AC 44 11 (1) LEYTON LEY 46 Borough of Leyton HEALTH REPORT FOR THE YEAR 1952. ANDREW W. FORREST, M.A., M.D., M.B., Ch.B., D.P.H., Medical Officer of Health, Borough of Leyton, Area Medical Officer, County of Essex. CONTENTS. pages 1. Index 2 2. Opening Remarks 13 3. Vital Statistics 22 4. Infectious Diseases 28 5. General Provision of Health Services in the 45 Area 6. Sanitary Circumstances of the Area 63 7. National Health Service Act, 1946, Part III 89 8. School Health Service 138 2 INDEX Page Acreage 12 After-care Association 128 Ambulance facilities 47,119 Ante-natal Clinics 92 Area Health Sub-committee 4 Aural Clinic 149 Bacteriological examinations 47 B.C.G. Immunisation 114 Biological examinations Birth notifications 92 Birth rate 22 Birth registrations 92 Births, illegitimate 22 Births, Inwards transferable 104 Births, institutions 104 Burial of the dead 49 Care and after-care 120 Care of mothers and young children 92 Census 1951 59 Child Guidance 157 Child Welfare Clinics 93 Chiropody 120 Cleanliness survey 140 Clinic sessions 91 Committees 4 Convalescence 99 Dairies and milk shops 79 Day Nurseries 99 Deaths, causes of 26 Death rate 23 Dental treatment 95,143 Diphtheria 30 Diphtheria immunisation 108 Diphtheria, Incidence and mortality 30 Disinfestations 65 District midwifery 102 Domestic Help Service 133 Dysentery 30 Education, Leyton Committee for 6 Encephalitis 30 Erysipelas 30 Extra nourishment 128 Factories Acts, 1937/8 88 Fog 52 Food and Drugs Act, 1938 83 Food, clean 87 Food, condemned 80 Food, inspection 79 Food poisoning 30 Food premises 79 Foot Clinic 120 Funeral arrangements 49 Gas and Air analgesia 102 Handicapped pupils 151 Health Centres 90 Health Education 123 Page Health Visiting 106 Home Help 133 Home Nursing 107 Hospitals 47 Housing 71 Ice cream 80 Immunisation 108 Infant mortality 22 Infectious disease 28 Influenza 54 Inquests 50 Laboratory facilities 47 Lectures and film shows 124 Legal proceedings 78 Local land charges 74 Malaria — Mass Radiography 125 Maternal mortality 95 Maternity nursing 102 Maternity outfits 102 Meals in schools 154 Measles 33 Medical Aid 103 Medical examinations of staff 137 Meningitis 36 Midwifery 102 Milk inspection 79 Minor Ailment Clinics 141 Mortuary 49 National Assistance Act, 1946 (Sees. 47 and 50) 49 National Health Service Act, 1946 (Part III) 89 Neo-natal mortality 22 Notices, sanitary 65 Notification of births 92 Nursery nursing certificate 101 Occupational therapy 131 Open air shelters 128 Ophthalmia neonatorum 36, 99 Ophthalmic Clinic 98 Oral hygiene 146 Orthopaedic Clinic 98, 147 Orthoptic Clinic 141 Paratyphoid fever 36 Pemphigus neonatorum 36 Pneumonia 36 Poliomyelitis 36 Population 12 Post mortems 50 Post-natal Clinic 94 Premature infants 94 Prevention of Damage by Pests Act, 1949 65 Prevention of illness 120 Puerperal pyrexia 40 Public Health Committee 4 3 Page Rateable value 12 Rehabilitation 128 Rodent control 65 Routine medical inspection 139 Sanitary circumstances of the area 64 Scabies Clinic 48 Scarlet fever 40 School Health Service 138 Shop window display 125 Sick room equipment 127 Smallpox 41 Smoke abatement 74 Social conditions 12 Page Speech therapy 155 Staff 7 Staff, Medical examinations 137 Stillbirths 22 Tuberculosis 41,128 Typhoid fever 43 Vaccination 108 Verminous houses 65 Vital statistics 22 Whooping cough 44 Whooping cough immunisation 113 Winter of 1952/3 52 4 PUBLIC HEALTH COMMITTEE 1952-53 The Worshipful Mayor—Alderman Mrs. R. King, j.p. (ex-officio) Chairman Councillor H. E. Martin Vice-Chairman Councillor P. W. Marshall Alderman B. G. Rayner „ E. A. Rigg Councillor Mrs. D. E. Barker „ Mrs. A. M. M. Burrell „ W. A. Chapman „ E. Martin „ W. J. Rands P. W. Wigg Leyton Health Area Sub-Committee of the Health Committee of the Essex County Council 1952-53 Chairman : Councillor Mrs. A. M. M. Burrell Vice-Chairman : Alderman G. S. Flack Representatives of Essex County Council County Aldermen : Mrs. M. Ball (ex-officio) (County Health Committee) Mrs. B. K. Lowton (County Health Committee) County Councillors : H. Burton (County Education Committee) Mrs. F. E. Cochrane (County Health Committee) H. Herridge (County Health Committee) Mrs. E. F. M. Hollis (County Health Committee) Dr. V. Skinner (ex-officio) (County Health Committee) 5 Representatives of Leyton Borough Council Aldermen : A. G. Cochrane Mrs. J. Hammond, o.b.e., j.p. Mrs. R. King, j.p. B. G. Rayner Councillors : W. A. Chapman W. J. Giffin E. W. R. Harding S. G. Hawkey, j.p. W. J. Low F. W. Marshall E. Martin I. C. Messenger J. J. Walsh Representative of Local Medical Committee Dr. J. F. B. Hill Representative of Hospital Management Committee Alderman The Lady McEntee, j.p. Representative of Executive Council for Essex J. W. Randall Nation, Esq., j.p. Representatives of Voluntary Organisations Mrs. A. M. Clewer (Leyton, Wanstead & Woodford Care Association) G. A. Dicker, Esq. (Leyton, Wanstead & Woodford Care Association) Mrs. E. Gardner (British Red Cross Society) Mrs. A. E. Sampson (St. John Ambulance Brigade) 6 LEYTON COMMITTEE FOR EDUCATION 1952-53 Chairman : Alderman Mrs. J. Hammond, o.b.e., j.p. Vice-Chairman : Councillor J. J. Walsh Representative Members (Leyton Borough Council) Alderman : A. E. Bechervaise Councillors : F. J. Abbott P. W. J. Ayerst Mrs. D. E. Barker A. W. Bourne H. Burton A. L. Chamberlain W. J. Child J. A. E. Collins The Rev. C. A. Fox, c.f. E. W. R. Harding W. J. Low C. J. Mills G. W. A. Robinson Co-optative Members Mrs. E. V. Pearson J. Fairfax M. Rayner S. G. Shepherd R. J. Thurston L. W. Turp Nominated Members (Appointed by the County Council) County Councillors : E. C. Hardy A. R. Sherrell 7 OFFICERS OF THE HEALTH SERVICES LEYTON BOROUGH COUNCIL Medical Officer of Health Borough School Medical Officer and Area Medical Officer (Essex County Council) Andrew Walker Forrest, m.a., m.d., m.b., ch.b., d.p.h. Deputy Medical Officer of Health Deputy Borough School Medical Officer and Assistant County Medical Officer (Essex County Council) Mary Lyle Gilchrist, m.d., m.b., ch.b., d.p.h. Senior Sanitary Inspector Edward Henry Gray. (Resigned 31. 10. 52) a, b Benjamin James Ashcroft, m.s.i.a., m.inst.b.e. a, b, c, e (Commenced 1.1. 53) Deputy Senior Sanitary Inspector Reginald Alfred Reeves, m.s.i.a. a, b Sanitary Inspectors Arthur Edward Barnes a, b John Clarke, m.s.i.a. a Phillip William Edwards, m.s.i.a. a, b Edward Raymond Hodge, m.s.i.a., m.r.s.i. a, b, a Graham Donald John, m.s.i.a. a Clifford Pomfret, m.s.i.a., a.r.s.i. a, b, c a. Certificate of the Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. b. Royal Sanitary Institute—Meat and Food Inspector's Certificate. c. Royal Sanitary Institute—Smoke Inspector's Certificate. d. Royal Sanitary Institute—Certificate in Sanitary Science as applied to Building and Public Works. e. Gold Medallist—Ollett Trust Competition. Public Analysts George Taylor, f.i.c. J. Hubert Hamence, M.sc., Ph.D. 8 Chief Cleric George Frederick Leserve. (Resigned 31.8.52) *W. Douglas Softley. (From 1. 9. 52) *Part-time. Clerical Staff James Burtt Frederick Charles Ware. (Resigned 2. 6. 52) Norman Gray. (From 1. 7. 52) Mrs. Violet Hatwell Leonard Williams Theodore Crute. (From 1.11.52) ESSEX COUNTY COUNCIL Assistant County Medical Officers *Mary L. Gilchrist, m.d., m.b., ch.b., d.p.h. Samuel C. Lovell, m.b.c.s., l.e.c.p. Ethel R. Emslie, m.b., ch.b., m.d., d.p.h., d.c.h. Shirin Dastur, m.b.c.s., l.b.c.p. *Anne S. Clark, m.b., ch.b. *Rachel Jacobs, m.d., d.obst., r.c.o.g. *Part-time. Specialist Part-time Medical Officers. (Regional Hospital Board Appointments) Ophthalmologist A. Logan Adams, m.r.c.s., l.r.c.p., m.b., b.s., d.o.m.s. Orthopaedic Surgeon B. Whitchurch Howell, f.r.c.s., m.b., b.s., m.r.c.s., l.r.c.p. Aural Surgeon s. hillman, l.r.c.p., l.r.c.s., l.r.f.p.s. Area Dental Officer Arthur E. Hall, l.d.s. (Liverpool) 9 Dental Officers John G. Douglas, l.d.s. (r.c.s.). (Until 14. 4. 52) Pauline T. Fuller, l.d.s. (From 28. 4. 52) *Dorothy M. Powell, l.r.c.p., l.r.c.s.(Ed), l.r.f.p.s. (Glas.), 1920, l.d.s.r.c.s. (Ed.) *Charles Shamash, b.d.s., l.d.s. (r.c.s.) Non-Medical Superintendent of Midwives Edna M. Wearn a, b, c Midwives Emily Daines a, b Clara L. Wackett a, b Superintendent Health Visitor Eve M. Franklin a, b, c Health Visitors / School Nurses Lucy Acton a, b, d Maud J. Charters a, c (from 12. 8. 52) Winifred J. Carey a, c (from 12. 8. 52) Elizabeth O. Corby a Gladys W. Craddock a, c Maud Murray a, b, c Mary E. Nangle a, d Margaret H. Roger a, b, c Quita H. Rolfe a, c (from 13.10.52) Ruth M. Edward a, c Christina B. Ferguson a, b, c Bridget King a, d, c Irene M. McPherson a, b, c Kathleen M. Munday a, c. (from 1.10.52) Margaret Sims a, b Joyce H. Souter a, b, c Ethel M. Walling a, b c Tuberculosis Visitors Constance G. Teale *Part-time. a, b, c, e Letitia M. Abbott a, f 10 Matrons of Day Nurseries Knotts Green Day Nursery— Elizabeth M. White a, d Ellingham Road Day Nursery— Dorothy M. McStay a, b (a) S.R.N. (b) S.C.M. (c) H.V. Cert. (d) S.R.F.N. (e) Q.N. (f) T.A. Cert. Orthoptist Kathleen S. Box, s.r.n., s.c.m., d.b.o. (Regional Hospital Board Appointment) Speech Therapist Mary E. Tippett Chiropodists Senior : John C. O'Brien, m.i.s.ch. Others : Joyce M. Hunter, m.i.s.ch. David D. Waters, m.b.a.ch., m.i.s.ch. Stanley A. Wightman, m.i.s.ch. *Richard Sadowski, m.i.s.ch. *Gordon E. Fenn, m.i.s.ch. Domestic Help Organiser Mrs. E. M. Saxby Oral Hygienist Miss J. Watts Dental Attendants Mrs. D. Blundell (from 1. 9. 52) Miss E. Corcoran Miss D. L. Smith (to 15. 7. 52) Miss A. I. Warren 11 Clinic Clerks Miss F. C. Cheetham Mrs. L. Neville Miss E. Nichols (Foot Clinic) Mrs. J. Price Chief Administrative Assistant W. D. Softley Administrative and Clerical Staff E. E. Jacobs (resigned 10. 3. 52) F. C. Ware (from 3. 6. 52) E. R. Price L. G. Goodbun G. A. Thurlow E. Lamb A. Keeys Miss E. Beckley Mrs. F. Wright Miss R. Carrington (from 1.12.52) K. Cockling (H.M. Forces 9. 9. 52) G. Whitehouse (from 1. 9.52) 12 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area in Acres 2,594 Population (Census 1951) 105,183 Population (Registrar-General's Estimate, June 1952) 104,200 Number of Families [Census (1 per cent. tables) 1951] 34,800 Number of Persons per Household [Census (1 per cent. tables) 1951] 2.94 Assessable Value for General Rate Purposes (1952/53) £783,242 Sum represented by a Penny Rate for General Rate purposes (1952/53) £3,180 13 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LEYTON. Mr. Mayor, Ladies and Gentlemen, I have the honour to present herewith my Annual Report on the health, sanitary circumstances and vital statistics of the Borough of Leyton for the year 1952, together with reports on the day-to-day administration of the services delegated by Essex County Council as Local Health Authority to Leyton Health Area Sub-committee and as Local Education Authority to Leyton Committee for Education. The report contains much information in the form of figures and facts required by the Ministry of Health and the County Council ; but it also contains general observations—and special reports contributed by members of the medical staff—on certain aspects of the local health services which are of current interest and are considered to merit special attention. Vital Statistics. The post-war high peak in the birth rate was reached in 1947, the level in that year being 22.35 births per thousand of the population. Thereafter there has been a progressive decline in the birth rate each year until 1951, when the rate was 12.52. In 1952, however, the rate rose slightly to 13.00. Compared with the previous year, there was in 1952 a reduction in the general death rate from 13.00 to 11.70 per thousand of the population. There was, however, an increase in deaths of infants under one year of age, from 27 in 1951 to 37 in 1952—the infantile death rate being increased from 20.59 to 27.30 per thousand live births. During the year under review one Leyton mother died from causes connected with pregnancy and childbirth, the maternal mortality rate being .72. The natural increase in the population of Leyton (i.e., increase of births over deaths) was 135. Further information regarding comparative vital statistics is to be found on pages 22 to 25. Census 1951 A most important landmark in the field of vital statistics was the enumeration and classification of the population in the official 14 Census held in 1951—the first to be held for twenty years. Although the full results will not be available for some time, a preliminary outline is now available and relevant extracts of local interest are shown on pages 59 to 62. The tables show that, although the populations of England and Wales, Greater London and Essex have all increased substantially since 1931, the population of Leyton has decreased by 23,130 (18%). Some 42% of households in the Borough live in shared dwellings. In the twenty years since 1931 there has been a reduction in the average number of persons per room (from 0.86 to 0.76), and in the number of persons per household (from 3.59 to 2.94). A study of the tables shows to what extent dwellings in Leyton are lacking in recognised domestic amenities. Infectious Diseases. For over half a century it has been recognised that one of the chief functions of a public health department has been the prevention and control of infectious diseases, especially those that killed and maimed infants, young children and mothers. Those of us who remember the high fatahty and morbidity rates of the so-called commoner infectious diseases during the early decades of this century can at least claim that our efforts have been successful—in fact so very successful that it has been found possible to close altogether many infectious disease hospitals throughout the country, and to allocate for other purposes a large proportion of beds in other hospitals formerly used for the isolation and treatment of fever patients. In my Annual Report for 1950 I included facts and figures showing the great reduction in deaths from infectious diseases during the last fifty years. That reduction, along with the great fall in deaths of infants under one year of age, has been largely responsible for the great increase in the expectation in life and the fundamental change in the age constitution of the population. In just over fifty years the average span of human life has been increased by some twenty-two years, and the proportion of the population over sixty-five years of age has been more than doubled. Facts and figures such as these represent a wonderful achievement, and serve to counteract the present-day tendency to decry the efforts of preventive, in favour of, curative, medicine. The preventive health services have justified and consolidated their position as a vital part of central and local government, and it is to their credit that they have been able to do so without impoverishing the financial resources of the country. 15 During 1952 there occurred no case of smallpox, diphtheria, pemphigus of the newborn, typhoid and paratyphoid fever or acute infective encephalitis; and only one case each of ophthalmia of the newborn, meningitis, and post infectious encephalitis. Only six cases of diphtheria have been notified in Leyton during the last five years, and the last death from diphtheria occurred in 1947. Nevertheless diphtheria still remains one of the dangerous diseases of infancy, and its elimination depends on whether or not the percentage of immunised children remains sufficiently high. Immunisation against diphtheria should be completed before the child's first birthday. Leyton, in common with most metropolitan and extrametropolitan areas, experienced the most widespread measles epidemic since figures became available. The number of cases notified during the year reached the record figure of 1,630. The fact that only one child died from measles, or its complications, suggests that the disease is becoming less severe in type. Scarlet fever was also much more prevalent than usual, but the very mildness of the prevalent type is making it most difficult to diagnose, and even more difficult to control. For the fourth time since the end of World War II the number of notified cases of acute poliomyelitis has reached double figures— twelve, of whom five had no paralysis of any kind and five were very mild. To such an extent have we succeeded in protecting infancy and childhood from the ravages of the commoner infectious diseases that used to kill and maim, that the occurrence of a few cases of poliomyelitis tends to give rise to a fear among mothers of young children almost amounting to panic. It is far from my purpose to attempt to minimise the seriousness of a severe case of poliomyelitis, for there can be no more tragic calamity in a family than for a child to retire to bed in a state of perfect health, and to wake up with limbs paralysed, possibly for ever ; but, in order to present it in its proper perspective and relative importance as a death-dealing danger, I submit these figures showing the annual number of deaths attributed to four common dangers to life in Leyton over a period of five years. 1948 1949 1950 1951 1952 Poliomyelitis Deaths — 1 — — — Road Deaths 11 8 9 9 7 Deaths in the Home .. 8 5 8 9 13 Deaths from Tuberculosis 49 33 32 35 31 16 Detailed information regarding the Leyton poliomyelitis cases of 1952 is to be found on pages 36 to 39. Tuberculosis. From the statistical summary on page 43 it will be seen that whereas during the last ten years the annual number of deaths from tuberculosis has been reduced by more than half (from 70 in 1943 to 31 in 1952), there has been no corresponding reduction in the incidence of the disease as shown by the annual number of notifications. Tuberculosis is still one of the major killing diseases, and the most serious infectious disease affecting the working section of the community at the time when their value to the national economy is greatest. Before 1948 the prevention of tuberculosis was regarded as being more important than its cure, and all the work connected with prevention and treatment (domiciliary and institutional) was under the control of the local health authority. Since 1948 the Regional Hospital Boards have been responsible for the staff and the work undertaken in chest clinics, and for all treatment either at home or in hospital; whereas the local health authorities have been responsible for the appointment and work of the tuberculosis health visitors. Such dichotomy of effort has given rise to administrative difficulty of the type inherent in any scheme which is subject to dual control. Owing to the lack of essential medical equipment and facilities at Leyton Chest Clinic, Leyton patients are subjected to unnecessary inconvenience, delay and expense by having to attend at the various institutions to which the work of the Leyton clinic has been farmed-out; and the supervision of contacts is therefore more difficult than it should be. Food Poisoning During the year some twenty Leyton residents were notified to be suffering from food poisoning, and fortunately all made good recoveries. Today eating in catering establishments and canteens is much more common than it used to be, and one careless or unclean food handler can infect a large number of people. It should be realised that it is dangerous for a person suffering from diarrhoea, or from sores on the skin, to handle food ; and that all food handlers should always wash their hands after using the lavatory. The old fear of metallic contamination ("ptomaine poisoning") has been shown to be groundless, and it should be realised that it is not the foods that smell badly that are most 17 dangerous. The greatest danger is from the lack of cleanliness of food handlers. Some practical advice on the avoidance of food contamination is to be found on pages 32 and 33. The Winter of 1952—53. It would be difficult to imagine a winter so uniformly depressing and unhealthy as the last. Fog, influenza and floods killed and incapacitated the population to an alarming degree. The five-day fog of last December was one of the worst within living memory, and some idea of the havoc it caused may be obtained by consulting pages 52 to 58. The prevention of atmospheric pollution, and the reduction in the smoke pall overhanging our cities, is one of the most urgent public health problems of today ; and it is to be hoped that those who are still inclined to regard the so-called " London Particular " as a temporary but unavoidable inconvenience will at least be able to read page 57. Sanitary Circumstances. A special report by the Senior Sanitary Inspector (pages 66 to 68) deals with the relative responsibilities and activities of the Council and of householders in the prevention of pests. Reference is made to the methods employed to control rodents, and to the work carried out during the year. Nothing contributes more to human health and happiness than adequate housing. For almost a decade the war interrupted the building of new houses and the repair of old ones, and added a further burden by the destruction of houses on a large scale by enemy action. The consequent acute shortage of houses has been rendered even more acute by the progressive increase in the number of families per thousand of the population. Nowadays young people are marrying at an earlier age than their parents, although their chance of obtaining a home of their own is so much less. There has been no increase, but rather a decrease, in overcrowding ; and an acute shortage of family units of accommodation. Many more, but much smaller, families are clamouring for houses of their own. Forty per cent. of households in Leyton are in shared dwellings, where they are subject to the acute irritations and worries, and to the more chronic nervous strain and grief, of those who cannot call their house their own. As with human beings, houses deteriorate with age, and have a definite expectation of useful life beyond which they become an economic and social liability. Even in normal times a vigorous programme of new building and re-housing is required merely to keep pace with expected obsolescence and dilapidation of dwellings ; and a number 18 of houses in Leyton are rapidly approaching the time when no amount of repair work can be expected to keep them in a state fit for human habitation. 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 statistical and graphical information regarding the concentration of smoke and sulphur dioxide in the Leyton atmosphere is to be found on pages 75 to 77. National Health Service Act, Part III. The comprehensive services under the various sections of this Act are administered by the local health authority (Essex County Council), who have delegated to Leyton Health Area Sub-committee the routine day-to-day administration of these services. It will be seen that the new Dawlish Road Clinic, opened in September, 1951 is now supplying a comprehensive list of clinic medical, dental, nursing and chiropodial services of which full advantage is being taken by residents in the area. Arrangements for public whooping cough immunisation were put into operation in September, 1951 ; and 909 children completed the course of immunisation during 1952. In April, 1952, the special approval of the Ministry of Health was obtained for Dr. Ethel Emslie to carry out a scheme for the protection of Leyton children against tuberculosis by the administration of B.C.G. Vaccine ; and a special report on the subject appears on pages 114 to 118. During the year Leyton residents took full opportunity to avail themselves again of the facilities for Mass Radiography, and in the body of the report will be found the results in the cases of the 8,362 persons who attended. The National Health Service. More than four years have now elapsed since the National Health Service Act, 1946 came into operation. Now that it has had time to get over what have been described as its preliminary " teething troubles ", some idea of its effects—at least in general outline—are becoming apparent. 19 There can be no doubt that the National Health Servioe is the greatest and most comprehensive scheme of public medical provision ever to be put into operation in any country. It has banished from countless homes one of the great sources of fear— fear of disease and the consequent impoverishment of family resources. It is a most salutary change for people, especially poor people, to know that they can avail themselves of all the resources of modern medical treatment (including specialist and hospital treatment) free of charge. The declared intention of the National Health Service Act was " to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness " ; but with the passage of time it is becoming increasingly apparent that the so-called Health Service is much more concerned with the treatment of illness than with the promotion of health. Knowing as we do that some of the greatest and most salutary advances in human health and happiness have been made in the realm of preventive medicine, and that it is much more economic to spend time and money on the prevention of disease than on its cure, widespread surprise is felt and expressed that the service should be devoting such overwhelming importance and expenditure to the cure of disease and such scant attention to its prevention. As far as cost is concerned, the most economical form of medical provision is preventive medicine, by far the most expensive being hospital provision. The aim of preventive medicine is not to cure established disease, but to prevent disease from occurring ; not to build larger and better hospitals, but to close them for want of patients. There is nothing spectacular and dramatic in prevention, which becomes " news " only when something goes wrong. The main defect in administration of the Act is that there are three independently constituted authorities—local health authorities, hospital management committees and executive councils— all dealing with different aspects of the same problem. For instance, there are now three independently constituted and unco-ordinated bodies concerned with maternity; and in none of the three is maternity the main function. It is to be hoped that there may be devised some method of co-ordinating the work of the three independently appointed and administered authorities responsible for the National Health Service. 20 School Health Service. The last section of the report contains information regarding the services administered by Leyton Committee for Education on behalf of the Local Education Authority—Essex County Council. Acknowledgments It is my privilege to acknowledge the support accorded to me by the members of the Council, and the helpful interest shown by the Chairmen and members of the Committees concerned with the work of the Health Department. It is with sincere thanks that I record my appreciation of the industry and loyalty of the members of the Health Department staff. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, Vital Statistics 22 Extract from Vital Statistics for the year 1952. Population 104,200 Live Births :— Legitimate Males 667 Females 632 Illegitimate Males 27 Females 29 Totals 1,355 Birth rate per 1,000 of population 13.00 Stillbirths :— Males 11 Females 19 Rate per 1,000 total (live and still) births 21.66 Deaths :— Males 635 Females 585 Totals 1,220 Death Rate per 1,000 11.70 Number of women dying from diseases and accidents of pregnancy and childbirth :— From Sepsis 0 From other causes 1 Rate per 1,000 total (live and still) births 72 Death rate of infants under one year of age :— All infants per 1,000 live births 27.30 Legitimate infants per 1,000 legitimate live births 25.09 Illegitimate infants per 1,000 illegitimate live births 53.57 The natural increase of population (i.e. excess of births over deaths) was 135. Comparability Factor To make approximate allowance for the way in which the sex and age distribution of the Borough population differs from that for England and Wales as a whole, the Registrar General has issued the following comparability factors for Leyton. Area comparability factor for births 0.93 Area comparability factor for deaths 0.96 23 These factors, when applied to the crude rates, produce the following adjusted rates :— Live births 12.09 Deaths 11.23 The usual comparison of birth and death rates with those for the whole country is shown in Table 1, on page 24. Deaths The Registrar-General's classification of causes of death by sex totals is shown in Table 4, on page 26. The total number of deaths in 1952 (1,220) compares with 1,362 in 1951, the respective death rates per 1,000 population being 11.70 and 13.00. Cancer Deaths from Cancer numbered 233 (126 males, 107 females). Death-rates per 1,000 of the population for the past ten years are as follows. Year Deaths Death rate 1943 207 2.35 1944 178 2.83 1945 189 2.16 1946 185 1.81 1947 206 1.95 1948 189 1.78 1949 232 2.17 1950 186 1.74 1951 226 2.15 1952 233 2.23 24 TABLE 1. Birth Rate per 1,000 Total Population and Annual Death Rates England and Wales 160 County Boroughs and Great Towns (Including London) 160 Smaller Towns London Leyton Birth Rate per 1,000 total population Live Births 15.3 16.9 15.5 17.6 12.09* Still Births 0.35 0.43 0.36 0.34 0.28 Annual Death Rate per 1,000 Population All causes 11.3 12.1 11.2 12.6 11.23* Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 0.00 Smallpox 0.00 0.00 0.00 0.00 0.00 Tuberculosis 0.24 0.28 0.22 0.31 0.23 Pneumonia 0.47 0.52 0.43 0.58 0.68 Whooping Cough 0.00 0.00 0.00 0.00 0.00 Diphtheria 0.00 0.00 0.00 0.00 0.00 Influenza 0.04 0.04 0.04 0.05 0.00 Acute Poliomyelitis 0.01 0.01 0.00 0.01 0.00 Rate per 1,000 Births All causes Under 1 year 27.6 31.2 25.8 23.8 27.30 Enteritis and Diarrhœa Under 2 years 1.1 1.3 0.5 0.7 0.00 *Adjusted by the Area comparability factor. TABLE 2. Case Rates fob Certain Infectious Diseases in 1952. Corrected Notifications rate per 1,000 of Population. Disease England and Wales 160 County Boroughs and Great Towns 160 Smaller Towns London Administrative County Leyton Typhoid Fever 0.00 0.00 0.00 0.00 0.00 Paratyphoid Fever 0.02 0.02 0.03 0.01 0.00 Meningococcal fever 0.03 0.03 0.03 0.02 0.00 Scarlet Fever 1.53 1.75 1.58 1.56 3.18 Whooping cough 2.61 2.74 2.57 1.66 2.34 Diphtheria 0.01 0.01 0.03 0.01 0.00 Erysipelas 0.14 0.15 0.12 0.14 0.64 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 8.86 10.11 8.49 9.23 15.64 Pneumonia 0.72 0.80 0.62 0.57 3.93 Acute poliomyelitis Paralytic 0.06 0.06 0.06 0.06 0.06 Non-paralytic 0.03 0.03 0.02 0.03 0.04 Food poisoning 0.13 0.16 0.11 0.18 0.19 Puerperal pyrexia 17.87 (a) 23.94(a) 10.22(a) 30.77(a) 28.16(a) (a) Per 1,000 total (live and still births). 25 TABLE 3. Comparative Statistics of Births, Mortality, Etc. LEYTON, 1901-1952. Year Population Births Birth Rate Deaths Death Rate Deaths under 1 year Intantile 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* D121420* 2560 19.4 1471 12.1 197 76.9 1917 B125352* D112452* 2005 16.0 1414 12.6 172 85.8 1918 B125352* D112452* 1791 14.3 1723 15.3 161 89.9 1919 b129062* d123896 2195 17.0 1397 11.3 154 70.16 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 1939 B116100* d110800* 1499 12.90 1242 11.21 46 31.65 1940 96500 1353 14.02 1563 16.2 50 39.03 1941 84790 1129 13.31 1142 13.46 37 38.30 1942 86960 1452 16.69 1123 12.91 73 50.27 1943 87880 1595 18.14 1248 14.20 57 35.73 1944 85440 1613 18.87 1285 15.04 68 42.15 1945 87330 1474 16.87 1147 13.13 52 35.27 1946 101910 2223 21.81 1181 11.58 64 28.78 1947 105550 2359 22.35 1278 12.10 78 33.06 1948 106100 1810 17.06 1118 10.53 38 20.99 1949 106700 1630 15.27 1232 11.54 43 26.38 1950 106600 1447 13.57 1134 10.64 29 20.04 1951 104700 1311 12.52 1362 13.00 27 20.59 1952 104200 1355 13.00 1220 11.70 37 27.30 *Population as estimated for purposes of b, Birth Rate, d, Death Rate. 26 TABLE 4. Causes of Death as given by the Registrar-General, 1952. Causes of Death Males Females Total 1. Tuberculosis (Respiratory) 15 5 20 2. Other forms of Tuberculosis 1 3 4 3. Syphilitic Disease 7 0 7 4. Diphtheria 0 0 0 5. Whooping Cough 1 1 2 6. Meningococcal Infections 1 0 1 7. Acute Poliomyelitis 0 0 0 8. Measles 0 1 1 9. Other Infective and Parasitic Diseases 1 0 1 10. Malignant Neoplasm—Stomach 22 15 37 11. Malignant Neoplasm—Lung and Bronchus 38 11 49 12. Malignant Neoplasm—Breast 1 22 23 13. Malignant Neoplasm—Uterus 0 4 4 14. Malignant Neoplasm—Others 65 55 120 15. Leukaemia 3 1 4 16. Diabetes 2 5 7 17. Vascular Lesions—Nervous System 52 87 139 18. Coronary Disease, Angina 125 44 169 19. Hypertension with Heart Disease 13 26 39 20. Other Heart Disease 68 133 201 21. Other Circulatory Disease 21 25 46 22. Influenza 0 1 1 23. Pneumonia 37 34 71 24. Bronchitis 68 38 106 25. Other Respiratory Diseases 9 1 10 26. Ulcer of Stomach or Duodenum 15 6 21 27. Gastritis, Enteritis and Diarrhœa 0 3 3 28. Nephritis and Nephrosis 6 2 8 29. Hyperplasia of Prostate 8 0 8 30. Pregnancy, Childbirth, Abortion 0 1 1 31. Congenital Malformations 7 2 9 32. Other Diseases 24 44 68 33. Motor Vehicle Accidents 7 2 9 34. All Other Accidents 9 9 18 35. Suicide 9 4 13 36. Homicide and Operations of War 0 0 0 Totals, 1952 635 585 1,220 Totals, 1951 696 666 1,362 Infectious Diseases 29 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Table showing the number of notified cases of infectious diseases and their disposal. Disease Notifications Received Removed to Hospital Smallpox ... ... Diphtheria ... ... Erysipelas 67 3 Scarlet Fever 332 86 Pemphigus Neonatorum ... ... Tuberculosis, Pulmonary 114 59 Tuberculosis, Other forms 13 7 Pneumonia 410 92 Ophthalmia Neonatorum 1 ... Typhoid Fever ... ... Paratyphoid Fever ... ... Puerperal Pyrexia 39 32 Meningococcal infection 1 1 Poliomyelitis, Paralytic 7 6 Poliomyelitis, Non-paralytic 5 5 Acute Encephalitis, Infective ... ... Acute Encephalitis, Post Infectious 1 1 Measles 1,630 39 Whooping Cough 244 8 Dysentery 14 11 Food Poisoning 20 10 2,898 360 30 DIPHTHERIA. Year Cases Notified Deaths Case Fatality per cent 1948 5 ... ... 1949 ... ... ... 1950 ... ... ... 1951 1 ... ... 1952 ... ... ... These figures show that no Leyton resident has died from diphtheria during the last five years, and that during the whole of that period only six persons have been notified to be suffering from the disease. The last case notified (in 1951) was a very mild infection in a girl who had never been immunised. Information regarding immunisation against diphtheria is to be found on page 108. DYSENTERY. Fourteen cases were notified. Ten cases were admitted to hospital. ACUTE ENCEPHALITIS, INFECTIVE. No cases were notified. ACUTE ENCEPHALITIS, POST INFECTIOUS. One case was notified and removed to hospital. ERYSIPELAS. Sixty-seven cases were notified, of which three were admitted to hospital. FOOD POISONING—1952. There were 20 persons notified during the year to be suffering from food poisoning. Of the 20 cases, 12 were single and apparently sporadic, four occurred in a hospital and are combined to form one "outbreak"; and four occurred in one "family outbreak." 31 (For purposes of classification, an "outbreak" means two or more related cases in persons of different families; a "family outbreak" means two or more related cases in members of the same family; and a "sporadic case" means a case which was not, as far as could be ascertained, related to other cases.) The number of cases in which no bacterial or chemical cause was found was six, whereas the bacterial cause was found in 14 cases. In the "family outbreak involving four persons, the organism isolated was staphylococcus, and the article of food considered to be responsible was spam. One "outbreak" involved four nurses in a large hospital, the bacterial cause being salmonella typhi-murium. After an interval of five months, two additional cases occurred in the nursing staff of the same hospital. In one, salmonella Tennessee was isolated, whereas no organism was isolated in the other. Of the 12 single and sporadic cases, six were found to be due to salmonella infection, and in the remaining six cases no bacterial cause was found. The relevant information regarding the 20 persons notified is shown hereunder in tabular form and in chronological order according to the date of notification. No. Date of Receipt of Notification Sex Age Date of Onset of Symptoms Interval bet. Onset and Notification (Days) Cause Identified 1 14.2.52 F 49 6.2.52 8 Unknown 2 15.2.52 F 31 7.2.52 8 Unknown 3 22.2.52 M 48 17.2.52 5 Unknown 4 4.3.52 M 21 29.2.52 4 Unknown 5 24.6.52 M 36 22.6.52 2 Staphylococcus 6 24.6.52 F 7 22.6.52 2 Staphylococcus 7 24.6.52 F 10 22.6.52 2 Staphylococcus 8 24.6.52 F 27 22.6.52 2 Staphylococcus 9 2.7.52 F 24 23.6.52 9 Salmonella 10 2.7.52 F 18 23.6.52 9 Salmonella 11 2.7.52 F 18 23.6.52 9 Salmonella 12 2.7.52 F 19 23.6.52 9 Salmonella 13 7.8.52 M 55 31.7.52 7 Unknown 14 5.8.52 F 62 27.7.52 9 Salmonella 15 20.8.52 F 63 5.8.52 15 Salmonella 16 3.9.52 F 64 25.8.52 9 Salmonella 17 16.9.52 F 9 13.9.52 3 Salmonella 18 9.10.52 M 3 ... ... Salmonella 19 22.11.52 F 19 ... ... Unknown 20 29.12.52 F ... ... ... Salmonella 32 From these figures it will be seen that, of the 20 cases, 15 were females and five were males. The youngest (three years), and the oldest (64), were notified from hospital; the latter as the result of post-mortem examination to establish the cause of death. The average interval between the onset of the symptoms and the notification was six-and-a-half days. The delay is generally due to the fact that cases are not notified until a bacterial cause has been found; and the isolation of the causative organism may take several days. Such delay accounts in great measure for the difficulty in tracking down the article of food responsible; for generally the food has been either all eaten or all destroyed by the time the case is officially notified. In the above list of cases notified during 1952 it will be seen that salmonella was responsible for half of the single cases and half of the cases in the two outbreaks. Such a high percentage of salmonella infections emphasises the need for greater attention being given to personal hygiene, especially to the washing of hands after visits to the water closet; for it should be realised that food poisoning is due not so much to unsound food and unsatisfactory methods of preparation as it is to the disregard of elementary personal hygiene by those who handle our food, whether they be at home or in catering establishments. An analysis of reports received by the Ministry of Health during 1950 showed that 48 per cent. (i.e., almost half) of all food outbreaks of discovered cause in England and Wales were due to the contamination of processed or made-up meat, e.g., meat pies, sausages, brawn, cold meat, stew, re-heated and made-up dishes, pressed beef, rissoles, gravy, stock and similar dishes. There is little danger of food poisoning from meat dishes eaten just after being cooked, when the food has a much better flavour and is more palatable. In this connection I quote from a Monthly Bulletin issued by the Ministry of Health in 1951— "It is for the catering trade to realise their responsibilities in this matter and to devise new methods for the preparation of food in large quantity. Food prepared one or two days before it is to be eaten, allowed to cool slowly—often in a warm kitchen—and then re-heated slowly to a moderate temperature well below 100°C. before it is served, is potentially dangerous to the consumer. If it is impossible for meals in canteens and restaurants to be prepared and eaten within a few hours, then 33 apparatus for the rapid cooling of the food, and refrigeration at 4°C. until it is to be re-heated, must be brought into general use. When such food is re-heated it must be brought to boiling point before it is served. "It is clear that, until food handlers are educated in personal hygiene, outbreaks will continue to occur. Hot water, soap and towels in kitchens and food preparation rooms, and the frequent use of them by the food handlers during the course of their work, would make a great and immediate contribution to the solution of the problem." MEASLES. Year No. Notified Removed to Hospital Deaths 1943 479 16 ... 1944 136 8 ... 1945 797 26 1 1946 439 19 2 1947 698 27 2 1948 1,088 33 ... 1949 1,031 56 ... 1950 1,111 34 ... 1951 1,540 29 2 1952 1,630 39 1 There was one death due to measles. Measles is one of the most highly infectious of all infectious diseases. Owing to the fact that the most infectious period is during the four days before the appearance of the rash, it is generally agreed that there is no known means of preventing outbreaks of measles or of limiting its spread once it has begun. All one can hope to do is to reduce mortality and morbidity by preventing the development of complications which kill and maim, especially among young infants and in cases where home conditions are unsuitable. Before the last war widespread outbreaks of measles occurred with explosive suddenness in and around London at regular intervals of two years, but for some reason which has never been explained the regular biennial periodicity of the disease has been upset during and since the war, as can be seen from the graph on page 35, showing the incidence of cases from 1941 to 1952. During 1952 we have experienced the most widespread measles epidemic in and around Leyton since figures became available. 34 The second graph, on page 35, shows the fluctuation in incidence month by month during 1952, and the slight but shortlived rise in August, followed a month later by the steep rise to the peak incidence of 787 cases during the month of December. It will be seen that there has been a welcome decrease in the number of cases notified during January (1953). The following figures show the relevant information, month by month, since the outbreak began to assume epidemic proportions last September. MEASLES — HOSPITALISATION Month No. of Cases Admitted to Hospital Deaths September, 1952 34 ... ... October, 1952 231 1 ... November, 1952 343 5 ... December, 1952 787 14 ... January, 1953 553 12 ... The total number of cases notified during the year reached the record figure of 1,630. The previous year of record incidence was 1936, when 1,556 cases were notified. In spite of the large number of young children who have suffered from measles during the recent epidemic, it is encouraging to be able to report that no child died of measles in Leyton. By way of comparison I submit these figures showing the annual number of deaths from measles of Leyton children in each of the first biennial epidemics of measles following my appointment as Medical Officer of Health. Year: 1928 1930 1932 1934 1936 Deaths: 17 26 28 13 23 As these deaths occurred during years of much less incidence than the year now under review, they provide very strong evidence that measles is gradually losing one of its principal dangers—that of a killing disease—and is becoming less severe in type as the years go by. 35 MEASLES. Incidence of cases 1941-1952. Cases notified 1952-53. 36 MENINGITIS. As the result of a post mortem examination by H.M. Coroner, one infant (aged 10 months) was found to have died from acute meningococcal infection. OPHTHALMIA NEONATORUM. One case was notified. As a result of treatment, vision was unimpaired. PARATYPHOID FEVER. No notifications were received. PEMPHIGUS NEONATORUM. No cases were notified during the year. PNEUMONIA. Four-hundred and ten notifications were received, of which 92 cases were admitted to hospital. POLIOMYELITIS ("INFANTILE PARALYSIS"). The first Leyton case in 1952 was notified on 21st July, after a period of some 20 months during which no notification had been received. Annual Incidence since 1940. The following list shows the annual number of cases of acute poliomyelitis notified in the Borough from 1940-1952 inclusive. Year Cases Notified Year Cases Notified 1940 ... 1947 14 1941 ... 1948 2 1942 5 1949 20 1943 ... 1950 14 1944 ... 1951 ... 1945 ... 1952 12 1946 3 37 Pilot Survey. Earlier in the year arrangements had been made in certain pre-selected parts of the country for a special pilot survey to be undertaken in collaboration with the Ministry of Health in order to obtain reliable information on certain features connected with the mode of spread of the disease. The County of Essex was one of the areas selected for the purpose, and the Ministry of Health is being supplied with all the records required. Incidence of Cases. During the year there were notified 12 cases, in five of which there was no paralysis of any kind. Of the seven paralysed cases the severity of the disease in two cases was moderate; In the remainder paralysis was mild. Mode of Spread. For the first time I have seen the occurrence of two cases in one house—both fortunately very mild. Otherwise, no common source of infection was established; and no affected child had been recently immunised against either diphtheria or whooping cough. Administrative Measures. On 21st July there was addressed to all local medical practitioners a letter drawing attention to existing arrangements and enlisting their co-operation in an endeavour to bring cases under treatment at as early a stage of the disease as possible. It has been reported that when poliomyelitis follows operations for removal of tonsils and adenoids, the disease tends to be more serious. Under the circumstances local ear, nose and throat surgeons were asked to consider the advisability of postponing operations on Leyton children until such time as the prevalence of poliomyelitis showed signs of receding. Although the water of swimming baths has been suspected as a potential source of spread, no definite evidence of such spread of the disease has been shown to exist. Nevertheless, in collaboration with the Baths Superintendent, special precautions were taken to ensure that the residual chlorine in swimming baths was kept at a constantly high level, and that all hired bathing suits and towels were adequately sterilised. 38 With regard to arrangements for immunisation against diphtheria and protection against whooping cough, it was not considered necessary to cancel existing arrangements, but parents were advised to defer for a month or two the commencement of new courses of inoculation. Cases Notified during 1952. In the form of an appendix hereto, on page 39 I submit the relevant information (in tabular form) regarding cases notified during the year. 39 Summary of Notified Cases of Acute Poliomyelitis No. Notified Sex Age Hospital Adm. Disch. Site of Paralysis Severity Progress 1 21.7.52 F 24 Chingford 18.7.52 21.8.52 Neck, back and both shoulders Moderate Much improved 2 23.7.52 M 3 Whipps Cross 17.7.52 8.8.52 None ... Quite recovered 3 23.7.52 M 7 Not removed ... ... Rt. eye. (Squint) Mild Persistent squint 4 25.7.52 M 16 Chingford 21.7.52 21.8.52 Weakness rt. hip Very mild Almost recovered 5 30.7.52 M 6 Eastern Fever 27.7.52 26.8.52 None ... No disability 6 31.7.52 M 6 Plaistow 28.7.52 23.8.52 None ... Quite recovered 7 6.8.52 F 2 Q. Elizabeth 1.8.52 Left leg Mild 8 15.8.52 F 13 Plaistow 11.8.52 5.9.52 None ... No disability 9 2.9.52 M 12 Plaistow 3.9.52 Rt. foot and leg Mild 10 5.9.52 M 1 7/12 Chingford 4.9.52 Back and Neck Moderate 11 5.9.52 F 7 Ilford 2.9.52 27.9.52 None ... Quite recovered 12 25.9.52 M 4½ Not removed ... ... Slight. Rt. leg Very mild No apparent disability 40 PUERPERAL PYREXIA. Thirty-nine notifications were received, of which 33 occurred in institutions. SCARLET FEVER. Year No. Notified Deaths Case Fatality per cent. 1943 386 ... ... 1944 110 ... ... 1945 312 ... ... 1946 201 ... ... 1947 221 ... ... 1948 160 1 0.62 1949 151 ... ... 1950 219 ... ... 1951 166 ... ... 1952 332 ... ... During the year under review there occurred the most widespread epidemic of scarlet fever since 1943. Fortunately the disease was of the mild type to which we have become accustomed during recent years; and of the 332 persons notified to be suffering from scarlet fever, only 86 were removed to hospital. The very mildness of the prevalent type of illness has made it one of the most difficult of infectious diseases to diagnose. If the infection is accompanied by a scarletiniform rash, it becomes an officially notifiable infectious disease necessitating the putting into operation of certain traditional methods of control. If, however, the same infection— and the same causative organism—gives rise to disability (e.g., epidemic sore throat) without a typical rash, no official action is called for, although the patient without the rash is equally—and possibly more—infectious. Such a bewildering state of affairs is tending to bring into disrepute the regulations for the notification of infectious disease and for the exclusion from school of contacts from infected households. 41 SMALLPOX. No case of smallpox was notified during 1952. For some eighty years vaccination against smallpox was compulsory. As the law enforcing vaccination became progressively less stringent the number of exemptions increased progressively until 5th July, 1948 when the Vaccination Acts were repealed and vaccination became no longer compulsory. Although 1,397 children were born in Leyton in 1952, only 328 infants under one year (i.e., 23.46%) were vaccinated against smallpox. Of 3,968 children inspected in school, only 1,534 (i.e., 38.66%) were found to be protected by vaccination. Recent outbreaks of virulent smallpox (in Brighton and Glasgow) have shown that we in this country are continuously exposed to the introduction of smallpox from abroad in spite of the strict precautions taken at sea ports and airfields to exclude the disease. TUBERCULOSIS. Notifications.—One-hundred and twenty-seven patients were notified for the first time in 1952 as suffering from tuberculosis. The number was made up as follows:— Males Females Total Pulmonary Tuberculosis 76 38 114 Non-Pulmonary Tuberculosis 6 7 13 82 45 127 The following is a statement of particulars appearing in the Register of Notification of Cases of Tuberculosis for the year ended 31st December, 1952:— 42  Pulmonary Non-Pulmonary total M. F. Total M. F. Total Number on Register at commencement of year 406 340 746 27 50 77 823 Number first notified during the year 76 38 114 6 7 13 127 Number of cases entered in Register otherwise than by Notification 24 14 38 4 ... 4 42 Number removed from the Register during the year 52 25 77 6 9 15 92 Number remaining at the end of the year 454 367 821 31 48 79 900 Details of cases removed from the Register during the year:— Died 25 4 29 1 1 2 31 Removed from the district 21 20 41 3 2 5 46 De-notified 6 1 7 2 6 8 15 Deaths.—Thirty-one deaths from tuberculosis were recorded. New Cases.—The following table gives particulars regarding the new cases which have occurred during the year:— Age Periods New Cases Pulmonary Non-Pulmonary M. F. M. F. 0 ... ... ... ... 1 ... 1 1 ... 5 ... 1 ... ... 10 2 1 1 ... 15 7 1 2 1 20 10 10 1 1 25 13 11 ... 1 35 10 7 ... ... 45 10 3 1 1 55 10 2 ... ... 65 and upwards 14 1 ... 3 Totals 76 38 6 7 43 Statistical Summary. The following tables have been compiled to show the annual numbers of new cases and deaths over a period of ten years. NOTIFICATIONS. Year Pulmonary Non-Pulmonary Total M. F. Total. M. F. Total. 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 1952 76 38 114 6 7 13 127 DEATHS. Year Pulmonary N on-Pulmonary Total M. F. Total. M. F. Total. 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 1952 25 4 29 1 1 2 31 TYPHOID FEVER. No notifications were received. 44 WHOOPING COUGH. Year No. Notified Removed to Hospital Deaths 1943 91 6 ... 1944 198 24 4 1945 99 16 2 1946 155 27 2 1947 178 11 3 1948 623 29 3 1949 316 18 ... 1950 769 19 ... 1951 593 12 ... 1952 244 8 2 Of the 244 children who developed whooping cough during the year, eight had to be removed to hospital, and of these, two children (aged two months and seven months) died. Further information regarding Protection against Whooping Cough will be found on page 113. 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. 46 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. 1. Public Health Officers of the Authority. Medical. No changes took place in the medical staff during the year. Dental. Two dental officers were appointed during the year, Mr. J. G. Douglas and Miss P. T. Fuller. Mr. Douglas resigned on 14th April, and Miss Fuller continues to carry out the duties of a dental officer. Nursing. Mrs. I. Twelvetree resigned on 11th October when, for the first time for many years, we had the approved establishment of nursing staff. Mrs. Carey, Miss Charters, Miss Munday and Mrs. Rolfe all commenced duty as combined-duties health visitors during the year. Mrs. Carey and Miss Charters were allocated to this area following their success in attaining Health Visitor Certificates under the County Council training scheme. Staff. During the year three members of the staff, who between them had completed 114 years' service in the local health services, retired on superannuation. Mr. E. H. Gray, Senior Sanitary Inspector since 1932, came to Leyton in 1925 as a district Sanitary Inspector. Mr. G. F. Leserve, Chief Clerk, Public Health Department since 1927, had worked in the department since 1907. Mr. E. E. Jacobs, Senior Clerk, commenced work in the Health Department in 1910. As a result of Mr. Gray's retirement, Mr. B. J. Ashcroft of Ilford, was appointed to the position of Senior Sanitary Inspector, and commenced duties on 1st January, 1953. After the retirement of Mr. Leserve it became evident that it was quite impossible to effect an arbitrary division in the duties of Chief Clerk to the Medical Officer of Health and of Chief Administrative Assistant to the Area Medical Officer, especially where both departments are accommodated in the same building. Agreement was therefore reached with Essex County Council whereby the Chief Administrative Assistant (Mr. W. D. Softley) devotes 25 per cent. of his time to duties on behalf of Leyton Borough Council. 47 Mr. E. E. Jacobs was transferred to the staff of the County Council in 1948. With his retirement (due to ill-health) the vacancy on the Health Area Establishment was filled by the appointment of Mr. P. C. Ware. 2. Laboratory Facilities. (а) Pathological Department, Whipps Cross Hospital, E.11. For pathological specimens. (b) 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 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. 48 5. Nursing Homes. There are in the Borough three 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. (3) 61, Wallwood Road, Leytonstone. With accommodation for 21 patients. 6. Scabies Clinic. On 1st November, 1950, the Special Clinic at Ruckholt School was discontinued; and facilities are now available by arrangement with Walthamstow Corporation at the Walthamstow Skin Clinic, High Street, Walthamstow. During the year 1952 eight Leyton residents attended for treatment. Six made one attendance and two made two 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 (10 mths.) ... ... 303 1,291 1943 522 632 1,154 2,490 1944 328 517 845 1,990 1945 302 454 756 1,462 1946 261 402 663 1,298 1947 91 156 247 495 1948 67 90 157 271 1949 18 25 43 105 1950 10 7 17 37 1951 2 ... 2 6 1952 7 1 8 10 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. 49 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 13 burials under this Section. 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 facilties at Whipps Cross Hospital mortuary has continued during the year. Number of bodies deposited, death being due to:— Natural causes 49 Suicide 5 Accidents 7 61 Number of Post-mortem examinations performed 61 In 49 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 10 ,, occlusion-atheroma 11 Aortic stenosis 2 Myocardial degeneration 3 Mitral stenosis 1 Myocardial infarction 1 Ruptured aortic aneurysm—specific 3 „ cerebral aneurysm 2 Bronchitis 1 Pneumonia 3 Hypertension 7 Phlebo-throm bosis 2 Strangulated hernia 1 Carcinoma 1 Pneumonitis and lung abscess 1 50 INQUESTS. The following verdicts on Leyton residents were recorded at inquests held during the year:— Accidental. Knocked down by motor car 3 „ ,, ,, lorry 3 ,, ,, ,, cycle — ,, ,, „ trolley-bus 1 Fall from roof 1 Fractures—falls at home 7 Aspirin poisoning 1 Asphyxia—overlaid 1 Cerebral haemorrhage 1 Scalds 1 Asphyxia—fumes 1 Post-operative shock 2 Suicide. Asphyxia due to hanging 2 Coal-gas poisoning 9 Gun-shot wound 1 Phosphorous poisoning 1 Open Verdict. Suffocation 1 Asphyxia 1 Drowning 1 Misadventure. Respiratory failure 1 CORONER'S POST-MORTEMS. During the year 181 Leyton residents were subjected to post-mortem examination by a Pathologist on the instructions of the Coroner. The findings at the post-mortem were:— Cancer of Pancreas 1 „ ,, Stomach 1 ,, „ Lung or Bronchus 6 „ „ Gall Bladder 1 „ „ Colon 2 ,, ,, Oesophagus 1 51 Pulmonary tuberculosis 3 „ embolism 9 Cerebral abscess 1 Ruptured developmental cerebral aneurysm 5 Coronary thrombosis 40 „ atheroma 17 Cardiac failure due to hypertension 7 Myocardial degeneration 9 Ruptured atheromatous aneurysm 6 Influenzal pneumonia 1 Ac. suppurative bronchitis 9 Broncho pneumonia 3 Chronic bronchitis 8 Ac. streptococcal pneumonitis 2 Gastric ulcer 3 Hepatic necrosis 1 Acute cerebro spinal fever 1 Streptococcal septicaemia 1 Ac. gastro enteritis 1 Diabetes mellitis 2 Cerebral thrombosis 3 Ruptured aorta 2 Aorta stenosis 2 Mitral stenosis 2 Developmental abnormality of the heart 1 Aortic incompetence 1 General peritonitis 5 Pulmonary oedema 1 Internal haemorrhage 1 Intestinal obstruction 1 Coronary oedema 1 Cerebral haemorrhage 7 Pontine haemorrhage 1 Atelectasis of the lungs 2 Prematurity 2 Hyperglycaemia 1 Fibrillation of the heart 1 Adrenal insufficiency 1 Internal haemorrhage 1 Perforation of the colon 1 52 THE WINTER OF 1952-53. From a health point of view the past winter must be regarded as one of the worst within living memory. The thick, smoke-laden, five-day fog in the early part of December, the widespread outbreak of influenza that raged for two-and-a-half months, and the disastrous tempest and floods at the end of January—these have combined to kill and incapacitate the population to an alarming degree. Week after week visibility was reduced by mist and fog, so that we could not see the moon by night nor yet the sun by day; and amid the encircling gloom there appeared in our midst a widespread epidemic of influenza—with its sequel, post-influenzal depression. Atmospheric Pollution and Fog. During five days, from 5th to 9th December (inclusive), Leyton and the greater part of Metropolitan London was enveloped in a thick, smoke-laden fog. The meteorological conditions at the time showed a high barometric pressure, low ground temperature and high relative humidity. The amount of atmospheric pollution in Leyton during the month of December 1952 was the highest recorded at any time since daily observations were begun in this Department in March, 1950. The maximum pollution occurred during the period of fog from Friday, 5th December to Monday, 8th December. The highest concentration was recorded during the 24 hours beginning noon on Monday, 8th December, when the amount of smoke was 219.5 milligrams per 100 cubic metres, and the amount of sulphur dioxide 64.0 parts per 100 million. These records of atmospheric pollution are about six times as high as the normal to be expected at that time of year. Figures are not available of the number of cattle that died from respiratory embarrassment during the fog, but it is known that at least 11 had to be slaughtered at Smithfield Fat Stock Show at the request of their owners. There was a spectacular rise in deaths of Leyton residents during the week ended 13th December. In 1952 Leyton deaths during that week numbered 130, compared with an average of 44 deaths for the same week in each of the previous four years. 53 Deaths registered in the County of London during the week ended 13th December totalled 2,484, whereas in the previous week the total was 945; and for each million inhabitants of London the rate of "excess of deaths over normal" was 445—a figure which is 202 greater than the comparable death rate during the week after the great fog of December, 1873; and 19 greater than when the cholera epidemic was at its worst in 1866. I submit hereunder a Table showing the weekly totals of deaths in the County of London following the dates of the densest fogs of which records are available. Year Dates of Dense Fog Deaths Weekly Totals 1873 Dee. 9—11 Dec. 13 1,759 Dec. 20 2,415 Dec. 27 1,540 Jan. 3 1,842 1880 Jan. 26—29 Jan. 31 2,200 Feb. 7 3,376 Feb. 14 2,495 Feb. 21 2,016 1892 Dec. 28—30 Dec. 31 1,830 Jan. 7 2,509 Jan. 14 2,503 Jan. 21 2,101 1948 Nov. 26—Dec. 1 Nov. 27 779 Dec. 4 1,019 Dec. 11 944 Dec. 18 891 1952 Dec. 5—9 Dec. 6 945 Dec. 13 2,484 Dec. 20 1,523 Dec. 27 1,029 The ratio of deaths in the week of suddenly-increased mortality to deaths in the previous week was 2.6 in the recent fog—a figure almost double that registered in any of the previous great fogs. In the Greater London area the five-day fog was responsible for 4,000 deaths during the two following weeks, and the Minister of Health has put the figure at 6,000 for the five weeks ended 3rd January, 1953. Most of the deaths were of people over 45 years of age; and deaths of younger people did not show any great increase except in infants under one year. It is to be hoped that the comparatively greater effect of the fog in the very young and very old will not divert attention from the damage caused to healthy people of between these extremes. For instance, the case is recorded of a healthy London policeman of 35 years who collapsed during the fog and was admitted to hospital only in time for his life to be saved by the administration of oxygen and treatment for shock. 54 The man-made fog of December was no new phenomenon; nor can it be regarded as a pestilence caused by an agent against which we have no defence. It is merely a repetition of what the medical officers of health of Manchester, Glasgow and other large industrial cities have been reporting for generations; and is the well-known result of certain well-defined meteorological conditions in an area where the atmosphere becomes overloaded with poisonous products of combustion to such an extent that the human air passages are irritated until death or acute disability overtakes those least able to withstand such irritation. Man-made fog is in effect an epidemic illness whose cause is known. It is therefore in great measure preventable, and should be prevented. Can it be that we are now more pre-occupied with the cure of disease rather than its prevention? The following is a quotation from a medical journal— "A few weeks earlier (than the fog) the Minister of Fuel and Power introduced to the House of Commons, with favourable emphasis, the Ridley Report, and at the same time made available 'off the ration' small unwashed coal to the domestic consumer. The National Coal Board promptly advised the public by advertisement how to burn this smoky coal in the smokiest possible way. Was there ever a greater fog over Whitehall than on this problem of atmospheric pollution?" These terrible fogs have a way of recurring all too frequently, and it would be well if the disastrous nature of the most recent one should lead to further investigation into all causes and effects. Influenza About the middle of January there were circulated reports of widespread influenza prevalence on the continent of Europe, and in America; and these reports were soon followed by news of large numbers of cases in this country, especially in London and the South of England. I submit, hereunder in tabular form, figures showing the effect of the influenza epidemic in Leyton in comparison with those of the Registrar-General's "160 Great Towns (including London)", which contain more than half the total population of England and Wales, of which roughly one-fifth are contained in the area described as "Greater London". 55 Deaths Week Ended (1953) Influenza Pneumonia 160 Great Towns Leyton (Cases Notified) Deaths 160 Great Towns Leyton 160 Great Towns Leyton Jan. 3rd 29 ... 846 15 510 7 Jan. 10th 51 2 685 18 490 10 Jan. 17th 72 ... 776 18 491 7 Jan. 24th 132 3 688 25 548 5 Jan. 31st 313 2 1,171 35 654 14 Feb. 7th 446 5 1,394 22 667 21 Feb. 14th 530 ... 1,443 37 802 21 Feb. 21st 521 3 1,173 12 772 16 TOTAL 2,094 15 8,174 182 4,934 101 These figures show the progressive increase in deaths from influenza, and in notifications and deaths from pneumonia from 28th December, 1952 until 14th February, 1953; and the welcome decrease in all columns during the week ended 21st February— the last week for which figures are available. From 1st January to 21st February there were 2,065 deaths from influenza in the Great Towns, compared with a figure of 266 for the same period of last year, and with 6,810 for the corresponding period of 1951, when a virulent epidemic of influenza was raging. Deaths from pneumonia in the same period total 4,424 this year, compared with 2,336 last year, and 5,604 in 1951. Although the figures fail to show the rapidity of the spread of influenza that took place, they confirm the clinical reports that the outbreak is not of the severe form of the epidemic that swept the country two years ago. In the epidemic, recovery from the acute symptoms has been usual after two or three days. In many patients the respiratory symptoms have been followed by gastrointestinal disturbance, and laboratory evidence confirms that the cases have been due to Virus A—Prime. On 27th January the Emergency Bed Service issued a "Red Warning" to hospitals. This warning is given when it is found 56 that hospitals can take less than 75 per cent. of the cases referred for admission. There was no restriction of admissions since 19th February, when the "White Warning" was issued. An influenza vaccine has been distributed for the inoculation of American troops in Europe; and we now await result of the influenza vaccine trial organised by the Ministry of Health and the Medical Research Council On page 58 I submit a graph showing the variation in the weekly Claims for Sickness Benefit received by the Leytonstone Branch of the Ministry of National Insurance from the beginning of December. The graph shows very clearly the sudden increase in claims (747) during the week ended 16th December (i.e. the week following the fog); the sudden fall in the number of claims (290) during the week ended 30th December (i.e. Christmas week); the steady and progressive rise until 3rd February (1,274); and the rapid fall since that time. Tempest and Flood. On the night of Saturday, 31st January the combination of a very severe gale with an unusually high tide produced one of the worst floods ever experienced in this country. The East Coast of England, from Yorkshire to Kent, was struck with a force considered to be without parallel since the beginning of the eighteenth century. Over 250 people lost their lives, many more were injured and incapacitated, and tens of thousands were rendered homeless. Sewage works were flooded and rendered useless; water supplies were contaminated. The disaster put a great strain on the health and welfare services of the local authorities, who dealt effectively with the many problems of health, welfare, sanitation, injury, illness and homelessness. From a purely public health point of view the most serious problems were connected with sewage and water supply. For instance, at Tilbury the main sewage works were put out of action, and at Grays the main sewer burst—with the result that the flood waters became contaminated. Fortunately the water-supply to that area was all from mains under pressure. The great problem has been one of welfare—the care of the homeless. Fortunately there has been no outbreak of enteric fever, but the possibility of odd cases of sewage-borne infection cannot be excluded in the affected areas. 57 General Observations. It is only when disaster overtakes a community that attention is drawn to the existence of the environmental services. Preventive medicine is one of the silent services, and becomes "news" only when something goes wrong. The basic requirements for good health are few—fresh air and sunshine, pure food and water, adequate rest and exercise, warmth. So vital are they that anything must be regarded as prejudicial to health which restricts in any way the quality of these fundamental needs. The greatest advances in human health and happiness have been made in the realm of preventive rather than curative medicine; and health is to be found in a way of life rather than in a bottle of medicine. It is to be hoped that local sanitary authorities and the appropriate central Government departments will devote more of their time and money to smoke abatement by encouraging the replacement of obsolete industrial plant, by providing some incentive to help in the elimination of smoke from domestic sources, and by taking steps to reduce the gross pollution from industries such as railways, gas works and electricity generating stations. Meanwhile town dwellers are languishing for want of the health-giving rays of the sun that cannot penetrate the overhanging pall of smoke, housewives are burdened with the frequent washing and cleaning of curtains and other fabrics, and their houses and public buildings are being defaced and destroyed by the corrosive action of the atmospheric pollution. 58 RECORD OF SICKNESS BENEFIT CLAIMS RECEIVED BY THE LEYTONSTONE OFFICE OF THE MINISTRY OF NATIONAL INSURANCE. NUMBER OF SICKNESS BENEFIT CLAIMS RECEIVED WEEK ENDING 59 CENSUS, 1951. The Fifteenth Census of the population of England and Wales was taken on the 8th April, 1951. The figures provided in the Preliminary Report, in order to meet the more urgent needs, are provisional and relate to the numbers only, by sex, of the population for England and Wales as a whole and for an extensive series of local areas. They are derived from local summaries rapidly compiled and then assembled centrally, and they are subject to confirmation in the substantive Census Reports which are based upon a central check of the actual Census returns. Judging by past experience, although the figures are provisional, material discrepancies are unlikely. The previous (Fourteenth) Census of England and Wales was taken in April, 1931. There was thus, for the first time since the series began in 1801, an interval of twenty years instead of the customary ten. The unprecedented length of the interval, the limited scope of the 1931 Census and the far-reaching changes in legislation and in social conditions since 1931 all had their influence on the range and content of the Census of 1951. The 1931 Census had been restricted for reasons of economy and because it was then intended to take a Census quinquennially. For reasons of economy this project had to be dropped, and the war prevented a Census in 1941. An innovation is being introduced on this occasion which goes some way to meet the complaint that the national tabulations of the Census results are not available for two or three years. A copy has been made of one schedule in every hundred relating to private households, and from the one per cent. sample so obtained has been produced a preliminary outline of the chief features to be expected from the main tables, which will appear later. Observations. It is estimated that there are in Leyton 27,650 separately assessed dwellings in which the 34,800 households are housed. As seen from the tables 14,700 households live in shared dwellings, i.e., 42 per cent. of the total households. There are no households in Leyton in which the density of occupation is more than two persons per room according to the One Per Cent. Sample Tables. 60 The national average of persons per room is 0.76, compared with the Leyton figure of 0.75; in the 1931 Census the comparable Leyton figure was 0.86 persons per room. The persons per household for Great Britain are 3.21 persons; the Leyton figure for 1951 is 2.94 persons, compared with 3.59 in the 1931 Census. Of the 34,800 households, 9,400 (27 per cent.) are without the exclusive use of a water closet, 23,600 households (67.8 per cent.) without the exclusive use of a fixed bath and 3,600 (10.3 per cent.) without the exclusive use of both stove and sink. It is apparent that there is much to be done to bring within the reach of all households the usual amenities of life. 61 CENSUS—1951 POPULATION Area Acres 1931 1951 Increase 1931—51 Decrease 1931—51 Inc. % Dec. % Persons Males Females Persons Males Females England and Wales 37,339,579 39,952,377 19,133,010 20,819,367 43,744,924 21,024,187 22,720,737 3,792,547 ... 9.5 ... Greater London 461,827 8,215,673 3,838,293 4,377,380 8,346,137 3,921,195 4,424,942 130,464 ... 1.6 ... Essex 977,760 1,755,459 844,625 910,834 2,043,574 980,215 1,063,359 288,115 ... 16.4 ... Leyton 2,594 128,313 61,047 67,266 105,183 49,352 55,831 ... 23,130 ... 18.0 AGE AND MARITAL CONDITION. (LEYTON) TOTAL Single Married Widowed and Divorced Males Females Males Females Males Females Males Females 46,900 58,300 16,900 23,000 27,500 28,400 2,500 6,900 Age (last Birthday):— 0—4 yrs. 5—14 yrs. 15—24 yrs. 25—34 yrs. 35—44 yrs. 45—54 yrs. 55—64 yrs. 65 and over Males Females Males Females Males Females Males Females Males Females Males Females Males Females Males Females 3,900 5,500 5,300 7,000 4,700 5,700 8,500 9,300 9,300 8,900 5,700 7,600 3,900 6,100 5,600 8,200 62 PRIVATE HOUSEHOLDS. (LEYTON) Number of households 34,800 Rooms occupied by households ... 136,800 Households in shared dwellings 14,700 Population in households ... 102,200 Households of Over and up to 2 persons per room 1,700 Persons per household (1931) 3.59 (1951) 2.94 Over 1 and up to 1½ persons per room 4,500 Up to 1 person per room 28,600 Persons per room 0.86 0.75 Households without exclusive use of Water closet 9,400 Percentage of persons living more than 2 per room 5.61 ... Fixed bath 23,600 Stove and sink 3,600 Sanitary Circumstances of the Area 64 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 1,403 Miscellaneous inspections 489 Re-inspections 10,904 Places of entertainment 14 Schools 31 Stables 15 Urinals 35 Visits in connection with infectious diseases 386 Factories without mechanical power 28 Factories with mechanical power 233 Rag and bone dealers 5 Foster-mothers' premises 1 Hairdressers' premises 76 Public Houses 61 Offensive trades 5 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 418 Sashcords renewed 199 Plaster repaired 669 Roofs repaired or renewed 707 Guttering repaired or renewed 309 Yards paved 28 Drains relaid or partly relaid 40 Choked drains cleared 28 New w.c. pans and traps provided 49 Sinks provided 16 W.c. cisterns repaired or renewed 125 65 Rain water pipes repaired or renewed 165 Vent pipes repaired or renewed 40 Sink waste pipes repaired or renewed 66 Stoves repaired or renewed 213 Coppers repaired or renewed 3 Floors repaired 219 Rooms redecorated 394 Windows, sills, etc., repaired 326 Cement work to sink waste gullies repaired 48 Miscellaneous defects remedied 364 Drainage. The drains of 184 houses were reconstructed. In 87 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 144 144 Prevention of Damage by Pests Act, 1949. Complaints received and investigated 463 Premises not treated (not genuine infestation) 12 Premises treated:— Rats Mice (a) Dwelling-houses 281 88 369 (b) Business premises 49 31 80 449 Notices Served. Informal 7 Statutory 1 Notices Complied With. Informal 7 Statutory 1 66 Rodent Control. Special report by the Senior Sanitary Inspector (Mr. B. J. Ashcroft). Statutory Powers and Duties of the Local Authority. The statutory powers of the local authority in regard to rodent control are derived from the Prevention of Damage by Pests Act, 1949, which came into operation on 31st March, 1950, on which date the Rats and Mice (Destruction) Act, 1919, was repealed. The powers and duties of local authorities are to be found in Part I of the Act. The important difference between the 1919 Act and the new Act is that Borough and District Councils are now local authorities for the purposes of the Act and not the County Councils as formerly. The duty of the local authority is threefold: (1) to inspect the area in order to ascertain the degree of infestation by rats and mice, (2) to destroy rats and mice on land of which they are the occupiers and (3) to ensure, if necessary by legal proceedings, that owners and occupiers of land are taking all practicable steps for the destruction of rats and mice. In furtherance of their duty under (3) the local authority may serve a notice upon the owner or occupier of land requiring him within such reasonable time as may be specified in the notice to take steps for the destruction of rats and mice on the land. If such a notice is not complied with the local authority may themselves take the necessary action and recover the cost from the owner or occupier concerned. Where rats and mice are found in substantial number on any land comprising premises in the occupation of different persons the local authority, instead of serving notice on the owners or occupiers as outlined above, may themselves enter upon the land and take such measures as may be necessary for the destruction of rats and mice thereon. This is a valuable provision which enables the local authority to deal effectively with a block of property. The expenses incurred by the local authority may be recovered from the several occupiers of the land concerned. It should be noted that land for this purpose includes any building or part of a building. Duty of Owners and Occupiers. The primary duty of destroying rats and mice on premises is placed upon the owner or occupier of those premises. The local authority is therefore only responsible for the actual destruction of rats and mice on land of which they are themselves the occupiers. 67 In addition the occupier of land is also under a legal obligation to give the local authority written notice if it comes to his knowledge that rats and mice are living on or resorting to his land in substantial numbers. The purpose of this notice is to enable the local authority either to require the individual occupier or owner to deal with the matter or for the local authority themselves to take the necessary steps by dealing not only with that property but with adjoining property. Notification of Rats or Mice on Food Premises. Under the Act owners and occupiers of food premises are required to notify the Ministry of Agriculture and Fisheries and NOT the local authority of any infestation of their premises by rats, mice, insects, etc., which involves the immediate or potential risk of substantial loss of, or damage to, food. The local authority are kept informed of any such notification received by the Ministry if the infestation includes rodents, to enable appropriate action to be taken. The local authority have full powers under Part I of the Act to inspect and require action to be taken against rodents in the food premises or other property, by service of formal notice on owner or occupier as appropriate. Exchequer Grants. In order to qualify for Exchequer Grant in relation to rodent control the local authority must comply with the following conditions: That the local authority:— (i) maintains an organisation adequate to the requirements for effective rodent control, according to the condition of infestation in its area; (ii) complies with the Ministry requirements on the methods to be employed; (iii) in particular, pays special attention to efficient rodent control in its sewers, refuse dumps, refuse destructors, and its other public service properties, and carries out periodical treatment in accordance with the guidance given by the Ministry, unless specifically exempted by the Ministry; and (iv) takes effective action for the control of rats and mice in all surface properties by securing full compliance of occupiers or entering and carrying out necessary treatment. 68 Present Position in Leyton. The three rodent operatives employed in the Public Health Department work in close liaison with the Sanitary Inspectors in investigating complaints received and locating the source of rodent infestation. They also assist Inspectors in carrying out smoke tests when drains and sewers are suspect. The operatives follow up this procedure with pre-bait and poisoned bait treatment as appropriate. Groups of premises in which there is a common infestation are disinfested as one unit—block control. No charge is made to occupiers of domestic property. Occupiers of business premises are charged on a labour and material basis. Periodic visits are paid to Council property including the refuse destructor works. Schools are also visited. The duties of the rodent operatives include sewer maintenance treatment in conjunction with the Borough Engineer and Surveyor. The administration of this Section of the Department and methods used for disinfestation are in accordance with the requirements of the Ministry of Agriculture and Fisheries. Rodent Control work carried out during 1952. During 1952 some 463 complaints relating to rat and mice infestation were investigated by the Department, as a result of which 369 private houses and 80 business premises were treated. The total number of visits in connection with these investigations and subsequent disinfestation work amounted to 1,387. The Council's sewers were baited in June and December, 1952. Each maintenance treatment was of 4 to 5 weeks duration, involving some 1,265 manholes, each of which was baited on three successive days. Conclusions and Observations. From available records and personal observations I am satisfied that the Department is fulfilling its statutory obligations under the provisions of the Prevention of Damage by Pests Act, 1949, as outlined earlier in this Report. The Divisional Rodent Officer of the Ministry is clearly satisfied, otherwise the Council would not qualify for Exchequer grant in aid. 69 It is found from experience that the source of surface infestation in domestic and other property is in the majority of cases traced to defects in drainage systems and sewers. When such evidence is found, appropriate action is taken by the Sanitary Inspectors under the Public Health Act, 1936, to effect necessary repairs. In this respect it is not always easy to discover faulty drains and sewer connections, and this undoubtedly is the cause of many long-standing infestations. By reason of its age much of the drainage in Leyton does not conform to accepted standards of design and construction. In those areas which contain groups of obsolescent properties it is found that drainage defects are invariably due to open clay joints or subsidence and failure of pipes owing to inadequate concrete support. Added to this, bombed sites and disused drains, perhaps imperfectly sealed from the sewer, provide ideal harbourage and nesting places for rats. This must account for many surface infestations. Having regard to the foregoing, it will be appreciated that the rat population on the surface bears some relationship to the rat population below the ground—namely, in the sewers. Put simply, if it were possible to confine rats to the sewers and drains—this would mean, of course, that all sewers and drains in the Borough would have to be in perfect order—the problem of surface infestation would not be so acute. As it is, defective drains and sewers provide a ready means of communication for rats migrating from the sewers in search of nesting places and change of diet. Rats travel along working sewers when scavenging for food, but they need dry undisturbed places for nesting. The only practicable method available to the local authority for reducing the rat population in sewers is by poisoning. The hazards of sewer baiting are well known; points at which poisoned baits can be laid in the sewers are necessarily limited to the manholes, and this, particularly where they are widely spaced, is one of the causes preventing elimination of rats from the sewers. Further, there is always the possibility of re-infestation from surface property after treatment, and many of the baits may be washed away during peak flow and flood periods. The probable state of the weather is therefore an important factor when considering the time at which such treatments are carried out. Because of these hazards some officers are inclined to be a little sceptical as to whether results obtained from sewer treatment justify the expenditure and labour involved. 70 In answer to this I would state that technical officers of the Rodent Division, Ministry of Agriculture and Fisheries, are confident that poisoning campaigns carried out by adjoining local authorities in the London area over the past nine years have undoubtedly resulted in a considerable reduction of rats in the sewers and in a proportionate decrease of surface infestation. The first sewer treatment ever carried out in London was, I believe, in 1943/44 when the Ministry of Food, who were then responsible for rodent control at central government level, focused attention on the rat problem in order to conserve the nation's food supplies. Measures taken to destroy rats, however successful, have only a limited and temporary effect. In this respect, most people know that rats are prolific, but few are aware of the rapidity with which their numbers increase. The usual litter varies from 5 to 14, and 16 is not uncommon. Rats breed throughout the year, although most young ones are born in the Spring. The period of gestation is about 21 days, and impregnation may be renewed within a few hours of the birth of a litter. They begin to breed when only three or four months old, and continue to breed five or six times in the year. Technical research has shown that a pair of rats and their descendants may produce, in the course of 12 months, well over 1,000 offspring. There is no positive cure or remedy for the rat problem in Leyton. The best we can do is keep the numbers down to a minimum by constant vigilance and attack. Unfortunately the difficulties associated with rodent control and the measures taken and methods employed for dealing with it are not readily appreciated by the public. It is one of the difficulties of this type of administration that we are not often in a position to offer definite proof of the efficiency of our efforts. The results of this work, like so many other aspects of environmental hygiene, are not easily seen, and in consequence doubt is often cast on the efforts of those whose job it is to combat the evils of bad housing, bad drainage, and allied problems. 71 Sewer Maintenance Treatments. All sewers in the Borough were treated in June and December 1952. 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 1,265 134 466 36.83 2nd Treatment 1,265 219 588 46.08 HOUSING. Of all the problems confronting the Sanitary Inspector's Section of the Public Health Department at the present time none is more important or indeed more difficult than that of securing the maintenance in a habitable condition of existing housing accommodation. The maxim "A stitch in time saves nine" is very true when applied to housing maintenance. Small items of disrepair, insignificant in themselves, may, if neglected, be the forerunners of serious dilapidation. Deterioration is rapid and progressive. In this respect, owing to prevailing economic factors it is becoming increasingly difficult for individual house owners to provide the necessary stitch. The relation of present-day costs to restricted property values has created a situation in which many good houses are falling into disrepair owing to the inability of owners to meet the cost of essential day-to-day maintenance. The situation is aggravated owing to the occupation by more than one family of so many houses originally designed and built to house only one family. The consequent increased wear and tear accentuates deterioration and the compulsory sharing of household amenities adds to the discomfort of the occupants. Lack of privacy in the use of personal washing and toilet facilities is particularly demoralising to the adolescent. By reason of its age much of the housing in Leyton falls short of the accepted minimum standards which are now considered necessary for the health and enjoyment of modern society. In particular, groups of obsolescent properties, which, by virtue of their type and condition, could well be dealt with by Housing Act procedure and demolished, must of necessity be retained for 72 housing purposes owing to the extreme difficulty in providing other accommodation for the persons who would he displaced as a result of such action. Unfortunately there is no immediate prospect of large-scale slum clearance operations under the Housing Act. Having regard to the before-mentioned factors it is not surprising that during the year under review some 1,542 complaints were received and dealt with by the Sanitary Inspectors. In almost every instance the complaint concerned some item or items of disrepair which had given rise to undesirable conditions such as dampness, leaking roofs, broken wall plaster, decayed floor timbers and the like. The economic factor already referred to is reflected in the high percentage of cases in respect of which it was necessary for the Sanitary Inspectors to initiate formal statutory action. In spite of the difficulties, however, a considerable amount of repair work to dwelling houses was carried out during the year as a result of notices served under the Public Health Act, 1936, and relevant legislation. Details of the improvements effected by completion of work specified on sanitary notices are given elsewhere in this report, although the benefit to the occupants in the terms of comfort and health cannot be measured or fully appreciated by reference to figures. Notices. Notices served—Informal 1,067 Statutory—Housing Acts Nil Public Health Acts 408 Notices complied with—Informal 1,146* Statutory— Housing Acts Nil Public Health Acts 440* *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 23 Flats 20 Temporary housing Nil (ii) By other Local Authorities Nil 73 (iii) By other bodies and persons— Houses 2 Flats Nil (6) With State assistance under the Housing Acts. (i) By the Local Authority— (a) For the purposes of Part V of the Act of 1936— Houses 23 Flats 20 Temporary housing Nil (b) For other purposes Nil (ii) By other bodies and persons Nil I.—Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,403 (b) Number of inspections made for the purpose 12,307 (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 1 (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 1,067 II.—Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action taken by the Local Authority or their officers 1,146 III.—Action under Statutory Powers during the Year:— (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil 74 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 408 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 440* (b) By Local Authority in default of owners Nil (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which demolition orders were made Nil (2) Number of dwelling-houses demolished in pursuance of demolition orders Nil (d) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil Local Land Charges. Particulars with regard to outstanding sanitary notices, not fully complied with, were given in reference to 1,396 enquiries. Smoke Abatement. During the year 89 observations have been made on factory chimneys. *Includes notices outstanding from previous year. 75 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. Observations, which were begun in March, 1950, have continued to be made daily. The recording apparatus is installed at the Public Health Department, Sidmouth Road, Leyton. The following tables show the results recorded during the twelve months ended 31st December, 1952, together with the corresponding figures for 1951:— CONCENTRATION OP SMOKE EXPRESSED IN MILLIGRAMS PER 100 CUBIC METRES. Month Monthly average Highest daily average Lowest daily average 1951 1952 1951 1952 1951 1952 January 40.4 35.3 120.5 89.7 10.9 14.4 February 38.0 43.7 97.7 79.6 17.7 17.5 March 35.8 30.6 154.1 110.5 11.9 12.7 April 16.6 17.6 37.1 36.1 4.7 3.9 May 12.2 5.8 45.9 12.0 2.0 1.9 June 3.5 5.0 7.7 9.6 0.4 2.9 July 4.2 3.5 9.7 7.6 0.5 0.7 August 6.2 5.6 10.5 12.5 3.3 1.4 September 8.5 10.3 16.9 20.1 0.6 5.1 October 28.3 26.2 82.6 111.9 5.7 8.4 November 32.3 39.0 73.3 94.6 11.6 5.7 December 48.9 59.5 172.7 219.5 12.5 8.1 CONCENTRATION OF SULPHUR DIOXIDE EXPRESSED AS PARTS PER 100 MILLION. Month Monthly average Highest daily average Lowest daily average 1951 1952 1951 1952 1951 1952 January 11.5 8.5 42.6 20.1 4.9 4.5 February 9.4 10.7 24.1 29.9 4.1 4.3 March 7.3 7.1 21.4 16.5 2.7 1.6 April 3.9 5.5 9.7 10.7 0.7 1.2 May 1.7 2.7 4.7 6.2 0.2 1.2 June 1.5 2.6 3.5 4.2 0.5 1.7 July 1.7* 1.8 3.5* 4.1 0.2 0.5 August 2.6* 2.5 4.0* 4.6 1.2* 0.9 September 3.9 3.6 7.2 6.2 0.7 1.5 October 8.3 6.7 18.8 15.3 2.0 3.6 November 9.5 8.7 16.0 22.4 4.6 3.4 December 11.4 17.1 38.2 64.0 3.5 4.0 * Estimated figures 76 In my Annual Report for 1951 I recorded a reduction of 9.3 per cent. in smoke pollution and of 7.5 per cent. in sulphur dioxide, compared with the year 1950. For the 11 months ended 30th November, 1952 there was again a slight reduction (1.5 per cent.) in the amount of both smoke and sulphur dioxide, compared with the corresponding period of 1951. But for the whole year 1952 there was an increase in smoke pollution of 2.6 per cent., and in sulphur dioxide of 6.6 per cent, compared with 1951. This increase was due to the dense fog which enveloped Leyton and the greater part of Metropolitan London during the five days from 5th to 9th December (inclusive). The following graphs show the monthly variation of smoke and sulphur dioxide pollution of the atmosphere recorded at Sidmouth Road, Leyton, during each of the past three years. Excluding the exceptional increase in the pollution of the air in December 1952 (which includes the five-day fog), the graphical representations of the smoke and sulphur dioxide content of the atmosphere varied little from year to year. They show— (а) that atmospheric pollution is at its lowest during the six summer months from May to September; (b) that from September it increases rapidly to its pollution peak in December; and (c) that the three months of greatest pollution are November, December and January. In other words, there is a close correlation between the variation in atmospheric pollution and domestic heating throughout the year. Further information on the five-day fog, and its effect on the health of the population, is to be found on pages 52 to 58. 77 ANNUAL VARIATION OF SMOKE ANNUAL VARIATION OF SULPHUR DIOXIDE. 78 Legal Proceedings. (Public Health Act, 1936.) Action taken under the provisions of the Public Health Act, 1936, has resulted in 1,586 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:— No. Date Non-compliance with Nuisance Order at Result 1 30.1.52 19, Florence Road Case adjourned 2 30.1.52 31, Avenue Road Case adjourned 3 30.1.52 28 and 212, Crownfield Road Case adjourned 4 30.1.52 117c, 121b. 121c, Whipps Cross Road Case adjourned 6 30.1.52 70, Canterbury Road Case adjourned 6 30.1.52 43, Fairlop Road Case adjourned 7 30.1.52 54/56, Cobden Road Case adjourned 8 19.3.52 32, Russell Road Nuisance Order made (21 days) 9 19.3.52 34, Acacia Road Case adjourned 10 19.3.52 40, Holloway Road Case adjourned 11 19.3.52 10, Southwell Grove Road Case adjourned 12 9.4.52 19, Florence Road Nuisance Order made (28 days) 13 9.4.52 134, Cannhall Road Nuisance Order made (28 days) 14 9.4.52 53, Kings Road Case adjourned 15 3.9.52 21, Fairlop Road Case adjourned 16 3.9.52 36, Birkbeck Road Case adjourned 17 3.9.52 3/5, Woodhouse Road Case adjourned 18 15.10.52 550, Lea Bridge Road Nuisance Order made (28 days) 19 15.10.52 31, Frith Road Case adjourned 79 INSPECTION AND SUPERVISION OF FOOD. FOOD PREMISES. Inspections. The following visits were made to food premises during the year:— Butchers 383 Bakehouses 75 Bakers 116 Fishmongers 136 Milkshops and dairies 145 Provision shops 713 Dining rooms 327 Greengrocers 221 Fish friers 122 Ice cream premises 369 MILK. Dairies and Milkshops. Number of registered premises from which milk is sold 85 Premises added to register during year 12 Premises removed from register during year 6 Visits of inspection 145 Biological Examinations. Six samples of milk were submitted for biological examination. In each case the sample gave a negative result. Bacteriological Examinations. Designated Milk. Licences No. Granted No. of Samples taken Result Phosphatase Reaction Methylene Blue Test Satisfactory Unsat. Satisfactory Unsat. Tuberculin Tested 23 5 5 ... 5 ... Accredited 12 ... ... ... ... ... Pasteurised 41 19 19 ... 18 1 Sterilised 80 7 7 ... 7 ... Supplementary Licences Tuberculin Tested 5 ... ... ... ... ... Pasteurised 5 ... ... ... ... ... Sterilised 6 ... ... ... ... ... Totals 172 31 31 ... 30 1 80 ICE CREAM. Twenty-eight 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 100 Ice Lollies 8 Results of Samples taken— Grade I. Grade II. Grade III. Grade IV. 60 30 5 5 Manufacturers of Preserved Food, etc. Premises on Register at 31-12-1952 64 Premises registered during 1952 Nil Premises removed from Register during 1952 Nil Meat and Foods condemned and destroyed. Apricots 27½ lbs. Baby Food 43 tins Bacon 86 lbs. Beef 997 lbs. Brawn 200 lbs. Butter 31½ lbs. Cheese 24 lbs. ,, 46 boxes. „ 3,385 pkts. Chickens 141 Cornflour 50 lbs. Coffee 4 Bottles Cornish Meat Hash 46 tins Fish 256 tins „ 70½ stones Fruit 1,904 tins 81 Fruit Salad 86 jars Gravy Browning 40 bottles Ham 127 tins „ 17½lbs lbs. Ham Loaf 80 lbs. Hares 34 „ 10 sacks Hens 12 Herring Roes 10 lbs. Jam 68 tins Jellies 6 pkts. Kidney 4 lbs. Lamb 1,778½ lbs lbs. Lights and Melts 170 lbs. Luncheon Meat 532 tins Luncheon Sausage 5½ lbs lbs. Milk 251 tins Miscellaneous Foodstuffs 31 pkts. Ox Cheek 200 lbs. Ox Hearts 87 Pork 201½ lbs lbs. Potatoes 121 cwts. Potato Crisps 10 pkts. Pressed Beef 24 lbs. Prunes 7 boxes „ 59 lbs. Puddings (various) 14 Rabbit 25 tins „ 64 lbs. Rabbits 30 Salad Cream 102 bottles Sausages 5 tins „ 118 lbs. Sheep's Heads 1,485 lbs. „ 40 Soup 224 tins Sugar 28 pkts. Stewed Steak 101 tins Tea 24 pkts. Tongue 4 lbs. Tripe 7 lbs. Vegetables 838 tins 82 Premises and Occupations which can be Controlled by Bye-Laws and Regulations. Premises. Dairies, Milkshops and Dairymen 91 Grocery and Provision shops 234 Hairdressers' Premises 75 Fish friers 24 Bakers and Bakehouses 41 Butchers 74 Cafes and Dining rooms 96 Fishmongers 21 Greengrocers 100 Food Hawkers— (a) Premises 40 (b) Persons 55 Shell Fish Vendors 13 Offensive Trades. Rag and Bone dealers 4 Tripe boiler 1 Registration of Hawkers of Food. During the year applications were received for the registration of 10 persons and 4 premises. Registration of Vendors of Shell-fish. During the year applications for registration were received from two 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. 83 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 389. 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 nine 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 Antiseptic Throat Pastilles 1 ... Aspirin Tablets 1 ... Baked Beans in Tomato Sauce 1 ... Barley 1 ... Beef Loaf (Minced) 1 ... Beer 7 ... Biscuits 1 ... Bread 1 ... Bread Crumbs 2 ... Bun Flour 1 ... Butter 1 ... Butter Beans 1 ... Cake Decorations 5 1 Cheese 1 ... Cheese (Processed) 1 ... Chocolate Cakes 1 ... Cider 2 ... Cider Vinegar 1 ... Cinnamon, ground 1 ... Cocoanut, sugared 1 ... Coconut Dates 1 ... Coffee 2 ... Coffee and Chicory 3 ... Coffee and Chicory Essence 2 ... Coffee and Chicory Mixture 1 ... Condiment (non-brewed) 1 ... Condiment Vinegar 2 2 Confectionery 2 ... 84  Samples analysed Samples unsatisfactory Cooking Fat 2 ... Cornflour 1 ... Cream (synthetic) 2 ... Cream Horns 1 ... Crystallised Fruits 1 ... Custard Powder 2 ... Dandelion Coffee, Essence of I ... Dates, stoned 1 ... Dragees, silver 2 ... Enerjoids 1 ... Flavouring, various 3 ... Frying Oil 1 ... Gelatine 1 ... Genaformint 1 ... Gin 1 ... Grape Fruit Segments 1 ... Halibut Liver Oil Capsules 1 ... Honey 1 ... Ice Cream 100 1 Ice Lollies 8 1 Jelly 6 ... Krusto 1 ... Lemon Squash 1 ... Lemonade Crystals 1 ... Lemonade Powder 1 ... Linseed, Liquorice and Chloridine Lozenges 1 ... Luncheon Meat 1 ... Margarine 4 ... Marmalade 1 ... Marshmallows 1 ... Meat Cutlets 1 ... Meringue Powder 1 ... Milk 52 1 Milk, condensed 1 ... Milk, dried 1 ... Mincemeat 1 ... Mint Sauce 1 ... Morfat Whipping 1 ... Multivite Pellets 1 ... Mussels 1 ... 85  Samples analysed Samples unsatisfactory Olive Oil 1 ... Orange Curd 1 ... Orange Squash 1 ... Pastilles, medicinal 1 ... Peanut Butter 1 ... Peel 1 ... Pepper 2 ... Pepper flavoured compound 1 ... Pineapple Syrup 1 ... Pork Luncheon Meat 2 ... Potato Chips 1 ... Pudding, Christmas 2 ... Raspberry Powder 1 ... Ribena 1 ... Rice 1 ... Rum 1 ... Saccharin Tablets 1 ... Sage and Onion Stuffing 1 ... Sago 1 ... Salami 1 ... Sausages, Pork 14 2 Sausages, Luncheon 1 ... Sausages, Beef 4 1 Sausage Meat, Pork 1 ... Sausage Meat, Unclassified 2 ... Savormix 1 ... Semolina 1 ... Sherry 1 ... Shortbread mixture 1 ... Soft Drink Tablets 1 ... Soup, Tomato 1 ... Sugared Strands 1 ... Tapioca Dessert 1 ... Tea Cake Mixture 1 ... Tomato Ketchup 1 ... Tonic Tabs 1 ... Veal and Ham Loaf 1 ... Vegetable Laxative 1 ... Vinegar 2 ... Vitamin and Mineral Capsules 1 ... 86  Samples analysed Samples unsatisfactory Welsh Rarebit 1 ... Whisky 5 ... Wine (Port Flavoured) 1 ... Wine (Raisin Flavoured) 1 ... Yeast and Sulphur Tablets 1 ... Zinc Ointment 1 ... Totals 328 9 Notices Served. Shops Act, 1950. Informal 3 Statutory 5 Food & Drugs Act, 1938. Informal 12 Notices Complied with. Shops Act, 1950. Informal 7* Statutory 6* Food & Drugs Act, 1938. Informal 17* Statutory 2* * This figure includes outstanding notices from previous year. 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:— 16/4/52 Adulteration of milk £10 fine £1/1/0 costs 16/4/52 Adulteration of milk £10 „ £1/1/0 „ 28/5/52 Glass in toffee £3 „ £2/2/0 „ 28/5/52 Glass in bread £3 „ £2/2/0 „ 5/6/52 Glass in bread £10/10/0 fine 87 FOOD HYGIENE. The problem of food hygiene may be divided into two parts : (a) the premises, and (b) the worker. (a) The Premises. Systematic inspection of all premises where food is prepared, handled, stored or sold is carried out by Sanitary Inspectors to ensure compliance with the Food and Drugs Act, 1938, the Clean Food Byelaws and relevant legislation, and it is pleasing to record that food traders in the Borough are co-operative in our endeavours to raise the standard of food hygiene. (b) The Worker. The most important and most unpredictable factor in food hygiene is the worker. Carefully designed and elaborate food premises are not proof against the careless food handler, and many outbreaks of food poisoning have been traced to premises which were structurally satisfactory. Nevertheless this argument can easily be exaggerated. It is possible to produce clean food in unsatisfactory premises, but it is very difficult. The education of the food handler is the greatest single step that can be taken in producing cleaner food. No amount of up-to-date equipment can prevent contamination of food if the staff are not instructed in the elementary principles of hygiene. In this respect children are receptive to learning and the almost universal provision of school meals gives the education authority an excellent opportunity to demonstrate the simple rules of personal cleanliness in relation to the preparation and service of food. 88 FACTORIES. THE FACTORIES ACT, 1937. 1. INSPECTIONS FOR PURPOSES OF PROVISIONS AS TO HEALTH. Including inspections made by Sanitary Inspectors. Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (1) (2) (3) (4) (5) Factories with mechanical power 402 233 4 ... Factories without mechanical power 73 28 ... Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) ... ... ... ... Total 475 261 4 ... 2. DEFECTS FOUND. Particulars Number of Defects Found Remedied Referred to H.M. Inspector (1) (2) (3) (4) Lack of cleanliness 1 1 ... Sanitary Conveniences:— Insufficient ... ... ... Unsuitable or defective 4 4 ... Not separate for sexes 1 ... Other Offences 4 3 ... Total 10 8 ... OUTWORK IN UNWHOLESOME PREMISES. (Section 111 of Act of 1937.) Nature of Work Instances Notices served Prosecutions (1) (2) (3) (4) Nil Nil Nil Nil National Health Service Act, 1946 Part III 90 SECTION 21 HEALTH CENTRES. There are three Health Service Clinics in the area, situate as follows:— Leyton Green Road, Leyton, E.10. (Opened in 1933). Granleigh Road, Leytonstone ( „ „ 1935). Dawlish Road, Leyton ( „ „ 1951). On the following page is shown in tabular form the various Clinic Sessions held. 91 HEALTH CLINICS—CLINIC SESSIONS Health Clinic Monday Tuesday Wednesday Thursday Friday Saturday Leyton Green Leyton Green Road, E.10. (LEYtonstone 3650, Ext. 267) A.M. Dental Minor Ailment Dental Orthoptic Minor Ailment Dental Minor Ailment Orthoptic Ophthalmic Dental Minor Ailment Ante-natal Dental Minor Ailment Toddlers Ophthalmic Orthoptic Minor Ailment Dental (alternate) Oral Hygiene P.M. Dental (1) Infant Welfare Dental Infant Welfare Dental Orthoptic Orthopaedic (3rd Wed.) Infant Welfare Dental Immunisation P.N. (2nd and 4th) Dental Orthoptic Special Medicals Park House Granleigh Road, E.ll. (LEYtonstone 3650, Ext. 268) A.M. Dental (1) Minor Ailment Ante-natal (2nd and 4th) Dental (1) Oral Hygiene Infant Welfare Minor Ailment Dental (1) Minor Ailment Dental (1) Oral Hygiene Minor Ailment Dental (1) Oral Hygiene Minor Ailment Toddlers (2nd and 4th) Dental (1) alternate P.M. Dental (2) Dental (1) Oral Hygiene Infant Welfare Dental (2) Ear, Nose and Throat Infant Welfare Dental (1) Oral Hygiene Infant Welfare Dental (1) Oral Hygiene Immunisation Dawlish Road Dawlish Road, E.10. (LEYtonstone 3650, Ext. 287) A.M. Minor Ailment Dental (1) Dental (2) Dental (1) Dental (2) Minor Ailment Dental (1) Dental (2) Minor Ailment Ante-natal Toddlers Dental (2) Minor Ailment Dental (1) Minor Ailment B.C.G. Dental (2) Minor Ailment Dental (2) alternate P.M. Dental (2) Infant Welfare Foot Clinic Dental (2) Immunisation Dental (2) Foot Clinic Infant Welfare Foot Clinic Dental (2) Foot Clinic Evening Foot Clinic Foot Clinic 92 SECTION 22 CARE OF MOTHERS AND YOUNG CHILDREN. Births. 1,355 births were registered during the year:— Males Females Total Legitimate 667 632 1,299 Illegitimate 27 29 56 694 661 1,355 The birth rate per 1,000 of the population was thus 13.00. 1,397 notifications of births were received during the year:— From medical practitioners 24 From midwives 1,373 Ante-natal Clinics. Attendances .— First Attendances 489 Subsequent Attendances 1,495 Total 1,984 The average number in attendance at the Ante-natal Clinics held at the Council's four Centres was 12.55 per session. The number of home visits made by health visitors to expectant mothers during the year was 135. Child Welfare Clinics. On page 93 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. 93 ATTENDANCES, EXAMINATIONS, etc., 1950—1952. Leyton Green 1950 1951 1952 Park House 1950 1951 1952 *DawIish Road 1951 1952 All Centres 1951 1952 Under 1 year— 1st attendances 561 487 413 622 573 506 46 262 1,106 1,181 Subsequent attendances 7,000 6,345 6,275 7,299 6,797 6,108 650 3,641 13,792 16,024 Total attendances 7,561 6,832 6,688 7,921 7,370 6,614 696 3,903 14,898 17,205 1-5 years— 1st attendances 142 96 60 122 89 85 17 79 202 224 Subsequent attendances 3,315 3,343 2,161 3,296 3,090 2,669 355 2,007 6,788 6,837 Total attendances 3,457 3,439 2,221 3,418 3,179 2,754 372 2,086 6,990 7,061 Total attendances, both age groups 11,018 10,271 8,909 11,339 10,549 9,368 1,068 5,989 21,888 24,266 Average attendance per session at Infant Clinics 68.43 56.12 48.36 68.64 54.15 52.08 31.38 54.6 53.27 51.68 „ „ ,, „ Toddlers „ 13.43 12.5 12.5 13.98 14.0 11.8 5.94 10.2 10.19 11.5 Number examined by clinic doctor 3,460 3,451 2,942 3,855 3,631 3,376 398 1,768 7,480 8,086 Number weighed 10,987 10,363 8,906 11,340 10,581 9,492 1,085 5,951 22,029 24,349 *Dawlish Road Clinic was opened to the public on 22nd September, 1951. 94 Post-natal Clinic. Leyton Green Clinic Lady Raleigh Training Home Total No. of Sessions 18 24 42 Letters of Invitation. 212 185 397 First Attendances 120 140 260 Re-Attendances 133 99 232 The disposal of these cases was as follows:— Discharged after one attendance 109 Re-attended for examination and treatment 232 Conditions found on examination:— Leyton Green Clinic Lady Raleigh Training Home Subinvolution of the uterus 2 5 Cystocele and rectocele 1 3 Retroversion of uterus 14 14 Anaemia 4 5 Cervical erosion 26 40 Vaginitis 2 1 Fibroids 1 – Inflamed adnexa 2 – Birth control advice 60 – Pregnancy 1 1 Anal fissure – 1 Cervical polypus – 3 Maternal obesity – 2 Cervicitis – 2 Haemorrhoids ... – 1 Care of Premature Infants. The term "premature infants" refers to babies weighing 5½ lbs. or less at birth, irrespective of period of gestation. Stillbirths are excluded. (a) Number of premature infants notified (1) Born at home 23 during the year (including transferred notifications) whose mothers norm- (2) Born in hospital ally reside in the Authority's area. or nursing home 72 95 (b) Premature infants born in the area (whether their mothers normally reside in the area or not) but exclud- 23 ing babies born in maternity homes and hospitals in the National Health Service. Born at Home Transferred to Hospital Nursed Entirely at Home Grand Total Died in First 24 hours Died on 2nd to 7th day Died on 8th to 28th day Survived 28 days Total 21b. 3oz.or less ... 1 ... ... ... 1 23 21b. 4oz.—31b. 4oz. ... ... ... ... 1 1 31b. 5oz.—41b. 6oz. ... ... 1 2 1 4 41b. 7oz.—41b. 15oz. ... ... ... ... 1 1 51b.—51b. 8oz. ... ... ... ... 16 16 Puerperal Pyrexia. Thirty-nine cases of puerperal pyrexia were notified during the year. Maternity Mortality. There was one maternal death of a Leyton resident during the year. Multipara (39 years), second child (first stillborn). Cause of death:— (i) (a) Paralytic ileus. (b) Post-operative (Caesarian section). (ii) Mitral stenosis. Dental Treatment. Report of Senior Dental Surgeon (A. E. Hall, l.d.s.). Facilities for the dental inspection and treatment of expectant or nursing mothers and pre-school children exist at Park House, Leyton Green and Dawlish Road dental clinics, the patients being referred to the dental officers by the Council's medical officers. Complete treatment is provided, including the supply of dentures where necessary. For dentures no charges are made, since the work is carried out by the Local Health Authority in pursuance of its duty under Section 22(1) of the National Health Service Act. 96 Local Authorities have power, however, to make a charge for replacement of dentures necessitated by lack of care (Circular 100/48 of 18th June, 1948, para. 5). It is among the young children, when seen with their mothers, that the scope for dental propaganda is so great, and I am sure large numbers of mothers could be persuaded to attend some three or four times a year for inspection and treatment, for a prophylactic cleaning, or for a talk on dental care if only we had the staff to deal with them. During part of the year Miss Watts (Oral Hygienist) has given short talks (by arrangement with the health visitors) to the expectant and nursing mothers attending the Maternity and Child Welfare Clinics, thus bringing the matter of dental hygiene to their attention and giving them the opportunity to ask questions. It has been possible to inspect and treat all children who were referred to the dental clinics by the matrons of the day nurseries in the Borough. 97 (A) NUMBERS PROVIDED WITH DENTAL CARE. Examined Needing treatment Treated Made Dentally Fit Expectant and Nursing Mothers 104 156 156 126 Children under five 617 594 594 540 (B) FORMS OF DENTAL TREATMENT PROVIDED. Extractions Anaesthetics Fiiiingt. Scalings or Scaling and Gum treatment Silver Nitrate treatment Dressings Radiographs Dentures provided Local General Complete Partial Expectant and Nursing Mothers 282 48 65 83 110 11 239 26 14 19 Children under five 856 71 335 257 ... 1,083 267 ... ... ... 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. 98 Orthopaedic Treatment. Primary Examinations.—During the year 12 children were referred from the Child Welfare Clinics to the Council's Orthopaedic Surgeon. The following conditions were found:— Midtarsal valgus 1 Pes piano valgus 5 Genu valgum and pes piano valgus 1 Intoeing 1 Torticollis 1 Fibula and flexion deformity 1 Congenital talipes equino varus 1 Hemiplegia 1 Re-examinations.—In addition to the 12 new cases mentioned above, 12 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 6 Genu valgum 1 Rickets both tibia 1 Knock knee 1 Digitus varus 1 Congenital mid tarsal varus 1 Pes piano valgus and genu valgum 1 Provision of Wedges. Wedges to boots were supplied in respect of 22 children. X-Rays. No arrangements were made for children to be X-rayed. Admission to Hospital. No children under 5 years of age were admitted to hospital. Special Eye Clinic. The Consultant Ophthalmic Surgeon had referred by the Clinic Medical Officers 68 pre-school children, who made 93 attendances for examination and treatment. 99 Convalescent Home Treatment. Children. Seven children recommended by the clinic medical officers were sent to convalescent homes. Mothers and Children. Arrangements were made for seven mothers and their children to have a period of convalescence. Ophthalmia Neonatorum. No. of Cases Notified Treated At Home In Hosp. Vision Unimpaired Vision Impaired Total Blindness Deaths 1 1 ... 1 ... ... ... Infant and Foetal Mortality. Year Live Births Deaths under Mortality Rate Stillbirths No. Rate per 1,000 (live and still) Births 1 year 4 weeks Infantile Neo natal 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 1952 1,355 37 24 27.30 17.71 30 21.66 Day Nurseries. There are two Day Nurseries in the area, each having accommodation for 60 children, of whom 20 are 0-2 years, and the remainder 2-5 years. Ellingham Road Day Nursery, Ellingham Road, Leyton, E.15. (Tel. MARyland 3683). Knotts Green Day Nursery, Leyton Green Road, Leyton, E. 10. (Tel. LEYtonstone 4100). 100  Knott s Green Ellingham Road Total 0-2 yrs. 2-5 yrs. 0-2 yrs. 2-5 yrs. 0-2 yrs. 2-5 yrs. No. of appioved places at end of year 15 35 15 35 30 70 No. of children on register at end of year 14 46 14 46 28 92 Total attendances during year 2,838 9,347 2,376 9,603 5,214 18,950 No. of days Open 256 256 256 The following list shows the number of children, under categories (a) in attendance at, and (b) awaiting admission to, each Day Nursery at the end of December, 1952. Category Knotts Green Ellingham Road (o) In attendance (b) Awaiting admission (a) In attendance (b) Awaiting admission 1. a Employed unman ied mothers who wish to keep their children with them when not at work 5 ... 5 ... 1. b Motherless children 1 ... 1 ... 2. a Employed widows 4 ... 1 ... 2. b Divorced from husbands 1 ... 1 ... 2. c Separated from husbands 10 ... 8 3 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 30 54 24 26 4. Mothers who are ill or being confined 5 1 ... ... 5. Others ... ... 20 ... 60 55 60 29 101 National Ntjbsery Examination Board. Pour 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 51 students who have sat for the examination, 47 have been successful in obtaining the Certificate. 102 SECTION 23 MIDWIFERY. Record of Cases attended by Council Midwives, 1952. Midwives employed by Essex County Council Attached to the Lady Rayleigh Training Home, Beachcroft Road Total Cases attended :— (a) As Midwives 102 200 302 (b) As Maternity Nurses 13 13 26 Ante-natal Visits 393 937 1,330 Ante-natal Examinations 742 1,433 2,175 Post-natal Visits 2,724 4,604 7,328 Administrations of Gas and Air Analgesia 69 110 179 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 302 Number of administrations of gas and air analgesia 179 Percentage of administrations 59.27 Maternity Sets. Maternity sets were issued to 124 expectant mothers who were having domiciliary confinement. 103 Medical Aid. Numbers of cases in which medical aid was summoned by midwives under Section 14 of the Midwives' Act, 1951:— (1) Where the Medical Practitioner had arranged to provide the patient with maternity medical services under the National Health Service 3 (2) Others 104 Total 107 Fees paid to Doctors. Sixty-nine accounts were received from general medical practitioners for assistance rendered to midwives under the provisions of the Medical Practitioners (Fees) Regulations. The total amount paid to medical practitioners during the year was £191 10s. 6d. Midwifery—Institutional and Domiciliary. Under the National Health Service all hospital treatment, which includes treatment in a maternity hospital, is free. Although no charge is made to mothers confined at home for the services of doctor and/or midwife, they have to meet many incidental expenses (e.g., cost of domestic help, equipment, food, washing, laundry, etc.) which are avoided by mothers who are confined in hospital. This very obvious discrimination in favour of hospital against domiciliary midwifery is responsible for the progressive relative increase in hospital confinements at the very time when the demand for other hospital beds cannot be met; and the anomaly of the position is bewildering, not only to mothers themselves—and to the doctors and midwives who are prepared to attend them at home—but to the general public, who cannot understand why the maternity benefit should be the same for women having their babies in hospital as it is for those who have them at home. 104 INWARD TRANSFERABLE BIRTHS—1952. Births in Institutions, Maternity Homes and private dwellings outside the Borough of Leyton during 1952. Mothers Hospital, E.5 308 Queen Mary's Hospital, E. 15 218 Forest Gate Hospital, E.7 227 London Hospital, E.l 16 Middlesex Hospital, W.l 4 Wanstead Hospital, E.l 1 52 East End Maternity Hospital, E.l 2 City of London Hospital, E.C.1 2 Mile End Hospital, E.l 8 Hackney Hospital, E.8 24 German Hospital, E.8 4 Queen Charlotte's Hospital, W.6 1 University College Hospital, W.C.1 5 St. Bartholomew's Hospital, E.C.1 1 Hammersmith Hospital, W.12 1 St. John & Elizabeth Hospital, N.W.8 1 Charing Cross Hospital, W.C.2 2 N. Middlesex Hospital, N. 18 1 Royal Northern Hospital, N.7 2 West Middlesex Hospital, Hounslow 2 Ilford Maternity Hospital, Ilford 2 Paddington Hospital, W.9 2 Royal Hospital, N.l 1 East Ham Memorial Hospital, E.7 2 Bethnal Green Hospital, E.2 1 Thorpe Combe Maternity Home, E.17 68 Mounts Bay Maternity Home, E.17 3 Plaistow Maternity Hospital, E.13 14 Bearstead Memorial Hospital, N.16 15 Maycroft Maternity Home, E.18 2 Upney Hospital, Barking 1 Royal Free Hospital, W.C.1 2 St. Mary's Hospital, W.2 1 Chase Farm Hospital, Enfield 1 Sunnedon House, Braintree 1 Others (private dwellings, etc.) 13 Total 1,010 105 BIRTHS IN INSTITUTIONS AND MATERNITY HOMES. The following table shows the percentage of births taking place in other than the patient's home since 1936. The steady increase in the percentage was not maintained in the year 1940, due to evacuation of expectant mothers, and in 1946/47 due to the shortage of maternity beds in hospitals. Year Percentage Year Percentage 1936 53.48 1945 65.87 1937 54.01 1946 56.67 1938 56.99 1947 56.29 1939 59.64 1948 63.86 1940 52.32 1949 68.03 1941 62.79 1950 71.18 1942 56.05 1951 69.71 1943 55.86 1952 73.20 1944 68.38 106 SECTION 24 HEALTH VISITING. Health Visitors. During the year the Health Visitors made 18,146 visits to homes. (а) To expectant mothers:— First visits 106 Total visits 135 (b) To children under 1 year of age:— First visits 1,357 Total visits 6,703 (c) To children between the ages of 1 and 5 years 5,868 (d) Other visits:— Whooping cough 3 Measles 12 Ophthalmia neonatorum 1 Discharging eyes 1 Diarrhoea 2 Puerperal Pyrexia 20 Children's Act 3 After deaths 22 After stillbirths 26 Miscellaneous 1,065 Ineffective 2,272 Chest Clinic. In addition to the above the Health Visitors attached to the Chest Clinic at 180, High Road, Leyton, interviewed 3,900 patients at the Chest Clinic, made 2,013 home visits and interviewed 1,819 patients at home. 107 SECTION 25 HOME NURSING. The County Council has made arrangements for Home Nurses to nurse sick persons in their homes. The services of these nurses are available free of cost upon the recommendation of the family doctor. The local centre for this service is :— The Lady Rayleigh Training Home, Beachcroft Road, Leytonstone, E.ll. (Tel. : LEY 2385) During 1952 the following work was carried out:— No. of new cases (surgical and medical) 1,567 No. of visits paid to above 51,740 108 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 328 35 9 68 440 Re-Vaccinated ... 3 14 185 202 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 626 23 649 (b) By Private Practitioners 272 14 286 2. Number of children who were given a secondary or reinforcing injection (i.e., subsequent to complete full course) 21 406 427 3. (a) Approximate estimated child population at end of year 7,423 13,594 ... (b) Percentage of child population considered to be immunised at end of year 52.36 86.2 ... 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 1952 1,939 1,492 76.9 855 696 81.4 1,123 919 81.8 109 Incidence and Mortality from Diphtheria. Annual totals of deaths and notifications during the past ten years have been: Year Leyton Notified Cases Deaths 1943 28 1 1944 24 1 1945 43 2 1946 38 1 1947 9 1 1948 5 ... 1949 ... ... 1950 ... ... 1951 1 ... 1952 ... ... Since the year 1935, when diphtheria immunisation was begun in Leyton, over 24,000 children in the area have been immunised against diphtheria. During that time the annual number of persons notified to be suffering from diphtheria has fallen from 276 in 1935 to 0 in 1952 : and the number of deaths from 8 in 1935 to 0 in 1952. In the last five years only six Leyton children have been notified to be suffering from diphtheria, and for the fifth year in succession no Leyton child has died from the disease. Nevertheless diphtheria remains one of the deadly diseases of infancy. Even when not fatal, it may give rise to very serious complications ; and the wise parent should seek protection of his/her child by immunisation. Fresh air, good food and cleanliness will prevent many diseases, but they cannot protect a child against diphtheria. So great has been the success of the campaign for protection against diphtheria that we now have a generation of young parents who may never have seen or heard of a case of the disease among their own or their neighbours' children, and are more afraid of the illnesses they know than of diphtheria. The very success of immunisation is tending to make parents wonder if it is still necessary to have their babies immunised. The object of the campaign remains the same—to secure the immunisation of at least 75 per cent, of babies, and the elimination of the disease depends on the maintenance of a sufficiently high percentage of immunised children in the community. 110 On page 111 there is submitted a table showing, from 1935 until now, the number of immunised children in Leyton at the end of each year, and on the following page is a graphical representation of these figures showing separately the age groups 0-5 years and 5-15 years. With regard to the age group 5-15 years, it is seen that there has been a progressive increase in the number of immunised children except during the late war years 1944-45-46, when so many children in that age group were evacuated to reception areas. In the age group 0-5 years, however, it is seen that there have been those periods during which the progressive increase has been interrupted:— (a) 1939-40; the first two years of the war, when so many mothers and young children had been evacuated to safer areas. (b) 1944—the year of the second evacuation due to danger from flying bombs. (c) 1950-51-52. In 1950 diphtheria immunisation was discontinued for two months during an outbreak of acute poliomyelitis; and since that time there has been a substantial decrease in attendances for immunisation, especially of young babies. It is unfortunate that immunisation has become associated with acute poliomyelitis in the minds of parents who, although they have no personal knowledge of a case of diphtheria, have had the opportunity of acquiring knowledge—either personal or from the press— regarding the lifelong paralysis that may follow an attack of poliomyelitis. The fear of diphtheria among parents has decreased in direct relation to the decline in the disease itself; but parents of young children are reminded that all is not well, that diphtheria still kills, and that they have a part to play in protecting their children and so helping to maintain the necessary high level of immunisation in the community. Immunisation against diphtheria should be completed before the child's first birthday. Protection takes about three months to become fully effective, and it is very important that babies should be protected during the second year of life. 111 Diphtheria Immunisation. Number of Children considered to be Immunised at end of Year 0—5 years 5—15 Years 1935 154 690 1936 307 1,348 1937 485 1,890 1938 603 2,883 1939 528 3,017 1940 463 3,169 1941 840 4,059 1942 1,469 5,137 1943 2,769 7,875 1944 2,688 8,166 1945 3,304 8,056 1946 4,141 8,017 1947 4,423 8,645 1948 5,381 8,814 1949 5,413 9,553 1950 5,384 9,814 1951 5,148 10,486 1952 3,888 11,728 112 NUMBER OF CHILDREN CONSIDERED TO BE IMMUNISED AGAINST DIPHTHERIA AT END OF EACH YEAR 1935-52. 113 Protection against Whooping Cough. In recent 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 full results of the investigation will not be available for some 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. 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 during 1952. Under 1 year years 5—14 years Total Number of children who completed the course of immunisation during the year 297 463 149 909 The protection is conferred by three injections of whooping cough vaccine at intervals of four weeks. Because the period of highest mortality from whooping cough is during the first six months of life it is recommended that immunisation should be begun as early as possible, even at as young an age as two months. 114 PROTECTION AGAINST TUBERCULOSIS BY B.C.G. VACCINE Nature of Tuberculous Infection. For centuries man has had little to defend him against what was for a long time considered to be malignant fate in the form of a wasting disease known as "consumption" or "phthisis It was in the year 1882 that Koch was able to isolate, from the sputum of persons suffering from "phthisis the cause of the disease—a germ called the Tubercle Bacillus, known popularly as " T.B.". When a person with tuberculosis of the lungs coughs, he sprays the germs into the surrounding air for a distance of several feet; and, as each germ is surrounded by a fatty envelope which resists drying, it can remain alive in dust for a considerable time. We cannot hope to escape infection, to which we are exposed daily, especially when we enter places such as crowded public conveyances and places of entertainment. Resistance to Infection. Fortunately most of us have considerable natural resistance, which is built up by exposure to the repeated small doses of infection to which we are subjected from day to day. But there are many who have little or no natural resistance, and many who are exposed to repeated massive doses of infection, and it is they who develop the disease. Treatment. During recent years the treatment of tuberculosis by means of new drugs has been most encouraging, but medical treatment is very far from being a certain cure and for those who do not respond to treatment by drugs the alternative surgical treatment has become increasingly severe. Prevention. Tuberculosis is essentially an infectious disease and, as in the case of other infectious diseases caused by bacilli (e.g., diphtheria, typhoid fever, tetanus, etc.), the only hope of eradicating it lies in prevention, by detecting the disease at the earliest possible moment, isolating those who are infectious, and building up the resistance of those exposed or susceptible to infection. 115 B.C.G. Vaccine In 1921, after many years of careful research, two famous French scientists (Calmette and Guerin) produced a vaccine that can be injected into human beings of all ages and so build up their resistance. The vaccine is a weakened strain of a bovine tubercle germ known as Bacillus Calmette-Guerin or B.C.G. Since that time much careful research has been devoted to determining the true value of B.C.G. vaccination; but Britain, which has so often taken a leading part in public health and progress in the past, appears to have lagged behind other countries (such as Scandinavia, Canada, U.S.A., Eire and Brazil), where it is claimed that B.C.G. vaccination has caused a remarkable reduction in the incidence and mortality. The Medical Research Council in this country is now conducting a large-scale investigation into the value of B.C.G. vaccination in school leavers and adolescents, and since October, 1950, we have been engaged, in collaboration with the M.R.C., in a trial of B.C.G. vaccine in Leyton Schools. The efficacy of the vaccine is being tested in school leavers, who will be kept under observation for three years. B.C.G. vaccination is not a form of treatment, but a means of prevention. It cannot protect those who have already been infected with tuberculosis, so in order to find out if this has occurred one or more skin tests have to be done before vaccination. Those found to be susceptible are then offered vaccination, and after about six weeks another skin test is done to see if the vaccination has " taken Certain persons need to be segregated from exposure to infection while the skin testing and vaccination are being carried out, and in connection with the Essex County _ Council Scheme residential accommodation is available at Ardmore Hostel, Buckhurst Hill. Responsibility for Vaccination with B.C.G. In a special Medical Memorandum (322/B.C.G.) issued in May, 1950, the Ministry of Health indicated that they were prepared to make B.C.G. vaccine, for use within the Local Health Authority's arrangements for vaccination of contacts, available only to Chest Physicians accredited to the hospital service who may wish to make use of it. 116 In October, 1950, application was made for a supply of vaccine with which to protect two Leyton infants whose mothers were suffering from active pulmonary tuberculosis, but the application was declined as it was not for use by a Chest Physician. Subsequently the local Chest Physician indicated that he was not prepared to undertake B.C.G. vaccination, and application was made to the Ministry of Health for approval of such vaccination being carried out in Leyton by Dr. Ethel Emslie, Assistant County Medical Officer of Health. Thereafter much inconvenience and delay was caused by the necessity of referring to the Hospital for Sick Children, Great Ormond Street, such Leyton children as were recommended for vaccination. It was not until April, 1952, that the approval of the Ministry of Health was received for Dr. Emslie to carry out B.C.G. vaccination in Leyton. Thereafter arrangements were made for her to undertake—at the Health Services Clinic, Dawlish Road—the preliminary testing of susceptibility of all Leyton contacts of tuberculosis under school-leaving age, the immunisation by B.C.G. vaccine of those found to be susceptible, and the subsequent follow-up and testing of immunised contacts. Leyton Cases—Extract from Report by Dr. Emslie. Before my final approval by the Ministry of Health in April. 1952, I was able to arrange for some 31 children to receive B.C.G. vaccination on our behalf at Great Ormond Street Hospital. Most of the preliminary and final skin testing were carried out by me in Dawlish Road Clinic. In all these cases the results of conversion of susceptibility were satisfactory and there were no complications. In addition, arrangements were made for a number of infants of mothers in attendance at the Ante-natal Clinic to receive B.C.G. vaccination at the Mothers' Hospital, Clapton or at Queen Elizabeth Hospital, Hackney. From June until the end of December, 1952, some 51 Leyton children were vaccinated by me with B.C.G.—12 were under one year of age, 14 from one to five years, and 25 over five years. All these cases were satisfactorily converted to Mantoux positive. There were no complications and no case has given any cause for anxiety. No child was vaccinated within at least six weeks of contact with an active case of tuberculosis. In most cases the contacts were quiescent and sputum negative, but even in these cases extreme care was advised until the tuberculin test was converted—indeed all the time, as protection is not absolute. 117 Occasionally home isolation is possible, especially with babies in arms; then sometimes the infectious contact is a relation in another house and contact can be avoided for some time. If there is an active case of tuberculosis in the family, it means waiting for the patient to be removed to hospital or for admission to Ardmore Hostel. Apart from actual vaccination, the preliminary testing sometimes gives valuable information. For instance, a child of two years, whose grandmother was a quiescent case, was found to be tuberculin sensitive. Further investigation showed that the grandmother's condition had deteriorated, that she was actually infectious and required further treatment. The two-year-old child herself had to be admitted to hospital, but of course was not vaccinated. Another toddler was admitted to hospital for treatment of an active primary infection disclosed by tuberculin testing. In another family, liable to be exposed to future infection, two young children were found to be tuberculin positive. On investigating the reason, it was found that there was in the house a lodger suffering from active tuberculosis. But as I am allowed to vaccinate only known contacts, we cannot expect to discover many new cases in this way. Tuberculin tests are often done as an aid to diagnosis in children attending our ordinary clinics, and during the last few months of the year several children discovered in this way have been admitted to hospital for treatment of a primary infection which was making unsatisfactory progress. In my opinion there are great advantages in having this work done at our Infant Welfare and School Clinics. The children are quite accustomed to come there, where they feel quite at home, and the Health Visitor and the Doctor are generally known to them already. On the other hand, at the Chest Clinic there is only one session a week at which children can attend, and this would make it very difficult to read tuberculin tests there. If, however, appointments were to be given for children to attend the adult sessions at the Chest Clinic, they would be exposed to a risk of infection there; but, on the other hand, primary tuberculosis in children is not infectious to others. Again, the necessary follow-up of cases is much easier to arrange at our own welfare clinics. Preliminary tuberculin testing is done at all ordinary sessions at Dawlish Road Clinic, and no special session is set aside for that purpose. The actual B.C.G. vaccination must be done on one 118 particular day for each batch of vaccine, which must be fresh; but it is done by appointment during or after the School Clinic session. Adults with tuberculosis have to be given special accommodation apart from others because of the danger of infection, but in the case of children separate accommodation is not necessary. By encouraging the attendance of children at Local Health Authority Clinics we are helping to show that tuberculosis is not due to malignant fate, but is a preventable infectious disease in the same category as diphtheria and whooping cough. General Observations. It is well known that infants and young children are very susceptible to tuberculous infection, and a Local Jlealth Authority should be in a position to offer immediate protection by B.C.G. vaccination whenever we learn that children are exposed to infection. Dr. Emslie has shown that the work can be undertaken satisfactorily in a Local Health Services Clinic, and has given reasons why it should be done there rather than at a Chest Clinic. All the evidence at our disposal is to the effect that B.C.G. vaccination is a valuable preventive measure, and the prevention of tuberculosis is not only better, but infinitely less expensive, than its cure. 119 SECTION 27 AMBULANCE SERVICES. I am indebted to the County Medical Officer for the following statistics relating to the work carried out, during the past five years, from the Ambulance Station, Auckland Road, Leyton, E.10. (Tel. LEY 6077.) 1948 1949 1950 1951 1952 Patients conveyed 7,132 15,167 23,300 24,196 29,586 Total mileage 44,824 82,109 108,654 114,558 123,995 Miles per patient 6.47 5.46 4.66 4.99 4.19 120 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 1952 1,662 18,239 19,901 Summary of Attendances and Treatment. (a) All Ages. During the year 19,901 attendances for treatment were made, representing an increase of 4,006 over the attendances during the previous year. First Attendances (new cases) Subsequent Attendances Total Attendances Males 306 3,172 3.478 Females 1,205 14,129 15,334 Children 151 938 1,089 Total 1,662 18,239 19,901 The number of persons who received free treatment was 76 (4.5 per cent, of the total number of new cases), and the following figures show the attendances of patients who received free treatment. First Attendances (new cases) Subsequent Attendances Total Attendances Males 18 359 377 Females 58 1,764 1,822 Total 76 2,123 2,199 121 Notwithstanding an increase in the number (11 per week) of sessions and in the number of patients booked per session in an attempt to reduce the waiting list, the list continues to increase, and the waiting period for new cases and return visits varies between seven and ten weeks throughout the year. Advantage was taken of accommodation at Dawlish Road Health Centre to use it as an extra Foot Clinic. The Clinic opened in January for four weekly sessions, two in the afternoons and two in the evenings. This was extended in April to six sessions, the afternoon sessions being increased to four. It is interesting to note that at Dawlish Road Clinic the free cases numbered 48 (or 17.9 per cent.) as against 28 (or 2.2 per cent.) at the main Clinic, illustrating the advantage taken by the old people in that area of the facility afforded them. A further innovation was the transport of infirm patients to and from the Clinics. Eleven patients have been able to receive treatment who otherwise would not have been able to attend. Defects Treated. Bursitis 100 Callosities 486 Corns 390 Hallux valgus 139 Hallux rigidus 23 Hammer toe 35 Hyperidrosis 27 Hyperkeratosis 3 Metatarsalgia 44 Mycotic infection 14 Nails, ingrowing 102 Nails, club 119 Pes planus 48 Rheumatic heel 2 Septic condition 14 Sprain 2 Trigger toe 2 Verruca pedis 112 122 Referred for Medical or Surgical Treatment. During the year 30 patients were referred to their own private medical practitioners or hospitals for the following conditions:— Arthritis 2 Arthrodesis of toe 2 Bilateral hallux valgus 10 Calcaneo spur 1 Cheiropompholyx 1 Contraction of tendons 1 Exostosis 2 Fracture of 5th metatarsal 2 Fracture of 1st metatarsal 1 Pes piano valgus 1 Onychosis 1 Plantar warts (multiple) 5 Removal of nail 1 (b) Children under School Age. Number of children 6 Number of attendances 22 Average number of attendances per child 3.66 Defects Treated Septic condition 2 Corn 3 Verruca pedis 1 Defects Referred to School Clinics — (c) School Children. Number of school children 145 Number of attendances 1,067 Average number of attendances per child 7.3 Defects Treated Bursitis 2 Callosities 2 Corns 45 Hammer toe 1 Hyperidrosis 3 Mycotic infection 2 Nail, ingrowing 10 Nail, club 1 Pes planus 1 Verruca pedis 78 123 Defects referred to School Clinics. Contraction of tendons 1 For removal of nail 1 Convalescence for Adults. (a) Number of applications during year 74 (b) Length of convalescence of cases sent during year:— Length of stay No. of Cases 1 week 2 2 weeks 31 3 weeks 33 4 weeks 8 Over 4 weeks ... (c) Where cases have been sent:— Name of Convalescent Home No. of Cases sent Essex Convalescent Home, Clacton 24 Samuel Lewis Convalescent Home, Walton 11 Spero Fund Homes 11 Bell Memorial Convalescent Home, Lancing 9 Merchant Taylor's Convalescent Home, Bognor 7 Rustington Convalescent Home, Littlehampton 3 Maitland House Convalescent Home, Frinton 2 Dolly Ross Convalescent Home, Cliftonville 1 St. Giles Christian Mission, Heme Bay 1 Resthaven Convalescent Home, Exmouth 1 Kelsdale Court Convalescent Home, Saxmundham 1 Wordsworth Home of Rest, Swanage 1 Church Army Home, St. Leonards 1 Hermitage Convalescent Home, Hastings 1 Health Education. 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. 124 Lectures and Film Shows. Date Where held Subject Type of Audience Attendance 20.2.52 Lady Rayleigh Training Home Films :One Man's Story Surprise Attack Artificial Pneumothorax Members of Royal College of Nursing 130 28.3.52 St. Luke's Hall, Ruckholt Eoad, E.10 Lecture: Domestic Help Service Townswomen's Guild 12 2.7.52 Town Hall, Leyton Lecture: History and Development of Sanatorium Treatment Members of T.B. Care Assoc'n. and general public 72 Exhibitions 17.3.52 to 15.4.52 Health Clinic Granleigh Road, E.ll. Dental Hygiene School Children Expectant and Nursing Mothers Average 50 per day 125 Shop Window Display, 280, High Road, Leyton, E.10. Commenced 22.1.52 Dates Subject 22.1.52 to 18. 2.52 Clean Food 19.2.52 to 17.3.52 Diphtheria Immunisation 18.3.52 to 19.5.52 Mobile Mass X-Ray 20.5.52 to 6.6.52 Foot Health 9.6.52 to 23. 6.52 Health Literature 24.6.52 to 17. 7.52 Domiciliary Midwifery Service 18.7.52 to 18. 8.52 Domestic Help Service 19.8.52 to 18. 9.52 Health Visiting 19.9.52 to 30.10.52 Smallpox Vaccination 31.10.52 to 16.12.52 Care of the Teeth 17.12.52 continuing Accidents in the Home Mass Radiography. Mass Radiography Unit 6.B was in operation in the Borough from 4th April until 16th May, 1952, 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 4th April 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. Attendances. Miniature Films Male Female Doctors' cases 128 209 General public 1,286 1,805 Appointments (Factories, etc.) 2,567 2,367 Totals 3,981 4,381 Grand Total 8,362 Recalls for Large Films Male Female Doctors' cases 41 44 General public 64 98 Appointments 128 83 Totals 233 225 Grand Total 458 126 Results of Survey. Incidence of Abnormality Males Females Total Number of attendances for miniature X-ray 3,981 4,381 8,362 Number passed as normal on miniature, or subsequent large, film examination 3,844 4,246 8,090 Percentage normal 96.56 96.92 96.76 Number showing some abnormality 137 135 272 Percentage showing some abnormality 3.44 3.08 3.24 Classification of Abnormalities Noted Males Females Total Congenital bony abnormalities 3 3 6 Chronic bronchitis and emphysema 34 22 56 Broncho-pneumonia (non-tuberculous) 1 2 3 Bronchiectasis 6 2 8 Pulmonary fibrosis (non-tuberculous) 3 3 6 Basal fibrosis 3 2 5 Pleural thickening 4 7 11 Consolidation of unknown cause 1 1 Intrathoracic tumours 1 I 2 Congenital heart disease 2 2 Acquired heart disease 7 9 16 Tuberculous lesions—all forms 66 66 132 Miscellaneous conditions 8 16 24 Totals 137 135 272 Tuberculous Lesions Males Females Total The tuberculous lesions, totalling 132, are further analysed as follows:— Inactive tuberculosis:— (a) Primary 7 21 28 (b) Adult type 50 37 87 Total 57 58 115 Active tuberculosis:— (a) Primary (b) Adult type 9 8 17 Total 9 8 17 These figures show that there were 17 cases of active tuberculosis disclosed by the Survey, giving a ratio of 2.03 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 male than the female examinees, the respective ratios being 2.26 and 1.82 per 1,000. 127 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. Loan of Sick Room Equipment. During the year 158 articles of sick room equipment were loaned on the recommendation of doctors, hospital almoners, etc. No. of articles loaned during 1952:— From Central Store From Lady Raleigh Training Home Air Beds 4 — Air Pillows — 1 Air Rings 16 20 Bed Back Rests 10 2 Bed Cradles 2 2 Bed Pans 7 34 Crutches 2 — Hot Water Bottles — 3 Invalid Chairs 8 — Rubber Draw Sheets 5 6 Sputum Cups — 2 Urinal Bottles 14 12 Feeding Cups — 5 Steam Kettles — 2 Sand bags — 1 Totals 68 90 Special items bought during the year:— 6 Air Rings. 2 Bed Pans. 2 Invalid Chairs. 1 Bed Cradle. 3 Bed Back Rests. 6 yds. Rubber Sheeting. 128 Tuberculosis. (a) Open Air Shelters. (1) Number of shelters in use at end of year 1 (2) Total number of visits made to shelter by health or tuberculosis visitors during year 13 (b) Extra Nourishment. Number of new cases during year supplied with free milk 109 Total number being supplied with free milk at end of year 100 (c) Rehabilitation. (1) 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 1 2 (2) Number of cases being assisted who, at the end of the year, had been assisted for— (a) less than 6 months — (b) 6 months to 1 year 1 (c) 1 year to 2 years — (d) over 2 years 2 (d) Home Visits. (1) Number of visits to tuberculosis cases by Tuberculosis Visitors 1,446 (2) Number of visits to tuberculosis cases by Health Visitors 567 Tuberculosis Care Association. The Secretarial duties of the Association were taken over temporarily by my Chief Administrative Assistant, Mr. W. D. Softley, owing to the retirement of Mr. E. E. Jacobs, due to ill-health. In June these duties were transferred to Mr. P. C. Ware, following his appointment as successor to Mr. Jacobs. 129 Despite the new rates of National Assistance Allowance which came into effect on the 16th June, 1952, many patients in the area have expressed gratitude for assistance granted to them by the Association, Extra Nourishment Vouchers have relieved anxiety from strained budgets in homes where tuberculosis has incapacitated the wage-earner, homes in which there would otherwise be very little money to provide the patient with such extra nourishment as the Association has been granting. The extent of assistance the Care Association can give to patients depends mainly on the financial resources of the Association. In September, owing to lack of funds, it was found necessary to reduce the value of extra nourishment vouchers. Before that time an average of 48 patients had received vouchers at a cost of £85 monthly. Individual vouchers of 10s., 7s. 6d. and 5s. per week were reduced in value to 5s. 6d. or 3s., and were granted to an average of 34 patients at a total cost not to exceed £40 for any one month. There was launched an energetic campaign to raise funds by voluntary effort. This included dances, whist drives, collecting boxes in business premises, and a record Christmas Seal Sale. A comparison between the two major items of expenditure and income during the year will give some indication of the financial problem which, if assistance at a high level is to be maintained, will now be a permanent feature of the work of the Association. d. s. £ 7 5 1,194 Payment of Extra Nourishment Vouchers 10 17 789 Grants received from the Essex County Counci 9 7 £404 Minimum balance to be raised by voluntary effort There are two possible solutions to this problem:— (1) A permanent reduction in assistance to patients in accordance with income. (2) A permanent programme of social events to raise funds. The former course may be inevitable due to the reduced amount of grants and the difficulty of raising money by local voluntary activities. Alternatively the raising of a large sum of money annually would involve the Secretary in activities which would take up too much of his time and is therefore impossible under existing arrangements. 130 The undermentioned are some of the grants made by the Association during 1952:— Extra Nourishment Vouchers 584 Beds and bedding 8 Clothing 8 Wireless licences 1 Fares to relatives visiting patients, or to patients proceeding for convalescence 27 Library books 15 Special holiday grants 2 Christmas grants to patients at home and in hospital 107 Loans have been made to the Instructor at the Occupational Therapy Centre to purchase wool and other materials for the use of patients, and these amounts are repaid when the articles are sold. Representation on the Executive Committee of the National Assistance Board, the Women's Voluntary Service and the British Legion has resulted in very close co-operation between all concerned with the welfare of patients, and on many occasions the Association has been relieved of expenditure on behalf of patients due to the willing acceptance of responsibility for assistance by one or other of these organisations. The Association carries out very useful work as a Centre of Information to which patients can refer their problems. An important factor in this work is the close liaison which exists between the health visitors of the Local Health Authority and the Association, whereby necessitous cases are brought to the notice of the Association. 131 OCCUPATIONAL THERAPY. In March, 1950, it was reported to the Leyton, Wanstead and Woodford Care Association that certain local patients 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 was appointed as instructor. Since that time Leyton Health Area Sub-committee has accepted financial responsibility for the instructor's fees and the cost of equipment. Report by the Instructor (Mrs. S. A. Wiltshire). "At the beginning of 1952, eleven patients were attending the class. The weaving of scarves, dinner mats and cushion covers is continuing, and jewellery and plastic work have been added to the activities. In March a 33-inch floor loom was added to the equipment, and the first length of tweed was in process of being worked. At the request of the County Medical Officer the instructor and some of the patients gave demonstrations at an Occupational Therapy stand at the Essex County Show held in June for two days. Seven patients there showed work on the big loom, the small table loom, jewellery and plastics. The Exhibit evoked considerable interest from members of the public attending the health exhibits. Different lines in jewellery and plastics were tried out during the year, and proved a great success. Tweed suit lengths, a bedspread, curtains, and fine woollen head scarves were woven on the large floor loom. In the autumn it was possible to add leather work to the activities of the class, and the results were sufficiently encouraging to justify the addition of this activity to the other crafts. A mechanical saw was kindly donated to the Centre, and a number of articles of woodwork (such as trays, table mats, etc.) were completed. It is hoped to extend this activity in the near future. A Christmas Exhibition and Sale was arranged for two days in December, and owing to the interest shown by the general public this was extended for a further three days. 132 Provision has been made for the supply of a rug loom so that the making of larger-sized rugs will be possible. During the year six students had improved sufficiently to be able to resume full-time employment and nine new patients joined the class. At the end of the year there were 14 patients on the register, and all are looking forward keenly to the Essex County Show in June, 1953, when we have been again requested to form part of the County Health Exhibit." As stated in my previous report, 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. 133 SECTION 29 DOMESTIC HELP. Six 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 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 1952 88 547 635 It will be seen that there has been a substantial decrease in thf annual number of maternity cases. Summary of Cases Helped during 1952. Maternity Other Total No. of cases dealt with 88 547 635 The following list shows the disabilities from which the 635 apphcants were suffering, and the number of cases in each category. Disability No. of Cases Maternity 70 General debility 4 Post operative debility 22 Heart disease 67 Bronchitis 39 Arthritis 29 Senility 69 Cerebral haemorrhage 7 Jaundice 1 134 Pre-natal 8 Post-natal 7 Neurosis 8 Thrombosis 17 Lumbago 2 Prostatotomy 1 Emergency 11 Hernia 2 Anaemia 6 Hodgkinson's Disease 1 Injuries 23 Cancer 24 Tuberculosis 30 Blind and infirm 19 Ulcerated leg 9 Hypertension 20 Diabetes 7 Pneumonia 7 Disseminated sclerosis 3 Miscarriage 3 Oedema of legs 3 Parkinson's Disease 2 Rheumatism 17 Cholecystectomy 1 Amputation of leg 6 Gall stones 1 Tonsilitis 1 Paralysis 2 Neuritis 3 Phlebitis 2 Gross obesity 2 Epilepsy 1 Varicosity 5 Other 9 Displaced disc 4 Quinsey 1 Pleurisy 2 Rheumatoid arthritis 38 Haemiplegia 14 Myxoedema 1 Malnutrition 1 Influenza 2 Rheumatic fever 1 135 (a) Number of helps and hours worked:— Number of domestic helps enrolled at end of year 81 Number of domestic helps actually employed at end of year 58 Number of hours worked during year 97,088½ (b) Work of the Domestic Help Organiser:— (1) First Visits to beneficiaries 277 (2) Re-visits to beneficiaries— (a) Domestic help present 212 (b) Domestic help not present 464 (3) Other visits 481 (c)Help provided:- Maternity Acute Sick Tuberculosis Chronic Sick Aged Not Sick Others Total Aged Others New cases helped during the year 85 22 12 155 42 32 21 369 Total cases completed during year 88 21 17 118 44 28 23 339 Cases being helped at end of year who have received help for:— Under 3 mths. 2 3 2 35 11 3 1 57 3—6 mths. ... ... ... 15 2 5 ... 22 6—12 mths. ... ... 4 34 4 7 2 51 Over 12 mths. ... ... 7 117 19 23 ... 166 Total 2 3 13 201 36 38 3 296 Total cases helped during the year 90 24 30 319 80 66 26 635 Hours of help provided during year 7,080 578½ 6,330¾ 53,217¼ 16,569 10,692¼ 2,620¾ 97,088½ 136 137 Medical Examination of Staff. (1) County Council employees— Number of medical examinations for: (a) Entrants to County Council's service 120 (b) Retirement on Superannuation — (c) Other purposes — Number of consultations with specialists arranged — (2) Employees of other local authorities, etc. Name of local authority, etc. No. of medical examinations Leyton Borough Council 53 Wanstead and Woodford 1 Entrants to Teachers Training Colleges 7 Berkshire City Council 1 Stratford Magistrates Court 1 School Health Service 140 The figures set out below relate to the calendar year ended December, 1952. Number Roll Average Attendance Percentage of Attendance 1. Secondary Schools 9 4,657 4,015 86.21 2. Primary Schools 18 8,937 7,620 85.26 Totals 27 13,594 11,635 85.59 ROUTINE MEDICAL INSPECTION. A.—Routine Medical Inspection. Number of Inspections in the prescribed groups. Entrants 1,939 Second Age Group 855 Third Age Group 1,123 Total 3,917 Of 3,917 children who were examined in the code age-groups, 2,982 (or over 76 per cent.) were accompanied by their parents. B.—Other Inspections. Special Inspections. The number of special inspections during the year was 10,694 comparing with 12,806 during the previous year. Re-inspections. The number of re-inspections during 1952 was 11,193. 141 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 1,939 301 15.5 Second Age Group 855 138 16.1 Third Age Group 1,123 158 14.1 Total (Code Groups) 3,917 597 15.2 Uncleanliness and Verminous Conditions.—At the special inspections held by the school nurses, 322 children were found to be unclean out of a total number of 24,999 examined (i.e., 1.28 per cent.) Cleanliness Surveys in Individual Schools. School Number of Examinations Number Cautioned Number Excluded Canterbury Road 1,552 4 ... Capworth Street 100 ... Cann Hall Road 1,229 5 ... Church Road 1,920 3 3 Tom Hood 71 ... Connaught Road 1,590 25 9 Downsell Road 2,861 50 9 Davies Lane 2,745 13 1 Farmer Road 543 4 ... Goodall Road 1,670 24 14 Lea Bridge Road 275 ... ... Mayville Road 2,777 75 9 Norlington Road 1,215 ... ... Newport Road 3,144 23 11 Sybourn Street 396 ... ... St. Joseph's 452 12 7 Trumpington Road 1,103 4 ... Knotts Green and Harrow Green 436 15 1 Leyton County High School 920 1 ... Occupation Centre ... ... ... Total 24,999 258 64 Number of individual children found unclean 258 of whom 64 were referred to the Minor Ailments Clinice. 142 The incidence of uncleanliness for the past 10 years is shown in the following table. Year Number of Examinations Number Cautioned Percentage Cautioned Number Excluded Percentage Excluded 1943 22,364 878 3.9 199 0.89 1944 18,090 841 4.6 160 0.88 1945 20,224 995 4.9 252 1.24 1946 21,134 604 2.85 137 0.64 1947 26,160 766 2.92 219 0.83 1948 28,422 659 2.31 194 0.58 1949 28,117 640 2.27 129 0.45 1950 28,179 515 1.81 104 0.37 1951 27,741 319 1.15 52 0.15 1952 24,999 258 1.03 64 0.25 MEDICAL TREATMENT. Minor Ailments Clinics. Attendances. During the year 3,867 individual children attended the clinics, and made 13,538 attendances. Defective Vision. Of the 3,917 children subjected to routine code group inspection in the schools, 216 (5.51 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 1,051 children. They made 1,559 attendances for examination and treatment. Sixty-five children were found to have no defect requiring treatment. Orthoptic Clinic. The special orthoptic clinic for children suffering from squint is held at Leyton Green Clinic on five sessions per week—Tuesday (morning), Wednesday and Friday (all day). As the Consultant Ophthalmic Surgeon (Dr. A. Logan Adam) holds special ophthalmic clinic sessions in the same building at the same time on two nornings (Wednesday and Friday), there is close co-operation between the Eye Specialist and the Orthoptist (Mrs. K. S. Box, S.R.N., S.C.M., B.B.O.). 143 Cases of squint requiring operation are referred to Mr. M. Klein, Ophthalmic Surgeon at Whipps Cross Hospital, and by virtue of the fact that the Orthoptist (Mrs. Box) also acts as Orthoptist at Whipps Cross Hospital, there is close liaison between the two Departments, and arrangements can be made with the minimum of delay for the treatment of cases requiring surgical operations. Orthoptic Report for 1952. Number of Sessions held 237 Number of cases investigated 1,035 Number of cases treated 302 Number of new cases seen 133 Number of cases discharged cured— With operation 21 Without operation 26 — 47 Number still under treatment 140 Number under observation 115 Number failing to attend for complete course 4 Number discharged unsuccessful 3 Total number of attendances for the year 1,838 144 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 No. of Children inspected No. requiring treatment No. approved for treatment No. accepting treatment No. refusing treatment Percentage of acceptances Canterbury ... ... ... ... ... ... Cann Hall 804 442 442 425 17 96.1 Capworth 501 356 356 350 6 98.3 Church ... ... ... ... ... ... Connaught ... ... ... ... ... ... Davies Lane 918 475 475 435 40 91.5 Downsell . ... ... ... ... ... ... Farmer 455 309 309 290 19 93.8 Goodall ... ... ... ... ... ... Harr ow Green ... ... ... ... ... ... Knotts Green ... ... ... ... ... ... Lea Bridge ... ... ... ... ... ... Mayville 950 483 409 332 77 81.1 Newport 432 379 379 346 33 91.3 Norlington ... ... ... ... ... ... Sybourn ... ... ... ... ... ... St. Joseph's 136 130 130 110 20 80.4 Tom Hood ... ... ... ... ... ... Trumpington ... ... ... ... ... ... County High ... ... ... ... ... ... Report by the Area Dental Officer (Mr. A. E. Hall). For nine months of the year the dental staffing position was slightly improved. With the assistance of a second full-time dental surgeon, it was possible to keep both Park House and Leyton Green dental surgeries open full-time. In addition, the services of a third dental officer were available for three half days a week in one of the two dental surgeries at Dawlish Road Clinic. Mr. Shamash continued his attendance at Park House Clinic on two half days a week to advise and treat orthodontic cases sent to him by the other dental officers. Even so, the manpower in terms of dental officers was only equal to 2 5/11ths, instead of the authorised strength of six. Working in conjunction with these dental officers, the Oral Hygienist (Miss Watts) devoted 7/11ths of her time to the school and maternity and child welfare services in the area. 145 Direct approach had been made to the private dentists in the area to devote some portion of their time to the treatment of school children on a sessional fee basis either in their own surgeries or in the Council's clinics, and, following receipt of Ministry of Health Circular 22/52 and Ministry of Education Circular 254, a further appeal was sent out to these practitioners through the Local Dental Committee. The response was very poor, and it was found impossible to get any help on a sessional basis from dental surgeons in the area. Two dental practitioners agreed to see in their own surgeries any urgent cases of toothache referred by the Council's dental officers. These facilities have been used on numerous occasions to the satisfaction of all concerned. Dental Inspection and Treatment. Routine inspection and treatment has been carried out in six schools, and in the Infants' Department of a seventh school. Not all children having dental defects were referred, as some discrimination in selecting children for treatment is necessary and justified in an under-staffed area. (Vide "Health of the School Child" 1950-51, p. 46.) In addition, all "urgent" or "casual" cases—referred to the dental clinics by doctors or teachers, or brought by parents—were seen, advised, and treated if necessary. Othodontics. There continues to be an increasing demand for the orthodontic service. Here again it is necessary to employ some selection of cases to ensure that those most likely to benefit from treatment are given the opportunity of receiving it. Table IV does not make any provision for detailed explanation of work done, so the following figures are included here:— Impressions taken 269 Study and progress models 197 New appliances fitted 72 Attendances for treatment 743 Advice to parents and adjustments to appliances 703 X-rays 25 Finished cases 20 146 Oral Hygiene In addition to the actual work she carried out in the scaling and cleaning of the teeth of children referred to her by the dental officers, the Oral Hygienist (Miss Watts) has spent a great amount of time on oral hygiene instruction—including the use of the toothbrush, which is so often used incorrectly. These talks appeared to be very much appreciated, and their value can hardly be over-estimated, for they lay the foundation on which the child's future interest in, and appreciation of, dental services will be built. In the Spring of 1952, during a period of about six weeks, Miss Watts organised a dental exhibition containing many models of teeth in health and disease. The exhibit, on loan from the Dental Board, was on show in the large waiting room at Park House Clinic. On no day were these exhibits seen by less than 50 people, and on some days by considerably more, as they were available for inspection by expectant and nursing mothers, pre-school and school children. Many questions were put to the staff by parents and children as a result of what they saw, and I think the exhibition could well be repeated in the future. Additional Statistics Other items of dentistry for which no allowance is made in Table IV are as follows:— Denture space retainers fitted 36 Denture space retainers repaired 2 X-ray films taken 189 Local anaesthetics 1,668 Applications of silver nitrate 1,311 Scaling and polishing 882 147 ORAL HYGIENE. The scaling and cleaning of teeth, and the imparting of instruction in dental hygiene, are the recognised sphere of operations of the Oral Hygienist, and since the appointment of Miss Watts to that post in May, 1951, she has carried out much useful work for expectant and nursing mothers and school children. Unfortunately the work which an Oral Hygienist is allowed to do cannot be expected to go far in relieving pressure in a grossly understaffed dental scheme in which there are many years of arrears of conservative dental surgery to be dealt with in addition to the great number of children requiring emergency extraction of painful teeth due to the fact that regular dental inspection and treatment of schools in the area has not been possible. The only way to relieve that pressure is by appointing the required number of dental surgeons. In routine examination of school children in this area it is found that some 17 per cent. of children needing treatment require the services of the oral hygienist for scaling, brushing, or the removal of green or black stains from the teeth. This does not take into account the value of the Oral Hygienist in teaching oral hygiene, a sphere where her services are of value to all children. There is little doubt that it is in this sphere that the main usefulness of an oral hygienist lies as far as the School Dental Service is concerned. The work done by the oral hygienist has been of great value to patients, and all her work has been well done. Exhibitions of posters and displays of dental models, organised and supervised by the oral hygienist, have been greatly appreciated by mothers and children. Talks on dental hygiene given to ante-natal and post-natal patients have been well received and of great value. At times it has been difficult to find sufficient dental work to employ the oral hygienist fully in consequence of the shortage of dental officers and her own limited sphere of operations. The oral hygienist has not made, and cannot be expected to have made, any marked effect in relieving the pressure on the school dental clinics. On the contrary, if her teaching results in an increased acceptance rate of treatment, the pressure will actually increase. 148 Orthopaedic Clinic. Examinations by Orthopaedic Surgeon Primary examinations 72 Re-examinations 147 The findings at primary examinations were:— Pes piano valgus 22 Genu valgum and pes piano valgus 3 Hallux rigidus 2 Hallux valgus 3 Fibula flexion deformity 2 Tibial „ ,, 1 Kyphosis 1 Intoeing 1 Hammer toes 6 Metatarsalgia 2 Genu valgum 4 Genu varum 1 Pes cavus and genu valgum 1 Genu varum and valgus ankles 1 Digitus varus and pes piano valgus 1 Valgus ankle 3 Torticollis 1 Knock knee 1 Pes cavus 2 Digitus varus 2 Exostosis 1 Os-calcis 1 Abnormal number vertebrae 1 Contraction of extensors 1 No disability 8 The following conditions were seen at re-inspections during the year:— Valgus ankles 2 Pes piano valgus 33 Pes piano valgus and digitus varus 1 Pes cavus 4 Hallux valgus 3 Genu varum and valgus ankles 1 Digitus varus 7 149 Genu valgum 11 Genu valgum, pes piano and valgus 10 Hammer toes 7 Congenital diseased hip 1 Congenital absence of fibula 1 Congenital scoliosis 1 Contraction of extensors 1 Congenital synostosis 1 Hemiplegia 1 Amputation of right forearm 1 Poliomyelitis, left lower limb 1 Poliomyelitis, right upper and lower limbs 1 Poliomyelitis, right upper limb 1 Haemangiona, left instep 1 Spasmodic flat foot 1 Congenital enlargement of limb 1 Congenital shortening of limbs 2 Congenital talipes equinus 1 Talipes equinus 1 Spastic hemiplegia 3 Arthritis right hip 1 Prominent scaphoid 1 Schlatter's disease 1 Spastic diplegia 1 Lymphatic cyst 1 Short digit 1 Kyphosis 1 Kyphosis dorsi-lumbar 1 Torticollis 3 Winged scapula 1 Double Sprengle 1 Loose body—knee 1 Scoliosis . 1 Abnormal number vertebrae 1 X-Rays Arrangements for X-rays were carried out in seven cases. Admissions to Hospital. Seven children were admitted to hospital, and the following 150 operations performed:— Tenotomy foot 1 Arthrodesis feet 2 Arthrodesis hands 2 Tenotomy of tendo achilles and division of plantar faciae 1 Schlatter's disease 1 Surgical Appliances and Boots. Minor alterations to boots (wedges, etc.) 66 Other alterations to boots (surgical) 3 Walking caliper and high boot 1 High boot 1 Artificial arm 1 AURAL CLINIC There were held during the year some 37 sessions of the special Aural Clinic for the diagnosis and treatment of defects and diseases of the ear, nose and throat. Of the 461 examinations carried out by the specialist, 123 were new cases and 338 were subsequent attendances. Sixteen appointments are made for each session, but the average number of attendances per session was 13. The conditions dealt with include:— Aural Cases. Deafness with or without other complications 34 Chronic suppurative otitis medial 30 Secretory otitis media Acute otitis media 4 Other ear conditions 8 Catarrhal Conditions. Nasal catarrh with or without obstruction 43 Other Defects of Nose and Throat. Sinusitis and antrum trouble 10 Deflected nasal septum 4 " Tonsil " cases 29 Polypus 1 Papilloma 1 Allergic rhinitis 2 166 151 The remainder of the cases were under treatment or observation from last year. Cases referred to Hospital for Further investigation or Treatment. For X-ray of sinuses 33 For antral lavage 10 For operation of tonsillectomy and adenectomy 34 For adenectomy 5 Polypus removed 2 Papilloma treated 1 Pure tone audiometry 14 99 Treatment carried out at Clinic. Displacements 3 Cauterisation 8 Politzerisation 27 Foreign body removed from ear 1 Foreign body removed from nose 1 40 Fifteen cases of otitis media were referred by the specialist for daily cleansing and medication at the minor ailment clinic. Some of these cases have to attend for weeks, others clear up in a short time. Politzerisation. This form of treatment was recommended in 11 new and 17 old cases. Frequently the children have to attend for two or three months for weekly treatment. The results of politzerisation in catarrhal deafness are very good, but the children do require to attend frequently for supervision. During the severe winter of 1952 many children had recurrent attacks, and needed more than one course of treatment. Results. Cases discharged completely 26 Ear conditions improved or apparently cured 15 Hearing cases improved 10 Cases to continue under fairly frequent observation 18 No treatment required 8 The remainder of the cases are still under treatment. 152 The Ear, Nose and Throat Surgeon (Mr. S. Hillman) reports that there has been an increase in secretory otitis media secondary to infected sinuses, tonsils and adenoids, and he considers that the increase was in great measure due to the unfavourable weather in the winter. Investigation by the pure-tone and gramophone audiometer into the hearing loss in children before and after treatment has shown the measure of improvement that can be effected by politzerisation, medical and/or surgical treatment such as lavage of the sinuses, and the removal of tonsils and adenoids. 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. Boys Girls Total No. of Delicate Pupils ascertained 28 20 48 No. admitted to Knotts Green Day Open Air School 17 3 20 No. admitted to Residential Open Air School 17 18 35 No. awaiting admission to Residential Open Air Schools at 31/12/52 1 4 5 Owing to the waiting time for admission to Residential Schools, several children who were ascertained late in 1951 were not placed until early 1952. This explains why the number of children placed exceeds those ascertained. 153 Physically Handicapped. Fortunately the number in this category is small, and attention is drawn to those receiving residential treatment, which is two at the end of 1952. There were none awaiting admission to either Day or Resident Schools. Boys Girls Total No. attending at Knotts Green Open Air School 14 12 26 No. attending at Residential Schools 2 — 2 No. ascertained in 1952 8 1 9 No. recommended Knotts Green Day Open Air School 4 1 5 No. recommended Residential Open Air School - — — No. recommended to continue at Ordinary School 4 — 4 Educationally Sub-normal. Boys Girls Total No. of Educationally Sub-normal Pupils ascertained in 1952 14 8 22 No. admitted to Harrow Green 9 6 15 No. admitted to Residential School 4 2 6 One child is awaiting admission to a Residential School. Maladjusted Pupils. 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 6 0 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. 154 One boy was ascertained to be totally deaf in 1952. There are six children of school age attending Residential Deaf Schools. Six 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 1952. There were two children at Residential Schools for the Partially Deaf. There is one child at a Day Partially Deaf School. 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 1952. Four children attend Residential Schools for the Blind. Partially Sighted. These are children who cannot follow the ordinary curriculum without detriment to their sight or to their educational development, but can be educated by methods involving the use of sight. No child was so ascertained during 1952. There was one boy in this category attending a school for Partially Sighted pupils. Epileptic Pupils. One child was ascertained as epileptic and 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 1952 four boys and one girl were notified as being incapable of education in the Special School. 155 Under Subsection 5 of Section 57 children who require supervision by the Mental Welfare Authority have to be notified. Two boys and one girl were so recommended in 1952. 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 1952 some 91 children were sent away for from four to six weeks— 36 girls and 55 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 1952 one child received education at home, and on the 31st December, nineteen children were receiving tuition while long-term in-patients of Whipps Cross Hospital. PROVISION OF MEALS. The number of individual children fed under the Authority's arrangements during 1952 was:— Dinners Milk Meals Free 352 10,517 For payment 4,410 — Totals 4,762 10,517 Number of meals supplied:— Dinners Milk Meals Free 74,420 2,096,394 For payment 878,666 — Totals 953,086 2,096,394 156 SPEECH THERAPY. 1. Children at present Undergoing Treatment— Diagnosis of Defects— Boys Girls Total Stammering 41 12 53 Dyslalia 79 33 112 Disphonia 3 — 3 Dyslalia and stammer 4 1 5 Cleft palate — 1 1 Stigmatism 4 4 8 Dyslalia and nasalisation 1 — 1 Retarded speech development 5 2 7 Motor aphasia 1 — 1 138 53 191 Incidence of speech defects among seniors, juniors and infants— Seniors Juniors Infants Total Stammering 21 16 16 53 Dyslalia 4 29 79 112 Disphonia 2 1 — 3 Stigmatism 2 4 2 8 Cleft palate 1 — — 1 Dyslalia and stammer 1 — 4 5 Dyslalia and nasalisation — — 1 1 Retarded speech development 1 1 5 7 Motor aphasia — — 1 1 32 51 108 191 157 2. Discharged—29. Seniors Juniors Infants Total Dyslalia — 4 16 20 Stammering 2 1 1 4 Dyslalia and stammer Retarded speech development 1 2 1 2 Dysphonia 1 1 — 2 4 6 19 29 3. On Waiting List Nil 4. Average Number of Cases Treated Daily 20 5. Homes Visited 15 6 School Departments Visited 44 7. Parents Interviewed 124 8. Children referred to other Clinics 8 9. No. of New Cases 96 10. Children re-admitted 3 11. No. of Children who left before Cured or Discharged 13 12. Total No. of Attendances2,384 13. No. of Children referred—No Treatment Necessary 2 158 CHILD GUIDANCE. Report of the Educational Psychologist to the Forest and Leyton Divisions (Miss M. Marshall). The work of the Educational Psychologist has expanded during the year, owing to the increasing number of schools and school children in the Forest Division, and to the development of a scheme in Leyton for helping children who are backward in reading. The Psychologist divides her time between work in the schools and work in the Child Guidance Clinic. Most of the individual testing is done in the schools, but some children are tested at the Clinic, where remedial teaching is given. Of some 32,000 school children in the combined area, the Psychologist has interviewed and tested 364 during the year. Boys Girls Total Forest 134 67 201 Leyton 124 39 163 These children are brought to the attention of the Psychologist either by the Head Teachers or the School Medical Officers. Parents' requests for an interview usually come "via" the school or the school clinic, and a few direct to the Child Guidance Clinic. The reasons given for requests for individual psychological assessments of children were:— Backwardness in school work (primarily reading) 55% Difficult behaviour: at home 19% at school 9% Physical symptoms, e.g., tic, enuresis, stammer, etc. 9% Requests by Children's Officer, Juvenile Employment Officer, Probation Officer, etc. 4% Educational advice, other than for backwardness 10% Some children are referred to the Psychologist for more than one reason, e.g., backwardness in reading and truancy. 159 Analysis of figures Forest Pre-school Infants Juniors Secondary Boys 3 47 61 24 Girls 2 24 27 14 Total 5 71 88 38 Leyton Pre-school Infants Juniors Secondary Boys 3 20 84 17 Girls 0 6 29 3 Total 3 26 113 20 Boys still predominate, and the Junior Departments ask for the most help from the Psychologist. The number of children in the Infant Departments is steadily increasing and is now considerably larger than the number referred from Secondary Schools. The ranges of intelligence of the children seen by the Psychologist were:— I.Q's. Below 71 71—90 91—110 111—130 131 + Total Forest 26 74 74 21 7 202 Leyton 9 46 76 25 6 162 As such a small proportion of the total school population can be seen individually, the Psychologist continually attempts to use the opportunities offered by the school visit to further the aim of general preventive mental health work in the schools. The relationship between, for instance, backwardness and truancy in one child can be a useful starting point for a more general discussion with the teachers on the adaptation of the individual to the school programme, the varying rates of learning in different children, or methods of remedial teaching. Discussion of one child's difficulties at school or home often throws light on many of the other problems of the teacher. 160 Of the 364 children interviewed by the Psychologist, 99 were selected for further investigation and help at the Child Guidance Clinic. Thus 265 children, who are presenting some problem of either behaviour or learning, have been seen only by the Psychologist and in some cases by the School Medical Officer. In addition to a discussion of these children's difficulties, the Psychologist has sent an individual report to the school on each child, stating the findings and making suggestions. This aspect of the Psychologist's work was further stressed by a course of six lectures given to teachers in the area on "Problem Children in the Schools". This was a continuation of an earlier course, given in the Autumn of 1951. The Psychologist also lectured at a residential course for teachers at Wansfell on "Backwardness in the Primary School"; to the Heads of Secondary Schools at Clacton on "What we can expect from the Child in the Secondary Modern School" (deputising for the County Psychologist), and by invitation gave a course of lectures to a large group of teachers in Hertfordshire. In addition to this, the Psychologist gave six separate talks to Parent-Teacher Associations, Mothers' Union groups, etc. The scheme for remedial teaching in reading in the Leyton Division is proving useful, not only in the help given to individual children, but in encouraging the teachers with large classes to find out how the success is being achieved with the small group. The scheme, which was started in January, 1952, is operated by three retired teachers under the general supervision of the Borough Education Officer, the Heads of the schools concerned and the Educational Psychologist. A group of 12 or 13 children has been selected in each of five Primary Schools. Each child is of average or good intelligence, but some two or more years retarded in reading, and they receive two lessons a week in groups of six. The results have been very encouraging; so far, every child has regained some of the lost ground, and some have made up to three years' progress in a period of two terms. A separate report has been prepared, giving fuller details of this scheme. During the year 11 children (all boys) have been given remedial teaching, two in arithmetic, eight in reading and one in handwriting. Five improved sufficiently for the special teaching to be discontinued, and six will go on in 1953. Altogether, these 11 children received 174 lessons (Leyton children 78; Forest children 96). The number of school visits made during the year was 191: Leyton 92; Forest 99. 161 ANALYSIS OF FIGURES FOR 1952 Walthamstow Out-Area W'stow C'ford Leyton Forest Number of oases referred to the Clinic 123 17 50 48 Number of cases diagnosed at Clinic 97 14 43 41 (a) Psychiatrist Diagnostic Interviews 96 15 43 41 Treatment Interviews 482 61 179 194 Other Interviews 2 (b) Psychologist Individual Testing interviews 281 71 162 202 Individual Remedial Teaching views 313 98 78 96 Other interviews: Clinic 17 4 10 3 Home or School 3 1 6 29 School Visits 112 35 92 99 (c) Play Therapist Treatment Interviews 186 ... 289 129 (d) Psychiatric Social Worker Interviews at Clinic 800 70 407 235 Interviews elsewhere 21 8 36 37 (e) Waiting List at 31.12.52. Cases for diagnosis 26 2 17 15 Awaiting treatment . 1 1 ... ... Cases suspended by agreement with S.M.O. or parents ... ... 3 5 (d) Number of pupils treated during year 113 19 70 60 Number of pre-school children treated during year 26 1 2 2 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. 162 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. 163 Progress in the Anti-Tuberculosis Vaccine Research Trial. Report by Dr. T. M. Pollock—Physician in charge of B.C.G. Trials. During the year continued progress was made in the Medical Research Council's investigation into the anti-tuberculosis vaccine, B.C.G. Leyton is one of 22 North London Boroughs taking part in the research, which is also being undertaken in Manchester and Birmingham. Its object is to determine whether a safe antituberculosis vaccine, at present used in Britain only for those in contact with the disease, is of sufficient value to the general population for its use to be advised on a wide scale. The 50,000 young people in the trial are all volunteers from Secondary Modern school "leavers". Of these, 628 come from Leyton and entered the trial between November 1950 and February 1952. Each volunteer had a chest X-ray and skin-test at school, and a proportion were given the vaccine. To determine its efficacy, it is essential to keep in touch during the next three years with the young people taking part, and this is being done mainly by Health Visitor visits and annual X-rays. Each volunteer is visited once a year by a Health Visitor from the Health Department, and the necessary information obtained. At the visit the volunteer is reminded of the trial and the impending X-ray appointment. These visits have been most successful, and much credit is due to the Health Visitors whose energy and enthusiasm in the research are playing a great part in making the scheme a success. The annual chest X-rays are carried out by the research team's mobile radiography unit, and in the cm-rent year took place at Dawlish Road Clinic during June 1952 and January 1953. These annual X-rays are of great value to the volunteers as thereby early chest disease can be detected at a stage when treatment is most likely to be effective, and before any symptoms are observed. It is thus very encouraging that 83 per cent. of the young people have kept their X-ray appointments, and we hope to have as good a response during the remaining period of the trial. This trial has still two years to run before its conclusion. The co-operation and team work of those taking part are proving to be of the high standard necessary to ensure its success. 164 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 1,939 Second Age Group 855 Third Age Group 1,123 Total 3,917 b. Other Inspections. Number of Special Inspections 10,694 Number of Re-inspections 11,193 Total 21,887 165 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 28 291 301 15.5 Second Age Group 47 95 138 16.14 Third Age Group 46 118 158 14.07 Total (Prescribed Groups) 121 504 597 15.24 Routine Inspections (Junior Occupation Centre) 19 20 35 68.62 TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1952. Defect or Disease Routine Inspections Special Inspections Number requiring Treatment Observation Number requiring Treatment Observation (1) (2) (3) (5) Skin 27 160 14 3 Eyes—(a) Vision 140 162 35 31 (b) Squint 52 26 7 ... (c) Other 24 311 4 2 Ears—(a) Hearing 7 6 51 12 (b) Otitis Media 12 53 52 ... (c) Other 64 243 29 2 Nose or Throat 64 200 149 6 Speech 14 46 15 4 Cervical Glands 2 8 46 1 Heart and Circulation 19 12 48 5 Lungs 20 50 67 11 Developmental—(a) Hernia 4 2 4 ... (b) Other 3 57 20 6 Orthopaedic—(a) Posture 8 2 28 2 (6) Flat Foot 55 17 35 ... (c) Other 90 110 75 6 Nervous System—(a) Epilepsy 1 7 8 1 (6) Other 6 12 22 5 Psychological—(a) Development 12 34 32 3 (b) Stability 6 25 14 2 Other 89 1,412 83 20 166 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 1,939 550 67.8 1,315 28.4 74 3.8 Second Age Group 855 257 30.1 568 66.4 30 3.5 Third Age Group 1,123 341 30.4 776 69.1 6 0.5 Other Routine Inspections . 51 8 15.7 39 76.5 4 7.8 Total 3,968 1,156 29.1 2,698 68.0 114 2.9 TABLE III.—Return of Defects Treated during the Year ended 31st December, 1952. 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 (1) By the Authority Otherwise Skin— Ringworm— Scalp 2 ... Body 1 ... Scabies 8 3 Impetigo 23 Other skin diseases 156 1 Minor Eye Defects— (External and other, but excluding cases falling in Group II) 268 42 Minor Eye Defects 422 28 Miscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 1,771 170 Total 2,651 244 167 TABLE III.—contd. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as mlnor ailments.—group I). Defect or Disease Number of Defects dealt with By the Authority Otherwise Errors of refraction (including squint) ... 316 Other defect or disease of the eyes (excluding those recorded in Group I) ... 3 Total ... 319 No. of Pupils for whom Spectacles were— (a) Prescribed ... 723 (6) Obtained ... 678 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 - 59 (b) for other nose and throat conditions - 13 Received other forms of treatment 422 28 422 100 Group IV.—Orthopedic and Postural Defects. (a) No. treated as in-patients in hospitals or hospital schools 7 (b) No. treated otherwise, e.g., in clinics or patient departments 72 Group V.—Child Guidance Treatment and Speech Therapy. No. of pupils treated— (a) Under Child Guidance arrangements 162 (b) Under Speech Therapy arrangements 191 168 TABLE IV. Dental Inspection and Treatment. (1) Number of pupils who were:— (a) Inspected by the Dentist 4,196 Specials (Casuals) 2,086 Grand Total6,282 (b) Found to require treatment 4,789 (c) Actually treated 3,554 (2) Half-days devoted to Inspection 34 1,133 Treatment 1,099—Total (3) Attendances made by children for treatment 9,006 (4) Fillings, Permanent Teeth 1,902 2,422 Temporary „ 520—Total (5) Extractions, Permanent Teeth 782 6,381 Temporary „ 5,599—Total (6) Administrations of general anaesthetics for extractions 1,791 (7) Other operations, Permanent Teeth 3,447 5,218 Temporary „ 1,771—Total TABLE V. Infestation with Vermin. (1) Total number of examinations in the Schools by School Nurses 24,999 (2) Number of individual pupils found to be infested 318 (3) Number of individual pupils in respect of whom cleansing notices were issued 3 (Section 54 (2) Education Act, 1944.) (4) Number of individual pupils in respect of whom cleansing orders were issued 9 (Section 54 (3) Education Act, 1944.)