Ac 4411 (1) LEYTON LEY 44 Borough of Leyton HEALTH REPORT FOR THE YEAR 1950. ANDREW W. FORREST, m.a., m.d., ch.b., d.p.h., Medical Officer of Health. CONTENTS. PAGES 1. Opening Remarks 3—5 2. Vital Statistics 8—20 3. Infectious Diseases 22—33 4. General (b) Scabies 36 (c) National Assistance Act, 1948 38 (d) Mortuary 41 5. Sanitary Circumstances of the Area 44—64 6. National Health Service Act, 1946, Part III 65—67 (a) Sec. 21 Health Centres 68 (b) „ 22 Care of Mothers and Young Children 69—78 (c) „ 23 Midwifery 79—80 (d) 24 Health Visiting 81 (e) „ 25 Home Nursing 82 (f „ 26 Vaccination and Immunisation 83-85 (g) „ 28 Prevention of Illness and After Care 86—93 (h) „ 29 Domestic Help 94-97 7. School Health Service 99 — 130 3 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LEYTON. Mb. 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 1950. Vital Statistics. The Registrar-General's estimate of the population of the Borough of Leyton during the year 1950 is 106,600 persons, a reduction of 100 persons compared with the previous year. The last official census of the population was taken in 1931, and the results of the 1951 census are not yet available. For the third year in succession there has been an appreciable fall in the birth rate, which is now the lowest since 1941, an abnormal war year in which a large number of Leyton expectant mothers were evacuated to safer areas. In 1950 the total number of live births was 1,447, a decrease of 183 compared with the previous year; and the birth rate has fallen from 15.27 to 13.57. The lowest birth rate recorded in Leyton was the rate of 11.78 in the year 1934. 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 1950 1,447 13.57 These figures show the extent of the sudden post-war increase in births which reached its maximum in 1947, and the progressive annual decrease that has taken place since then. Deaths of Leyton residents during the year numbered 1,134, giving a death rate of 10.64. The corresponding figures for the previous year were 1,232 and 11.54 respectively. 4 The infantile mortality rate (20.04) was the lowest ever recorded ; and compares with a rate of 26.3 for London, and of 29.8 for England and Wales. During the year under review no Leyton woman died from diseases or accident associated with pregnancy or childbirth. Additional vital statistical material, with a table showing comparative figures over a period of fifty years, is to be found on page 20; and on pages 10 and 11 will be found some interesting information regarding expectation of life at birth and advancing years. Sanitary Circumstances. The burning of crude coal for heating throws into the atmosphere about three million tons of sulphur every year—about as much as would make up for our national shortage of sulphur, if it could be collected. In addition, the use of raw coal in fireplaces discharges into the atmosphere smoke and vapours which are injurious to health, damage our clothes and our buildings, and increase the work of the housewife. The question of smoke prevention, a most serious public health problem, cannot be solved until we are in possession of the relevant ' data In order to assist in the investigation of atmospheric pollution Leyton Council is now collaborating with the Department of Scientific and Industrial Research, and has installed in the Health Department the apparatus necessary to furnish daily measurements of the concentration of atmospheric smoke and sulphur dioxide. Full details of the procedure are furnished in the appropriate section in the body of the report, along with records and graphs of the atmospheric pollution. Infectious Disease. For the second year in succession no confirmed case of diphtheria has been notified. Measles and whooping cough were both epidemic during the year, but no death occurred due to either type of infection. Scarlet fever is now so mild in type as to be almost negligible as a cause of death. For the third year since 1947 acute poliomyelitis has been epidemic, and is now one of the most serious infectious diseases in the country. Unfortunately it is one of the most distressing, for it leaves a permanent disability which does not interfere otherwise with health. 5 Research Work. During the year the medical and nursing staff were engaged, in collaboration with learned bodies outside, in investigations in three different fields of research, i.e., Protection against Whooping Cough, Anti-tuberculosis Vaccine (B.C.G.) and House-to-house Spread of Tuberculosis. See pages 30, 85, 124. National Health Service Act, Part III. The comprehensive services provided under the various sections of this Act are now administered by Essex County Council. In the appropriate section of this report will be found information regarding these services, preceded by some general observations regarding general administration of the Act. School Health Service. In the section of the report dealing with the School Health Service will be found information regarding the services administered by Leyton Committee for Education on behalf of the County Council. I have the honour to be, Mr. Mayor, Ladies and Gentlemen Your obedient Servant, Vital Statistics Extract from Vital Statistics for the year 1950. Population 106,600 Live Births:— Legitimate Males 721 Females 680 Illegitimate Males 26 Females 20 Totals 1,447 Birth Rate per 1,000 of population 13.57 Stillbirths:— Males 12 Females 15 Rate per 1,000 total (live and still) births 18.31 Deaths:— Males 543 Females 591 Totals 1,134 Death Rate per 1,000 10.64 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 20.04 Legitimate infants per 1,000 legitimate live births 19.98 Illegitimate infants per 1,000 illegitimate live births 21.74 9 Infantile Mortality. Fifty years ago (in 1900) some 410 infants died before they reached their first birthday—an infantile mortality rate of 140 per 1,000 live births. Fifty years later (in 1950) the number of infants in Leyton who died during their first year was 29—the infantile mortality rate being 20.04. During these fifty years the infantile mortality rate has been reduced from 140 to 20.04—meaning that there has been an annual saving of 120 infant deaths out of every thousand infants born alive. Mortality from Infectious Diseases. The following figures give some idea of the great reduction in deaths due to infectious diseases during the last fifty years. For purpose of comparison I have taken a period of five years at the end of last century (1896-1900), and compared it with the five-year period 1946-1950. The average population now is roughly one-fifth greater than it was fifty years ago; so that the mortality figures shown for the last five years should be reduced by one-fifth to give a strictly corrected comparison. Five-Year Period. 1896—1900 1946—1950 Average Population 88,600 105,372 Total Deaths—of Infants under One Year 1,886 252 Deaths due to:— Enteric Fever 60 0 Diphtheria 132 2 Scarlet Fever 39 1 Measles 107 4 Whooping Cough 182 8 Diarrhoea and Enteritis 583 22 Tuberculosis of Lungs 425 187 These two factors—the reduction in deaths of infants, and the fall in deaths due to infectious disease have been responsible in great measure for the great increase in the expectation of life, and the consequent fundamental change in the age constitution of the population. Fifty years ago the proportion of the population above 65 years of age was 4.7 per cent.; to-day it is 10.8 per cent.—more than double. On the other hand, the proportion of the population 10 under 15 years of age has fallen from 32.4 per cent, to 22.4 per cent, in that time. The relevant statistics are:— AGE CONSTITUTION OF POPULATION—ENGLAND & WALES 1901 1950 Under 15 years 12,420,000 32.4% 11,348,000 22.4% 15—65 years 24,105,000 62.9% 33,905,000 66.8% Over 65 years 1,808,000 4-7% 5,481,000 10.8% Expectation of Life. From vital statistics it is possible to estimate actuarially the number of years the average newborn child will live; and the official 'expectation of life' figures are the basis on which life assurance companies work in estimating the amount of annual premiums to be paid on life assurance policies. We know that people are living longer to-day than they were doing half a century ago; but how much longer? The answer is to be found in the official ' expectation of life at birth ' figures. For purpose of comparison I show the figures for the decennium ended 1900; and compare them with the last available annual figures, those for 1949. EXPECTATION OF LIFE AT BIRTH Males. Females. 1891/1900 44.13years 47.77years 1949 66.01 „ 70.63 „ The average male child born to-day can therefore expect to five 21.88 years longer than a male child born just before the beginning of the century; and the female child born to-day 23.86 years longer. After the great increases in the expectation of life during the lifetime of our fathers and mothers, it was expected that future increases would be on a dwindling scale; but even between the years 1931 and 1949 there has been an increase of 7.27 years for males, and 7.75 for females. 11 It may be regarded as a wonderful achievement that, in just over fifty years, some 22 years has been added to the average span of human fife. Advancing Years Some idea of the longevity of Leyton residents may be got from these figures showing the number of Leyton residents above 65 years of age who died during 1950 and the ages at death. Deaths Age Males. Females Total 65—70 years 87 60 147 70—75 „ 85 93 178 75—80 90 103 193 80—85 „ 59 85 144 85—90 26 49 75 90—95 „ 8 16 24 95 and upwards 7 7 355 413 768 It will be seen that, in all age groups above 70 years, many more women than men reached an advanced age. For instance, twice as many women as men reached the age group 90-95 years; and no man died after the age of 95 years, although seven women reached that advanced age-group. Of all deaths of Leyton residents in 1950, some 74.2 per cent, were of persons over 65 years of age. Of all male deaths, 65.7 per cent, were above 65 years; and of all female deaths, 83.4 per cent, were above that age. TABLE 1. Berth-bate, Death-rate and Analysis of Mortality During the Year 1950 Birthrate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Births. Percentage of Total Deaths. All Causes. Enteric Fever. Smallpox. Tuberculosis. Pneumonia. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under 2 Years). All Causes 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 15.8 0.37 11.6 0.00 ... 0.36 0.46 0.01 0.00 0.10 1.9 29.8 ... ... ... ... 126 County Boroughs and Great Towns, including London 17.6 0.45 12.3 0.00 ... 0.42 0.49 0.01 0.00 0.09 2.2 33.8 ... ... ... ... 148 Smaller Towns. Estimated Resident Populations 25,000 to 50,000 at Census, 1931 16.7 0.38 11.6 0.00 ... 0.33 0.45 0.01 0.00 0.10 1.6 29.4 ... ... ... ... London 17.8 0.36 11.8 0.00 ... 0.39 0.48 0.01 0.00 0.07 1.0 26.3 ... ... ... ... LEYTON 13.57 0.25 10.6 0.00 ... 0.32 0.48 0.00 0.00 0.05 1.3 20.04 80.9 3.6 15.5 ... 12 13 TABLE 2. Registered Bibths, 1950. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Total. January 3 10 1 ... 10 5 1 2 3 3 38 February 4 8 2 3 6 3 6 4 4 4 44 March 5 9 4 4 8 6 1 6 6 49 April 3 5 1 2 3 4 3 5 1 2 29 May 4 7 3 1 2 1 2 2 4 2 28 June 2 1 5 2 4 4 4 2 1 1 26 July 3 7 3 2 5 2 4 2 1 4 33 August ... 3 2 2 3 3 2 2 3 3 23 September 9 6 6 6 8 4 3 2 3 5 52 October 3 5 1 3 3 4 ... 2 4 3 28 November 1 5 2 1 6 2 2 2 1 .. 22 December 4 4 3 1 8 1 2 1 4 4 32 Transferables 84 175 81 84 194 142 76 104 62 41 1,043 Totals 125 245 114 111 260 181 106 136 97 72 1,447 14 TABLE 3. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE BOROUGH OF LEYTON, 1950. Sex. All Ages. Acts 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 Tuberculosis, respiratory M 20 ... ... ... ... 1 2 7 3 4 1 2 10 4 F 11 ... ... ... ... 2 2 3 3 ... 1 ... 3 1 Tuberculosis, other M 2 ... ... 1 ... ... ... ... ... ... 1 ... 1 1 F 2 ... ... ... ... 1 ... ... 1 ... ... ... 1 1 Syphilitic disease M 2 ... ... ... ... ... ... ... 1 ... ... 1 4 1 Diphtheria F 3 ... ... ... ... ... ... ... 1 1 1 ... 4 1 M ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whopping cough F ... ... ... ... ... ... ... ... ... ... ... ... ... ... M ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meaninggococcal F ... ... ... .. ... ... ... ... ... ... ... ... ... ... M ... ... ... ... ... .... ... ... ... ... ... ... ... ... F .. .. ... .. .. .. .. ... ... ... ... ... 1 ... Acute Poliomyelitis M ... ... ... ... ... ... ... ... ... ... ... ... 1 ... F ... ... ... ... ... ... ... ... ... .. ... ... ... ... Measles M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other infective and parasitic diseases M 2 ... ... ... ... ... ... ... ... 1 ... ... 1 ... F 2 .. ... ... ... ... ... ... 2 ... ... ... ... ... Malignant neoplasm,stomach M 27 ... ... ... ... ... ... 3 5 2 14 3 14 11 F 12 ... ... ... .... ... ... ... .. 4 4 4 19 2 Malignant neoplasm, lung, bronchus M 25 ... ... ... ... ... ... 3 9 5 6 2 35 2 F 10 ... ... ... ... ... ... 1 ... 5 4 ... 12 4 Malignant neoplasm, breast M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 14 .. ... ... ... ... ... 5 2 3 2 2 25 2 Malignant neoplasm, uterus M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 11 ... ... ... ... ... ... 1 1 4 5 ... 12 6 Other malignant and lymphatic neoplasms M 43 ... ... ... .... .... ... ... 3 8 16 15 58 16 F 44 ... ... ... ... ... ... 2 6 12 9 15 53 13 Leukaemia. aleukaemia M 3 .. ... ... ... ... ... ... 1 1 1 .. 2 1 f 7 ... ... ... ... ... ... ... 1 1 3 2 5 1 Vascular lesions of nervous system M 51 ... ... ... ... ... ... 2 2 7 20 20 49 13 F 73 ... ... ... ... ... ... 2 5 11 24 31 96 32 Coronary disease, angina m 74 ... ... ... ... ... .... 1 5 20 29 19 41 17 F 40 ... ... ... ... ... .... ... ... 5 17 18 26 8 Hypertension with heart disease M 22 ... ... ... ... ... ... ... ... 2 10 10 17 9 F 27 .... ... ... ... ... ... 1 1 6 12 7 41 11 Other heart disease M 91 4 9 19 59 140 42 F 167 .... .... ... .... .... .... 1 8 14 33 110 189 60 Other circulatory disease M 10 ... ... .... ... .... .... ... ... 1 2 7 28 7 F 16 ... .. ... .... .... ... ... ... 2 g 9 41 7 Influenza M 5 ... ... .... .... .... .... ... ... .... 4 ... 3 1 F 1 ... .... .... ... .... .. 1 .... .... .... .... .... ... Pneumonia M 25 1 .... ... .... .... ... 1 1 2 7 13 47 11 F 27 3 ... ... ... .... .... 2 1 3 5 13 56 16 Bronchitis M 44 1 ... .... ... ... .... 2 2 12 14 13 37 7 F 36 ... .... ... .... .... ... ... .... 4 10 22 13 4 Other diseases of respiratory system M 10 ... ... .... .... ... ... 2 ... 3 4 1 4 2 F 1 ... ... ... ... ... ... ... .... ... ... 1 5 2 Ulcer of stomach and duodenum M 11 ... ... ... ... ... ... 1 2 ... 7 1 22 4 F 5 .... ... ... ... .... ... ... ... 2 1 2 5 3 Gastritis, enteritis and diarrhoea M 2 1 ... ... ... .... .... ... ... ... 1 ... 1 2 F 4 1 ... ... ... ... ... ... ... 1 1 ... 3 1 Nephritis and nephrosis M 4 ... ... ... .... ... .... .... 1 ... ... 3 10 3 F 6 ... ... ... ... ... ... 1 2 ... 3 ... 16 1 Hyperplasia of prostate Pregnancy, ohildbirth, abortion Congenital malformation M 4 ... ... ... ... ... ... ... ... 1 1 2 8 ... F ... ... ... ... ... ... .... .... ... ... ... ... 3 ... M 4 3 ... ... ... ... ... ... ... .... ... ... 8 1 Other defined and ill defined disease F 3 3 ... ... ... ... ... .. ... ... ... ... 2 .. M 37 7 1 1 .. .. 1 3 5 3 8 8 36 16 F 54 7 .. ... 3 .. 1 4 4 8 6 21 40 19 Motor vehicles acoidents M 6 ... ... ... ... ... ... ... ... 2 3 1 4 3 F 3 ... ... ... ... ... ... ... ... ... 1 1 4 1 All other Accidents M 9 ... ... ... ... .... .... 1 2 .. 3 2 9 3 F 4 2 ... ... ... ... ... ... .... ... .... 2 1 2 Suicide M 9 ... .... ... .... ... 2 ... ... 2 3 1 3 3 F 7 ... ... ... ... ... 1 ... 3 ... 2 1 ... 2 Total M 543 29 1 4 4 6 12 51 88 171 323 445 1,274 F 591 1 s TABLE 4. DEATHS EN WARDS, 1950 CAUSES OF DEATH. Lej'ton. Lea Bridge. Central North. Central South. Forest. Ley tonstone. Grove Green. Harrow Green. Cann Hall. Wansteat Slip. 1 2 3 4 5 6 7 8 9 10 11 Tuberculosis respiratory 1 6 3 2 8 3 2 3 ... Tuberculosis, other .. ... 1 ... 1 ... .. 2 ... 3 Syphilitic disease ... 3 ... ... 1 ... ... 1 ... .. .Diphtheria ... ... ... ... .. ... .. ... ... ... Whooping cough .... ... ... ... ... ... .... ... ... .... Meningococcal infection ... ... ... ... .. ... ... ... ... ... Acute poliomyelitis .... ... ... ... ... ... .... ... ... ... Measles .... .... ... .... .... ..... ..... ..... ... ... Other infective and parasitic diseases ... ... ... ... ... 3 ... ... 1 ... Malignant neoplasm, stomach 3 6 6 2 7 3 2 2 3 ... Malignant neoplasm, lung, bronchus 4 5 2 7 2 2 2 2 3 5 Malignant neoplasm, breast ... 2 3 1 3 1 2 ... 6 3 Malignant neoplasm, uterus 1 ... 1 1 2 2 ... ... 4 ... Other malignant and lymphatic neoplasms 7 12 6 8 22 10 6 5 6 5 Leukamia, aleukaemia 1 ... ... 1 ... ... ... 1 ... 1 Diabetes ... 3 ... ... 3 1 1 ... ... 1 Vascular lesions of nervous system 9 21 1 10 20 13 7 1 2 .. ... Coronary disease, angina 6 23 12 17 21 13 6 2 10 8 Hypertension with heart disease 1 8 3 5 12 5 5 4 3 4 Other heart disease 13 29 20 24 37 39 20 26 34 8 Other circulatory disease 4 2 2 3 3 3 1 1 7 16 Influenza ... ... ... ... 4 3 1 1 7 ... Pneumonia 5 13 4 3 10 5 ... 1 l Bronchitis 6 10 8 5 10 8 3 3 4 2 Other diseases of respiratory system 2 1 2 ... 1 1 8 14 8 4 Ulcer of stomach and duodenum 2 1 2 1 1 3 2 1 3 1 Gastritis, enteritis and diarrhoea ... 3 ... ... 1 ... ... ... 2 Nephritis and nephrosis ... 2 2 ... 1 2 ... 1 1 ... Hyperplasia of prostate 1 1 ... 1 2 2 ... 1 1 1 16 Pregnancy childbirth, abortion ... ... ... ... ... ... ... ... ... ... Congenital malformation ... ... 1 1 2 2 ... .. 1 ... Other defined and ill-defined diseases 8 19 5 10 14 10 3 3 14 5 Motor vehicles accidents ... 3 ... 2 1 ... 1 ... 2 ... All other accidents 1 3 ... 2 3 1 2 ... 1 Suicide 2 3 3 ... 3 3 1 ... 1 .... Totals 77 179 96 112 193 133 72 83 124 65 17 18 TABLE 5. Vital Statistics of Whole District coring 1950 and Previous Years. Year. Inward Transferable 3 Births. Total Deaths Registered in Transf Dea erable ths Nett Deaths belonging to the Borough. Nett. Number. 6 Rate. 7 of Nonresidents registered in the Borough. 8 of Residents not registered in the Borough. 9 Under 1 Y ear of Age. At all Ages Number. 10 Rate per 1,000 Nett Births. 11 Number. 12 Rate. 13 1 Number. 4 Rate. 5 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 1950 1043 1447 13.57 2134 20.0 1274 274 29 20.04 1134 10.64 19 table 0. Infantile Mortality, Year 1950—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 2 1 ... ... ... ... ... 1 ... 1 Pneumonia (all forms) ... ... ... ... 3 1 ... ... ... 4 Diarrhoea ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... 1 1 ... 2 Gastritis ... ... ... ... ... ... ... ... ...... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... 1 ... ... ... ... 2 Injury at birth 3 ... ... ... 3 ... ... ... ... 3 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital malformations 2 ... ... ... 2 ... ... ... ... 3 Premature birth 8 ... ... ... 8 ... ... ... ... 9 Atrophy, debility and marasmus ... ... ... ... ... ... ... ... ... ... Other causes 4 1 ... ... 5 ... ... ... ... 5 Totals 19 2 1 22 3 1 3 ... 29 Nett Births registered during Legitimate 1,401 the calendar year Illegitimate 46 Nett Deaths registered during Legitimate infants the calendar year Illegitimate infants 28 1 20 TABLE 7. Comparative Statistics of Births, Mortality, Etc. LEYTON, 1901-1950. Year. Population. Births. Birth Rate. Deaths. Death Rate. Deaths under 1 year. Infantile Death Rate. 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 D21420* 1917 B125352* 2005 16.0 1414 12.6 172 85.8 dl12452* 1918 B125352* 1791 14.3 1723 15.3 161 89.9 dl12452* 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 bl16100* 1939 dl10800* 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 1950 106600 1447 13.57 1134 10.64 29 20.04 * Population as estimated for purposes of b, Birth Rate, d, Death Rate. Infectious Diseases 22 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 59 3 Scarlet Fever 219 66 Pemphigus Neon ... ... Tuberculosis Pulmonary 130 40 Tuberculosis other forms 15 4 Pneumonia 333 152 Ophthalmia Neon 2 ... Typhoid Fever 1 1 Paratyphoid Fever ... ... Puerperal Pyrexia 5 4 Meningococcal infection 2 2 Poliomyelitis Paralytic 8 7 Poliomyelitis Non Paralytic 6 6 Acute Encephalitis Infective 1 1 Acute Encephalitis Post Infectious 1 ... Measles 1,111 34 Whooping Cough 769 19 Dysentery 65 64 Food Poisoning 30 ... 2,757 403 23 DIPHTHERIA. Last year I was pleased to be able to report that, for the first time since official figures became available, no case of confirmed diphtheria had been notified, and it gives me added pleasure to record a second successive year in which no confirmed case has been notified. Year. Cases Notified. Deaths. Case Fatality. per cent. 1941 44 1 2.27 1942 39 0 0.00 1943 28 1 3.57 1944 24 1 4.16 1945 43 2 4.60 1946 38 1 2.60 1947 9 1 11.10 1948 5 0 0.00 1949 0 0 0.00 1950 0 0 0.00 In order to provide in brief outline a tabular picture of diphtheria incidence and mortality, I append below the relative information shown at ten-yearly intervals since 1890:— Year. Cases Notified. Deaths. Case Fatality per cent. 1890 210 47 22.30 1900 224 28 12.50 1910 167 22 13.20 1920 354 27 7.60 1930 313 12 3.90 1940 55 0 0.00 1950 0 0 0.00 To those of us who remember diphtheria as one of the chief causes of death and lifelong disability, and a severe drain on public expenditure, these figures provide encouraging evidence of a welcome turn in the tide of diphtheria incidence and mortality. Information regarding immunisation against diphtheria is to be found on page 26 of this report. SCARLET FEVER. Since the year 1941 only one death has been attributable to scarlet fever—and the disease still continues of the mild type to which we have become accustomed. 24 The following figures show the incidence and mortality from the type of infection prevalent at ten-yearly intervals since 1900. Year. Cases Notified. Deaths. Case Fatality per cent. 1900 243 7 2.80 1910 551 16 2.90 1920 450 5 1.10 1930 461 2 0.40 1940 87 0 0.00 1950 219 0 0.00 MEASLES. Measles continued its epidemic prevalence. Of the 1,111 notified cases, it was necessary to admit 34 to hospital. For the third year in succession no child in the area has died from measles. Before the outbreak of the last war one of the most characteristic features of measles was its biennial periodicity—a year of relatively low incidence was followed by a year in which the disease was epidemic. These two-yearly epidemics of measles occurred with such regularity that the onset of the outbreak could be foretold with precision. For some reason which has never been explained, the disease lost its characteristic periodicity soon after the outbreak of World War II, and has never reverted to its pre-war two-yearly epidemic phase. Year. No. Notified Removed to Hospital Deaths. 1941 466 22 0 1942 1,102 22 1 1943 479 16 0 1944 136 8 0 1945 797 26 1 1946 439 19 2 1947 698 27 2 1948 1,088 33 0 1949 1,031 56 0 1950 1,111 34 0 These figures show, in respect of each year since 1941, the number of notified cases and deaths. Since that time there has been no biennial epidemic periodicity. 25 The figures show that the incidence of measles has been high during each of the last three years. They also show the mildness of modern measles. Of the ten years shown, there were six years in which no death occurred. WHOOPING COUGH. In the year under review there was also a widespread outbreak of whooping cough. Year. No. Notified. Removed to Hospital. Deaths. 1941 336 28 4 1942 128 7 1 1943 91 6 0 1944 198 24 4 1945 99 16 2 1946 155 27 2 1947 178 11 3 1948 623 29 3 1949 316 18 0 1950 769 19 0 These figures show that, although there was a very widespread epidemic in 1950, there was no death due to whooping cough in either of the last two years. Details regarding the special investigation, in collaboration with the Medical Research Council, are given on page 85. POLIOMYELITIS ("INFANTILE PARALYSIS") From the standpoint of poliomyelitis prevalence, the last eleven years may be divided in two periods—the war years (1940-45) and the post-war years (1946-50). In the first period were four years when no case was notified; and in the only year (1942) when cases occurred, only five cases were notified. On the other hand, as can be seen by consulting the figures, no post-war year has been free from poliomyelitis; and in three of these years the incidence has been such as to justify the prevalence being regarded as exceptional—1947 (14 cases), 1949 (20 cases) and 1950 (14 cases). Fuller information regarding the 1950 cases is available on page 28. 26 The following list shows the annual number of cases of acute poliomyelitis notified in this Borough from 1940-50 inclusive. 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 1950 14 It will be seen from these figures that, with the exception of the year 1942, the war years were free from poliomyelitis. On the other hand, no year since the war has been free; and in three post-war years (1947-49 and 1950) the number of cases notified annually has been large enough to justify the prevalence being regarded as exceptional. Cases Notified in 1950. The first case was notified on 25th June, and by the end of August 10 cases had been notified in Leyton. Towards the end of June the Chief Medical Officer of the Ministry of Health circulated to all Medical Officers of Health throughout the country a letter in which he suggested that, in any locality in which poliomyelitis is becoming exceptionally prevalent, it would be prudent to suspend for the time being the use of diphtheria antigens as well as of those containing pertussis vaccine. On 11th August I circulated to local general medical practitioners a letter giving information regarding the cases, of whom three children attended different classes in the same school (infants' department). Other than that, no common source of infection was established between any two notified cases; and no affected child had been immunised against diphtheria or whooping cough within a year of the onset of the poliomyelitis. As the incidence of cases at that time could be regarded as evidence that the disease was more than usually prevalent in this area, I conferred with the County Medical Officer, who agreed that the County Council's Scheme for the immunisation of young children against diphtheria should be discontinued for two months. Local doctors were informed that during that period no Local 27 Health Authority Immunisation Clinics would be held at the Council's Health Centres in this Borough, and that no fees would be paid by the County Council in respect of the immunisation of pre-school and school children by local general medical practitioners in connection with the County Health Authority's arrangements under the provisions of Section 26 of the National Health Service Act, 1946. Only four more cases were notified after the end of August. The following list gives in tabular form the relevant information regarding the 1950 cases. Fortunately there has been no fatality, nor has there been any case of respiratory paralysis requiring treatment in an 'iron lung'. None of the cases could be described as of great severity; whereas the majority are mild, and three have no paralysis of any kind. POLIOMYELITIS. No. Date of Notification. Sex. Age. Hospital. Site of Initial Paralysis. Condition at end of Year. Admitted. Discharged. 1 25/6/50 M 5 25/6/50 8/8/50 Palate and face Complete recovery. 2 8/7/50 M 7 8/7/50 29/7/50 None Complete recovery. 3 19/7/50 F 2 19/7/50 30/10/50 Right arm and right leg Right sided limp. Has full use of arm. 4 24/7/50 M 2 23/7/50 6/8/50 Right arm and shoulder Improving with treatment. 5 26/7/50 F 10 26/7/50 6/9/50 None Complete recovery. 6 28/7/50 M 6 27/7/50 22/9/50 Palate Complete recovery. 7 1/8/50 M 32 1/8/50 18/9/50 Right arm, left leg and trunk Improving with treatment. 8 18/8/50 F 19 18/8/50 19/9/50 Palate and pharynx Returned to Switzerland. 9 21/8/50 F 5 4/6/50 23/8/50 Right facial Improving with treatment. 10 25/8/50 M 26 19/8/50 19/9/50 None Complete recovery. 11 8/9/50 M 8 Not removed Left facial Complete recovery. 12 12/9/50 F 9 12/9/50 7/11/50 Left facial Improving with treatment. 13 14/9/50 F 13 13/9/50 7/10/50 Weakness of left arm Complete recovery. 14 2/11/50 M 24 18/10/50 — Both legs Still in hospital. Paralysis still present. 28 29 TUBERCULOSIS. Notifications.—One hundred and forty-five patients were notified for the first time in 1959 as suffering from tuberculosis. The number was made up as follows:— Males. Females. Total. Pulmonary Tuberculosis 79 51 130 Non-Pulmonary Tuberculosis 7 8 15 86 59 145 The following is a statement of particulars appearing in the Register of Notifications of Cases of Tuberculosis for the year ended 31st December, 1950:— Pulmonary. Non Pulmonary. Total. M. F. Total. M. F. Total. Number on Register at commencement of year 372 278 650 24 43 67 717 Number first notified during the year 79 51 130 7 8 15 145 Number of oases entered in Register otherwise than by Notification 7 10 17 2 1 3 20 Number removed from the Register during the year 48 39 87 5 6 11 98 Number remaining at the end of the year 410 300 710 28 46 74 784 Details of cases removed from the Register during the year:— Died 24 13 37 2 2 4 41 Removed from the district 20 16 36 36 De-notified 4 10 14 3 4 7 21 30 Deaths.—Thirty-five 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 1 3 1 1 5 3 4 2 ... 10 3 4 ... 1 15 8 5 ... 1 20 13 9 2 1 25 13 15 2 3 35 12 8 ... 1 45 10 2 ... ... 55 8 1 ... ... 65 and upwards 7 ... ... ... Totals 79 51 7 8 House-to-house Spread of Tuberculosis. In collaboration with the London School of Hygiene and Tropical Medicine, there was commenced an investigation which has for its purpose more definite information than is now available of the extent to which tuberculosis is spread from house-to-house. Statistical Summary. The following tables have been compiled to show the annual numbers of new cases and deaths over a period of ten years. 31 TUBERCULOSIS. NOTIFICATIONS. Year. Pulmonary. Non-Pulmonary. Total. M. F. Total. M. F. Total. 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 1950 79 51 130 7 8 15 145 DEATHS. Year. Pulmonary. Non-Pulmonary. Total. M. F. Total. M. F. Total. 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 1950 20 11 31 2 2 4 35 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1950 DISEASE. At All Ages Under 1 1-3 3-5 5-10 10-15 15-25 25-45 45-65 65 and up Smallpox ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... Erysipelas 59 ... ... ... 2 ... 2 13 21 21 Scarlet fever 219 ... 17 57 123 16 4 1 1 ... Pemphigus Neon: ... ... ... ... ... ... ... ... ... ... Tuberculosis pulmonary 130 1 2 2 7 7 35 48 21 7 Tuberculosis other forms 15 ... 2 ... 2 1 4 6 ... ... Pneumonia 333 17 20 27 29 9 16 60 78 77 Ophthalmia neon 2 2 ... ... ... ... ... ... ... ... Typhoid fever 1 ... ... ... ... ... ... ... 1 ... Paratyphoid fever ... ... ... ... ... ... ... ... ... ... Puerperal pyrexia 5 ... ... ... ... ... 2 3 ... ... Meningococcal infection 2 ... 1 1 ... ... ... ... ... ... Poliomyelitis paralytic 8 ... 2 ... 5 ... ... 1 ... ... Poliomyelitis non paralytic 6 ... ... ... 1 2 2 1 ... ... Acute encephalitis infective 1 ... ... ... 1 ... ... ... ... ... Acute encephalitis post infectious 1 ... ... ... ... ... ... ... ... 1 Measles 1111 26 216 328 531 7 1 2 ... ... Whooping Cough 769 44 165 250 299 7 7 4 12 12 Dysentery 65 ... 3 10 1 1 15 11 Food Poisoning 30 5 ... 1 2 1 2 10 5 4 Totals 2757 95 428 676 1003 51 83 160 139 122 32 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1950. DISEASE. Total. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Removed to Hospitals. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... Eriysipelas 59 9 5 3 23 4 6 3 5 1 ... 3 Scarlet Fever 219 17 17 23 25 33 16 15 17 38 18 66 Pemphigus Neon ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis Pulmonary 130 16 21 9 6 19 20 5 12 14 8 40 Tuberculosis other forms 15 1 3 3 1 3 1 1 1 1 ... 4 Pneumonia 333 26 25 17 73 118 33 19 14 4 4 152 Ophthalmia Neon 2 ... ... ... 1 ... 1 ... ... ... ... ... Typhoid Fever 1 ... ... ... ... 1 ... ... ... ... ... 1 Paratyphoid Fever ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 5 ... ... 1 ... 4 ... ... ... ... ... 4 Meningococcal Infection 2 ... ... ... ... 1 ... ... ... ... ... 2 Poliomyelitis Paralytic 8 1 3 ... ... 1 2 1 ... ... ... 7 Poliomyelitis Non-Pamlytic 6 1 ... 1 1 1 ... 1 1 ... ... 6 Acute Encephalitis Infective 1 ... ... ... ... ... 1 ... ... ... ... 1 Acute Encephalitis post infectious 1 ... ... ... ... ... ... ... ... ... ... ... Measles 1111 79 127 79 117 304 166 67 101 18 53 34 Whooping Cough 769 70 82 111 100 99 99 33 77 43 55 19 Dysentery 65 ... ... 1 2 58 1 1 2 ... ... 64 Food Poisoning 30 2 2 1 ... 6 7 1 ... 5 2 ... Totals 2757 222 289 249 349 653 353 147 230 125 140 403 33 General SCABIES CLINIC. NATIONAL ASSISTANCE ACT, 1948 PUBLIC MORTUARY. 36 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 1950 10 7 17 37 It will be seen that there has been a welcome and progressive decrease in the number of cases treated at the Clinic; and during January until October, 1950, the Clinic has had occasion to deal with only 10 cases. In early September the Medical Officer of Health reported to the appropriate Committee:— It may be considered uneconomic to make provision for the treatment of such a small number of cases, and I have received a letter from the Borough Education Officer asking whether it would be possible for the premises to be made available to the Youth Centre to accommodate the Domestic Science and Dressmaking Classes. Since receipt of his letter I have been in communication with the Medical Officer of Health, Walthamstow, who informs me that his Council would be prepared to treat Leyton patients on the basis of 7s. 6d. per attendance. The Scabies Clinic in Walthamstow is situated in High Street, Walthamstow. In November the Medial Officer of Health submitted the following report:— At the September Meeting of your Committee I submitted a report outlining the work of the special clinic and cleansing centre at Ruckholt Road School from the date of its establishment in 1941 until this year. I also reported receipt of a 37 request from the Borough Education Officer for the clinic accommodation to be made available for Youth Centre purposes, and that Walthamstow Borough Council would be prepared to treat Leyton patients on the basis of 7s. 6d. per attendance. At that Meeting I was authorised to enquire as to the possibility of utilising accommodation in other municipal buildings for the treatment of scabies cases, and to enter into arrangements with the Walthamstow Corporation on the terms suggested in the event of no suitable alternative accommodation being found. As I have not been able to find in other municipal buildings any suitable premises which could be made available for the treatment of scabies, I have made arrangements with Walthamstow Corporation for the treatment of Leyton patients at the Walthamstow special clinic on the basis of 7s. 6d. per attendance. The new arrangement came into operation on 1st November, 1950. 38 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. During the year arrangements were made for the carrying out of fifteen burials under this Section. RESERVATION OF LAND FOR BURIAL GROUNDS. In 1949, in response to a letter from the Ministry of Health suggesting the grouping of authorities who might share burial grounds, two conferences were held by the Councils of Leyton, Walthamstow, Chingford, Wanstead and Woodford, and Chigwell regarding the possibilities of a joint burial ground. During 1950 two additional conferences of representatives of these Councils were held and, with the exception of one area, the representatives of all the other areas agreed to participate in the formation of a Joint Cemetery Board. Negotiations between these authorities are still proceeding. Conference of Burial and Cremation Authorities. As the delegate of your Council, Mr. G. F. Leserve, Chief Clerk, Public Health Department, attended—along with some 450 delegates from all over the country—a Special Conference held at Bournemouth and later submitted to your Council a special report on the matter. The following are some of the observations contained in that report. Crematoria—Alternative Types of Governing Bodies. A crematorium may be provided and maintained by a Cremation Authority:— (a) A Joint Board ½ (b) A Joint Committee; (c) A single Cremation Authority. Preference was expressed for provision and maintenance by one Cremation Authority. The advantages included simplification of administration and a greater facility for competitive business. It 39 was important, however, if a single Cremation Authority provided a crematorium to serve other areas, that its management should be entrusted to a committee of the Council which was not also responsible for other services of such a number and importance as to push cremation into the background. This question must be regarded from two points of view, namely, the point of view of the Authority owning the land on which it was planned to provide a crematorium and the point of view of an Authority invited to join with other neighbouring Authorities in providing a crematorium on another Authority's land. The Law and Cremation. Since cremation is from every point of view the best means of disposal of the dead, every unnecessary hindrance to the popularisation of cremation should be removed. The law in its present form was such a hindrance and therefore it should be modified so as to reduce to an absolute minimum the special requirements in relation to cremation as opposed to earth burial of the dead. The intention of the legislation was threefold:— (1) To ensure that crematoria are so sited, constructed, maintained and operated that neither nuisance nor any offence to public or private sensibilities shall occur; (2) To ensure that individual prejudice against cremation is respected; (3) To ensure that cremation is not used to conceal crime: that is to say to hide the fact that the deceased died from violence, poison, privation or neglect. It was considered that, with regard to (3), the regulations needed drastic amendment. After a review of the various forms and procedure required at present, he suggested that all these could be safely replaced by one form to be completed by the doctor in attendance immediately before death. It was felt that though the Interdepartmental Committee was obviously desirous of simplifying the procedure it over-estimated both the risk of cremation enabling crime to be concealed and the value of safeguards which it is practicable to impose. A submission was made that we should not tacitly accept the recommendation of the Committee as the best we can hope for at present, but that we should exert all the influence we can to persuade 40 the Secretary of State for the Home Department that "the procedure for cremation and that for earth burial should be more closely assimilated" now, and not when the number of cremations has reached 50 per cent. of the total deaths. Burials and Planning in an Area with a Population of 111,000. There are enormous demands for land at the present time. including agriculture, houses, playing fields, parks, schools, etc. In each case larger areas of land are required for these purposes now than formerly. Even allowing for the continuing rise in the numbers of cremations in relation to the total, the land requirements will be something in the order of an average of 200 acres per annum for, say, the next 20 years; which means a total of 4,000 acres in that period. As, in the main, this has to be provided near to large towns, and unless the necessary steps are taken to reduce the number of earth burials, it is clear that land convenient for large areas will be made unavailable for other purposes essential for living, as the area mentioned in the previous sentence would provide sites for 50,000 houses. The estimated cost of laying out 120 acres in the land in the district, excluding the Chapel, but consisting of paths, drainage, soil drainage and ancillary buildings, is approximately £330,000, and this figure is borne out by a recent extension to burial ground, which cost, with the provision of roadways and drainage, about £2,700 per acre. The burial ground of 120 acres is designed to provide for 3,000 interments per year and makes provision for about 70 years' life. As against this, a modern crematorium, with the necessary paths, etc., including two Chapels, would cost something in the order of £100,000, depending, of course, on the site chosen and other circumstances. A crematorium of this size would deal with at least 3,000 cremations per year, so that the capital cost of laying out a burial ground to deal with approximately the same number of people is at least three times as much as that required to establish a crematorium. To this problem there are two solutions, (1) one of cremation and (2) the carrying out of earth burial on forest and other lands of no agricultural value. 41 PUBLIC MORTUARY. The arrangement entered into between the Council and the Hospital Management Committee (Leytonstone No. 10 Hospital Group) in September, 1949, for the provision of public mortuary facilities at Whipps Cross Hospital mortuary has continued during the year. Number of bodies deposited, death being due to:— Natural causes 58 Suicide 7 Accidents 6 71 Number of Post-mortem examinations performed 70 Number of Inquests held 14 In 56 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 10 ,, occlusion-atheroma 13 Myocardial degeneration 7 Developmental aneurysm 2 Phlebo thrombosis 1 Epilepsy 1 Specific aortitis 1 Cerebral haemorrhage 5 Hypertension 3 Broncho pneumonia 1 Suppurative bronchitis 2 Pulmonary tuberculosis 1 Chronic nephritis 1 Aortic stenosis 2 Hyaline necrosis 1 Cancer 3 Pulmonary emphysema 1 Stillborn 1 The following verdicts were recorded at inquests held in the district during the year:— Accidental 8 Suicide 6 Sanitary Circumstances of the Area 44 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 3,142 Miscellaneous inspections 1,069 Re-inspections 12,525 Places of entertainment 12 Schools 57 Stables 17 Urinals 36 Visits in connection with infectious diseases 379 Factories without mechanical power 35 Factories with mechanical power 190 Rag and bone dealers 5 Foster-mothers'premises 3 Hairdressers' premises 33 Public Houses 54 Offensive trades 96 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 651 Sashcords renewed 381 Plaster repaired 1,319 Roofs repaired or renewed 994 Guttering repaired or renewed 310 Yards paved 62 Drains relaid or partly relaid 47 Choked drains cleared 61 New w.c. pans and traps provided 84 Sinks provided 19 W.c. cisterns repaired or renewed 161 Rain water pipes repaired or renewed 234 Vent pipes repaired or renewed 72 Sink waste pipes repaired or renewed 111 Stoves repaired or renewed 389 Coppers repaired or renewed 12 45 Floors repaired 408 Rooms redecorated 1,321 Windows, sills, etc., repaired 634 Cement work to sink waste gullies repaired 67 Miscellaneous defects remedied 633 As a result of notices served upon owners, it is estimated that approximately £30,000 of repairs have been executed. Drainage. The drains of 96 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 130 130 Prevention of Damage by Pests Act, 1949. Complaints. Although all complaints received during the year have been promptly investigated, and steps have been taken to free premises from rats and mice, the amount of infestation within the Borough is still high. As has been pointed out on previous occasions, the main source of rats is from the Council's sewers. With the coming into force of the Pests Act, 1949, it is obligatory for persons with rats to notify the Local Authority, and there are penalties for failure to do so. The following figures give some idea of the amount of work undertaken during the year:— Complaints received and investigated 489 Premises not treated (not genuine infestation) 51 Premises treated:— (а) Dwelling-houses 459 (b) Business premises 74 533 Premises freed 480 Sewer Maintenance Treatments. All sewers in the Borough were treated in July, 1950 (followed by a further treatment in January, 1951). 46 The following figures show the results of these two treatments : No. of Manholes baited No. of complete prebait takes Total No. of complete and partial prebait takes Percentage of takes 1st Treatment 1,160 163 616 53.1 2nd Treatment 1,312* 812 1,236 94.2 * Including 115 surface water manholes. It will be seen from the results obtained during the baiting of the public sewers that there remains 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. In the premises where the source of infestation was not traced, it is considered that the fault lies in undiscovered drain connections. Unless further attention is given to sealing off drains when houses are demolished the trouble is likely to be increased in future years. HOUSING. Complaints. During the year 2,129 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 1,627 Statutory—Housing Acts Nil Public Health Acts 637 Notices complied with—Informal 1,009* Statutory— Housing Acts Nil Public Health Acts 621* *This figure includes notices outstanding from previous year. 47 Housing. Number of houses erected during the year:— (a) Total (including numbers given separately under (b) ). (i) By the Local Authority- House 90* Flats 18 Temporary housing Nil (ii) By other Local Authorities Nil (iii) By other bodies and persons— Houses 23 Flats Nil (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 90* Flats 18 Temporary housing Nil (b) For other purposes Nil (ii) By other bodies and persons Nil * Including 16 houses erected by Leyton Corporation in Janson Road, West Ham. 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) 3,142 (b) Number of inspections made for the purpose 15,667 (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 1,627 48 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 1,009 III.—Action under Statutory Powers during the Year:— (а) 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 (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 (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 637 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners 621 (b) 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 Closing 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 Enquiries are constantly being received from other Local Authorities in connection with residents of Leyton applying for housing accommodation elsewhere. Investigations have been made and the necessary particulars furnished wherever possible. 49 Local Land Charges. Particulars with regard to outstanding sanitary notices, not fully complied with, were given in reference to 1,383 enquiries. Smoke Abatement. During the year 107 observations have been made on factory chimneys. Infringements were found in three instances, and letters of warning were issued in these cases. It was not found necessary to institute legal proceedings. A laundry chimney was found to be emitting a large amount of grit, and was causing nuisance in the neighbourhood. After representations to the owner, a modern type of aero-dynamic grit arrester was installed, and has proved very effective in preventing the nuisance. Investigation of Atmospheric Pollution. In August, 1949, the Chairman of the Standing Conference of Co-operating Bodies (Investigation of Atmospheric Pollution) addressed a circular letter to the Council, of which the following is an extract:— "Many Local Authorities are perturbed at the nuisance and damage caused by smoke and other pollution in the air. The injury to buildings, cost of laundering, the bad effect upon health, are only some of the ill effects of pollution, quite apart from the waste of the valuable substance lost up the chimneys. "There is no one simple practicable remedy. The cure lies in the steady improvement of factors such as selection of fuels, design of furnaces and domestic grates, methods of flue gas cleaning, education in the use of fuels and equipment, and so on. "But behind these changes there must be a constant watch on the actual state of the atmosphere to find what are the chief sources of pollution and how much the introduction of improved methods of burning fuel affects the amount and incidence of pollution. Reliable data are needed on which to base the justification for changes. "The collection of such data is undertaken by a number of Local Authorities and other organisations collaborating 50 with the Department of Scientific and Industrial Research. Such co-operating bodies are entitled to appoint representatives to the Standing Conference. "At their last meeting the Standing Conference considered that an extension of the investigation was highly desirable, and they decided to call the attention of all Local Authorities to the work that is being done, and to invite further cooperation." This letter was submitted to the Public Health Committee, and the Senior Sanitary Inspector reported thereon. He recommended, as an experiment, the purchase of a set of apparatus to enable daily measurements to be taken of the concentration of atmospheric smoke and sulphur dioxide, the apparatus to be installed at the Public Health Department, Sidmouth Road, Leyton. This recommendation was adopted, and the Chairman and Senior Sanitary Inspector were nominated as the Council's representatives on the Standing Conference. The Superintendent of Observations, of the Department of Scientific and Industrial Research, was consulted as to the siting and equipment of the station, and observations were begun on 1st March, 1950. Daily measurements of the average concentration of smoke and sulphur dioxide in the air during the preceding 24 hours are made by the "volumetric" method—one of the standard methods recommended by the Department of Scientific and Industrial Research. The outside air is drawn in at a steady rate of about 60 cubic feet per day, the actual volume being measured with a gas meter. The air is first passed through a white filter paper in such a way that the suspended solid impurities (chiefly consisting of smoke) remain in the filter paper as a greyish or brownish stain. An estimate of the intensity of this stain is made by visual comparison with a calibrated scale of shades, and from this the concentration of smoke is calculated. After passing through the smoke filter, the air is bubbled through a dilute solution of hydrogen peroxide where the sulphur dioxide is removed from the air and combines with the hydrogen peroxide to form sulphuric acid. At the end of a day's run, the volume of standard alkali needed to neutralise the sulphuric acid is measured and the average concentration of sulphur dioxide is then calculated. 51 The following observations of the weather are also made— of wind speed and direction, visibility, air temperature and rainfall. All observations are recorded; and monthly returns are submitted to the Superintendent of Observations, the figures being included in the monthly Atmospheric Pollution Bulletin published by the Department of Scientific and Industrial Research. The following table shows the results recorded during the ten months ended 31st December, 1950:— CONCENTRATION OF SMOKE AND SULPHUR DIOXIDE EXPRESSED IN MILLIGRAMS PEP 100 CUBIC METRES. SMOKE SULPHUR DIOXIDE Month 1950. Monthly average Highest daily average Lowest daily average Monthly average Highest daily average Lowest daily average March 44.3 127.4 10.1 29.2 82.6 10.0 April 24.6 39.1 13.8 16.0 31.5 5.1 May 11.8 30.8 0.5 4.9 13.4 0.3 June 5.6 9.5 1.1 5.6 12.6 0.6 July 5.7 11.7 2.4 6.3 14.6 1.4 August 6.4 9.8 3.4 8.3 12.6 4.0 September 8.9 20.0 3.3 8.6 16.9 1.7 October 24.8 57.8 9.3 18.0 41.2 7.7 November 36.5 92.9 15.2 27.2 57.2 11.2 December 47.4 102.7 14.1 36.0 62.3 12.9 There was a very great variation in the amount of pollution from day to day, as can be seen from a comparison of the highest and lowest daily averages in the above table. It was found that this variation had a close connection with the varying weather conditions, important factors being the speed and direction of the wind and the degree of turbulence of the air—that is, the readiness with which air mixes with itself. For example, the highest daily average smoke concentration during eight of the ten months under review occurred on days when the air was almost completely calm, with accompanying fog or haze—conditions which indicate a low turbulence. On the other hand, eight of the lowest daily average sulphur dioxide readings were obtained when a moderate northeasterly wind was blowing. In addition to the irregular daily variations in the amount of pollution, there was a well defined and much more regular variation 52 in the monthly average figures. This variation was found to have a close connection with the outdoor temperature. The minimum pollution occurred during the summer months when little or no coal is used for artificial heating. During the winter, the smoke pollution reached almost ten times the summer average; the colder the weather, the more fuel is burned. The annual variations are clearly shown on the attached graphs and curves for Central London are also shown for comparison. The graphs were prepared by the Superintendent of Observations, Department of Scientific and Industrial Research, who comments that "there is more smoke in Leyton during the winter owing to the larger number of coal-burning open domestic fires, whereas the sulphur dioxide is lower throughout the whole year, since there is a smaller total consumption of fuel in Leyton". 53 54 Legal Proceedings. (Public Health Act, 1936.) Action taken under the provisions of the Public Health Act, 1936, has resulted in 1,630 houses being brought up to a reasonable standard of fitness. Legal proceedings wre found necessary in 26 instances, and the following is the result of such action:— Non-compliance with Abatement Notice at:— 1. 4/1/50 67, Millais Road. Nuisance Order made (28 days). £1 costs. 2. 4/1/50 75, Millais Road " " 3. 4/1/50 77, Millais Road ,, ,, 4. 11/1/50 33, Forest Drive West Nuisance Order made (28 days). £2 costs. 5. 11/1/50 138, Sidmouth Road ,, ,, 6. 15/2/50 149, Church Road Nuisance Order made (28 days). One guinea costs. 7. 15/2/50 118, Malvern Road Nuisance Order made (42 days). 8. 5/4/50 17, Selby Road Nuisance Order made (28 days). Two guineas costs. 9. 5/4/50 19, Selby Road „ ,, 10. 5/4/50 28, Lancaster Road ,, ,, 11. 26/4/50 62, Woodhouse Road ,, ,, 12. 26/4/50 68, Woodhouse Road ,, ,, 13. 26/4/50 60, Lansdowne Road. Case adjourned Sine Die. 14. 26/7/50 33, Kingston Road Nuisance Order made (28 days). Seventeen shillings costs. 15. 27/4/50 51, Acacia Road ,, ,, 16. 27/4/50 68, Cathall Road ,, ,, 17. 27/4/50 9, Clarence Road ,, ,, 18. 27/4/50 162, Crownfield Road ,, ,, 19. 27/4/50 80, Langthorne Road ,, ,, 20. 27/4/50 7, Millais Road ,, ,, 21. 27/4/50 26, Millais Road ,, ,, 22. 27/4/50 31, Norman Road ,, ,, 23. 8/11/50 8, Woodville Road Nuisance Order made (56 days). Ten shillings and sixpence costs. 24. 8/11/50 692, High Road, E.10 Nuisance Order made (28 days). One guinea costs. 25. 8/11/50 138, Cann Hall Road Nuisance Order made (28 days). £1 penalty. 26. 8/11/50 142, Cann Hall Road ,, ,, 55 INSPECTION AND SUPERVISION OF FOOD. FOOD PREMISES. Inspections. The following visits were made to food premises during the year Slaughter-houses 16 Butchers 315 Bakehouses 126 Fishmongers 116 Milkshops and dairies 87 Provision shops 430 Dining rooms 321 Greengrocers 137 Fish friers 82 Ice cream premises 256 MILK. Dairies and Milkshops. Number of registered premises from which milk is sold 59 Premises added to register during year Nil Premises removed from register during year 9 Visits of inspection 87 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 20 4 4 ... 4 ... Accredited 2 ... ... ... ... ... Pasteurised 39 16 16 ... 16 ... Sterilised 53 1 1 ... 1 ... Supplementary Licences Tuberculin Tested 4 ... ... ... ... ... Pasteurised 5 ... ... ... ... ... Sterilised 6 ... ... ... ... ... Totals 129 21 21 ... 21 ... 56 ICE CREAM. Twenty-seven new applications to retail ice cream have been granted by the Council. The standard of quality and purity has been maintained. Warnings have been given, but it has not been necessary to institute legal proceedings nor to remove any firm from the register. No case of illness due to eating ice cream has been reported. Number of Samples taken during 1950 102 Results of Samples taken— Grade I. Grade II. Grade III. Grade IV. Unsuitable for bacterial analysis. 40 34 17 8 3 Manufacturers of Preserved Food, etc. Premises on Register at 31-12-1950 64 Premises registered during 1950 Nil Premises removed from Register during 1950 3 Meat and Foods condemned and destroyed. Bacon 79£ lbs. Beef 355½ lbs. Beef, Top-bit 1 Beef, Rump 1 Biscuits 35½lbs. Biscuits, Chocolate 32 pkts. Butter 1½ lbs. Cereals 151 pkts. Cheese 68 lbs. Cheese 25 pkts. Chickens 54 Chocolate 4 bars. Chocolate 13 boxes. Chocolate Marzipan 44 lbs. Chocolate Cup 112 pkts. Chocolate Cigars 9 Condensed Milk 224 tins. Corned Beef 85 tins. 57 Currants 49½ lbs. Ducks 1 Eggs 470 Evaporated Milk 484 tins. Fish 273 tins. Fish 1,848 lbs. Flour 4 bags. Fowls 36 Fruit 251 tins. Ham 14 tins. Hens 51 Jam 117 tins. Kippers 280 lbs. Luncheon Meat 237 tins. Margarine 3 lbs. Mincemeat 6 tins. Mutton 633½ lbs. Mutton, legs of 2 Oats 60 pkts. Ox Cheeks 252 lbs. Ox Cheeks 10 hampers. Ox Heads 100 Peanuts 10 lbs. Pickles 3 jars. Pork 2¼ lbs. Pork Head Meat 335 lbs. Prunes 24½lbs. Puddings 5 tins. Pudding Mixture 2 cwt. Pudding Mixture 3 pkts. Rabbit 16 tins. Rabbits 777 lbs. Rabbits 216 Salad Cream 333 botts. Sauce 8 botts. Sausages 3 tins. Sheeps Heads 126 Sheeps Pluck 80 lbs. Soup 332 tins. Sugar Icing 20 lbs. Sweets 5½ lbs. Tea 7 pkts. 58 Toffee 21 lbs. Tongue 1 tin. Vegetables 644 tins. The quantity of food destroyed continues to be high and gives rise to some little concern. Most of the trouble, it would appear, is caused by the fact that packet and tinned foods are kept in store too long before being released for sale to the public. Premises and Occupations which can be Controlled by Bye-Laws and Regulations. Premises. Dairies, Milkshops and Dairymen 59 Grocery and Provision shops 225 Hairdressers' Premises 80 Fish friers 26 Bakers 38 Butchers 75 Cafes and Dining rooms 93 Fishmongers 21 Greengrocers 95 Offensive Trades. Rag and Bone dealers 3 Tripe boiler 1 Contagious Diseases of Animals Acts and Orders. Steps have been taken to comply with the recommendations contained in the various Orders and Regulations issued by the Ministry of Agriculture and Fisheries during the year. 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 381. It is encouraging to note that there is little adulteration of food nowadays. 59 As will be seen from the Public Analyst's Report, 381 samples, taken from a very large variety of food and drugs, were submitted for analysis with very satisfactory results. Samples analysed. Samples unsatisfactory. Ale—Toby 1 ... Almond Flavour 1 ... Almonds, Ground 1 ... Barley Flakes 1 ... Beef—Pressed 1 ... Beer 2 ... Blanc-Mange Powder 1 ... Brawn 2 ... Butter 3 1 Butter Crunches 1 ... Cake Mixture 2 ... Caramel Solution 1 ... Caraway Seeds 1 ... Cereal 1 ... Cheese 1 ... Chocolate Eclairs 1 ... Christmas Pudding 1 ... Cider 1 ... Cinnamon, Ground 2 ... Cocoa 1 ... Coconut, Shredded in Syrup 1 ... Coffee 3 ... Coffee in Chicory 3 ... Cordial, Lemon 1 ... Currants 1 ... Curry Powder 1 ... Custard Powder 2 ... Cydelux 1 ... Dessert Powder (Sweetened) 2 ... Doughnuts 1 ... Emprota 1 ... Farinco 1 ... Fat, Cooking (Kosher) 1 ... Fish Paste 4 ... Fish, Tinned 1 ... Flour, Cake 4 ... Flour, Self-raising 1 ... Fru-grains 1 ... Fruit, Pectin Liquid 1 ... Gelatine 2 ... 60  Samples analysed. Samples unsatisfactory. Ginger, Ground 2 ... Ginger Wine 2 ... Gravy Mixture 4 ... Herbs, Dried Mixed 2 ... Honey 1 ... Horseradish Sauce 3 ... Ice Cream 99 ... Ice Gateau 1 ... Jam 2 ... Jam Tarts 1 ... Jelly 2 ... Jelly Crystals 1 ... Lager 1 ... Lemonade Crystals 1 ... Lemon Squash 1 ... Liquorice Comfits 1 ... Mace 1 ... Margarine 3 ... Meat Cutlets 1 ... Meat, Luncheon 2 ... Meat Paste 1 ... Meat Pie 4 ... Meat, Tinned 1 ... Meringue 1 ... Milk 75 ... Milk, Condensed 3 ... Milk Powder 1 ... Mincemeat 2 ... Mincepie, Piece of 1 ... Mint Sauce 1 ... Muscado 1 ... Mustard, French 1 ... Nougat I ... Nut Assortment 1 ... Nut Paste 1 ... Nutmeg, Ground 1 ... Orange Crush 1 ... Orange Flavour 1 ... Pancake Mixture 1 ... Pastry Mixture 2 ... 61  Samples analysed. Samples unsatisfactory. Peas, Processed 1 ... Peel Cut, Mixed 1 ... Pepper 5 ... Peppermint Lumps 1 ... Pork, Pressed 1 ... Potato Crisps 2 ... Prunes 1 ... Pudding Powder (Yorkshire) 2 ... Rennet, Essence of 1 ... Rice 2 ... Rock (Confectionery) 1 ... Runa Flavour 1 ... Salad Cream 2 ... Sandwich Spread 3 ... Sauce 2 ... Sausages 17 ... Sausage, Liver 1 ... Sausage, Luncheon 2 ... Sausage Meat 1 ... Sausage (Black Pudding) 1 ... Savource 1 ... Sild 1 ... Soup, Meat 1 ... Spaghetti in Tomato Sauce 1 ... Spice, Mixed 2 ... Sponge Mixture 3 ... Suet 1 ... Tapioca 2 ... Toffees 2 ... Tomato Ketchup 1 ... Tomato Puree 1 ... Tomato Soup 1 ... Vinegar 5 ... Ammoniated Tincture of Quinine 1 ... Bile Beans 1 ... Bismuth Indigestion Mixture 1 ... Bronchial Lozenges 2 ... Bronchitis Mixture 1 ... Camphorated Oil 1 ... Castor Oil 1 ... 62  Samples analysed. Samples unsatisfactory. Catarrh Pastilles 1 ... Eucalyptus Oil 1 ... Glycerine Cough Elixer 1 ... Halibut Oil Capsules 1 ... Iodised Fruit Pastilles 1 ... Koray Tablets 1 ... Nipits 1 ... Olive Oil 1 ... Phensic Tablets 1 ... Saccharin Tablets 1 ... Salpurn Tablets 1 ... Sulphur Tablets 1 ... Syrup of Figs 1 ... 98 5 Clean Food Campaign. During the year further steps were taken to see that all premises where food is prepared, stored or sold were up to a reasonable standard. Improvements and alterations have been carried out, and the general standard of cleanliness is now much higher than previously. Some premises are of a very high standard; but some time must elapse before the general standard attains the ideal. One of the difficulties is that many premises now used were not originally constructed for the purpose; and, short of reconstruction at a great cost, cannot be made suitable. The remedy is to be found in the compulsory registration of all food premises. It would mean that many existing premises would probably not be registered by the Local Authority; but this would be preferable to the existing method of having first to prove a contravention of the Food and Drugs Act or local Byelaw before improvements can be effected. Some might consider this procedure harsh; but in the interests of public health it is essential, even if some compensation were to be given for loss of business. Another matter of great importance is the control of the type of person engaged in the trade of catering. The day has passed when any person, however ignorant, should be permitted to prepare, 63 handle or sell food intended for human consumption. Experience shows that there is a lack of knowledge of the necessity for strict cleanliness, and of the elementary precautions to be taken to protect food from contamination. Training of catering staff in the principles of hygiene and sanitation should be insisted upon. It is this lack or want of knowledge that so often proves to be the primary cause of outbreaks of intestinal disorder or food poisoning. Arrangements might be made whereby classes could be held at the evening schools to cater for persons wishing to obtain knowledge of the subject. Training should also be given at the day schools to students prior to leaving school. During the last three years efforts have been made to interest members of the staff of local catering establishments. They have been invited to attend talks and film shows arranged by the Health Department. At first the attendances were encouraging, but of late they have been disappointing. Experience shows that organised meetings are not popular. On the other hand, much good is done by the Sanitary Inspectors in the way of informal chats during the routine inspection of food premises; and it is to be regretted that pressure of work does not allow of more propaganda of this kind. Co-operation between the staffs engaged and the Officers concerned is vital if there is to be early and lasting improvement in the cleanliness of food premises. 64 FACTORIES. THE FACTORIES ACT, 1937. 1. INSPECTIONS FOR PURPOSES OF PROVISIONS AS TO HEALTH. Including inspections made by Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers Prosecuted. (4) Factories with mechanical power 190 6 - Factories without mechanical power 35 2 - Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 1 - - Total 225 8 — 2. DEFECTS FOUND. Particulars. (1) Number of Defects. Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Lack of cleanliness 4 4 — Sanitary Conveniences:— Insufficient 4 4 — Unsuitable or defective 15 13 2 Other Offences 3 3 — Total 26 24 2 OUTWORK IN UNWHOLESOME PREMISES. (Section 111 of Act of 1937.) Nature of Work. (1) Instances (2) Notices served. (3) Prosecutions, (4) Nil Nil Nil Nil National Health Service Act, 1946 Part III 66 NATIONAL HEALTH SERVICE ACT, 1946. It was on 5th July, 1948, that there came into being the National Health Service—the greatest and most comprehensive scheme of public medical provision ever to be put into operation in any country. In the knowledge that nothing impoverishes a people more than war and disease, the Government decided that medical treatment should be available free-of-charge to every man, woman and child in the country; and by so doing it was hoped that disease and disability would be brought under control. In spite of the fact that most of the greatest and most beneficent advances in human health and happiness have been made in the realm of preventive medicine, and that it is much more economic to spend time and money on the prevention of disease rather than on its cure, widespread surprise was felt and expressed that the National Health Service Act devoted such overwhelming importance to the cure of disease and such scant attention to its prevention. Now that the Service has been in operation for over two years, and has got over what has been described as its "teething troubles", some idea of its effects are becoming apparent. There can be no doubt whatever that it has banished from countless homes one of the great sources of fear—fear of disease and impoverishment due to the cost of medical treatment. It is a welcome and beneficent change for people to know that they can avail themselves of all the resources of modern medical treatment (including specialist and hospital treatment) free of charge. The administration of the National Health Service is entrusted to three independently constitutional authorities—Hospital Boards, Executive Councils and Local Health Authorities; and the success of the service will depend primarily on the extent to which these three administrative branches can be intertwined. There is already evidence that they are tending to become independently isolated units, whereas there is need for the closest possible h'aison between them. Before "the appointed day" there was one authority responsible for the maternity service; now there are three. There is also division in responsibility for the treatment and care of those 67 suffering from mental illness, of the tuberculous, and of the chronic sick. In previous annual reports I have drawn attention to the disastrous position in which expectant and nursing mothers and young children are now placed in consequence of the dental arrangements set up under the National Health Service, and the tragedy that priority dental service for these mothers and children is fast disappearing. This decline of the so-called priority dental service is indicative of the general transfer of emphasis from preventive to curative medicine. As far as cost is concerned, the most expensive form of medical care is treatment in hospital, domiciliary care occupies an intermediate position, and by far the least costly is preventive medicine. 68 SECTION 21 HEALTH CENTRES. Former Relief Office Premises, 135, Dawlish Road, E.10. In my last two Annual Reports I have outlined the position regarding the establishment of a health centre at the above premises, which were allocated to the Health Authority for health purposes on 5th July, 1948. At the end of 1950 negotiations were still proceeding between the Authorities concerned regarding the necessary conversion of the premises. Dwelling House, 133, Dawlish Road. In consequence of the considerations mentioned in my last Annual Report, the Health Authority has now decided to let the premises to one of the County Mental Welfare Officers. 69 SECTION 22 CARE OF MOTHERS AND YOUNG CHILDREN. Births. 1,447 births were registered during the year:— Males. Females. Total. Legitimate 721 680 1,401 Illegitimate 26 20 46 747 700 1,447 The birth rate per 1,000 of the population was thus 13.57. 1,478 notifications of births were received during the year:— From medical practitioners 198 From midwives 1,280 Ante-Natal Clinics. Attendances.— First Subsequent Attendances. Attendances. Total. 587 1,580 2,167 The average number in attendance at the Ante-Natal Clinics held at the Council's three Centres during 1950 was 14.25 per session. The number of home visits made by health visitors to expectant mothers during the year was 192. Child Welfare Clinics. On page 70 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. ATTENDANCES, EXAMINATIONS, etc., 1948—1950. Leyton Green Park House All Centres 1948 1949 1950 1948 1949 1950 1948 1949 1950 Under 1 year— 705 638 561 682 650 622 1387 1288 1183 1st attendances Subsequent attendances 7806 8061 7000 7601 8344 7299 15407 16405 14299 Total attendances 8511 8699 7561 8283 8994 7921 16794 17693 15482 1-5 years— 94 126 142 81 112 122 175 238 264 1st attendances Subsequent attendances 1997 2639 3315 2423 3091 3296 4420 5730 6611 Total attendances 2091 2765 3457 2504 3203 3418 4595 5968 6875 Total attendances, both age groups 10602 11464 11018 10787 12197 11339 21389 23661 22357 Average attendance per session at Infant Clinics 70.21 75.90 68.43 69.59 78.69 68.64 69.89 77.32 68.53 ” ” ” ” ” Toddlers „ — — 13.43 — — 13.98 — — 13.70 Number examined by clinic doctor 2999 3107 3460 3350 3651 3885 6349 6758 7345 Number weighed 10597 11448 10987 10787 12197 11340 21384 23645 22327 70 71 Voluntary Workers at Clinics. Ever since the initiation of Maternity and Child Welfare Clinics in Leyton, the responsible Maternity and Child Welfare authority has been fortunate in having available the services of a number of Voluntary Workers who have attended regularly and rendered valuable assistance at the Child Welfare Clinics. I should like to commend for special mention and appreciation Miss H. S. and Miss E. H. Holl, who have been acting as Voluntary Workers without a break since 1926. During the war years, in addition to their work at the Council's Welfare Centres during the day, they assisted in the health work connected with the Tunnel Shelters during the night. For a period of over twenty years their regular and unfailing attendance at Clinics, their very practical help and their pleasing personalities have won for them the admiration and respect of the permanent staff with whom they have worked and of the mothers and young children whom they have served. In these days the quiet day-to-day voluntary service of publicspirited persons of goodwill should be encouraged; and I suggest that some public recognition should be given to public service of this kind. Unfortunately Miss H. S. Holl has been incapacitated and confined to her home due to illness for the past two years, but her sister is still a regular voluntary helper at the Child Welfare Clinics. At the end of the year the Health Committee had decided that, subject to the concurrence of the respective Councils, an appreciation, bearing the Common Seals of the Essex County Council and the Leyton Borough Council, be presented to the Misses E. H. and H. S. Holl respectively for their long and willing service at the Park House Health Clinic, both while administered by the District Council and subsequently by the County Council. 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. 72 The following is a summary of the work carried out:— Leyton Green Clinic Essex County Training Home Total No. of Sessions 16 23 39 Letters of Invitation 151 241 392 First Attendances 97 176 273 Re-Attendances 122 192 314 The disposal of these cases was as follows:— Discharged after one attendance 115 Re-attended for examination and treatment 121 Failed to re-attend 37 Conditions found on examination Leyton Green Clinic. Essex County Training Home. Subinvolution of the uterus 4 3 Cystocele and rectocele 4 12 Retroversion of uterus 11 15 Anaemia 3 9 Cervical erosion 12 88 Vaginitis 3 8 Fibroid 1 — Inflamed adnexa 1 — Pregnancy 2 1 Cracked nipples — 3 Sterility. 1 — Birth control advice 45 — Anal fissure — 3 Observation by Dr. R. Jacobs, Medical Officer, Post Natal Clinic, Essex County Training Home. Though these figures are relatively small, and therefore not suitable for detailed statistical analysis, the results must be regarded as very satisfactory. In the first place, one must point to the high attendance rate, which is a result of the educational work done by the District Nurses. Their personal relation to the patient in the home is naturally much more intimate than would be possible in hospital and gives them much better opportunities to enlighten the mother on the importance of the post-natal examination. As for clinical results, I am most impressed by the rarity of perineal tears in our cases. In hospital, perineal lacerations are 73 relatively common, but in our series of domiciliary cases they are very rare. Apart from the skill of the attending midwives, I believe that this is due to the home environment, more natural than that of hospital, which induces better relaxation by the mother during labour. The incidence of uterine and vaginal wall prolapse in our cases has also been relatively small. This is due to very careful selection of cases as to suitability for home confinement, with the result that we had no unduly prolonged labours on the district and the number of forceps deliveries was extremely small. The main problem in the post-natal clinic is the treatment of cervicitis and cervical erosion, the incidence of which appears to be high. Apart from local antiseptic treatment, we find that the best results are achieved by specific treatment of the causative infection with sulphonamides and antibiotics. The number of patients who have to be referred to hospital for cauterization is small (four during the period under survey). These figures show that excellent results can be achieved in domiciliary midwifery by good team work. The clinic doctor must carefully select the cases suitable for home confinement and must maintain continuous supervision throughout the ante-natal period, together with the midwife. The midwife must have adequate skill and experience m conducting labour and an experienced general practitioner obstetrician must be available in case of emergency. In my opinion, the most important factor in successful home midwifery is proper selection of cases for home confinement. Care of Premature Infants. The term "premature infants" refers to babies weighing 5½ lbs. or less at birth, irrespective of period of gestation. Stillbirths are excluded. (a) Number of premature infants notified (1) Born at home 25 during the year (including transferred notifications) whose mothers norm- (2) Born in hospital ally reside in the Authority's area. or nursing home 69 (b) Premature infants born in the area (whether their mothers normally reside in the area or not) but exclud- 25. ing babies born in maternity homes and hospitals in the National Health Service. 74 Born 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. - 1 - - - 1 }25 3 to 4 lbs. — — 1 — — 1 4 to 5½ lbs. 3 — — - 20 23 Puerperal Pyrexia. Five 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.) All cases referred from Ante and Post Natal Clinics were seen, advised and treated by the dental officers ; but a comprehensive system of following up all patients is not possible due to staff shortage. Pre-school children from 2 years to 5 years ought to be examined two, and preferably three, times a year if their teeth are to be preserved until the natural time for shedding of the temporary dentition. In the absence of such regular inspection and treatment it is inevitable that one finds among the school entrants much gross dental decay which ought never to have occurred. Many teeth must, therefore, be sacrificed; but, where possible (in the absence of septic processes) they are treated with silver nitrate solution and retained as space preservers for the second dentition. The circumstances leading up to the present very unsatisfactory services for the so-called "priority classes" were dealt with by Dr. Forrest in his Health Report for 1949, page 95, et seq. 75 (A) NUMBERS PROVIDED WITH DENTAL CARE. Examined. Needing treatment. Treated. Made Dentally Fit. Expectant and Nursing Mothers 141 140 140 125 Children under five 535 501 491 465 (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 302 61 71 72 71 — 115 20 12 17 Children under five 345 37 328 202 — 790 521 6 — — 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. 76 Orthopaedic Treatment. Primary Examinations.—During the year 23 children were referred from the Child Welfare Clinics to the Council's Orthopaedic Surgeon. The following conditions were found:— Pes piano valgus 5 Genu valgum 5 Congenital mid-tarsal varus 2 Torticollis 2 Genu varum 2 Anterior poliomyelitis 1 Tibial and flexial deformity digits 1 Congenital disease of hip 1 Valgus ankles 1 Pigeon chest 1 Shortening lower limb 1 ? Sprengle 1 Re-examinations.—In addition to the 23 new cases mentioned above, 62 children under five years of age attended for re-examination by the Orthopaedic Surgeon. The following conditions were seen at re-inspections:— Pes piano valgus 10 Genu valgum 7 Congenital talipes 4 In-toeing 2 Genu varum 1 Kyphosis 1 Lymphatic cyst-heels 1 Congenital cynostosis radius and ulna 1 Haemangioma 1 Talipes calcaneo valgus 1 Anterior poliomyelitis 1 Torticollis 1 Congenital enlargement lower limb 1 Flat foot 1 Provision of Surgical Appliances. Alterations to surgical boots or new appliances were supplied to 24 children as follows:— 19 Minor alterations (wedges). 5 Surgical alterations to boots. 77 X-Rays. Arrangements were made for three children to be X-rayed. Admission to Hospital. No children under 5 years of age were admitted to hospital. Special Eye Clinic. The Consultant Ophthalmic Surgeon had referred by the Clinic Medical Officers 64 pre-school children, who made 84 attendances for examination and treatment. The following conditions were found:— Hypermetropia with squint 22 Squint only 5 Epicanthus 19 Ptosis 1 Convalescent Home Treatment. Children. Twenty-three children recommended by the Clinic Medical Officers were sent to Convalescent Homes. Nursing and Expectant Mothers. Arrangements were made for one mother and her baby to have a period of convalescence following confinement, and for one expectant mother prior to her confinement. Ophthalmia Neonatorum. No. of Cases Notified. Treated At Home. In Hosp. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. 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. 1946 2,223 64 47 28.78 21.14 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 1950 1,447 29 22 20.04 15.20 27 18.31 78 Day Nurseries. Number of Children in Attendance and Awaiting Admission. The following list 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, 1950. 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 7 - 9 - 1. b Motherless children 2 - 1 - 2. a Employed widows 2 — 3 — 2. b Divorced from husbands - - 3 - 2. c Separated from husbands 9 3 12 - 2. d Deserted by husbands 4 - - - 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 33 81 28 100 4. Mothers who are ill or being confined — — 4 — 60 84 60 100 National Nursery Examination Board. Five student nurses were successful in obtaining the Certificate of the National Nursery Examination Board during the year. Since the Nurseries were opened in 1942, out of 39 students who have sat for the examinations 38, have been successful in obtaining the Certificate. 79 SECTION 23 MIDWIFERY Record of Cases attended by Council Midwives, 1950. Midwives employed by Total. Essex County Council. Attached to the Essex Nurses' Training Home, Beachcroft Road. Cases attended:— (a) As Midwives 116 241 357 (b) As Maternity Nurses 13 39 52 Ante-natal Visits 433 1,028 1,461 Ante-natal Examination 907 2,367 3,274 Post-natal Visits 2,365 6,723 9,088 Administrations of Gas and Air Analgesia 64 198 262 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 357 Number of administrations of gas and air analgesia 262 Percentage of administrations 73.38 Maternity Sets. During 1950 maternity sets were issued to 166 expectant mothers who were having domiciliary confinement. 80 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 6 (2) Others 162 Total 168 Fees paid to Doctors. One hundred and forty-seven 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 £364 0s. 6d. 81 SECTION 24 HEALTH VISITING. Health Visitors. During the year the Health Visitors have made 16,797 visits to homes, as follows:— (a) To expectant mothers:— First visits 163 Total visits 192 (b) To children under 1 year of age:— First visits 1,534 Total visits 5,249 (c) To children between the ages of 1 and 5 years 6,445 (d) Other visits:— To cases of whooping cough 72 To cases of measles 11 To cases of ophthalmia neonatorum 2 To cases of discharging eyes 7 To cases of diarrhoea 1 To cases under Children's Act 31 Visits after deaths 17 Visits after stillbirths 16 Miscellaneous visits 2,080 Ineffective visits 2,674 Chest Clinic. In addition to the above, the Health Visitors attached to the Chest Clinic at 180, High Road, Leyton, assisted at 4,651 chest examinations, made 1,938 home visits and interviewed 1,704 patients. 82 SECTION 25 HOME NURSING. The following summary shows the work undertaken during the whole of the year 1949:— No. of new cases (surgical and medical) 1230 No. of visits paid to above 44414 83 SECTION 26 VACCINATION AND IMMUNISATION. Vaccination against Smallpox. NUMBER OF PERSONS VACCINATED (OR RE-VACCINATED). Age at date of vaccination Total. Under 1 year. 1—4 years. 5—14 years. 15 years or over. Vaccinated 292 56 31 29 408 Re-Vaccinated — 2 5 77 84 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 857 38 895 (b) By Private Practitioners 235 9 244 2. Number of children who were given a secondary or reinforcing injection (i.e., subsequent to complete full course) - 230 230 3. (a) Approximate estimated child population at end of year 9,088 12,300 - (b) Percentage of child population considered to be immunised at end of year 59.2 79.8 — 84 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 6 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 % 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 1950 1,405 1,061 75.5 1,237 951 76.0 1,079 880 81.5 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. 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 4,971 85 0 0 1950 - — 0 0 85 Protection against Whooping Cough. In collaboration with the Medical Research Council, there was continued in 1950 the controlled investigation—began in February, 1949—into the efficacy of certain brands of whooping cough vaccine. Although the actual courses of inoculation of over 1,000 young children have been completed, the necessary work connected with the supervision and following-up will be continued for at least another year. 86 SECTION 28 PREVENTION OF ILLNESS, CARE AND AFTER-CARE. Foot Clinic. Annual Attendances—1936 to 1950. 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 War years 564 5,617 6,181 1940 387 4,730 5,117 1941 444 4,269 4,713 1942 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 1950 1,246 12,860 14,106 Summary of Attendances and Treatment. (A) All Ages. During the year 14,106 attendances for treatment were made, representing an increase of 469 over the attendances during the previous year. First Attendances (new cases). Subsequent Attendances. Total Attendances. Males 239 2,404 2,643 Females 835 9,488 10,323 Children 172 968 1,140 Total 1,246 12,860 14,106 The number of persons who received free treatment was 22 (1.86 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 2 373 375 Females 20 1,774 1,794 Total 22 2,147 2,169 A total of 159 patients received treatment at a reduced fee in accordance with the Council's scale of necessity. 87 Defects Treated. Bursitis 65 Callosities 354 Corneous conditions 230 Hallux rigidus 26 Hallux valgus 78 Metatarsalgia 30 Nails, club 77 Nails, ingrowing 82 Mycotic infection 10 Pes planus 68 Hyperhidrosis 23 Verruca pedis 155 Hammer toe 27 Septic conditions 21 Referred for Medical or Surgical Treatment. During the year .38 patients were referred to their own private medical practitioners or hospitals for the following conditions:— Exostosis 5 Morton's toe 3 Trigger toe 2 Apophysitis (os calcis) 1 Pes piano valgus 1 Ulceration 1 Recurring verruca 1 Hallux valgus 7 Intermittent claudication 1 Neuroma 2 Fibrositis 5 Calcaneo spur 1 Lichen planus 1 Sepsis 1 Arthritis 1 Removal of nail 1 Tight plantar fascia 1 Darier's disease 1 X-ray of tarsus 1 Dermatitis 1 88 (B) Children under School Age. Number of children 5 Number of visits made 12 Average number of visits per child 2.4 Defects Treated Com 3 Clawed toe 1 Advice for footwear 1 (c) School Children. Number of children 167 Number of visits made 1,128 Average number of visits per child 6.7 Defects Treated Corns 14 Nail, ingrowing 7 Blisters callosities 2 Pes planus 4 Mycotic infection 4 Bromidrosis 1 Sepsis 4 Bursitis 1 Nail club 1 Verruca pedis 129 Defects referred to School Clinics Exostosis 1 Tight plantar fascia 1 Removal of nail 1 Convalescence for Adults. (a) Number of applications (with medical support) during year 51 (B) Length of convalescence of cases sent during year:— Length of stay No. of Cases 1 week 3 2 weeks 27 3 weeks 18 4 weeks 3 Over 4 weeks - 89 (c) Where cases have been sent:— Name of Convalescent Home No. of Cases sent Seligman Convalescent Home, Etchingham 2 Essex Convalescent Home, Clacton-on-Sea 26 Limpsfield Convalescent Home, Surrey 3 Hartington Convalescent Home, Hove 1 Beau Site Convalescent Home, Hastings 1 Samuel Lewis Convalescent Home, Walton-on-Naze 4 Samuel Lewis Convalescent Home, Etchingham 1 Victorian Convalescent Home, Bognor 3 Bell, Memorial Convalescent Home, Lancing 1 Rustington Convalescent Home 1 Hebron Convalescent Home, Heme Bay 1 Fairby Grange Convalescent Home, Dartford Effingham House, Copthorne 1 Merchants Taylors Convalescent Home, Bognor 1 Godden Green Convalescent Home, Sevenoaks 1 Larkshill Convalescent Home 1 Caxton Convalescent Home, Limpsfield 1 Health Education The most valuable form of health education is the efficient day-to-day administration of the municipal health services; and no amount of preaching will make up for bad practice. Another most valuable form of health education is the advice given daily by doctors, dentists, health visitors and sanitary inspectors. The following list shows some other forms of health publicity undertaken during the year:— 90 (a) Lectures and Film Shows. Date Where Held Details of Subject Type of Audience Estimated Attendance 18. 5.50 Essex County Training Home. The Welfare of Cerebral Palsied Children. Adult 157 21. 9.50 St. Lukes Hall, Leyton. Food Hygiene. ,, 110 27. 9.50 Leytonstone Branch Library, Church Lane, E.11. Social Health: The Story of One Hundred Years. Films: The Londoners. Health of a Nation. ,, 84 11.10.50 ,, Municipal Health Film: One Man's Story (The Work of a Medical Officer of Health). ,, 46 25.10.50 ,, "Nuisances" and Health Films: Town Rats. Sewage Disposal. ,, 40 8.11.50 ,, Health in the Kitchen Films: Another Case of Poisoning. Every Drop to Drink. ,, 52 22.11.50 ,, Industrial Health Talk, illustrated with slides (lantern), by Irene H. Charley, S.R.N., S.C.M., H.V. ,, 27 6.12.50 ,, Foundation of Health Film: The World is Rich. ,, 23 91 (b) Exhibitions. In association with the Crusade Insurance Company, Ltd., an exhibition was staged in the waiting halls of the Health Clinics showing the services available to mothers under the National Health Service Act, 1946. Period Where staged No. of attendances Week commencing 5th June, 1950 Park House Health Clinic. 1,889 Week commencing 12th June, 1950 Leyton Green Health Clinic 1,410 92 Tuberculosis Care Association. In my Annual Report for the year 1949 I drew attention to the County Medical Officer's request, following the resignation of the then Hon. Secretary and Treasurer of the Leyton, Wanstead and Woodford Tuberculosis Care Association, that these duties might be carried out by a member of the County Council's staff under the provisions of the National Health Service Act (Section 28). These duties have been carried out by Mr. E. E. Jacobs, a member of the staff of the Health Department, during the past year, and a great deal of useful work has been accomplished despite the need for more funds, the main source of which are received from the County Council by way of grants for Care Association work and the Sunday Entertainment Act, 1932. Occupational Thekapy. Realising the need for occupational therapy on behalf of certain patients, in April the Care Association decided to allocate funds for the purchase of a weaving loom and accessories, and the employment of an instructor. As no suitable premises were available at the Chest Clinic, accommodation has been provided in the premises of the proposed health centre in Dawlish Road. Since the 26th April a class averaging 6 patients has met weekly for instruction by Mrs. L. Wiltshire, instructor from the hand loom centre. The articles made include such useful things as scarves, cushion covers, table centres, mats, etc. Since the class—a new venture in this area—was begun, two additional looms have been purchased—also a rug frame on which rugs are now being made. The under-mentioned are some of the other activities dealt with by the Care Association during 1950 :— Provision of Extra Nourishments—125 patients received a total of 984 monthly grants. ,, „ Clothing, Bedding, etc.—11 cases. „ „ Fares for Relatives visiting patients in Hospitals and Sanatoria—68 grants. ,, ,, Wireless Licences—2 (and Receiver in one instance). ,, ,, Holiday Convalescence—3 cases. 93 Many patients also received free Milk, on a Chest Physician's recommendation, under the County Council's Scheme and the Association assist in bringing suitable cases to the notice of the Chest Physician and this benefit is much appreciated by the recipients. Another item extablished is a library of books for distribution to tuberculosis sufferers, and many take advantage of this. The Association's thanks are accorded to Mr. E. Sydney, the Borough Librarian, for kindly providing the books from withdrawn copies, for this service. Mass Radiography. The year 1946 was the last occasion when inhabitants and workers in the Borough had the opportunity of availing themselves of Mass Radiography. Towards the end of the year arrangements were made for a visit to Leyton of Unit 6.B, and it is hoped that the Unit will then be able to remain sufficiently long in the area to allow an opportunity for mass radiography to be offered to every inhabitant in the Borough. Five years is much too long an interval between two successive visits of a Mass Radiography Unit to any area; and it is hoped that the Regional Hospital Board may soon be able to arrange for more frequent visits. Loan of Sick Room Equipment. During the year 14 articles of sick room equipment were loaned on the recommendation of doctors, hospital almoners, etc. In September, 1950, the Health Area Sub-Committee decided to extend the service by the purchase of £140's worth of equipment, to set up in the area a central store at the Health Offices for relatively large equipment, and to extend the stores at the County Training Home, Beachcroft Road, E.ll. 94 SECTION 29 DOMESTIC HELP. It was in October, 1946, that the Leyton Council, the then Maternity and Child* Welfare Authority, extended their scheme for domestic help by including the provision of domestic help in necessitous cases other than mothers and infants; and in my last two annual reports I have dealt at some length with certain difficulties of administration—the duties of an Area Domestic Help Organiser, the arguments for and against part-time employment of helpers, the different types of cases to be helped, how the scheme is administered and other aspects of the subject. As the new scheme has now been in operation for four complete years, some idea of the increase in the work may be gathered from these figures:— Year Number of Cases Maternity Other Total 1947 211 27 238 1948 162 85 247 1949 168 214 382 1950 136 464 600 It will be seen that, whereas there has been no increase—in fact, a decrease since 1949—in the annual number of maternity cases, the number of cases other than maternity has been increasing greatly each year. Summary of Cases Helped during 1950. Maternity. Other. Total. No. of cases dealt with136 464 600 The following list shows the disabilities from which the 600 applicants were suffering, and the number of cases in each category 95 Disability. No. of Cases. Maternity 136 General debility 23 Post operative debility 25 Heart disease 60 Bronchitis 27 Arthritis 33 Senility 64 Cerebral haemorrhage 10 Pre-natal 20 Post-natal 17 Neurosis 2 Thrombosis 8 Lumbago 2 Prostatotomy 1 Hepatitis 1 Burns 1 Hernia 1 Anaemia 3 Hodgkinson's Disease 1 Injuries 17 Cancer 20 Tuberculosis 30 Blind and infirm 9 Ulcerated leg 2 Hypertension 6 Diabetes 6 Pneumonia 4 Disseminated sclerosis 2 Miscarriage 8 Oedema of legs 6 Peptic ulcer 3 Parkinson's Disease 5 Rheumatism 6 Cholecystectomy 2 Amputation of leg 2 Fibrositis 3 Gall stones 3 Thyrotoxicosis 2 Tonsilitis 1 Vertigo 2 96 Paralysis 2 Cerebral tumour 3 Breast abscess 2 Vaginal prolapse 1 Neuritis 5 Phlebitis 2 Gross obesity 1 Epilepsy 1 Varicosity 5 Pyelitis 1 Other 3 Duration of cases:— Duration of Cases Maternity Acute Sick Chronic Sick Others* Full Time Part Time Full Time Part Time Full Time Part Time Full Time Part Time Cases completed during year 1 week 1 9 ... 19 ... 10 ... 19 2 weeks 98 13 2 2 ... 5 3 o 10 3 weeks 7 1 ... 4 ... 10 2 10 4 weeks 2 1 ... 5 ... 3 1 4 5 or 6 weeks 1 2 ... 3 ... 6 ... 9 7 or 8 weeks ... 2 ... 5 ... 2 ... 5 8 weeks—3 months ... ... ... 2 ... 5 2 15 3—6 months ... ... ... 8 ... 19 ... 13 6—12 months ... 2 ... 1 ... 20 ... 12 Over 12 months ... ... ... ... 1 19 ... 5 Incomplete Cases Under 3 months 2 ... 1 2 1 20 2 25 3—6 months ... ... ... 1 1 16 1 14 6—12 months ... ... ... ... ... 38 ... 19 Over 12 months ... ... ... ... ... 43 ... 12 Hours worked during year (all cases) All durations 9614 1408½ 532¾ 3199 ¼ 3477½ 47314 *Analysis of "other" cases:— Category of Cases No. of Cases Hours worked Infectious 1 118½ Old people (not sick) 64 8728½ Tuberculosis 30 6243¾ Post and Pre-Natal 37 2770¼ Injuries 17 3924¾ Blind and Infirm 9 1098 Post Operative 25 3324½ 97 Number and hours worked:— Full-time Part-time No. of domestic helps enrolled at end of year 3 64 No. of domestic helps actually employed at end of year 3 53 No. of hours worked during year 15,707 76,047 School Health Service 100 The figures set out below relate to the calendar year ended December, 1950. Number Roll Average Attendance Percentage of Attendance 1 Secondary Schools 9 4,257 3,831 89.99 2. Primary Schools 18 7,909 6,915 87.43 Totals 27 12,166 10,746 88.33 ROUTINE MEDICAL INSPECTION. A.—Routine Medical Inspection. Number of Inspections in the prescribed groups. Entrants 1,405 Second Age Group 1,237 Third Age Group 1,079 Total 3,721 Of 3,721 children who were examined in the code age-groups, 2,776 (or over 74 per cent.) were accompanied by their parents. B.—Other Inspections. Special Inspections. The number of special inspections during the year was 7,603 comparing with 5,751 during the previous year. Re-inspections. The number of re-inspections during 1950 was 8,428. 101 The Findings of Medical Inspection. Number of Individual Children found at Routine Medical Inspection to require treatment (excluding defects of nutrition, uncleanliness and Dental Diseases). Group. (1) Number of Children. Percentage of Children found to require treatment. (4) Inspected. (2) Found to require treatment. (3) Code Groups— Entrants 1,405 290 20.6 Second Age Group 1,237 193 15.6 Third Age Group 1,079 158 14.6 Total (Code Groups) 3,721 641 17.2 Uncleanliness and Verminous Conditions.—At the special inspections held by the school nurses, 619 children were found to be unclean out of a total number of 28,179 examined (i.e., 2.2 per cent.) Cleanliness Surveys in Individual Schools. School. Number of Examinations. Number Cautioned. Number Excluded. Canterbury Road 3,337 71 8 Capworth Street 1,548 39 3 Cann Hall Road 2,196 15 1 Church Road 2,609 68 7 Tom Hood 487 7 1 Connaught Road 1,476 73 6 Downsell Road 2,019 54 23 Davies Lane 2,398 36 3 Farmer Road 504 2 — Goodall Road 979 15 3 Kirkdale Road - - - Lea Bridge Road 211 4 — Mayville Road 2,101 33 20 Norlington Road 1,229 6 — Newport Road 2,408 22 11 Sybourn Street 2,279 28 7 St. Joseph's 239 10 2 Trumpington Road 729 7 2 Knotts Green and Harrow Green 447 18 6 Leyton County High School 934 7 1 Occupation Centre 49 — — Total 28,179 515 104 Number of individual children found unclean 619 of whom were referred to the Minor Ailments Clinics. 104 102 The incidence of uncleanliness for the past 10 years is shown in the following table. Year Number of Examinations Number Cautioned Number Excluded 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 1950 28,179 515 104 222,875 7,586 1,764 MEDICAL TREATMENT. Minor Ailments Clinics. Attendances. During the year 2,662 children attended the clinics, and 13,120 attendances were registered. Defective Vision—Of the 3,721 children subjected to routine code group inspection in the schools, 189 (5.1 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 879 children. They made 1,203 attendances for examination and treatment. Orthoptic Clinic. 1. Number of sessions held 246 2. Number of cases investigated 340 3. Number of cases treated 231 4. Number of cases refused — 5. Number cured: Complete. Cosmetic only. (a) Without operation 31 — (b) With operation 10 6 (c) Total 41 6 (d) Number of cases of Amblyopia included in above total cured 35 6. Number still under Treatment 91 7. Number failing to attend for complete course 8 103 8. Discharged unsuccessful 2 9. Number on waiting list 15 10. Number of cured cases relapsing and requiring further treatment during: First Year following discharge Nil Second „ „ „ 3 Third ,, „ „ 1 11. Total number of attendances 1,785 Cases of squint requiring operation were referred to Mr. M. Klein, Ophthalmic Surgeon, Whipps Cross Hospital, who operates on all cases referred to him from the Leyton Clinic. 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 ... ... ... ... ... ... Capworth ... ... ... ... ... ... Church ... ... ... ... ... ... Connaught ... ... ... ... ... ... Davies Lane 465 426 182 194 282 80.5 Downsell ... ... ... ... ... ... Farmer ... ... ... ... ... ... Goodall ... ... ... ... ... ... Harrow Green ... ... ... ... ... ... Kirkdale ... ... ... ... ... ... Knotts Green ... ... ... ... ... ... Lea bridge ... ... ... ... ... ... Mayville ... ... ... ... ... ... Newport 451 469 172 198 292 78.9 Norlington 456 ... 236 ... 157 66.5 Sybourn ... ... ... ... ... ... St. Joseph's ... ... ... ... ... ... Tom Hood ... ... ... ... ... ... Trumpington 180 164 76 84 108 67.5 County High ... ... ... ... ... ... Report by Authority's Senior Dental Officer (A. E. Hall, L.D.S.) Once again I regret I have to draw attention to the melancholy fact that the School Dental Service is rapidly disintegrating due to lack of dental surgeons to treat the children. Not only are dental officers leaving the school service throughout the country; but, what is far more serious from the long-term point of view, there is no recruitment of young practitioners wishing to make the treatment of children their life's work. 104 In the Leyton area there have been employed, during 1950, the equivalent of 1.5/11ths dental officers for the inspection and treatment of approximately 12,500 school children. These same dental officers treated all patients referred by the Maternity and Child Welfare Services. In addition, we have had the service of a dental officer two sessions per week from 20th March for orthodontic work, the total service available being less than one-third of the authorised establishment. Routine inspection was carried out in only four schools in the area; but two schools, inspected in December, 1949, also received treatment during the year under review, in addition to those children in the schools inspected. 2,525 accident or toothache cases attended as casual cases during the year and received treatment. A summary of the treatment carried out will be found in Table IV on page 129. In addition to the work detailed in Table IV, the following items of treatment were carried out. For these there are no headings in Table IV, other than "Other operations", viz.:— Denture space retainers 25 ,, ,, ,, repaired 1 X-ray films 56 Local anaesthesics 883 Root filhngs 2 Acrylic crowns 2 Gingivectomy 1 Apicectomy 2 Application of silver nitrate 330 As no provision is made in Table IV for details of this treatment it is set out below:— Impressions taken 277 Study models made 277 New applications fitted 96 Attendances 498 Advice 341 Adjustments to appliances 437 X-rays 34 Finished cases 8 Orthodontic Clinic. Mr. Shamash was appointed in March, 1950, for orthodontic work on two half days a week; and has carried out a considerable amount of work under this heading. 105 Orthopaedic Clinic. Examinations by Orthopaedic Surgeon. Primary examinations 51 Re-examinations 112 The findings at primary examinations were:— Congenital talipes 1 Pes piano valgus 13 Metatarsal deformity 1 Hammer toes 2 Hallux valgus 10 Congenital disease hip 1 Torticollis 1 T.B. hip 1 Valgus ankles 1 Genu valgum 9 Pes cavus 1 Ganglion dorsal wrist 1 In toeing 1 Double Sprengle 1 Digitus varus 1 Congenital flexion deformity 1 Kyphosis 2 Kypho-scoliosis 1 ,, -laudosis 1 Scoliosis 1 Prominent scaphoid 1 Schlatter's disease 1 Round shoulders 1 The following conditions were seen at re-inspections during the year:— Pes piano valgus 10 ,, cavus 2 Hallux valgus 5 Digitus varus 4 Genu valgum 9 Hammer toes 4 Congenital disease hip 2 „ talipes 2 „ scoliosis 1 Spinal curvature 1 106 Congenital shortening of limbs 2 Sacral pain 1 Talipes-calcaned valgus 1 Scoliosis 3 Kyphosis 4 Osteo-myelitis 1 Schlatter's disease 1 Spastic Hemiplegia 1 Flat foot 1 Hemiplegia 2 Anterior poliomyelitis 3 Fracture clavicle 1 Kypho-scoliosis 1 Torticollis 3 Winged scapula 1 Polio-encephalitis 1 ? Freiberg 1 Abnormal mobility-knee 1 Valgus ankles 1 Amputation forearm 1 Loose body—knee 1 Instability knees 1 X-Rays. Arrangements for X-rays were carried out in 9 cases. Admissions to Hospital. Four children were admitted to hospital, and the following operations performed Tenotomy digit 5, left foot (3 cases). Arthrodesis of proximal phalanx, rt. 2nd toe. Surgical Appliances and Boots. Minor alterations to boots (wedges, etc.) 25 Other alterations to boots (surgical) 6 Walking caliper 1 107 HANDICAPPED PUPILS. (Report by Dr. Mary Gilchrist.) Under Section 34 of the Education Act, 1944, it is the duty of the Local Education Authority to ascertain what children in their area require special educational treatment; and the Minister of Education has laid down, in the Handicapped Pupils Regulations, the several categories of pupils who are considered to require such special educational treatment. The children affected are those considered to be Blind, Partially Sighted, Deaf, Partially Deaf, Delicate, Diabetic, Educationally Sub-normal, Epileptic, Maladjusted, Physically Handicapped, and Pupils suffering from Speech Defects of a severe degree. Many children with minor degrees of some of the above-listed defects are able to cope with the work of the ordinary school, and are not ascertained as Handicapped Pupils. It is not always necessary that a child so listed should attend a Special School, but may be taught in a special class, or given some preferential treatment in an ordinary class—e.g., a special position near the teacher or blackboard, to overcome defects of hearing or sight. Delicate Pupils. These are pupils who, by reason of impaired physical condition, cannot without danger to their health be educated under the normal arrangements of an ordinary school. This is the largest group of the Handicapped Pupils, and it includes all children recommended for Day or Residential Open Air Schools and those who go to Convalescent Homes for periods of three months or more. The defect is rarely of a permanent nature, but many children suffer from recurrent attacks of the same illness, e.g., bronchitis, asthma and upper respiratory infections, nervous and general debility, chorea, etc. These children are frequently absent from school, and many of them in consequence suffer educational retardation. The anxiety produced by their school difficulties tends to precipitate either another attack of the same illness, or a new defect. In this type of case the special educational, as well as the physical, environment of an open air school, with small classes and a more elastic curriculum, proves to be of great help, and the children overcome both their scholastic difficulties and their physical handicap. 108 In the Day Open Air School children remain from one to six terms, or longer. In the Residential School they remain one or two terms, but a few stay beyond this—from three to six terms. Boys Girls Total No. of Delicate Pupils ascertained 1950 29 38 67 No. admitted to Knotts Green Day Open Air School 10 10 20 No. admitted to Residential Open Air School 19 28 47 ysically Handicapped. There are pupils who, not being pupils suffering from a defect of sight or hearing, are, by reason of disease or crippling defect, unable to be educated in an ordinary school without detriment to their health or educational development. The categories "Delicate" and "Physically Handicapped" tend to overlap, but in the main the Physically Handicapped child has a defect which is likely to be more permanent or of a much more serious nature than that of the "Delicate" child. Cases of severe rheumatic infection, tuberculosis, infantile paralysis and congenital deformities are found in this group. Fortunately the number so ascertained in each year is small, and a survey made in 1950 showed that there were in the whole school age group (i.e., from 5 to 16 years) only 36 children in the category of Physically Handicapped Pupils. Boys. Girls. Total. No. attending at Knotts Green Open Air School 7 15 22 No. attending at Residential Schools 7 7 14 No. ascertained in 1950 2 3 5 No. recommended Knotts Green Day Open Air School 1 2 3 No. recommended Residential Open Air School 1 1 2 109 Educationally Sub-normal. These are pupils who, by reason of limited ability or other conditions resulting in educational retardation, require some specialised form of education wholly or partly in substitution for the education normally given in ordinary schools. Boys. Girls. Total. No. of Educationally Sub-normal Pupils ascertained in 1950 9 10 19 They were all admitted to Harrow Green Educationally Subnormal School. Maladjusted Pupils. These are pupils who show evidence of emotional instability or psychological disturbance, and require special educational arrangements in order to bring about their personal, social or educational readjustment. Before these children are ascertained as Maladjusted the help of the local Child Guidance Clinic has usually been sought and treatment instituted there. But the great majority of these children are maladjusted either because of mismanagement at home or of an unfavourable home environment; and treatment cannot be given successfully while the child remains at home. It is then necessary to certify the child as maladjusted so that he can be transferred to a boarding school of a special type recognised by the Ministry of Education as suitable for such cases or to a foster home or hostel where he can live while attending for treatment at a Child Guidance Clinic. Boys. Girls. Total. No. ascertained as Maladjusted in 1950 5 1 6 Deaf Pupils. These are pupils who have no hearing, or whose hearing is so defective that they require education by the methods used for deaf pupils without naturally acquired speech or language. There were two Totally Deaf pupils ascertained in 1950—one boy and one girl. There are two children of school age attending Residential Deaf Schools and two awaiting admission. It is unfortunate that the shortage of places in Deaf Schools continues owing to shortage of teaching staff. 110 Partially Deaf Pupils. These are children whose hearing is so defective that they require for their education special arrangements or facilities, but not all the educational methods used for deaf pupils. They usually do learn speech in a normal fashion, with or without hearing aids. There was one boy notified as Partially Deaf in 1950. There are three- children at Residential School for the Partially Deaf, and two awaiting admission. There are six children at Day Partially Deaf Schools, and one now awaiting admission. Two have been awaiting admission for over eighteen months. One child has just recently been ascertained (in 1951). Blind. These are children who are blind, or whose sight is so defective that they cannot be educated by methods involving the use of sight. No child was ascertained as blind in 1950. Three children attend Residential Schools for the Blind. Partially Sighted. These are children who cannot follow the ordinary curriculum without detriment to their sight or to their educational development, but can be educated by methods involving the use of sight. One boy was so ascertained during 1950, and is attending a Partially Sighted School. No other pupils are in this category at present. In 1950 no children were ascertained under any of the other categories mentioned. Three children are at present in Residential Epileptic Schools. Section 57, Education Act, 1944. Under Subsection 3 of this section of the Education Act children found to be ineducable have to be notified to the Mental Welfare Authority. In 1950 three boys and three girls were notified as being incapable of education in the Special School. Under Subsection 5 of Section 57 children who require superision by the Mental Welfare Authority have to be notified. Seven boys and two girls were so recommended in 1950. 111 Section 48 of the Education Act. Under this Section of the Act it is possible to send children in need of a short recuperative holiday to a Convalescent or Holiday Home. This is an excellent method of dealing with children who are very debilitated either after a severe illness, such as pneumonia, or after a series of infections, such as whooping cough, measles and influenza—a very common sequence of events during the autumn and winter of 1950. They quickly improve with four weeks at the seaside or in the country, and thereby reduce the number of cases which might have to spend a long time in a day open air school. In 1950 some 91 children were sent away for four weeks— 41 girls and 50 boys. Camp Convalescence. The closing of Itchingfield School Camp is a serious blow to the rehabilitation of a certain number of boys and girls in the Senior Schools. The onset of puberty makes a serious call on the physical resources of certain children, and the School Health Service Staff have found it useful to be able either to recommend children for a month at the Camp or to encourage parents to allow their children to go two or three times in the school year. In a few cases two months have been recommended ; and in 1950 there were five girls and seven boys recommended for this longer spell at Camp. With the closing of the Camp in August, 1951, it is likely that a greater call will be made on the already overcrowded waiting list for admission to Convalescent and Holiday Homes, which are more expensive to run. 112 PROVISION OF MEALS. The number of individual children fed under the Authority's arrangements during 1950 was:— Dinners. Milk Meals. Free 614 10,974 For payment 5,137 — Totals 5,751 10,974 Number of meals supplied:— Dinners. Milk Meals. Free 102,062 2,058,955 For payment 908,134 — Totals 1,010,196 2,055,955 SPEECH THERAPY. 1. Children at present Undergoing Treatment— Diagnosis of Defects— Boys Girls Total Stammering 42 8 50 Dyslalia 47 27 74 Alalia 1 — 1 Lisp 10 1 11 Deafness 2 — 2 Cleft palate 2 2 4 Disarthria — 1 1 Excessive nasality 1 1 2 105 40 145 113 Incidence of speech defects among seniors, juniors and infants—  Seniors Juniors Infants Total Stammering 11 32 7 50 Dyslalia - 18 56 74 Alalia — — 1 1 Lisp — 3 8 11 Deafness — 1 — 2 Disarthria — — 1 1 Cleft palate 1 1 2 4 Excessive nasality 1 1 — 2 13 57 75 145 2. Discharged—33. Seniors Juniors Infants Total Dyslalia — 1 13 14 Stammering 5 11 — 16 Lisp — 1 1 2 Cleft palate 1 — — 1 6 13 14 33 3. On Waiting List Nil 4. Average Number of Cases Treated Daily 29 5. Homes Visited 49 6. Schools Visited 37 7. Children referred to other Clinics:— To the Psychiatrist 2 For further medical advice 3 For dental treatment 1 6 8. Total No. of Attendances 2,106 114 CHILD GUIDANCE. Report of the Educational Psychologist to the Forest and Leyton Divisions (Miss M. Marshall), 1950. The Educational Psychologist has continued to visit the schools in the Forest and Leyton Divisions during the year. The increase in the school population has resulted in many more requests from schools for visits and a waiting list of these has had to be compiled so that they may be taken in order. Unfortunately it has not been possible to meet all requests within the school term in which they are made. Owing to the rapid increase in the school population in the Forest Division, it was decided to divide the work, and in September the Educational Psychologist for Walthamstow took over the Chingford area. The school population for the remainder of the Forest Division plus that of the Leyton Division is now roughly 30,000. Fifty-four schools were visited during the year for the purpose of interviewing and testing individual children. Visits were also made to other schools to discuss the problems of a particular child with the teaching staff. Altogether 278 children were given individual tests of intelligence and attainment, the great majority in school. Of these 119 were in Leyton Schools and 159 in the Forest Division. Information about the 278 children seen individually 'by the Psychologist is as follows:— I. Number under school age 4 Number from Infant Depts. 57 Number from Junior Depts. 151 Number from Secondary Dept. 66 II. Number referred at request of parents 19 Number referred by Head Teacher and School Medical Officer 252 Number referred by Probation Officer, and Children's Officer 7 115 III. The reasons for referral are as follows:— (a) Slow progress in school work 129 (b) Behaviour problems at home and/or school, e.g., pilfering, fighting, nervous, unhappy, etc. 116 (c) Educational and vocational advice 18 (d) Miscellaneous, e.g., neglected, poor speech, deaf, etc. 15 IV. Number of Girls referred 79 Number of Boys referred 199 The children ranged in intelligence from the very bright to the very dull. The number seen in each of three broad categories was:— V. Dull Average Bright (I.Qs. below 85) (I.Qs. between 85 (I.Qs. over 115) and 115) 90 148 40 Certain of the children seen individually by the Psychologist are later referred to the Child Guidance Centre. In 1950 the number was:— VI. Boys. Girls. Leyton 37 21 Forest 42 16 It will be noticed that the numbers of Infant and Secondary School children referred to the Psychologist are about equal. As the School Psychological Service and the Child Guidance Centre become more familiar, it is hoped that the numbers of infant children referred may increase and the number of Secondary School children may decrease. The earlier problems of adjustment are brought to light the better are the hopes for the success of measures taken to relieve them. During the early part of the year two of the students in training as Educational Psychologists from London Child Guidance Training Centres assisted in this individual testing in schools in order to gain experience. 51 of the 278 individual tests were given by these students under the supervision of the permanent Educational Psychologists at the Centre. 116 Large scale group testing was carried out in the Leyton Primary Schools by the Head Teachers, and the Educational Psychologist prepared a report on the general intellectual ability of the 10-year old children in the Leyton Schools (1,091 tested) from the results of the tests. This report was finally submitted to the Leyton Committee for Education. Remedial teaching of 13 children was carried out in the Child Guidance Centre during the year, eight in reading, two in arithmetic, two in both reading and arithmetic, and one in spelling. These children are selected for this special help by the Psychiatrist. Various lectures have been given to Parents' Associations and other organisations and the Psychologist took part in a short course at Wansfell Residential Adult College, Theydon Bois. Unfortunately, the course of lectures for teachers on "Problems in the Primary and Secondary Schools" had to be abandoned because of illness. As in 1949, there was a period of about six months in 1950 when there was no Psychiatric Social Worker for the Leyton and Forest Divisions. This inevitably increased the work of the Psychologist in the Centre, with a coresponding decrease in the amount of time available for work in schools. 117 AUDIOMETRY. Report of the County Audiometrician (Miss Margaret O'Leary). An Audiometric Survey of School Children in the following School Departments: Primary, Secondary, Special, and County High Schools, which together totalled 19 Departments, was carried out in the Borough of Leyton from February, 1950, to July, 1950. Facilities for Testing Conditions for Group Testing in this Borough have been very difficult, due to the overcrowding of Schools and the limited number of accessory rooms available. However, most teachers did cooperate to the very best of their ability, and the following are the results of the Survey:— Number Requiring Treatment. Type of School No. of Children Referred for Treatment Number Tested Total Percentage Boys Girls Secondary 2,804 50 1.7 33 17 Primary 3,754 82 2.15 50 32 Open Air 79 4 5.0 3 1 Educationally Sub. 118 19 16.0 9 10 County High School for Girls 444 4 .9 — 4 County High School for Boys 499 7 1.4 7 — Totals 7,698 166 2.1 102 64 Analysis of Defects. The statistical analysis of those invited to attend the Clinics was as follows:— Primary Schools Secondary Schools Special Schools Total No. invited to attend the Clinics 83 60 23 166 No. actually seen at the Clinics 82 58 23 163 No. with Unilateral Loss of Hearing only 57 43 11 111 No. with Bilateral Loss of Hearing 25 15 12 52 No. with severe Unilateral Loss of 30 d/b and over 15 11 1 27 No. with severe Bilateral Loss of 30 d/b and over 7 4 6 17 118 Causation of Deafness. The following is the Clinical Diagnosis of the probable cause of Deafness in the 166 children referred for treatment:— Primary Schools Secondary Schools Special Schools Total 1. Nasal Catarrh 27 1 2 30 2. Otorrhoea (present) 13 4 2 19 3. „ (past) 4 6 7 17 4. Following Mastoidectomy 4 1 — 5 5. Wax and Foreign Body 12 23 4 39 6. Following Infectious Diseases 2 4 — 6 7. Following Tonsillectomy — — — — 8. Gross Adenoidal and Tonsillar Enlargement 11 5 16 9. Probably Hereditary 1 1 - 2 10. Polypus 1 - — 1 11. Trauma — 2 — 2 12. Congenital - — 2 2 13. N.A.D. 8 13 6 27 Totals 83 60 23 166 Of the 166 Children seen at the Clinics:— 104 Children were referred for Re-testing. 50 Children were referred to the E.N.T. Specialist. 12 Children were referred to other Hospitals. No. Re-tested 86. No. found to have normal hearing after re-testing 67 No. who failed the re-test 19 No. who failed to attend for re-testing 18 Total 104 Of the 50 children referred to the Ear, Nose and Throat Specialist, 22 were seen by him. 9 Children were given Pure Tone Tests. 3 Children were recommended for Hearing Aids. 6 Children were recommended for Lip Reading. Owing to great pressure of work, the Ear, Nose and Throat Specialist will be unable to see the remaining children on his list until a future date. Finally, I should like to extend my sincere appreciation of the help and co-operation shown to me by the Medical Officers and the Staff of the Public Health Department. 119 Observations by Dr. M. L. Gilchrist on the Audiometrician's Report. There are several comments that must be made on the Report submitted by the Audiometrician, otherwise a false impression is given of the position in Leyton following the survey made in 1950. Her report was necessarily incomplete; and the follow-up of the cases by the school medical staff since the Report was made in September necessitates a new assessment of her findings. Complete reports are available on 157 of the 166 cases originally re-tested. Nine of the children had left school, or left the district, or their parents preferred to have treatment elsewhere, and these are not included in this survey. Cases of Deafness Previously Undetected—10. Ten cases can be said to have been discovered by the Audiometrician's survey. They were not considered to be deaf, either by the medical or school staff, their parents, or themselves. One had a bilateral hearing loss of 30 decibels in each ear, but as this was due to recurrent rhinitis and catarrh, it responded quickly to treatment. All other cases had unilateral defect only. In 7 cases no treatment can help, and its doubtful what value can be placed on the discovery of this unilateral deafness. Causes of deafness in this group are:— Meningitis 1 Trauma 1 Early Otosclerosis 1 Infectious Disease 1 Cause unkown 3 One case is still under investigation. One case of acute otitis media, first attack during week of original test, is now improved. 120 No Defect Found on Re-examination—27. Twenty-seven children had no defect whatsoever, and had normal hearing on re-testing. The children gave various reasons for their failure at the tests previously performed in school—cold, been swimming, noise in room, etc. Wax in Ears—19. There were 19 in this group ; ten unilaterally affected and nine bilaterally. After re-testing, hearing was normal. Some of these children had to have their ears syringed at regular intervals ; but it was surprising how deaf from wax children can be and yet not notice their deficiency. Catarrhal Conditions—29. Twenty-nine children suffered from recurrent catarrhal conditions. Seventeen of these had improved at re-testing, and needed no further treatment. Twelve were referred for further treatment. Twelve were referred for further treatment to clinic or private doctor. Ten, on re-testing, had improved; two are still under treatment. Mastoidectomy—9. Nine children had a history of this trouble, three with bilateral and six with unilateral damage. In none was the hearing loss sufficient to interfere with schooling, and in all except one re-tests showed improvement in hearing loss. Two of the unilateral mastoidectomies had chronic suppurative otitis media, and one of them also had a polypus. The hearing of both is improving with treatment. Chronic Suppurative Otitis Media (C.S.O.M.)—42. Twenty-five had unilateral trouble and 17 bilateral trouble. All 42 were either under observation or treatment at time of test. Twenty-five have improved, with or without treatment. Nine cannot be improved by further treatment, and eight are still under treatment. 121 Miscellaneous Cases—21. Conductive deafness probably due to infectious disease 4—I.S.Q. Nasal obstruction 5—Awaiting treatment. High frequency deafness 2— „ ,, Chronic rhinitis 1—Improved. Cleft palate and c.s.o.m 1— ,, Acute otitis 2— „ Trauma 1—I.S.Q. Septal defect 1—Awaiting treatment. Over-anxiety 1—Improved. Unknown 3—I.S.Q. The Audiometrician in her second Table has reported that 27 children have a hearing loss of 30 decibels or over in one ear and 17 in both ears. These figures are not accurate, and the position is better stated as follows:— TABLE I. No. With Hearing Loss of 30 Decibels 1 Ear and Under 12 in Other Ear—21. Cause of Deafness No. Treatment Result on Follow-up Catarrhal condition 3 At clinic 2 Normal hearing 1 Improved C.S.O.M. 4 ,, ,, All Improved No defect found 3 None required Normal Wax 1 Syringed Normal Mastoidectomy (Unilateral) 2 None possible 1 Hearing Loss of 18 only 1 I.S.Q. Acute Otitis Media 2 At clinic 1 Normal, 1 Improved Nasal obstruction and and c.s.o.m. 1 Still awaiting operation Normal No cause found 1 None possible I.S.Q. Measles 1 ,, ,, ,, Fractured skull 1 ,, ,, ,, Meningitis 1 ,, ,, ,, 1 not yet known 1 ,, ,, ,, 122 No. With Hearing Loss of 30 Decibels or Over in One Ear and More Than 12 in Other Ear—13. Cause of Deafness No. Treatment Result on Follow-up C.S.O.M. 6 2 Hearing Aids and Lip Reading also 5 Improved I Normal 4 still under treat ment High frequency 2 1 Hearing Aid, and both Lip Reading Both improved practically but not on audiometer test Cleft Palate and c.s.o.m. 1 Hearing Aid and Lip reading Improved Nasal obstruction 1 Operation Improved Recurrent Catarrh and rhinitis 1 At clinic Improved Wax I Syringed Normal Not diagnosed yet 1 Still under treatment I.S.Q. Hearing Aid and Lip Reading Cases. Some further explanation of these cases is necessary. Two brothers were admitted from another area to the E.S.N. School because of presumed low-grade intelligence. It was quickly noticed that they suffered from high-frequency deafness and were of average intelligence. They are awaiting transfer to Partially Deaf Schools. The one more severely affected has a hearing aid, the other is being investigated still for this. Both have been under the speech therapist for lip reading for a year and have made excellent progress in speech and lip reading. They are doing well in school, as the small classes in the special school give them a better chance than in the ordinary school. It is hoped they will be moved soon to Partially Deaf Schools. The two other cases recommended lip reading are low grade defectives, and their deafness is not really so much affected as their intelligence. They should not be in this category at all. The Children in the Educationally Subnormal School. Miss O'Leary tested every child in this School, even those in the "entrants class", where mental ages of 3-4 are to be found. This really invalidates the figures, as the test requires more concentration and intelligence than these children can give. No Infant School children were tested anywhere because of this fact. Onethird of the cases reported as having defective hearing in the E.S.N. School should not have been tested. 123 Except for the two cases of high-frequency deafness in this school, the 11 other children with defective hearing due to various causes were mentally retarded irrespective of their hearing loss. They were backward, not because of their ear trouble, but in addition to their ear trouble. They have all been included in the above report. Nevertheless, the proportion of children with ear trouble seems to be higher than in the ordinary school. Conclusions. The survey appears to be worth doing, but all but ten of these children were known to have had treatment or to require treatment for ear defects. The few cases of acute otitis media would eventually have had treatment either at the clinic or from their private medical attendants. One good point about the survey is that it keeps all the School Health Service team aware of the progress that those cases are making, and the "follow-up" work perhaps is improved to that extent. It is obviously impossible to do this, of course, every year in each area; but it might be of some use to do one year group in each district, and so "screen" the children at least once in their school life—say at the age of 10 years. There are no children in any primary or secondary school unable to benefit from education because of defective hearing. One in a secondary school has a hearing aid; but, as she manages so well, she is not considered to be partially deaf. 124 RESEARCH WORK. Anti-tuberculosis Vaccine (B.C.G.). In collaboration with the Medical Research Council, there was begun a Trial of Anti-tuberculous Vaccine (B.C.G.). The B.C.G. vaccine distributed at present by the Ministry of Health is intended essentially for use in groups who may be heavily exposed to tuberculosis. However, there is little direct unequivocal evidence of its value in persons exposed to the ordinary conditions of life in this country. The question as to whether anti-tuberculosis vaccine should be used as a method of massimmunisation in countries such as our own has not been satisfactorily answered. It is this question which the Medical Research Council would like to answer through the trial now being planned, which has the full approval of the Ministry of Health. The trial involves at the outset children leaving secondary modern schools at the age of 15, and it is proposed to follow them up by regular examinations for at least three years. Participants in the trial are volunteers. Circulars describing the scheme and asking for volunteers were sent to all parents of school-leavers. The circulars to the parents stressed the fact that all children participating in the scheme have the advantage of routine medical examinations, and described in essence the character of the examinations. Meetings of headmasters and headmistresses were arranged to explain the scheme and obtain their full co-operation. The scheme is being operated by a Medical Research Council team especially assigned to this work. The sequence of examinations is as follows :— Penultimate school term : Initial tuberculin-testing and X-raying of volunteers ; inoculation with B.C.G. of those tuberculin-negatives selected for vaccination. Final school term (12-16 weeks later) : Second tuberculin test and second X-ray of all children tuberculin-negative at first test (whether vaccinated or not). All groups will be X-rayed and tuberculin-tested at regular intervals for at least three years. In addition, they will receive regular visits from a health visitor. The examinations began towards the end of October, and the investigation is now well under way. 125 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 1,405 Second Age Group 1,237 Third Age Group 1,079 Total 3,721 B. Other Inspections. Number of Special Inspections 7,603 Number of Re-inspections 8,428 Total 16,031 126 C. Pupils Found to Require Treatment. Number of individual pupils 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 8 282 290 20.6 Second Age Group 63 130 193 15.6 Third Age Group 66 92 158 14.6 Total (Prescribed Groups) 137 504 641 17.2 Other Routine In spections — — — — Grand Total 137 504 641 17.2 TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1950. Defect or Disease. Routine Inspections. Special Inspections. Number requiring Treatment. Observation. Number requiring Treatment. Observation. (1) (2) (3) (4) (5) Skin 9 14 393 — Eyes—(a) Vision 138 28 182 18 (b) Squint 37 7 25 — (c) Other 14 3 333 2 Ears—(a) Hearing 11 23 42 4 (b) Otitis Media 12 41 70 2 (c) Other 92 12 313 1 Nose or Throat 79 181 251 1 Speech 5 12 22 1 Cervical Glands 4 57 2 — Heart and Circulation 20 40 4 1 Lungs 16 74 78 5 Developmental—(a) Hernia 4 2 2 — (b) Other 5 18 69 5 Orthopaedic— (a) Posture 22 51 3 1 (b) Flat Foot 35 34 12 2 (c) Other 67 47 59 3 Nervous System—(a) Epilepsy 4 2 10 — (b) Other 8 14 30 1 Psychological—(a) Development 3 4 3 5 (b) Stability 10 24 32 8 Other 136 27 2,173 53 127 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. °/ /o No. % No. 0/ /o[/##] Entrants 1,405 293 20.9 1,023 72.8 89 6.3 Second Age Group 1,237 312 25.2 867 70.1 58 4.7 Third Age Group 1,079 462 42.8 608 56.4 9 0.8 Other Routine Inspections — — — — — — — Total 3,721 1,067 28.7 2,498 67.1 156 4.2 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. Number of Defects treated or under treatment during the year. By the Authority Otherwise (1) Skin— Ringworm— Scalp 3 — Body 1 — Scabies — - Impetigo 17 — Other skin diseases 370 — Minor Eye Defects— (External and other, but excluding cases falling in Group II) 399 3 Minor Eye Defects 605 16 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 3,185 150 Total 4,580 169 128 TABLE III.—contd. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as minor allments.—group I). Defect or Disease Number of Defects dealt with By the Authority Otherwise Errors of refraction (including squint) 350 390 Other defect or disease of the eyes (excluding those recorded in Group I) 158 — Total 508 390 No. of Pupils for whom Spectacles were— (a) Prescribed 267 302 (b) Obtained — 558 Grout III.—Treatment of Defects of Nose and Throat. Total number treated. By the Authority. Otherwise. Received operative treatment:— (a) for adenoids and chronic tonsillitis - 31 (b) for other nose and throat conditions - 2 Received other forms of treatment 605 6 605 49 Grout IV.—Orthopedic and Postural Defects. (a) No. treated as in-patients in hospitals or hospital schools 3 (b) No. treated otherwise, e.g., in clinics or patient departments 48 Group V.—Child Guidance Treatment and Speech Therapy. No. of pupils treated— (a) Under Child Guidance arrangements 45 (b) Under Speech Therapy arrangements 60 129 TABLE XV. Dental Inspection and Treatment (1) Number of pupils who were :— (a) Inspected by the Dentist:— Age Groups Aged: Total 2,611 3 — 4 — 5 273 6 308 7 337 8 240 9 234 10 294 11 201 12 288 13 222 14 213 15 1 16 — Specials (Casuals) 2,525 Grand Total 5,136 (6) Found to require treatment 3,870 (c) Actually treated 2,925 (2) Half-days devoted to Inspection 21 Treatment 659— Total 680 (3) Attendances made by children for treatment 6,344 (4) Fillings, Permanent Teeth 1,609 Temporary „ 347—Total 1,956 (5) Extractions, Permanent Teeth 556 Temporary ,, 4,116—Total 4,672 (6) Administrations of general anaesthetics for extractions 1,560 (7) Other operations, Permanent Teeth 1,545 Temporary „ 2,251—Total 3,796 130 TABLE V. Infestation with Vermin. (1) Total number of examinations in the Schools by School Nurses 28,179 (2) Number of individual pupils found to be infested 619 (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.)