36 Schools 52 Stables 6 Urinals 38 Visits in connection with infectious diseases 351 Factories without mechanical power 59 Factories with mechanical power 233 Rag and bone dealers 1 Foster-mothers' premises 7 Hairdressers' premises 56 Public Houses 21 Offensive trades 106 Nature of Work Executed and Improvements Effected in Dwelling-houses and other Premises under the Provisions of the Housing and Public Health Acts. Dampness remedied 646 Sashcords renewed 347 Plaster repaired 1,079 Roofs repaired or renewed 1,283 Guttering repaired or renewed 415 Yards paved 44 Drains relaid or partly relaid 69 Choked drains cleared 42 New w.c. pans and traps provided 101 Sinks provided 34 W.c. cisterns repaired or renewed 125 Rain water pipes repaired or renewed 289 Vent pipes repaired or renewed 50 Sink waste pipes repaired or renewed 136 Stoves repaired or renewed 369 Coppers repaired or renewed 14 41 Floors repaired 403 Rooms redecorated 1,482 Windows, sills, etc., repaired 593 Cement work to sink waste gullies repaired 65 Miscellaneous defects remedied 654 Drainage. The drains of 71 houses were reconstructed. In some instances the reconstruction related to portions of the public sewers, and in these cases the work was carried out under the supervision of the staff of the Borough Engineer and Surveyor's Department, the expenses incurred thereby being recovered from the owners. Verminous Houses. Infested. Disinfested. Number of houses 158 158 Rats and Mice (Destruction) Act, 1919. Ministry of Food—Infestation Order 1943 S. R. & 0. 680. Complaints Complaints received and investigated 647 Premises not treated (not genuine infestation) 51 Premises treated :— (a) Dwelling-houses 515 (b) Business premises 81 596 Premises freed 517 Sewer Maintenance Treatments. All sewers in the Borough were treated in July, 1949 (followed by a further treatment in January, 1950). The following figures show the results of these two treatments : No. of Manholes baited. No. showing complete prebait take. No. showing some prebait take. Percentage of take. 1st Treatment 1,208 193 617 50.9 2nd Treatment 1,214 283 730 59.2 It will be seen from the results obtained during the baiting of the public sewers that there is still a heavy rat infestation in the sewers. In order to reduce the infestation it may be necessary to treat the sewers more often in future. From experience it is found that most of the infestation of premises is due to faulty sewers and drains. 42 General. Treatments have been carried out with success on the Corporation's properties and schools. The refuse destructor works and adjoining land and buildings on the west side of the Borough, to the allotments at Lammas Road have been kept under observation and treatment, and periodic baiting has been undertaken at Whipps Cross and Langthorne Hospitals. HOUSING. Complaints. During the year 2,225 complaints were received and investigated. The nature of the complaints included sanitary defects in houses, drains choked or defective, premises infested with vermin, etc. Notices. Notices served—Informal 1,810 Statutory—Housing Acts Nil Public Health Acts 648 Notices complied with—Informal 1,716* Statutory- Housing Acts Nil Public Health Acts 488* *This figure includes notices outstanding from previous year. Housing. Number of houses erected during the year:— (a) Total (including numbers given separately under (b) ). (i) By the Local Authority— Houses 166 Flats Nil Temporary housing Nil (ii) By other Local Authorities Nil (iii) By other bodies and persons— Houses 40 Flats Nil 43 (b) With State assistance under the Housing Acts. (i) By the Local Authority— (a) For the purposes of Part V of the Act of 1936— Houses 166 Flats Nil Temporary housing Nil (b) For other purposes Nil (ii) By other bodies and persons Nil I.—Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,296 (b) Number of inspections made for the purpose 15,398 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 & 1932 Nil (b) Number of inspections made for the purpose Nil (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 4 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,810 II.—Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action taken by the Local Authority or their officers 1,716 III.—Action under Statutory Powers during the Year:— (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil 44 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil (6) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 648 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 488 (6) By Local Authority in default of owners Nil (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which demolition orders were made Nil (2) Number of dwelling-houses demolished in pursuance of demolition orders Nil (d) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Clpsing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil A very pleasing feature noticed during the survey of dwelling houses has been the high standard of cleanliness maintained by the occupiers, and the improvement in environmental conditions. Where unsatisfactory circumstances were found to exist, they were largely caused by the want of better and more adequate accommodation and amenities. In many cases, want of privacy, sharing of amenities, etc., created almost an intolerable position. Enquiries are constantly being received from other Local Authorities in connection with residents of Leyton applying for housing accommodation elsewhere; 89 such enquiries were received during 1949. 45 Investigations have been made and the necessary particulars furnished wherever possible. Housing Act, 1936. Information regarding 867 houses was supplied in connection with the "permitted number of persons" in dwellings under the Act. Local Land Charges. Particulars with regard to outstanding sanitary notices, not fully complied with, were given in reference to 1,538 enquiries. Smoke Abatement. During the year 121 observations have been made on factory chimneys. Infringements were found in five instances, and letters of warning were issued in these cases. It was not found necessary to institute legal proceedings. Repairs. The number of complaints received from occupiers of dwelling houses regarding defective conditions is still high. Most of the defects are attributable to the age of the property and the lack of repairs carried out during the war years. Owing to the acute shortage of housing accommodation it has not been found practicable to deal with possible clearance areas and demolitions. Action taken under the provisions of the Public Health Act, 1936, has resulted in 2,204 houses being brought up to a reasonable standard of fitness. Legal proceedings were found necessary in 20 instances, and the following is the result of such action:— Legal Proceedings. (Public Health Act, 1936.) 1. 12/1/49 Non-compliance with Abatement Notice at:— 3, Stewart Road. Nuisance Order made (28 days). Two guineas costs. 2. 12/1/49 67, Cathall Road. Nuisance Orders made (14 days). Five guineas costs. 69, Cathall Road. 71, Cathall Road. 73, Cathall Road. 75, Cathall Road. 79, Cathall Road. 91, Cathall Road. 3. 26/1/49 26, Richmond Road. Nuisance Order made (28 days). Two guineas costs. Failing to comply with Nuisance Order on:— 4. 26/1/49 11, Carlisle Road. Fined £2 and two guineas costs. 46 Failing to comply With Nuisance Order on:— 5. 26/1/49 171, Capworth Street. Fined £1 and daily penalty of £2, but operation of daily penalty postponed for one month. 6. 9/3/49 10, Forest Glade. Fined £2 and 2 guineas costs. Daily penalty of £2 suspended for 28 days. Non-compliance with Abatement Notice at:— 7. 9/3/49 10, Ivy Road. Nuisance Order made (28 days). Two guineas costs Non-compliance with Nuisance Order on:— 8. 8/6/49 10, Forest Glade. Fined £20. 9. 14/9/49 152, Ashville Road. Summons withdrawn. (Work completed.) 10. 14/9/49 34, Acacia Road. Summons withdrawn. (Defendant deceased.) 11. 14/9/49 24, Florence Road. Summons withdrawn. (Work completed.) Non-compliance with Abatement Notice at:— 12. 14/9/49 19, Leigh Road. Nuisance Order made (28 days). Two guineas costs. 13. 19/10/49 34, Acacia Road. Nuisance Order made (28 days). One guinea costs. 14. 19/10/49 17, Newcomen Road. Nuisance Order made (28 days). One guinea costs. 15. 19/10/49 65, Thorpe Road. Nuisance Order made (28 days). One guinea costs. 16. 19/10/49 95, Thorpe Road. Nuisance Order made (28 days). One guinea costs. 17. 30/11/49 4, Eve Road. Nuisance Order made (28 days). Ten shillings costs. 18. 30/11/49 16, Eve Road. Nuisance Order made (28 days). Ten shillings costs. 19. 30/11/49 18, Eve Road. Nuisance Order made (28 days). Ten shillings costs. 20. 30/11/49 8, Eve Road. Nuisance Order made (56 days). Ten shillings costs 47 INSPECTION AND SUPERVISION OF FOOD. FOOD PREMISES. Inspections. The following visits were made to food premises during the year:— Slaughter-houses 28 Butchers 281 Bakehouses 90 Fishmongers 152 Milkshops and dairies 116 Provision shops 478 Dining rooms 252 Greengrocers 139 Fish friers 96 Ice cream premises 190 MILK. Dairies and Milkshops. Number of registered premises from which milk is sold 64 Premises added to register during year 2 Premises removed from register during year 1 Visits of inspection 116 Biological Examinations. Two samples of milk were submitted for biological examination. In each case the sample gave a negative result. Bacteriological Examinations. Designated Milk. Licenses. No. Granted. No.of Samples taken. Result. Phosphatase Reaction. Methylene Blue Test. Satisfactory. Unsat. Satisfactory. Unsat. Tuberculin Tested 14 4 4 — 4 — Accredited 2 — — — — — Pasteurised 39 12 12 — 12 — Sterilised 42 — — — — — Supplementary Licences — — — — — — Tuberculin Tested 2 — — — — — Pasteurised 5 — — — — — Sterilised 2 — — — — — Totals 106 16 16 — 16 — 48 ICE CREAM. Number of premises registered— As Manufacturers (Of this number only 15 are actually manufacturing at the moment). 24 For Sale or Storage (Of this number only 134 are actually selling at the moment). 170 Number of Samples taken during 1949 50 Results of Samples taken— Grade I. Grade II. Grade III. Grade IV. 17 18 5 10 In all cases the results of the bacteriological examinations have been forwarded to the persons concerned and every endeavour made to rectify errors in preparation, handling and storage. Manufacturers of Preserved Food, etc. Premises on Register at 31-12-1949 67 Premises registered during 1949 Nil Premises removed from Register during 1949 Nil MEAT. Slaughter - Houses.—There are six licensed slaughterhouses in the Borough, and 28 inspections of these slaughterhouses were made. Meat and Foods condemned and destroyed. Baby foods 21 tins. Bacon 6 lbs. Beef 47½ „ Beef sausages 17 „ Butter 1 lb. Cake mixture 6 pkts. Calves feet 5 sets. Cheese 103¾ lbs. Cheese 7 boxes. Chocolate spread 31 ctns. Christmas puddings 14 Condensed milk 152 tins. Cooking oil 80 galls. 49 Corned beef 119 tins. Dates 70½lbs- Danish pork 61 tins. Dried egg 5 „ Ducks 64 lbs. Eggs 300 Evaporated milk 1,003 tins. Figs 14 lbs. Fish 421 tins. Fish 3,757½ lbs. Fowls 164 French pork 85 lbs. Fruit 238 tins. Jam 134 „ Lamb, shoulder of 1 Locust beans 84 lbs. Luncheon meat 255 tins. Margarine 1½lbs Meat loaf 6 „ Miscellaneous 65 pkts. Mutton 36½ lbs. Oats 34 „ Ox brains 40 „ Ox cheeks 3,707 Ox heads 5 Ox tails 1 Ovaltine 5 tins Pickles 95 jars. Poussins 62 Pudding mixture 8 pkts. Pullets 23 Rabbits 84 Rabbits 73 lbs. Rabbits 42 tins. Salad cream 29 botts. Sauce 7 „ Sheeps heads 128 Shrimps 12 ctns. Soup 220 tins. Sugar 112 lbs. Sweephat 21pkts. Sweets 7 lbs. Tomato puree 1,332 tins. 50 Tripe 31 lbs. Turkeys 2 Vegetables 692 tins. Carcases Inspected and Condemned. No local slaughtering took place during the year. Premises and Occupations which can be Controlled by Bye-Laws and Regulations. Premises. Slaughter-houses 6 Dairies, Milkshops and Dairymen 64 Grocery and Provision shops 247 Hairdressers' Premises 65 Fish friers 21 Bakers 38 Butchers 82 Cafes and Dining rooms 97 Fishmongers 32 Greengrocers 92 Offensive Trades. Rag and Bone dealers 4 Tripe boiler 1 Contagious Diseases of Animals Acts and Orders. One notice defining " infected place" in connection with Fowl Pest outbreaks during the year was issued by officers of the Ministry of Agriculture and Fisheries. Temple Mills Cattle Sidings. Special attention has been given during the year to the conditions under which horses and cattle in course of transit are kept at the above sidings. Food and Drugs Act, 1938. The number of samples taken for analysis under the provisions of this Act from 1st January to the 31st December was 217. Samples analysed. Samples unsatisfactory. Ale 2 ... Baking powder 1 ... Black pudding 1 ... Bread 1 1 Bun flour 2 ... Butter 1 ... 51  Samples analysed. Samples unsatisfactory. Chip potatoes 6 ... Cod liver paste 1 ... Coffee 1 ... Coffee and Chicory essence 3 ... Cough lozenges 1 ... Crab, dressed 1 ... Crab, paste 1 ... Cream buns 1 ... Cream doughnuts 1 ... Curry powder 4 2 Custard powder 3 ... Dessert powder 1 ... Farinoca 1 ... Flake pastry. 2 ... Flavourings 2 ... Flour 1 ... Fried fish 6 ... Gelatine 1 ... Ginger, ground 1 ... Ginger wine 1 ... Ginger wine flavouring 1 ... Golden pudding powder 1 ... Gravy, thick 1 ... Grit (on food) 1 ... Ice cream 50 ... Jam 1 ... Jam tarts 2 ... Jelmol 2 ... Margarine 2 ... Marmalade 1 ... Master mix 1 ... Milk 32 ... Mustard 2 ... Nutmeg, ground 1 ... Olive oil 1 ... Orangeade 1 ... Orange squash 4 ... Pepper 4 ... Peppermint lozenges 1 ... Pickle, sweet 1 ... Pudding mixture 3 ... 52  Samples analysed. Samples unsatisfactory. Sage and onion stuffing 1 ... Sago 1 ... Salad cream 3 ... Salami 1 ... Sausages, beef 1 ... Sausages, liver 1 ... Sausages, pork 1 ... Sausages, unspecified 1 1 Sausage meat 1 ... Scone flour mixture 2 ... Soya flour 1 ... Spice, mixed 2 ... Spice, pickling 1 ... Sweephat 1 ... Tapioca, cooked 1 ... Tapioca, pearl 1 ... Tea seed oil 1 ... Tomato ketchup 2 ... Tomato soup 1 ... Vegetable oil 2 2 Vinegar 3 1 Yorkshire pudding mixture 1 ... Ammoniated tincture of quinine 1 ... Aspro 1 ... Blackcurrant and liquorice tablets 1 ... Boracic ointment 2 ... Calamine ointment 1 ... Camphorated oil 1 ... Castor oil 1 ... Cough balsams and syrups 3 ... Glaubers salt 1 ... Glucose and blackcurrant pastilles 1 ... Glycerine, lemon and honey 1 ... Glycerine and thymol pastilles 1 ... Iodised fruit pastilles 1 ... Liquorice and menthol tablets 1 ... Lung syrup 1 ... Meggezones (cough tablets) 1 ... Menthol tablets 1 ... Phenol ointment 1 ... Saccharin tablets 1 ... 53  Samples analysed. Samples unsatisfactory. Sweet spirit of nitre 1 ... Tincture of iodine 1 ... Vita glucose tablets 1 ... Zinc ointment 2 ... 217 8 Only eight unsatisfactory results were reported from the 217 samples of food and drugs taken for analysis. In each case a letter of warning was sent out. Cleanliness of Food Premises. Efforts have been continued throughout the year in an endeavour to bring all food premises up to a high standard of suitability and cleanliness. During the visits by the Sanitary Inspectors particular attention has been paid along the lines of educating the employer and his staff in the importance of food hygiene. Informal talks and advice have been given by the Inspectors wherever possible, and notices regarding cleanliness have been displayed at the premises. The importance of the Clean Food Campaign has been emphasised. The Council have sought permission to adopt the Model Byelaws of the Ministry of Food regarding the Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air, and meetings were being arranged with the local Chamber of Commerce, the Bakers Arms Traders' Association and other local organisations. Many improvements were effected in food premises and special attention has been given to cafes, canteens and school kitchens. Much progress has been made, and greater precautions and care are being exercised by the staffs generally. Legal Proceedings. (Food and Drugs Act, 1938.) 1. 16/3/49 Selling food (one rabbit) unfit for human consumption. Case dismissed. 2. 16/3/49 Having in possession for purpose of sale 25 rabbits intended for but unfit for human consumption. Fined £25 and five guineas costs. 3. 18/5/49 Selling food (one cream bun) unfit for human consumption. (Dead mouse therein.) Fined £20 and two guineas costs. 54 FACTORIES. THE FACTORIES ACT, 1937. 1. INSPECTIONS FOR PURPOSES OF PROVISIONS AS TO HEALTH Including inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted (1) (2) (3) (4) Factories with mechanical power 233 15 — factories without mechanical power 59 1 — Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 1 — — Total 293 16 — 2. DEFECTS FOUND. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) Lack of cleanliness 9 9 — Sanitary Conveniences:— Insufficient 10 9 — Unsuitable or defective. 7 6 — Other Offences 3 2 — Total 29 26 — OUTWORK IN UNWHOLESOME PREMISES. (Section 111 of Act of 1937.) Nature of Work. Instances Notices served. Prosecutions (1) (2) (3) (4) Nil Nil Nil — National Health Service Act, 1946 Part III 56 SECTION 21 HEALTH CENTRES. Former Relief Office Premises, 135, Dawlish Road, E.10. On the "Appointed Day"—5th July, 1948—the former Relief Office premises in Dawlish Road, E.10, were allocated to the County Health Authority for health purposes ; and in September of that year I was asked to submit a report containing recommendations as to how these buildings—together with the land and dwelling house adjoining—could be utilised for health purposes. In my Annual Report for the year 1948 I included a copy of that report, which contained the following recommendations:— 1. That arrangements be made for the establishment of a Subsidiary Health Centre in the premises at 135, Dawlish Road, Leyton, which were used by the Public Assistance Committee as a Relief Station prior to 5th July, 1948. 2. That the adjoining house be used to provide residential accommodation for members of the staff of the health department. 3. That the health centre provide the necessary facilities in connection with the medical, dental and nursing services of the Health and Education Authorities to serve the area of the Borough comprising Central North and Central South Wards. 4. That authority be given for the structural and decorative work necessary to adapt the premises for these purposes, and for the purchase of the necessary furniture and equipment. Since that time negotiations have been proceeding between the County Council, the District Council and the Government Departments concerned, and at the end of the year the position was that the County Architect had been asked to prepare a draft scheme. Dwelling House, 133, Dawlish Road. My suggestion that the dwelling house should be used for providing residential accommodation for members of the staff was based on these considerations:— (a) The acute shortage of midwives and health visitors. (b) The failure of repeated advertisements to attract applicants for the vacant posts. 57 (c) The assumption that provision of residential accommodation would attract suitable applicants. (d) Ministry of Health Circulars 96 and 98 of May, 1946, in which the Minister recommended the provision of housing accommodation for midwives and health visitors by local Housing Authorities. (e) The recommendation contained in the " Rushcliffe Report " that employing authorities should in suitable areas and circumstances establish district hostels. Authority has since been given for the use of the dwelling house to provide furnished residential accommodation, and all the structural and decorative work has been completed. Recent advertisements offering accommodation have attracted applicants, but experience in the interviewing of these applicants has shown that their chief purpose in applying for the posts was to obtain accommodation for themselves and for relatives or dependants. The off er of accommodation does not seem to attract unmarried applicants. As a result of such experience I suggest that consideration be given to the question as to whether it is justifiable to furnish and equip valuable housing accommodation which could be used otherwise to better purpose. 58 SECTION 22 CARE OF MOTHERS AND YOUNG CHILDREN. Births. 1,630 births were registered during the year :— Males. Females. Total. Legitimate 829 743 1,572 Illegitimate 34 24 58 863 767 1,630 The birth rate per 1,000 of the population was thus 15.27. 1,694 notifications of births were received during the year:— From medical practitioners 290 From midwives 1,404 Ante-Natal Clinics. Attendances .— First Attendances. Subsequent Attendances. Total. 754 1,345 2,099 The average number in attendance at the Ante-Natal Clinics held at the Council's three Centres during 1949 was 14.27 per session. The number of home visits made by health visitors to expectant mothers during the year was 128. Child Welfare Clinics. On page 59 will be found a Table giving detailed information regarding the attendances of infants and children at the child welfare clinics during the last three years. 59 ATTENDANCES, EXAMINATIONS, etc., 1947—1949. Leyton Green Park House All Centres 1947 1948 1949 1947 1948 1949 1947 1948 1949 Under 1 year— 1st attendances 896 705 638 877 682 650 1773 1387 1288 Subsequent attendances 8967 7806 8061 8332 7601 8344 17299 15407 16405 Total attendances 9863 8511 8699 9209 8283 8994 19072 16794 17693 1-5 years— 1st attendances 82 94 126 78 81 112 160 175 238 Subsequent attendances 1552 1997 2639 1781 2423 3091 3333 4420 5730 Total attendances 1634 2091 2765 1859 2504 3203 3493 4595 5968 Total attendances, both age groups 11497 10602 11464 11068 10787 12197 22565 21389 23661 Average attendance per session 76.64 70.21 75.90 73.78 69.59 78.69 75.21 69.89 77.32 Number examined by clinic doctor 3029 2999 3107 3092 3350 3651 6121 6349 6758 Number weighed 11493 10597 11448 11065 10787 12197 22558 21384 23645 60 Post-Natal Clinic. Under the provisions of the National Health Service Act, 1946, arrangements are made for the post-natal examination of all women who have been confined six weeks previously. Women who have been confined in hospital have the post-natal examination in the hospital; those who have booked a general medical practitioner have the examination at home ; only women who have had a midwife have to attend local health authority post-natal clinics. In June the Committee sanctioned the commencement of a post-natal clinic to be held at the Essex County Training Home once a month. In November the number of sessions was increased to two per month. The usual two sessions per month have been held throughout the year at Leyton Green Health Centre. The following is a summary of the work carried out :— Number of Sessions 35 Letters of Invitation 494 First Attendances 283 Re-attendances 259 During the year 35 sessions of the Post-Natal Clinic were held. The number of new patients who attended was 283, out of 494 who received appointments to attend (57 per cent.). Of these, 226 were post-natal (i.e., they had had confinements within the previous three months); and 57 were gynaecological. The disposal of these cases was as follows:— Discharged after one attendance 132 Re-attended for examination and treatment 134 Failed to re-attend after first visit 17 The total number of attendances was 542. The average attendance per session was 15.5. The following are the main conditions which have been found on examination:— Subinvolution of the uterus 20 Cystocele and rectocele 6 Retroversion of uterus 41 til Anaemia 11 Cervical erosion 35 Vaginitis 2 Fibroid 1 Birth control 73 Inflamed adnexa 1 Pregnancy 3 Cracked nipples 1 Care of Premature Infants. The term " premature infants" refers to babies weighing lbs. or less at birth, irrespective of period of gestation. Stillbirths are excluded. (a) Number of premature infants notified during the year (including transferred notifications) whose mothers normally reside in the Authority's area. (1) Born at home . 30 (2) Born in hospital or nursing home 36 (b) Premature infants born in the area (whether their mothers normally reside in the area or not) but excluding babies born in maternity homes and hospitals in the National Health Service. Nil. Bom at Home. Transferred to Hospital. Nursed Entirely at Home. Grand Total. Died in First 24 hours. Died on 2nd to 7th day. Died on 8th to 28th day. Survived 28 days. Total. Under 3 lbs. ... ... ... ... ... ... ... 3 to 4 lbs. ... ... ... ... ... ... 4 to 5½ lbs. 3 ... ... ... 27 27 30 Issue of Vitamin Products. The following figures issued by the Ministry of Food show the average weekly issue of vitamin products during the year 1949. Orange Bottles. Juice. Per cent Cod Liver Oil. Bottles. Per cent. A and D Tablets. Packets. Per cent. Leyton 2,773 54 668 42 162 52 Divisional Total 186,156 48 43,350 38 10,858 40 62 Puerperal Pyrexia. Ten cases of puerperal pyrexia were notified during the year. Maternity Mortality. There were no maternal deaths of Leyton residents during the year. Dental Treatment. Report of Senior Dental Surgeon (A. E. Hall, L.D.S.) Whereas all expectant or nursing mothers and pre-school children referred by the Council's medical officers and by the Essex County Training Home were seen, advised and treated, owing to shortage of dental staff it was impossible to afford to expectant and nursing mothers and young children the comprehensive dental inspection and treatment they require. Many pre-school children are seen at 3 or 4 years of age with decayed and abscessed teeth needing extraction. Following the relief of their pain they are probably not seen again until 5 or 6 years of age when in school, and when they are again found to have unsaveable temporary teeth, which leads to the clinical picture so often seen by school dental officers of children of 6 or 7 years of age with all their temporary molars gone and loss of space for the succeeding permanent teeth. With the present state of knowledge concerning the predisposing and exciting causes of dental decay these pre-school children should be inspected every three or four months from about the age of eighteen months or two years if it is hoped to save their temporary dentitions until the correct time for them to be shed. It is pleasing to be able to record that there was an increase in the number of new cases of all groups, i.e., expectant and nursing mothers, and also infants during the year, with a corresponding increase in the total amount of work done, details of which will be seen in the accompanying table. 63 (A) NUMBERS PROVIDED WITH DENTAL CARE. Examined. Needing treatment. Treated. Made Dentally Fit. Expectant and Nursing Mothers 186 186 186 147 Children under five 498 498 498 467 (B) FORMS OF DENTAL TREATMENT PROVIDED. Extractions. Anaesthetics. Fillings. Scalings or Scaling and Gum treatment. Silver Nitrate treatment. Dressings. Radiographs. Dentures provided. Local. General. Complete. Partial. Expectant and Nursing Mothers 355 58 89 110 81 ... 200 6 4 8 Children under five 686 56 294 235 ... 656 ... ... ... ... At the end of the year there were several patients awaiting dentures which were in course of construction or awaiting further consolidation of gum tissue. 64 Orthopaedic Treatment. Primary Examinations.—During the year 35 children were referred from the Child Welfare Clinics to the Council's Orthopaedic Surgeon. Re-examinations.—In addition to the 35 new cases mentioned above, 73 children under five years of age attended for re-examination by the Orthopaedic Surgeon. The following conditions were found on examination :— Pes piano valgus. Genu valgum. Genu varum. Congenital talipes. Congenital synostosis. Congenital enlargement of limb. Acute poliomyelitis. Bowed tibiae. Lymphatic cyst. Kyphosis. Haemiplegia. In-toeing. Tibial deformity. Provision of Surgical Appliances. Alterations to surgical boots or new appliances were supplied to 56 children as follows :— 46 Minor alterations (wedges). 4 Surgical alterations to boots. 3 Valgus T. straps and sockets to calipers. 1 Valgus pad and wedges. 1 Caliper repaired. 1 Pair genu valgum braces. Admission to Hospital. One child was admitted to Hospital and the following operation was performed by the Orthopaedic Consultant Surgeon :— Manipulation and application of bilateral leg. Special Eye Clinic. The Consultant Ophthalmic Surgeon had referred by the Clinic Medical Officers 159 pre-school children, who made 178 attendances for examination and treatment. 65 The following conditions were found :— Hypermetropia with squint 46 Squint only 13 Epicanthus 25 Convalescent Home Treatment. Children. Twelve children recommended by the Clinic Medical Officers were sent to Convalescent Homes. Nursing Mothers. Arrangements were made for 5 mothers and their babies to have periods of convalescence following confinement. Ophthalmia Neonatorum. No. of Cases Notified. Treated Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. In Hosp. 2 2 — 2 — — — Infant and Foetal Mortality. The following figures show the infantile, neo-natal and stillbirths mortality rates during the last five years. Year. Live Births. Deaths under Mortality Rate. Stillbirths. No. Rate per 1000 (live and still) Births. 1 year. 4 weeks. Infantile. Neo natal. 1945 1,474 52 26 35.27 17.63 34 22.54 1946 2,223 64 47 28.78 2 .14 53 23.24 1947 2,359 78 45 33.06 19.07 42 17.49 1948 1,810 38 22 20.99 12.15 27 14.69 1949 1,630 43 27 26.38 16.56 34 20.43 (Observations by Dr. M. L. Gilchrist.) In the year 1948 the stillbirth rate in Leyton reached the very low figure of 14.69—markedly below the average for the country and even for the neighbouring areas. This year the rate is back to 20.43—still a very good figure. 66 An examination of the possible causal factors in the stillbirth returns shows that, in two of the six still-births which occurred in home confinements, more experienced midwifery might have avoided the calamity, and in four out of the twenty-five hospital still-births the same criticism might apply. Dr. Ian Sutherland, of the Institute of Social Medicine, has published a monograph on still-births, and the factors he has listed as affecting the numbers of still-births are comparable with the findings in the Leyton area except in one respect. In Leyton in 1949 there were thirteen male and eighteen female still-births, which is a reversal of the usual trend. Prematurity, with or without complications of pregnancy, multiple births, difficult labour, accidents of childbirth and congenital abnormalities are the main factors in this rate. Similar factors operate in the neonatal rate as operate in the still-birth rate. The infant mortality rate of 26.83 is also higher than last year, a not unexpected happening since we have noticed before that a very good rate well below the average for the country as a whole seems to be followed by a slight rise. The number of congenital abnormalities was very high—twelve this year as against nine the year before, when the number of births was higher ; and fourteen cases of prematurity as against seven for 1948. There were also seven cases of acute suppurative bronchopnuemonia, of which five of the infants died within twenty-four hours of becoming ill. The other two—frail, underweight twins— had gastro-enteritis and bronchitis before the terminal pneumonia set in. Apart from the twins, none of these infants had any connection in time or place with each other—these deaths occurring in January, March, July, August and November. Six of the fourteen premature babies, where no complications were noted in the pregnancy to account for the premature birth, weighed under 2 lbs. 11 ozs. Three of these, twelve weeks' premature, were born at home and removed to hospital. Two of these were born while visiting relatives and the births took place before' the midwife arrived. It is not surprising that these two infants, one under 2 lbs., the other 2 lbs. 8 ozs., did not survive. 67 Day Nurseries. Number of Children in Attendance and Awaiting Admission. The following fist shows the numbers of children in each category (a) in attendance at, and (b) awaiting admission to, each of the two nurseries at the end of December, 1949. Category. Knotts Green. Ellingham Road. (a) In attendance. (b) Awaiting admission. (a) In attendance. (b) Awaiting admission. 1. a Employed unmarried mothers who wish to keep their children with them when not at work 10 — 10 — 1. b Motherless children 1 — 1 — 2. a Employed widows 4 — 3 5 2. b Divorced from husbands — — 1 — 2. c Separated from husbands 14 2 19 7 2. d Deserted by husbands 5 1 — — 2. e Those who have children of whom the husband is not the father 1 — — — 3. Mothers employed in industries vital to production for essential home needs and for export 24 105 26 149 4. Mothers who are ill or being confined — — — — 60 108 60 161 National Nursery Examination Board. During the year four students appeared for the examination for the Certificate of the National Nursery Examination Board, and all four were successful in obtaining the Board's Certificate. Dental Treatment. Children attending the two day nurseries were inspected once during the year and received treatment where necessary—a totally inadequate amount of dental supervision for children of these ages. Although many mouths appeared macroscopically sound, decay progresses so rapidly in many cases that treatment must be instituted at once, especially in the case of first temporary molars if they are to be saved. Dental inspection of children of these ages should be carried out every three or four months. 68  Inspected. Required treatment. Percentage requiring treatment. Knotts Green 33 6 18.2 Ellingham Road 41 11 26.8 Owing to the great interest and kindly co-operation of the Matrons, 100 per cent. acceptance rate for treatment was obtained in each Nursery. 69 SECTION 23 MIDWIFERY Record of Cases attended by Council Midwives, 1949. Midwives employed by Total. Essex County Council. Attached to the Essex Nurses' Training Home, Beachcroft Road. Cases attended:— (a) As Midwives 133 330 463 (6) As Maternity Nurses 14 44 58 Ante-natal Visits 470 2,162 2,632 Ante-natal Examination 1,051 2,847 3,898 Post-natal Visits 2,501 7,549 10,050 Administrations of Gas and Air Analgesia 48 196 244 Administration of Gas and Air Analgesia. Of the Council's three Municipal Midwives directly employed, all are in possession of the necessary certificate for administration of gas and air analgesia. The following list shows the number of domiciliary confinements attended by midwives (not including cases attended as maternity nurses) during the year and the number of such cases to whom gas and air analgesia was administered:— Cases attended as Midwives 463 Number of administrations of gas and air analgesia 244 Percentage of administrations 52.69 Maternity Sets. During 1949 maternity sets were issued to 184 expectant mothers who were having domiciliary confinement 70 Medical Aid. Numbers of cases in which medical aid was summoned by midwives during the year under Section 14 (1) of the Midwives' Act, 1918:— (1) Where the Medical Practitioner had arranged to provide the patient with maternity medical services under the National Health Service 5 (2) Others 198 Total 203 Fees paid to Doctors. One hundred and sixty-six accounts were received from general medical practitioners for assistance rendered to midwives under the provisions of the Medical Practitioners (Fees) Regulations, 1948. The total amount paid to medical practitioners during the year was £453 16s. 4d. Staff. It is with deep regret that I have to report the following injuries to two members of the staff of Essex County Nursing Home, Beachcroft Road, as the result of an accident on 1st February, 1949. Shortly after 10 p.m. on that date, Miss Alfreda M. Anderson, a domiciliary midwife, and Miss A. N. Bowmer, a pupil midwife, were cycling back to Beachcroft Road Nurses' Home after having attended a domiciliary confinement in Wellesley Road, Leytonstone. Just after they had passed under the Midland arch a motor car collided with them. Miss Anderson was killed instantly, and Miss Bowmer was admitted to Whipps Gross Hospital critically ill as a result of injuries. Miss Anderson was a member of the staff of the Essex County Nurses' Home for 15 years, and since 1937 she had been employed as a midwife in connection with the Local Health Authority's arrangements for domiciliary midwifery. Miss Bowmer had been a pupil midwife at the Home for four months. I have been associated with Miss Anderson in her work for over ten years, and I have always regarded her as one of the most competent and reliable midwives with whom I have been associated. Possessed of a very pleasing personality, she was popular with her colleagues, and highly respected by the mothers in the district. 71 Miss Bowmer was a State-registered nurse who had been undergoing her training as a pupil midwife during the past four months. It is very tragic and shocking that such an accident should have occurred to two midwives in the exercise of their duties. The tragic circumstances, under which such a popular and highly respected public servant met her death, created a profound impression in the area, especially among mothers who had been attended by Miss Anderson in her professional capacity. On Sunday, 13th February, there was held in St. John's Church, Leytonstone, a memorial service, in which there took part the Rev. J. A. Stanley, Vicar of St. John's; Canon H. E. Tilston, Vicar of St. Margaret's; and Miss E. M. Wearn, S.R.N., S.C.M., Matron of Essex County Training Home, Beachcroft Road, E.11. The congregation included His Worship the Mayor and Mayoress, Aldermen and Councillors of the Borough of Leyton, Miss Anderson's nursing colleagues in uniform, members of the staff of the health department, and hundreds of members of the general public. The impressive nature of the service, and the fact that the Church could not accommodate all those who attended, provided an eloquent testimony to the high regard and esteem in which Miss Anderson was held. SECTION 24 HEALTH VISITING. Health Visitors. During the year the Health Visitors have made 13,148 visits to homes, as follows:— (a) To expectant mothers:— First visits 125 Total visits 128 (b) To children under 1 year of age:— First visits 1,743 Total visits 6,478 (c) To children between the ages of 1 and 5 years:— Total visits 6,542 72 SECTION 25 HOME NURSING. In my last Annual Report I included a personal appreciation of the Home Nursing arrangements in this Borough, along with a summary of the Home Nursing undertaken by Nurses attached to Essex County Nurses, Training Home, Beachcroft Road, E.ll, from 5th July until the end of December, 1948. The following summary shows the work undertaken during the whole of the year 1949:— No of Visits made. Medical 38,455 Surgical 7,466 Tuberculosis 661 Maternity 7,833 Ante-Natal 2,162 Post-Natal 7,549 Out-Patients, Medical 2,696 „ Surgical 1,978 Miscellaneous 324 Total 69,124 73 SECTION 26 VACCINATION AND IMMUNISATION. Vaccination. NUMBER OF PERSONS VACCINATED (OR RE-VACCINATED). Age at 31/12/49. Total. Under 1 year. 1—4 years. 5—14 years. 15 years or over. Vaccinated 114 125 9 17 265 Re-Vaccinated - 2 4 62 68 Diphtheria Immunisation. Age 0-5 years. Age 5-15 years. Total. 1. Number of children who completed the course of immunisation during the year: (a) At Municipal Clinics 1,149 77 1,226 (b) By Private Practitioners 308 23 331 2. Number of children who were given a seoondary or reinforcing injection (i.e., subsequent to complete full course) 302 302 3. (a) Approximate estimated child population at end of year 9,212 11,800 — (6) Percentage of child population considered to be immunised at end of year \ 58.7 80.9 — 92 74 The above Return—Section 3 (b)—shows the percentage of the child population considered to be immunised. As these percentage figures are calculated on the estimated child population, they are liable to a considerable margin of error. In order to verify or otherwise the accuracy of these percentage figures, since 1944 it has been the practice for records to be kept of the state of immunisation against diphtheria of all children submitted to routine medical examination in school; and the following table shows the percentages of immunised children in the three code groups of children inspected in school during each of the last five years. Percentage of School Children Immunised. Entrants Second Age Group Third Age Group No. Exmd. No. Immunised % No. Exmd. No. Immunised % No. Exmd. No. Immunised % 1944 1,282 922 71.9 647 513 79.0 759 470 61.9 1945 693 487 70.2 965 779 80.7 743 561 75.5 1946 1,240 919 74.1 1.191 889 74.6 913 634 69.4 1947 2,465 1,866 75.7 994 834 83.9 208 121 58.1 1948 1.200 914 76.1 1,062 879 82.7 1.018 752 73.8 1949 773 594 76.3 1,041 835 80.0 1,117 815 72.9 Incidence and Mortality from Diphtheria. Totals of deaths and notifications during the past ten years have been as follows: Year. England and Wales. Leyton. Notified Cases. Deaths. Notified Cases. Deaths. 1940 46,281 2,480 55 — 1941 50,797 2,641 44 1 1942 41,404 1,827 39 — 1943 34,662 1,371 28 1 1944 29,949 934 24 1 1945 25,246 722 43 2 1946 18,283 472 38 1 1947 10,465 244 9 1 1948 8,034 150 5 — 1949 - - 0 0 75 Protection against Whooping Cough. In my last Annual Report I submitted a full report containing recommendations for the initiation in this area of a controlled investigation into the efficacy of whooping cough vaccines in collaboration with the Medical Research Council. At their meeting held on 9th September, 1948, the County Health Committee approved the recommendations. Dr. Menzies left the area medical staff in that month and it was not possible to put the new scheme into operation until early in January by holding special clinics alternately at Park House and Leyton Green Health Centres. Unfortunately there is no available suitable accommodation in the Health Department Office for the clerical and administrative work to be carried out. When arrangements were made for this investigation in Leyton in collaboration with the Medical Research Council, it was on the understanding that in this area the Leyton contribution to the investigation would be in respect of 1,000 cases. At the present rate of progress we shall soon reach our investigation total of 1,000 cases ; and, in order that some decision may be arrived at with regard to the advisability of providing protection against whooping cough, I submit the following extract from a recent Report by the Medical Research Council on the progress of the investigation so far :— . . Seven of the earlier trials, comprising a total of 4,691 test and control children, have now been in progress for two years ; and from a preliminary analysis of the results the following general conclusions may be drawn :— (1) In six of the trials the incidence and severity of whooping cough in the test groups have been appreciably less than in the control groups. In the seventh trial the results have been only slightly more favourable in the test group. (2) There has been considerable variation in the prophylactic efficacy of vaccines from different sources and of different batches of vaccine from the same source. (3) One particular type of vaccine, not at present available in this country, has been found to give much better protection against the disease than any of the others tested." 76 SECTION 28 PREVENTION OF ILLNESS, CARE AND AFTER-CARE. Foot Clinic. Annual Attendances—1936 to 1949. The Municipal Foot Clinic was opened at High Road Baths, Bakers Arms, in March, 1936, and the following list shows the number of attendances for treatment each year since that time :— Year. First attendances (new cases). Subsequent attendances. Total attendances. 1936 (from March) 1,281 3,341 4,622 1937 879 5,650 6,529 1938 1,054 7,702 8,756 1939 564 5,617 6,181 1940 387 4,730 5,117 1941 444 4,269 4,713 1942 War years 623 5,841 6,464 1943 484 5,354 5,838 1944 500 5,572 6,072 1945 436 5,599 6,035 1946 822 8,220 9,042 1947 932 9,070 10,002 1948 1,313 11,998 13,311 1949 1,162 12,475 13,637 Summary of Attendances and Treatment. (a) All Ages. During the year 13,637 attendances for treatment were made, representing an increase of 326 over the attendances during the previous year. First Attendances (new cases). Subsequent Attendances. Total Attendances. Males 234 2,383 2,617 Females 770 9,005 9,775 Children Total 158 1,087 1,245 1,162 12,475 13,637 The number of persons who received free treatment was 43 (3.70 per cent, of the total number of new cases). The following figures show the attendances of patients who received free treatment. First Attendances (new cases). Subsequent Attendances. Total Attendances. Males 12 508 520 Females 31 1,984 2,015 Total 43 2,492 2,535 77 Defects Treated. Bursitis 73 Callosities 292 Corneous conditions 207 Hallux rigidus 22 Hallux valgus 88 Metatarsalgia 35 Nails, club 81 Nails, ingrowing 70 Mycotic infection 12 Pes planus 85 Hyperhidrosis 10 Pernio 1 Verruca pedis 128 Hammer toe 22 Septic conditions 28 Conditions due to sprain 1 Trigger toe 2 Referred for Medical or Surgical Treatment. During the year 31 patients were referred to their own private medical practitioners or hospitals for the following conditions :— Dropsical oedema 1 Sub-ungual exostosis 3 Ulceration 2 Fascitis 1 Pes piano valgus. 6 Pes cavus 1 Ganglion 2 Hallux valgus 8 Hallux rigidus 2 Neuroma 1 Fibrositis 2 Dermatitis 1 Freiberg's infraction 1 (b) Children under School Age. Number of children 5 Number of visits made ... 7 Average number of visits per child 1.4 78 Defects Treated Corn 1 Nail, ingrowing 1 Callosities 1 Nail, club 1 Hammer toe (c) School Children. Number of children . 153 Number of visits made 1,238 Average number of visits per child .8.09 Defects Treated Corns 13 Nail, ingrowing 3 Blisters callosities 4 Pes planus 4 Mycotic infection 2 Hallux valgus 1 Sepsis nail, club 1 Bursitis metatarsalgia 2 Hyperhidrosis septic condition 3 Verruca pedis 120 Defects referred to School Clinics Septic condition, sprain of ankle . 1 Tinea pedis 1 Pes planus, elongation of 3rd metatarsal 1 Convalescence for Adults. During the year 24 persons were sent away for convalescent facilities. Length of Stay. 2 weeks 5 cases. 3 „ 14 „ 4 „ 5 „ Disposal. E.C.C. Convalescent Home, Clacton 18 cases. Samuel Lewis Convalescent Home, Walton 2 „ St. Joseph's Convalescent Home, Bournemouth 1 „ St. Michael's Convalescent Home, Clacton 1 „ Rest Haven Convalescent Home, Exmouth 1 „ Maitland Convalescent Home, Frinton 1 ,, Reason for Convalescence. Post operative debility 10 Debility following influenza 1 ,, „ bronchitis 2 ,, ,, asthma 1 ,, „ tuberculosis 1 ,, ,, pneumonia 1 ,, ,, peptic ulcer 1 ,, ,, inflammation of lung 1 General debility 1 Neurosis 2 General debility and rheumatism 2 ,, ,, ,, anaemia 1 Orthopaedic Clinic. Pour patients who have left school have attended the Clinic for after-care, making a total of 10 attendances. The conditions examined were :— Congenital absence of fibula 1 Disease of hip 1 Erb's paralysis 1 Anterior poliomyelitis 1 X-Rays. One patient was X-rayed. Hospital. One patient was admitted to Hospital for :— Rotation osteotomy, radius. Provision of Surgical Appliances. One surgical boot with concealed cork, strap, socket and wedges. One pair special surgical boots and hinged walking calipers. Health Publicity—Public Meeting. In connection with the Local Health Authority's arrangements for health education and publicity under the provisions contained in Section 28 of the National Health Service Act, at the request of the Chairman, arrangements were made for a public meeting to be held at the Co-operative Hall, 380, Lea Bridge Road, Leyton, on Thursday, 3rd February, at 7.45 p.m. 80 The chair was taken by Councillor Mrs. A. M. M. Burrell, Essex County Council, Chairman of the Borough of Leyton Public Health Committee and of the Leyton Health Area Sub-Committee. Addresses were given by the Deputy Medical Officer of Health, Leyton (Dr. Mary L. Gilchrist, M.D., D.P.H.), on " The National Health Service Act, 1946, and the Local Health Services ", and by Miss E. M. Wearn, S.R.N., S.C.M., Queen's Nurse (Matron, Essex County Nurses' Training Home, Beachcroft Road, E.ll) on " Home Nursing The talks were followed by a presentation of health films on the safeguarding of milk supplies and on district nursing. As the seating accommodation in the hall was somewhat restricted, invitations were sent to each recognised voluntary association in the Borough to send up to six representatives. Tuberculosis Care Association. Towards the end of the year I received a letter informing me that the Honorary Secretary and Treasurer (Mr. Lamb) of the above Association has stated his intention of resigning from these duties on 31st December, and that the local Hospital Management Committee have intimated that they wish the tuberculosis dispensary clerk (Miss Whyte) to be relieved of her duties in connection with the Care Association as soon as possible. The County Medical Officer therefore asked if these duties could be carried out in future by some member of the County Council's staff under the provisions of the National Health Service Act (Section 28). I have informed the County Medical Officer that I foresee certain difficulties in having the secretarial work of the Care Association carried out by a member of the staff of this Department, which is situated at some distance from the Chest Clinic. To what extent these Care Association duties will interfere with other duties of the clerical staff of this Department I have not yet been able to form a very definite opinion, but I have promised the County Medical Officer that I propose to give this scheme a trial. I have, therefore, nominated Mr. E. E. Jacobs as temporary Secretary of the Care Association, and he is at present taking steps to acquaint himself with the duties connected therewith. Summer School in Health Education, 1949. The Central Council for Health Education held a residential Summer School at the School of Domestic Economy, Eastbourne, 81 from Thursday, 28th July, to Thursday, 11th August, 1949. The Ministry of Health approved the course as suitable for a refresher course for health visitors, and also approved payments made by Local Health Authorities, in their capacity as such, of the expenses of persons attending the School who are engaged on the services of the Authority under Part III, National Health Service Act, 1946, to be recognised by the Ministry of Health for the purposes of a grant under the Act. With the approval of the Chairman of the Committee, arrangements were made for Miss M. H. Roger, a health visitor in this area, to attend the above Summer School. SECTION 29 DOMESTIC HELP. The scope of the Service has been widened considerably since its initiation, and help is now provided in the following types of case :— The mother who is being confined at home, or the mother discharged from a maternity hospital after the minimum period of lying-in, is relieved of her household duties during that time. In other cases of illness, where hospital treatment is not available or suitable, necessary domestic assistance is supplied. Applications from tuberculosis patients are now increasing owing to the lack of sanatorium accommodation ; and after discharge from sanatorium or hospital such patients, if women, should be given help in resuming their household duties inasmuch as some are permanently incapacitated. These persons would rather remain with their families than seek further institutional treatment, and it is in these cases that the Domestic Help Service could render valuable help. There are also the cases of people who have been unfortunate enough to have suffered from an accident. We had one case recently of a woman who fell downstairs and was bedridden for two weeks as a result of this accident. In such cases it is necessary to supply the service with the shortest possible delay. 82 The chronic case, aged and infirm, requires assistance in the home in most cases for as long as the patient lives, and apart from the actual work done in the home the helper can bring comfort and companionship to many lonely people. The integrity of spirit and service of helpers exerts an inspiring influence on those dependent upon their practical domestic assistance. A doctor's certificate is required in all cases. The nature and extent of the helper's duties depend on whether she is employed full-time or part-time. The home confinement cases are usually allocated full-time help, and at present in this Area there are six of these helpers who have been appointed fulltime because of their general suitability for full employment. The cases of the aged, infirm and chronic sick are usually allocated part-time help ; and some of the part-time helpers attend as many as three cases in the day as it is felt that it is better to give a little help to many rather than a lot of help to a few. Only volunteers are to be sent to homes where there is an infectious case, and they are to be informed how to exercise care. Precautionary notices are issued both to householders and workers, particularly in regard to tuberculosis cases. Arrangements have been made for medical examination and radiographs to be carried out for home helpers who have intimated their willingness to attend households of tuberculosis patients. Each helper is required to complete a time-sheet, and the applicant or other responsible person in the house completes a form showing the number of hours worked each time the helper attends, and signs testifying that the work has been carried out satisfactorily. Wages and accounts are based on these time-sheets, and the Organiser visits the households where helpers are employed to ascertain when the emergency is past, so that the helper may be diverted to where the need is considered to be greater. A scheme has recently been put into operation in the County for the training of domestic helpers. The names of six candidates have been submitted for the examination. The candidates will in due course be interviewed by an officer from the Institute of Houseworkers, and each candidate will be required to write a letter at the time of the interview to the Chairman of the National Institute of Houseworkers explaining her reasons for desiring to take the Diploma Examination. Prior to the interview a report 83 on each candidate will be submitted by me for the information of the interviewer. Each candidate will be required to carry out her duties under supervision for one week in a household to be selected by the interviewer. This will entail normal cleaning, cooking, etc. The welfare and efficiency of helpers is one of the chief concerns of an Organiser. For instance, changing the households to which a helper is sent creates variety and often adds to the interest and outlook of the helper towards her cases. Some homes are known to be difficult and the patients tedious, and work is more strenuous in some places than in others ; and the Organiser watches for signs of strain and occasionally switches round the rotas so that all helpers get " the rough with the smooth The success of the Service depends in great measure on the Organiser, who should be able to inspire the helpers, enabling them to take a pride and interest in their work. She has to be careful to enrol only those women who have the necessary personal qualities for the work, much of which may have to be done under difficult conditions. The time spent on the preliminary interviews of prospective helpers is important, since at the moment there is no way—apart from references, which are of little use—of ascertaining the helpers' attitude for the work. Helpers are therefore engaged for a probationary period of one month. It is impressed on each helper that her duties should never infringe upon or interfere with those of the doctor, midwife or nurse who may be attending a patient. The following is an extract from a letter which I have received from the son of a chronic case to whom help was supplied recently : . . the Helper you sent gave complete satisfaction in everything she did, her duties were performed cheerfully, thoroughly and with such a kindly and sympathetic understanding that she contributed greatly to my late mother's peace of mind and endeared herself to everyone. Anyone who is fortunate enough to be given the services of this Helper will find that they have indeed a home, or more aptly, a homely helper. May I thank you for your assistance and place on record my pleasure at this Service which operates with speed, lack of formality, and has for its object the provision of help when it is most needed." This is typical of letters of appreciation received from time to time. There can be no doubt of the beneficent value of this 84 social service, and it is clear that the domestic help service is expanding at such a rate that it will soon be one of the most important and costly of the services administered by the health authority. Domestic Help Service—Accommodation. In my last Annual Report I drew attention to the increasing number of applications for domestic help on behalf of certain types of patients (aged and infirm, chronic sick and tuberculous) for whom accommodation could not be found in institutions owing to the shortage of hospital beds, and expressed the opinion that such shortage of beds would probably prove to be a great strain on available domestic help facilities for some time to come. Since that time the Ministry of Health has addressed to Local Health Authorities a letter from which the following is an extract:— " I am directed by the Minister of Health to inform you that he has had under consideration the action which can be taken to relieve the growing pressure on hospital accommodation in the London area and which, according to past experience, is likely to increase during the next three months. " In this connection every effort is being made by the Hospital Service to increase the number of beds available, 1 ut it is clear that immediate relief can only come by making the fullest and best possible use of existing beds, a procedure which may involve a slow up in the present rate of admissions to hospitals of non-urgent cases so as to enable emergency cases to be admitted. " The Minister is aware that if this action becomes necessary it. will place a still heavier burden on the Local Health Authority's Home Nursing and Domestic Help Services but he is confident that during these critical winter months the Authority will co-operate with the Hospital Service and do their utmost to meet the needs of sick persons at home." Since its inauguration your Domestic Help Service has grown rapidly ; and, even without the additional expansion which will be required to meet the shortage of hospital beds, I anticipate that it will manifest the growth of any healthy young organism by progressive expansion until it becomes one of the most important of the local health services. Although there has been a progressive increase in the amount of help supplied and in the number of domestio helpers employed, the central administrative arrangements are of a primitive and makeshift nature. 85 In 1946 the service was inaugurated with an approved administrative staff of one clerk and one temporary case visitor. Since that time it has been necessary to effect changes in that staff to meet emergencies as they have arisen. There is at present no separate accommodation available for the domestic help service, and both domestic helpers and applicants for help have to be interviewed in a passageway. Such interviews entail the giving and receipt of information of a confidential and strictly domestic nature, and applicants for help are entitled to expect some privacy when being interviewed. I therefore recommended that suitable office accommodation be provided as soon as possible for the Domestic Help Service— one room for the Domestic Help Organiser and one room for the Clerk. Summary of Cases Helped during 1949. The following figures show in brief outline the relevant particulars regarding cases helped during the year :— No. of cases dealt with Maternity. Other. Total. ... 168 214 382 Help supplied : (a) Full-time ... 118 16 134 (b) Part-time ... 50 198 248 The following list shows the disabilities from which the 382 applicants were suffering and the number of cases in each category that were helped during the year :— Disability. No. of Cases. Maternity 168 General debility 24 Post operative debility 18 Heart disease 22 Bronchitis 17 Arthritis 15 Senility 13 Cerebral haemorrhage 12 86 Fractures 7 Cancer 6 Influenza 5 Tuberculosis 5 Blindness 5 Ulcerated leg 5 Hypertension 5 Diabetes 3 Pneumonia 3 Disseminated sclerosis 3 Miscarriage 3 Appendicectomy 2 Oedema of legs 2 Peptic ulcer 2 Radical mastectomy 2 Parkinson's disease 2 Rheumatism 2 Cholecystectomy 2 Amputation of leg 1 Asthma 2 Fibrositis 1 Menorrhagia 1 Hysterectomy 1 Gall stones 1 Thyrotoxicosis 1 Tonsilitis 1 Vertigo 1 Paralysis 1 Cerebral tumour 1 Breast abscess 1 Arterio sclerosis 1 Vaginal prolapse 1 Neuritis 1 Phlebitis 1 Ascites 1 Gross obesity 1 Other 10 Provision of Domestic Helps for Chronic Cases. The County Council's proposals for the provision of domestic help for chronic cases draws attention to the rapid increase in applications of this nature, and in a number of cases help is required 87 for the duration of the patient's life. In such cases, it is suggested that a domestic help be provided in the first instance for a period not exceeding three months, subject to review by the Committee before the expiration of that period. In November the County Health Committee resolved that the Chairman of the Health Area Sub-Committee review these cases every three months. Examination of Domestic Helpers by the National Institute of Houseworkers. Five Domestic Helpers from this Area were selected to undergo the examination in order to obtain the Diploma of the National Institute of Houseworkers. The candidates were interviewed by an Officer from the Institute on the 16th September, and each candidate was required to write a letter at the time of the interview to the Chairman of the National Institute of Houseworkers explaining her reasons for desiring to take the Diploma Examination. A report on each of the Helpers was made by me for the information of the interviewer. The practical part of the examination was carried out during the week commencing 10th October at a house at Woodford Green. Four of the candidates were successful in passing the examination and were presented with their Diplomas by the Chairman of the County Health Committee at the County Hall, Chelmsford, in December. The successful candidates are now entitled to an additional one penny per hour in respect of cases attended. School Medical Service 90 The figures set out below relate to the calendar year ended 1949. Number Roll Average Attendance Percentage of Attendance 1. Secondary Schools 8 4,227 3,782 89.47 2. Primary Schools 18 7,610 6,680 87.78 Totals 26 11,837 10,462 88.38 ROUTINE MEDICAL INSPECTION. A.—Routine Medical Inspection. Number of Inspections in the prescribed groups. Entrants 773 Second Age Group 1,041 Third Age Group 1,117 Total 2,931 Of 2,931 children who were examined in the code age-groups 1,981 (or over 67 per cent.) were accompanied by their parents. B.—Other Inspections. Special Inspections. The number of special inspections during the year was 5,751 comparing with 4,639 during the previous year. Re-inspections. The number of re-inspections during 1949 was 8,851. 91 School Leavers—Choice of Employment. At the routine medical inspection of the " Leaver " group of children the opportunity is taken to discuss the choice of work with the parent and the child. If the choice is thought to be unsuitable in view of the health record of the child, advice is given to the parents, and if necessary the Juvenile Employment Officer is advised about any special difficulties. Very few children, outside the severely handicapped, are unable to follow the trade or profession they have set their hearts on. When the children left school at the age of 14 years, and were therefore examined at the age of 13 years, very few children had much idea of what they wished to do. Now that they have another year in which to mature before leaving school, this difficulty has been overcome in the majority of cases. One of our School Medical Officers collected this year a record of the trades and professions selected by a group of 247 girls in Secondary Modern Schools. Only 23 of them had no idea what they wished to do, and one said she did not want to work at all. Most appeared to select work in which they would quite probably make a success. The following is a summary of the choices of employment:— All types of office work 67 Dressmaking, tailoring, needlework 55 Factory—machining 27 Shop assistants 15 Hairdressing 11 Nursing 9 Children's nurse 6 Land-girl 5 Air hostess 4 Mannequin 4 Dress designing 4 Work with animals 3 Telephonist 3 Window dressing 2 Singer 1 Cook 1 French polisher 1 Dental receptionist 1 Did not want to work 1 Did not know 23 92 The Findings of Medical Inspection. Number of Individual Children found at Routine Medical Insfectior to require treatment (excluding defects of nutrition, uncleanliness and Dental Diseases). Group. (1) Number of Children Percentage ol Children found to require treatment. (4) Inspected. (2) Found to require treatment. (3) Code Groups— Entrants 773 181 23.4 Second Age Group 1.041 177 17.0 Third Age Group 1,117 118 10.5 Total (Code Groups) 2,931 476 16.2 Uncleanliness and Verminous Conditions.—At the special inspections held by the school nurses, 769 children were found to be unclean out of a total number of 28,117 examined (i.e., 2.7 per cent.) Cleanliness Surveys in Individual Schools. School. Number of Examinations. Number Cautioned. Number Excluded. Canterbury Road 2,556 20 5 Capworth Street 1,138 38 6 Cann Hall Road 2,154 46 4 Church Road 2,525 69 21 Cobbold Road 490 13 2 Connaught Road 1,456 94 11 Downsell Road 2,347 55 17 Davies Lane 3,419 72 1 Farmer Road 530 2 — Goodall Road 1,214 22 4 Kirkdale Road — — — Lea Bridge Road 174 5 2 Mayville Road 2,105 39 12 Norlington Road 1,191 5 1 Newport Road 2,776 75 27 Sybourn Street 1,862 23 3 St. Joseph's 196 11 — Trumpington Road 1,055 8 2 Knotts Green and Harrow Green 472 36 8 Leyton County High School 457 7 3 Total 28,117 640 129 Number of individual children found unclean 769 of whom 129 were referred to the Minor Ailments Clinics. 93 The incidence of uncleanliness for the past 10 years is shown in the following table. Year Number of Examinations Number Cautioned Number Excluded 1940 9,871 504 160 1941 12,746 894 174 1942 17,439 794 196 1943 22,364 878 199 1944 18,090 841 160 1945 20,224 995 252 1946 21,134 604 137 1947 26,160 766 219 1948 28,422 659 194 1949 28,117 640 129 204,567 7,575 1,820 MEDICAL TREATMENT. Minor Ailments Clinics. Attendances. During the year 2,298 children attended the clinics, and 13,040 attendances were registered. Defective Vision.—Of the 2,931 children subjected to routine code group inspection in the schools, 153 (5.2 per cent.) were found to be suffering from some eye defect requiring treatment. Special Eye Clinic. During the year there were referred to the Ophthalmic Surgeon 896 children. They made 1,129 attendances for examination and treatment. Orthoptic Clinic. 1. Number of sessions held 264 2. Number of cases investigated 303 3. Number of cases treated 242 4. Number of cases refused — 5. Number cured : Complete. Cosmetic only. (a) Without operation 35 — (b) With operation 11 — (c) Total 46 — (d) Number of cases of Amblyopia included in above total cured 30 6. Number still under Treatment 76 7. Number failing to attend for complete course 7 94 8. Discharged unsuccessful 4 9. Number on waiting list Nil 10. Number of cured cases relapsing and requiring further treatment during : First Year following discharge Nil Second „ „ „ Nil Third „ „ „ Nil 11. Total number of attendances 1,320 Cases of squint requiring operation are now referred to Dr. M. Klein, Ophthalmic Surgeon, Whipps Cross Hospital, who has kindly consented to operate on all cases referred to him from the Leyton Clinic. A report on every case requiring operation is sent to Dr Klein, who then sees the patient and carries out the operation in 14 to 28 days. Hitherto cases were referred to various London Hospitals, and the waiting period for operation varied from 18 months to two years. I am indebted to Dr. Klein for his co-operation and help in operating on these cases with the minimum of delay. School Dental Service. Findings of Dental Inspection. The following table shows in statistical form the results of school dental inspection in the individual schools mentioned. School. .Number inspected. Number referred for treatment. Number accepting treatment. Percentage of acceptances. Boys. Girls. Boys. Girls. Canterbury ... ... ... ... ... ... Cann Hall 380 378 146 163 260 84.1 Capworth ... ... ... ... ... ... Church ... ... ... ... ... ... Connaught ... 472 ... 232 146 62.9 Davies Lane ... ... ... ... ... ... Downsell ... ... ... ... ... ... .Farmer ... ... ... ... ... ... Goodall 237 210 155 148 181 59.7 Harrow Green ... ... ... ... ... ... Kirkdale ... ... ... ... ... ... Knotts Green ... ... ... ... ... ... Lea Bridge ... ... ... ... ... ... Mayville 331 343 16 1 144 218 71.4 Newport ... ... ... ... ... ... Norlington ... ... ... ... ... ... Sy bourn 454 406 145 160 227 74.4 St. Joseph's ... ... ... ... ... ... Tom Hood 130 136 61 64 72 57.6 Trumpington ... ... ... ... ... ... County High ... ... ... ... ... ... 95 Dental Inspection and Treatment. It is generally agreed that a nation's greatest wealth lies in the health of its inhabitants. Recognising this, progressive nations have taken steps to safeguard the health of present and future generations by regarding the health of mothers and young children as the foundation on which their social structures should be built. With that end in view we have, during and since the war, granted certain priorities in foods and vitamins to expectant and nursing mothers and to young children. When the National Health Service Act, 1946, was framed it was the declared policy of the Government that dental inspection and treatment should be concentrated on the priority needs of expectant and nursing mothers and children ; and in Circular 118/47 of July, 1947, dealing with the health services to be provided by local health authorities, the Ministry of Health stressed that :— " The intention of Section 22 is clearly to put them (expectant and nursing mothers and young children) in a preferential position and to afford them some guarantee of treatment not given to other classes. Local Health Authorities cannot give effect to this intention without expanding substantially the provision now made by Welfare Authorities as part of their Maternity and Child Welfare Services, and putting more emphasis on conservative treatment." The Inter-Departmental Committee on Dentistry (" Teviot " Committee) set up by the two Health Ministers were concerned not only to ensure that the dental care was made available to mothers and children, but also that they should accept it. " The claims of these classes need hardly be argued. In the case of the expectant and nursing mother, the harm that oral disease can cause both to mother and child is well known. As regards the young it is not only that their health and development benefit in a special degree from dental care ; a point ultimately of even greater significance is that if they come to a true valuation of dental health, our major problem is solved not only for them in their adult lives, but also for future generations." In consequence of the serious state of these special dental services throughout the country in general, and in Leyton in 96 particular, I beg to draw attention again to the following extract from my annual report of last year :— " Unfortunately these precepts are, and will be for some considerable time, impossible to put into practice due to the great shortage of dental surgeons throughout the country and the fact that dental surgeons are leaving the service of local authorities in large and alarming numbers in order to take advantage of the greatly-enhanced remuneration available in private practice since ' the appointed day If mothers and children showed willingness to attend private dental surgeons for conservative dentistry (fillings, etc.), the new dental arrangements under the provisions of the National Health Service Act could be regarded as, in any case, a substitute for the local authority dental services ; but the evidence so far available in this area is that they are continuing to rely on the local authority dental surgeons for inspection and treatment. Even in the Grammar Schools, where one would expect the highest proportion of pupils to have their own private dental practitioners, the number was only 1 per cent, in the case of boys and 3 per cent, among girls. An additional feature of the new dental ' set-up ' is that whereas a few mothers have taken their children to private dentists to have teeth extracted, they do not attend there for regular inspection and fillings. " The loss in a young child of unsaveable teeth by extraction is unnecessary mutilation which can and should . be avoided, and the only method I know of avoiding it is by the regular dental inspection and treatment of all children—at least every six months—from two years of age until they leave school. The attainment of that ideal requires first of all an adequate dental staff. It also requires much individual persuasion and tact on the part of the available staff who conduct the routine inspections. " Under the circumstances, I cannot regard the new dental arrangements, and the alarming drift of local authority dental surgeons into private practice, as other than a disaster as far as expectant and nursing mothers and school children are concerned. " It is clear that the Government was fully alive to the exceptional needs of mothers and children when the Act was framed, and it is unfortunate that the great disparity in the subsequent remuneration of public and private dental surgeons 97 has been instrumental in frustrating the Government's declared intention. Unless something is done at once to remove this anomaly, the harm which will be done to the dental welfare of expectant and nursing mothers and young children will have widespread and far-reaching effects on their future health." The following is the report of the Senior Dental Surgeon, whose record of work done under trying circumstances has much to commend it. Report by the Authority's Senior Dental Officer (A. E. Hall, L.D.S.) The year 1949 has, like its predecessor, proved a disastrous one from the dental staff point of view. In April one of the parttime dental officers (at Leyton Green Health Centre) who had the previous year reduced his sessions of attendance from four to two, found it necessary to resign from the service. This was followed in December by the resignation of a part-time dental officer who had attended for four sessions per week at Park House Centre. Over the whole year there was available an average staffing equivalent to 1 5/11ths dental officers for the inspection and treatment of approximately 12,500 school children in the area. In addition, the same dental officers devoted an average of 2.3 sessions per week to the Maternity and Child Welfare dental service. When this is considered against the background of what is considered adequate staffing for the area (six full-time dental officers for the school children alone), it is obvious that nothing like satisfactory service from the preventive and conservative aspects has been possible. Routine inspection has been carried out in only six of the schools of the area ; and treatment for the children of these six schools, plus one other school which was inspected in December, 1948. In addition, treatment for 2,411 accident and toothache cases, which presented themselves without appointments, was finished. The acceptance rate for the area was 70.08 per cent., which could be improved upon if there was sufficient staff to deal with them. The disappointing feature of this staff shortage is the delay in detecting and preventing tooth troubles. The school dental clinic is therefore assuming what one might describe as the function of the dental out-patient department of a hospital—the relief of toothache by extraction of hopelessly decayed teeth. That was 98 never the main object of a dental health service established to enable children to receive regular attention and to leave school without the loss of permanent teeth and trained in their care. In addition to the details of dental treatment shown in Table IV on page 111 one girl of school leaving age received full upper and lower dentures due to the results of rapid and gross dental decay, and 30 children had denture space retainers made following accidents or decay resulting in the loss of anterior teeth. During the year a new Stirling X-ray apparatus was provided and, although it was not in use until the end of June, it has been of inestimable value in the cases for which it was used, both orthodontic and accident. Orthodontic Clinic. A selected number of cases were undertaken during the year somewhat fewer than the previous year, but one must remember that in an understaffed dental scheme only a limited amount of this work should be done and confined to the most urgent cases likely to benefit greatly from such treatment. Any encroachment on the limited time available for conservative treatment by filling needs considerable justification and, if it is not possible to see patients and do fillings as soon as necessary, there is little object in straightening the teeth in the first place as it would be necessary to take them out at a later date due to decay. Analysis of Orthodontic Cases, 1949. Impressions taken 119 Study models made 119 New appliances fitted 36 Attendances 408 Advice 187 Adjustments to appliances 226 X-rays 23 Patients left district 1 Treatment abandoned by patient 1 It will be seen that, with the dental staff available, a fair amount of the various branches of dental surgery has been carried out. It is, however, very disheartening to all concerned that, after years of persuasion and advice to our patients that they must attend the health centres when advised to do so in order that their teeth can be filled and saved, we should now find ourselves in the position of not being able to do all the treatment necessary as soon as we know it to be present. 99 It can only be hoped that a more enlightened policy will be pursued in the near future in connection with the priority classes, otherwise it would appear that there will be an end to organised school dental services as we have known them in the past, and have worked to develop oyer many years. Orthopaedic Clinic. Examinations by Orthopaedic Surgeon. Primary examinations 57 Re-examinations 111 The findings at primary examinations were :— Congenital talipes 1 Pes piano valgus 7 Instability knees 1 Hammer toes 3 Hallux valgus 17 ,, rigidus 1 Tibial deformity of digits 3 Exostosis feet 1 Valgus ankles 2 Genu valgum 3 ,, varum 2 Plantar wart 1 In toeing 2 Flat feet 1 Digitus varus 1 Deformity arm 1 Kyphosis 2 Kypho-scoliosis 1 Scoliosis 1 Sacral pain 1 Schlatter's disease 1 No defect 4 The following conditions were seen at re-inspections during the year:— Pes piano valgus 8 „ cavus 1 Hallux valgus 4 Digitus varus 4 Deformity of feet 2 „ „ hand 1 100 Congenital shortening of limbs 4 In-toeing 1 Talipes 4 Scoliosis 5 Kyphosis 1 External semilunar cartilage 2 Schlatter's disease 1 Mid-tarsal varus 2 Flat foot 1 Hemiplegia 2 Anterior poliomyelitis 2 Fracture clavicle 1 Round shoulders 1 Torticollis 1 Winged scapula 1 Polio-encephalitis 1 Traumatic osteochondritis (knee) 1 Dislocation hip 1 Erb's deformity 1 Spastic diplegia 1 Loose body—patella rt. 1 X-Rays. Arrangements for X-rays were carried out in 4 cases. Admissions to Hospital. Five children were admitted to hospital, and the following operations performed :— 1. (a) Opponens operation. (b) Arthrodesis base of thumb. 2. Tenotomy digit 5, rt. foot. 3. Crushing of popliteal nerve, left. 4. Rotation osteotomy of rt. humerus. 5. Manipulation of rt. foot and application of plaster of Paris. Surgical Appliances and Boots. Minor alterations to boots (wedges, etc.) 22 Other alterations to boots (surgical) 7 Hallux valgus splints Pairs 3 101 HANDICAPPED PUPILS. Medical Examinations. During the year, some 129 children were referred for special medical examination. As the result of examination these 129 children were classified as follows :— Educationally sub-normal 18 Unfit for education within the school system 10 Maladjusted 3 Physically handicapped 15 Deaf 1 Partially deaf 4 Delicate 78 129 In addition to the above, 30 children were examined because of difficulties at home or school, and were ascertained as set out below : Behaviour problems 10 Dull and backward 11 Backward only 4 Notified for supervision 5 30 Several of these children are being referred to the Child Guidance Clinic for appropriate treatment. Special School for Educationally Sub-Normal Pupils. Admitted 38 Discharged 16 102 Physically Handicapped Pupils. Knotts Green Open Air School. Admitted during the year 49 Discharged 10 PROVISION OF MEALS. The number of individual children fed under the Authority's arrangements during 1949 was :— Dinners. Milk Meals. Free 630 9,775 For payment 5,446 — Totals 6,076 9,775 Number of meals supplied :— Dinners. Milk Meals. Free 139,831 2,350,609 For payment 1,111,631 — Totals 1,251,462 2,350,609 SPEECH THERAPY. The following summary shows the number of children treated and the speech defects from which they were considered to be suffering :— 1. Children at present Undergoing Treatment— Diagnosis of Defects— Boys Girls Total Stammering 46 12 58 Dyslalia 42 15 57 Alalia — 1 1 Lisp 5 3 8 Hyperrhinophonia 1 1 2 Cleft palate 1 1 2 Disarthria — 1 1 95 34 129 103 Incidence of speech defects among seniors, juniors and infants— Seniors Juniors Infants Total Stammering 15 34 9 58 Dyslalia 1 10 40 57 Alalia — — 1 1 Lisp — 2 6 8 Hyperrhinophonia 1 1 — 2 Disarthria — — 1 1 Cleft palate 1 1 — 2 18 54 57 129 2. Discharged—41. Seniors Juniors Infants Total Dyslalla — 6 8 14 Stammering 5 10 6 21 Lisp 1 1 4 5 Hyperrhinophonia — 1 — 1 3 18 18 41 3. On Waiting List Nil 4. Average Number Of Cases Treated Daily 30 5. Homes visited 40 6. Schools Visited 35 7. Children referred to other Clinics :— To the Psychiatrist To the Psychologist 2 For further medical advice — For dental treatment — 2 Ever since we centralised our Speech Therapy Clinic, that is, ceased having separate Clinics in three schools centred round the Borough, and have concentrated the work at the High Road Baths, we have been faced with the difficulty of the children attending regularly when mothers are unable to make the journey, or are just neglectful about it. 104 When the mother herself is unable to bring the child, the students attending at the Speech Clinic for training have been bringing the children to and from schools. Occasionally an adult helper from the infants' school will bring a child when the students are absent because of examinations, or in holiday periods. It had been hoped that when the Local Education Authority set up its own transport system that this was one of the services they would cover. It seems that it should be within the scope of this service to take children to and from the Speech Clinic so that they lose as little time as possible from school, but up to the present the Education Office has not been able to arrange it. Perhaps when this service expands to its full extent the Speech Clinic will be sympathetically considered. CHILD GUIDANCE. Report of the Educational Psychologist to the Forest and Leyton Divisions (Miss M. Marshall), 1949. During the year 47 schools were visited by the Educational Psychologist in the two Divisions and testing of individual children was carried out both in the schools and in the Child Guidance Clinic ; 263 children were given individual tests of intelligence and standardised attainment tests during the year, 93 in Leyton and 170 in the Forest Division. These children were selected by the Head Teachers (sometimes at the request of the parents) or by the School Medical Officers. the School Medical Officers. The distribution of these 263 children, according to age and sex, is as follows :— Infant Junior Secondary Girls Boys Girls Boys Girls Boys Leyton 2 7 18 50 5 11 Forest 7 21 29 51 25 37 It will be noticed that, as in previous years, a larger proportion of boys and girls is put forward for this individual examination, which seems to indicate that boys, on the whole, adapt themselves less easily to school life than girls. Of the actual children referred to the Child Guidance Centre, the proportions are still more heavily weighted on the boys' side. Girls Boys Leyton 7 25 Forest 11 27 105 If the individual children tested are divided into three groups according to intellectual ability, it will be seen that the Psychologist's time has not been entirely devoted to the duller children. Dull Average Bright (I.Qs below 85) (I.Qs. 85-115) (I.Qs. 115 and over) 84 143 36 The reasons for the requests for special examination can be summarised as follows :— A. Problems at School :— Backwardness in school work (particularly reading and spelling) 125 Other school problems :— (a) Educational advice — (b) Fighting, truanting, pilfering, etc. — (c) Apathy, speech defect, etc. 77 B. Problems at Home :— Nightmares, pilfering, unruliness, enuresis, etc. 58 C. Probation Officer 3 The largest single educational problem is still that of reading failure, especially amongst boys. The problem can be tackled most hopefully with the youngest children in the Junior School, and those schools which have paid particular attention to their backward 7-year olds are finding that the effort made is well repaid in the later stages of the Junior School. Those schools which have adopted a simple standardised word reading test are finding the regular testing of the backward children's progress to be both a guide and an incentive to further effort. This emphasis on the 7-year old group is not intended to imply that special classes for older backward children will not be necessary when staffing and accommodation allows, but it should help to reduce the numbers (still far too large) of boys with average or above average ability reaching the secondary modern school still unable to read. Large scale group testing has been carried out in several areas by the Teachers and Psychologist working together. It has been found that an objective measurement of ability obtained from a group test of intelligence is of great assistance to the Secondary Modern School which accepts children from several Junior Schools. The Psychologist has spent a certain amount of time each week in remedial teaching. Fifteen children were helped during 106 the year, 14 in reading and 1 in arithmetic. Most of these children have other problems in addition to their failure in reading, and so present unusual difficulties to the teacher, and it is for this reason that they have been given individual teaching at the Clinic. Each of them has one 40-minute lesson a week and, even in spite of this very limited time, every one has made progress. Two courses of lectures have been given by the Psychologist during the year. The first, during the Summer Term, was on "The Education of Backward Children", and was given in Woodford ; the second, during the Autumn Term, was on "Mental Health in Children", and was given in Leyton. It may be of interest to note that far fewer people applied to attend the second of these two courses than the first. Other lectures have been given to the Dagenham Educational Fellowship, the Forest Educational Fellowship, the Special Schools Association, the Leyton Branch of the Nursery School Association, Parents' Guilds and Parent-Teacher Associations. The Psychologist also assisted at a week's residential course at Saffron Walden Training College on the " Education of Backward Children It should be noted that for five months out of the year there has been no Psychiatric Social Worker for the Leyton and Forest Divisions, and this has meant that the Educational Psychologist has had to give more time to work in the Clinic than is normally required, with a corresponding decrease in the amount of time which has been spent in the schools. 107 STATISTICAL APPENDIX. TABLE I. Medical Inspection of Pupils attending Maintained Primary and Secondary Schools. a. Periodic Medical Inspections. Number of Inspections in the prescribed Groups :— Entrants 773 Second Age Group 1,041 Third Age Group 1,117 Total 2,931 b. Other Inspections. Number of Special Inspections 5,751 Number of Re-inspections 8;851 Total 14,602 108 C. Pupils Found to Require Treatment. Number of individual children found at Periodic Medical Inspection to require treatment (excluding dental diseases and infestation with vermin). Group. For Defective Vision (excluding Squint). For all other Conditions Total individual Pupils Percentage of children found to require Treatment. Entrants 3 228 181 23.4 Second Age Group 80 123 177 17.0 Third Age Group 52 75 118 10.5 Total (Prescribed Groups) 135 426 476 16.2 Other Routine In spections — — — — Grand Total 135 426 476 16.2 TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1949. Defect or Disease. Routine Inspections. Special Inspections. Number requiring Treatment. Observation. Number requiring Treatment. Observation. (1) (2) (3) (4) (5) Skin 7 5 452 — Eyes—(a) Vision 135 29 239 11 (6) Squint 12 11 30 — (c) Other 6 7 458 1 Ears—(a) Hearing 7 9 25 — (b) Otitis Media 13 27 65 — (c) Other 6 11 317 1 Nose or Throat 100 91 409 — Speech 10 6 44 — Cervical Glands 7 22 22 — Heart and Circulation 5 18 11 — Lungs 17 41 115 1 Developmental—(a) Hernia 6 1 3 — (b) Other 4 12 65 — Orthopaedic— (a) Posture 9 11 8 — lb) Flat Foot 42 13 30 — (c) Other 67 32 80 1 Nervous System—(a) Epilepsy 2 1 18 — lb) Other 3 6 59 1 Psychological—(a) Development 1 15 21 — (b) Stability 6 19 69 5 Other 96 26 3,624 6 109 TABLE II. B. Classification of the General Condition of Pupils Inspected during the Year in the Age Groups. Age Groups. No. of Pupils Inspected. A. Good. B. fair. C. Poor. No. % No. % No. % Entrants 773 130 16.8 569 73.6 74 9.5 Second Age Group 1,041 269 25.8 668 64.2 104 9.9 Third Age Group 1,117 355 31.7 714 63.9 48 4.3 Other Routine Inspections — . — — — — — — Total 2,931 754 25.7 1,951 66.6 226 7.7 TABLE III.—Return of Defects Treated during the Year ended 31st December, 1949. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Table V). Disease or Defect. (1) Number of Defects treated or under treatment during the year. Skin— Ringworm— Scalp—(1) X-ray treatment — (2) Other 6 Body 2 Scabies 3 Impetigo 24 Other skin diseases 416 Minor Eye Defects— (External and other, but excluding cases falling in Group II.) 454 Minor Ear Defects 315 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 1584 Total 2804 110 TABLE III.—contd. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as minor ailments.—group I). Defect or Disease. Number of Defects dealt with. Errors of refraction (including squint) 727 Other defect or disease of the eyes (excluding those recorded in Group I) 164 Total 891 No. of Pupils for whom Spectacles were— (a) Prescribed 725 (b) Obtained — Group III.—Treatment of Defects of Nose and Throat. Total number treated. Received operative treatment:— (a) for adenoids and chronic tonsillitis 127 (b) for other nose and throat conditions 26 Received other forms of treatment 150 303 Group IV.—Orthopædic and Postural Defects. (a) No. treated as in-patients in hospitals or hospital schools 6 (b) No. treated otherwise, e.g., in clinics or patient departments 46 Group V.—Child Guidance Treatment and Speech Therapy. No. of pupils treated— (a) Under Child Guidance arrangements 93 (b) Under Speech Therapy arrangements 129 1ll TABLE IV. Dental Inspection and Treatment (1) Number of pupils who were :— (a) Inspected by the Dentist:— Aged Age Groups Specials (Casuals) Grand Total 3 ... Total 3,477 4 ... 5 309 6 355 7 370 8 250 9 317 10 343 11 409 12 331 13 275 14 218 15 34 16 266 ... 2,411 ... 5,888 (o) Found to require treatment 3,990 (c) Actually treated 3,135 (2) Half-days devoted to Inspection 27 Treatment 830—Total 857 (3) Attendances made by children for treatment 7,338 (4) Fillings, Permanent Teeth 2,079 Temporary „ 600—Total 2,679 (5) Extractions, Permanent Teeth 593 Temporary ,, 4,824—Total 5,417 (6) Administrations of general anaesthetics for tions 1,988 (7) Other operations, Permanent Teeth 1,456 Temporary ,, 2,075—Total 3,531 112 TABLE V. Infestation with Vermin. (1) Total number of examinations in the Schools by School Nurses 2,8117 (2) Number of individual pupils found to be infested 769 (3) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2) Education Act, 1944.) — (4) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3) Education Act, 1944.) —