AC 4411(1) LEYTON LEY 45 Borough of Leyton HEALTH REPORT FOR THE YEAR 1951. ANDREW W. FORREST, M.A., M.D., Ch.B., D.P.H., Medical Officer of Health, Borough of Leyton, Area Medical Officer, County of Essex. CONTENTS. pages 1. Opening Remabks 3—6 2. Vital Statistics 8—18 3. Infectious Diseases 20—28 4. General (a) General Provision of Health Services in the Area 30 (b) National Assistance Act, 1948 34 (c) Licensed Establishments for Massage or Special Treatment 35 (d) Mortuary 37 (e) Inquests and Coroner's Post-mortems 38—40 5. Sanitary Circumstances of the Area 42—65 6. National Health Service Act, 1946, Part III (a) Sec. 21 Health Centres 68—72 (b) „ 22 Care of Mothers and Young Children 73—82 (c) „ 23 Midwifery 83—84 (d) „ 24 Health Visiting 85 (e) „ 25 Home Nursing 86 (/) „ 26 Vaccination and Immunisation 87-89 (ig) „ 28 Prevention of Illness and After Care 90-100 (h) „ 29 Domestic Help 101—103 7. School Health Service 106-131 3 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LEY TON. 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 1951. Vital Statistics. The Registrar-General's estimate of the population of Leyton in 1951 was 104,700 persons, a reduction of 1,900 persons compared with the officially estimated population of the previous year. The results of the official census of 1951 are not yet available. The birth rate, 12.52 births per thousand of the population, continues its uninterrupted decline from the highest post-war rate of 22.35 registered in 1947. Deaths of Leyton residents during the year numbered 1,362, giving a death rate of 13.00 per thousand population. Twenty-seven infants died under one year of age, the infantile mortality rate being 20.59. Last year the infantile mortality rate was the lowest ever recorded (20.04). During the year under review three Leyton mothers died from causes connected with pregnancy and childbirth. On page 9 is a table showing the comparative birth and death rates for the year in England and Wales, the Great Towns, London and Leyton; and on page 18 is a summary of the annual vital statistics of Leyton over a period of fifty years. Infectious Diseases. As recently as the year 1930 there were as many as 138 cases of smallpox in Leyton; but for the last 18 years the Borough has been quite free from smallpox. Enteric fever is now so firmly under control that no death has been caused by it for eight years. An even more remarkable achievement is that during 1951 no infant in Leyton died from diarrhoea and enteritis. 4 The only case of diphtheria notified during the year was a very mild infection in a child who had never been immunised. Scarlet fever continues to be of the prevalent mild type. Measles not only continued its epidemic prevalence of the last three years, but established a new high record of incidence since the disease became notifiable in 1940. Although the incidence of whooping cough was not so great as in the previous year, it was sufficiently widespread to cause much invalidity. It is, however, encouraging to be able to report that in this area there has been no death due to whooping cough for three years. On page 88 will be found information regarding the progress of the investigation (dealt with in my last two Annual Reports) being carried out in this area, in collaboration with the Medical Research Council, into the reliability of certain makes of whooping cough vaccines; followed by details of the scheme initiated for the protection of children against whooping cough. It is with relief that I am able to record that no case of poliomyelitis (infantile paralysis) was notified throughout 1951, this being the first year of complete freedom from poliomyelitis since 1945. Although there has been, as compared with the previous year, a decrease in the number of persons notified to be suffering from tuberculosis, there has been an increase in deaths due to tuberculous infection. Sanitary Circumstances. The provision of adequate housing is undoubtedly one of the most important of the many problems to be dealt with by local sanitary authorities. Much of the house property in Leyton, designed and built to accommodate one family, is now subdivided into two or more flats. Not only does such a state of affairs give rise to overcrowding, but to untold worry and grief owing to the compulsory sharing of household amenities. Another disquieting factor is the age and dilapidation of most of the dwellings in the area. Unfortunately Leyton is a built-up area, with few sites available for the erection of new houses; but it will not be possible to deal with the clearance of unfit areas under the provisions of the Housing Acts until dwellings are available for the rehousing of tenants from areas to be cleared. Of all conditions prejudicial to health, unfit housing is a prime contributory cause; and until adequate dwellings are 5 available, all other types of building should be subjected to some retardation. It has been wisely averred that the provision of hospital beds for tuberculosis is an expensive and unsatisfactory substitute for unhealthy dwellings. Increasing attention is devoted to the prevention of damage from rats and mice in private dwellings and business premises. In spite of organised baiting, there is still a large rat population in the sewers; and much of the trouble comes from undiscovered faulty connections to sewers and drains. The investigation of atmospheric pollution, in collaboration with the Department of Scientific and Industrial Research, continues to occupy the attention of the sanitary staff; and interesting information regarding the concentration of smoke and sulphur dioxide in the Leyton atmosphere is to be found on pages 47 to 50. As will be seen from the figures shown in the body of the report, a very great amount of food has again been condemned as unfit for human consumption. Whereas the amount condemned is an indication of the vigilance of your food inspectors in protecting the consumers from unsound food, it should be a matter for public reproach and investigation that so much good food should have to be wasted at a time when it is so scarce and so expensive. Following the coming into operation of the Leyton Corporation Act, 1950, it became necessary for all hairdressers and barbers to be registered by the Corporation. Byelaws now control not only the cleanliness of premises, utensils and equipment; but also the cleanliness of the persons and their clothing. Under the provisions of the new local Act of 1950 it also became possible to register and control hawkers of food and vendors of shell-fish. National Health Service Act, Part III. The comprehensive service under the various sections of this Act, although provided locally, are administered by Essex County Council in its capacity as Local Health Authority. The routine day-to-day administration of these services has been delegated to Leyton Health Area Sub-committee. In the relevant section of this report are to be found facts and figures required by the Ministry of Health and the County Council. 6 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 8 Extract from Vital Statistics for the year 1951. Population 104,700 Live Births:— Legitimate Males 655 Females 603 Illegitimate Males 29 Females 24 Totals 1,311 Birth Rate per 1,000 of population 12.52 Stillbirths:— Males 16 Females 15 Rate per 1,000 total (live and still) births 23.1 Deaths:— Males 696 Females 666 Totals 1,362 Death Rate per 1,000 13.00 Number of women dying from diseases and accidents of pregnancy and childbirth:— From Sepsis 0 From other causes 3 Rate per 1,000 total (live and still) births 2.24 Death rate of infants under one year of age:— All infants per 1,000 live births 20.59 Legitimate infants per 1,000 legitimate live births 19.07 Illegitimate infants per 1,000 illegitimate live births 56.60 9 TABLE 1. Birth-rate, Death-rate and Analysis of Mortality During the Year 1951 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 15.5 0.36 12.5 0.00 0.00 0.31 0.61 0.01 0.00 0.38 1.4 29.6 ... ... ... ... 126 County Boroughs and Great Towns, including London 17.3 0.45 13.4 0.00 0.00 0.37 0.65 0.01 0.00 0.36 1.6 33.9 ... ... ... ... 148 Smaller Towns. Estimated Resident Populations 25,000 to 50,000 at Census, 1931 16.7 0.38 12.5 0.00 0.00 0.31 0.63 0.01 0.00 0.38 1.0 27.6 ... ... ... ... London 17.8 0.37 13.1 0.00 0.00 0.38 0.61 0.01 0.00 0.23 0.7 26.4 ... ... ... ... LEYTON 12.52 0.29 13.0 0.00 0.00 0.38 0.77 0.00 0.00 0.20 0.00 20.59 80.5 3.1 16.3 ... 10 TABLE 2. Registered Births, 1951. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Total. January 7 6 1 3 8 2 2 4 3 5 41 February 1 6 ... 3 8 3 5 1 2 2 31 March 5 7 3 1 4 3 2 3 4 5 37 April 2 6 5 1 4 2 1 2 2 4 29 May 3 2 2 5 6 3 3 4 3 2 33 June 5 4 7 6 8 6 6 2 1 2 47 July 5 3 4 1 8 4 4 1 1 2 33 August 1 5 2 4 2 3 1 2 6 5 31 Sepetember 4 4 3 1 9 2 2 2 ... 3 30 October 2 4 ... 2 7 4 2 4 4 1 30 November 3 ... 1 ... 11 6 3 3 2 ... 29 December 1 3 1 ... 5 1 3 3 2 7 26 Transferables 74 158 81 66 166 113 67 73 70 46 914 Totals 113 208 110 93 246 152 101 104 100 84 1,311 12 TABLE 3. CAUSES OE DEATH AT DIFFERENT PERIODS OF LIFE IN THE BOROUGH OF LEYTON, 1951. 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 26 ... ... ... ... 1 4 5 7 4 4 1 8 4 F 9 ... ... ... ... 2 2 5 ... ... ... 1 1 Tuberculosis, other M 4 ... ... ... 1 ... ... 1 2 ... ... ... 4 1 F 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... Syphilitic disease M 7 ... ... ... ... ... ... 1 ... ... 4 2 2 3 F 1 ... ... ... ... ... ... ... ... ... 1 ... 2 ... Diphtheria M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping cough M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Meningococcal infection M 2 2 ... ... ... ... ... ... ... ... ... ... ... 1 F ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Poliomyelitis M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 2 1 ... 1 ... ... ... ... ... ... ... ... ... ... Other infective and parasitic diseases M 2 ... ... 1 ... ... ... ... ... ... ... 1 2 ... F 4 ... ... ... ... ... 1 ... 1 1 ... 1 1 ... Malignant neoplasm, stomach M 18 ... ... ... ... ... ... ... 2 6 6 4 29 7 F 17 ... ... ... ... ... ... ... ... ... 7 10 10 5 Malignant neoplasm, lung, bronchus M 33 ... ... ... ... ... ... 2 7 12 10 2 38 9 F 14 ... ... ... ... ... ... ... 4 1 6 3 3 6 Malignant neoplasm, breast M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 14 ... ... ... ... ... ... ... 2 5 2 5 20 8 Malignant neoplasm, uterus M ... ... ... ... ... ... ... ... ... ... ... ... ... ... F 4 ... ... ... ... ... ... ... 1 2 1 ... 5 2 Other malignant and lymphatic neoplasms M 71 ... ... ... 1 ... ... 3 7 15 26 19 60 25 F 55 ... ... 1 1 ... ... ... 11 8 15 19 56 19 Leukaemia, aleukaemia M 2 ... ... ... 1 ... ... ... ... 1 ... ... 7 ... F 3 ... ... ... ... ... ... ... 1 1 1 ... 6 2 13 Diabetes M 1 ... ... ... ... ... ... ... ... ... 1 ... 2 1 F 4 ... ... ... ... ... ... ... ... 2 ... 2 3 ... Vascular lesions ofnervous system M 50 ... ... ... ... ... ... ... 1 8 18 23 88 24 F 64 ... ... ... ... ... ... ... 3 9 18 34 114 31 Coronary disease, angina M 83 ... ... ... ... ... ... ... 6 27 28 22 48 16 F 47 ... ... ... ... ... ... 2 2 6 17 20 26 11 Hypertension with heart disease M 31 ... ... ... ... ... ... ... 2 2 18 9 39 12 F 27 ... ... ... ... ... ... ... ... 6 9 12 52 16 Other heart disease M 108 ... ... ... ... 1 ... 1 4 5 23 74 78 38 F 168 ... ... ... ... ... 2 2 3 6 37 118 141 46 Other circulatory disease M 17 ... ... ... ... ... ... ... ... ... 9 8 45 16 F 16 ... ... ... ... ... 1 ... 1 3 4 7 63 14 Influenza M 11 ... ... ... ... ... ... ... ... 2 7 2 1 ... F 10 ... ... 1 ... ... ... 1 ... ... 3 5 2 1 Pneumonia M 34 3 ... 1 1 ... ... 2 2 4 11 10 81 21 F 45 1 ... ... ... 1 2 2 1 1 15 22 71 19 Bronchitis M 78 ... ... ... ... ... ... 1 10 14 25 27 73 23 F 62 ... ... ... ... ... 1 1 2 5 19 33 32 8 Other diseases of respiratory system M 7 ... ... ... ... ... ... 1 1 2 1 2 7 1 F 8 ... ... ... ... ... ... ... 2 2 2 2 9 3 Ulcer of stomach and duodenum M 12 ... ... ... ... ... ... 1 1 2 6 2 24 6 F 12 ... ... ... ... ... ... 2 ... 2 5 3 9 5 Gastritis, enteritis and diarrhoea M 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... F 8 ... ... ... ... ... ... 1 1 1 3 2 1 ... Nephritis and nephrosis M 6 ... ... 2 1 ... ... ... ... 2 ... 1 ... 1 F 3 ... ... ... ... 1 ... ... 1 ... ... 1 1 1 Hyperplasia of prostate Pregnancy, childbirth, abortion M 10 ... ... ... ... ... ... ... ... ... 3 7 16 3 F 3 ... ... ... ... ... 2 1 ... ... ... ... 3 ... Congenital malformation M 7 3 1 1 1 ... 1 ... ... ... ... ... 3 ... F 5 2 l ... 1 ... ... l ... ... ... ... 3 1 Other defined and ill-defined disease M 55 9 ... 1 2 1 2 2 7 7 13 11 44 21 F 41 5 ... 1 1 2 ... 3 4 5 10 10 59 17 Motor vehicles accidents M 7 ... ... ... 1 2 1 1 ... ... ... 2 3 3 F 3 ... ... ... ... 2 ... 1 ... ... ... ... 2 ... All other Accidents M 9 ... ... ... ... 1 ... 3 1 ... 1 3 7 1 F 11 ... ... ... ... ... 2 ... ... ... ... 9 7 6 Suicide M 4 ... ... ... ... ... ... 2 ... 1 1 ... 2 2 F 5 ... ... ... ... ... 1 2 1 1 ... ... 1 3 Totals M 696 27 3 10 12 13 22 47 107 181 390 550 1,421 461 F 666 14 TABLE 4. DEATHS IN WARDS, 1951 CAUSES OF DEATH. Leyton. Lea Bridge. Central North. Central South. Forest. Levtonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. 1 2 3 4 5 6 7 8 9 10 11 Tuberculosis respiratory 4 7 2 2 5 2 3 4 4 2 Tuberculosis, other ... 2 1 ... ... ... 1 1 ... ... Syphilitic disease 1 3 2 ... ... ... ... 2 ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... ... ... ... ... ... Meningococcal infection ... ... ... ... ... ... 1 1 ... ... Acute poliomyelitis ... ... ... ... ... ... ... ... ... ... Measles ... ... 2 ... ... ... ... ... ... ... Other infective and parasitic diseases 1 ... 1 1 2 ... ... 1 ... ... Malignant neoplasm, stomach 3 3 1 3 9 6 7 2 1 ... Malignant neoplasm, lung, bronchus 6 9 3 1 7 7 3 6 3 2 Malignant neoplasm, breast ... 4 1 ... 2 3 ... ... 4 ... Malignant neoplasm, uterus ... ... 1 ... 1 1 1 ... ... ... Other malignant and lymphatic neoplasms 10 25 8 13 15 17 6 13 9 10 Leukamia, aleukaemia ... ... ... ... 2 1 1 ... ... ... Diabetes ... ... 1 ... 1 1 ... 1 1 ... Vascular lesions of nervous system 9 15 9 13 17 16 10 7 13 5 Coronary disease, angina 11 21 9 19 27 11 7 7 13 5 Hypertension with heart disease 2 8 4 6 15 7 1 5 6 4 Other heart disease 18 25 15 31 43 40 23 29 35 17 Other circulatory disease 2 3 3 2 7 4 2 3 5 17 Influenza 1 2 2 2 3 3 3 2 2 1 Pneumonia 5 21 6 8 11 6 7 1 10 4 Bronchitis 12 25 9 13 20 12 18 6 11 14 Other diseases of respiratory system ... 2 ... 1 3 1 3 ... 2 3 Ulcer of stomach and duodenum 2 5 1 1 4 4 1 1 4 1 Gastritis, enteritis and diarrhoea 1 4 ... 2 ... 1 ... 1 ... Nephritis and nephrosis 2 ... ... 3 1 1 ... 1 1 ... Hyperplasia of prostate ... 2 3 ... 1 1 ... 1 1 1 Pregnancy childbirth, abortion 1 ... ... ... 2 ... ... ... ... ... Congenital malformation ... 1 1 ... 3 3 1 3 ... ... Other defined and ill-defined diseases 4 21 6 5 21 13 5 7 9 5 Motor vehicles accidents 1 3 ... ... 3 ... 1 1 ... 1 All other accidents ... 2 1 4 7 2 ... ... 4 ... Suicide 2 1 ... 2 3 1 ... ... ... ... Totals 98 214 92 132 235 163 106 105 140 77 15 16 TABLE 5. Vital Statistics of Whole District during 1951 and Previous Years. Year. Births. Total Deaths Beoistered in the Borough. Transferable Deaths Nett Deaths belonging to the Borough. Inward Transferables Nett. of Nonresidents registered in the Borough. of Besidents not registered in the Borough. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 3 4 5 6 7 8 9 10 11 12 13 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 193S 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 1951 914 1311 12.52 2503 23.9 1427 286 27 20.59 1362 13.00 17 TABLE 6 Infantile Mortality, Year 1951—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 ... ... ... ... ... ... ... 1 ... 1 Scarlet fever ... ... ... ... ... ... ... ... ... ... Whooping cough ... ... ... ... ... ... ... ... ... ... Diphtheria and croup ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Tuberculous meningitis ... ... ... ... ... ... ... ... ... ... Abdominal tuberculosis ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... ... ... 1 Pneumonia (all forms) 2 1 ... ... 3 1 ... ... ... 4 Diarrhoea ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth 3 ... ... ... 3 ... ... ... ... 3 Atelectasis 2 ... ... ... 2 ... ... ... ... 2 Congenital malformations 1 ... ... ... 1 1 3 ... ... 5 Premature birth 7 ... ... ... 7 ... ... ... ... 7 Atrophy, debility and marasmus ... ... ... ... ... ... ... ... ... ... Other causes ... 1 ... ... 1 1 1 ... 1 4 Totals 15 2 ... ... 17 4 4 1 1 27 Ndt Births registered during Legitimate 1,258 Nett Deaths registered during Legitimate infants 24 the calendar year Illegitimate 53 the calendar year Illegitimate infants 3 18 TABLE 7. Comparative Statistics of Births, Mortality, Etc. LEYTON, 1901-1951. 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 d121420* 1917 b125352* 2005 16.0 1414 12.6 172 85.8 d112452* 1918 b125352* 1791 14.3 1723 15.3 161 89.9 d112452* 1919 b129062* 2195 17.0 1397 11.3 154 70.16 B123896 1920 128832* 3168 24.6 1330 10.3 207 65.34 1921 128432 2679 20.86 1290 10.04 182 67.94 1922 131600 2416 18.36 1420 10.79 155 64.16 1923 132800 2328 17.53 1228 9.25 106 45.53 1924 133500 2101 15.74 1325 9.92 110 52.36 1925 132700 2091 15.76 1349 10.16 114 54.51 1926 130000 2022 15.55 1261 9.7 131 64.79 1927 128920 1826 14.16 1322 10.25 80 43.81 1928 130300 1853 14.22 1290 9.90 91 49.10 1929 128300 1731 13.49 1510 11.76 100 57.77 1930 128300 1757 13.69 1222 9.52 81 46.09 1931 128600 1812 14.09 1365 10.61 71 39.18 1932 127140 1666 13.10 1341 10.54 89 53.43 1933 125700 1499 11.91 1468 11.67 76 50.70 1934 123430 1454 11.78 1317 10.67 64 44.02 1935 121690 1493 12.26 1225 10.06 60 40.18 1936 119900 1421 11.85 1272 10.61 74 52.07 1937 118100 1420 12.02 1349 11.42 75 52.81 1938 117200 1509 12.87 1148 9.79 70 46.38 B116100* 1939 d110800* 1499 12.90 1242 11.21 46 31.65 1940 96500 1353 14.02 1563 16.2 50 39.03 1941 84790 1129 13.31 1142 13.46 37 38.30 1942 86960 1452 16.69 1123 12.91 73 50.27 1943 87880 1595 18.14 1248 14.20 97 35.73 1944 85440 16l3 18.87 1285 15.04 08 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 1951 104700 1311 12.52 1362 13.00 27 20.59 *Population as estimated for purposes of b, Birth Rate, d, Death Rate. Infectious Diseases 20 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Table showing the number of notified cases of infectious diseases and their disposal. Disease. Notifications Received. Removed to Hospital. Smallpox ... ... Diphtheria 1 1 Erysipelas 52 5 Scarlet Fever 166 35 Pemphigus Neon ... ... Tuberculosis Pulmonary 100 33 Tuberculosis other forms 14 12 Pneumonia 372 119 Ophthalmia Neon ... ... Typhoid Fever 1 1 Paratyphoid Fever 2 2 Puerperal Pyrexia 16 15 Meningococcal infection 3 3 Poliomyelitis Paralytic ... ... Poliomyelitis Non-Paralytio ... ... Acute Encephalitis Infective ... ... Acute Encephalitis Post Infectious ... ... Measles 1,540 29 Whooping Cough 593 12 Dysentery 56 16 Food Poisoning 57 17 2,973 300 21 SMALLPOX. During the first year of my tenure of office as Medical Officer of Health, there were in Leyton seven persons suffering from smallpox ; and two years afterwards, in the year 1930, there were as many as 138 cases of smallpox in the Borough. Since 1933—some 18 years ago—Leyton has been quite free from smallpox. It is now so rare that the occurrence of but one case would not only mobilise the resources of the whole public health department, but would no doubt be the cause of headlines in the local press and something akin to panic in the town. During these 18 years of freedom from smallpox, cases of virulent Asiatic smallpox have gained entrance to this country, and many close contacts of these cases have been kept under close supervision in Leyton. The fact that recent epidemics of smallpox in this country have been stamped out at once does not find its way into the public press, because the prevention of disease—even although it requires close vigilance from day to day—is not "news". ENTERIC FEVER. Enteric Fever, one of the great killing infectious diseases of a generation ago, is now not only rare, but mild. Last year there were three Leyton residents found to be suffering from enteric fever (one from true typhoid, and two from paratyphoid), of whom all made good recoveries. In the last eight years there has been no death from enteric fever; but in the same period fifty years ago that disease killed 103 Leyton residents. About the same period Diarrhœa and Enteritis used to kill Leyton children under five at the rate of over 100 a year ; but it has now been brought under control to such an extent that no death is attributable to that cause in the year under review. DIPHTHERIA. Year. Cases Notified. Deaths. Case Fatality, per cent. 1942 39 0 0.00 1943 28 1 3.57 1944 21 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 1951 1 0 0.00 22 Diphtheria, formerly one of the chief causes of death and lifelong disability and a severe drain on public expenditure, has responded so well to active measures of prevention by immunisation that it has recently become a clinical rarity. During my first year (1928) in Leyton there were 346 cases, of whom 18 died. The Leyton Council's arrangements for diphtheria prevention by immunisation were put into operation in February, 1935, and five years afterwards (in the year 1940) it was possible to report—for the first time in the history of the disease—that no child had died among the 55 who had contracted the disease during that year. The second milestone on the road to diphtheria prevention was reached in 1949 when I was able to report that, for the first time in the Borough's history, not a single case of diphtheria had occurred. Last year (1950) I had the pleasure of recording a second successive year in which no confirmed case had been notified. Unfortunately I am unable to do "the hat trick" by recording a third clear year in succession, for a girl of seven years spoiled the sequence by developing clinical diphtheria in 1951. Unlike the majority of children of her age, she had never been immunised against diphtheria. The infection was mild, was not confirmed bacteriologically, and the patient made an uninterrupted recovery; in fact there might have been some justification for regarding it as a case of tonsillitis, but the presence of a small patch of typical membrane on the throat was sufficient on which to make a diagnosis of clinical diphtheria. It is indeed a welcome turn in the tide of diphtheria incidence when one case of such mildness can be of such statistical significance. Information regarding Immunisation against Diphtheria is to be found on page 87. SCARLET FEVER. Year No. Notified. Deaths. Case Fatality, per cent. 1942 318 0 0.00 1943 386 0 0.00 1944 110 0 0.00 1945 312 0 0.00 1946 201 0 0.00 1947 221 0 0.00 1948 160 1 0.62 1949 151 0 0.00 1950 219 0 0.00 1951 166 0 0.00 23 Scarlet Fever is still with us, and there occurred last year some 166 cases, of whom it was found necessary to remove only 35 to hospital. The mild type of scarlet fever now prevalent has caused only one death in Leyton in the last ten years. In the same period at the end of last century the very virulent type of the disease accounted for some 118 Leyton deaths. MEASLES. Year. No. Notified Removed to Hospital Deaths. 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 1951 1,540 29 2 Of the 1,540 cases notified during 1951, some 29 were removed to hospital; and of these, two children (aged seven months and three years) died of broncho pneumonia following measles. WHOOPING COUGH. Year. No. Notified. Removed to Hospital. Deaths. 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 1951 593 12 0 Of the 593 children who developed whooping cough during the year, 12 had to be removed to hospital. For the third year in succession there was no death due to whooping cough. Further information regarding Protection against Whooping Cough will be found on page 88. 24 MENINGITIS. Three persons were notified to be suffering from meningococcal infection; and were admitted to hospital. As the result of a post mortem examination by H.M. Coroner, one infant (aged ten months) was found to have died from acute meningococcal infection. TUBERCULOSIS. Notifications.—One hundred and fourteen patients were notified for the first time in 1951 as suffering from tuberculosis. The number was made up as follows:— Males. Females. Total. Pulmonary Tuberculosis 47 53 100 Non-Pulmonary Tuberculosis 6 8 14 53 61 114 The following is a statement of particulars appearing in the Register of Notifications of Cases of Tuberculosis for the year ended 31st December, 1951:— Pulmonary. Non-Pulmonary. TOTAL M. F. Total. M. F. Total. Number on Register at commencement of year 410 300 710 28 46 74 784 Number first notified during the year 47 53 100 6 8 14 114 Number of cases entered in Register otherwise than by Notification 7 9 16 2 3 5 21 Number removed from the Register during the year 58 22 80 9 7 16 96 Number remaining at the end of the year 406 340 746 28 49 77 823 Details of cases removed from the Register during the year:— Died 29 10 39 2 1 3 42 Removed from the dis¬* trict 21 6 27 3 3 6 33 De-notified 8 6 14 4 3 7 21 25 Deaths.—Forty 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 3 1 2 1 5 3 1 ... 2 10 1 2 ... ... 15 2 8 2 ... 20 4 8 1 3 25 12 8 ... 2 35 6 8 ... ... 45 5 10 ... ... 55 4 4 1 ... 65 and upwards 7 2 ... ... Totals 47 53 6 8 Statistical Summary. The following tables have been compiled to show the annual numbers of new cases and deaths over a period of ten years. 26 TUBERCULOSIS. NOTIFICATIONS. Year. Pulmonary. Non-Pulmonary. Total. M. F. Total. M. F. Total. 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 1951 47 53 100 6 8 14 114 DEATHS. Year. Pulmonary. N on-Pulmonary. Total. M. F. Total. M. F. Total. 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 1951 26 9 35 4 1 5 40 27 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1951. DISEASE. Total. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonetone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Removed to Hospitals. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 1 ... ... ... ... ... 1 ... ... ... ... 1 Erysipelas 52 1 3 3 18 6 12 5 1 3 ... 5 Scarlet Fever 166 17 18 10 25 32 15 10 16 11 12 35 Pemphigus Neon ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis Pulmonary 100 9 12 8 8 15 14 7 11 10 6 33 Tuberculosis other forms 14 ... 3 1 ... 4 2 1 1 ... 2 12 Pneumonia 372 6 31 21 80 126 71 21 11 3 2 119 Ophthalmia Neon ... ... ... ... ... ... ... ... ... ... ... ... Typhoid Fever 1 ... ... ... ... 1 ... ... ... ... ... 1 Paratyphoid Fever 2 ... ... ... ... 2 ... ... ... ... ... 2 Puerperal Pyrexia 16 ... 2 1 1 8 2 ... 2 ... ... 15 Meningococcal Infection 3 ... ... ... ... 2 ... ... 1 ... ... 3 Poliomyelitis Paralytic ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis Non-Paralytic ... ... ... ... ... ... ... ... ... ... ... ... Acute Encephalitis Infective ... ... ... ... ... ... ... ... ... ... ... ... Aoute Encephalitis post infectious ... ... ... ... ... ... ... ... ... ... ... ... Measles 1540 134 282 158 150 134 165 77 128 163 149 29 Whooping Cough 593 36 85 40 41 178 86 26 33 22 46 12 Dysentery 56 2 4 1 ... 15 5 4 8 6 11 16 Food Poisoning 57 1 8 ... 1 13 4 3 8 7 12 17 Totals 2973 206 448 243 324 536 377 154 220 225 240 300 28 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1951. 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 1 ... ... ... 1 ... ... ... ... ... Erysipelas 52 ... ... ... ... ... 1 17 19 15 Scarlet Fever 166 1 14 34 104 11 ... 1 1 ... Pemphigus Neon ... ... ... ... ... ... ... ... ... ... Tuberculosis Pulmonary 100 1 1 3 4 3 22 34 23 9 Tuberculosis other forms 14 ... 1 2 2 ... 6 2 1 ... Pneumonia 372 20 29 37 45 5 12 65 82 77 Ophthalmia Neon ... ... ... ... ... ... ... ... ... ... Typhoid Fever 1 ... ... ... ... ... ... ... ... 1 Paratyphoid Fever 2 ... ... ... ... ... 2 ... ... ... Puerperal Pyrexia 16 ... ... ... ... ... 5 11 ... ... Meningococcal Infection 3 2 1 ... ... ... ... ... ... ... Poliomyelitis Paralytic ... ... ... ... ... ... ... ... ... ... Polimyelitis Non-Paralytic ... ... ... ... ... ... ... ... ... ... Acute Encephalitis Infective ... ... ... ... ... ... ... ... ... ... Acute Encephalitis post infectious ... ... ... ... ... ... ... ... ... ... Measles 1540 48 363 560 536 18 11 4 ... ... Whooping Cough 593 47 146 235 156 6 2 1 ... ... Dysentery 56 2 11 10 12 7 3 8 2 1 Food Poisoning 57 9 6 5 7 3 5 14 5 3 Totals 2973 130 572 886 867 53 69 157 133 106 General GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. NATIONAL ASSISTANCE ACT, 1948. INQUESTS AND CORONER'S POST MORTEMS. PUBLIC MORTUARY. LICENSED ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT. 30 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. 1. Public Health Officers of the Authority. Medical. In July, 1951, Leyton Health Area Sub-committee recommended that an additional post of Assistant Medical Officer be created having regard to:— (a) The opening of the Essex County Health Services Clinic, Dawlish Road. (b) The increased medical duties resulting from the raising of the school leaving age. (c) The rise which took place in the birth rate during 1946/47 ; the children born in these years will be entering school. (d) The need for providing adequate medical supervision at Capworth Street Junior Occupation Centre. (e) Additional individual medical attention to pupils at the Harrow Green Special School. (/) The desirability of the medical staff attending the Paediatric Department of Whipps Cross Hospital. (g) The advisability of arranging the medical inspection of the older students at the two local grammar schools. (h) Reducing the number of sessions then undertaken by temporary part-time doctors in carrying out routine medical work connected with the Health Services for children up to the age of 15 years. Leyton Health Area Sub-committee recommended to the County Health Committee that such an additional post be created, and this recommendation was agreed by the County Council at their meeting on 2nd October, 1951. It was not until March, 1952, that the newly appointed Assistant County Medical Officer, Dr. Shirin Dastur, M.R.C.S., L.R.C.P., commenced duty. Dental. No major changes took place in the staff of dental officers during the year. During May the Emergency Committee of the County Council approved the appointment of an Oral Hygienist to undertake duty in the Leyton Area ; and Miss Jill Watts, who holds the 31 Ministry of Health Certificate in Oral Hygiene, commenced duty on 15th May, 1951. Since that time, under the direction of the Area Dental Officer, Miss Watts has been occupied with dental scaling and cleaning, and with hygiene instruction to patients attending the dental clinics. A certain amount of topical application of fluorine to the teeth of the sound mouths of the school entrant group has also been carried out. Nursing. During the year two members of the health visiting staff, viz., Miss J. Haining and Miss K. Greene, resigned to take up appointments in other areas. Miss M. Murray commenced duty in February; and Miss B. King, formerly a tuberculosis visitor in the area, resumed duty in September, 1951, after having successfully passed the Health Visitors' examination. Mrs. I. E. Tate, a midwife employed in the Area, resigned her appointment as from the 30th September, 1951. Having regard to the fall in the birth rate and the number of domiciliary confinements, the Health Area Sub-committee adopted my recommendation that the position be not filled at the present time. Clerical. In June the County Council approved the establishment of administrative and clerical staffs (excluding clinic clerks) recommended by Leyton Health Area Sub-committee:— Grade No. of Posts A.P.T. VI 1 „ IV 1 „ II 2 Clerical Div. 2 General Div 7 Three of the General Division posts will not be filled until the Health Committee is satisfied that the volume of work in the Area warrants that course. At subsequent meetings of the Leyton Health Area Staff Subcommittee, appointments were made as follows:— A.P.T. VI Mr W. D. Softley ,, IV Mr. E. E. Jacobs ,, II Mr. E. R. Price ,, II Mr. L. C. Goodbun 32 Clerical Division Mr. G. A. Thurlow ,, ,, Mr. E. E. Lamb General Division Mr. A. D. Keeys ,, „ Mr. K. Cockling „ „ Miss E. M. Beckley ,, ,, Mrs. F. Wright The General Purposes Committee agreed to the variation of provisional establishments of staff in the Leyton Health Area by the creation of a post of Domestic Help Organiser in Grade A.P.T.I. Mrs. E. L. Saxby, Acting Domestic Help Organiser, was appointed to this post. 2. Laboratory Facilities. (а) Pathological Department, Whipps Cross Hospital, E.ll. For pathological specimens. (б) Central Public Health Laboratory, Colindale. For special bacteriological investigations; supply of lymph for vaccination; supply of diphtheria toxin (A.P.T.). (c) Counties Public Health Laboratories, Queen Victoria Street, London. For bacterial and chemical examination of water, milk and other foods. (d) Public Analysts, Analytical Laboratory, 20, Eastcheap, E.C.3. For analysis under provisions of Food and Drugs Act, 1938. 3. Ambulance Facilities. In July, 1948, the County Council became responsible for the provision of ambulance facilities in the area. The service is now administered centrally from Chelmsford, the vehicles and staff being accommodated at the Ambulance Depot in Auckland Road. (Telephone LEY 6077/8.) 4. Hospitals. The following hospitals, administered by the Leytonstone (No. 10) Group Hospital Management Committee on behalf of 33 London N.E. Regional Hospital Board, are situated within the Borough of Leyton. (a) Whipps Cross Hospital. Accommodation 846 beds. (b) Langthorne Hospital. Accommodation 700 beds. 5. Nursing Homes. There are in the Borough two Nursing Homes registered under the provisions of the Public Health Act, 1936. (1) 1, Queen's Road, Leytonstone. With accommodation for 22 patients. (2) "Brooklands," 22, Fairlop Road, Leytonstone. With accommodation for 23 patients. 6. Scabies Clinic. On 1st November, 1950, the Special Clinic at Ruckholt School was discontinued; and facilities are now available by arrangement with Walthainstow Corporation at the Walthamstow Skin Clinic, High Street, Walthamstow. During the year 1951 two Leyton residents attended for treatment, and each made three attendances. The following table shows how the number of Leyton patients has decreased since the special facilities became available in 1942. Year Cases Treated Total attendances for treatment Children Adults Total 1942 - - 303 1291 (10 mths.) 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 1951 2 ... 2 6 7. Clinics. There are in the Area three Essex Health Service Clinics:— Leyton Green Road, Leyton, opened September 1933. Granleigh Road, Leytonstone, opened September, 1935. Dawlish Road, Leyton, opened September 1951. 34 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 nine burials under this Section. Some Extracts from the Report of the Council's Delegates, Councillor H. E. Martin (Chairman, Public Health Committee) and Mr. G. F. Leserve. During the past twenty-two years the amount of land estimated to have been appropriated by local authorities for cemetery purposes has increased from 16,000 to 25,000 acres. During the same period the average loss to the local rates for each interment had increased from 18s. 9d. to £4 17s. 10d. despite the fact that charges made by the burial authorities for their services had increased by approximately 100 per cent, since 1928. The present three methods of control and administration (single authority, joint burial committee, joint crematorium board) are unsatisfactory in the case of, say, under 50,000 potential population. It was suggested therefore that the Minister should be approached with a view to promoting a General Powers Bill, by which local authorities could form Joint Crematorium Boards without the necessity for each to be an existing burial authority or having to go to the trouble of promoting a special Parliamentary Bill for the purpose. Centrally placed chapels of rest are essential in all large towns : and "public readings" or "mass burials" should be abolished. There was a striking increase in the number and proportion of cremations in Great Britain, as the following figures show:— CONFERENCE OF BURIAL AND CREMATION AUTHORITIES. Cremation Cremations Deaths Percentage 1925 2,270 539,000 0.4 1935 9,614 552,800 1.7 1945 43,000 544,600 8.0 1950 89,000 590,000 15.0 35 There was no doubt that there would be much more cremation if there were more crematoria. To-day, throughout the country, municipal cemeteries covered more than 25,000 acres. The lack of land in and immediately around our towns and cities, and the urgent claims of housing, industries, schools, playing fields and other open spaces made it more than ever urgent that some check should be placed on the spread of cemeteries. There were 16 crematoria in Great Britain in 1925. In 1935 there were 29; in 1945 there were 58; and still only 58 in 1950. All new crematoria authorised since the war are municipally owned. LICENSED ESTABLISHMENTS FOR THE ADMINISTRATION OF MASSAGE OR SPECIAL TREATMENT. Council's Byelaw Prescribing Technical Qualifications. Essex County Council Act, 1933—Part IV; Section 58. Since the date of the passing of the above Act it has been illegal for any person to carry on an establishment for massage or special treatment in the area without a licence from the Council ; and your Council has designated me as the person authorised by Section 61 of the Act to enter and inspect premises. In September, 1934, your Council made Byelaws for the regulation of establishments; but these Byelaws did not prescribe the technical qualifications to be possessed by persons administering any of the forms of special treatment, which include:— (a) Massage, manicure or chiropody; (b) Radiant heat, light, electric, vapour or baths for therapeutic treatment; or (c) Other similar treatment. Under Section 58 of the Act the Council may refuse to grant or renew a licence in respect of any establishment in which massage or special treatment is or may be administered by any person who does not possess "such technical qualifications as may be reasonably necessary" ;but there has been laid down no standard by which the many and varied types of qualifications could be judged. The Board of Registration of Medical Auxiliaries (Incorporated 1936) prescribes not only the course of training, but also the examination standard to be possessed by candidates for approved certificates and diplomas, and publishes the official National Register of Medical Auxiliary Services containing the names, 36 addresses and qualifications of persons holding Approved Qualifications in medical auxiliary work. In March, 1939, in order to safeguard against the exploitation of specialised forms of medical auxiliary work by persons of inadequate training, I recommended that licences be granted only to persons possessing technical qualifications recognised and approved by the Board of Registration of Medical Auxiliaries; and your Council instructed the Town Clerk to draft a Byelaw giving effect to these suggestions. The draft Byelaw was subsequently approved by your Council, and thereafter the statutory notice of the Council's intention to frame the Byelaw was duly given. As no objection to the Council's intention was received, the Byelaw was adopted by the Council and subsequently confirmed by the Secretary of State for Home Affairs in December, 1940. Leyton Council Byelaw prescribing Technical Qualifications:— "No person shall administer massage or special treatment at any establishment within the Borough of Leyton, licensed under Part IV of the Essex County Council Act, 1933, unless such person possesses appropriate qualifications in Medical Auxiliary work approved by the Board of Registration of Medical Auxiliaries as evidenced by the entry of that person's name in the National Register of Medical Auxiliary Services. Provided that this Byelaw shall not apply to any establishment licensed at the date of confirmation of this Byelaw until the expiration of two years from such date of confirmation." Practice in Other Areas. Although the power to make Byelaws prescribing technical qualifications is common to all Authorities possessing powers of control over these establishments, Leyton Corporation was the first and only Authority in the country to make a Byelaw prescribing technical qualifications. Board of Registration of Medical Auxiliaries The Board consider that certain safeguards are essential in the public interest:— (1) Definition of the field of Chiropody. (2) Agreement as to required standards of education and ethics. 37 and require from bodies applying for registration proof in regard to these points:— (а) That they have a system of education conforming to the standards laid down, with a curriculum covering a period of not less than two academic years; (б) That their system of examination is adequate ; (c) That their standards of ethics and discipline would ensure on the part of their members conformity with the regulations laid down as to the field of Chiropody. In my opinion these conditions are perfectly reasonable, and do not prejudice in any way persons who are prepared to undertake that amount of training which is considered to be the essential minimum to ensure that the public may have confidence in the ability of practitioners. Any Society or body of Chropodists who can prove to the satisfaction of the Board of Registration that these standards have been their rule and practice are eligible to apply for recognition, and the Board are prepared to carry out the necessary inspection. Bodies outside the Register are in that position because of their refusal to adopt the regulations deemed necessary by the Board for the protection of the public. 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 67 Suicide 7 Accidents 6 80 Number of Post-mortem examinations performed 80 In 67 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:— Coronary thrombosis 15 „ occlusion-atheroma 14 38 Myocardial degeneration 4 Mitral stenosis 1 „ insufficiency 2 Myocardial infarction 2 Ruptured aortic aneurysm—specific 1 „ cerebral aneurysm 2 Bronchitis 2 Pneumonia 6 Perforated gastric ulcer 3 Hypertension 6 Phlebo-thrombosis 2 Cellulitis leg 1 Strangulated hernia 1 Carcinoma 1 Pulmonary tuberculosis 1 Stillborn 1 Birth injury 1 Ruptured tubal ectopic pregnancy 1 INQUESTS. The following verdicts on Leyton residents were recorded at inquests held during the year:— Accidental. Knocked down by motor car 1 „ „ „ „ lorry 1 „ „ „ „ cycle 1 ,, ,, „ trolley-bus 1 Collision between motor car and lorry 2 Fall from motor cycle pillion 3 Overturned sports car 1 Crushed by electric train 1 ,, ,, railway trolley 1 Aeroplane crash 1 Carbon monoxide poisoning in form of coal gas— Escape from gas stove 3 Strychnine poisoning 1 Suffocation—face embedded in pillow 1 Fall from roof 1 Fractures—falls at home 10 39 Suicide. Coal-gas poisoning 6 Gun-shot wound 1 Aspirin poisoning 1 Sodium amytal poisoning 1 Open Verdict. Delayed narcotic poisoning 1 Natural Causes. Coronary occlusion 1 Circulatory failure associated with asbestosis 1 Intestinal obstruction (unmasticated piece of orange impacted in small intestine) 1 CORONER'S POST-MORTEMS. During the year 227 Leyton residents were subjected to postmortem examination by a Pathologist on the instructions of the Coroner. The findings at the post-mortem were:— Cancer of Stomach 1 „ Lung or Bronchus 5 ,, Gall Bladder 4 Colon 7 „ Larynx 1 ,, Rectum 3 ,, Oesophagus 2 „ Brain 1 „ Prostate 2 Pulmonary tuberculosis 6 Specific aortic aneurysm 6 Ac. Suppurative meningitis 1 Ac. Meningococcal meningitis 1 Pulmonary embolism 2 Pyelo-nephritis 2 Cerebral haemorrhage 9 Cerebral abscess 2 Ruptured developmental cerebral aneurysm 1 Coronary thrombosis 36 ,, atheroma 24 Cardiac failure due to hypertension 14 Myocardial degeneration 16 ,, infarction 2 40 Aortic stenosis 5 Mitral insufficiency 1 Von Gierke's disease ot heart 1 Arterio sclerosis 1 Phlebo thrombosis 6 Influenzal pneumonia 1 Ac. suppurative bronchitis 13 Broncho pneumonia 5 Lobar pneumonia 4 Chronic bronchitis 9 Ac. streptococcal pneumonitis 1 Pulmonary emphysema 1 Status asthmaticus 2 Gastric ulcer 12 Renal toxaemia—Ac. enteritis 1 Diverticulitis of colon 1 Myoadenomalosis of prostate 1 Enlargement of prostate 1 Coronary embolism following childbirth 1 Post partum haemorrhage 1 Status epilepticus 2 Hepatic necrosis 2 Strangulated hernia 3 Disseminated sclerosis 1 Aplastic anaemia 1 Adrenal haemorrhage 1 Post operative shock 1 Sanitary Circumstances of the Area 42 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 2,412 Miscellaneous inspections 651 Re-inspections 13,774 Places of entertainment 13 Schools 54 Stables 41 Urinals 5 Visits in connection with infectious diseases 358 Factories without mechanical power 89 Factories with mechanical power 393 Rag and bone dealers 8 Foster-mothers' premises 3 Hairdressers'premises 141 Public Houses 65 Offensive trades 3 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 637 Sashcords renewed 283 Plaster repaired 922 Roofs repaired or renewed 967 Guttering repaired or renewed 388 Yards paved 36 Drains relaid or partly relaid 51 Choked drains cleared 56 New w.c. pans and traps provided 60 Sinks provided 24 W.c. cisterns repaired or renewed 122 Rain water pipes repaired or renewed 233 Vent pipes repaired or renewed 39 Sink waste pipes repaired or renewed 73 Stoves repaired or renewed 278 Coppers repaired or renewed 8 43 Floors repaired 243 Rooms redecorated 954 Windows, sills, etc., repaired 423 Cement work to sink waste gullies repaired 25 Miscellaneous defects remedied 526 Drainage. The drains of 162 houses were reconstructed. In 111 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 90 90 Prevention of Damage by Pests Act, 1949. Complaints. The number of complaints received was higher than in the previous year, probably due to increased publicity given to the danger arising from rat and mouse infection. Every endeavour has been made to comply with the requirements of the Ministry of Agriculture and Fisheries, and an increased number of business premises were treated. There is still a large population of rats in the seweis; and a considerable amount of infestation, not definitely traced, comes from undiscovered faulty connections to sewers and drains. It is important that, where buildings are demolished, care should be exercised in seeing that all openings to the sewer are effectively sealed, thus preventing unnecessary trouble in later years. More education of the general public is needed on the danger to public health of food contamination by mice. Complaints received and investigated 525 Premises not treated (not genuine infestation) 76 Premises treated:— Rats Mice (a) Dwelling-houses 241 77 318 (b) Business premises 63 43 106 424 Premises freed 401 44 Sewer Maintenance Treatments. All seweis in the Borough were treated in July, 1951. Owing to a temporary shortage of staff, the second treatment in December, 1951, was abandoned, with the consent of the Ministry of Agriculture and Fisheries, when two-thirds completed. 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 1,192 269 840 70.47 2nd Treatment 786 159 588 74.81 HOUSING. Complaints. During the year 1,880 complaints were received and investigated. The nature of the complaints included sanitary defects in houses, drains choked or defective, premises infested with vermin, etc. Figures in themselves cannot give a true picture of the amount of benefit derived from compliance with notices issued. To get this it has to be borne in mind that in each case some undesirable condition has been rectified, oi some improvement effected in the home. Until more houses for occupation become available, it is not possible to tackle the housing problem radically. Since 1939 the houses have aged, depreciated and fallen into disrepair; and the completion of war damage repairs from time to time has been the salvation of many dwellings that would otherwise have become entirely unfit for human habitation. An important aspect of the housing situation, often overlooked, is that in Leyton a high percentage of dwelling-houses originally designed to house one family are now let in two or more flats, the result being that the tenants have to share the same amenities :—water supply, toilet facilities, scullery sink arrangements, washing accommodation and cooking facilities. Moreover, few houses have bathrooms or food cupboard accommodation, 45 consequently the moral outlook of the occupants—which plays an important part in the life of the individual, especially the child— is affected by the want of privacy and reasonable amenities. Notices. Notices served—Informal 1,405 Statutory—Housing Acts Nil Public Health Acts 644 Notices complied with—Informal 801* Statutory— Housing Acts Nil Public Health Acts 632* *This figure includes notices outstanding from previous year. Housing. Number of houses erected during the year:— (a) Total (including numbers given separately under (b) ). (i) By the Local Authority— Houses 47 Flats Nil Temporary housing Nil (ii) By other Local Authorities Nil (iii) By other bodies and persons- Houses 20 Flats Nil (6) With State assistance under the Housing Acts. (i) By the Local Authority— (а) For the purposes of Part V of the Act of 1936— Houses 47 Flats Nil Temporary housing Nil (б) For other purposes Nil (ii) By other bodies and persons Nil I —Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,412 (b) Number of inspections made for the purpose 16,186 46 (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 2 (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 1,405 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 801 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:— (а) By owners Nil (б) By Local Authority in default of owners Nil (б) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 644 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners 632 (б) By Local Authority in default of owners Nil 47 (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 Local Land Charges. Particulars with regard to outstanding sanitary notices, not fully complied with, were given in reference to 1,522 enquiries. Smoke Abatement. During the year 80 observations have been made on factory chimneys. Infringements were found in two instances, and letters of warning were issued in these cases. It was not found necessary to institute legal proceedings. Investigation of Atmospheric Pollution. A description of the procedure adopted for the systematic measurement of the concentration of atmospheric smoke and sulphur dioxide was given in my Report for 1950. Daily observations were begun in March, 1950; and have continued throughout 1951. The recording apparatus is installed at the Public Health Department, Sidmouth Road, Leyton. 48 The following tables show the results recorded during the twelve months ended 31st December, 1951, together with the corresponding figures for 1950 (with the exception of January and February):— CONCENTRATION OF SMOKE EXPRESSED IN MILLIGRAMS PER 100 CUBIC METRES. Month. Monthly average. Highest daily average. Lowest daily average. 1950 1951 1950 1951 1950 1951 January ... 40.4 ... 120.5 ... 10.9 February ... 38.0 ... 97.7 ... 17.7 March 44.3 35.8 127.4 154.1 10.1 11.9 April 24.6 16.6 39.1 37.1 13.8 4.7 May 11.8 12.2 30.8 45.9 0.5 2.0 June 5.6 3.5 9.5 7.7 1.1 0.4 July 5.7 4.2 11.7 9.7 2.4 0.5 August 6.4 6.2 9.8 10.5 3.4 3.3 September 8.9 8.5 20.0 16.9 3.3 0.6 October 24.8 28.3 57.8 82.6 9.3 5.7 November 36.5 32.3 92.9 73.3 15.2 11.6 December 47.4 48.9 102.7 172.7 14.1 12.5 CONCENTRATION OF SULPHUR DIOXIDE EXPRESSED AS PARTS PER 100 MILLION. Month. Monthly average. Highest daily average. Lowest daily average. 1950 1951 1950 1951 1950 1951 January ... 11.5 ... 42.6 ... 4.9 February ... 9.4 ... 24.1 ... 4.1 March 10.2 7.3 28.9 21.4 3.5 2.7 April 5.6 3.9 11.0 9.7 1.8 0.7 May 1.7 1.7 4.7 4.7 0.1 0.2 June 2.0 1.5 4.4 3.5 0.2 0.5 July 2.2 1.7* 5.1 3.5* 0.5 0.2* August 2.9 2.6* 4.4 4.0* 1.4 1.2* September 3.0 3.9 5.9 7.2 0.6 0.7 October 6.3 8.3 14.4 18.8 2.7 2.0 November 9.5 9.5 20.0 16.0 3.9 4.6 December 12.6 11.4 21.8 38.2 4.5 3.5 * Estimated figures. It will be seen from the above tables that in seven out of the ten months for which comparative figures are available, the monthly average values of smoke were less in 1951 than in the previous year; 49 sulphur dioxide was less in six of the ten months. The average concentration of smoke for the ten months ended December, 1950, was 21.6 milligrams per 100 cubic metres, whilst the figure for the same period in 1951 was 19.6. This amounts to a reduction in smoke pollution of 9.3 per cent. A reduction in the average concentration of sulphur dioxide also occurred, amounting to 7.5 per cent. It is probable that the reduced pollution was largely attributable to weather conditions. The sulphur dioxide figures for July and August, 1951, had to be estimated owing to a fault in the apparatus which affected the results. An alternative method of measuring the amount of sulphur dioxide in the air is by the exposure of a cylinder coated with lead peroxide, a material which readily absorbs sulphur dioxide. In order to assist the Department of Scientific and Industrial Research in its examination of this method, a lead-peroxide instrument was installed early in 1951 in close proximity to the existing inlet point of the volumetric apparatus at Sidmouth Road, Leyton, thereby enabling a comparison of the two methods to be made. The instrument was provided and is maintained by the Department of Scientific and Industrial Research. Two other lead-peroxide instruments have been installed in the Borough during the year; both are situated in the Lea Bridge area. The following graphs show the annual variations of smoke and sulphur dioxide in Leyton compared with Central London:— 50 51 Legal Proceedings. (Public Health Act, 1936.) Action taken under the provisions of the Public Health Act, 1936, has resulted in 1,433 houses being brought up to a reasonable standard of fitness. Legal proceedings were found necessary in 19 instances, and the following is the result of such actions:— Non-compliance with Abatement Notice at:— 1. 10/1/51 11, Trinity Street Nuisance Order made (28 days). Two guineas costs. Non-compliance with Nuisance Order at:— 2. 10/1/51 142, Cann Hall Road £2 fine. £1 costs. 3. 10/1/51 138, Cann Hall Road £2 fine. £1 costs. 4. 28/2/51 11, Trinity Street £5 fine. £1 costs. 5. 28/2/51 8, Woodville Road £5 fine. £2 costs. Non-compliance with Abatement Notice at:— 6. 28/2/51 27, Florence Road Nuisance Order made (28 days). £2 costs. 7. 28/2/51 72, Cathall Road Nuisance Order made (28 days). £2 costs. 8. 2/5/51 73, Ferndale Road Nuisance Order made (seven days). 9. 2/5/51 30, Norman Road Nuisance Order made (seven days). One guinea costs. 10. 2/5/51 32, Norman Road Nuisance Order made (seven days). One guinea costs. 11. 11/7/51 6, Colchester Road Nuisance Order made (28 days). £2 fine. 12. 11/7/51 26, Brewster Road Nuisance Order made (56 days). 13. 11/7/51 47, Goodall Road Nuisance Order made (42 days). 14. 11/7/51 57, Browning Road Nuisance Order made (28 days). 15. 11/7/51 146, Wallwood Road Nuisance Order made (three months). 16. 7/11/51 70, Canterbury Road Case adjourned sine die. 17. 7/11/51 60, Trinity Street Case adjourned sine die. 18. 7/11/51 21, Frith Road Case adjourned sine die. 19. 12/12/51 33, Frith Road Nuisance Order made (28 days). One guinea costs. 52 INSPECTION AND SUPERVISION OF FOOD. FOOD PREMISES. Inspections. The following visits were made to food premises during the year:— Butchers 327 Bakehouses 99 Bakers 122 Fishmongers 138 Milkshops and dairies 138 Provision shops 702 Dining rooms 289 Greengrocers 196 Fish friers 118 Ice cream premises 238 MILK. Dairies and Milkshops. Number of registered premises from which milk is sold 86 Premises added to register during year 27 Premises removed from register during year Nil Visits of inspection 138 Biological Examinations. Four 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 7 7 7 ... Accredited 2 ... ... ... ... Pasteurised 38 17 17 ... 17 ... Sterilised 51 7 7 ... 7 ... Supplementary Licences Tuberculin Tested 5 ... ... ... ... ... Pasteurised 6 ... ... ... ... ... Sterilised 6 ... ... ... ... ... Totals 128 31 31 ... 31 ... 53 ICE CREAM. Twenty-six new applications to retail ice cream have been granted by the Council. A large quantity of this food is retailed within the Borough. The premises and utensils have been inspected regularly, and it is satisfactory to report that a high standard of cleanliness is maintained. No case of illness due to eating ice cream was notified. Number of Samples taken:— Ice Cream 50 Ice Lollies 17 Results of Samples taken— Grade I. Grade II. Grade III. Grade IV. Chemical analysis only 26 9 4 5 6 Manufacturers of Preserved Food, etc. Premises on Register at 31-12-1951 64 Premises registered during 1951 Nil Premises removed from Register during 1951 Nil Meat and Foods condemned and destroyed. Albumen 6 lbs. Almonds 3¼ lbs. Bacon 26½ lbs. Beef 510 lbs. Beef Trimmings 68 lbs. Biscuits 477¼ lbs. Butter ¾ lb. Catfish 3 stone Cheese 30¾ lbs. Cheese (Gruyere) 47 boxes Chickens 63 Chocolate Bars 35 Chocolate Buns 29 Chocolate Puffs 120 Christmas Pudding 1 54 Corned Meat 60 tins Cream, Whipped 41 jars Cucumber 1 barrel Ducks 15 Figs 8 pkts. Fish 198 tins Fish 108½ stone Fish 4 boxes Fish Paste 5 tins Flour 13 lbs. Fowls 6 Fruit 1,626 tins Fruit 37 jars Fruit 69 cartons Geese 1 Gherkins 8 tins Ham 203 tins Ham 7 lbs. Hens 61 Jam 122 tins Jellies 48 pkts. Kidney 95 lbs. Lamb 34½ lbs. Lemon Barley Powder 45 pkts. Liver 8 lbs. Luncheon Meat 462 tins Macaroni 14½ lbs. Marmalade 2 tins Milk 406 tins Miscellaneous Foodstuffs 271 pkts. Mussels 1 bag Orange Squash 17 bots. Ox Cheeks 848 lbs. Ox Heads 35 Peanut Butter 2 tins Pearl Barley 11 lbs. Peas 13½ lbs. Peel (Mixed) 101 pkts. Pheasant 1 Pigs' Feet 100 lbs. Pigs' Head 8 lbs. Pork 25 lbs. Pork Chops 16 Potatoes 2 sacks 55 Prawns 9 lbs. Prunes 3 lbs. Puddings (Various) 21 Rabbit 36 tins Rabbit 7 cases Rabbit 126 lbs. Rice 7 lbs. Salad Cream 50 jars Salad Cream 17 bots. Sauce 31 bots. Sausages 17 tins Semolina 19¾ lbs. Sheep's Carcases 4 Sheep's Heads 516 Soup 322 tins Soup 48 pkts. Sauerkraut 41 tins Sweets 38 lbs. Turkey Roll 19 lbs. Vegetables 595 tins Vita Cup 1 tin The quantity of food condemned as "unfit for human consumption" is still a serious problem. Most of the condemned food is tinned, and the main reason why so much becomes unfit is because it is kept too long in store or stock. In order to avoid such loss, some arrangement should be made whereby stocks are released earlier from the warehouses, and, if necessary, reduced in price after a certain period. It is regrettable that food—which is scarce in the country—should be allowed to deteriorate due to lack of foresight on the part of those responsible for its distribution to retailers. Premises and Occupations which can be Controlled by Bye-Laws and Regulations. Premises. Dairies, Milkshops and Dairymen 78 Grocery and Provision shops 229 Hairdresser's Premises 74 Fish friers 24 Bakers and Bakehouses 42 Butchers 77 56 Cafes and Dining rooms 97 Fishmongers 21 Greengrocers 96 Food Hawkers— (a) Premises 26 (b) Persons 44 Shell Fish Vendors 11 Offensive Trades. Rag and Bone dealers 3 Tripe boiler 1 Hairdressers and Barbers. On 1st August, 1951, there came into operation Section 48 of the Leyton Corporation Act, 1950, which contains the following provisions. No person shall carry on the business of a hairdresser or barber on any premises in the Borough unless he and those premises are registered by the Corporation. Any person who makes an application in that behalf and furnishes the Corporation with particulars of his name and residence and of the premises in respect of which he desires to be registered shall be registered in respect of those premises by the Corporation. The Corporation may make byelaws for the purpose of securing— (a) the cleanliness of premises registered under this section and of the instruments, towels, materials and equipment used therein; and (b) the cleanliness of persons employed in such premises in regard to both themselves and their clothing. A person registered under this section shall keep a copy of the said byelaws and of his certificate of registration displayed in the premises in respect of which he is registered. Byelaws. The following Byelaws, made under Section 48 of the Leyton Corporation Act, 1950, were confirmed by the Minister of Local Government and Planning; and came into operation on 25th September, 1951. 1. In these byelaws "premises" means any premises used for the purpose of carrying on the trade or business of a hairdresser or barber in the BOROUGH OF LEYTON. 57 2. For the purpose of securing the cleanliness of the premises, every person carrying on the trade or business of a hairdresser or barber shall cause— (a) the surface of all internal walls, partitions and ceilings and the underside of the roof of any room where there is no ceiling to be kept at all times in such repair and to be so painted, distempered, whitewashed, papered or similarly treated in manner appropriate to each such surface and to be so cleansed at such intervals as to maintain the same in a cleanly condition; (b) the floor of every room to be cleansed at least once during every day on which trade or business is carried on; (c) the floor to be swept as often as may be necessary to prevent the accumulation of hair clippings, neck wool or other litter; (d) a sufficient number of covered receptacles to be provided and a!! hair clippings, neck wool or other litter swept from the floor or otherwise accumulating in connexion with the trade or business to be placed therein. He shall cause every such receptacle to be emptied as often as may be necessary and at least once during every day upon which the trade or business is carried on; (e) every chair or seat to be cleansed as often as may be necessary; (/) every shelf, fitting or table on which instruments, towels or materials are placed to be kept clean; (g) every washbasin and all fixtures and fittings used in connexion therewith to be kept clean. 3. For the purpose of securing the cleanliness of the instruments, towels, materials and equipment used in the premises, every person carrying on the trade or business of a hairdresser or barber shall cause— (a) each metal instrument to be cleansed before use upon each person; (b) each hairbrush, comb or other similar instrument used for the purposes of the trade or business to be thoroughly washed at least once daily and otherwise kept clean; (c) each shaving brush, sponge or other article similarly used and each shaving mug or other similar utensil to be 58 cleansed immediately after use for each person so as to ensure that no dirt, soap, lather or other matter remains adhering thereto; (d) where neck wool or other material is used any one piece of such wool or material to be used for not more than one person; Provided that if a material other than wool is used which is capable of being cleansed this byelaw shall not operate so as to prevent the subsequent use of any one piece of material after being cleansed; (e) any styptic, not applied by means of a spray or upon fresh cotton wool or other clean material, to be clean; (f) soap, other than liquid or powdered or tube soap or shaving cream, to be thoroughly rinsed before use for each separate person; (g) every towel or other similar article used in connexion with the trade or business to be clean; (h) paper or linen placed on the back of the chair or head rest to be clean; (i) a fresh supply of water for each person to be used for shaving, lathering or washing. 4. For the purpose of securing the cleanliness of the persons employed in the premises in regard to both themselves and their clothing, any person carrying on the trade or business of a hairdresser or barber shall cause every hairdresser or barber while employed on the premises to keep his hands, his clothes and any overall which he may wear in a cleanly condition. 5. The byelaws for the purpose of securing the cleanliness of any premises in the Borough of Leyton used for the purpose of carrying on the business of a hairdresser or barber and of the instruments, towels and materials used in such premises which were made by the Mayor, Aldermen and Burgesses of the Borough of Leyton acting by the Council on the 17th day of May, 1935, and were confirmed by the Minister of Health on the 29th day of July, 1935, are hereby repealed. Registration of Hawkers of Food. On 1st January, 1951, there came into operation Section 62 of the Leyton Corporation Act, 1950, which contains the following provisions:— 59 No person other than a person keeping open shop for the sale of food shall either by himself, or by any person employed by him, sell, offer or expose for sale any food from any cart, barrow or other vehicle or from any basket, pail, tray or other receptacle unless he is registered with the Corporation. No premises shall be used as storage accommodation for any food intended for sale from a cart, barrow or other vehicle or from a basket, pail, tray or other receptacle unless the premises are registered as aforesaid. The Corporation shall on registering any premises issue to the person making the application a certificate of registration which shall be kept affixed in a conspicuous place in the premises. The Corporation may refuse to register any person or premises under this section or (after giving one month's notice to the person registered or in whose name the premises are registered) may revoke the registration of any person or premises under this section if they are satisfied— (a) as regards a person that the public health is or is likely to be endangered by any act or default of his in relation to the quality, storage or distribution of food, or (b) as regards premises that the premises are not suitable to be used for the purposes aforesaid. The Corporation shall keep a register of the persons and premises registered under the provisions of this section. The provisions of this section shall not apply to any premises registered under Section 14 of the Food and Drugs Act, 1938, or to any dairy or dairyman registered under Part II of that Act or under any regulations made thereunder. During the year applications were received for the registration of 44 persons and 26 premises. Registration of Vendors of Shell-fish. Section 63 of the Leyton Corporation Act, 1950, which came into operation on 1st January, 1951, contains the following provisions:— No person shall by himself, or by any person employed by him, sell or offer or expose for sale shell-fish in any premises unless such person and such premises are registered for that purpose by the Corporation. The Corporation shall keep a register of the persons and premises registered under the provisions of this section. 60 During the year applications for registration were received from 11 vendors in respect of their premises. Contagious Diseases of Animals Acts and Orders. Attention has been given to the various orders issued during the year; and no case of contagious disease has occurred within the Borough. Inspections were carried out at the railway sidings where horses are derailed for slaughter at neighbouring slaughterhouses; and the conditions found were satisfactory. Water and food are available for the animals, and protection from the weather is adequate. 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 240. The range of samples taken covered a wide field; and, as far as possible, every effort was made to discover any possible offence under the Act or Ministry Regulations and Orders. It is pleasing to be able to report that the results of the analyses were generally satisfactory, there being only five cases in which the reports were adverse. Increasing care is being exercised by manufacturers, producers and retailers to comply with the required standards. Samples analysed. Samples unsatisfactory. Baby Cereal 1 .. Baking Powder 1 .. Beef Dripping 1 .. Beef Suet 1 .. Beer 1 .. Bemax 1 .. Bev 1 .. Biscuits 2 .. Black Pudding 1 .. Blanc Mange Powder 2 .. Butter 2 .. Cake Mixture 1 .. Cheese 1 .. Cherries Glace 1 .. Cherryade 1 .. Coconut (sweetened) 1 .. 61  Samples analysed. Samples unsatisfactory. Coffee 2 .. Coffee Extract 1 .. Coffee and Chicory Essence 1 .. Corned Beef 1 .. Crab Paste 1 .. Cream Synthetic 2 .. Curry Powder 1 .. Custard Powder 2 .. Essence of Rennett 1 .. Farex 1 .. Fat, cooking 2 .. Festival Relish 1 .. Fish Cakes 1 .. Fish Paste 5 .. Flour 2 .. Fruitarian Luncheon 1 .. Fruitlets 1 .. Fruit Chutney 1 .. Gelatine, dessert 1 .. Glucose, powder 1 .. Ice Cream 50 1 Ice Lollies 16 .. Jelly 3 1 Lentils 1 .. Luncheon Meat 1 .. Luncheon Pork 1 .. Luncheon Sausage 1 .. Margarine, Kosher 1 .. Marmite 1 .. Marshmallow Creme 1 .. Meat Paste 3 .. Milk 46 .. Milk, dried 1 .. Milk, whipping compound 1 .. Milk Yoghourt 2 .. Mince Meat 1 .. Mustard Pickle 1 .. Nutona 1 1 Orange Squash 1 .. Pastry 1 .. 62  Samples analysed. Samples unsatisfactory. Pearl Barley 1 .. Pepper 3 .. Pepper, flavoured compound 3 .. Pie Crust 1 1 Raspberry Chews 1 .. Rice 1 .. Rice Creamola 1 .. Salad Cream 1 .. Salmon, dressed 1 .. Sausage Meat 2 .. Sausage, liver 1 .. Sausages 9 1 Semolina 1 .. Spice, pickling 1 .. Sponge Mixture 2 .. Sugar Wheat Puffies 1 .. Sweets 4 .. Tapioca 1 .. Trifle 1 .. Vinegar 4 .. Vinegar, raspberry 1 .. Virol 1 .. Whiskey 2 .. Adexolin Capsules 1 . . Aspirin 1 .. Back Ache Pills 1 .. Bismuth Magnesia Tablets 1 .. Cough Mixture 1 .. Dr. Cassells Tablets 1 .. Epsom Salt Tablets 1 .. Halibut Oil Capsules 1 .. Head and Stomach Pills 1 .. Lactogol 1 .. Saccharin Tablets 1 .. Sodium Bicarb 1 .. Tincture of Iodine 1 .. Zinc and Castor Oil Cream 1 .. 240 5 63 Legal Proceedings. (Food & Drugs Act, 1938.) In five instances legal proceedings were taken under the provisions of Section 9 of the above Act, and the following is the result of such action:— 10/1/51 Paper in sausage £2 fine £2 costs 31/1/51 String in sausage £5 fine £2 costs 31/10/51 Insects in Milk £5 fine 7/11/51 Dirt in Milk £3 fine 7/11/51 Wire in Milk £3 fine Preparation, Storage and Handling of Food. An encouraging and pleasing feature has been the steady improvement in the general standard of food premises. Alterations in structure and improvements in design have been effected, and attention paid to siting of food premises and proper use of equipment. Most important of all, every endeavour is made to promote the observance of personal hygiene by the staffs engaged; and there has been a willing response to the advice given by the Sanitary Inspectors. The more elaborate improvements have naturally been at premises of the larger business firms—bakers, butchers, fish-friers and cafes. The food-traders in the district are anxious to conform to the requirements of the Food and Drugs Act and the Council's Bye-laws; but high building costs and shortage of materials are deterrents in their endeavour to reach the ideal. Ignorance of the dangers likely to result from carelessness is one of the shortcomings to be overcome. There appears to be more hope from the employment of the proper type of food handler and increased education of the staff, rather than from prosecutions for offences committed. Food-carrying Vehicles. Improved types of these are now in use and more attention is given to clean overalls and head-dress for the use of the men. Dogs in Food Shops, Restaurants, etc. In October, 1951, the Ministry of Food issued Circular MF 20/51, from which the following is an extract:— The Minister of Food has been considering whether any measures can be taken to prevent dogs being brought into 64 premises in which food is sold. In the House of Commons on the 2nd November, 1950, the Minister said, in answer to a question:— "I agree that dogs should not be allowed in food shops. It is a most unhygienic practice. But I cannot feel that I would have any great success if I tried to stop it by a prohibitive regulation. Here is a problem more likely to be solved by voluntary action and I appeal to the public and the food trade to co-operate in keeping dogs out of their shops." The Minister is aware that many local authorities have encouraged food traders to display a notice signed by the Medical Officer of Health requesting customers not to bring dogs into the premises. He feels that the general adoption of this practice would be a practical step to a higher standard of food hygiene and therefore recommends all authorities to consider the advantage of issuing a notice on the lines of the model set out overleaf in the appendix to this circular. At their meeting in November the Leyton Council decided to adopt the Ministry's suggestion, and copies of the following notice were printed for publication in food shops, restaurants, etc.:— Dogs. In the interest of Hygiene you are requested not to bring your dog into premises in which food is sold. (Sd.) A. W. FORREST, Medical Officer of Health. Circulars were sent to the 568 food premises in the Borough asking for the proprietors' co-operation in exhibiting the notice, and 95 replies were received requesting a total of 171 copies of the notice. 65 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 393 12 ... Factories without mechanical power 89 4 ... Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) ... ... ... Total 482 16 ... 2. DEFECTS FOUND. Particulars. (1) Number of Defects. Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Lack of cleanliness 13 12 ... Sanitary Conveniences:— Insufficient 3 2 ... Unsuitable or defective 11 6 ... Other Offences ... ... ... Total 27 20 ... 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 68 SECTION 21 HEALTH CENTRES. Former Relief Office Premises, 135, Dawlish Road, E.10. On the "Appointed Day"—5th July, 1948—the former Relief Office premises in Dawlish Road, E.10, were allocated to the County Health Authority for health purposes; and in September of that year there were submitted the following recommendations as to how these buildings—together with the land and dwelling house adjoining—could be utilised for health purposes. That arrangements be made for the establishment of a Subsidiary Health Centre in the premises at 135, Dawlish Road, Leyton. That the health centre provide the necessary facilities in connection with the medical, dental and nursing services of the Health and Education Authorities to serve the area of the Borough comprising Central North and Central South Wards. That authority be given for the structural and decorative work necessary to adapt the premises for these purposes, and for the purchase of the necessary furniture and equipment. Existing Health Centre Facilities. The two existing health centres in the Borough—at Leyton Green and Park House—were specially built for the purpose in 1933 and 1935 respectively, and provide accommodation in their respective areas for the combined medical, dental and nursing services of the Health and Education Authorities. Whereas these two centres were considered to be models at the time they were built, the great expansion in the scope of health services since that time has been such that they can no longer be considered adequate. The establishment of an additional health centre undoubtedly relieves the overcrowding and congestion at the two existing centres. The former Relief Office buildings in Dawlish Road are situated near the centre of that densely-populated part of the Borough containing the Wards known as Central North and Central South, with a combined population—according to the last official census returns—of some 22,414 persons. 69 Site and Buildings in Dawlish Road. The buildings were erected by West Ham Board of Guardians as a Relief Office and dwelling house in 1925. The site covers an area of 2,253 sq. yds. On the eastern aspect there is a vacant piece of ground—now set out in allotments—with a road frontage in Dawlish Road of 75 ft. and an area of 7,650 sq. ft. The road frontage of the main building is 84 ft. Suitability of Premises. The Special Committee appointed to consider the functions and design of health centres to be provided under the National Health Service Act, 1946, were unanimous in recommending that health centres should be in new buidlings specially designed for the purpose. Adaptation of an existing building is generally unsatisfactory, and is often at best a makeshift arrangement; but as it might be a long time before any new "ad hoc" building became available, the Relief Office Building in Dawlish Road had the great advantage that it could be made available for use in the near future. The main building was structurally sound. The floors, of wooden blocks, were in good condition throughout; and the walls, except in the room formerly used as a Committee Room, were tiled to a height of 5 ft. with dismal, dark-brown coloured tiles. Internally the premises had the inhospitable and severe "institutional" appearance and atmosphere characteristic of barracks and Boards of Guardians' institutions of the time, and they lacked many desirable features and amenities we expect to find in modern health centres. Although the main building was large, so much of the accommodation was devoted to the large central waiting hall that the accommodation available for actual clinic purposes was relatively small. On each side of the hall there were three rooms available for clinics, but none sufficiently large to justify it being considered ideal as a room to serve either as a school minor-ailment clinic or as a weighing room for infants and toddlers. With regard to situation, the premises had the great advantage that they were so easily accessible to such a large and densely populated area of the Borough. On the other hand, they were more than 400 yards from the nearest bus route and could not be 70 sidered suitable for the establishment of a main health centre with specialist clinics to serve the whole Borough. Notwithstanding these deficiencies, it was considered that the building could be adapted to provide' accommodation for a subsidiary health centre as adequate as could be expected in any building not specially designed for the purpose; and that the large vacant piece of ground to the east of the main building could be used to provide accommodation for future extensions of health services. Conversion of Premises. At the end of 1950 the Health Authority had decided to let the dwelling house to one of the County Mental Welfare Officers, and negotiations were proceeding between the Authorities concerned regarding the conversion of the main building. Eventually the necessary work was begun on 9th April, and completed by 22nd September. The conversion was effected wholly within the external walls of the building, the only external work being the erection of a perambulator store and alterations to the front entrance. The original main hall was reduced in length by the construction of an entrance lobby and clerk's office at the front and the school minor ailments clinic at the rear. A suspended ceiling was introduced, taking away the barn-like appearance of the building and forming a more compact lecture hall and waiting room with improved lighting and acoustics. This hall now forms the focal point of the various services and clinics in the surrounding rooms, all of which have access thereto. The side rooms were completely reconstructed. The doctor's consulting room has direct access both to the ante-natal and infant welfare clinic and through a small lobby to the school minor ailments clinic. The doctor's consulting room, and the adjoining room used for maternal and infant welfare, get any sunshine which is available by virtue of their southern exposure. On the other hand, all the dental rooms are served with north light, and the dental surgeries are insulated from the main hall by means of a small lobby and double doors. Both dental surgeries have access to the recovery room, from which a lobby leads to a separate exit. A dental mechanic's workshop is connected to Surgery No. 2 by means of another lobby. 71 The remaining accommodation consists of a dispensary, caretaker's kitchen, and staff room; and separate lavatories are available for staff and public. The following sketch plan shows the lay-out of the premises after the conversion was effected. 72 Official Opening. During the afternoon of Saturday, 22nd September, the new Essex County Health Service Clinic in Dawlish Road was formally opened by the Mayoress of Leyton (Councillor Mrs. A. M. M. Burrell, E.C.C.), Chairman of Leyton Health Area Sub-committee, in the presence of the Worshipful the Mayor (Councillor G. W. Burrell, J.P.), the Rev. R. W. Sorensen, Member of Parliament for Leyton, County Alderman F. S. Foster, C.B.E. (Chairman, Essex County Council), County Councillor K. E. B. Glenny (Chairman, County Health Committee), Alderman G. S. Flack (Vice-Chairman, Leyton Health Area Sub-committee), the Rev. Canon R. B. Bertin (Rural Dean of Leyton) and officers of the County and Borough Health Services. On the following page, in the form of an inset, is a photograph of the actual opening ceremony—the unveiling of the plaque— by the Chairman in the presence of the Worshipful the Mayor and County Alderman F. S. Foster. 73 SECTION 22 CARE OF MOTHERS AND YOUNG CHILDREN. Births. 1,311 births were registered during the year:— Males. Females. Total. Legitimate 655 603 1,258 Illegitimate 29 24 53 684 627 1,311 The birth rate per 1,000 of the population was thus 12.52. 1,425 notifications of births were received during the year:— From medical practitioners 27 From midwives 1,398 Ante-Natal Clinics. Attendances.— First Attendances. Subsequent Attendances. Total. 524 1,381 1,905 The average number in attendance at the Ante-Natal Clinics held at the Council's four Centres during 1951 was 12.95 per session. The number of home visits made by health visitors to expectant mothers during the year was 200. Child Welfare Clinics. On page 74 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. 74 ATTENDANCES, EXAMINATIONS, ETC., 1949—1951. Leyton Green Park House *Dawlish Road 1951 All Centres 1949 1950 1951 1949 1950 1951 1949 1950 1951 Under 1 year— 1st attendances 638 561 487 650 622 573 46 1288 1183 1106 Subsequent attendances 8061 7000 6345 8344 7299 6797 650 16405 14299 13792 Total attendances 8699 7561 6832 8994 7921 7370 696 17693 15482 14898 1-5 years— 1st attendances 126 142 96 112 122 89 17 238 264 202 Subsequent attendances 2639 3315 3343 3091 3296 3090 355 5730 6611 6788 Total attendances 2765 3457 3439 3203 3418 3179 372 5968 6875 6990 Total attendances, both age groups 11464 11018 10271 12197 11339 10549 1068 23661 22357 21888 Average attendance per session at Infant Clinics 75.9 68.43 56.12 78.69 68.64 54.15 31.38 77.32 68.53 53.27 „ „ „ „ „ Toddlers „ ... 13.43 12.5 ... 13.98 14.0 5.94 ... 13.70 10.19 Number examined by clinic doctor 3107 3460 3451 3651 3855 3631 398 6758 7345 7480 Number weighed 11448 10987 10363 12197 11340 10581 1085 23645 22327 22029 * Dawlish Road Clinic was opened to the public on 22nd September, 1951. 75 Post Natal Clinic. The following is a summary of the work carried out:— Leyton Green Clinic Lady Raleigh Training Home Total No. of Sessions 15 24 39 Letters of Invitation 180 251 431 First Attendances 121 161 282 Re-Attendances 113 132 245 The disposal of these cases was as follows:— Discharged after one attendance 125 Re-attended for examination and treatment 251 Conditions found on examination:— Leyton Green Clinic. Lady Raleigh Training Home Ovarian cyst 1 - Subinvolution of the uterus 6 5 Cystocele and rectocele 1 7 Retroversion of uterus 17 22 Anaemia 2 7 Cervical erosion 39 57 Vaginitis 2 3 Fibroid - 1 Inflamed adnexa - 4 Sacro-iliac strain - 2 Cracked nipples - 1 Thrombo-phlebitis - 1 Birth control advice 58 - Defective perineum 1 - Observation by Dr. R. Jacobs, Medical Officer, Post-Natal Clinic, Lady Raleigh Training Home. The attendance rate at the post-natal clinic held at Lady Raleigh Training Home continued to be relatively satisfactory throughout 1951. Out of a total of 251 invitations, 167 new cases attended for first examination, an attendance rate of 66.5%. Most patients showed appreciation of the treatment received, and understanding of the importance of post-natal examination and treatment has certainly increased. Nearly all conditions requiring treatment were treated in the clinic, and it was necessary to refer patients to hospital only very rarely. Cervical Erosion presents the main problem in treatment. The cases have been classified in two groups: (1) those which 76 required observation only and healed spontaneously within a period of three months; and (2) the more extensive ones, accompanied by discharge and requiring active treatment. In the treatment of the second group it was a great advantage to have the help of the laboratory service of Whipps Cross Hospital, where all the cervical cultures were examined. The pathological reports made it possible to give specific treatment with sulphonamides, penicillin or other antibiotics; and I am grateful to Dr. W. W. Walther and his pathological staff for their invaluable assistance. No patient in the second group was discharged until treatment had been effective and the erosion was completely healed. Other conditions were treated on the usual lines and presented no special difficulty. On the whole, the second year's work at this clinic has continued to show the need for post-natal supervision and treatment and the satisfactory response of the mothers when it is made available for them. 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. (а) Number of premature infante notified (1) Born at home 23 during the year (including transferred notifications) whose mothers norm(2) Born in hospital ally reside in the Authority's area. or nursing home 61 (b) Premature infants born in the area (whether their mothers normally reside in the area or not) but exclud23. ing babies born in maternity homes and hospitals in the National Health Service. Born at Home. Nursed Entirely at Home. Transferred to Hospital. Died in First 24 hours. Died on 2nd to 7th day. Died on 8th to 28th day. Survived 28 days. Total. Grand Total. Under 3 lbs. ... ... ... ... 1 1 23 3 to 4 lbs. ... ... ... ... 4 4 4 to 5½ lbs. ... ... ... ... 18 18 77 Puerperal Pyrexia. Nineteen cases of puerperal pyrexia were notified during the year. Maternity Mortality. There were three maternal deaths of Leyton residents during the year. 1. Multipara (33 years)—3rd child. Due to coronary embolism following childbirth. 2. Multipara (36 years)—3rd child. Due to post partum haemorrhage following placenta praevia. 3. Primipara (29 years). Pulmonary embolism due to femoral and tibial phlebothrombosis. As deceased was six weeks pregnant at time of death, the death must be classified as due to pregnancy. Dental Treatment. Report of Senior Dental Surgeon (A. E. Hall, l.d.s.) One or more sessions per week at each Clinic, as necessity demanded, have been devoted to the dental treatment of expectant or nursing mothers and pre-school children referred to the dental officers by the medical officers at the various Centres. To all these patients a complete service has been available, X-ray, extraction, filling, the supply of crowns or inlays, and dentures if necessary. In cases of gross dental decay in very young children, and in the absence of pain, many teeth have been treated by application of silver nitrate solution to arrest decay and preserve the teeth with space for the succeeding permanent dentition. It has not been possible to devote to young children anything like the amount of attention they should have under a comprehensive dental service. From about three years of age these children should be recalled for examination and treatment if necessary, three times a year. That would afford an opportunity to preserve the temporary dentition intact until its natural time for shedding. Such regular care not only preserves the teeth, but prevents loss of space for the permanent successors and aids normal jaw development, thus reducing the need for orthodontic treatment at a later date. 78 It is among the expectant and nursing mothers that the need for the services of our Oral Hygienist is greatest. She is also able, when rendering this service, to interest them in matters of oral hygiene and answer questions concerning the care of their children's teeth. This is a service which has been very much appreciated and, inasmuch as it is educational, is of greater value in increasing the demand rate for treatment. The amount and nature of work done for these patients is shown in the table of figures appended. There is an increase in the number of patients of all classes treated under this heading and a consequent increase in the amount of work done. Due to a carry-over from December, 1950, more patients were treated than were referred to the department during the year. 79 (A) NUMBERS PROVIDED WITH DENTAL CARE. Examined. Needing treatment. Treated. Made Dentally Fit. Expectant and Nursing Mothers 162 162 196 165 Children under five 718 698 763 693 (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 372 52 83 103 185 8 252 19 11 26 Children under five 961 63 415 11 ... 1350 391 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. 80 Orthopaedic Treatment. Primary Examinations.—During the year 9 children were referred from the Child Welfare Clinics to the Council's Orthopaedic Surgeon. The following conditions were found:— Pes piano valgus 4 Genu valgum 1 Digitus varus 1 Torticollis, deviation of digits 1 Rickets 1 Anterior poliomyelitis, no disability found 1 Re-examinations.—In addition to the 9 new cases mentioned above, 34 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 13 Genu valgum 6 Congenital talipes 2 Genu varum 2 Lymphatic cyst-heels 1 Congenital mid tarsal varus 1 Haemangioma 1 Talipes equino varus 1 Anterior poliomyelitis 1 Naevous dorsal region 1 Flat foot 2 No disability found 3 Provision of Surgical Appliances. Alterations to surgical boots or new appliances were supplied to 25 children as follows:— 24 Minor alterations (wedges). 1 Metal splint. X-Rays. Arrangements were made for one child to be X-rayed. Admission to Hospital. No children under 5 years of age were admitted to hospital. 81 Special Eye Clinic. The Consultant Ophthalmic Surgeon had referred by the Clinic Medical Officers 49 pre-school children, who made 87 attendances for examination and treatment. The following conditions were found:— Hypermetropia with squint 31 Squint only 5 Epicanthus 5 Ptosis 2 Convalescent Home Treatment. Children. Twenty-one children recommended by the Clinic Medical Officers were sent to Convalescent Homes. Mothers and Children. Arrangements were made for nine mothers and their children to have a period of convalescence. Ophthalmia Neonatorum. No. of Cases Notified. Treated Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. In Hosp. ... ... ... ... ... ... ... 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. Neonatal. 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 1951 1,311 27 17 20.59 12.96 31 23.1 82 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, 1951. Category. Knotts Green. Ellingham Road. (a) In attendance. (6) Awaiting admission. (a) In attendance. (6) Awaiting admission. 1. a Employed unmarried mothers who wish to keep their children with them when not at work 6 ... 9 ... 1. b Motherless children 1 ... 3 ... 2. a Employed widows ... 1 ... 3 ... 2. b Divorced from husbands 2 ... 3 ... 2. c Separated from husbands 11 ... 17 4 2. d Deserted by husbands 4 ... 2. e Those who have children of whom the husband is not the father ... ... ... ... 3. Mothers employed in industries vital to production for essential home needs and for export 32 68 25 172 4. Mothers who are ill or being confined 3 ... ... ... 60 68 60 176 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 45 students who have sat for the examinations, 43 have been successful in obtaining the Certificate. 83 SECTION 23 MIDWIFERY Record of Cases attended by Council Midwives, 1951. Midwives employed by Total. Essex County Council. Attached to the Lady Raleigh Training Home, Beachcroft Road. Cases attended:— (a) As Midwives 116 230 346 (b) As Maternity Nurses 12 24 36 Ante-natal Visits 420 1,136 1,556 Ante-natal Examination 871 1,554 2,425 Post-natal Visits 2,492 5,439 7,931 Administrations of Gas and Air Analgesia 77 156 233 Administration of Gas and Air Analgesia. Of the Council's two 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 346 Number of administrations of gas and air analgesia 233 Percentage of administrations 67.34 Maternity Sets. During 1951 maternity sets were issued to 142 expectant mothers who were having domiciliary confinement. 84 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 7 (2) Others 103 Total 110 Fees paid to Doctors. Eighty-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 £232 12s. 6d. 85 SECTION 24 HEALTH VISITING. Health Visitors. During the year the Health Visitors have made 18,187 visits to homes. (а) To expectant mothers:— First visits 175 Total visits 200 (b) To children under 1 year of age:— First visits 1,350 Total visits 4,617 (c) To children between the ages of 1 and 5 years 7,911 (d) Other visits:— To cases of whooping cough 18 To cases of measles 13 To cases of ophthalmia neonatorum 5 To cases of discharging eyes — To cases of diarrhoea 2 To cases under Children's Act 21 Visits after deaths 23 Visits after stillbirths 31 Miscellaneous visits 1,037 Ineffective visits 2,662 Chest Clinic. In addition to the above, the Health Visitors attached to the Chest Clinic at 180, High Road, Leyton, interviewed 4,834 patients at the Chest Clinic, made 2,462 home visits and interviewed 2,206 patients at home. 86 SECTION 25 HOME NURSING. The following summary shows the work undertaken during the year. No. of new cases (surgical and medical) 1,473 No. of visits paid to above 46,592 87 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 353 55 50 189 647 Re-Vaccinated - 3 31 573 607 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 844 50 894 (b) By Private Practitioners 411 26 437 2. Number of children who were given a secondary or reinforcing injection (i.e., subsequent to complete full course) - 484 484 3. (a) Approximate estimated child population at end of year 8,820 12,424 - (b) Percentage of child population considered to be immunised at end of year 59.5 84.4 - 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 1951 1,460 1,108 75.9 968 747 77.2 1,065 822 77.2 88 Incidence and Mortality from Diphtheria. Annual totals of deaths and notifications during the past ten years have been: Year. Leyton. Notified Cases. Deaths. 1942 39 0 1943 28 1 1944 24 1 1945 43 2 1946 38 1 1947 9 1 1948 5 0 1949 0 0 1950 0 0 1951 1 0 Protection against Whooping Cough. Investigation into Efficacy of Whooping Cough Vaccines. In my last two Annual Reports I have submitted information regarding the controlled investigation, into the efficacy of whooping cough vaccines, undertaken in collaboration with the Medical Research Council. The investigation began in February, 1949, and finished in June, 1951, the Leyton contribution being 1,000 cases. Although the actual inoculations of these 1,000 children were completed, the necessary work connected with the supervision and following-up will be continued. The full results of the investigation will not be available for some considerable time, but those available so far show that the incidence and severity of whooping cough in the protected groups have been appreciably less than in the control groups. There has been considerable variation in the amount of protection afforded by vaccines from different sources, and one particular type of vaccine has been found to give much better protection against the disease than any of the others tested. Arrangement for Public Protection. In April, 1951, I reported to the appropriate Committee the existence of a considerable local demand for the continuation of facilities for protection against whooping cough after the termination of the controlled trials, and application was made to the 89 County Council for the necessary approval. The appropriate Committee of the County Council approved the continuation in Leyton of the scheme for protection of children against whooping cough provided that a particular type of vaccine be used and that parents be informed that there can be no guarantee that the vaccine will protect the child completely against an attack of whooping cough. The arrangements for public whooping cough immunisation in the Area were put into operation on 10th September, 1951; and the following table gives the available information regarding the number and age groups of the children who were immunised between that date and the end of the year. Under 1 year. l-5 years. 5—14 years. Total. Number of children who completed the course of immunisation during the year 34 147 18 199 90 SECTION 28 PREVENTION OF ILLNESS, CARE AND AFTER-CARE. Foot Clinic. Annual Attendances. Year. First attendances (new cases). Subsequent attendances. Total attendances. 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 1951 1,337 14,558 15,895 Summary of Attendances and Treatment. (a) All Ages. During the year 15,895 attendances for treatment were made, representing an increase of 1,789 over the attendances during the previous year. First Attendances (new cases). Subsequent Attendances. Total Attendances. Males 258 2,590 2,848 Females 895 10,887 11,782 Children 184 1,081 1,265 Total 1,337 14,558 15,895 The number of persons who received free treatment was 19 (1.42 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 4 313 317 Females 6 1,493 1,499 Total 10 1,806 1,816 91 Defects Treated. Bursitis 78 Callosities 356 Corneous conditions 253 Hallux rigidus 23 Hallux valgus 103 Metatarsalgia 36 Nails, club 99 Nails, ingrowing 94 Mycotic infection 9 Pes planus 38 Hyperhidrosis 21 Verruca pedis 148 Hammer toe 37 Septic conditions 15 Referred for Medical or Surgical Treatment. During the year 29 patients were referred to their own private medical practitioners or hospitals for the following conditions:— Exostosis verruca pedis 2 Hammer toe 2 Ganglion 1 Osteo porosis 1 Pes piano valgus 5 Phlebitis 1 Purpural Rash 1 Hallux valgus (bilateral) 7 Fractured 5th metatarsal 1 Neuroma 1 Hallux rigidus 2 Calcaneo bursitis 1 Oedema 2 Arthritis 1 Removal of nail 1 92 (b) Children under School Age. Number of children 6 Number of visits made 11 Average number of visits per child 1.8 Defects Treated Corneus condition 5 Verruca pedis 1 (c) School Children. Number of children 178 Number of visits made 1,254 Average number of visits per child 7.1 Defects Treated Corneus condition 18 Nail, ingrowing 8 Blisters callosities 8 Septic condition 2 Mycotic infection 2 Hallux valgus 2 Metatarsalgia 2 Trigger toe 2 Sprain 1 Verruca pedis 131 Defects referred to School Clinics Hammer toe 2 Oedema 1 Verruca pedis 1 Convalescence for Adults. (a) Number of applications (with medical support) during year 56 (b) Length of convalescence of cases sent during year:— Length of stay No. of Cases 1 week 2 2 weeks 22 3 weeks 29 4 weeks 3 Over 4 weeks — 93 (c) Where cases have been sent:— Name of Convalescent Home No. of Cases sent Essex Convalescent Home, Clacton 24 Samuel Lewis Convalescent Home, Walton 12 Merchant Tailor Convalescent Home, Bognor 2 Caxton Convalescent Home, Limpsfield 2 Bell Memorial Convalescent Home, Lancing 6 British Red Cross Convalescent Home, Hurlingham 1 Roberta Convalescent Home, Westgate 1 St. Michael's Convalescent Home, Westgate 1 All Saints Convalescent Home, Eastbourne 1 Soldiers and Sailors Convalescent Home, Eastbourne 1 Lloyds Memorial Convalescent Home, Deal 1 Dolly Ross Convalescent Home, Cliftonville 1 Spero Fund Convalescent Home 3 Health Education The promotion of Health Education is one of the duties placed on Local Health Authorities under the provisions of the National Health Service Act, 1946. One of the most valuable forms of such education is in the form of routine advice given by doctors, dentists, health visitors and sanitary inspectors. I have always contended that the ideal form of health education is the efficient administration of the public health services, where members of the public learn from official practice rather than by precept. The Health Department, the department primarily responsible for Health Education, should be a model of cleanliness, where members of the general public can see in actual operation what they have been taught to expect with regard to such elementary hygienic amenities as effective heating, ventilation and environmental cleanliness. On the following page will be found a list of some of the forms of health publicity undertaken during the year. When compared with the list of the previous year, there was a substantial fall in the attendance of the public at these special meetings. 94 Lectures and Film Shows. Date Where Held Details of Subject Type of Audience Estimated Attendance 17.1.51 Leytonstone Branch Library, Church Lane, Leytonstone. The Healthy Way of Life. Film: A Start in Life. Adult 26 31.1.51 ” Personal Hygiene (1). Films: Breath of Danger. The Nose has It. Round Figure. ” 29 14.2.51 ” Personal Hygiene (2). Films: Old Wives' Tale. A Modern Guide to Health. ” 27 28.2.51 ” Take Care of Your Health—Accidents in the Home. Films: Playing with Fire. Accidents Don't Happen. ” 29 14.3.51 ” The Restoration of Health. Films: His Fighting Chance. Rehabilitation in Industry. ” 26 28.3.51 ” Health of Mind and Body. Film: The Feeling of Rejection. ” 27 95 Tuberculosis Care Association. In ray Annual Report for the year 1950 I reported that, at the request of the County Medical Officer, the duties of Secretary and Treasurer of the Leyton, Wanstead & Woodford Care Association had been carried out by Mr. E. E. Jacobs, a member of the staff of the Health Department. Owing to illness Mr. Jacobs was absent from duty from early September, and I arranged for Mr. W. D. Softley of this Department to carry out the secretarial work involved. A great deal of useful work has been accomplished by the Association despite the need for more funds, the main source of which is from the County Council by way of grants for Care Association work and the Sunday Entertainment Act, 1932. Unfortunately the income from the Sunday Entertainment Act, 1932, ceased on 31st December, 1951. The Executive Committee of the Association are doing their utmost to replace this loss by increased voluntary effort. The undermentioned are some of the activities dealt with by the Association during 1951:— 80 patients received a total of 585 monthly grants. 3 patients were assisted with the supply of beds and bedding. 5 patients received clothing. 2 patients were issued with wireless licences. 37 grants of fares to relatives visiting patients in hospitals and sanatoria. A library of popular books, comprising 1,000 volumes, is available for use by tuberculosis patients through the courtesy of the Borough Librarian, who provides us with books which have been withdrawn from public service. Loans have been made to the Instructor of the Occupational Therapy Centre to purchase wool, etc. for the use of patients. These amounts are repaid when the articles are sold. Tuberculosis. Extra Nourishment. Number of new cases during year supplied with free milk, 107 Total number being supplied with free milk at end of year, 210 96 Rehabilitation. (i) New cases— Preston Hall Papworth Hall Number of new cases assisted during year 1 ... Number of cases for whom the Council ceased to be responsible 1 ... Number of cases being assisted at end of year 2 1 (ii) Number of cases being assisted who, at the end of the year, had been assisted for— (а) less than 6 months 1 (b) 6 months to 1 year — (c) 1 year to 2 years 1 (d) over 2 years 1 Occupational Therapy. In March, 1950, it was reported to the Leyton, Wanstead & Woodford Care Association that certain patients in this area suffering from tuberculosis would be likely to benefit from a course of occupational therapy, and the Association decided that the necessary facilities be provided. A weaving class was commenced and Mrs. S. A. Wiltshire, a member of the Handloom Centre, was appointed as instructor. Since that time the Leyton Health Area Sub-committee has accepted financial responsibility for the instructor's fees and the cost of a loom. The following is a report by Mrs. Wiltshire on the activities of the Weaving Class (October, 1951). "The first class was held at Leyton Chest Clinic on 26th April, 1950. Two patients attended. The equipment consisted of one 12-in. table loom and accessories, and at the end of the day weaving in white and coloured cotton was being carried out. Four weeks later the class was transferred to a room at the Old Relief Station, Dawlish Road, and carried on there until April 1951. By this time the register had increased to 10 patients and to the equipment had been added an 18-in. table loom, 18-in. floor loom and a rug frame. Two patients have now returned to their normal occupations and two to sanatoria for further treatment. Two patients are engaged on 97 each table loom, one on the floor loom; and another on the rug frame. Thus the six patients attending have carried on continual work. Scarves, dinner mats and cushion covers have been woven and sold, and at present towels are being made, and the first small rug is taking shape on the frame. The finished articles have all been of saleable quality, and some 30 scarves, three sets of dinner mats and twelve cushion covers have been sold. Eight towels, each pair having different colours and texture, are almost complete. Woollen material of Fair Isle pattern is being made up into hoods, with matching mittens for children. Most of the articles have been sold by the patients themselves, and repeat orders have shown that there is a ready market close at hand. It is hoped at a later date to start a dyeing class, and so lower the cost of yams and give a wider range of colours in cotton and wool for use on the looms. Since moving to the shop premises at 280, High Road, Leyton, in April, the class has increased by four new students: and the need for more equipment, giving wider scope, has arisen. With the extra space now at the disposal of the patients, and the keen interest they are showing, the need is being felt for larger equipment more suitable for men and capable of weaving single width tweed and furnishing material ...." From my personal observation of the working of the Occupational Therapy Centre since its inception, I am more firmly convinced than ever that these patients derive great physical and mental benefit from the fact that they are engaged in useful work. Patients suffering from tuberculosis tend to become increasingly introspective, morbid and depressed: and occupational therapy is of great value in changing their mental outlook. They derive much satisfaction from the knowledge that they are producing articles which are of use to the community, and occupational therapy is a very valuable form of medical treatment. At the meeting of Leyton Health Area Sub-Committee on 29th October, 1951, the Sub-Committee agreed to the purchase of one H.L.C. 32-in. 4-shaft floor loom at a cost of approximately £80, and that an additional class be held each week. 98 During the latter part of the year a Jewellery Class was commenced, and a new patient desiring to carry out plastic work was assisted in this direction. During two years the class has grown from two patients to fourteen, and the County Medical Officer has arranged for the Instructor and some of the patients to carry out weaving and jewellery making at Essex County Show to be held in June, 1952. Mass Radiography. Prior to the year under review, the last time public facilities for mass radiography were available in the Borough was during the year 1946. As five years is considered to be much too long an interval between two successive visits by a Mass Radiography Unit, representation was made to the Regional Hospital Board for more frequent and more regular visits. Mass Radiography Unit 6.B was in operation in the Borough from 6th February until 21st March, 1951, a period of six weeks. The premises used were those of the Council at 280, High Road, Leyton. Although by no means ideal, the premises (an empty shop) had the great advantage of accessibility and situation in a main road. On 6th February the opening ceremony was performed, in the presence of the Chairman of the Health Area Sub-Committee and Members of the Council, by His Worship the Mayor, who was the first person to be X-rayed. In spite of the inclemency of the weather at the time the attendance of the general public was very satisfactory, and broke all previous records of the Unit. After three weeks at 280, High Road, Leyton, the Unit was transferred for an additional period of three weeks to premises owned by the North Thames Gas Board. The latter situation was unfortunate as the approach to the building was through a sports field, which became a quagmire during wet weather. Attendances. Miniature Films. Male. Female. Doctors' cases 198 269 General public 1,322 1,741 Appointments (Factories, etc:) 3,378 2,538 Totals 4,898 4,548 Grand Total 9,446 99 Attendances—continued. Recalls for Large Films. Male. Female. Doctors' cases 56 58 General public 77 116 Appointments 194 142 Totals 327 316 Grand Total 643 Results of Survey. Incidence of Abnormality. Males. Females. Total. Number of attendances for miniature X-ray 4,898 4,548 9,446 Number passed as normal oil miniature, or subsequent large, film examination 4,552 4,302 8,854 Percentage normal 92.5 94.6 93.7 Number showing some abnormality 346 247 593 Percentage showing some abnormality 7.5 5.4 6.3 Classifications of Abnormalities Noted. Males. Females. Total. Congenital bony abnormalities 3 10 13 Chronic bronchitis and emphysema 73 21 94 Broncho-pneumonia (non-tuberculous) 2 1 3 Bronchiectasis 21 12 33 Pulmonary fibrosis (non-tuberculous) 5 4 9 Basal fibrosis 44 5 49 Pleural thickening 9 6 15 Pleural effusion (non-tuberculous) 1 ... 1 Spontaneous pneumothorax 1 ... 1 Intrathoracic tumours 4 4 8 Congenital heart disease 2 1 3 Acquired heart disease 6 11 17 Tuberculous lesions—all forms 127 126 253 Miscellaneous conditions 48 46 94 Totals 346 247 593 Tuberculous Lesions. Males. Females. Total. The tuberculous lesions, totalling 253, are further analysed as follows:— Inactive tuberculosis:— (a) Primary 39 47 86 (b) Adult type 77 65 142 Total 116 112 228 Active tuberculosis:— (a) Primary ... ... ... (b) Adult type 11 14 25 Total 11 14 25 100 These figures show that there were 25 cases of active tuberculosis disclosed by the Survey, giving a ratio of 2.64 per 1,000 examinations. This compares favourably with the national figure for Mass Radiography, which is between 3 and 4 (nearer 4) per 1,000. The incidence was greater in the female than the male examinees, the respective ratios being 3.07 and 2.24 per 1,000. This is a usual finding as far as the area covered by this Unit is concerned. All necessary action has been taken in respect of cases, both tuberculous and non-tuberculous, requiring further medical attention. I should like to take this opportunity of conveying my appreciation of the co-operation of the Director of the Unit (Dr. Lawless) and his staff, and of the valuable administrative work carried out by the Chief Clerk of the Health Department (Mr. G. F. Leserve). Loan of Sick Room Equipment. During the year 182 articles of sick room equipment were loaned on the recommendation of doctors, hospital almoners, etc. No. of articles loaned during 1951:— From Central Store. From Lady Raleigh Training Home. Air Beds 1 — Air Pillows — 4 Air Rings 18 28 Bed Back Rests 13 14 Bed Cradles — 5 Bed Pans 9 33 Crutches 2 — Hot Water Bottles — 2 Invalid Chairs 14 — Rubber Draw Sheets 3 4 Sputum Cups — 2 Urinal Bottles 11 19 Totals 71 111 Special items bought during the year:— 3 Air rings 6 Invalid chairs 2 Bed back rests 1 Pair crutches 101 SECTION 29 DOMESTIC HELP. Five years have now elapsed since 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 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 1951 119 564 683 It will be seen that, whereas there has been no increase—in fact, a substantial decrease—in the annual number of maternity cases, the number of cases other than maternity has been increasing each year. Summary of Cases Helped during 1951. Maternity. Other. Total. No. of cases dealt with 119 564 683 The following list shows the disabilities from which the 683 applicants were suffering, and the number of cases in each category. Disability. No. of Cases. Maternity 119 General debility 16 Post operative debility 21 Heart disease 85 Bronchitis 35 Arthritis 56 Senility 77 Cerebral haemorrhage 15 102 Pre-natal 5 Post-natal 16 Neurosis 10 Thrombosis 17 Lumbago 4 Prostatotomy 1 Emergency 8 Hernia 2 Anaemia 6 Hodgkinson's Disease 1 Injuries 24 Cancer 19 Tuberculosis 32 Blind and infirm 13 Ulcerated leg 10 Hypertension 25 Diabetes 5 Pneumonia 9 Disseminated sclerosis 4 Miscarriage 8 Oedema of legs 1 Parkinson's Disease 3 Rheumatism 7 Cholecystectomy 1 Amputation of leg 3 Fibrositis 2 Gall stones 1 Tonsilitis 1 Vertigo 1 Paralysis 2 Neuritis 1 Phlebitis 2 Gross obesity 2 Epilepsy 1 Varicosity 8 Pyehtis 1 Other 3 103 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 8 7 2 16 ... 10 ... 10 2 weeks 85 8 3 17 1 10 ... 8 3 weeks 7 ... ... 6 ... 3 ... 5 4 weeks 1 2 1 6 ... 7 ... 3 5 or 6 weeks 1 ... ... 5 1 13 ... 5 7 or 8 weeks ... ... ... 3 ... 3 ... 7 8 weeks—3 months ... 1 ... 4 1 11 1 6 3—6 months ... 1 1 6 ... 21 ... 18 6—12 months ... ... ... 1 1 22 2 13 Over 12 months ... ... ... ... ... 28 1 13 Incomplete Cases Under 3 months 2 1 ... ... ... 33 1 13 3—6 months ... ... ... ... ... 32 ... 12 6—12 months ... ... ... ... ... 43 1 25 Over 12 months ... ... ... ... 1 67 ... 30 Hours worked during year (all cases) All durations 9056 1005 914 3498 2395 58463 3608 30053 * Analysis of "other" cases:— Category of Cases No. of Cases Hours Worked Completed Incomplete Tuberculosis 14 32 8614 Old people (not sick) 40 37 12934 Emergencies 4 4 1159 Injuries 14 10 6614 Blind and Infirm 3 10 2084 Post Oprative 17 4 2256 Number and hours worked:— Full-time Part-time No. of domestic helps enrolled at end of year 16 67 No. of domestic helps actually employed at end of year 15 57 No. of hours worked during year 15,973 93,019 School Health Service 106 The figures set out below relate to the calendar year ended December, 1951. Number Roll Average Attendance Percentage of Attendance 1. Secondary Schools 9 4,775 4.353 91.16 2. Primary Schools 18 8,035 7,076 88.06 Totals 27 12,810 11,429 89.21 ROUTINE MEDICAL INSPECTION. A.—Routine Medical Inspection. Number of Inspections in the prescribed groups. Entrants 1,460 Second Age Group 968 Third Age Group 1,065 Total 3,493 Of 3,493 children who were examined in the code age-groups, 2,565 (or over 73 per cent.) were accompanied by their parents. B.—Other Inspections. Special Inspections. The number of special inspections during the year was 12,806 comparing with 7,603 during the previous year. Re-inspections. The number of re-inspections during 1951 was 9,640. 107 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. Number of Children. Percentage of Children found to require treatment. Inspected. Found to require treatment. (1) (2) (3) (4) Code Groups— Entrants 1,460 361 24.8 Second Age Group 968 165 17.0 Third Age Group 1,065 249 23.5 Total (Code Groups) 3,493 775 22.2 Uncleanliness and Verminous Conditions.—At the special inspections held by the school nurses, 371 children were found to be unclean out of a total number of 27,741 examined (i.e., 1.3 per cent.) Cleanliness Surveys in Individual Schools. School. Number of Examinations. Number Cautioned. Number Excluded. Canterbury Road 2,586 10 5 Capworth Street 1,485 29 1 Cann Hall Road 2,357 8 3 Church Road 1,949 8 2 Tom Hood 369 ... ... Connaught Road 1,507 48 10 Downsell Road 2,576 14 10 Davies Lane 2,233 18 1 Farmer Road 992 2 ... Goodall Road 1,577 22 2 Lea Bridge Road 337 2 1 Mayville Road 1,925 46 2 Norlington Road 1,132 1 ... Newport Road 2,205 52 9 Sybourn Street 2,269 16 1 St. Joseph's 369 15 4 Trumpington Road 786 5 ... Knotts Green and Harrow Green 466 18 1 Leyton County High School 553 1 ... Occupation Centre 68 4 ... Total 27,741 319 52 Number of individual children found unclean 371 of whom 52 were referred to the Minor Ailments Clinics. 108 The incidence of uncleanliness for the past 10 years is shown in the following table. Year Number of Examinations Number Cautioned Number Excluded 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 1951 27,741 319 52 237,870 7,011 1,642 MEDICAL TREATMENT. Minor Ailments Clinics. Attendances. During the year 3,520 children attended the clinics, and 13,688 attendances were registered. Defective Vision.—Of the 3,493 children subjected to routine code group inspection in the schools, 135 (3.86 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 1,232 children. They made 1,697 attendances for examination and treatment. Orthoptic Clinic. 1. Number of sessions held 228 2. Number of cases investigated 460 3. Number of cases treated 280 4. Number of cases refused — 5. Number cured: Complete. Cosmetic only. (а) Without operation 25 — (b) With operation 20 — (c) Total 45 — (d) Number of cases of Amblyopia included in above total cured 29 109 6. Number still under Treatment 160 7. Number failing to attend for complete course 4 8. Discharged unsuccessful 2 9. Number on waiting list 25 10. Number of cured cases relapsing and requiring further treatment during: First Year following discharge 1 Second „ „ „ 3 Third „ „ „ Nil 11. Total number of attendances 1,921 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 ... 571 ... 322 245 76.0 Davies Lane 67 47 55 32 30 ... Downsell ... ... ... ... ... ... Farmer ... ... ... ... ... ... Goodall ... ... ... ... ... ... Harrow Green ... ... ... ... ... ... Kirkdale ... ... ... ... ... ... Knotts Green ... ... ... ... ... ... Lea Bridge ... ... ... ... ... ... Mayville 76 83 68 63 36 ... Newport 64 60 47 46 34 ... Norlington ... ... ... ... ... ... Sybourn ... ... ... ... ... ... St. Joseph's ... ... ... ... ... ... Tom Hood ... ... ... ... ... ... Trumpington ... ... ... ... ... ... County High 479 549 258 327 376 ... Report by Authority's Senior Dental Officer (A. E. Hall, L.D.S.) The main development in the dental services of the area during the year 1951 was the opening on 22nd September of the Dawlish Road Treatment Centre with two dental surgeries, recovery room, and dental laboratory for four dental technicians. 110 At the end of the year under review it had not been found possible to obtain the services of dental officers to staff this centre; but one of the surgeries was opened part-time in January, 1952. The Dental Whitley Council Agreement of February, 1951, with regard to the salaries of Local Authority Dental Officers has not proved sufficiently attractive to dental surgeons, and consequently did not enable the Authority to increase its dental staff during the year. The present staff of dental surgeons is approximately two-thirds of what it was in 1939, but only onethird of the present authorised establishment. Six dental officers are necessary to carry on the service as it ought to be carried on. Apart from one full-time dental officer, the work has been carried on by three part-time dental surgeons, and it has been due to their loyalty in remaining in their appointments, and their keen interest in children's work, that all patients who have sought the aid of the department during the year have been able to receive it. Routine examination and treatment have been carried out in three schools of the Borough. In addition, and at the request of the County Council, a survey —of the condition of the teeth of the school entrant group to ascertain the incidence of decayed, missing and filled teeth—was carried out in the Infants' Departments of six schools. The number of sound mouths in school entrants was found to be only 18.82 per cent. The average number of decayed, missing and filled teeth per child was 5.07. Following recommendations made in the Teviot Committee Report on Dentistry concerning the employment of ancillary dental workers in the public dental service, a limited number of Oral Hygienists have been employed by Local Authorities ; and on 16th May, 1951, Miss Watts commenced duties in the Leyton area. Since that date she has done very much useful workscaling and cleaning teeth, minor gum treatment, and talks to mothers and children on matters of dental hygiene. Unfortunately, the scope of her duties is too limited for her to be employed to full advantage among school children, the need for scaling in school children's mouths having been found to average only 17 per cent, of all cases needing dental attention in the schools inspected during the year. 111 A certain amount of preventive treatment has been carried out by the application of sodium fluoride solution to sound teeth. There is a divergence of opinion among dental surgeons as to the value of this treatment; but there is much evidence that, while it cannot be said to prevent dental decay when established, it does appear to delay its onset. Mr. Shamash, L.D.S., has attended Park House Clinic two sessions per week to carry out orthodontic treatment for the most urgent cases. This is a service which is very much sought after, and greatly appreciated by parents and children; but it cannot, with the present limited facilities, be developed to the full. As no provision is made in Table IV for details of orthodontic work, the following statistical information is submitted:— Impressions taken 225 Study models made 225 New appliances fitted 66 Attendances made for treatment 572 Advice to parents and adjustments to appliances 570 X-rays 17 Finished cases 5 Other items of dentistry carried out for which no headings are provided in Table IV are as follows:— Denture space retainers supplied 28 Denture space retainers repaired 1 X-ray films 46 Local anaesthetics 1,238 Application of silver nitrate 1,641 Pivot crowns fitted 2 Fraenectomy 1 Scalings 238 Table IV shows that there has been an increase in the amount of work done during the year, although the number of children inspected is smaller. The apparent anomaly, whereby the number of children found to require treatment is greater than the number inspected, ,is dub to a carry-over from the previous year. 112 Orthopaedic Clinic. Examinations by Orthopaedic Surgeon. Primary examinations 61 Re-examinations 143 The findings at primary examinations were:— Hemiplegia talipes equinus 1 Pes piano valgus 13 Metatarsal deformity 1 Hammer toes 4 Hallux valgus 2 Ankylosis 1 Torticollis 2 Callosity with exostosis 1 Bursitis 1 Genu valgum 10 Pes cavus 2 Ganglion dorsal wrist 1 In toeing 1 Short digit 1 Digitus varus 7 Congenital flexion deformity 2 Overlapping digits 2 Genu recurvatum 1 Hypertension 1 Bunion 1 Flat feet 1 Schlatter's disease 1 Exostosis of tubercle of heel 1 Paralysis of flexors 1 Tibia deformity 1 The following conditions were seen at re-inspections during the year:— Pes piano valgus 2 „ cavus 2 Hallux valgus 2 Digitus varus 7 Genu valgum 7 Hammer toes 3 Congenital deformity 4 „ scoliosis 1 113 Medium Stoffel 1 Metatarsal deformity 2 Congenital shortening of limbs 1 Ganglion dorsal wrist 1 Talipes equinus 2 Exostosis dorsum 1 Dropped foot 1 Prominent scaphoid 1 Schlatter's disease 2 Bowed tibia 1 Flat foot 1 Bakers cyst 1 Athetosis 1 Kyphosis lordosis 1 Kyphosis dorsi-lumbar 1 Torticollis 3 Winged scapula 1 Amputation forearm 1 Loose body—knee 1 X-Rays. Arrangements for X-rays were carried out in 6 cases. Admissions to Hospital. Five children were admitted to hospital, and the following operations performed:— Tenotomy digit (2 cases). Arthrodesis digit 2, left foot. Tenotomy of left tendo achilles. Congenital deformity—manipulation and plaster. Surgical Appliances and Boots. Minor alterations to boots (wedges, etc.) 38 Other alterations to boots (surgical) 4 Walking caliper 1 114 Aural Clinic. During the year 1951 it was found necessary to increase the number of sessions of the Aural Clinic from one a month to one a week. The long waiting list was seriously hampering the usefulness of the clinic, particularly in cases of ear trouble where the child's hearing might be affected seriously or permanently. These weekly sessions were begun in May and there were 29 sessions held during 1951, with a total attendance of 181 new cases and 168 re-attendances. This gives an average of 12 per session. Although 16 appointments are made for each session, attendance averages are brought down by occasional very poorly attended sessions owing to sickness among the children, or inclement weather. Aural cases, e.g. chronic suppurative otitis media, secretory otitis media and other hearing difficulties 77 Nasal obstruction 15 Nasal catarrh and allied conditions 16 "Tonsils" cases 32 Adenoids 4 Septal defects 5 Allergic rhinitis 4 Polypus (nose or ear) 3 Atrophic rhinitis 1 Otosclerosis 1 Miscellaneous 23 181 Of the 168 subsequent attendance cases 105 were cases of chronic otitis media, secretory otitis and other ear conditions. Many of the children had to attend for examination two or three times. In this type of work it is not easy to say how many cases are discharged as cured or improved, for the depressing thing about ear trouble is that even after many months of being free of any type of trouble or disability fresh infection occurs and the work has to be done all over again. "Tonsils". Very few children are referred to the Aural Clinic on the appearance or size of the tonsils alone ; almost all had some other sign or symptom which might or might not be due to the 115 condition of the tonsils or adenoids. In the 32 cases in which the doctor who referred the case to the specialist considered the tonsils to be the cause of trouble, 16 were recommended for operation, 7 were referred for a further period of observation, and 9 were diagnosed definitely as not requiring any surgical treatment. Politzerisation. This treatment was recommended in 24 new cases and 23 old cases; and of these 47 cases, only 2 old and 2 new did not improve in hearing as a result. The children attend a weekly session for a prescribed number of treatments, and then have their hearing re-tested to see what progress has been made. The weekly treatments are given by the school nurse in charge of the Aural Clinic; and the Aural Surgeon (Mr. Hillman) has been very pleased with the results, particularly in cases of secretory otitis media. Other Treatments or Investigations. Cauterised at clinic 4 Antral lavage or other operation at hospital 9 Referred for X-rays 10 For pure tone audiometer test at hospital 19 For gramophone audiometer test at clinic 19 No child was notified from this clinic as deaf. Seven children with deafness of one ear were advised to sit in the front row of the class, reports being sent to the school for the information of the head teacher and class teacher. All children attending the Aural Clinic are seen as special re-inspection cases when the school doctor visits their schools. It is rather depressing that a small minority of children need constant supervision to see that they have any recurrence of ear or nasal trouble treated efficiently. This is particularly true of children with a current otitis media of one ear. Children are found with one ear blocked with pus, and quite a substantial loss of hearing, who know quite well that they can have treatment at once with good results if they will take the trouble to attend. It usually means daily treatment for some weeks, and this is a drawback to the older children; but an even commoner cause of failure to attend is that, although swimming has been prohibited, they have broken the prohibition and do not wish to confess to the cause of the fresh attack. This is unfortunate, but understandable. 116 HANDICAPPED PUPILS. 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. 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. 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 27 31 58 No. admitted to Knotts Green Day Open Air School 8 12 20 No. admitted to Residential Open Air School 16 34 50 No. awaiting admission to Residential Open Air Schools at 31/12/51 2 4 6 Owing to a short waiting list for admission to Residential Schools, several children who were ascertained late in 1950 were not placed until early 1951. This explains why the number of children placed exceeds those ascertained. 117 Physically Handicapped. These are pupils who, not 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. Fortunately the number in this category is small, and attention is drawn to those receiving residential treatment, which had dropped to one at the end of 1951. There were none awaiting admission to either Day or Resident Schools. Boys. Girls. Total. No. attending at Knotts Green Open Air School 11 12 23 No. attending at Residential Schools — 1 1 No. ascertained in 1951 2 5 7 No. recommended Knotts Green Day Open Air School 1 2 3 No. recommended Residential Open Air School 1 1 2 No. recommended to continue at Ordinary School — 2 2 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 1951 7 7 14 No. admitted to Harrow Green 6 6 12 No. admitted to Residential School 1 — 1 One child was ascertained to be educationally sub-normal, but was recommended to remain at an ordinary school. 118 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. Boys. Girls. Total. No. ascertained as Maladjusted 4 2 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 1951—one boy and one girl. There are five children of school age attending Residential Deaf Schools and one awaiting admission. Two children are at Day Schools for the Deaf. 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 learn speech in a normal fashion, with or without hearing aids. No children were ascertained as Partially Deaf in 1951. There was one child at Residential School for the Partially Deaf, and one awaiting admission. There are four children at Day Partially Deaf Schools. Hearing aids have been supplied to four children who are able to carry on at Ordinary Schools satisfactorily. 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 1951. Two children attend Residential Schools for the Blind. 119 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 1951. There are two boys in this category, and both are attending a school for Partially Sighted pupils. Epileptic Pupils. In 1951 two children were ascertained as epileptic. One was admitted to Harrow Green Special School and the other was admitted to a residential school. 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 1951 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 supervision by the Mental Welfare Authority have to be notified. Four boys and three girls were so recommended in 1951. 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. 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 1951 some 77 children were sent away for from four to six weeks— 35 girls and 42 boys. Section 56 of the Education Act. Under this section the Local Authority is empowered to provide education for children who are unable to attend a day or residential school. During 1951 one child received education at home. She was prevented from attending school because of rheumatic carditis, and on the 31st December, twelve children were receiving tuition while long-term in-patients of Whipps Cross Hospital. 120 PROVISION OF MEALS. The number of individual children fed under the Authority's arrangements during 1951 was:— Dinners. Milk Meals. Free 624 11,505 For payment 7,068 — Totals 7,692 11,505 Number of meals supplied:— Dinners. Milk Meals. Free 87,677 2,057,037 For payment 1,018,407 — Totals 1,016,144 2,057,037 SPEECH THERAPY. 1. Children at present Undergoing Treatment— Diagnosis of Defects— Boys Girls Total Stammering 40 8 48 Dyslalia 65 39 104 Disphonia 2 — 2 Lisp 9 6 15 Cleft palate 1 2 3 Excessive nasality 1 3 4 118 58 176 121 Incidence of speech defects among seniors, juniors and infants— Seniors Juniors Infants Total Stammering 17 23 8 48 Dyslalia 6 28 70 104 Disphonia 1 1 — 2 Lisp 1 5 9 15 Cleft palate 1 1 1 3 Excessive nasality 1 1 2 4 27 59 90 176 2. Discharged—73. Seniors Juniors Infants Total Dyslalia 3 16 26 45 Stammering 4 6 3 13 Lisp 1 4 6 11 Cleft palate — — 1 1 Excessive nasality 1 1 1 3 9 27 37 73 3. On Waiting List Nil 4. Average Number of Cases Treated Daily 35 5. Homes Visited 77 6 School Departments Visited 51 7. Parents Interviewed 83 8. Children referred to other Clinics Nil 9. No. of New Cases 76 10. Total No. of Cases treated 176 11. No. of Children who left before Cured or Discharged 15 12. Total No. of Attendances 2,391 122 CHILD GUIDANCE. Report of the Educational Psychologist to the Forest and Leyton Divisions (Miss M. Marshall), 1951. During the year 1951 the Educational Psychologist has continued to develop her work along the lines already established. Visits to schools were made daily for consultation with the teachers on the problems of individual children, and remedial teaching of backward children has been continued at the Child Guidance Clinic. Owing to an absence through illness of some seven weeks in the early part of the year, the actual number of individual children seen is somewhat less this year, in spite of the fact that the school population in this combined area has risen to over 32,000. The total number of children seen by the Educational Psychologist during the year and given individual tests of intelligence and attainments was 256. These numbers were divided as follows amongst the different school departments. Pre-School Infant Junior Secondary Leyton 3 28 77 20 Forest 3 43 49 33 The number of school visits made was: Leyton 65 Forest 75 Total 140 In addition, 49 other visits were made to meet school medical officers, parents, juvenile employment officers, etc. The children interviewed may be divided into the following categories:— Dull I.Q. below 85 Average I.Q. 85—115 Bright I.Q. over 115 Total Leyton 27 80 21 128 Forest 40 59 29 128 Total 67 139 50 256 Compared with the figures for the previous year, fewer dull children were seen, and a larger number of children of superior intelligence. 123 As in previous years, the number of boys referred to the Psychologist was more than double the number of girls. Girls Boys Total Leyton 34 94 128 Forest 42 86 128 Total 76 180 256 Of these, 117 were later referred to the Child Guidance Clinic for a fuller investigation. Of these children, 39 were girls and 78 boys. The reasons for requests to the Psychologist for individual examination were:— 1. Educational Advice: (a) Backwardness 135 (b) Other educational problems 14 2. Problems of behaviour: (a) At School 46 (b) At home 38 3. Reports needed by Juvenile Court or Probation Officer 17 4. Other evidence of maladjustment, e.g. stammer, enuresis, tics, asthma, etc. 12 Some children may be referred for more than one reason, e.g., backwardness and behaviour disorders. During the year the Psychologist has given one course of lectures to teachers on "Problems in the Primary and Secondary School", and also separate lectures to Parents' Association meetings, etc. She lectured on two occasions to students at Wansfell Residential Adult College. The Psychologist also assisted at a six-day residential course for teachers at St. Osyth's Training College, Clacton, in July. Remedial teaching has been continued with certain children selected by the Psychiatrist. Eight children attended for this during the year, and received a total of 165 lessons. All the children received some help with reading and two with arithmetic also. The aim of these lessons is not only to increase 124 skill, but also to encourage the child to adopt a new attitude towards his past failure. In every case this new determination to succeed was evident before the lessons were discontinued, and more confidence was shown. In every case the actual reading or arithmetic age improved also. Two student psychologists have worked in the area for a time during the year under the supervision of the Educational Psychologist. In the summer a survey was made in one Infant School of the reading ability of the whole group who were due to transfer to the Junior School after the summer holiday. Such surveys may help to throw some light ou the problems of reading failure in the later stages of education. During the Autumn Term preparations were made in Leyton to begin some special remedial teaching of reading in the schools for children of average or above average intelligence who were two or more years retarded in reading. This entailed an increase in the number of Junior children seen by the Psychologist. The plan was to confine the remedial teaching at first to children of 9 and 10 years of age. Two retired teachers are being employed for this special work, and each of them is taking groups of 6 children at a time for an hour to an hour and a half's lesson twice a week. At present the experiment is being confined to only four of the Primary Schools, and the total number of children receiving this remedial teaching is 48. 125 RESEARCH WORK. Anti-tuberculosis Vaccine (B.C.G.). In collaboration with the Medical Research Council, there is being undertaken in Leyton schools a Trial of Anti-tuberculous Vaccine (B.C.G.). 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. The scheme is being operated by a Medical Research Council team especially assigned to this work, and comprises the following examinations:— (a) Penultimate school term: Initial tuberculin-testing and X-raying of volunteers; inoculation with B.C.G. of those tuberculin-negatives selected for vaccination. (b) 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). (c) 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, 1950, and the investigation has been in progress since then. The following figures give some idea of the progress of the investigation during 1951: Spring Term Summer Term Autumn Term No. of School leavers 207 297 286 No. of Acceptances 102 145 134 Percentage of Acceptances 49.2 28.8 47.0 No. attending first test 93 139 110 No. inoculated with B.C.G. 21 46 29 No. of controls 21 43 31 No. positive to O.T. 1/3000 and 1/100.. 42 47 31 126 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 1,460 Second Age Group 968 Third Age Group 1,065 Total 3,493 b. Other Inspections. Number of Special Inspections 12,806 Number of Re-inspections 9,640 Total 22,446 127 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 20 341 361 24.7 Second Age Group 45 120 165 17.0 Third Age Group 46 203 249 23.4 Total (Prescribed Groups) 111 664 775 22.18 Other Routine Inspections ... ... ... ... Grand Total 111 664 775 22.18 TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1951. Defect or Disease. Routine Inspections. Special Inspections. Number requiring Treatment. Observation. Number requiring Treatment. Observation. (1) (2) (3) (4) (5) Skin 14 12 244 1 Eyes— (a) Vision 103 27 203 19 (b) Squint 15 9 15 1 (c) Other 17 7 297 7 Ears— (a) Hearing 7 34 18 10 (b) Otitis Media 10 44 37 ... (c) Other 91 34 266 1 Nose or Throat 75 152 253 8 Speech 9 7 46 3 Cervical Glands 2 64 4 1 Heart and Circulation 31 30 12 6 Lungs 13 59 57 10 Developmental- (a) Hernia 4 4 1 ... (b) Other 8 16 33 1 Orthopædic- (a) Posture 17 46 8 1 (b) Flat Foot 38 24 17 2 (c) Other 57 56 59 1 Nervous System- (a) Epilepsy 2 6 5 3 (b) Other 3 18 11 6 Psychological- (a) Development 2 6 12 5 (b) Stability 3 18 23 ... Other 58 59 1,751 7 128 TABLE II. B. Classification of the General Condition of Pupils Inspected during the Year in the Age Groups. Age Groups. No. of Pupils Inspected. A. Good. B. Fair. C. Poor. No. % No. % No. % Entrants 1,460 338 23.2 1,066 73.0 56 3.8 Second Age Group 968 321 33.2 607 62.7 40 4.1 Third Age Group 1,065 429 40.3 628 59.0 8 0.7 Other Routine Inspections ... ... ... ... ... ... ... Total 3,493 1,088 31.1 2,301 65.9 104 3.0 TABLE III.—Return of Defects Treated during the Year ended 31st December, 1951. 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 4 2 Body 3 1 Scabies ... ... Impetigo 14 1 Other skin diseases 277 4 Minor Eye Defects— (External and other, but excluding cases falling in Group II) 183 2 Minor Ear Defects 566 30 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 1,920 261 Total 2,967 301 129 TABLE III.—contd. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as minor ailments.—group I). Defect or Disease Number of Defects dealt with By the Authority Otherwise Errors of refraction (including squint) ... 371 Other defect or disease of the eyes (excluding those recorded in Group I) ... 104 Total ... 475 No. of Pupils for whom Spectacles were— (a) Prescribed ... 606 (b) Obtained ... 592 Group III.—Treatment of Defects of Nose and Throat. Total number treated. By the Authority. Otherwise. Received operative treatment:— (a) for adenoids and chronic tonsillitis - 90 (b) for other nose and throat conditions - 2 Received other forms of treatment 566 30 566 122 Group IV.—Orthopædic and Postural Defects. (a) No. treated as in-patients in hospitals or hospital schools 5 (b) No. treated otherwise, e.g., in clinics or outpatient departments 43 Group V.—Child Guidance Treatment and Speech Therapy. No. of pupils treated— (a) Under Child Guidance arrangements 128 (b) Under Speech Therapy arrangements 76 130 TABLE IV. Dental Inspection and Treatment. (1) Number of pupils who were:— (a) Inspected by the Dentist:— Aged: Age Groups 3 — Total 1,996 4 — 5 368 6 29 7 — 8 9 — 10 1 11 168 12 380 13 345 14 382 15 204 16 79 17 28 18 12 Specials (Casuals) 1,471 Grand Total 3,467 (b) Found to require treatment 2,855 (c) Actually treated 3,214 (2) Half-days devoted to Inspection 21 Treatment 722— Total 743 (3) Attendances made by children for treatment 6,885 (4) Fillings, Permanent Teeth 2,046 Temporary „ 461- Total 2,507 (5) Extractions, Permanent Teeth 771 Temporary „ 4,383— Total 5,154 (6) Administrations of general anæsthetics for extractions 1,494 (7) Other operations, Permanent Teeth 2,052 Temporary „ 2,037- Total 4,089 131 TABLE V. Infestation with Vermin. (1) Total number of examinations in the Schools by School Nurses 27,741 (2) Number of individual pupils found to be infested 371 (3) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2) Education Act, 1944.) Nil (4) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3) Education Act, 1944.) Nil