Borough of Leyton. HEALTH REPORT FOR THE YEAR 1953. 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 15 3. Vital Statistics 18 4. Infectious Diseases 26 5. General Provision of Health Services in the 50 Area 6. Sanitary Circumstances of the Area 59 7. National Health Service Act, 1946, Part III 109 8. School Health Service 160 2 INDEX Page Acreage 12 Ambulance facilities 51,138 Ante-natal Clinics 109 Ante-natal exercises 111 Area Health Sub-Committee 4 Atmospheric pollution 100 Aural Clinic 170 Bacteriological examinations 83 B.C.G. Immunisation 135 Biological examinations 83 Birth notifications 109 Birth rate 18 Birth registrations 109 Births, illegitimate 18 Births, Inwards transferable 123 Births, institutions 123 Burial of the dead 53 Business and Industrial Establishments, Inspection of 77 Cancer 20 Care Association 152 Care of mothers and young children 109 Chest Clinic 125 Child Guidance 177 Child Welfare Clinics 111 Chiropody 139 Cleanliness survey 161 Clinics 52 Ante-natal 109 Chest 125 Child Guidance 177 Child Welfare 111 Clinic Sessions 110 Foot Clinic 139 Minor Ailment 163 Ophthalmic 117 Orthopaedic 116,168 Orthoptic 164 Post Natal 113 Scabies 51 Committees 4 Convalescence 117,142 Day Nurseries 118 Deaths, causes of 25 Death rate 18 Dental treatment 114,165 Diphtheria 29 Diphtheria immunisation 134 Diphtheria, Incidence and mortality 29 Diseases of Animals Acts and Orders 98 Disinfestations 75 District midwifery 121 Domestic Help Service 157 Dysentery 28 Page Education, Leyton Committee for 6 Encephalitis 29 Erysipelas 29 Extra Nourishment 150 Factories Acts, 1937/48 92 Food and Drugs Act, 1938 83 Food, clean 89 Food, condemned 83 Food, inspection 77 Food poisoning 30 Food premises 77, 85 Foot Clinic 139 Funeral arrangements 53 Gas and Air analgesia 121 Handicapped pupils 171 Health Centres 109 Health Education 89,142 Health Services General—- Provision of 50 Health Visiting 125 Health Visitor, The 126 Home Nursing 131 Home Safety 145 Hospitals 51 Housing development, Future 59 Housing Statistics 70 Housing and Tuberculosis 39 Ice Cream 85 Immunisation 132 Index 2 Infant mortality 117 Infectious disease 26 Inquests 54 Introduction 15 Laboratory facilities 50 Lectures and film shows 144 Legal proceedings 72 Leyton Corporation Act, 1950 88, 94 Massage and special treatment establishments 56 Mass Radiography 147 Maternity nursing 121 Maternity outfits 121 Meals in schools 175 Measles 32 Medical Aid 122 Medical examinations of staff 159 Medical Research 128, 181 Meningococcal infection 32 Meteorological conditions 13 Midwifery 121 Milk inspection 86 Minor Ailment Clinics 163 Mortuary 53 3 Page National Assistance Act, 1948 (Sees. 47 and 50) 52, 53 National Blood Transfusion Service 56 National Health Service Act, 1946 (Part III) 109 Neo-natal mortality 117 Notices, sanitary 71 Notification of births 109 Nursery nursing certificate 119 Nurseries and Child Minders Regulation Act, 1948 159 Nursing Homes 51 Occupational Therapy 154 Open air shelters 150 Ophthalmia neonatorum 32, 117 Ophthalmic Clinic 117 Oral hygiene 167 Orthopaedic Clinic 116,168 Orthoptic Clinic 164 Paratyphoid fever 32 Pemphigus neonatorum 32 Pet Animals Act, 1951 93 Pneumonia 33 Poliomyelitis 33 Population 12 Post mortems 53 Post-natal Clinic 113 Premature infants 113 Prevention of Damage by Pests Act, 1949 74 Puerperal pyrexia 36 Public Health Committee 4 Rag Flock Act, 1951 94 Rateable value 12 Rehabilitation 151 Rodent control 73 Routine medical inspection 160 Page Samples for analysis 78 Sanitary circumstances of the area 59 Sanitary conveniences, washing facilities 90 Scabies Clinic 51 Scarlet fever 36 School Health Service 160 Shop window display 143 Sick room equipment 151 Smallpox 37 Smoke abatement 100 Smokeless zones 103 Smoking and lung cancer 20 Social conditions 12 Speech therapy 175 Staff 7 Staff, medical examinations 159 Statistics, comparative 24 Stillbirths 18, 117 Tuberculosis 37 Administrative arrangements 41 B.C.G. immunisation 135 Care Association 152 Chest Clinic 125 Deaths 42 Extra nourishment 150 Housing 39, 46 Mass radiography 147 Notifications 38 Occupational therapy 154 Open air shelters 150 Rehabilitation 151 Typhoid fever 37 Uncleanliness 162 Vaccination 132 Vital statistics 18 Whooping cough 37 Whooping cough immunisation 134 4 PUBLIC HEALTH COMMITTEE 1953-54 The Worshipful Mayor—Councillor A. A. French, j.p. (ex officio) Chairman Councillor H. E. Martin Vice-Chairman Councillor F. W. Marshall Alderman G. S. Flack „ B. G. Rayner „ E. A. RIGG Councillor Mrs. A. M. M. Burrell „ W. A. Chapman ,, Miss V. D. Gostling „ E. Martin F. W. WlGG Leyton Health Area Sub-Committee of the Health Committee of the Essex County Council 1953-54 Chairman : Councillor Mrs. A. M. M. Bttrrell Vice-Chairman : Councillor J. J. Walsh Representatives of Essex County Council County Aldermen ; Mrs. M. Ball (ex-officio) (Chairman, County Health Committee) F. D. Smith County Councillors : H. Burton (County Education Committee) Mrs. F. E. Cochrane H. Herridge F. R. Richards Dr. C. Skinner (ex-officio) (Vice-Chairman, County Health Committee) 5 Representatives of Leyton Borough Council Aldermen : G. S. Flack Mrs. J. Hammond, o.b.e., j.p. Mrs. R. King Councillors : W. A. Chapman J. A. E. Collins W. J. Giffin Miss V. D. Gostling E. W. R. Harding W. Hook, m.p.s. W. J. Low F. W. Marshall E. Martin T. C. Messenger 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 1953 54 Chairman : Alderman Mrs. J. Hammond, o.b.e., j.p. Vice-Chairman : Councillor A. L. Chamberlain Representative Members (Leyton Borough Council) Alderman : A. E. Bechervaise Mrs. R. King Councillors : F. J. Abbott, j.p. Mrs. D. E. Barker A. W. Bourne The Rev. C. A. Fox (o.f.) Miss V. D. Gostling E. W. R. Harding W. Hook, m.p.s. W. J. Low E. Martin C. J. Mills G. W. A. Robinson J. J. Walsh 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 P. V. Faning 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 B. J. Ashcroft, m.s.i.a., m.inst.b.e. a, b, c, e Deputy Senior Sanitary Inspector R. A. Reeves, m.s.i.a. a, b Sanitary Inspectors A. E. Barnes a, b J. Clarke a, b P. W. Edwards, m.s.i.a. a, b E. R. Hodge, m.s.i.a., m.r.s.i. a, b, d (Resigned 2.11.53) G. D. John, m.s.i.a. a C. 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 Woiks. e. Gold Medallist—Ollett Trust Competition. Public Analysts G. Taylor, f.r.i.c. J. H. Hamence, m.sc., Ph.D., f.r.i.c. 8 Chief Clerk *W. D. Softley *Part-time. Clerical Staff N. Gray J. Burtt Mrs. V. Hatwell L. Williams T. Crute ESSEX COUNTY COUNCIL Assistant County Medical Officers *Mary L. Gilchrist, m.d., m.b., ch.b., d.p.h. Samuel C. Lovell, m.r.c.s., l.r.o.p. Ethel R. Emslie, m.b., ch.b., m.d., d.p.h., d.c.h. Shirin Dastur, m.r.c.s., l.r.c.p. (Resigned 31.1.1953) Elsie Lilian Peet, m.d., m.b., b.Ch. (from 1.2.53) *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. (to 15.4.53) H. A. Oatley, m.b., b.s., f.r.c.s. (from 4.6.53) Aural Surgeon S. Hillman, l.r.c.p., l.r.c.s., l.r.f.p.s. (to 22.7.53) A. N. Cammack, b.m., b.ch., d.l.o. (from 29.7.53 to 16.12.53) Area Dental Officer A. E. Hall, l.d.s. (Liverpool) 9 Dental Officers Miss P. T. Fuller, l.d.s. (Resigned 2.7.53) *Mrs. D. 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.) *c. shamash, b.d.s., l.d.s. (r.c.s.). Miss P. M. Ball, b.d.s. (New Zealand). (From 16.3.53 to 23.5.53) *Mr. P. G. Arnold, l.d.s., b.d.s. (From 15.7.53) *Mr. P. J. Pearce, b.d.s. (Lond.). (From 21.9.53) *Mr. G. M. Ritchie, l.d.s., r.c.s. (From 16.11.53) *Miss S. Rogart, l.d.s., r.c.s. (From 23.11.53) *Mr. T. D. H. Millar, l.d.s., r.c.s. (Ed.). (From 27.11.53) *Mr. L. Altmann, l.d.s. (From 21.7.53 to 13.8.53) Non-Medical Superintendent of Midwives Miss E. M. Wearn a, b, c, e Midwives Miss E. Daines Mrs. C. L. Wackett Superintendent Health Visitor Miss E. M. Franklin Health Visitors / School Nurses Miss L. Acton a, b, d Mrs. I. M. Adamson a. b. c Miss I. D. Appledore a, b (Commenced 20.7.53) Miss M. J. Charters a, c Mrs. D. E. Chat field a Miss E. O. Corby a Miss G. W. Craddock a, c Miss J. M. Denman a, b, c (Commenced 4.8.53) Miss R. M. Edward a, c Miss C. B. Ferguson a, b, c ♦Part-time. a, b a, b a, b, c Miss B. King a, c, d Miss K. M. Munday a, c Miss M. Murray a, b, c (Resigned 31.3.53) Miss M. E. Nangle a, d (Resigned 30.11.53) Miss M. H. Roger a, b, c Mrs. Q. H. Rolfe a, c (Resigned 30.11.53) Mrs. M. Sims a, b Mrs. J. H. Souter a, b, c Miss E. M. Walling a, b, c (Resigned 13.8.53) 10 Tuberculosis Visitors Miss C. G. Teale a, b, c, e Mrs. L. M. Abbott a, f Matrons of Day Nurseries Knotts Green Day Nursery— Mrs. E. M. White a, d Ellingham Road Day Nursery— Mrs. D. M. McStay a, b (a) S.r.N. (d) S.r.F.N. (b) S.C.M. (e) Q.N. (c) h.V. Cert. (f) T.A. Cert. Orthoptist Mrs. K. S. Box, s.r.n., s.c.m., d.b.o. (Regional Hospital Board Appointment) Speech Therapist Miss M. E. Tippett Chiropodists Chief : J. C. O'Brien, m.ch.s. Others : Miss J. M. Hunter, m.ch.s. D. D. Waters, m.ch.s. S. A. Wightman, m.ch.s. *R. Sadowski, m.ch.s. *G. E. Fenn, M.ch.s. Domestic Help Organiser Mrs. E. M. Saxby Oral Hygienist Miss J. Watts *Part-time. 11 Dental Attendants Mrs. D. Blundell Miss. E. Corcoran Miss A. I. Warren *Mrs. Ayres. (From 16.11.53) *Mrs. Ferris. (From. 25.11.53) *Part-time. 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 F. C. Ware E. R. Price L.. G. Goodbun G. A. Thurlow E. Lamb A. Keeys Miss E. Beckley Mrs. F. Wright Miss R. Carrington G. Whitehouse 12 STATISTICS AND SOCIAL CONDITIONS OF AREA. Area in Acres 2,594 Population (Census 1951) 105,183 Population (Registrar-General's Estimate, June 1953) 103,200 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 (1953/54) £786,946 Sum represented by a Penny Rate for General Rate purposes (1953/54) £3,140 13 METEOROLOGICAL CONDITIONS, 1953 Summary of Temperature, Rainfall and Sunshine Records These figures—supplied by the Director of the Meteorological Office of the Air Ministry—summarise the official recordings of temperature, rainfall and sunshine made at Kew Observatory during the year 1953. From a meteorological point of view the year was regarded as a dry and sunny one, with the temperature a little above average ; and the following is a verbal summary of the main features of the weather in London month by month. January : Dry ; rather cold. The driest January at Kew since 1929. February : Wet and snowy, becoming mild. March : Very dry and foggy. Fog on 14 days. The driest March at Kew since 1944. April : Changeable. Sunshine above average. May : Fine, then changeable. One of the coldest and wettest firsts of May this century. The sunniest May at Kew since 1940. June : Mainly cool; warmer at the end. Sunshine below normal. July : Very wet; rather cool. Wettest July at Kew since 1941 ; and coldest there since 1940. Sunshine about average in spite of excessive rain. August: Changeable, but sunny. The sunniest August since 1947. 14 September : Sunny, but rather wet. The sunniest September since 1934. October : Dry at first, then wet. Sunshine below average. November : Dry and mild. December : Very mild and very dry. The mildest December since 1934 ; the driest since 1933. With regard to Public Holidays, the Easter week-end (3rd6th April) had the coldest Easter Sunday in April since 1936. The Whitsun week-end (23rd-25th May) was the warmest since 1944. The August week-end (lst-3rd August) was one of the sunniest since 1933, and the Christmas Holiday (24th-27th December) was the sunniest since 1929. 15 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LEYTON. Me. Mayor, Ladies and Gentlemen, I have the honour to present herewith my Annual Report on the health, sanitary circumstances, and vital statistics of the Borough of Leyton during the year 1953. The Report is drawn up in accordance with the instruction contained in Article 17(5) of the Sanitary Officers (Outside London) Regulations (1935), and on the lines required by Ministry of Health Circular 1/54 of January, 1954. The Report also contains information regarding the services administered by Leyton Health Area Sub-Committee and by Leyton Committee for Educatiorf on behalf of Essex County Council. In previous years I have endeavoured to include in this preamble a short survey of matter contained in the body of the Report, but with the ever increasing scope and duties of the Health Department it has become more difficult and more invidious to select material for such an introductory survey. The following pages contain of necessity much information in the form of figures and facts required by the Ministries of Health and Education, but they also contain general observations and special reports by members of the staff on many aspects of the Health Services which are of current interest and are considered to merit special attention. On page 2 will be found an index designed to facilitate easy reference to special subjects. From the table of vital statistics on page 24 it will be seen that the post-war increase in the population of Leyton was short lived, and that the gradual but progressive decline in population since 1949 still continues. The birth rate, which reached its postwar maximum in 1947, has declined since then almost to the level of the lowest pre-war figure. No Leyton mother died from causes connected with pregnancy and childbirth, and the Leyton infantile mortality rate (23.45) is lower than the comparative rates for the country as a whole, London, and the great towns. The high death rate of 19.66 per thousand is due to a new method of calculation introduced by the Registrar-General (see page 19) whereby Leyton is credited with the deaths of over eight hundred residents from other areas who died in Lanethorne Hospital during the year. As far as vital statistics show, the health of the people in the Borough remains remarkably good ; but medical officers, sanitary 16 inspectors, health visitors and other social workers are confronted daily with an accumulating amount of unhappiness, frustration and despair due to the necessity of sharing of households. Since the end of the last war there has been a substantial increase in the number of families. Due to lack of housing accommodation, we see daily the great physical and mental strain borne by young families who are growing up in households not their own, and the equally great strain borne by the older people who have to share the accommodation. Of the many duties and responsibilities of the Medical Officer of Health, the chief is still the prevention of epidemic disease, and, of the epidemic diseases not yet brought under control, those that now give rise to the greatest anxiety are tuberculosis and poliomyelitis. 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. It is now common knowledge that people are living longer to day than they used to do—so much so, that increased longevity has now become a matter for concern rather than for gratification. For instance, the provision of accommodation for old people has now become one of the most serious problems confronting hospital and housing authorities, and the length of life of pensioners is proving a serious drain on the national exchequer and local superannuation funds. The provision of adequate housing and the prevention of pollution of the atmosphere are two of the most important public health problems of our time, and reports dealing with these two subjects are to be found in the section of the report dealing with Sanitary Circumstances. This section of the Report has been largely re-arranged and in great measure re-written by Mr. B. J. Ashcroft, who took over the duties of Senior Sanitary Inspector in January, 1953. 17 It is my privilege to acknowledge again the support accorded to me by the members of the Council, and the interest and encouragement shown by the Chairmen and Members of the Committees concerned with the work of the Health Department, and it is with sincere thanks that I record my appreciation of the industry and efficiency of my colleagues on the staff. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant. 18 Vital Statistics Population 103,200 Live Births :— Legitimate Males 645 Females 594 Illegitimate Males 20 Females 20 Totals 1,279 Birth rate per 1,000 of population 12.39 Stillbirths :— Males 17 Females 12 Rate per 1,000 total (live and still) births 22.17 Deaths :— Males 986 Females 1,043 Totals 2,029 Death Rate per 1,000 19.66 Number of women dying from diseases and accidents of pregnancy and childbirth :— From Sepsis 0 From other causes 0 Rate per 1,000 total (live and still) births .00 Death rate of infants under one year of age :— All infants per 1,000 live births 23.45 Legitimate infants per 1,000 legitimate live births 23.41 Illegitimate infants per 1,000 illegitimate live births 25.00 The natural decrease of population (i.e. excess of deaths over births) was 750. 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 0.96 Area comparability factor for deaths ... ... 0.91 19 These factors, when applied to the crude rates, produce the following adjusted rates :— Live births 11.89 Deaths 17.89 The usual comparison of birth and death rates with those for the whole country is shown in Table 1, on page 23. Deaths The Registrar-General's classification of causes of death by sex totals is shown in Table 4, on page 25. The total number of deaths in 1953 (2,029) compares with 1,220 in 1952, the respective death rates per 1,000 population being 11.70 and 19.66. N.B.—In October, 1952, the Registrar-General issued instructions whereby the following types of institutions are regarded as the usual place of residence of their inmates, and that, as from 1st January, 1953, in these types of institutions the births and deaths are assigned to the area in which the event takes place. Hospitals for the Chronic Sick. Nursing Homes for Aged and Chronic Sick. Mental Deficiency Institutions and accommodation provided under Part III of the National Assistance Act, 1948. The effect of this is that nearly eight hundred deaths (in Langthorne Hospital), which would have been transferred to districts other than Leyton have been assigned to -this area with the result that the death rate of 19.66 is the highest this century, as against an adjusted death rate of 10.92 had this not come into effect. 20 Cancer.—General. Deaths from Cancer numbered 346 (184 males, 162 females). Death-rates per 1,000 of the population for the past ten years are as follows. Year Deaths Death rate 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 1953 337 3.35 Cancer.—Lung and Bronchus It is only since 1950 that there has been available figures of the annual number of deaths from Cancer of the Lung and Bronchus. From the figures so far available (1950 to 1953 inclusive) it is evident that Cancer of the Lung is increasing as a cause of death, especially among males. Year Males Females Total 1950 25 10 35 1951 33 14 47 1952 38 11 49 1953 62 17 79 Smoking and Lung Cancer In 1950 there was published in the British Medical Journal a paper by Dr. Doll and Prof. Bradford Hill giving evidence of the existence of a causal relationship between smoking and cancer of the lung. A second paper, reinforcing their previous findings, appeared in the same Journal in 1952, and in 1953 there appeared a further paper by three American workers showing that the experimental painting of mice with tobacco tar caused a cancer of the skin. 21 These findings have been assessed carefully by a special panel under the chairmanship of the Government acting on behalf of the Standing Advisory Committee on Cancer and Radiotherapy, and the Standing Advisory Committee of the Central Health Services Council has advised the Ministry of Health that a relationship between smoking and cancer of the lung has been established, and that young persons should be warned of the risk. The strength of the evidence put forward so far has moved tobacco manufacturers in America to set up a special committee for research into the connection between lung cancer and smoking, and it is significant that manufacturers of tobacco in Britain have now given a donation of £250,000 to the Medical Research Council to be used at the Council's discretion. It is proverbially difficult to teach old dogs new tricks, and in the meantime the older generation of smokers will no doubt continue to please themselves ; but every effort should be made to dissuade young people from the use of tobacco—especially cigarettes. As long ago as 1857 there appeared in The Lancet a long and lively correspondence on what was called " The Great Tobacco Question," and the conclusion at that time, although based on different arguments, appears to be appropriate today :— " We most earnestly desire to see the habit of smoking diminish and we entreat the youth of the country to abandon it altogether." % Coronary Thrombosis Coronary thrombosis—the clotting of blood in the arteries supplying blood to the heart muscle—has become " news " during recent years, for it is a common cause of death among well known public personages, and many others less well known. In any case, it is commonly regarded as one of the diseases, such as gastric or duodenal ulcer, due to the stress and nervous strain of modern life— therefore on the increase. In the official classification of causes of death there was no separate classification of coronary diseases before 1950, when they were included among heart diseases. But since (and including) 1950 22 the annual number of Leyton residents who died from coronary diseases has been shown separately, and these are the Leyton figures :— Year Male Female Total 1950 74 40 114 1951 83 47 130 1952 125 44 169 1953 111 48 159 It will be seen that, in the short space of four years since separate figures became available, the number of Leyton residents whose deaths have been certified as due to coronary disease has increased from 114 to 159 (i.e., by 39.47 per cent.). 23 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 15.5 17.0 15.7 17.5 11.89* Still Births 0.35 0.43 0.34 0.38 .28 22.4(a) 24.8(a) 21.4(a) 21.0(a) 22.17(a) Annual Death Rate per 1,000 Population All Causes 11.4 12.2 11.3 12.5 17.89* Typhoid and Paratyphoid 0.00 0.00 ... ... 0.00 Whooping Cough. 0.01 0.01 0.00 0.00 0.00 Diphtheria 0.00 0.00 0.00 ... 0.00 Tuberculosis 0.20 0.24 0.19 0.24 0.28 Influenza 0.16 0.15 0.17 0.15 0.13 Smallpox 0.00 0.00 0.00 ... 0.00 Acute Poliomyelitis (including polioencephalitis) 0.01 0.01 0.01 0.01 0.01 Pneumonia 0.55 0.59 0.52 0.64 1.61 Deaths All causes Under 1 year 26.8(6) 30.8 24.3 24.8 23.45 Enteritis and Diarrhoea Under 2 years of age 1.1 1.3 0.9 1.1 0.01 * Adjusted by the area comparability factor. (a) Per 1,000 Total (Live and Still) Births. (b) Per 1,000 related Live Births. • TABLE 2. Case Rates for Certain Infectious Diseases in 1953. Disease England and Wales 160 County Boroughs and Great Towns 160 Smaller Towns London Administrative County Leyton Notifications (Corrected) Typhoid Fever 0.00 0.00 0.00 0.01 0.00 Paratyphoid Fever 0.01 0.01 0.01 0.01 0.00 Meningococcal fever 0.03 0.04 0.03 0.03 0.00 Scarlet Fever 1.39 1.50 1.44 1.02 2.68 Whooping cough 3.58 -3.72 3.38 3.30 5.47 Dipht heria 0.01 0.01 0.01 0.00 0.00 Erysipelas 0.14 0.14 0.13 0.12 0.46 Smallpox 0.00 0.00 0.00 0.00 Measles 12.36 11.27 12.32 8.09 8.91 Pneumonia 0.84 0.92 0.76 0.73 4.69 Acute poliomyelitis (including Polioencephalitis) Paralvtic 0.07 0.06 0.06 0.07 0.03 Non-paralytic 0.04 0.03 0.04 0.03 0.03 Food poisoning 0.24 0.25 0.24 0.38 0.25 Puerperal pyrexia 18.23(a) 24.33(a) 12.46(a) 28.61(a) 33.67(a) (a) Per 1,000 Total (Live and Still) Births. 24 TABLE 3. Comparative Statistics of Bibths, Mortality, Etc. LEYTON, 1901-1953. Year Population Births Birth Rate Deaths Death Rate Deaths under 1 year Infantile Death Rate 1901 100000 2963 29.63 1243 12.4 404 136 1902 100000 3152 31.52 1183 11.8 336 106 1903 102000 3273 32.08 1112 10.9 322 99 1904 104000 3198 30.07 1370 13.1 444 138 1905 105000 3209 30.05 1177 11.2 303 94 1906 108000 3344 30.9 1327 12.2 382 114.5 1907 120000 3190 26.6 1269 10.6 182 86.6 1908 121200 3071 25.3 1185 9.8 242 78.8 1909 121200 2979 24.6 1208 9.9 244 81.9 1910 123300 3011 24.4 1112 9.0 191 63.4 1911 124736 2931 23.5 1473 11.8 327 116.6 1912 126700 2797 22.1 1343 10.6 223 79.7 1913 129366 2904 22.4 1336 10.3 242 83.3 1914 130847 2800 21.4 1363 10.4 219 78.2 1915 124497 2655 21.3 1510 12.1 225 84.7 1916 B132107* 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 1 1.70 37 27.30 1953 103200 1279 12.39 2029 19.66 30 23.45 * Population as estimated for purposes of b, Birth Rate, d, Death Rate. 25 TABLE 4. Causes of Death as given by the Registrar-General, 1953. Causes of Death Males Females Total 1. Tuberculosis (Respiratory) 17 11 28 2. Other forms of Tuberculosis 0 1 1 3. Syphilitic Disease 3 0 3 4. Diphtheria 0 0 0 5. Whooping Cough 0 0 0 6. Meningococcal Infections 1 0 1 7. Acute Poliomyelitis 1 0 1 8. Measles 0 0 0 9. Other Infective and Parasitic Diseases 2 1 3 10. Malignant Neoplasm—Stomach 31 22 53 11. Malignant Neoplasm—Lung and Bronchus 62 17 79 12. Malignant Neoplasm—Breast 0 31 31 13. Malignant Neoplasm—Uterus 0 12 12 14. Other Malignant and Lymphatic Neoplasms 82 80 162 15. Leukaemia and Aleukaemia 1 2 3 16. Diabetes 1 6 7 17. Vascular Lesions of Nervous System 139 155 294 18. Coronary Disease, Angina 111 48 159 19. Hypertension with Heart Disease 31 46 77 20. Other Heart Disease 159 330 489 21. Other Circulatory Disease 32 35 67 22. Influenza 5 9 14 23. Pneumonia 92 75 167 24. Bronchitis 100 84 184 25. Other Diseases of Respiratory System 11 1 12 26. Ulcer of Stomach and Duodenum 9 6 15 27. Gastritis, Enteritis and Diarrhoea 3 3 6 28. Nephritis and Nephrosis 5 5 10 29. Hyperplasia of Prostate 9 0 9 30. Pregnancy, Childbirth, Abortion 0 0 0 31. Congenital Malformations 3 8 11 32. Other Defined and Ill-defined Diseases 49 44 93 33. Motor Vehicle Accidents 10 3 13 34. All Other Accidents 8 8 16 35. Suicide 8 0 8 36. Homicide 1 0 1 Totals, 1953 986 1,043 2,029 Totals, 1952 635 585 1,220 26 Infectious Diseases PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Table showing the number of nofc'fied cases of infectious diseases and their disposal. Disease Notifications Received Removed to Hospital Smallpox ... ... Diphtheria ... ... Erysipelas 48 3 Scarlet Fever 277 56 Pemphigus Neonatorum ... ... Tuberculosis, Pulmonary 78 33 Tuberculosis, Other forms 13 10 Pneumonia 484 114 Ophthalmia Neonatorum 1 1 Typhoid Fever ... ... Paratyphoid Fever ... ... Puerperal Pyrexia 44 38 Meningococcal infection ... ... Poliomyelitis, Paralytic 4 i Poliomyelitis, Non-paralytic 4 4 Acute Encephalitis, Infective ... ... Acute Encephalitis, Post Infectious ... ... Measles 920 30 Whooping Cough 565 8 Dysentery 35 22 Food Poisoning 26 5 2,499 328 27 THE PUBLIC HEALTH (INFECTIOUS DISEASES) REGULATIONS, 1953. On 14th March the Ministry of Health circulated to Local Authorities the Public Health (Infectious Diseases) Regulations, 1953, which supersede the Public Health (Infectious Diseases) Regulations, 1927 and the Infectious Diseases (London) Regulations, 1927. The new regulations came into operation on 1st April, 1953. In their general substance and form the new regulations are similar to the old ; that is to say, they require notification of malaria, dysentery, acute primary pneumonia and acute influenzal pneumonia, and provide for preventive steps to be taken against the spread of certain diseases specified in the Fourth Schedule to the regulations. This schedule has been framed to accord with the present shape and working of the health services ; and, in Part III, it differs from the corresponding part of the earlier regulations in some important respects concerning prevention of food poisoning. The provisions about action to be taken by local authorities and Medical Officers of Health against the risk of food poisoning applied under the old regulations to " enteric fever and dysentery They now apply to " typhoid fever, paratyphoid fever or other salmonella infections, dysentery, and staphylococcal infection likely to cause food poisoning". (The phrase "typhoid fever, paratyphoid fever or other salmonella infections " comprises the diseases previously described as " enteric fever ".) They provide for action to be taken not only in respect of a person suffering from the disease in question, but also of a person shown to be a carrier of the disease ; and a "person in either class may now be prevented not only from continuing to work in an occupation connected with food or drink, but also from entering such an occupation. In the new regulations, while the same general principle is maintained (because action may involve the local authority in paying compensation under Section 278(1) of the Public Health Act, 1936), there is provision to enable a local authority to give its Medical Officer of Health such authorisation as will permit him to take the prescribed action in a particular case without waiting to report it—though he is required to report it at the earliest opportunity—if in his judgment this action needs to be taken as a matter of immediate urgency to prevent the spread of infection. . 28 Local Authorities and their Medical Officers of Health have been limited in the past to action against actual sufferers from infection, but their preventive powers are now extended to include any person connected with food preparation or handling who is suspected of being a "carrier". Formerly a Medical Officer of Health could not take action without first informing the Local Authority, but now he will be able to take immediate action in an emergency. DYSENTERY. During the year 40 notifications of dysentery were received. Five were subsequently withdrawn, owing to corrected diagnosis ; and, of the remainder, 24 cases were admitted to hospital and 11 treated at home. An analysis of the cases notified shows that 12 occurred in hospitals, eight in "Part III" accommodation, and 15 in private homes ; whilst bacteriological investigations revealed infection of the Shigella Sonnet type in 32 instances, Flexner dysentery two, and not known one. Outbreak of Sonne Dysentery in School. Towards the end of November it was reported to me that the attendance in one class of an Infants' Department of a school was less than half the children on roll, and that a substantial number of absentees were said to be suffering from diarrhoea and vomiting. Investigation showed that the adjaceYit Junior School was free from infection, and that not only one, but four, classes in the Infants' Department were affected. An intensive inspection of the school catering arrangements revealed no unsatisfactory circumstances in the preparation, cooking or serving of tlife meals, and no illness or suspected illness among members of the catering staff. Nor was there any correlation between school meals and children affected ; in fact, the majority of the affected children had not been partaking of school meals. As a result of daily visits to the school, and with the co-operation of the private medical attendants and the school attendance officer, the school medical officer and school nurse were soon able to localise the outbreak without interfering with the attendance of children who gave no cause for suspicion. 29 Of 31 children from whom rectal swabs were taken for bacteriological examination, four school children and three pre-school home contacts were found to have Shigella Sonnei in their stools. Early in this outbreak the finger of suspicion pointed to a girl who had been absent on two previous occasions—from 25th to 30th November, and again from 2nd to 7th December—with vague " tummy trouble When she was found to be suffering from Sonn6 dysentery, and excluded from school along with her classmates whom she probably infected, there was a progressive improvement in attendance, culminating in the good attendance one expects at the school Christmas Party. DIPHTHERIA. Year Cases Notified Deaths Case Fatality per cent. 1949 ... ... ... 1950 ... ... ... 1951 1 ... ... 1952 ... ... ... 1953 ... ... 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 one person has 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 133. ACUTE ENCEPHALITIS, INFECTIVE. No cases were notified. ACUTE ENCEPHALITIS, POST INFECTIOUS. No cases were notified. ERYSIPELAS. Of the 48 cases notified, three were admitted to hospital. 30 FOOD POISONING. There were 24 persons notified during the year to be suffering from food poisoning. Of these, 11 were " single " and apparently sporadic; three occurred in a hospital, and are combined to form one "outbreak and 10 occurred in four "family outbreaks". (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 23, whereas the bacterial cause was found in only one case. In the four "family outbreaks," involving 10 persons, no pathogenic organisms were isolated. One "outbreak" involved three residents in the Part III accommodation of a local hospital. No. Date of Receipt of Notification Sex Age Date of Onset of Symptoms lnteival bet. Onset and Notification (Days) Cause Identified 1 17.1.53 F 39 15.1.53 2 Unknown 2 17.1.53 F 6 15.1.53 2 Unknown 3 30.3.53 M 2½ 28.3.53 2 Unknown 4 14.4.53 F 26 13.4.53 1 Unknown 5 17.4.53 F 31 10.4.53 7 Unknown 6 18.4.53 M 18 14.4.53 4 Unknown 7 28.4.53 M 29 26.4.53 2 Unknown 8 8.5.53 F 6 3.5.53 5 Unknown 9 11.5.53 F 25 8.5.53 3 Unknown 10 8.6.53 F 33 1.6.53 7 Unknown 11 8.6.53 F 1 4.6.53 1 Unknown 12 24.7.53 F 70 19.7.53 5 Unknown 13 4.9.53 M 25 2.9.53 2 Unknown 14 4.9.53 F 53 1.9.53 3 Unknown 15 4.9.53 M 57 2.9.53 2 Unknown 16 2.10.53 F 39 28.9.53 4 Unknown 17 2.10.53 M 47 28.9.53 4 Unknown 18 9.11.53 F 50 5.11.53 4 Unknown 19 9.11.53 F 37 5.11.53 4 Unknown 20 30.11.53 F 26 20.11.53 10 Unknown 21 11.12.53 F 2 6.12.53 5 Salmonella typhimurium 22 31.12.53 F 52 28.12.53 3 Unknown 23 31.12.53 M 31 29.12.53 2 Unknown 24 31.12.53 F 30 28.12.53 3 Unknown 31 Of the 11 single and "sporadic" cases, one was found to be due to salmonella typhimurium, and in the remaining 10 cases no bacterial cause was found. The relevant information regarding the 24 persons notified is shown above in tabular form and in chronological order according to the date of notification. From these figures it will be seen that, of the 24 cases, 17 were females and 7 were males, the youngest being one year and the oldest 70 years of age. The average interval between the onset of the symptoms and the notification was 3.3 days. "Food Poisoning" is not a disease ; it is merely an assumption by a general medical practitioner that a manifestation of illness in one or more of his patients may be due to the ingestion of food. But such information can be very useful to the health officer in helping him to track down cases which may prove to be the first of a widespread outbreak. Under the circumstances it is not a matter for surprise that the majority of cases notified as " food poisoning " should be found not to be suffering from any disease of bacterial origin. It is the responsibility of the health officer to confirm or otherwise the assumption of the general medical practitioner. The value of notification is diminished by the length of time that elapses between the onset of symptoms and notification ; and in the preponderating majority of cases notified during 1953 the patient or patients were quite free from symptoms, and all traces of suspected food had been destroyed, by the time the health officer carried out his investigation following notification. It is significant that, of 24 cases notified during the year under review, 20 were notified by one medical practitioner. In my last Annual Report I included certain suggestions to the catering trade regarding precautions which should be taken in the preparation and keeping of food in large quantity. Processed and made-up meat foods are still responsible for more than half the outbreaks of food poisoning in the country ; and the following is an extract from a recent publication by the Ministry of Health. " After processed and made-up foods, the problem presented by the use of duck eggs needs consideration. Though the proportion of infected duck eggs may be very low the actual 32 number of infected eggs may be considerable, and if one infected egg is used in mayonnaise, meringue or similar mixtures in cooking, or if duck and hen eggs are mixed in liquid or frozen eggs, the chances of large outbreaks are greatly increased. Duck eggs should therefore be boiled for at least 10 minutes or used only in the preparation of foods which are submitted to a temperature of 100 C. or over for this length of time at some stage after the eggs have been added. " ♦ MEASLES. Year No. Notified Removed to Hospital Deaths 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 1953 920 30 ... As will be seen from these figures, there has been during 1953 a welcome reduction in measles incidence. When compared with the previous year (1952), when Leyton had the most widespread epidemic since figures became available, there has been a decrease of over 700 cases. No child died from measles during 1953. MENINGOCOCCAL INFECTION. No cases were notified. OPHTHALMIA NEONATORUM. One case was notified. As a result of treatment, vision was unimpaired. PARATYPHOID FEVER. No cases were notified. PEMPHIGUS NEONATORUM. N o cases were not ified. 33 PNEUMONIA. Four hundred and eighty-four notifications were received, of which 114 cases were admitted to hospital. Acute influenzal and acute primary pneumonia are notifiable under Section 143, Public Health Act, 1936, and Regulation (1207) made by the Minister of Health, 1927. During the past ten years the notifications have increased, as shown by this table. Year Year 1944 67 1949 241 1945 44 1950 333 1946 141 1951 372 1947 192 1952 410 1948 155 1953 484 Of the 484 cases of pneumonia notified in 1953, there were 97 notifications from hospitals, 291 from one general medical practitioner, and 96 from all the other local medical practitioners. Under the circumstances no useful purpose would be served by an attempt to explain the increase on etiological grounds. POLIOMYELITIS (" INFANTILE PARALYSIS "). Annual Incidence since 1947. The following list shows the annual number of cases of acute poliomyelitis notified in the Borough from 1947-1953 inclusive. Year Year 1947 14 1951 — 1948 2 1952 12 1949 20 1953 8 1950 14 Source of Infection. In none of the cases notified during 1953 has it been possible to trace infection to a previous case of the disease ; nor has any case followed immunisation against diphtheria or whooping cough, removal of tonsils and adenoids, or dental extraction. Administrative Measures. In consequence of the great diversity in the measures of control in operation in neighbouring areas where cases had been occurring, on 21st July there was addressed to all local medical practitioners a letter containing information regarding the incidence of the disease and the measures recommended for dealing with it. 34 No steps have been taken to suspend the arrangements for immunisation of young children against diphtheria or whooping cough at local authority clinics, but a change was effected in the site of injection and the material used for immunisation against diphtheria. Although the arrangements were not suspended, mothers were advised verbally to defer until a later date the commencement of new courses of immunisation for their children. Cases Notified during 1953. On the following page there is a table showing in summary form the relevant information regarding the cases notified dining the year. It will be seen that, of the eight notified cases, one (a male of 68 years) died as the result of severe and widespread paralysis involving the muscles of respiration. Of the seven remaining cases, four had no paralysis of any kind. Of the three paralytic cases, two are now quite recovered without any disability, and one has a slight weakness of the muscles of the little finger of the left hand. With the exception of the fatal case—the first case of the year— the infection in the subsequent cases was very mild. Four times (in 1947, 1949, 1950 and 1952)-since the end of the last war the number of notified cases of poliomyelitis has reached double figures ; but in the year under review the number (eight) is slightly less. Without in any way trying to minimise the danger or the seriousness of a bad case, I submit this extract from my last Annual Report:— "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." Mortality. In order to show the relative importance of poliomyelitis as a cause of death, I submit these figures of the annual number of deaths due to four common dangers to life in Leyton during recent years. 1948 1949 1950 1951 1952 1953 Poliomyelitis Deaths ... 1 ... ... ... 1 Road Deaths 11 8 9 9 7 10 Deaths in the Home 8 5 8 9 13 6 Deaths from Tuberculosis 52 37 35 40 24 29 35 Summary of Notified Cases of Acute Poliomyelitis—1953. No. Date of Notification Sex Age Hospital Admd. Dischd. Site of Paralysis or Paresis Severity Progress 1 20.1.53 M 68 Whipps Cross Hospital St. Anne's, Tottenham 19.1.53 20.1.53 20.1.53 22.1.53 Speech. Respiration. All limbs Severe Died 22.1.53 2 23.4.53 F 21 Not removed Left leg Mild After-care Connaught Hp. Recovered. At work 3 15.8.53 M 19 Ilford Isolation Hospital 15.8.53 15.9.53 None No disability. At work 4 • 21.8.53 F 31 Ilford Isolation Hospital 28.8.53 3.10.53 Left arm and hand Mild At work. Some weakness 5th finger (L) 5 22.8.53 F 8 Ilford Isolation Hospital 21.8.53 14.9.53 None No disability 6 2.9.53 M 9 Eastern Fever Hospital 2.9.53 23.9.53 None No disability 7 10.10.53 F 10 St. Anne's, Tottenham 10.10.53 23.11.53 None Full recovery 8 31.10.53 F 2 Ilford Isolation Hospital 9.10.53 19.11.53 Left leg Very mild Full recovery 36 Morbidity With regard to the amount of subsequent disablement suffered by persons notified during previous years, these cases are followed up from year to year, and the following table shows in summary form the disposal, progress and present state of cases notified since 1947—the first year of increased incidence. 1947 1948 1949 1950 1952 Totals Number notified (Excluding extra-district cases) 14 2 16 16 14 62 Number died 1 ... 2* ... ... 3 Number removed from district 5 1 4 2 3 15 Number completely recovered 3 1 3 7 4 18 Number with paralysis and paresis remaining Slight 3 ... 5 4 5 17 Moderate 1 ... 2 1 1 5 Severe 1 ... ... 1 1 3 Diagnosis not confirmed ... ... ... 1 ... 1 * One of these deaths was not due to poliomyelitis. It should be noted that, of the paralysed cases (25), only three are now regarded as severe—and, of the three, only one is now • wearing a metal calliper. PUERPERAL PYREXIA. Forty-four notifications were received, of which 38 occurred in institutions. SCARLET FEVER. Year No. Notified Deaths Case Fatality per cent. 1944 110 ... ... 1945 312 ... ... 1940 201 ... ... 1947 221 ... ... 1948 160 1 0.62 1949 151 ... ... 1950 219 ... ... 1951 166 ... ... 1952 332 ... ... 1953 277 ... ... 37 SMALLPOX. No case of smallpox was notified during 1953. 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 1,301 children were born in Leyton in 1953, only 362 infants under one year (i.e., 27.82%) were vaccinated against smallpox. Of 4,038 children inspected in school, only 1,556 (i.e., 38.53%) were found to be protected by vaccination. TYPHOID FEVER. No notifications were received. WHOOPING COUGH. Year No. Notified Removed to Hospital Deaths 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 1953 565 8 ... Of the 565 children who developed whooping cough during the year, eight had to be removed to hospital. Further information regarding Protection against Whooping Cough will be found on page 134. TUBERCULOSIS. Notifications.—Ninety-one patients were notified for the first time in 1953 as suffering from tuberculosis. The number was made up as follows :— Males Females Total Pulmonary Tuberculosis 43 35 78 Non-Pulmonary Tuberculosis 5 8 13 48 43 91 38 The following is a statement of particulars appearing in the Register of Notification of Cases of Tuberculosis for the year ended 31st December, 1953 :— Pulmonary Non-Pulmonary total M. F. Total M. F. Total Number on Register at commencement of year 454 367 821 31 48 79 900 Number first notified during the year 43 35 78 5 8 13 91 Number of cases entered in Register otherwiie than by Notification 9 16 25 1 1 26 Number removed from the Register during the year 44 31 75 3 4 7 82 Number remaining at the end of the year 462 387 849 33 53 86 935 Detai's of cases removed from the Register during the year :— Died 24 11 35 4 4 39 Removed from the district 18 18 36 2 2 38 De-notified 2 2 4 1 1 5 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 3 2 ... 1 5 ... 1 ... ... 10 ... 1 1 ... 15 2 3 ... 1 20 2 7 1 ... 25 10 11 1 2 35 7 4 1 1 45 6 3 1 2 55 8 2 ... 1 65 and upwards 5 1 ... ... Totals 43 35 5 8 39 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 N on-Pulmonary Total M. F. Total. M. F. Total. 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 1919 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 1953 43 35 78 5 8 13 91 DEATHS. Year Pulmonaty Non-Pulmonary Total M. F. Total. M. F. Total. 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 1953 24 11 35 4 4 39 Tuberculosis, with Special Reference to Housing. As it is impossible to appreciate the importance of housing in the control of tuberculosis without some idea of how infection is spread, I submit some preliminary facts regarding the disease and the germ that causes it. The Disease. The disease known as tuberculosis is due to the invasion of human tissues and organs by a germ called the tubercle bacillus (" T.B."). 40 Nature of Infection. When the infection is not in the lungs (" non-pulmonary e.g., in glands, bones and joints) there is no danger to other people unless there is a discharging sore, and even then the danger is limited. But when there is active disease in the lungs ("pulmonary" or " respiratory ") living germs get into the surrounding air when the affected person breathes and speaks, and the organisms are sprayed into the atmosphere to a distance of several feet when he coughs or sneezes. Infection is generally caused by inhaling infected air, or by swallowing infected food or drink ; but by far the commonest route of infection is from the air. Mode of Spread. Most germs that cause disease cannot live without warmth and moisture, and they die soon after they leave the human body ; but the tubercle bacillus is so well protected in its surrounding fatty envelope that it resists drying, and can remain alive in the dust or droplets of the air for a considerable time. Resistance of Infection. We cannot hope to escape infection, to which we are exposed daily ; but fortunately most of us are protected by a natural resistance, and most children by the time they leave school have acquired a considerable resistance by exposure to repeated small doses of infection from day to day. But there are many young children who are subjected to repeated doses of infection long before they have had time to acquire immunity, while others have their relative immunity swamped by exposure to massive closes of infection. Influence of Heredity. There is no justification for the old and widely-held belief that tuberculosis (" consumption") is hereditary. Children born of tuberculous parents are free from the disease, and if they are removed from their parents at birth they do not develop it; but there is abundant evidence that children living with infectious parents are more liable than other children to contract the disease, and that the liability increases when the doses of infection are large and repeated. 41 Medical Treatment. During recent years the treatment of tuberculosis by means of new drugs has given cause for encouragement, 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 and Control. Tuberculosis is essentially an infectious disease and, as in the case of other infectious diseases caused by bacilli, the only hope of eradicating it is by prevention—that is, by detecting the disease at the earliest possible moment, by isolating as far as possible those who are infectious, and by building up the resistance of those exposed or susceptible to infection. ADMINISTRATIVE ARRANGEMENTS. I had hoped to be able to describe the path of a typical patient as he proceeds from one responsible official body to another in his search for restoration to health and fitness to resume work ; but so closely is that path beset by a variety of independently constituted and staffed public bodies that I find it easier to submit in tabular form a list of the authorities, local committees and officers responsible for the various services undertaken on behalf of those afflicted by tuberculosis. This list is submitted in the form of an Appendix on page 49. Not only is there diversity of responsibility between differently constituted public bodies, but there is diversity -between different committees of the same authority. For example, the fitness for habitation of the patient's home and environment is the responsibility of one Committee (Public Health), and the re-housing of the patient and his family is the responsibility of another Committee (Housing). TUBERCULOSIS IN LEYTON—1928 to 1953. Incidence and Mortality. Hereunder is submitted a statistical summary showing, in respect of each year since 1928—a period of 26 years—the annual number of Leyton residents notified to be suffering from tuberculosis, and the number who died from the disease. The information is submitted also in the form of a graph. 42 Year Notifns. Deaths Year Notifns. Deaths Year Notifns. Deaths 1928 180 97 1937 131 63 1946 108 47 1929 145 91 1938 129 64 1947 98 45 1930 157 100 1939 107 63 1948 144 52 1931 161 111 1940 106 73 1949 127 37 1932 174 74 1941 114 55 1950 145 35 1933 154 90 1942 104 75 1951 114 40 1934 135 76 1943 118 70 1952 127 24 1935 146 77 1944 105 64 1953 91 29 193C 133 69 1945 122 41 These figures show the welcome fall in deaths, from 97 in 1928 to 24 in 1952. Roughly speaking, the Leyton death rate today is only about a quarter of what it was 25 years ago. In some quarters the fall in the tuberculosis death rate is attributed to the results of treatment by modern anti-biotic drugs such as penicillin, streptomycin and aureomycin. It will be seen, however, that the rate of fall has been fairly uniform over the whole of the 25-year period, and that it has not been accelerated since anti-biotic drugs became available for treatment some five years ago. The figures and graph also show a corresponding decrease in the annual number of cases notified in Leyton from 1928 until the outbreak of World War II, during which the number remained somewhat stationary. In 1948, however, there was a remarkable rise in incidence, and the rise has been roughly maintained since that time—no doubt due to the effect of mass radiography in the detection of the disease at an earlier stage. Age at Death. During the 25 year period some 1,633 Leyton residents have died from tuberculosis ; and the following figures show the number and percentage of these deaths in each of the tabulated age groups. Age No. of Deaths Percentage Age No. of Deaths Percentage Under 1 yr. 14 0.8 15 to 25 yrs. 311 19.1 1 to 2 yrs. 20 1.2 25 to 45 yrs. 622 38.2 2 to 5 yrs. 32 2.0 45 to 65 yrs. 467 28.5 5 to 15 yrs. 54 3.3 65 upwards 113 6.9 43 TUBERCULOSIS IN LEYTON—1928 to 1953. DEATHS _______NOTIFICATIONS 44 The figures in the table show the extent to which tuberculosis takes its heaviest toll of human life, at the very time when its victims are of greatest value to the community and the national economy, for it will be seen that the great majority (85.8%) died between 15 and 65 years of age. SURVEY OF SIXTY SPUTUM-POSITIVE CASES. In order to provide your Committee with up-to-date information I have, since your last meeting, undertaken a somewhat rapid but intensive survey of the relevant family and home circumstances connected with some 60 residents in the Borough who were ascertained during the past year to be suffering from tuberculosis of the lungs in such an active state that the germs of the disease (" T.B.") could be demonstrated in their sputum. They are therefore not only infectious, but a source of danger to those with whom they live and associate. Of these 60 cases, seven have since died and four have removed from the district—leaving 49 concerning whom the relevant information is submitted hereunder. Sex : Males 27 (55.1%) Females 22 (44.9%) Average Age 44.3 years Marital State Married 42 (85.7%) Single 7 (14.3%) Housing Accommodation of Family 6 Rooms 15 cases (30.6%) 5 „ 9 „ (18.4%) 4 „ 3 „ (6.1%) 3 „ 15 „ (30.6%) .2 „ 3 „ (6.1%) 1 Room 4 „ (8.2%) Separate Dwelling 30 „ (61.2%) Shared Dwelling 19 „ (38.8%) Exclusive use of Kitchen 40 „ (81.6%) Bath 18 „ (36.7%) „ „ Water Closet 35 „ (71.4%) No Bath in House 21 „ (42.9%) 45 Homing Accommodation of Patient Separate Room 28 cases (57.1%) Shares Room 21 ,, (42.9%) Separate Bed 30 ,, (61.2%) Shares Bed 19 „ (38.8%) Number of Home Contacts 7 Contacts 2 cases (4.0%) 6 „ 1 case (2.0%) 5 „ 4 cases (8.2%) 4 „ 4 „ (8.2%) 3 „ 17 „ (34.7%) 2 „ 10 „ (20.4%) 1 Contact 11 „ (22.5%) 'total Number of Home Contacts 138 X-rayed 90 (65.2%) Under 15 years of age 21 (15.2%) Protected by B.C.G. 8 (38%) Names on Council's Housing List 11 (22.5%) Previous cases in Same House 10 (20.4%) Previous cases in Adjoining House 10 (20.4%) It may be contended that the number of cases dealt with in the above survey is too small to be of substantial statistical significance— a contention which is only too true. But many worth-while investigations begin in a small way ; and, now that it has taken shape, it is intended to extend it by following up the cases already dealt with, and add to it by the inclusion of new sputum-positive cases as they are ascertained. Small though the number of surveyed cases may be, even a casual analysis of the findings is sufficient to indicate the lines on which action should be taken in the interests of the public health. The patient who coughs up live tubercle bacilli is a danger to those around him, and it is deserving of note that of the Leyton cases surveyed only 57.1 per cent, had a separate room to sleep in, and only 61.2 per cent, had a separate bed. Unless an infectious tuberculous patient can be reasonably isolated in his home_ there appears to be little hope of controlling the disease effectively. Hospital Authorities cannot provide beds for a large proportion of tuberculous patients in need of institutional treatment, and it is 46 contended that over 20 per cent. of patients in sanatoria are there only because there is not suitable accommodation at home for them to return to. It has been truly stated that the provision of sanatorium beds is an expensive and unsatisfactory substitute for unhealthy homes, and that it is not so much more hospital beds that are wanted as more homes with accommodation to prevent the exposure of contacts to repeated and massive doses of infection. HOUSING AND TUBERCULOSIS. In the light of our knowledge (outlined above) of how the disease is spread, it is not a matter for surprise that the death rate from tuberculosis varies inversely with the size of the house, and that the disease is from three to four times greater in one-roomed houses than in those with four or more rooms. Evidence of the correlation between overcrowding and tuberculosis is overwhelming, and it has been shown that overcrowding is the cause, rather than the result, of the disease. Before 1948 the prevention of tuberculosis was regarded as being of more importance than its cure, but since the advent of the National Health Service prevention has taken a second place to treatment. But advances in medical treatment, however spectacular, can have little effect as long as four out of five infectious cases are living at home where they can infect their families and other people. It is recognised that the home contacts of a person suffering from tuberculosis are five times more liable to develop the disease than persons who are not contacts ; and investigations in a London borough have shown that whereas the spread of tuberculosis to other members of the family had taken place in one out of every eight good houses, it had occurred in one out of every five bad houses. It is realised that the problems confronting local housing authorities are many, and that the allocation of tenancies in the limited number of properties available is a difficult task. Every applicant for a municipal house naturally presents his claim in as cogent a manner as possible, and it is no easy task to select the cases that are most needy. Collaboration with Housing Authority. Since 1950 I have had close co-operation with your Council's Housing Officer in respect of applications for re-housing where 47 tuberculosis is stated to be a factor, and I take this opportunity of recording my appreciation of his helpful collaboration. There must be few postal deliveries that do not contain at least one plaintive letter from a housing applicant who begs me to support his/her claim because tuberculosis is a factor. Such applicants are interviewed or visited in order to verify their claims, and a report is obtained from the Chest Physician with regard to the activity of the disease and the infectivity of the patient. It is only after establishing that the housing conditions are such as to be a source of danger to home contacts that the name is added to the Housing Officer's list of applicants who are recommended for special consideration because active tuberculosis is a factor. Since this collaboration has been in operation (i.e., since 1950) some 43 of these cases have been re-housed by the Housing Committee : 5 in 1950 ; 20 in 1951 ; 7 in 1952 ; and 11 in 1953. Active-T.B.-Factor List. •There are still on the Active-Tuberculosis-Factor List some 37 cases in which re-housing is recommended on public health grounds because the present home conditions are conducive to the spread of infection, and an analysis of these 37 cases is summarised in tabular form below. Accommodation of Family. Persons in Family Rooms (excluding Scullery) 1 2 3 4 5 6 1 ... ... ... ... ... ... 2 3 6 ... ... ... ... 3 2 2 3 ... ... ... 4 4 2 5 2 ... ... 5 2 2 2 ... ... 6 ... ... ... ... ... 1 7 ... ... ... 1 ... ... Sleeping Accommodation of Patient. Share Bed 28 Separate Room 5 Share Room/Separate Bed 4 Subsequent Cases of Tuberculosis in same House since Patient on Housing List. In two cases there have been two home contacts notified. In three cases there has been one home contact notified. Quiescent-T.B.-Factor List. This is a second list of housing applicants (seven in number) in whose present home there is a person in the quiescent stage of pulmonary tuberculosis. 48 Although the disease is no longer considered to be in an active state, re-housing is recommended in order to prevent possible recurrence of activity. The nation is spending great sums of money on hospital and sanatorium treatment in the hope of converting "active" into "quiescent" cases and finally arresting the disease altogether ; but much of the effort is wasted if patients have to leave the sanatorium in a "quiescent" state and return home to the same conditions that gave rise to the disease when it first became active. The quiescent patient on his return from sanatorium is full of hope to resume his work and his part as a useful member of the community, and I can think of no greater stimulus to his rehabilitation, mental and physical, than the public provision of housing accommodation in which he can practise the way of life he has been enjoined to lead in the sanatorium. SUMMARY AND CONCLUSIONS. Figures are quoted to show that in Leyton during the last 26 years there has been a progressive fall in the number of desths from tuberculosis ; but no corresponding fall during recent years in the number of persons suffering from the disease. Among persons officially notified to be suffering from tuberculosis there is wide variation in the degree of individual infectivity according to the site and activity of the disease. Some are capable of conveying the disease to those around them, and some are not. The dangerous cases are those who cough up living germs—known as " sputum positive ". In a recent survey of sputum-positive cases in Leyton, 42.9 per cent, were found to be sharing a bedroom and 38.8 per cent, a bed. The success of any measure of control depends on the degree of isolation of the infectious patient; but a patient cannot be considered to be effectively isolated at home unless he sleeps by himself. Of all measures of prevention, the provision of adequate housing accommodation is the most practicable. Although the prevention of infectious disease is the responsibility of the Public Health Committee, it cannot hope to carry out established measures of control in respect of tuberculosis without the active co-operation of the Housing Committee in the granting of the highest possible priority in re-housing to residents suffering from tuberculosis in an actively infectious form. 49 TUBERCULOSIS. Administrative Arrangements. Authority Local Committee Local Officers Services Available Local Authority (Leyton Borough Council) Sanitary (Public Health Committee) Medical Officer of Health Sanitary Insprs. Disinfecting Staff Notification Disinfection Prevention and control of infection Meat and food inspection Housing. (Housing Committee) Re-housing Health Authority. (Essex County Council) Health Area Sub-Committee Area Medical Officer Health Visitors Home visiting Clinic Nursing Supervision of Contacts Immunisation (B.C.G.) Rehabilitation Boarding out of child contacts Occupational therapy Sickroom equipment Domestic Help Open air shelters Convalescence Extra Nourishment Financial grants Bedding Clothing After-Care Association Secretary Hospital Authority (Regional Hospital Board) Hospital Management Committee Chest Physician Specialist consultation and diagnosis; Mass Radiography Specialist treatment, (Domiciliary and institutional) Practitioner Service Executive Council General Medical Practitioners Pharmacists Initial diagnosis Home treatment Welfare Service National Assistance Committee Area Officer • Financial Assistance 50 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. 1. Public Health Officers of the Authority. Medical. Dr. Shirin Dastur, Assistant County Medical Officer, resigned in January, and Dr. Elsie L. Peet was appointed her successor. Dental. Miss Pauline T. Fuller, a full-time dental officer, resigned in July, and, since that time, several sessional dental officers have been appointed. There have been no additions to the full-time dental staff. Nursing. Three health visitors (Miss E. Walling, Miss M. Murray and Mrs. Q. Rolfe) and one school nurse (Miss M. Nangle) left the staff of the local authority during the year. Two successful students from the County Health Visitors' Course were allocated to the Area, viz., Miss I. Appledore and Miss J. Denman. Sanitary Inspection. Mr. B. J. Ashcroft commenced duties as Senior Sanitary Inspector on 1st January, 1953. 2. Laboratory Facilities. (a) Pathological Department, Whipps Cross Hospital, E.ll. 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. 51 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 872 beds. (b) Langthorne Hospital. Accommodation 687 beds. 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 were then available by arrangement with Walthamstow Corporation at the Walthamstow Skin Clinic, High Street, Walthamstow. On 1st August, 1953, the Walthamstow Skin Clinic closed. With the co-operation of Hackney Borough Council facilities for Leyton patients were made available at the Cleansing Centre, Millfields Road, Hackney. The Cleansing Centre is open for treatment on Mondays to Fridays (inclusive) from 9 a.m. to 12 noon, and on Saturdays from 9-11 a.m. 52 General medical practitioners who desire to refer a patient for treatment are requested to give the patient a note showing the patient's name and address and that he is considered to be suffering from scabies. It is also requested that the Superintendent of the Cleansing Centre be advised by telephone (AMH 5930) when the patient is likely to arrive. After treatment the patient is advised to report back to the medical attendant. During the year 1953, one Leyton resident attended for treatment, and made three attendances. The following table shows how the number of Leyton patients has decreased since the special facilities became available in 1942. Year Cases Treated Total attendances for treatment Children Adults Total 1942 (10 mtks.) ... ... 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 1953 ... 1 1 3 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. NATIONAL ASSISTANCE ACT, 1948. Section 47—Removal to suitable premises of persons in need of care and attention. One case was dealt with under this section during the year. 53 Section 50—Burial and Cremation of the Dead. During the year arrangements were made for the carrying out of nine 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 facilities at Whipps Cross Hospital mortuary has continued during the year. Number of bodies deposited, death being due to:— Natural causes 38 Suicide 2 Accidents 2 • 42 Number of Post-mortem examinations performed 42 In 38 instances no inquest was considered necessary in consequence 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-atlieroma 6 Myocardial degeneration 5 Mitral stenosis 1 Ruptured aortic aneurysm—specific 2 „ cerebral aneurysm 2 Pneumonia 4 Strangulated hernia 1 Carcinoma 3 Pulmonary tuberculosis 3 Pontine haemorrhage 1 54 INQUESTS. The following verdicts on Leyton residents were recorded at inquests held during the year:— Accidental. Motor-cycle accident 1 Knocked down by motor car 3 ,, ,, lorry 3 ,, ,, ,, motor cycle 1 ,, ,, ,, trolley-bus 1 ,, ,, ,, train 1 Fractures—falls at home 5 ,, —falls at work 1 Coal gas poisoning 1 Cerebral haemorrhage 1 Scalds 1 Asphyxia—fumes 1 Post-operative shock 1 Drowning 1 Head injuries 1 Suicide. Asphyxia due to hanging 1 Coal-gas poisoning 3 Fall in front of train 1 Fall from roof 1 Self-inflicted wounds 1 Open Verdict. Not ascertainable 1 Misadventure. Train accident 1 Murder. Gun-shot wound 1 55 CORONER'S POST-MOR I EMS. During the year 162 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 2 ,, ,, Breast 1 „ ,, Lung or Bronchus 2 ,, ,, Prostate 1 „ „ Colon 4 ,, ,, Oesophagus 1 ,, ,, Ovaries 1 ,, „ Liver 1 „ „ Glands 1 Pulmonary tuberculosis 5 ,, embolism 10 Cerebral tumour 1 Ruptured developmental cerebral aneurysm 7 Coronary thrombosis 30 ,, atheroma 9 Cardiac failure due to hypertension 6 Myocardial degeneration 21 Uraemia 1 Influenzal pneumonia 2 Ac. suppurative bronchitis 11 Broncho pneumonia 2 Chronic bronchitis 3 Strangulated hernia 3 Enlargement of prostate 1 Collapse of lungs 1 Biliary obstruction 2 Pyelonephritis 1 Myocardial infarction 1 Diabetes mellitis 1 Mitral regurgitation 1 Ruptured aorta 2 Aorta stenosis 1 Mitral stenosis 1 Encephalitis 1 Aortic incompetence 1 Circulatory failure 3 Pulmonary emphysema 3 56 Internal haemorrhage 1 Intestinal obstruction 1 Cerebral oedema 1 Cerebral haemorrhage 3 Lobar pneumonia 4 Post operative ileus 1 Chronic glomerulonephritis 1 Congenital cerebral agenesis 1 Addison's anaemia 1 Status epilepticus due to hydrocephalus 2 Hypostatic pneumonia due to hydrocephalus 1 LICENSED ESTABLISHMENTS FOR THE ADMINISTRATION OF MASSAGE OR SPECIAL TREATMENT. During 1953 the Council granted licences in respect of the following establishments for massage or special treatment. Name Address of Premises Mr. G. E. Fenn 42 Fairlop Road, E.l 1 Mr. S. A. Kelly 46 Harrington Road, E.l! Mr. G. V. Ledger 10 Church Lane, E.11 Mr. R. Sadowski 762 Lea Bridge Road, E.10 National Blood Transfusion Service. Blood transfusion was an established form of medical treatment before the war. During the war the need for blood was so great, and the response was so excellent, that there were more than a million blood donors in the country. Just after the war the number of donors fell to about a quarter of a million, but there is now in the country a panel of over half a million regular donors between 18 and 65 years of age. Human blood is required for a great and increasing number of medical emergencies. It may be required to replace blood lost from wounds and accidents, to save the life of a newly born "blue baby", or during one or other of the lengthy new surgical operations, e.g., on the chest. 57 Hospitals are now using and needing much more human blood than before, and the National Blood Transfusion Service is building up reserves of blood plasma which can be stored indefinitely in a dry state for future use. Some idea of the increase in the demand may be obtained from consideration of the fact that in some hospitals, where about 80 blood transfusions in a year were given before the war, these may now be given as many in a week. In October, 1952, the then Mayor of Leyton (Alderman Mrs. King, J.P.) issued a local appeal for 1,000 new volunteer blood donors, especially young people, to ensure the continuity of the blood tranfusion service. Donors can be of either sex, but must be between 18 and 65 years of age. After a preliminary medical examination designed to exclude the possibility of disease in the donor, about two-thirds of a pint of blood is withdrawn from a vein in the arm. After a rest of about 20 minutes the donor is again quite fit to carry on as before; and within about two days the body has made up the amount of fluid lost. In November, 1952, the Health Authority placed at the disposal of the Blood Transfusion Service the use of local Clinics for blood donor sessions, and the following table gives the relevant information regarding sessions held since that time. Date Where Sessions Held Number of Donors 1952 Essex County Health Services Clinic, Dawlish Road, E.10 Bled Not Bled 8th Nov. 89 14 14th Nov. 81 16 21st Nov. Do. do. 76 13 28th Nov. Do. do. 77 8 6th Dec. 1953 Do. do. 42 ... 2nd Jan. Do. do. 43 6 15th Feb. Do. do. 37 ... 27th Feb. Do. do. 85 13 24th April Do. do. 63 ... 25th June Do. do. 72 3 24th July Do. do. 41 4 28th Aug. Do. do. 41 4 23rd Oct. Do. do. 58 4 11th Dec. Do. do. 102 10 18th Dec. Do. do. 79 4 58 Special sessions were held of Leyton Borough Council employees who volunteered to be bled. Date Where Sessions Held Number of Donors 1952 9th Dec. Town Hall, Leyton Bled 40 NotBled 12 1953 25th Sept. Town Hall, Leyton 35 ... 59 Sanitary Circumstances of the Area Future Housing Development. The following is an extract from a joint report on the above subject submitted to the Council by the Medical Officer of Health and Senior Sanitary Inspector. PRELIMINARY SURVEY. Nature and Object. A preliminary survey of housing conditions in ten areas in the Borough—carried out under the Housing Act, 1936—has now been completed. The object of the survey was to obtain, in respect of each area, information regarding— (a) the total number of buildings—dwelling houses, shops, commercial and industrial premises; (b) the approximate proportion of dwelling houses considered to be sub-standard having regard to the requirements of the Housing Acts ; (c) the number of families and persons residing in substandard dwelling houses; and (d) the approximate total population—families and persons— in the whole area. Classification Adopted. For the purpose of this preliminary survey dwelling houses have been broadly classified in two categories:— Category A.—Houses which appear to be in such a condition as would justify their being dealt with under the slum clearance or re-development procedures of the Housing Act, 1936. Category B.—Houses which appear to be reasonably fit for habitation and outside the scope of Housing Act procedure at the present time. 60 The absence of a precise definition of what the Act describes as a "fit" or "unfit" house renders classification by cursory examination difficult. In determining for the purpose of the Housing Act whether a house is unfit for habitation, regard should be had to the extent to which by reason of disrepair or sanitary defects the house falls short of accepted standards of design and construction as controlled by relevant byelaws and regulations. "Sanitary defects" include lack of air space or of ventilation, darkness, dampness, absence of adequate and readily accessible water supply or sanitary accommodation or other conveniences, and inadequate paving or drainage of courts, yards or passages. Owing to staff and time limitations it has not been possible to give due consideration to all the factors laid down in the Housing Act for the purpose of determining accurately the category in which houses should be placed. It has been practicable to carry out only a superficial examination of each area, and in consequence the information obtained must necessarily be of an approximate and provisional nature. To confirm the position would require a detailed survey of each house, involving a considerable amount of technical work and additional staff. It may be necessary in many cases, in order to assess the controversial "reasonable expense" factor (referred to later in this Report), to prepare specifications and obtain estimates of the cost of the works considered necessary to restore properties to a proper standard of fitness. Areas Surveyed. The boundaries of each area were determined by Town Planning and other considerations, and on Public Health grounds. It was therefore inevitable that each area should contain a proportion of good and of bad houses. For similar reasons it was not possible to include within the boundaries of these areas all the Category A houses in the Borough. It is estimated that, in addition to the number of Category A houses shown in Column 3 of the attached Appendix (page 69), there are some 500 additional houses, situated outside the boundaries of the areas under review, which could be placed in that category, and there are many more whose type and condition justify their being regarded as borderline cases as regards fitness for habitation. Findings. The results of the preliminary survey are tabulated separately in the form of an Appendix. It will be noted that each of the 10 areas 61 has been allocated only a number meantime, and that no reference is made at this stage either to the location of individual areas or the names of the roads in these areas. The 10 areas surveyed contain 1,665 dwellings, of which 539 (32.4%) are in Category A. Of the total population of 6,306 persons in the areas surveyed, 2,127 (33.7%)—and of the total number of 2,082 families, 674 (32.4%)—live in Category A houses. FUTURE RE-HOUSING. Whatever plans may be made for the future development of these areas, many years must necessarily elapse before their fulfilment. This means that much of the sub-standard housing, within and without the boundaries of the areas under review, will have to be retained and maintained for housing purposes for many years to come, and it will be realised that, with the passage of time, the problem of maintaining existing housing will become more acute, with a consequent increase in the number of houses in Category A. The Problem. As we see it, Leyton's housing problem is two-fold:— 1. The long-term or future need—involving re-planning and development of outworn areas having regard to:— (a) town planning requirements—provision of well-balanced amenities and services essential for a modern society (such as open spaces, playing fields, schools, recreational facilities and domiciliary requirements); (b) re-location of industry ; (c) re-housing of displaced families in houses of modern type; (d) clearance of areas of insanitary properties (slum clearance); and (e) finance. 2. The short-term or immediate need, involving:— (i) re-housing of urgently necessitous cases; (ii) maintenance and improvement of existing housing accommodation; (iii) demolition or closure of individual houses which require urgent action by reason of their being totally unfit for habitation and dangerous to the health of the occupants. 62 The Way to Solution. We are of the opinion that the two aspects of the problem are inseparable. The extent (if any) to which a long-term programme can be formulated and put into effect will depend to a considerable extent on the adequacy of the measures we are able to take to provide for the immediate need. The long term plan—with the exception of slum clearance which is a matter for the Public Health Committee—may be said to fall within the province of the Housing and Town Planning Committee and will do doubt be dealt with by the officers of the department concerned. The short-term aspect is undoubtedly the concern and responsibility of the Public Health Committee. Close liaison between these two committees, and mutual appreciation of the difficulties relating to each aspect of the problem, is essential if agreement on a satisfactory and practicable policy is to be reached. Delegated Powers and Duties. In January, 1937 and in November, 1943 the Council delegated to the Public Health Committee the powers and duties of the Council under:— 1. Sections 9, 10, 11 and 12 of the Housing Act, 1936 relating to the repair, demolition and closing of insanitary houses; and 2. Part III of the Public Health Act, 1936 relating to premises in such a state as to be prejudicial to health or a nuisance. In the light of these delegated powers and duties we consider it desirable at this stage to submit the following observations on the short-term or immediate need—the concern of the Public Health Committee. PROCEDURE UNDER THE HOUSING ACT. Before serving a repair notice under Section 9 of the Housing Act, 1936 a local authority must be satisfied:— (а) that the house is in certain respects unfit for human habitation ; (b) that it is capable at reasonable expense of being rendered so fit; and (c) that the required standard of fitness would be achieved by the work specified in the notice. 63 In determining whether a house can be rendered fit for human habitation at reasonable expense, subsection 3 of section 9 states that regard should be had to (i) the estimated cost of the works necessary to render it so fit, and (ii) the value it is estimated that the house will have when the works are completed. The Reasonable Expense Factor. The interpretation of the term "reasonable expense" has exercised the minds of local authorities ever since it was introduced into the Housing Act. Various methods of determining this factor have been put forward, but they all amount to this—that "reasonable expense" is basically a matter of income and expenditure. By Section 10 of the Act a local authority is empowered to enter and execute works in default of the owner. Any expense so incurred may be recovered by the local authority and made a charge on the premises. Present-Day Anomalies. These powers were of great value to local authorities prior to 1939, but unfortunately the position today is very different. Owing to prevailing economic conditions—high building costs in relation to low rentals—this powerful weapon for securing the repair and re-conditioning of defective houses is no longer available to the local authority. Action under Sections 9 and 10 is impossible owing to the qualifying words of the Section relative to "reasonable expense"; and this is likely to have a serious effect on the rate of deterioration of existing houses in the Borough, since the only sure method of arresting decay of house property is by systematic house-to-house inspection under the Housing Act. Unfortunately deterioration due to maintenance difficulties is not confined to sub-standard houses. Genuine instances are coming to light where owners of houses of a good habitable standard are unable to meet the cost of running repairs from income derived from the rent. We are referring to the type of property which, although lacking in amenities that may be considered desirable according to modern ideas, compares favourably with the general standard of dwelling houses in the district and comprises the 64 backbone of Leyton's existing housing accommodation. Its neglect, owing to the reasons stated, must be viewed with concern when it is realised that small items of disrepair, insignificant in themselves, may be the forerunners of serious dilapidation. The maxim "a stitch in time saves nine" is very apt when applied to housing maintenance, where deterioration can be rapid and progressive. The situation is aggravated by the increased wear and tear due to the occupation by more than one family of so many houses originally designed and built to house only one family. Houses which fall outside the scope of Section 9 qualify automatically for demolition or closure under Sections 11 and 12 of the Housing Act, 1936. Because of the artificial economic values indicated above, this action could be applied to a substantial proportion of occupied controlled houses. It is only too well known that, owing to the absence of alternative accommodation, it is not practicable to operate these sections as was intended, even in respect of houses totally unfit for habitation and dangerous to health by reason of their bad structural condition—and not merely technically unfit on economic grounds. Consequently'your Sanitary Inspectors, in full realisation of the re-housing complications, have been avoiding any action under the Housing Act likely to lead to demolition or closing proceedings. At the same time they are continually being reminded of their statutory responsibilities in the form of complaints received from members of the public. In order to secure the abatement of nuisances arising from housing defects we are obliged to operate the procedure under the Public Health Act, 1936 in an attempt to maintain house property, irrespective of type, in a habitable condition. PROCEDURE UNDER THE PUBLIC HEALTH ACT, 1936 Limited Scope. The extent to which procedure under the Public Health Act, 1936 can be applied to the repair of dwelling houses is limited to the enforcement of essential works necessary to abate statutory nuisances. Use and Abuse. Owing to the anomalies referred to above, the Public Health Act is being used to a far greater extent today than ever before. In short, we are trying to overcome our difficulties by making this 65 procedure do the work of the Housing Act. Great restraint must therefore be exercised to curb the tendency to inflate the amount of work which can be properly specified and enforced on a statutory notice in order to meet the urgent demands made upon us. This applies particularly to the repair of decayed and outworn properties which, but for the Council's inability to provide necessary rehousing, would be dealt with by the Housing Act procedure and demolished. This situation is exemplified in the increase in the number of prosecutions instituted against owners for non-compliance with the requirements of statutory notices and nuisance orders. Having once obtained a nuisance order from the Court, the local authority is of course entitled to carry out the works necessary to abate the nuisance in the owner's default and recover the costs incurred; but this is a poor substitute for the comparable but more comprehensive powers under Sections 9 and 10 of the Housing Act, 1936. It is doubtful whether the legislature intended that Public Health Act procedure should be used to the extent it is being applied today for the purpose of renovating house property. PROPERTIES ABANDONED BY OWNERS. The economic pressure of ownership is shown by the number of properties now being abandoned by owners ; and such abandonment is undoubtedly increasing. Reason for Abandonment. Houses may be abandoned in a variety of ways, but the reason for abandonment is more or less always the same. The owner has reached a point where he can no longer fulfil his statutory obligations to the local authority or to his tenants, and the method he chooses to adopt to get rid of his responsibilities depends on the integrity of the individual owner. For instance, he may simply discontinue to collect rents from his tenants and fail to pay rates to the local authority, in which case the Council and the Inland Revenue Commissioners eventually step in and collect rents to defray arrears of rates and income tax; or the owner may convey the property to some illiterate and impecunious person who gladly accepts it, little knowing what is to follow. On the other hand the owner may inform the local authority that he cannot afford to maintain his property in a habitable condition, and request the Council either to purchase the dwelling house or to take appropriate action under Housing Act procedure. 66 Alternative Methods of Disposal. Such properties present particular difficulties to the Council since, owing to the economic factors indicated earlier, the only proper action which could be taken under the Housing Act, 1936 would be either demolition or closure with the consequent problem of re-housing the occupants. An alternative procedure would be for the Council to exercise its purchasing powers under the Housing Acts, 1936/49 by buying the property and carrying out works of renovation and maintenance. We realise that the Council may be reluctant to take this step to acquire financially unprofitable investments, but in our view the health and future well-being of the occupants are the paramount factors. It is also realised that the difficulties associated with the maintenance of existing houses are not confined to the private owner, as many local authorities have found to their cost in dealing with the old houses requisitioned by them during the war period; but, with the extreme shortage of houses and the consequent need for conserving our already meagre supply, all aspects of each case should be considered carefully before such an offer is rejected. Factors to be considered. (a) First and foremost, the re-housing problem that would arise in the event of the house being demolished. (b) Is the type and structural condition of the house such as would justify a recommendation under Part II of the Housing Act, 1949 for financial assistance by Exchequer grant towards the cost of works for conversion and/or improvement carried out by the local authority or the owner ? (c) Are the circumstances such as would justify a loan by the local authority to the owner under Section 4 of the Housing Act, 1949 ? If so, would such a loan be acceptable by the owner to enable him to fulfil his statutory obligations in carrying out essential repairs ? (d) If items of disrepair were made good without any additional improvements, would the house so repaired compare favourably with the general standard of housing accommodation in the district, having regard to the type and condition of other properties ? 67 (e) To what extent would the cost of repairs necessary to restore the house to a reasonable state of fitness, and to render unnecessary any further major repairs for a period of from 10 to 15 years, compare with the cost of demolition and consequential works of weatherproofing and shoring of party walls, levelling site and other measures. It may be found that it would cost almost as much to pull the house down as to repair it. In arriving at a decision as to whether a structurally sound building should be retained for housing purposes, the prime consideration is the urgency of the housing need in the area. How does the cost of acquisition and renovation compare with the cost of providing equivalent accommodation in terms of new building— which may be from £1,500 to £2,000 per family unit at the present time ? When judged from this point of view, expenditure which may be held to be clearly unreasonable in relation to the investment value of the property within the terms of Section 9 assumes quite a different aspect. In certain circumstances it may be considered a reasonable proposition to reinstate an existing building which has all the essential services intact and which is capable, without undue expenditure, of providing a reasonable home for one or more families until sufficient new houses are available. GENERAL OBSERVATIONS. Effect of War Damage Repairs. The present housing conditions in the Borough would undoubtedly be much worse but for the incidence of War Damage and subsequent repair of the properties. The difficult task of the War Damage Commission in trying to separate inherent decay and dilapidation from defects due to War Damage (direct and consequential) has undoubtely lengthened the life of a large number of houses renovated by the execution of War Damage repairs. When the War Damage subsidy ends, as it must very soon, economic difficulties associated with the enforcement of essential repairs to dwelling houses will become more pronounced than at present, and it is disquieting to reflect on the consequences. Responsibility of Public Health Committee. It is in the face of the anomolous situation described in this Report that the Public Health Committee is endeavouring to discharge the statutory functions, under the Housing and Public 68 Health Acts, delegated to it by the Council. The bridging of the interval between the demolition of old insanitary houses and the provision of new dwellings is undoubtedly an essential part of any long-term redevelopment programme, and an extremely complicated and difficult task which the Public Health Committee has to face; but in so doing can we afford to overlook the immediate problem? Already there are a number of houses in the Borough which have reached a stage where—in spite of all statutory action under the Public Health Act, 1936—it has not been possible to bring about any improvement in the insanitary conditions in which the occupants are living. The position of these houses is one of stalemate— for it appears that we can neither repair nor demolish. It would be cold comfort for the occupants to be told that because of long-term planning commitments the Council is unable to fulfil its statutory duty of improving insanitary conditions; and this means in effect that the tenants are deprived of their lawful right to complain. The question to be considered is—how long can we reasonably hope to evade taking decisive action in respect of such properties whose numbers, having regard to the economic factor emphasised earlier in this report and in the absence of new legislation, is likely to increase rather than to diminish ? Claims on New Housing Units. It is highly probable that in the not-too-distant future the Public Health Committee may be compelled by weight of public opinion, in the interests of tenants and in fulfilment of its statutory obligations, to recommend to the Council the making of demolition or closing orders in appropriate cases under Sections 11 and 12 of the Housing Act, 1936. The competing claims on available new housing units, between the immediate need from the point of view of public health and the long-term need in relation to future planning and development, must therefore figure prominently in any future consideration of the general question of housing development in the Borough. As indicated earlier in this Report, we find it difficult to conceive how a long-term redevelopment programme can be formulated and operated with any degree of success unless provision is first made for an allocation of re-housing units for occupants of individual houses which, by reason of their bad structural condition, have already reached or are rapidly reaching a state of total unfitness for habitation and may therefore require urgent demolition many years before the completion of the scheme of re-development, and perhaps even before the scheme is due to be put into operation. 69 Appendix. BOROUGH OF LEYTON. Results of Preliminary Survey of Houses in Ten Areas of the Borouoh. (1) (2) (3) (4) (5) Area No. Total No. of Houses Houses in Category A Population Population in Category A Houses Number Percentage Families Persons Families Persons Number Percentage Number Percentage 1 128 86 67.2 149 459 100 67.1 314 68.4 3 205 56 27.3 242 696 62 25.6 197 28.3 5 155 49 31.6 170 563 47 27.6 175 31.1 7 322 146 45.3 370 1,123 171 46.2 514 45.8 8 and 9 228 63 27.6 334 987 106 31.7 346 35.0 10 268 56 20.9 378 1,140 84 22.8 260 22.8 10A 127 2 1.5 155 508 2 1.3 6 1.1 11 127 36 28.3 173 503 56 32.4 182 36.2 12 64 17 26.6 70 204 18 25.7 49 24.0 15 41 28 68.3 41 123 28 68.3 84 68.3 Totals 1,665 539 32.4% 2,082 6,306 674 32.4% 2,127 33.7% 70 70 Housing Statistics. (i) Census, 1951. The under-mentioned statistics for Leyton have been extracted from the 1 per cent, sample tables issued in advance of the national tabulation of the 1951 Census results. Number of separately assessed dwellings 27,650 Number of Households 34,800 In shared dwellings 14,700 = 42% Of over 1 and up to 2 persons per room 1,700 Of over 1and up to 1½ persons per room 4,500 Up to 1 person per room 28,600 Households without the exclusive use of— Water closet 9,400 = 27% Fixed bath 23,600 = 67.8% Stove and sink 3,600 = 10.3% Number of rooms occupied by households 136,800 Population in households 102,200 Persons per household 2.94 Persons per room 0.75 (ii) Complaints received. During 1953 some 1,671 housing 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. Details of the improvements effected by completion of work specified on sanitary notices are given on page 73, but the benefit to the occupants in terms of comfort and health cannot be measured or fully appreciated by reference to figures. (iii) Local Land Charge Enquiries. During 1953 land charge enquiries were received in respect of 1,364 properties. These involved a search of office records to ascertain whether any sanitary notices (statutory or informal) had been served in respect of the premises concerned and to what extent (if any) the notices had been complied with. 71 Inspection of Dwelling Houses and Statutory Action. (i) Housing Acts and Housing Consolidated Regulations, 1925/32. No statutory proceedings were instituted, or official representations made, during the year under the repairs sections (9 and 10) of the Housing Act, 1936, the demolition and •closure sections (11, 12, 13, and 16), or the Housing Consolidated Regulations, 1925/32. Attention is drawn, however, to the joint report by the Medical Officer of Health and the Senior Sanitary Inspector on page 59, which gives details of a preliminary survey of housing conditions in 10 areas in the Borough. This survey involved some 4,446 visits by Sanitary Inspectors, and its findings are tabulated separately in the form of an Appendix to that Report—page 69. (ii) Public Health Acts (a) Houses and Inspections Details are given hereunder of the number of houses inspected under the provisions of the Public Health Acts in consequence of complaints received and routine inspection of district. Number of houses inspected 2,144 Number of inspections made for the purpose 12,146 Number of houses found not reasonably fit for human habitation 1,023 (b) Notices Served. (i) Informal. During the year 1,023 written intimations (informal notices) were served requiring execution of works to remedy defects in dwelling houses. (ii) Statutory or Formal. During the year 454 statutory (formal) notices were served requiring execution of work to remedy defects in dwelling houses. (c) Remedy of Defects. (i) Informal. Number of houses in which defects were remedied in consequence of informal action 531 (ii) Statutory or Formal. Number of houses in which defects were remedied in consequence of statutory or formal notices: By owners 316 By the Local Authority in default of owners 79 72 Legal Proceedings. Resulting from the 454 statutory notices served on owners under the nuisance abatement procedure of the Public Health Act, 1936, in 11 instances it was necessary to institute legal proceedings to secure compliance therewith. The results of such action are given hereunder. Date of hearing Address Nature of nuisance or offence Result of Court proceedings 18.2.53 72 Colville Road, E.11 General defects, dry rot, dampness Abatement Order, 21 days 6.5.53 87 Matcham Road, E.11 Defective wall, plaster and roofs Abatement Order, 3 months 6.5.53 14/16 Esther Road, E.11 Defective roofs and gutters, dampness Abatement Order, 28 days 6.5.53 95/99, 103/105 Cathall Road, E.ll General defects, dampness woodworm Abatement Order, 2 months 6.5.53 Shed, 2 Percy Road, E.11 Defective roof, dampness, accumulation of refuse Abatement Orders, 28 days for repair work, 7 days for removal of refuse 26.8.53 Shed, 2 Percy Road, E.11 Non-compliance with Court Abatement Order £5 fine 28.10.53 544 Lea Bridge Road, E.10 General defects, dampness Abatement Order, 28 days 28.10.53 8 Southwell Grove Rd., E.11 Defective walls of scullery and W.C. Abatement Order, 28 days 28.10.53 28.10.53 2 Cecil Road, E.11 165/167 Ramsay Road, Defective brickwork of party wall. Defective wall plaster General defects, dampness, dry rot Abatement Order, 28 days Abatement Order, 28 davs 30.12.53 14 Grange Road, E.10 General defects, dampness, woodworm Abatement Order, 28 days Number of New Houses Erected during the Year. Total With State assistance (included in the Total) Type of Building By the local authority By other local authorities By other bodies and persons By the local authority By other local authorities By other bodies and persons Houses 8 ... 1 8 ... ... Flats 122 ... ... 122 ... ... Temporary Housing ... ... ... ... ... ... Total housing units 130 ... 1 130 ... ... 73 Dwelling houses improved. The following table contains a summary of the nature of work executed and improvements effected in dwelling houses and other premises as a result of the aforementioned action (formal and informal) taken under the Statutory Powers. Cement work to sink waste gullies repaired 55 Choked drains cleared 37 Coppers repaired or renewed 4 Dampness remedied 423 Drains relaid or partly relaid 63 Floors repaired 165 Guttering repaired or renewed 261 Miscellaneous defects remedied 351 New w.c. pans and traps provided 53 Plaster repaired 567 Rain water pipes repaired or renewed 102 Roofs repaired or renewed 636 Rooms redecorated 240 Sashcords renewed 230 Sinks provided 16 Sink waste pipes repaired or renewed 70 Stoves repaired or renewed 144 Vent pipes repaired or renewed 28 W.C. cisterns repaired or renewed 118 Window sills, etc., repaired 270 Yards paved 18 3,851 Drainage. During the year drainage systems of some 116 houses were repaired or reconstructed, wholly or in part. In 79 cases the public sewer was involved, and the work was carried out by the Council under the supervision of the Borough Engineer and Surveyor, the expenses incurred thereby being recovered from the owners. Rodent Control. (i) Work carried out during 1953. During 1953 some 443 complaints relating to infestation by rats and mice were investigated by the Health Department Staff— 651 private houses and 134 business premises were dealt with. The total number of visits, in connection with these investigations and subsequent disinfestation work, amounted to 4,251. 74 The Council's sewers were baited in June, 1953. The treatment was of four to five weeks' duration, involving some 1,158 manholes each of which was baited on three successive days, and the percentage of " takes " amounted to 51.46 per cent. The staff required for a sewer treatment comprises four employees of the Borough Engineer's Department (two sewermen and two labourers) and two rodent operatives. Two gangs, with a rodent operative in charge of each, operate in different parts of the district. During these periods the remaining rodent operative endeavours to deal with complaints and other essential duties in the Public Health Deparrtment. The December treatment had to be postponed owing to shortage of rodent staff. The 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 a proportionate decrease in surface infestation ; but measures taken to destroy rats, however successful, have only a limited and temporary effect. Most people know that rats are prolific, but few are aware of the rapidity with which their numbers increase. Research has shown that a pair of rats and their descendants may produce, in the course of 12 months, well over 1,000 offspring. Poison baiting of sewers was not expected to eliminate sewer rats completely for the impossibility of bringing all rats to feed at available baiting points is evident. The primary need is therefore to take all possible steps to prevent the migration of rats from defective sewers and drains to adjoining buildings. All infestations are carefully investigated by the Sanitary Inspectors, who then arrange for drainage systems suspected of being a source of trouble to be smoke-tested. If defects in the house drains and/or public sewers are confirmed, a report is submitted to the Public Health Committee requesting authority to enable appropriate statutory action to be taken in accordance with the provisions of the Public Health Act, 1936. (ii) Statistics. (a) Prevention of Damage by Pests Act, 1949. Complaints received and investigated 443 Premises not treated (not genuine infestation) 2 75 Premises treated : Rats Mice Total Dwelling houses 373 278 651 Business premises 66 68 134 Total 439 346 785 Notices : Informal notices served 6 Informal notices complied with 6 Statutory notices served (b) Disinfection/Disinfestation. Number of verminous houses treated 139 Number of houses disinfected 118 76 INSPECTION OF BUSINESS AND INDUSTRIAL ESTABLISHMENTS. Approximate numbers of business premises in the Borougn and functions involved. (i) Food and business premises which are licensed or registered for a specific purpose. TYPE OF PREMISES ADDITIONAL LICENCES, REGISTRATIONS AND OTHER FUNCTIONS INVOLVED TOTAL 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Ice Cream Milk Preserved Food Shell Fish Power Factory Non-Power Factory Catering Off Licence Bakehouse Confectionery Fish Frier Grocer Barber With Storage Poultry Slaughterhouse Hairdressing. A Baker 28 1 28 2 42 B Butcher 63 3 4 1 76 C Catering 54 1 97 D Confectionery 65 70 E Fish 13 10 29 47 F Greengrocer 1 3 97 G Grocer 58 85 1 2 228 H Multiple Store 3 2 3 1 4 I Milk 1 2 12 J Ice Cream 106 K Bag Flock 7 2 11 L Pet Animals 1 13 M Horse Flesh 2 N Hairdresser 43 79 O Hawker 51 79 P Public House 10 32 35 Q Off Licence 4 2 2 23 B Factory 64 36 423 S School 1 17 18 T Council Property 2 2 4 U Hospital 2 2 Total Premises 1,468 Totals, Additional Functions 189 88 64 13 40 66 80 32 28 2 29 15 43 51 1 1 742 See summary in paragraph (iv) page 77. 77 (ii) Factories. These figures are inclusive of those shown in Columns R, 5 and 6, and constitute the total number of Power and Non-Power Factories maintained on the Factory Registers under statutory legislation. Description Total Factories with Mechanical Power 39 Factories without Mechanical Power 65 Total 461 (in) Miscellaneous Shops and, other Business Establishments. The approximate number of miscellaneous shops and other business establishments is 754. business establishments is 754. (This includes boot and shoe retail shops, builders' merchants, drapers, florists, furniture dealers, gent's and ladies' outfitters, hardware shops, newsagents, radio and television dealers, etc.). (iv) Summary. Food and other business premises which are licensed or registered 1,468 Additional functions involved 742 Factories—Power and Non-Power 461 Miscellaneous shops and other businesses 754 Total number of premises and functions ... 3,425 Inspection and Supervision of Food Premises. (i) Summary of Inspections by Sanitary Inspectors. The following inspections were carried out in relation to the under-mentioned food premises, having regard to the requirements of the Public Health Act 1936, Food and Drugs Act 1938 and associated Orders and Regulations, Clean Food By-laws 1950, Ice-Cream (Heat Treatment Reg.) 1947/52, Shops Act 1950, Factories Act 1937, Leyton Corporation Act 1950, Essex County Council Act 1952, and relevant legislation. Food and Drugs Sampling. (i) Food and Drugs Authority and Sampling Officers. The Council is the food and drugs authority for the district and your Sanitary Inspectors are authorised under the Food and Drugs Act, 1938 to procure and purchase samples of food and drugs for chemical analysis or for bacteriological or other examination. (ii) Public Analyst. Dr. J. H. Hamence, F.R.I.C., and Mr. George Taylor, F.R.I.C., 20, Eastcheap, London, E.C.3, continued to act as Public Analysts for the area. (iii) Samples submitted for chemical analysis. During the period 1st January to 31st December, 1953, some 278 samples of food and drugs were procured by the Sanitary Inspectors for submission to the Public Analyst for chemical analysis. It will be seen from the tabular statement which follows that a wide variety of commodities were sampled, and that in seven instances adverse reports were received. The circumstances relating to these seven samples were fully reported to the Public Health Committee and are summarised hereunder. Type of Premises No. of Inspections Bakehouses 91 Bakers 125 Butchers 454 Catering Establishments 412 Confectioners 158 Dairies and Distributors of Milk 179 Factory Canteens 33 Fish Fryers 87 Fishmongers 131 Greengrocers 212 Horse-flesh Dealers 5 Ice-Cream Places 448 Itinerant Stalls and Vehicles 112 Food Dealers J Food Storage Accommodation 100 Off Licences 34 Provision Shops 767 Public Houses 58 School Canteens 20 Shell-fish Vendors 26 Slaughterhouses (Poultry) 139 Total Inspections 3,591 78 79 Bread. The first of the two samples of bread adversely reported upon appeared to be discoloured by black foreign matter. The Public Analyst's report confirmed that the discolouration was due to charring of the bread and no statutory action was justified. Regarding the second sample of bread, the Public Analyst reported that such discolouration was due to contamination by rat excreta, and the Public Health Committee decided to institute legal proceedings against the baker. The case was taken to Court, and the defendant was fined £5 and ordered to pay £2 2s. cost6. Cream Buns. An anonymous complaint was received in relation to cream buns alleged to be contaminated and unfit for food. The Public Analyst confirmed the presence of a foreign body which rendered the food unfit for human consumption, but the Public Health Committee decided that no statutory action was justified owing to the anonymity of the complaint and consequent lack of evidence to support legal proceedings. Tinned Snacks. In the opinion of the Public Analyst the wording of the labels on the tins constituted a technical infringement of the Labelling of Food Orders. The manufacturers were communicated with and agreed to amend the labels accordingly. Christmas Pudding. The seventh unsatisfactory sample consisted of a Christmas Pudding contaminated with mould. The mould was not considered by the Public Analyst to be injurious to health, but indicated that the pudding was out of condition. A warning letter was sent to the manufacturers in this rase. (iv) Details of Samples taken for Chemical Analysis. Commodity No. of Samples analysed No. of Samples unsatisfactory Apple Tart 1 ... Apricot Conserve 1 ... Aspirin Tablets 1 ... Baby Cereal 1 ... Baked Beans 1 ... Baking Powder 1 ... 80 Commodity No. of Samples analysed No. of Samples unsatisfactory Batter Flour 1 ... Beans with Pork Sausages 1 ... Beef, Pressed 1 ... Bemax 1 ... Blackcurrants 1 ... Blancmange Powder 1 ... Brawn 1 ... Bread 2 2 Butter 2 ... Cake Mixture 2 ... Caraway Seeds 1 ... Cheese 4 ... Cheese Spread 1 ... Chest and Throat Lozenges 1 ... Chocolate,Drinking 1 ... Chocolate Raisins 1 ... Cochia Pills 1 ... Cocoa 1 ... Coconut, Desiccated 1 ... Coffee and Chicory Essence 1 ... Cooking Fat 4 ... Crab Paste 2 1 Cream 7 ... Cream Buns... 2 ... Cream Soda ... 1 ... Curry 3 ... Custard Powder 1 ... Ephedrine Hydrochloride 1 ... Farex 1 ... Fish Cakes 1 ... Fish Paste . 1 ... Fling (soft drink) 1 ... Fruit Sauce 1 ... Ginger, Ground 1 ... Glucose, Medicinal 1 ... Grapes, Canned 1 ... Grape Fruit Segments 1 ... Gravo Thick 1 ... Groats 1 ... Commodity No. of Samples analysed No. of Samples unsatisfactory Honey 1 ... Ice Cream 69 ... Jam 1 ... Jelly 2 ... Lactagol 1 ... Liquorice, linseed and chlorodine Table 1 ... Lollies 6 ... Lozenges 1 ... Margarine 2 ... Marmite 1 ... Marmalade 2 ... Meat Paste 1 ... Meat Pudding 1 ... Mincemeat 1 ... Mint Concentrate 1 ... Mint, Dried 1 ... Milk 38 ... Milk, Condensed 2 ... Milk, Dried (full cream) 1 ... Milk Food 1 ... Milk, National Dried 1 ... Molasses 1 ... Olive Oil 1 ... Orange Curd 1 ... Orange Squash 1 ... Peas, Canned 1 ... Peas, Processed 1 ... Peel, Mixed 1 ... Pepper 1 ... Pickle 1 ... Pilchards 1 ... Pile Tablets 1 ... Pineapples 1 ... Pineapple Juice 1 ... Pineapple Pieces 1 ... Popcorn 1 ... Pork, Minced 1 ... Pork and Beef Paste 1 ... Pudding, Christmas 2 1 81 Commodity No. of Samples analysed No. of Samples unsatisfactory Quinine Tablets 1 ... Rice, Creamed 1 ... Rice, Ground 1 ... Ricory (Coffee Preparation) 1 ... Rock Confections 4 ... Rum and Butter Toffees 1 ... Sandwich Spread 1 ... Sauces 5 ... Sausages, Beef 1 ... Sausages, Liver 1 ... Sausages, Pork 1 ... Sausage Meat, Beef 1 ... Sausage Rolls 1 ... Snacks (Tinned) 3 ... Self-raising Flour 1 ... Semolina 1 ... Spice, Mixed 3 ... Steak, Stewed 2 ... Steak and Kidney Pudding 1 ... Stomach and Liver Mixture 1 ... Suet, Shredded Beef 3 ... Sugar 2 ... Sultanas 1 ... Sweets and Confectionery 3 ... Tapioca, Dessert 2 ... Tapioca Flakes 1 ... Tea 2 ... Throat Drops 1 ... Throat Tablets 1 ... Trufood 2 ... Vinegar 3 ... Vinegar, Malt 1 ... Virol 1 ... Yeast Tablets 1 ... Yeast, Dried Brewers 1 ... Zinc Ointment 1 ... Totals 278 7. 82 83 (v) Samples submitted for Bacteriological Examination. (a) Designated Milk. Thirty-two samples of designated milk were taken and submitted to the County's Public Health Laboratories for bacteriological examination. logical examination. The results of such examination are summarised as follows :— Designation No. of Samples Taken Result Phosphatase Reaction Methylene Blue Test Satis. Unsatis. • Satis. Unsatis. Tuberculin Tested 6 6 ... 6 ... Accredited 2 2 ... 2 ... Pasteurised 14 14 ... 14 ... Sterilised... 10 10 ... 10 ... Total 32 32 ... 32 ... (b) Ice Cream. Seventy samples of ice cream and six of ice lollies were taken and submitted to the County's Public Health Laboratories for bacteriological examination. bacteriological examination. The results of such examination are summarised as follows :— Commodity No. of Samples taken Result Grade I Grade II Grade III Grade IV Satis. Ice Cream Ice Lollies 70 6 41 18 7 4 6 (vi) Samples submitted for Biological Examination. Two samples of milk were submitted for biological examination and in each case a negative result was obtained. Food and Drugs Act, 1938, Sections 9 and 10. (i) Meat and Food Condemned and Destroyed. Condemnation certificates were issued in respect of the undermentioned unsound foodstuffs surrendered by various traders in the Borough as a result of routine inflection of food premises. The food condemned was destroyed by fire at the Council's Destructor Works. 84 Commodity Ton Cwt. Qtr. Lb. Commodity Units Bacon ... ... 2 3 Cheese 22 boxes Cheese ... ... ... 7 Chickens 317 Chocolate ... ... ... ... Ducks 47 Coconut Bars ... 5 ... ... Fish 192 tins Fish ... 5 3 14 Fruit 2,327 tins Ground Rice ... ... ... 7 Ham 97 tins Ice Cream Powder ... ... ... 21 Ice Cream Cones 10 boxes Hearts ... 2 1 27 Ice Cream Wafers 99 tins Liver ... ... ... 12½ Jam 27 tins Meat 2 ... 2 18 Luncheon Meat 406 tins Potatoes ... ... 2 14 Milk 259 tins Rabbits ... 2 2 25 Miscellaneous Foodstuff 114 pkts. Raisins ... ... 1 2 Patent Barley 50 tins Salmon ... 1 2 ... Prune/Apple Puddings 51 tins Sausages ... I 3 24 Salad Cream 23 bottles Sausage Meat ... 2 2 ... Sausages 36 tins Suet ... ... ... 20 Sheeps Heads 64 Sultanas ... 2 ... 16 Soup 113 tins Sweetbreads ... ... ... 19 Vegetables 598 tins Sweetened Fat ... 3 ... 7 Weasands ... ... 2 27 Notices Served. (i) Food and Drugs Act, 1938 (Sec. 13). This section sets out certain minimum requirements as to hygiene, cleanliness, structural conditions, hot and cold water and washing facilities, and affects rooms in which food intended for human consumption is prepared for sale or sold or offered or exposed for sale, or deposited for the purpose of sale or in preparation for 6ale. Notices in relation to contraventions of this section were served in respect of 33 food premises, and all notices were complied with. In addition to these written notices, numerous verbal intimations were given by Sanitary Inspectors to occupiers of food establishments—more in the nature of advice than of official direction—with the object of securing co-operation in maintaining a high standard of food hygiene. (ii) Shops Act, 1950, Sec. 38. Eight notices were served under this section on occupiers or owners of shop premises regarding insufficient sanitary arrangements available for use of persons employed in or about the shop. These notices were satisfactorily complied with. 85 Legal Proceedings. In two instances it was necessary to institute legal proceedings, as under :— Nature of Contravention Act under which summons was issued Date of summons Result Storage of food under dirty conditions Food and Drugs Act, 1938, Sec. 13 23.7.53 40s. fine on each of two summons Sale of food unfit for human consumption Food and Drugs Act, 1938, Sec. 9 22.12.53 £5 fine, with £2 2s. costs REGISTRATION AND LICENSING OF FOOD PREMISES. (i) Food and Drugs Act, 1938, Sec. 14. This section provides for the registration by the Local Authority of premises used in connection with the sale, or the manufacture for the purpose of sale, of ice cream, or the storage of ice cream intended for sale, or the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale. (a) Ice Cream Premises. In connection with the retail sale and storage of ice cream 21 new applications for registration were approved. Details are given hereunder of the number of ice cream premises registered under this section. Premises on register at 1st January, 1953 285 Premises removed from register during 1953 11 274 Premises registered during 1953 21 Premises on register at 31st December, 1953 295 During the year 448 inspections of ice cream premises were carried out, and of the 69 samples obtained for chemical analysis) 86 all conformed with the standard prescribed by the Food Standards (Ice Cream) Order, 1953, viz. :— " Ice cream shall contain not less than 5 per cent, fat, 10 per cent, sugar and 7½ per cent, milk solids other than fat. Provided that— (i) Ice cream containing any fruit, fruit pulp or fruit puree shall either conform to the standard set forth above or, alternatively, the total content of fat, sugar and milk solids other than fat shall be not less than 25 per cent, of the ice cream including the fruit, fruit pulp or fruit puree, as the case may be, and such total content of fat, sugar and milk solids other than fat shall include not less than 7½ per cent, fat, 10 per cent, sugar and 2 per cent, milk solids other than fat; (ii) " Parev " (Kosher) ice sold, offered or exposed for sale under that description shall contain not less than 10 per cent, fat and not less than 14 per cent, sugar, and the standard for ice-cream set forth above shall not apply to this product." The results of 70 samples of ice cream submitted for bacteriological examination are given on page 83. (b) Premises Manufacturing Preserved Food. Two new applications were received and approved for registration of butchers' premises for the manufacture of preserved food. The following table gives details of premises registered for this purpose. Premises on register at 1st January, 1953 80 Premises removed from register during 1953 18 62 Premises registered during 1953 2 Premises on register at 31st December, 1953 64 (ii) Food and Drugs (Milk and Dairies and Artificial Cream) Act, 1950—Milk and Dairies Regulations, 1949. These Regulations require local authorities to keep a register of persons carrying on the trade of milk distributor and of all dairy premises other than dairy farms in their districts, and make special provisions relating to the treatment, handling and storage of milk. 87 Shops where milk is sold only in the unopened containers in which it is received are registered as distributors, and nine such registrations were approved during the year. Details of premises registered under these regulations are : Premises on register at 1st January, 1953 97 Premises removed from register during 1953 6 91 Premises registered during 1953 9 Premises on register at 31st December, 1953 100 One hundred and seventy-nine visits were made to premises dealing in milk, and of the 38 samples submitted for chemical analysis, all complied with the Sale of Milk Regulations, which provide (subject to certain exceptions) that milk shall contain not less than 3 per cent, milk fat and 8.5 per cent, milk solids other than milk fat. (iii) Milk (Special Designation) (Pasteurised and Sterilized Milk) Regulations, 1949, and Milk (Special Designations) (Raw Milk) Regulations, 1949. One hundred and eighty-four licences were granted in respect of designated milk as a result of applications received. of designated milk as a result of applications received. The following is a summary of these licences. Special Designation Tuberculin Tested Accredited Pasteurised Sterilised No. of licences granted 25 12 43 88 No. of supplementary licences granted 5 5 6 Total 30 12 48 94 The results of 32 samples of designated milk submitted for bacteriological examination are given on page 83, para. (v) (a). 88 (iv) Essex County Council Act, 1952—Section 103. (a) Persons engaged in Hawking Food and their Premises. Applications were received from 10 persons for registration as hawkers of food, and for registration of their premises to be used for storage of food. (b) Persons engaged in Hawking Food. Applications were received from 10 persons for registration as hawkers of food. Details of the number of persons and premises registered under this section are given hereunder. Persons Premises On register at 1.1.53 60 59 42 41 Removed from register during 1953 1 1 Registered during 1953 20 10 On register at 31.12.53 79 51 (v) Leyton Corporation Act, 1950—Section 63. Registration of Vendors of Shell-fish and their Premises. An application was received from a fishmonger in the Borough for registration as a vendor of shell-fieh and for registration of premises to be used for storage. Details oi the number of premises registered for this purpose are :— Persons and premises on register at 1st January, 1953 13 Persons and premises removed from register during 1953 1 12 Persons and premises registered during 1953 1 Persons and premises on register at 31st December, 1953 13 89 % HEALTH EDUCATION AND THE CAMPAIGN FOR CLEANER FOOD. Details have already been given of the number of visits made by the Sanitary Inspectors in regard to the inspection of food and all types of premises where food is prepared, handled, stored or sold, to ensure compliance with the various Acts, Orders and Regulations, and the Council's By-laws for " securing the observance of sanitary and clean conditions and practices in connection with the handling, wrapping and delivery of food sold or intended for sale for human consumption and in connection with the sale or exposure for sale in the open air of food intended for human consumption It is pleasing to place on record appreciation of the co-operation received from food traders in the Borough in complying with our requirements, but it should be realised that clean food is not wholly concerned with structural conditions of premises. The most important and unpredictable factor in food hygiene is the worker. Carefully designed and elaborate food premises are not proof against the careless food handler who fails to observe elementary principles of personal hygiene. One employee in a food establishment— by ignorance, apathy or mere carelessness—may jeopardise the health of hundreds of people. The education of the food handler is therefore the greatest single step that can be taken in producing cleaner food. Health education should not be confined to the adult worker, but should begin at the earliest possible age at home and at school. The general provision of school meals gives the educational authorities an excellent opportunity to inculcate in children the simple rules of personal cleanliness in relation to the preparation and service of food. A film strip projector has been obtained with the object of extending the field of health education to include (in addition to lectures) the showing to food handlers at school canteens and catering and food establishments of film strips dealing with food hygiene and the dangers of food poisoning. Unfortunately the existing staff of Sanitary Inspectors are fully employed in dealing with routine day-to-day requirements and there is little margin to enable this important aspect of environmental hygiene to receive adequate attention. 90 Legal sanctions and official inspections can achieve much, hut it must be remembered that the public themselves can also assist in the campaign for cleaner food by favouring with their custom the clean shop rather than the dirty shop, by complaining and criticising in no uncertain terms any obvious breach of hygiene and by imposing a standard which they expect to be observed by shop-keepers and food handlers whom they patronise. WASHING FACILITIES IN PUBLIC SANITARY CONVENIENCES. Prior to 1953, in eachPublic Sanitary Convenience administered by the Sanitary Authority there was provided only one water closet and one wa6h-hand basin for use by members of the public free of charge. For the use of all other water closets the charge was a penny, and for the use of wash-hand basins and towels the charge was threepence As the imposition of charges for such services appeared to be in conflict with hygienic teaching, especially in respect of persons handling food, towards the end of 1952 the following report was submitted to the Sanitary Authority by the Medical Officer of Health. " Most outbreaks of food poisoning have been traced to food prepared or eaten outside the home, and one healthy carrier of pathological enteric organisms may be responsible for the illness of many people by lack of cleanliness in the preparation of food. In consequence of the great increase during recent years of cases of food poisoning, a Clean Food Campaign has been sponsored by the appropriate central government departments, with the help of the Central Council for Health Education. In this Campaign your sanitary inspectors have taken a prominent part, by drawing the attention of food handlers in catering establishments to the association between clean hands and 6afe food, and posters on these lines have been displayed on public hoardings, in clinic premises, and at 280, High Road, as part of the Health Education for which Local Health Authorities are responsible under the provisions of the National Health Service Act. Metal plaques bearing the slogan " Always wash your hands after using 91 the W.C." have been distributed by me to Hospitals and Catering Establishments in the Borough, to be fixed on the inner side of water closet doors and in urinals. I consider that these plaques (or similar advice) should be displayed in the Council's public conveniences, which are widely used by food handlers of all kinds ; but the reason for giving such advice is liable to misrepresentation in premises where charges are made for the use of both water closets and wash-hand basins. The person who has been charged a penny for the use of a water closet in a public convenience is not likely to be well disposed towards a Sanitary Authority that advises him to wash his hands in the public interest and then charges him twopence for the privilege for doing so. It has been truly stated that " Man (homo sapiens) is the only animal that deliberately runs the risk of soiling or contaminating his hands (or forepaws) as the terminal act of defaecation, and then uses these same hands for all sorts of purposes affecting others of his kind (e.g. shaking hands, fingering coins and paper money, preparing food, etc.)." Law and custom compel him to wear clothes which he keeps clean at the risk of soiling his hands. If the officers of the Sanitary Authority advise him to wash his hands for the protection of others, he should not be charged for complying with the advice given. After consideration of that report the Council decided (1) That no charge be made for the use of water closets or wash-hand basins in the Council's public conveniences ; (2) That free paper towels be provided for the latter purpose ; and (3) That linen towels continue to be provided at the existing charge of threepence per towel, when required." During the year 1953, 14,078 linen towels and 18,757 paper towels were issued. Inspection of business premises other than food premises. (i) Summary of inspections by Sanitary Inspectors. The following inspections were carried out during the year in relation to the under-mentioned business premises having regard to the requirements of the Public Health Act, 1936 ; the Shops Act, 1950 ; the Factories Act, 1937 ; the Pet Animals Act, 1951 ; the 92 Rag Flock and Other Filling Materials Act, 1951 ; the Diseases of Animals Acts and Orders the Leyton Corporation Act, 1950 ; and relevant legislation. Type of Premises No. of Inspections Factories with mechanical power 452 Factories without mechanical power 44 Hairdressers and Barbers 117 Hospitals and Nursing Homes 5 Local Authority Properties 31 Miscellaneous Shops, etc. 420 Offensive Trades 5 Outworkers 421 Pet Animal Shops 41 Piggeries 19 Places of Entertainment 12 Public Conveniences 25 Rag and Bone Dealers 5 Rag Flock 22 Schools 14 Stables 9 Total inspections 1,517 (it) Factories Act, 1937/1948. The following is an extract from a statutory return, made annually to the Ministry of Health, showing inspections made and an analysis of notices served under the provisions of the Factories Act, 1937. 1. INSPECTIONS FOR PURPOSES OF PROVISIONS AS TO HEALTH Including inspections made by Sanitary Inspectors. Piemi.es Number on Register Number of Inspections Written Notices Occupiers Prosecuted (1) (2) (3) (4) (5) Factories with methanical power 396 452 22 ... Factories without mechanical power 65 44 3 ... Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) ... ... ... ... Total 461 496 25 ... 93 2. DEFECTS FOUND. Particulars Number of Defects Found Remedied Referred to H.M. Inspector (1) (2) (3) (4) Lack of cleanliness 1 ... ... Sanitary Conveniences:— Insufficient 1 1 ... Unsuitable or defective 18 9 ... Not separate for sexes 4 4 ... Other Offences 6 3 ... Total 30 17 ... 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 Registration and Licensing. (i) Pet Animals Act, 1951. This is an Act to regulate the sale of pet animals, and the persons in occupation of Pet Shops are required to be licensed by the local authority in respect of:— (i) the accommodation provided for the animals, with regard to size, temperature, lighting, ventilation and cleanliness ; (ii) the provision of suitable food and drink ; and (iii) animals, being mammals, not being sold at too early an age. Applications were approved, and licences granted in respect of, 13 pet animal shops. Such licences are reviewed annually. The following table gives details of registration and licences issued:— On register at 31st December, 1952 12 Licences issued during 1953 13 Removed from register during 1953 Nil On register at 31st December, 1953 13 94 (it) Leyton Corporation Act, 1950 (Section 48). Registration of Hairdressers and Barbers, and of premises in which business is carried on. Twelve new applications were approved for registration as hairdressers/barbers and of the premises in which the business is carried on. On register at 1st January, 1953 78 Removed from register during 1953 1 77 Registered during 1953 2 On register at 31st December, 1953 79 (iii) Rag Flock and other Filling Materials Act, 1951. (a) Registration, Section 2. An application was received from a trader in the Borough for registration of premises under the provisions of the above Act. The present position regarding such registrations is : On register at 1st January, 1953 11 Removed from register during 1953 3 8 Registered during 1953 1 On register at 31st December, 1953 9 (b) Sampling—Section 15. Ten formal samples of various filling materials were taken in accordance with the requirements of the Rag Flock and Other Filling Materials Act, 1951. Set out below in tabular form are the findings of the Prescribed Analyst. 95 [Appropriate Tests Standard prescribed by R.F. & O.F.M. Begs., 1951 Results of Analysis Remarks and Action Taken (») Sample No. 1/53—Cotton Felt Oil and soap test Not to contain more than 2% of oil Oil content 6% Sample Unsatisfactory Warning letter to Manufacturers Trash content Test (in triplicate) Not to contain more than 7J% of trash or other impurities Trash content: (i) 9.3%, (ii) 9.1%, (iii) 9%, average 9.1 % Dust index test (in duplicate) To have a dust index of not more than 3, where the test is carried out under ihe conditions specified in para. 40 of Part 6 of British Standard 1425 : 1951 Dust index: (i) 1.6% (ii) 1.8% average 1.7% (ii) Sample No. 2/53—Rag Flock Sample Satisfactory Impurities Test (in triplicate) • Not to contain more than 1.8% of soluble impurities Sol. impurities : (i) 1.3% (ii) 1.3% (iii) 1.3% average 1.3% Oil 1.4% Soap .9% Chlorine content 20 parts per 100,000 Oil and soap test Not to contain more than 5% of oil and soap Chlorine test Not to contain more than 30 parts per 100,000 of chlorine in the form of soluble chlorides (iii) Sample No/ 3/53—Layered Coir Fibre •Impurities test (in triplicate) Not to contain more than 1.5% of insoluble impurities ; and where the filling consists wholly or partly of used materials, not to contain more than 1.5% of soluble impurities Insoluble impurities : (i) -7% (ii) -7% (iii) .7% average .7% Sample Satisfactory (iv) Sample No. 4/53—Rag Flock Impurities test (in triplicate) Not to contain more than 1.8% of soluble impurities Sol. impurities : (i) 1-4% (ii) 1.6% (iii) 1.4% average 1.5% Sample Satisfactory Oil and soap test Not to contain more than 5% of oil and soap Oil 1.7% Soap 1.1% Appropriate Tests Standard prescribed by R.F. & O.F.M. Regs., 1951 Results of Analysis Remarks and Action Taken (iv) Sample No. 4/53—Rag Flock—cont. Chlorine test Not to contain more than 30 parts per 100,000 of chlorine in the form of soluble chlorides Chlorine content: 16 parts per 100,000 (v) Sample No. 5/53—Rag Flock Impurities test (in triplicate) Not to contain more than 1.8% of soluble impurities Sol. impurities : (i) 1.9% (ii) 2% (Hi) 1-9% Sample Unsatisfactory Warning letter to Manufacturers Oil and soap test Not to contain more than 5% of oil and soap Oil 1.9% Soap 1% Chlorine test Not to contain more than 30 parts per 100,000 of chlorine in the form of soluble chlorides Chlorine content: 15 parts per 100,000 (vi) Sample No. 6/53—Cotton Felt Oil and soap test Not to contain more than 2% of oil Oil content .5% Sample Unsatisfactory Trash content test (in triplicate) Not to contain more than 7J% of trash or other impurities Trash content: (i) 8.7% (ii) 8% (iii) 8% Average 8.2% Warning letter to Manufacturers Dust index test (in duplicate) To have a dust index of not more than 3, where the test is carried out under the conditions specified in para. 40 of part 6 of British Standard 1425 : 1951 Dust index : (i) 1.5 (ii) 1.5 (vii) Sample No. 7/53—Woollen Mixture Felt Impurities test (in triplicate) Not to contain more than 1.5% of soluble impurities Sol. impurities : (i) 1.3% (ii) 1.2% (iii) 1.3% average 1.3% Sample Satisfactory Oil and soap test Not to contain more than 5% of oil and soap Oil 1.4% Soap 1% 96 97 AAppropriate Tests Standard prescribed by R.F. & O.F.M. Regs., 1951 Results of Analysis Remarks and Action Taken (vii) Sample No. 7/53—Woollen Mixture Felt—cont. Chlorine test Not to contain more than 30 parts per 100,000 of chlorine in the form of soluble chlorides Chlorine content: 12 parts per 100,000 Animal Fibre content 69.6% (viii) Sample No. 8/53—Rag Flock Impurities test (in triplicate) Not to contain more than 1.8% of soluble impurities Sol. impurities : (i) 1.8% (ii) 1.7% (iii) 1.7% Average 1.7% Sample Satisfactory Oil and soap test Not to contain more than 5% of oil and soap Oil 2.5% Soap 1.1% Chlorine test Not to contain more than 30 parts per 100,000 of chlorine in the form of soluble chlorides Chlorine content: 15 parts per 100,000 (tar) Sample No. 9/53—Rag Flock Impurities test (in triplicate) Not to contain more than 1.8% of soluble impurities Sol. impurities : (i) -8% (ii) -7% (iii) .8% Average .8% Sample Satisfactory Oil and soap test Not to contain more than 5% of oil and soap Oil 1.6% Soap 1.1% Chlorine test Not to contain more than 30 parts per 100,000 of chlorine in the form of soluble chlorides Chlorine content: 9 parts per 100,000 (x) Sample No. 10/53—Layered Coir Fibre Impurities test (in triplicate) Not to contain more than 1.5% of insoluble impurities and where the filling consists wholly or partly of used materials not to contain more than 1.5% of soluble impurities. Insoluble impurities : (i) -9% (ii) .9% (iii) 1% Sample Satisfactory 98 Diseases of Animals, Acts and Orders. (i) Administration. The Diseases of Animals Acts, and Statutory Rales and Orders, deal generally with :— (а) Prevention of scheduled diseases of animals. (б) Control of outbreaks of diseases of animals. (c) Prevention of the introduction of diseases of animals from abroad ; and (d) Protection of animals against unnecessary suffering. The administration of the law relating to diseases of animals is carried out partly by officers of the Ministry of Agriculture and Fisheries and partly by officers of County Councils and Local Sanitary Authorities. In this Borough your Sanitary Inspectors are officers authorised under the various Acts and Orders to deal with the matters which are the responsibility of the Leyton Council. (ii) Swine Fever (Infected Areas) Order, 1953. The Swine Fever (Infected Areas) Order, 1953—made by the Ministry of Agriculture and Fisheries (Animal Health Division) pursuant to Section 20 of the Diseases of Animals Act, 1950— came into operation on the 27th April, 1953. Its object is to prevent the spread of infection of swine fever by imposing restrictions governing both the holding of markets of swine and the movement of swine into, out of, and within the areas specified (which include the County of Essex). On 18th November, 1953 a circular letter was received from the Ministry stating that the swine fever position had improved, and that it was possible to withdraw the special restrictions. (a) Licences Issued. While the above Order was in force seven licences were granted, involving a movement of 56 pigs from this Borough to a neighbouring authority for slaughter. (iii) Fowl Pest. Diseases of Animals (Extension of Definition of Poultry) Order, 1953. Psittacosis or Ornithosis Order, 1953. The above Orders came into force during the year and are primarily concerned with the control of fowl pest. Measures were 99 taken to publicise their requirements by inspection and the circulation of leaflets and posters as required by the Diseases of Animals Act, 1950. The following is an extract from a letter circulated to poultry keepers, bird fanciers, pet shops and corn chandlers throughout the Borough :— " Investigations into recent outbreaks have revealed that one of the most important provisions of the Live Poultry (Restrictions) Order, 1952, is not in all cases being strictly observed. This is the rule that makes it an offence for live poultry to be moved from premises on to which any live poultry have been moved during the preceding 28 days. The main reason for this provision is that if poultry are in the incubative stage offowl pest when they are moved on to any premises, the symptoms should become noticeable in those birds or in the contact birds during this detention period of 28 days. The only exceptions to this rule are that live poultry may be moved from authorised markets and from shows organised by an agricultural society or poultry club. The rule applies to all other premises including premises on to which birds have been moved from a show or a market during the previous 28 days. Strict adherence to this rule by poultry-keepers is of vital importance in preventing the spread of fowl pest. The Diseases of Animals (Extension of Definition of Poultry) Order, 1953, extends the definition of ' poultry ' in the Diseases of Animals Act, 1950, so as to include parrots and certain other birds likely to spread the disease known as psittacosis (or ornithosis) and fowl pest. The Psittacosis or Ornilhosis Order, 1953, extends the definition of the expression ' disease ' for the purposes of the Diseases of Animals Act, 1950, to include the disease known as psittacosis or ornithosis so that the provisions of that Act may apply to domestic poultry, parrots and other birds affected with, or suspected of being affected with, the disease. The Order also provides for the detention and isolation of affected or suspected birds and for the cleansing and disinfection of premises and utensils used for such birds. Copies of the above-mentioned Orders can be purchased from H.M. Stationery Office, Kingsway, W.C.2, price 3d. each." 100 ATMOSPHERIC POLLUTION. Smoke Abatement. (i) Inspections by Sanitary Inspectors. Some 89 observations were made of the quantities of smoke emitted from chimneys of industrial and commercial premises. Letters were sent to the management of a number of business undertakings regarding excessive smoke and grit emission, but no statutory nuisance was established within the terms of the Public Health Act, 1936. (II) Report of the Committee on National Policy for the use of Fuel and Power Resources. The following is an extract from a special report submitted to the Public Health Committee by the Senior Sanitary Inspector in March, 1953 :— In July 1951 the Ministry of Fuel and Power appointed, under the chairmanship of Viscount Ridley, C.B.E., a Committee on National Fuel Policy to consider whether any further steps could be taken to promote the best use of the nation's fuel and power resources having regard to growing demands and in the light of technical developments. The Report is an informative document and brings to light differences of opinion held by the National Coal Board, the British Electricity Authority and the Gas Council. The National Coal Board state in their evidence that the use of electricity for ordinary heating purposes, for 6pace heating, water heating or cooking, is incompatible with the national interest; and that, if the load were taken by coal (either burnt raw or after conversion into coke and gas) not only would the nation 6ave seven million tons of raw coal, but load-shedding would end and the electricity supply industry would be able to meet any likely expansion in the demand for electricity for purposes of light and power without using more coal than at present. The Coal Board claims that unless the heating load now carried by electricity is removed coal will become scarcer still, that there will be an everincreasing use of the wrong fuels for heating purposes, and that the efficiency of coal utilisation will decline. Their remedy is the expansion of the carbonisation industry, the production of more coke (which in its turn would force consumers to abandon inefficient grates and replace with new smokeless appliances) and the expansion of bricquetting. 101 The British Electricity Authority on the other hand claims that in the lighting, cooking, water heating and space heating fields, electrical methods are in general more efficient from a fuel utilisation point of view than the methods they have replaced. Rising standards of hygiene and comfort in an increasing population have been obtained without any commensurate increase in the total quantity of fuel consumed, including the coal equivalent of gas and electricity, and with a substantial diminution of atmospheric pollution. The Authority argues that the theoretical advantages of certain types of modern solid fuel appliances are minimised by such factors as :— (i) the inability of the average householder to maintain the theoretical practical efficiency ; (ii) the tendency to use more efficient apparatus to secure greater comfort rather than to save fuel; (iii) the additional materials and labour needed to produce such appliances ; (iv) the physical disadvantage of transporting and utilising solid fuel. The Gas Council claims that the provision of domestic heat services by an appropriate combination of gas and coke results in a smaller demand on coal resources than any alternative method, and that appropriate heat services can be provided by the medium of gas with a substantially smaller capital investment than is required by alternative methods. These basic arguments are the subject of considerable controversy among the three bodies mentioned, and show how very difficult it is to say categorically what is the right pattern for fuel use. For those of us whose professional interests lie in the field of atmospheric pollution and its prevention the controversy is academic rather than practical. Main Sources of Atmospheric Pollution. (i) Some 12 million old fashioned domestic open fire grates burn more than 30 million tons of coal a year and produce one million tons of smoke. Thus the townsman pays heavily for smoke, both directly as a coal consumer and as a citizen living in a dirty atmosphere. (ii) Smaller industrial boilers and furnaces burning raw coal. (iii) Steam railway locomotives. (It is interesting to note the omission of large industrial boilers and furnaces as smoke producers.) 1(2 Cost to the Community. The heavy social and monetary cost of smoke pollution to the community is emphasised by the Committee. Among the social costs are the loss of sunlight and the harm to the health of citizens ; the reduction in the amenities of town life ; the damage to buildings and textile fabrics ; the extra costs of painting, washing and laundry ; and the loss of food production which results from the smoke deposited in the countryside around towns. These are only a few of the main losses incurred by the community due to smoke. Proposals. Proposals are made in the Report for increasing efficiency by each of the three main smoke producing users. These include :— 1. Domestic Use. (а) The development of more efficient types of open fire which will burn coal with less smoke and even greater efficiency than the standard improved fires now coming into popular use. (b) The use of more gas domestically during peak hours of the electricity supply system, with correspondingly greater supplies of coke. 2. Industrial Use. (a) Expansion of the fuel advisory services. (b) Financial incentives to firms for installing fuel efficiency equipment. (c) Requirement of prior approval for heating installations in new industrial and commercial buildings. (b) More schemes for training stokers in the efficient and smokeless firing of boilers and furnaces. 3. Steam Railway Locomotives. As there appears to be no practicable method of making the standard steam locomotive fuel efficient and smokeless, progress must come from the switch to other methods of traction. The Committee also considered more general adoption of smoke Byelaws and the establishment of smokeless zones. They did not feel that at the present time the extension of Byelaw control would 103 make a great contribution to the smoke problem ; but they felt that, as the number of suitable appliances and the amount of smokeless fuel increases, there is a good case for more widespread declaration of smokeless zones. The wealth of technical data and the recommendations set out in the Report provide food for thought for Public Health Committees and officials who are concerned with the evils of smoke pollution and who are anxious to see some progress towards its abatement. The recommended increase in the use of improved domestic appliances is not likely to have any substantial effect on atmospherical pollution unless smokeless fuels are used. The use of unwashed nutty slack in slow burning grates, which produce dense smoke over long periods, is hardly the answer to the smoke problem. When considering this question of smoke abatement it is well to remember that it means more than the removal from the atmosphere of visible smoke. Sulphur dioxide is not less important because its presence is felt rather than seen. Grit emission from large industrial furnaces, which show little (if any) smoke, poses a problem extremely difficult of solution. (iii) Smokeless Zones. The following is an extract from a special report on the above subject submitted by the Senior Sanitary Inspector to the Public Health Committee at its meeting on 14th July, 1953. " Smokeless Zones " are areas in which all smoke and other material pollution are prohibited, and may be of any size from a few acres upwards. Essential requirements are : (i) Possession of necessary statutory powers. (ii) The conversion of existing obsolete domestic open fires and ranges to modern type suitable for smokeless fuel with gas ignition. (iii) Replacement of inefficient industrial furnace installations by modern smoke-consuming appliances. (iv) Adequate supplies of smokeless fuel for domestic users. (v) Adequate supplies of suitable fuel for industrial furnaces. 104 Possible Establishment of Smokeless Zones in Leyton—Factors to be Considered. Sources of Atmospheric Pollution. Since Leyton is one small unit in a large belt of smokeproducing Boroughs, it is necessary to consider the sources of atmospheric pollution in relation to the Greater London area as a whole. The main sources of pollution are :— (a) Old-fashioned domestic open-fire grates burning ordinary solid fuel. (b) Modern domestic open-fire grates burning bituminous coal instead of the smokeless fuel for which they were designed— due to scarcity of supplies and cost of smokeless fuel. (c) Smaller industrial boilers and furnaces burning raw coal. (d) Steam railway locomotives. (e) Sea-going ships and coastal vessels using the River Thames and docks. Town Planning. The Borough's future planning and redevelopment proposals must figure prominently in the selection of any area as a proposed smokeless zone, having regard to heavy expenditure likely to be incurred by the Council and/or the owners in converting existing appliances. The geographical layout of Leyton differs very considerably from that of the cities of Coventry and Manchester, where such zones have been established, in that there is no central area predominantly commercial—offices, shops and places of entertainment. Unlike Coventry, Leyton contains no blitzed vacant sites suitable for large-scale replanning and rebuilding without considerable interference with and demolition of existing premises. Smokeless zones are likely to be of little value unless, sooner or later, they are able to expand. This would involve liaison with neighbouring Boroughs, and reference to the County of London development plan. Without room for expansion a smokeless zone in Leyton would be no more than a small smokeless island surrounded by a permanent sea of smoke ; and, since the smoke-polluted atmosphere of Greater London is not likely to respect our boundaries, little (if any) material advantage would be gained. The situation is rendered more complicated by reason of the fact that it would be difficult, if not impossible, to control smoke from steam railway locomotives passing through Leyton. 105 General Observations. Leyton is one small unit in a large belt of smoke-producing Boroughs. Having due regard to this, and the afore-mentioned factors, it would appear to be neither practicable nor profitable to attempt to deal with the problem of atmospheric pollution in Leyton by the setting up of smokeless zones without also taking into consideration the Greater London Area as a whole. The problem of smoke abatement is closely related to redevelopment—relocation of industry, slum clearance and new housing. Many of the questions to be considered in creating smokeless zones are of national as well as of local significance—a Central Government Committee of Enquiry has already been set up to investigate and report on atmospheric pollution. In conclusion, attention is drawn to the fact that Leyton is one of the few Boroughs throughout the country which possesses special local powers for smoke prevention not contained in national legislation. Section 50 of the Leyton Corporation Act, 1950, imposes restrictions on the type of new furnaces installed for steam raising in certain types of industrial and commercial buildings. The furnaces must, as far as practicable, be capable of being operated continuously without emitting smoke. Although this Section is not applicable to domestic premises, the desirability of installing appliances suitable for smokeless fuel in new housing will no doubt be borne in mind by the appropriate Department of the Council when plans for future housing development in the Borough are considered. Prior approval of proposed fuel burning installations should be regarded as supplementary to the smokeless zone. As a method of control of atmospheric pollution in an area it is less spectacular and of lesser news value than the smokeless zone, but is more practical in its operation in that control is applied to individual cases as they arise and it consequently produces less opposition and is more practicable than the immediate prohibition of all smoke by one comprehensive enactment. It is one thing to abate smoke to below an accepted nuisance level and another to abolish it entirely as must be done in smokeless zones. 106 Investigation carried out in conjunction with the Department of Scientific and Industrial Research. Investigation. A description of the procedure adopted for the systematic measurement of the concentration of atmospheric smoke and sulphur dioxide was given in my Report for 1950. Daily observations, which were begun in March 1950, have continued throughout 1953 with the exception of four weeks in March and April, when observations had to be suspended owing to damage to the apparatus by trespassers. The investigation is carried out in full co-operation with the Fuel Research Station of the Department of Scientific and Industrial Research. A summary of the observations is included in the monthly " Atmospheric Pollution Bulletin " published by the Department. The recording apparatus is situated at the Public Health Department, Sidmouth Road, E.10. The following tables show the results recorded during 1953, together with the corresponding figures for 1952. No results are available for the month of March, 1953 ; and the figures for April relate to 14 days only. CONCENTRATION OF SMOKE EXPRESSED IN MILLIGRAMS PER 100 CUBIC METRES. Month Monthly average Highest daily average Lowest daily average 1952 1953 1952 1953 1952 1953 January 35.3 48.7 89.7 162.6 14.4 9.0 February 43.7 26.3 79.6 60.1 17.5 10.5 March 30.0 ... 110.5 ... 12.7 ... April 17.6 12.5 36.1 28.9 3.9 4.7 May 5.8 4.9 12.0 16.2 1.9 1.9 June 5.0 4.0 9.6 7.6 2.9 0.5 July 3.5 3.1 7.6 5.6 0.7 0.5 August 5.6 3.7 12.5 5.6 1.4 2.0 September 10.3 6.5 20.1 21.4 5.1 1.5 October 26.2 26.3 111.9 71.4 8.4 4.4 November 39.0 36.6 94.6 115.6 5.7 12.1 December 59.5 36.7 219.5 56.8 8.1 22.0 107 CONCENTRATION OF SULPHUR DIOXIDE EXPRESSED AS PARTS PEI 100 MILLION. Month Monthly average Highest daily average Lowest daily average 1952 1953 1952 1953 1952 1953 January 8.5 13.7 20.1 45.9 4.5 3.6 February 10.7 8.8 29.9 24.3 4.3 3.5 March 7.1 ... 16.5 ... 1.6 ... April 5.5 4.5 10.7 13.3 1.2 1.2 May 2.7 2.3 6.2 5.8 1.2 1.1 June 2.6 2.4 4.2 5.6 1.7 0.4 July 1.8 2.1 4.1 3.2 0.5 0.2 August 2.5 2.5 4.6 3.9 0.9 1.6 September 3.6 3.7 6.2 9.4 1.5 1.7 October 6.7 7.7 15.3 18.8 3.6 3.1 November 8.7 12.5 22.4 29.2 3.4 4.6 December 17.1 13.2 64.0 21.6 4.0 4.9 The total amount of smoke pollution recorded during the year was 16.7 per cent, less than in 1952. The concentration during December 1953 was abnormally low—only a little more than half that recorded during December, 1952. This reduction was no doubt due to the mild weather which prevailed during December 1953, compared with the very cold, foggy conditions of the previous year. The total amount of sulphur dioxide recorded in 1953 was slightly greater (4.3 per cent.) than in 1952. At the request of the Director of Fuel Research, a special additional investigation was undertaken in April and was continued throughout the year. This involved the daily determination of the amount of both " fixed " and " free " acids in the air, and also the amount of atmospheric ammonia. The following graphs show the annual and monthly variations of smoke and sulphur dioxide pollution during each of the past four years. 108 ANNUAL VARIATION OF SMOKE ANNUAL VARIATION OF SULPHUR DIOXIDE 109 National Health Service Act, 1946 Part III 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. SECTION 22 CARE OF MOTHERS AND YOUNG CHILDREN. Births. 1,279 births were registered during the year :— Males Females Total Legitimate 645 594 1,239 Illegitimate 20 20 40 665 614 1,279 The birth rate per 1,000 of the population was thus 12.39. 1,300 notifications of births were received during the year From medical practitioners 29 From midwives 1,271 Ante-natal Clinics. Attendances .— First Subsequent Attendances Attendances Total 742 3,589 4,331 The above figures include expectant mothers in attendance at the Ante-natal Clinics held at the Council's four Centres and at the homes of the two municipal midwives. The number of home visits made by health visitors to expectant mothers during the year was 178. 110 HEALTH CLINICS—CLINIC SESSIONS Health Ciinic 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 Antenatal Dental Minor Ailment Ophthalmic Orthoptic Minor Ailment Dental P.M. Dental Infant Welfare Dental Infant Welfare Dental Orthoptic Infant Welfare Ophthalmic Dental Immunisation P.N. (2nd and 4th) A.N. Exer. Orthopaedic (1st Thurs.) Dental Orthoptic Special Medicals A.N. Exer. (Alt. Fridays) Park House Granleigh Road, E.ll. (LEYtonstone 3050, Ext. 268) A.M. Dental (1) Minor Ailment Ante-natal (2nd and 4th) Oral Hygiene Dental (1) Oral Hygiene Minor Ailment Dental (1) & (2) Minor Ailment Oral Clinic Dental (1) Oral Hygiene Minor Ailment Dental (1) Oral Hygiene Minor Ailment Dental (1) alternate Minor Ailments Oral Hygiene (Alt.) P.M. Dental (1) & (2) Ante Natal Exercises Dental (1) Oral Hygiene Infant Welfare Dental (1) & (2) lnfant Wefare Dental (I) O.al Hygiene Infant Welfare Dental (1) Immunisation Ante Natal Exercises 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 (1) Minor Ailment Dental (1) & (2) Minor Ailment B.C.G. Minor Ailment P.M. Dental (1) & (2) Infant Welfare Foot Clinic Dental (1) & (2) Immunisation Dental (2) Foot Clinic Infant Welfare Foot Clinic Dental (1) & (2) Foot Clinic Ante Natal Exercises Evening Foot Clinic Foot Clinic Ill Ante-natal Exercises for Expectant Mothers. Recent developments in obstetrics have shown that labour is easier and less painful, and convalescence shorter, in the case of women who have practised certain -exercises—especially relaxation exercises—during pregnancy. In order to be in a position to provide the necessary facilities, arrangements were made for a special course of instruction to be given to local health visitors at S.E. Essex Technical College. After the health visitors had completed the course of training, arrangements were made for a special weekly session of one hour's duration to be held at each of the three clinics in this area (Leyton Green, Park House and Dawlish Road). During these sessions instruction in ante-natal exercises is given to expectant mothers by health visitors who have undergone a special course of training in this work. It is considered that these exercises are beneficial to all primiparae, unless in cases where there is some contra-indication on medical grounds. The best time to begin the course is from the third to fifth month of pregnancy, and there are some 12 weekly lessons. Classes are held at the following times :— Leyton Green Clinic Thursdays 2.30 to 3.30 p.m. Park House Clinic Fridays 2.30 to 3.30 p.m. Dawlish Road Clinic Fridays 2.30 to 3.30 p.m. The first sessions were held on Thursday and Friday, 15th and 16th January, 1953, and the domiciliary midwife who has been booked for the confinement co-operates in the arrangements. Early in December, 1952, a letter outlining the arrangements had been addressed to all Leyton doctors who have undertaken to provide maternity medical services. Since the arrangements became available some 75 expectant mothers have made 497 attendances ; and, as far as can be judged from unsolicited testimonials, the facilities are much appreciated by expectant mothers. Child Welfare Clinics. On page 112 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. 112 ATTENDANCES, EXAMINATIONS, etc., 1951—1953. Leyton Green Park House Dawlish Road All Centres 1951 1952 1953 1951 1952 1953 1951 1952 1953 1951 1952 1953 Under 1 year— 1st attendances 487 413 344 573 506 472 46 262 251 1,106 1,181 1,067 Subsequent attendances 6,345 6,275 4,904 6,797 6,108 5,880 650 3,641 3,742 13,792 16,024 14,526 Total attendances 6,832 6,688 5,248 7,370 6,614 6,352 696 3,903 3,993 14,898 17,205 15,593 1-5 years— 1st attendances 96 60 67 89 85 69 17 79 40 202 224 176 Subsequent attendances 3,343 2,161 2,475 3,090 2,669 1,995 355 2,007 2,129 6,788 6,837 6,599 Total attendances 3,439 2,221 2,542 3,179 2,754 2,064 372 2,086 2,169 6,990 7,061 6,775 Total attendances, both age groups 10,271 8,909 7,790 10,549 9,368 8,416 1,068 5,989 6,162 21,888 24,266 22,368 Average attendance per session at Infant Clinics 56.12 48.36 46.92 54.15 52.08 48.93 31.38 54.6 48.9 53.27 51.68 48.31 Number examined by clinic doctor 3,451 2,942 2,601 3,631 3,376 2,601 398 1,768 1,726 7,480 8,086 6,524 Number weighed 10.363 8,906 7,783 10,581 9,492 9,163 1,085 5,951 6,164 22,029 24,349 23,110 Dawlish Road Clinic was opened to the public on 22nd September, 1951. 113 Post-natal Clinic. Leyton Green Clinic Lady Raleigh Training Home Total No. of Sessions 15 20 35 Letters of Invitation 235 172 407 First Attendances 111 102 213 Re-Attendances 87 148 235 Conditions found on examination :— Leyton Green Clinic Lady Raleigh Training Home Subinvolution of the uterus 1 5 Cystocele and rectocele 6 4 Retroversion of uterus 10 11 Anaemia ... 3 Breast complications ... 1 Vaginitis 6 3 Deficient perineum 1 2 Erosion of cervix uteri 20 ... (a) Not requiring treatment ... 7 (b) Requiring treatment ... 11 Prolapse 1 1 Miscellaneous ... ... Pruritus, obesity etc. ... 5 Pregnancy 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. (а) Number of premature infants notified during the year (including transferred notifications) whose mothers normally reside in the Authority's area. (b) Premature infants born in the area (whether their mothers normally reside in the area or not) but excluding babies born in maternity homes and hospitals in the National Health Service. (1) Born at home 25 (2) Born in hospital or nursing home 67 25 114 Born at Home Nursed Entirely at Home Transferred to Hospital Died in First 24 hours Died on 2nd to 7th day Died on 8th to 28th day Survived 28 days Total 3lb. 4oz. or less 1 ... 1 ... 2 31b. 5oz.—41b. 6oz. ... ... ... ... 2 2 41b. 7oz.—41b. 15oz. ... ... ... ... 4 4 51b.—5lb. 8oz. 2 ... 1 1 13 17 Puerperal Pyrexia. Forty-four cases of puerperal pyrexia were notified during the year. Maternity Mortality. There were no maternal deaths of Leyton residents during the year. Dental Treatment. Report by the Area Dental Officer (Mr. A. E. Hall). Inspection and treatment was given to all expectant and nursing mothers and pre-school children referred to the dental officers by medical officers at the three local authority clinics, and many pre-school children, who had been treated in the past, were brought back for re-inspection and treatment if necessary. The oral hygienist (Miss Watts) saw many of these mothers for prophylactic work, and gave talks on dental hygiene. The longterm value of this aspect of dentistry cannot be easily estimated, but there can be no doubt that an educational service of this kind is bound to do much to establish the habit of regular care of the teeth, coupled with periodical visits to the dentist for inspection, instead of the old method of waiting for pain to announce the onset of trouble. Many teeth, which could not be filled due to advanced decay in the mouths of young children, were 6aved temporarily by the application of silver nitrate, thus avoiding extraction and eliminating one predisposing cause of irregularity in the second dentition. (A) NUMBERS PROVIDED WITH DENTAL CARE. Examined Needing treatment Treated Made Dentally Fit Expectant and Nursing Mothers . 144 142 142 130 Children under five 502 484 484 410 (B) FORMS OF DENTAL TREATMENT PROVIDED. Extractions Anaesthetics Fillings Scalings or Scaling and Gum treatment Silver Nitrate treatment Dressings Radiographs Dentures provided Local General Complete Partial Expectant and Nursing Mothers 250 75 51 95 65 7 179 36 8 8 Children under five 802 72 297 221 1 861 305 3 ... ... 115 116 With a staff of dental officers more nearly approaching establishment it would be possible to recall these very young children for examination every three months, and so enable them to preserve their temporary dentition until the natural time for shedding. All children referred from day nurseries were seen and treated at the dental clinics. Orthopaedic Treatment. Primary Examinations.—During the year 23 children were referred from the Child Welfare Clinics to the Orthopaedic Surgeon. The following conditions were found :— Pes piano valgus 9 Pes piano valus with marked intoeing 1 Genu-valgum 2 Genu-valgum with pes planus 2 Genu varum 1 Varus deformity 2 Talipes calcaneo valgus 2 Dorsiflexion—both feet 1 Trigger thumb 1 Bowed tibia 1 Overriding toes 1 Re-examinations.—In addition to the 23 new cases mentioned above, 19 children under five years of age attended for reexamination by the Orthopædic Surgeon. The following conditions were seen at re-inspections :— Pes piano valgus 8 Genu valgum 1 Intoeing 1 Talipes calcaneo valgus 2 Digitus varus 1 Congenital mid tarsal varus 1 Pies piano valgus and genu valgum 3 Torticollis 1 Lymphatic cyst 1 Provision of Wedges. Wedges to boots were supplied in respect of 25 children. 117 X-Rays. Arrangements were made for two children to be X-rayed. Admission to Hospital. One child under 5 years of age was admitted to hospital for operative treatment to trigger thumb. Physiotherapy. One child was referred to hospital for treatment. Special Eye Clinic. The Consultant Ophthalmic Surgeon had referred by the Clinic Medical Officers 51 pre-school children, who made 81 attendances for examination and treatment. Convalescent Home Treatment. Children. Six children recommended by the clinic medical officers were sent to convalescent homes. Mothers and Children. Arrangements were made for three 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 Neo-natal 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 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 1953 1,279 30 21 23.45 16.05 29 22.17 118 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. (1) Ellingham Road Day Nursery, Ellingham Road, Leyton, E.15. (Tel. MARyland 3683). (2) Knotts Green Day Nursery, Leyton Green Road, Leyton, E.10. (Tel. LEYtonstone 4100). Day Nursery Facilities Introduction of Standard Charge. Ministry of Health Circular 23/52 authorised the making of charges for Day Nurseries on the basis that the standard charge per day (including charges for meals or articles provided) shall not exceed a sum based on the actual cost of the Council's day nursery services, including a sum representing a fair apportionment of central administration costs ; and intimated that it is for the Local Health Authority to determine in each individual case whether any (and, if so, what) charge—within the limits of the standard charge— would be reasonable, having regard to the means of the persons concerned. The County Treasurer reported to the Health Committee that the average daily cost of Day Nursery facilities, based on the number of places provided, but excluding administrative charges, was 7s. 7d. per place per day for the year ended 31st March, 1952 ; and the County Council approved the introduction of a charge of 7s. 6d. per full day per child in the Nurseries with effect from 18th January, 1953. As a result of the introduction of the standard charge, 22 of the 42 persons who were assessed to pay the full weekly charge of £1 17s. 6d. withdrew their children from the Nurseries in the area. The waiting list at Ellingham Road Day Nursery was completely expended, and the list at Knotts Green Day Nursery was reduced to six. Some idea of the effect of the introduction of the standard charge (on 18th January, 1953) may be obtained from a perusal of 119 the statistical information submitted in the table appearing on the following page. The table shows—in respect of each of the two Day Nurseries in the area— (a) the number of children in attendance, and (b) the number awaiting admission, in the months before, during and after the introduction of the standard charge, and at the end of the year. It is clear, especially from the serried rows of blanks in the upper part of the waiting-list figures, that the original scheme of categories recommended for priority of admission bears no relationship to conditions now obtaining. Knotts Green Ellingham Road Total 0-2 yrs. 2-5 yrs. 0-2yrs. 2-5 yrs. 0-2 yrs. 2-5 yrs. No. of approved places at end of year 15 35 15 35 30 70 No. of children on register at end of year 13 47 14 46 27 93 Total attendances during year 2,539 9,647 2,426 7,403 4,965 17,050 No. of days Open 254 255 National Nursery Examination Board. Four 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 59 students who have sat for the examination, 55 have been successful in obtaining the Certificate. 120 DAY NURSERIES. Categories Children in Nursery Children on Waiting List 31 Dec., 52 31 Jan., 53 9 Feb., 53 31 Dec. 53 31 Dec., 52 31 Jan., 53 9 Feb., 53 31 Dec., 53 E.R. K.G. E.R. K.G. E.R. K.G. E.R. K.G. E.R. K.G. E.R. K.G. E.R. K.G. E.R. K.G. 1. Employed unmarried mothers who wish to keep their babies with them when not at work 5 5 3 5 3 5 7 5 ... ... ... ... ... ... ... ... Motherless children 1 1 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 2. Employed widows 1 4 1 3 1 4 5 7 ... ... ... ... ... ... ... ... Divorced from husbands 1 1 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... Separated from husbands 8 10 8 6 6 7 9 9 3 ... ... ... ... 1 ... ... Deserted by husbands ... 4 ... 4 ... 2 ... 2 ... ... ... ... ... ... ... ... Those who have children of whom their husbands are not the fathers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Mothers employed in industries vital to production for essential home needs and for exports 44 30 45 35 44 32 36 33 26 54 ... 1 ... 2 2 11 4. Mothers who are ill or being confined ... 5 ... 4 ... 5 3 4 ... 1 ... 2 ... 3 ... ... Total 60 60 60 57 57 56 60 60 29 55 ... 3 ... 6 2 11 Abbrevations: E.R. = Ellingham Road Day Nursery. K.G. = Knotts Green Day Nursery. 121 SECTION 23 MIDWIFERY. Record of Cases attended by Council Midwives, 1953. Midwives Total Essex County Council Attached to the Lady Rayleigh Training Home, Beachcroft Road Cases attended :— (a) As Midwives 97 180 277 (b) As Maternity Nurses 8 24 32 Ante-natal Visits 513 727 1,240 Ante-natal Examinations 780 1,067 1,847 Post-natal Visits 1,702 5,421 7,123 Administrations of Gas and Air Analgesia 87 119 206 Administrations of Pethidine 41 59 100 Administration of Gas and Aer Analgesia. Of the Council's two Municipal Midwives directly employed, both 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 277 Number of administrations of gas and air analgesia 206 Percentage of administrations 74.36 Maternity Sets. Maternity sets were issued to 246 expectant mothers who were having domiciliary confinement. 122 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 Nil (2) Others 98 Total 98 Fees paid to Doctors. Seventy 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 £207 17s. Od. 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. DOMICILIARY MIDWIVES. Lady Rayleigh Training Home, Beachcroft Road, Ley tonstone, E. 11 Telephone: LEY 2385 Miss E. Daines, 149, Francis Road, E.10 LEY 4909 Mrs. C. L. Wackett, lll.Fairlop Road, E.ll LEY 4731 123 INWARD TRANSFERABLE BIRTHS—1953. Births in Institutions, Maternity Homes and private dwellings outside the Borough of Ley ton during 1953. Queen Mary's Hospital, E.15 209 Forest Gate Hospital, E.7 201 Plaistow Maternity Hospital, E.13 18 Wanstead Hospital, E.ll 57 Thorpe Coombe Maternity Home, E.17 83 Mounts Bay Maternity Home, E.17 7 Mothers Hospital, E.5 281 Hackney Hospital, E.8 40 Royal Northern Hospital, N.7 2 St. Andrews Hospital, E.3 2 London Hospital, E.l 10 German Hospital, E.8 4 St. Bartholomew's Hospital, E.C.I 3 Bearstead Memorial Hospital, N.16 10 Westminster Hospital, S.W.I 1 University College Hospital, W.C.I 2 Royal Free Hospital, W.C.I 3 Uford Maternity Hospital, Ilford 4 Mile End Hospital, E.l 4 Maycroft Maternity Home, E.18 3 Queen Charlotte's Hospital, W.6 1 Whittington Hospital, N.19 1 Belsize Grove Maternity Home, Hampstead, N.W 2 East End Maternity Hospital, E.l 2 St. Margaret's Maternity Home, E.9 1 St. Mary's Hospital, Colchester 1 Guy's Hospital, S.E.I 1 St. George's Hospital, S.W.I 1 Elizabeth Garrett Anderson Hospital, N.W.I. 1 Oldchurch Hospital, Romford 1 Others (private dwellings, etc.) 7 Total 963 124 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 during the war years, due to evacuation of expectant mothers, and subsequently 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 1953 74.07 125 SECTION 24 HEALTH VISITING. Health Visitors. During the year the Health Visitors made 15,367 visits to homes. (a) To expectant mothers :— First visits 119 Total visits 178 (b) To children under 1 year of age :— First visits 1,309 Total visits 6,897 (c) To children between the ages of 1 and 5 years 5,189 (d) Other visits :— Whooping cough 10 Measles 7 Ophthalmia neonatorum Discharging eyes 27 Diarrhoea Puerperal Pyrexia 16 Children's Act 16 After deaths 51 After stillbirths 29 Miscellaneous 761 Ineffective 2,069 Old people 39 Hospital follow-up 78 Chest Clinic. In addition to the above the Health Visitors attached to the Chest Clinic at 180, High Road, Leyton, interviewed 3,374 patients at the Chest Clinic, made 3,385 home visits and interviewed 3,050 patients at home. 126 THE HEALTH VISITOR. (Report by Dr. Mary Gilchrist) Recently there has been much controversy about the function of the Health Visitor, and the training and experience she should have. Some have gone so far as to state that she should not be a State Registered Nurse, should have a minimum of nursing training, and go on to a University for a Social Science Course and then become the "Social Worker" visitor in an area. Those who advocate this course have lost sight of the " universal " function of the health visitor. The health visitor goes to every home where a newly-notified birth has been recorded, and it is her duty to follow up that child until it enters school; and then, if she does combined duties under the National Health Service Act and the Education Act, she will continue to see the child in school. She should be the guide, philosopher and friend of the parent and the child. She gains her entry to the home primarily because she can help the mother with the management of the child's physical needs. Nowadays, with small families the rule rather than the exception, many young mothers have no previous experience of handling a young infant, and they are greatly helped by the reassurance which the experienced health visitor can give. All Training and Refresher Courses for health visitors now emphasise the importance (for future mental health) of the proper handling of the young infant emotionally, and this aspect of their work is likely to grow in importance as its significance becomes more widely appreciated. What has to be realised by the administrator and teacher, outside of the actual field of work of the health visitor, is that only a very small proportion of the visiting deals with problem families (except in an exceptionally bad social-problem area of a town). It is known that these families take up a disproportionate amount of the health visitor's time, but the greatest contribution is really made in preventing her " border line " families from becoming fully developed problem families, and her contact with this group is made primarily because she is a nurse. The social worker can deal only with the developed case and rehabilitation, but the health visitor is the preventive worker, and I cannot see how a social worker can take her place in this respect. 127 The health visitor is also the interpreter to the family of the social and preventive Health Services provided by the local authority, and she could be of great assistance to the general practitioner in these cases where advice and support is needed as distinct from the actual nursing work carried out by District Nurses who have a quite different function to perform. The duties of the health visitor cover many fields: care of mothers and young children, responsibility for the supervision of the health and hygiene of the school child, care and after-care of tuberculous patients and liaison with the Chest Clinic physician, responsibility for after-care visits to discharged hospital patients, and increasingly advising on the care of the aged in their own homes; and along with all this continual "Health" education of families in her district—not only in physical matters but in the factors nowadays considered important in promoting mental well-being. To do this exacting work, the practitioner of it requires not only the specialised training as given in the very exacting Health Visitor's Certificate Course, but the right personality and a sense of vocation if she is to influence profoundly the families in her care. She has a preventive function to perform—to see that the borderline problem family is enabled to help itself before it falls into the category requiring the care of the social worker, probation officer and others, and for this her personality and prestige is allimportant. We in Leyton are well served by the team of Health Visitors (never unfortunately at full strength) we have working for us here. There is another function the health visitor has lately been called upon to perform to an unusually marked degree and that is in a collection of information for Medical Research projects. 128 MEDICAL RESEARCH. Medical Research is generally recognised to be of two more or less distinct kinds :— (i) Clinical or bedside research, carried out by hospital and laboratory staff; and (ii) Epidemiological or social research, the sphere of those who are concerned with preventive medicine and the public health. Before the second world war much valuable research work was carried out by the members of the medical staff of the Public Health Department, and the Annual Reports of the Medical Officer of Health of that time contained the results of many valuable pieces of research undertaken and completed by the staff. Dining my tenure of office in Leyton I have been fortunate in being associated with colleagues who have been not only well qualified to take part in research work, but keen at all times to undertake special investigations of current interest without any consideration as to whether the work either could or should be done in Council hours or at home. The Annual Reports of the Medical Officer of Health of Leyton used to be substantial publications of more than 200 pages, of which a large proportion was devoted to the results of special investigations carried out by the staff of the Health Department. Unfortunately the war, and the shortage of paper, caused strict curtailment of these Annual Reports, and they have not yet recovered their pre-war position as repositories of local epidemiological research and special investigation. One reason may be that the initiation of the National Health Service, and the upheaval it caused in health departments, has interfered with the keenness of health officials to add to the already great amount of paper work. One of the most salutary effects of the National Health Service is that it has led to the " discovery " by medical research workers outside the Local Government field of the Health Visitor and to the use by them of her unrivalled knowledge of the family in the home in the setting up of the many and varied enquiries on subjects of medical and social interest. So many demands have been made in the last year or so by outside organisations that no research work initiated locally could have been carried out. However, as the research work initiated by these outside bodies would ultimately 129 be of use, when the results were tabulated and summarised, to the preventive services, no one grudged the time spent on visiting the homes and completing the questionnaires (many at great length) and arranging medical examinations, etc., if such were required by the authority interested in the research. In Leyton since 1946 the staff have assisted in the following projects :— 1. A survey of social and economic aspects of pregnancy and childbirth undertaken by a joint committee of the Royal College of Obstetrics and Gynaecology and the Population Investigation Committee. This consisted at first of visiting and obtaining much information about every child born in Leyton during one week in March, 1946. Every area of the country took part in this survey and much useful information was obtained, since reported upon in the medical press. These children are still being followed up and the survey is now being carried on by the Population Investigation Committee, the Society of Medical Officers of Health and the Child Health Institute of the University of London. There are some 13-14 children still under review in Leyton, reported on by the School Medical Officer, the Health Visitor and the School Nurse. Now that these children are in school, information on their progress is available. 2. In August, 1950, the Tuberculosis Research Unit of the Medical Research Council initiated a very useful piece of research work into the preventive aspect of B.C.G. inoculations given to school leavers in secondary schools. Leyton was one of the areas chosen to participate in the work. It started in 1950, and still continues. Some 250 children are in this investigation. They are visited twice yearly by the Health Visitor/School Nurse, and twice yearly four evenings are given up to helping at the skin testing: and X-ray sessions when the Medical Research Council Tuberculosis Research Units visits Leyton. This piece of research work into the value of B.C.G. vaccination is of great interest, and its results, which will not be completed for another two years at least, are eagerly awaited as upon the findings of the work will depend future policy as regard the giving of B.C.G. vaccination to susceptible members of the population. 3. In 1952 we agreed to take part in a survey initiated by the Institute of Preventive Medicine in Cardiff whereby all children 130 born in 1952 were visited once a month in order to record the illnesses experienced by that child each month until the child was one year old. This proved a very heavy burden indeed and entailed much more work than had been expected, especially as the Health Visiting staff was never at full strength. The work began on 1st January, 1952, and was completed by 31st December, 1953. 4. In September, 1952 we were asked to participate in a special enquiry into the causes of prematurity, conducted by the National Birthday Trust Fund. This entailed the visiting of 34 cases and completion of certain forms. This enquiry was completed in June, 1953. 5. Information has been collected, for the Ministry of Health and Medical Research Council, on the incidence of a special form of blindness (Retrolental fibroplasia) occurring in very small premature infants. All premature infants born in 1951 of a certain birth weight, surviving more than two months, were visited and the questionnaire completed for each child. Twenty-six children were so reported upon. This was carried out in December, 1952. 6. Information is being collected for the Department of Surgery, Guy's Hospital, at present on children who have never received breast milk. This is a very small survey and does not entail much work. 7. Since 1949 reports upon all pregnant women who have suffered from a virus infection such as German Measles, mumps, measles and chicken pox are being sent to the Ministry of Health. This is a very small number and does not entail much work. In the last few years our Health Visitors/School Nurses have been engaged in many pieces of research work. Some of this work has tended to harass our Health Visiting Staff overmuch and in future such heavy commitments will not be accepted. 131 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 on 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 1953 the following work was carried out:— No. of new cases (surgical and medical) 1,942 No. of visits paid to above 56,213 132 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 362 39 16 73 490 Re-Vaccinated ... 5 16 202 223 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 743 26 769 (b) By Private Practitioners 297 16 313 2. Number of children who were given a secondary or reinforcing injection (i.e., subsequent to complete full course) 44 363 407 3. (a) Approximate estimated child population at end of year 7,720 13,839 ... (b) Percentage of child population considered to be immunised at end of year 52.46 88.1 ... 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 l.192 76.9 855 696 81.4 1,123 919 81.8 1953 1,680 1,438 85.59 1,271 1,019 80.2 1,587 829 76.3 133 Incidence and Mortality from Diphtheria. Since the year 1935, when diphtheria immunisation was begun in Leyton, over 25,000 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 1953: and the number of deaths from 8 in 1935 to 0 in 1953. In the last five years only one Leyton child has been notified to be suffering from diphtheria, and for the sixth year in succession no Leyton child has died from the disease. The following are figures for deaths and notifications since 1944. Year Deaths Corrected Notifications England and Wales Leyton England and Wales Leyton 1944 934 1 23,199 24 1945 722 2 18,596 43 1946 472 1 11,986 38 1947 244 1 5,609 9 1948 156 ... 3,575 5 1949 84 ... 1,890 ... 1950 49 ... 962 ... 1951 33 ... 664 1 1952 32 ... 376 ... 1953 24* ... 240* ... *Provisional. The number of children immunised under local authority arrangements (including those immunised by the family doctors for which records were received by the local authority) from the beginning of 1940 to the 30th June, 1953,. was 10,569,796 (21,485 in Leyton). During the first half of 1953, 270,584 (688 Leyton) children were immunised, of whom 103,123 (347 Leyton) were under one year of age. The object of the campaign remains the same : to secure immunisation of not less than 75 per cent. of babies before their first birthday. Having regard to the birthrate during 1953, the immunisation objective for 1954 is 498,000 children under one year. Only 28 per cent. of the number of babies reaching the age of one year in 1951 were immunised ; in 1952 the figure rose to 31 per cent. but in the first half of 1953 it improved only to 31.5 per cent. This is still a disturbingly low figure. 134 As elimination of this disease is conditional upon the maintenance of an adequate level of immunisation, an intensive effort will be required to secure the full benefit of the campaign. If parents leave their children unprotected there may be a return of diphtheria outbreaks, as exemplified during a recent outbreak in the Midlands, where among 78 cases there were 6 deaths—all of them children who had not been immunised. 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 1953 4,050 12,203 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 1953. 135  Under 1 year years 5—14 years Total *Number of children who completed the course of immunisation during the year 453 337 57 847 * These figures include innoculations given by private medical practitionen under the County Council Scheme from 1.4.53. 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. Protection against Tuberculosis by B.C.G. Vaccine. In April, 1952, 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 Essex County 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. I submit Dr. Emslie's report on this work for the year 1953 :— " At present this is restricted to children who are, or are likely to be, in contact with the disease ; but is is hoped that in the near future we shall be able to offer protection to those about to leave school whether or not they have a known source of infection. At this age young people are particularly susceptible to infection, and may unwittingly come in contact with the disease at work or during travel. " The total number of children who came for vaccination against tuberculosis in 1953 was 215. Of these, 53 were found to be ' Mantoux positive ' and therefore unsuitable for vaccination; six were postponed for various reasons (usually illness of some X-ray abnormality); and 23 withdrawn without having been vaccinated. The remaining 133 were vaccinated after having had a negative X-ray report and a negative 136 Mantoux test (1 in 100)—except new born babies. All except six of the 133 have been tested and found to be Mantoux converted since vaccination. Of the six untested cases, three refused further testing, one ignored several appointments, and two have removed from the district. No child has been found not to be Mantoux converted after vaccination. "No serious complications have occurred among the vaccinated. An enlarged gland in the axilla was found in 20 cases, varying in size from just large enough to be felt to the size of a bean. In no case was there softening of the gland or discharge from it; but in two cases there was a rather deep ulcer which filled up and healed. In the other cases the reaction was trivial. "Mantoux tests a year or more after vaccination have been done on 17 of the cases vaccinated in 1952, to see whether sensitivity had been maintained. We have not been successful in persuading all mothers to bring their children for re-testing a year after vaccination. It is perhaps natural that they feel further testing should not be necessary, and in fact the Mantoux test was definitely and often markedly positive in all cases tested a year or more after vaccination. "It is not proposed to repeat the test if the reaction is still positive at the end of the year ; but parents are advised to have their children re-tested about the age of 11 years and re-vaccinated then if necessary. "B.C.G. vaccination is only one of several factors in the prevention of tuberculosis, and no spectacular results are to be expected—at least in the near future. It is nevertheless one of the most important specific measures in the prevention of disease, and should have a prominent place in public health propaganda. "It is worth noting that, of the 53 children who were not vaccinated because they had already absorbed the infection, 14 were under the age of five years and therefore at an age when infection was dangerous. "Except for cases we may come across in our own district, we at Dawlish Road Clinic are dependent for the direction of cases to us primarily on the staff of the Chest Clinic who have first hand information about the location of sources 137 of infection. Many cases have been sent to us also by the Local Authority medical staff, Health Visitors, and School Nurses of the other districts in Leyton. The co-operation of all these is essential and very much valued. " It would not have been possible to have tested and vaccinated so many cases if all Clinic sessions had not been made available for this work instead of occasional sessions only. This has meant additional work for the nursing staff in daily or twice daily sterilising of instruments and laying out of materials ; and it is due to them to record with appreciation that this has always been done most willingly and that co-operation generally has been enthusiastic." 138 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.) 1949 1950 1951 1952 1953 Patients conveyed 15,167 23,300 24,196 29,586 31,238 Total mileage 82,109 108,654 114,558 123,995 130,110 The types of cases conveyed by Ambulances from the Leyton Ambulance Station during 1953 were :— Accident 730 Maternity 571 Other emergency 893 Non-emergency 29,044 Total 31,238 139 SECTION 28 PREVENTION OF ILLNESS, CARE AND AFTER-CARE. Foot Clinic. Leyton Corporation was among the first local authorities in the country to provide a municipal foot clinic, where residents afflicted with defects of the feet could obtain skilled treatment from qualified chiropodists. It was in 1936 that the Leyton Foot Clinic was established at High Road Baths, with your present Senior Chiropodist (Mr. J. C. O'Brien, M.Ch.S) as the chiropodist in charge—and the only one. That the facilities provided made an early appeal may be judged from the fact that before the clinic had been open for a month the number of applicants for treatment was so great that even in these early days appointments were being made for as long as five weeks ahead. Although since that time the staff of permanent full-time chiropodists has been increased from one to four, and although it has been necessary to engage temporary part-time assistance to overtake accumulated arrears of work, never has it been possible to reduce the waiting time for appointments to less than five weeks. In fact five weeks has come to be regarded as the minimum waiting period, below which it is not possible to go, at least in Leyton, and eight weeks as the average or normal waiting time between appointments. Prior to 1948 the treatment facilities were confined to Leyton residents, and the production of national identity cards was a condition of eligibility for treatment; but, with the incorporation of the foot clinic facilities under Part III of the National Health Service Act, the service became national instead of local. The extent to which extra-district residents take advantage of the chiropodial facilities may be gathered from the fact that, of 1,325 new patients who attended during the year, 142 (10.7 per cent.) were resident outside the Borough. Towards the end of 1951 the Health Authority approved my suggestion that, in order to overtake accumulating arrears of work, a temporary foot clinic should be established in a dental workshop in Dawlish Road Clinic which was not being used ; and a foot clinic was established there in January, 1952. Since that time a chiropodist from the main foot clinic at High Road Baths has provided two additional weekly sessions at Dawlish Road Clinic. That the new clinic is supplying a long-felt want in a densely populated area may be gathered from the fact that already the waiting-time for 140 appointments is as long as 12 weeks. Whereas a patient who attends regularly at High Road Baths can put in 4.1 attendances during the year, only 3.5 annual attendances are possible for a patient at Dawlish Road Clinic. It is of interest to note that the percentage of patients who received free treatment was 11.2 per cent. at Dawlish Road, as compared with 3.2 per cent. at the main clinic. The disparity in these figures shows the extent to which the elderly and necessitous take advantage of facilities for foot care when the facilities are accessible to them. The provision of chiropody is one of the most beneficent public services available to elderly people. In May, 1952 arrangements were made with the Ambulance Supervisor for non-ambulant cases to be transported to the Foot Clinic by ambulance. The numbers of patients who have availed themselves of this service since its inauguration are, 1952 (May to December), 11 patients ; 1953, 22 patients. Patients transported by motor ambulance are required to supply the Ambulance Supervisor with a medical certificate from their own doctor stating that they are not fit to travel by public transport. Summary of Attendances and Treatment. (a) All Ages. During the year there were 21,528 attendances for treatment, representing an increase of 1,627 over the attendances during the previous year. First Attendances (New Cases) Subsequent Attendances Total Attendances Males 332 3,452 3,784 Females 1,055 15,660 16,715 Children 154 875 1,029 Total 1,541 19,987 21,528 The number of persons who received free treatment was 66 (4.2 per cent. of the total number of new cases). The following are the figures of attendances for these patients only. 141  First Attendances (New Cases) Subsequent Attendances Total Attendances Males 23 487 510 Females 43 1,962 2,005 Total 66 2,449 2,515 Defects Treated. Advice on shoes 1 Bursitis 78 Callosities 415 Corns 401 Hallux valgus 113 Hallux rigidus 28 Hammer toe 43 Hyperidrosis 30 Fissures 3 Metatarsalgia 33 Mycotic infection 15 Nail, ingrowing 91 Nail, club 123 Pes planus 31 Strain 2 Septic condition 11 Trigger toe 3 Verucca pedis 120 Referred for Medical Treatment. Thirty-four patients were referred to their private medical practitioners for advice on treatment for the following conditions. Arthritis 6 Oedema 7 Bi-lateral hallux valgus 3 Varicose condition 5 Calcaneal spur 1 Erythema pernio 8 Exostosis 1 Subungeal exostosis 2 Fracture of 2nd metatarsal (" March Foot ") 1 (b) Children under School Age. Number of children 6 Average number of attenNumber of attendances 11 dances per child 1.83 Defects Treated. Advice on shoes 1 Nail, ingrowing 1 Corns 3 Verruca pedis 1 (c) School Children. Number of school chil- Average number of atten- dren 148 dances per child 6.8 Number of attendances 1,016 142 Defects Treated. Bursitis 2 Callosities 3 Corns 23 Hammer toe 4 Nail, ingrowing 1 Nail, club 1 Trigger toe 1 Pes planus 1 Verruca pedis 108 Convalescence for Adults. (a) Number of applications during year 71 (b) Length of convalescence of cases sent during year :— Length of stay No. of Cases 1 week 2 2 weeks 22 3 weeks 39 4 weeks 8 Over 4 weeks — (c) Where cases have been sent:— Name of Convalescent Home No. of Cases sent Essex Convalescent Home, Clacton 27 Bell Memorial Home, Lancing 11 Spero Fund Homes 9 Rustington Convalescent Home, Littlehampton 6 Church Army Homes 3 Samuel Lewis Home, Walton 3 National Institute for the Blind Home 2 Limpsfield Convalescent Home 2 Wordsworth Home of Rest, Swanage 1 Merchant Taylors' Home, Bognor 1 Brook Lane Rest House, Brighton 1 John Howard Convalescent Home, Brighton 1 St. Michael's Convalescent Home, Westgate 1 Cumberland Convalescent Home, Heme Bay 1 St. Joseph's Convalescent Home, Bournemouth 1 Mrs. Loveland, Broadstairs 1 HEALTH EDUCATION. World Health Organisation—Visit of Delegates. During April, 1953 the World Health Organisation, by arrangement with the Ministry of Health of the United Kingdom, held in London the International Seminar on Health Education. This was the first Conference of its kind ever to be held, and the delegates comprised senior health officers of Governments from within World Health Organisations, European Region. The Health Education 143 problems of Europe, though varying from country to country, have sufficient similarity to warrant discussion on a collective basis. Delegates were given the opportunity of attending at various centres to see what is being done in this country ; and, at the request of the Ministry of Health, arrangements were made for a party to visit Leyton on Wednesday, 15th April. The delegates were taken to view the Health Education shop window, 280 High Road ; then to the Mass Radiography Unit, where they saw the X-raying of persons working in shops and factories. A visit was afterwards made to Dawlish Road Health Clinic, where the Chiropody Clinic, Minor Ailments Clinic and Dental Services were inspected. The party then proceeded to Park House Health Clinic, where the County Foot Exhibit was displayed, and films on the Care of the Feet, and Teaching Children to Walk, were being shown by the County Health Education Officer to nursing mothers and children attending the Clinic session. The delegates viewed the Infant Welfare Clinic in progress, and then had a discussion lasting an hour and a half. They were most impressed with what they had seen, and it is felt that the visit was of mutual interest both to the delegates and to medical and nursing staff of the County Council. The delegates were :— 1. The Director of Social Hygiene, Ministry of Hygiene and Population, France. 2. Superintendent Health Visitor, Orleans, France. 3. The Director of Inter-Departmental Centre for Health Education, France. 4. Director-General of Social Medicine, Ministry of Public Health and the Family, Belgium. 5. Public Health Officer, Federal Ministry of Interior, Bonn, Germany. Shop Window Displays, 280 High Road, Leyton, E.10. Dates Subject 17.12.52 to 17. 1.53 Accidents in the Home 19. 1.53 to 18. 3.53 Coughs and Colds 19. 3.53 to 22. 6.53 Mobile Mass X-Ray 22. 6.53 to 17. 8.53 Nutrition 31. 8.53 to 8.10.53 Clean Food 9.10.53 to 30.11.53 Foot Health 1.12.53 to 30.12.53 T.B. Care Association 144 LECTURES AND FILM SHOWS — 1953. Date Where held Subject Type of Audience Attendance 12.5.53 to 15.5.53 Health Clinic, Granleigh Road, E.11 Home Safety — Film and Display Expectant and Nursing Mothers and Children 170 18.5.53 to 20.5.53 Health Clinic, Leyton Green Road, E.10 Do. Do. 170 28.5.53 Health Clinic, Dawlish Road, E.10 Do. Do. 30 28.9.53 Do. Films : ' Brother for Susan ' ' Your Child Walking ' ' Surprise Attack ' ' Fly about the House ' General public 50 1.12.53 to 3.12.53 Health Clinic, Granleigh Road, E.ll Foot Health — Films and Display Nursing Mothers 87 8.12.53 to 10.12.53 Health Clinic, Leyton Green Road, E.10 Do. Nursing and Expectant Mothers 99 14.12.53 to 18.12.53 Health Clinic, Dawlish Road, E.10 Do. Do. 41 EXHIBITIONS. 13.4.53 to 24.4.53 Health Clinic, Granleigh Road, E.11 Foot Health Expectant and Nursing Mothers and School Children Fair 145 Home Safety. At a Meeting of the Health Area Sub-Committee held on 16th February, 1953 the Area Clerk submitted a request from the Leyton Borough Council's Road Safety Committee for consideration to be given to the desirability of suitable action being taken to deal with the question of home safety. The Committee resolved that the matter be left to the discretion of the Chairman, in consultation with the appropriate Officers, to take any suitable action. As a result of this I conferred with the Chairman, and with the co-operation of Miss Charley, Accident Prevention Officer, Crusader Insurance Company, an exhibition and film show on Home Safety was held at the Health Services Clinics on the following dates. The films were projected by the Road Safety Officer, and I take the opportunity of thanking him for his assistance. Venue Date Numbers Attending Park House Clinic 12th-15th May 170 Leyton Green Clinic 18th-20th May 170 Dawlish Road Clinic 28th May 30 Further to this, all mothers and children using the Clinics had an opportunity of viewing the exhibition, and these numbered several hundreds. Leaflets dealing with avoidance of scalds and burns, and the safe use of gas and electricity, were distributed. A film show dealing with Home Safety was arranged for the parents of babies attending the Essex County Health Services Clinic, Dawlish Road on Monday evening, 28th September, 1953 at the Clinic. Fifty parents were in attendance. For many years it has been routine practice in this Area for health visitors to deal with the necessity of efficient fireguards during their visits to homes, for posters to be exhibited in the clinics, and for suitable pamphlets to be distributed to expectant and nursing mothers. Home Office Circular No. 106/1953. The Circular—issued in May, 1953—accompanied the Report on "Accidents in the Home" issued by the Standing Interdepartmental Committee which had been investigating the problem over a period of five years. 146 Attention was drawn to the large number of home accidents primarily caused by carelessness or ignorance, to the need for education of the general public on the importance of safety precautions in the home, and to the desirability of collaboration between the health, fire and education departments of local authorities. The most effective form of publicity is generally that carried out by medical officers, health visitors and sanitary inspectors—and other health workers who enjoy the confidence of the public—in the course of their routine duties. The Committee's Report emphasised the importance of good building design and equipment, and this aspect of the problem was dealt with in a special circular addressed by the Ministry of Housing and Local Government to Housing Authorities. The Problem. During the ten years from 1940 to 1949 over 60,000 people in this country died from accidents in their homes compared with about 48,000 deaths on the roads. The majority of victims are young children and old people, and fatal accidents in the home are the third largest cause of death. As there is no obligation to notify non-fatal accidents in the home, their number is not known accurately ; nor are any official records available of the man-hours lost to industry. But some idea of the problem in terms of pain and disablement may be gained from these figures relating to one Birmingham Hospital. Among the population served by that hospital there were treated in the Accidents Hospital (for home accidents) during one year some 9 per cent. of the children under ten years and 3 per cent. of the adults. The average length of treatment for a burn was 35 days, and for a bad burn (generally caused by clothing catching fire) 50 days in hospital. The Commonest Kinds of Accidents. The commonest kinds of home accidents are :— Falls (58 per cent.); burns and scalds (13 per cent.); suffocation (12 per cent.); coal gas poisoning (8 per cent.). The Commonest Causes of Accidents in the Home falls. (1) A dustpan and brush left on an ill-lighted staircase. Stairs should be kept clear and well lit. 147 (2) A loop of flex across a living room. This is a double danger : the flex may be tripped over, or worn insulation might cause an electric shock. (3) A loose mat on a slippery floor. An old person who slips and falls may be fatally injured. (4) Loose stair carpets. burns and scalds. (5) An unguarded fire in a bedroom. It may easily set fire to the hem of a frock or nightdress and cause a fatal accident. (6) A saucepan handle sticking out over the edge of a stove. A child could scald itself badly by pulling the saucepan over. (7) A loose tablecloth which a child can reach and pull off, carrying with it teapots, hot pans, books or vases of flowers which might be on the table. Bad bruises or scalds can be caused in this way. electrocution. (8) An electric fire or radio set in a bathroom. Electric appliances of all kinds are dangerous in bathrooms. poisoning. (9) Medicines or garden chemicals left within reach of a child. A comparatively small amount of poison, which would not hurt an adult, can kill a child. suffocation. (10) Down pillows for small babies. If the baby turns over it may suffocate. Many babies in fact die each year in this way. Precautions on Leaving the House. See that: your cigarette is out, the iron is unplugged, gas taps are turned off, fires are guarded, and the television and wireless are switched off, or better still, disconnected. Mass Radiography. A further survey in the Area was carried out by Mass Radiography Unit 6B in the months of April, May and June over a period of approximately seven weeks. 148 Owing to the unsuitability for the purpose of the premises at 280 High Road, Leyton Corporation kindly put at the disposal of the Radiography Unit (free of charge) their Summer Theatre in the Coronation Gardens. The new premises (the Summer Theatre) are much more suitable in every way, the only drawback being that adequate heating is not available in cold weather. Unfortunately the survey was held during a spell of cold weather, when the members of the public and of the staff were unduly exposed to the cold. This undoubtedly interfered with the attendances, and arrangements have been made for the survey to be undertaken later in the year in future. The Medical Director (Dr. Lawless) concludes his report with an expression of thanks to Leyton Council for the accommodation provided, and to the members of the Health Department for their help and co-operation. Attendances. Miniature Films. Doctors' cases 199 General public 2,421 Appointments (factories, etc.) 4,984 Total . 7,604 Four-hundred and sixty-five persons were recalled for large films. Results of Survey. Males Females Total Number of attendances for miniature X-ray 3,555 4,049 7,604 Number passed as normal on miniature or subsequent large film examination 3,345 3,879 7,224 Number showing some abnormality 210 170 380 Percentage showing some abnormality 5.90 4.19 4.99 149 Classification of Abnormalities Noted. Male Female Total Congenital abnormality of bony thorax 23 4 27 Chronic bronchitis and emphysema 34 19 53 Broncho-pneumonia ... 1 1 Consolidation of unknown cause 2 ... 2 Bronchoiectasis 6 3 9 Pulmonary fibrosis 6 4 10 Pneumoconiosis 1 ... 1 Basal fibrosis 22 9 31 Pleural thickening 9 3 12 Intrathoracic tumours 3 2 5 Congenital cardio-vascular lesions 1 ... 1 Acquired cardio-vascular lesions 3 7 10 Miscellaneous 22 25 47 Pulmonary tuberculosis—all types 78 93 171 Total 210 170 380 Tuberculous Lesions. Inactive Tuberculosis. Male Female Total Primary 28 39 67 Post-primary 43 43 86 Total 71 82 153 Active Tuberculosis. Primary ... ... ... Post-primary 7 11 18 Total 7 11 18 These figures show that there were 18 cases of active tuberculosis disclosed by the survey, giving a ratio of 2.36 per 1,000 examinations. This compares favourably with the national figure for Mass Radiography, which is 3.3 per 1,000. The incidence was greater in the female than the male examinees, the respective ratios being 2.68 and 1.96 per 1,000. All necessary action has been taken in respect of cases, both tuberculous and non-tuberculous, requiring further medical attention. 150 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. As a result of the visit of the Mass X-ray Unit in April, 1953, a member of the teaching staff of a local Primary School was found to be suffering from pulmonary tuberculosis, and it was considered advisable that all children at the school should be tested to find out whether any of them had been infected. The parents of all children attending the school were invited to a meeting for the purpose of having the test explained to them. Dr. Ethel Emslie, Assistant County Medical Officer—who, in April, 1952, obtained the special approval of the Ministry of Health to the carrying out of a scheme for the protection of Leyton children against tuberculosis by the administration of B.C.G. vaccine— addressed the 100 parents who accepted the invitation to attend the meeting. Consent forms for the skin test were then issued to all parents ; and, as a result, 181 children were tested. In five cases the parents of the children refused to take advantage of the offer. Of the 181 children tested, 172 (95.03 per cent.) were found to be Mantoux negative, and nine (4.97 per cent.) Mantoux positive. The nine " positive " children were therefore subjected to special clinical and X-ray examination by the Chest Physician. The X-ray of one child showed a suspicious shadow and, as there was some slight rise in evening temperature, admission to sanatorium for observation was offered, but declined by the parents. The eight remaining cases—with the exception of one who was doubtful— had normal X-rays, and showed no abnormal physical signs. They continue to be under the care of the Chest Physician. It is pleasing to be able to record the parents' interest and understanding of the necessity for these tests, which is proved by the low figure of 2.6 per cent, refusals. Tuberculosis. (a) Open Alb Shelters. (1) Number of shelters in use at end of year Nil (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 110 Total number being supplied with free milk at end of year 124 151 (c) Rehabilitation. (1) New cases— Preston Hall Papworth Ha ll Number of new cases assisted during year 1 1 Number of cases for whom the Council ceased to be responsible ... 2 Number of cases being assisted at end of year 2 1 (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 2,623 (2) Number of visits to tuberculosis cases by Health Visitors 894 Loan of Sick Room Equipment. During the year 201 articles of sick room equipment were loaned on the recommendation of doctors, hospital almoners, etc. From Central Store From Lady Raleigh Training Home Air Beds 3 ... Air Pillows ... ... Air Rings 32 13 Bed Back Rests 30 3 Bed Cradles 3 3 Bed Pans 30 16 Crutches 2 ... Hot Water Bottles ... ... Invalid Chairs 11 ... Rubber Draw Sheets 13 10 Sputum Cups ... 1 Urinal Bottles 15 13 Feeding Cups ... 1 Steam Kettles ... 1 Sand bags ... ... Commode 1 ... Totals 140 61 152 Special articles bought during the year :— 1 Air Bed. 2 Air Rings. 3 Bed Cradles. 13 Bed Pans. 6 Bed Rests. 4 Bed Trays. 1 Commode. I Dunlopillo Ring. 9 Rubber Sheets. 19 Urinal Bottles. 3 Invalid Chairs. TUBERCULOSIS CARE ASSOCIATION. I submit a report by Mr. F. C. Ware, the Secretary of Leyton, Wanstead and Woodford Tuberculosis Care Association. " The activities of the Association have been increased considerably during the year, and it is due mainly to these efforts that in March, 1953 it was possible for weekly extra nourishment vouchers to be increased in value to 10s. and 7s. 6d. For the ten ration periods following the increase, this valuable assistance alone cost the Association an average of £65 10s. Od. each month as compared with approximately £32 previously. " The majority of extra nourishment grants are made to families in which the wage earner has been incapacited by tuberculosis and the income is being supplemented by a National Assistance Allowance. In these families the benefit which the patient derives from this assistance is an important factor in combating the disease, whether it be granted at the time of initial diagnosis and subsequent inactivity whilst awaiting or receiving treatment, or during convalescence following discharge from hospital. "Visits by relatives to patients in hospital and sanatorium are usually encouraged, and considered an important aid to treatment. The Association has therefore always given special consideration to applications for financial assistance for this purpose. During the year 76 grants for fares were made, compared with 27 the previous year. 153 The undermentioned are some of the grants made by the Association during 1953:— Extra nourishment vouchers 441 Beds and bedding 7 Wireless licences 4 Fares of visiting relatives or to patients proceeding to convalescence 76 Holiday grants 2 Christmas grants to patients in hospital and at home 108 Removal expenses 1 Rehabilitation course fees 1 Financial grants 3 Fares of patients attending Occupational Therapy Centre (2 visits weekly) 9 Clothes 1 " The Association maintains a keen interest in the Occupational Therapy Centre, and a grant of £25 was made to the Instructor for the purchase of materials. Members of the Committee continued to render an important service by assisting with the sale of finished articles of weaving, jewellery, woodwork, Christmas gifts, etc. In addition to any material help which may be given to patients, an almost equally important feature of the work of the Care Association is the advice it gives to patients with domestic and financial problems. Although it is not claimed that a satisfactory solution is found in every case (e.g., housing problems) the fact that there is an organisation for the specific purpose of dealing with the special problems affecting persons suffering from tuberculosis is usually an encouragement to patients and greatly appreciated by them. " On many occasions it has been possible to enlist the help of the British Legion, Women's Voluntary Services, The R.L. Glasspool Trust, and the St. John & British Red Cross Library Department ; and to refer patients to the National Assistance Board for special grants. The Association has been fortunate to receive the closest co-operation from these Organisations throughout the year. " A close liaison is maintained with the Chest Clinics, and the Association receives valuable advice from the Chest Physicians. The Health Visitors also render an indispensable service by working in close liaison with the Secretary in matters concerning the welfare of patients. 154 "Finances were strengthened considerably during the year as a result of record Christmas Seals Campaign Sales. The income from sale in 1952/53 was increased by almost £100 to £303, and sales for 1953/54 have reached over £500. "The 'per capita ' grants and the Sunday Entertainments Grants from the Essex County Council have provided most of the income of the Association until this year, when these grants amounted to £533 5s. 3d. compared with £789 17s. lOd. the previous year—a decrease of £276 14s. 5d. Fortunately some compensation for this loss has been achieved by increased voluntary effort. Although the ' per capita " grant has been increased from 30s. to 40s. per thousand, the Sunday Entertainments Grant has decreased over the last years, presumably due to decline in the patronage of Sunday Cinemas. " The Association can, therefore, no longer rely on grants to provide the larger proportion of its income ; and, if assistance to patients is to be maintained at the present level, the raising of funds must continue to be a major consideration of the Committee and its officials." 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 end of 1952 five patients had returned to work or undertaken training courses f<3r re-employment; and, on 1st January, 1953 there remained on the register 10' patients. By June, five new patients had been enrolled ; and three, who were on the register in January, had resumed full employment. At the request of the Chest Physician, Walthamstow Chest Clinic the Leyton Health Area Sub-Committee agreed to allow a few patients from Walthamstow to attend the Centre 155 subject to there being vacancies, and bearing in mind the limited accommodation available. In May it was possible to allow two Walthamstow patients to join the centre, and in November a further one. "The County Medical Officer requested that the Centre should again display samples of work at the County Show ; and in addition the instructor and patients gave demonstrations of weaving, jewellery making, etc. Despite the heavy rain which fell on the second day, and the obscure position of the marquee, the Occupational Therapy stand attracted considerable interest, and sales were almost as high as the previous year. "Attendance at the Centre was almost 100 per cent, from June onwards, and everyone worked hard for the Open Day, on 30th November. The opening ceremony was again performed by Alderman Mrs. R. King (Deputy Mayor), and Councillor Mrs. A. M. M. Burrell (Chairman, Health Area Sub-Committee) was in attendance. The work displayed for sale included:— Weaving (rugs, tweeds, scarves, aprons, headscarves and table linen). Leather work. Felt novelties. Woodwork. Basketry. Calendars. Basket work is the latest craft undertaken at the Centre, and a high standard of work is already being achieved. " The year has been encouraging due to the number of patients returning to full employment, and the standard of work by patients at the Centre. It is anticipated that another three patients will be returning to work in the near future, and that new patients will fill the vacancies created." It is increasingly apparent that the Occupational Therapy Centre has made an important contribution to the successful rehabilitation of many patients ; an opinion which, to some extent, is confirmed by the number of patients returning to full employment following attendance at the Centre. 156 The benefits which patients can derive from Occupational Therapy have already been outlined in my previous reports; but of almost equal importance is that the Instructor should create and maintain an atmosphere of friendliness and goodwill at the Centre which will encourage patients to attend. Mrs. S. A. Wiltshire, the Instructor since the opening of the Centre four years ago, has taken a very keen interest in the work and welfare of the patients. It is due mainly to her efforts that the Centre has gained such a high reputation among patients and the public. 157 SECTION 29 DOMESTIC HELP. Seven 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 1953 69 693 762 (a) Number of helps and hours worked:— Number of domestic helps enrolled at end of year— Whole-time helps 16 Regular part-time helps 65 Number of domestic helps actually employed at end of year 80 Number of hours worked during year 101,965¾ (6) Work of the Domestic Help Organiser:— (1) First Visits 312 (2) Re-visits to beneficiaries— (a) Domestic help present 254 (b) Domestic help not present 650 (3) Other visits 374 158 (c) Help provided :— Maternity Acute Sick Tuberculosis Chronic Sick Aged Not Sick Others Total Aged Others New cases helped during the year 67 32 23 255 64 20 5 466 Total cases completed during year 65 29 16 160 56 22 7 355 Cases being helped at end of year who have received help for:— Under 3 mths. 4 6 9 49 6 5 ... 79 3—6 mths. ... ... 2 34 4 1 41 6—12 mths. ... ... 2 74 15 7 ... 98 Over 12 mths. ... ... 7 139 19 24 ... 189 Total 4 6 20 296 44 36 1 407 Total cases helped during the year 69 35 36 456 100 58 8 762 Hours of help provided during year 4,802½ 1,081½ 3,012 65,766¼ 15,661¾ 11,041½ 600¼ 101,965¾ 159 Medical Examination of Staff. (1) County Council employees— Number of medical examinations for: (a) Entrants to County Council's service 109 (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 58 Glamorgan County Council 1 Bolton Borough Council 1 NURSERIES AND CHILD MINDERS REGULATION ACT, 1948. At the end of the year one child minder was registered as a child minder, and is allowed to take up to four children. Frequent visits have been made by the health visitor, and the conditions are reported to be satisfactory. During the year an application for registration was received from an applicant who desired to undertake the care of 12 children between the ages of three and five years. After considering a detailed report on the premises and facilities, the Health Area Sub-committee refused to register as a child minder on the grounds that the presence of several elderly patients in the premises would prejudice the appropriate care of the children. Several enquiries have been made by persons desiring to register for this purpose ; but, when the stringent regulations are explained, and especially when they realise that it is not likely to be a profit-making concern, the applications are not proceeded with. 160 School Health Service The figures set out below relate to the calendar year ended December, 1953. Number Roll Average Attendance Percentage of Attendance 1. Secondary Schools 9 4,759 4,153 87.27 2. Primary Schools 18 9,080 8,543 94.09 Totals 27 13,839 12,696 91.74 ROUTINE MEDICAL INSPECTION. A.—Routine Medical Inspection. Number of Inspections in the prescribed groups. Percentage of parents present Entrants 1,680 95.35 Second Age Group 1,271 84.9 Third Age Group 1,087 33.7 Total 4,038 Of 4,038' children who were examined in the code age-groups, 3,053 (or over 75 per cent.) were accompanied by their parents. B.—Other Inspections. Special Inspections. The number of special inspections during the year was 9,005 comparing with 10,694 during the previous year. Re-inspections. The number of re-inspections during 1953 was 11,441. 161 The Findings of Medical Inspection. NUmbeR op 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 1,680 211 12.56 Second Age Group 1,271 210 16.6 Third Age Group 1,087 115 10.58 Total (Code Groups) 4,038 536 13.27 Uncleanliness and Verminous Conditions.—At the special inspections held by the school nurses, 306 children were found to be unclean out of a total number of 28,081 examined (i.e., 1.09 per cent.) Cleanliness Surveys in Individual Schools. School Number of Examinations Number Cautioned Number Excluded Canterbury Road 2,513 5 ... Capworth Street 1,144 6 1 Cann Hall Road 2,478 43 3 Church Road 1,487 3 ... Tom Hood ... ... ... Connaught Road 1,499 12 2 Downsell Road 2,997 29 2 Davies Lane 2,733 19 1 Farmer Road 547 ... ... Goodall Road 1,585 19 11 Lea Bridge Road 324 1 3 Mayville Road 2,699 63 4 Norlington Road 518 ... ... Newport Road 3,257 31 4 Sybourn Street 1,869 8 ... St. Joseph's 549 9 5 Trumpington Road 879 14 ... Knotts Green anD Harrow Green 441 6 ... Leyton County High School 506 ... ... Occupation Centre 56 2 ... Total 28,081 270 36 Number of individual children found unclean 306 of whom 36 were referred to the Minor Ailments Clinics. 162 UNCLEANLINESS. Those of us who can remember the appearance—and the smell— of scholars and school rooms before the first world war can have no doubt regarding the hygienic transformation that has taken place in the cleanliness of pupils since that time. Uncleanliness of scholars is not a popular subject in educational circles ; and even in health education it is kept well in the background But although the precept may not have a great direct educational appeal, the practice of personal cleanliness in school has a most salutary indirect effect in the promotion of self respect, for habits of personal cleanliness acquired in school persist throughout life. It should also be realised and remembered that the uncleanliness of scholars was one of the original reasons for the employment of school nurses and school doctors. Ever since the initiation of the School Health Service a persistent campaign has been waged against vermin in school children, and the conducting of cleanliness inspections in school makes a heavy demand on the time of school nurses. The older members of the staff, who remember the heavily infested heads once so common, are impressed with the improvement in the standard of cleanliness ; for nowadays a child's head is classed as verminous even if one nit is discovered. From year to year I include in my Annual Report a list showing the annual incidence of uncleanliness in Leyton schools over a period of 10 years; but, in order to give a wider view of the situation, I submit these figures showing the percentage of Leyton school children found to be unclean over a period of 40 years. Year Number examined Number found to be unclean Per cent. 1913 4,048 772 19.07 1923 47,074 3,301 7.01 1933 35,461 1,540 4.34 1943 22,364 1,077 4.81 1953 28,081 306 1.09 In 1913 the number of children (4,048) submitted to cleanliness inspection in school was relatively small, but so was the number (one) of the school nursing staff; and the high rate and severe nature of the verminous infestation then prevalent must have occupied a very large proportion of the nurse's time. But the most 103 important features of the figures submitted are the high percentage (19.07 per cent.) of children found to be unclean in 1913, and the substantial decrease in the percentage of unclean school children over the period of 40 years—from 19.07 per cent, in 1913 to 1.09 per cent, in 1953. Had it not been for the second world war, the decrease would no doubt have been progressive, but in 1943 conditions were exceptional and the progressive fall suffered a temporary check. The most remarkable fall in the percentage incidence of uncleanliness occurred in the 10-year period that ended in 1923 ; and the following extract—from the Annual Report of my predecessor for the year 1925—throws some light on the extent to which such vermin as head lice may be regarded as the " hangerson " of the world of fashion. " By far the majority of these verminous conditions are due to lice and nits, which of course are most numerous in the long hair of girls. Bobbed and shingled hair is an undisguised blessing. May the fashion long continue. Cleanliness and freedom of the brain-case from the weight and heat of great masses of hair more than compensate for the loss of the abundant locks to which an old fetish attributes woman's glory." MEDICAL TREATMENT. Minor Ailments Clinics. Attendances. During the year 3,772 individual children attended the clinics, and made 9,597 attendances. Defective Vision. Of the 4,038 children subjected to routine code group inspection in the schools, 188 (4.65 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 1,198 children. They made 1,658 attendances for examination and treatment. Sixty-three children were found to have no defect requiring treatment. 164 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 Wednesday (all day), and Friday (morning), 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.). Gases 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 1953. Number of Sessions held 230 Number of cases investigated 540 Number of cases treated 438 Number of new cases seen 140 Number of cases discharged cured— With operation 19 Without operation 28 47 Number still under treatment 210 Number under observation 187 Number failing to attend for complet e course 4 Number discharged unsuccessful 2 Total number of attendances for the year 1,774 165 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 ... ... ... ... ... ... Capworth ... ... ... ... ... ... Church ... ... ... ... ... ... Connaught ... ... ... ... ... ... Davies Lane ... ... ... ... ... ... Downsell ... ... ... ... ... ... Farmer ... ... ... ... ... ... Goodall ... ... ... ... ... ... Harrow Green ... ... ... ... ... ... Knotts Green ... ... ... ... ... ... Lea Bridge ... ... ... ... ... ... Mayville ... ... ... ... ... ... Newport 716 639 639 504 20 79.29 Norlington 529 384 362 263 2 72.65 Sybourn ... ... ... ... ... ... St. Joseph's ... ... ... ... ... ... Tom Hood 427 302 284 174 6 61.27 Trumpington 295 206 188 143 4 76.06 County High 474 319 317 152 47.95 Report by the Area Dental Officer (Mr. A. E. Hall). At the beginning of the year the dental staff was the equivalent of 25/11ths full-time dental surgeons ; and by the end of the year it had risen to 34/11ths—the highest figure ever to be reached. Unfortunately even the latter record figure is only just over half of the authorised establishment. Recent additions to the dental staff—the result of an appeal to the Deans of dental teaching schools —have been newly or recently-qualified dental surgeons who are prepared to devote several sessions per week to the service of two or more authorities while waiting for appointments as house surgeon in hospital or studying for additional qualifications. Although their help is greatly appreciated, it is unfortunate that the present conditions of service are such that the remuneration of a full-time dental surgeon of long experience is substantially less than that of a 166 recently-qualified peripatetic part-time temporary dentist. One of the great needs in the public dental service today is the recruitment of young full-time dental surgeons who wish to make the public dental service their career. In 1952—following the receipt of Ministry of Health Circular 22/52 and Ministry of Education Circular 254—a special appeal was made by the Local Dental Committee to provide dental practitioners to devote a portion of their time to the treatment of school children on a sessional fee basis, either in their own surgeries or in local authority clinics ; but the response to the appeal was very poor. During 1953 an appeal was again made to local dental surgeons in private practice to undertake the treatment of priority class patients (expectant or nursing mothers, and children up to the age of 16 years) during one or more sessions per week. The appeal stressed the acute shortage of local authority dental staff and the great arrears of dental work that had accumulated in the school dental service ; but the appeal had no response from dental surgeons in the area. Fortunately a dental surgeon from another area heard of the appeal and offered to assist at one weekly session. Dental Inspections. Periods between dental inspections in schools are still far too long, and with the increased number of children and the shortage of dental staff, the most that one can do by way of eliminating wasted time is not to offer treatment to children whose parents have habitually refused to accept it, other than emergency treatment for the relief of pain. Six schools were inspected and treated during the year. Orthodontics. Due to the reduction of the special orthodontic sessions from two to one per week, it has become even more necessary to select cases which will offer the greatest chance of success coupled with the greatest good to the patient. Table IV (page 187) does not allow space for the following items of Orthodontic Treatment:— Impressions taken 179 New appliances fitted 62 Attendances for treatment 594 Advice and adjustment to appliances 593 X-rays 9 Finished cases 39 167 Additional Operations not Tabulated in Table IV. Denture space retainers fitted 23 Denture space retainers repaired 2 Local anaesthetics used 1,718 Application of silver nitrate 1,513 Scaling and polishing 1,375 X-ray films taken 283 Oral Hygiene. During the year 1953 the Oral Hygienist (Miss Watts) has been devoting 7/11ths of her official time to work in Leyton area and the remainder in Walthamstow. All cases referred to her have been seen by one of the Authority's dental officers, and checks of the finished work are carried out by qualified dental surgeons. All her operative work has been well done, and she has the confidence of the patients. During the year all head teachers of schools in the area were asked by the Borough Education Officer if they wished Miss Watts to visit the school and give short talks to the children on dental hygiene, to be illustrated by a colour film, " Let's Keep our Teeth," hired from the Educational Foundation Film Library. Visits were made to five schools in the area who accepted these arrangements ; and subsequent reports by the head teachers spoke very favourably of Miss Watts's efforts and asked for repeat visits at a later date. An evening talk has also been given to the Parents' Association of one school. A day was devoted to the Essex Agricultural Show in June. In addition to operative work (scaling, cleaning and simple gum treatment) for the mothers attending the Maternity and Child Welfare Clinics, the hygienist has devoted much time to the giving of talks on matters of dental hygiene. One difficulty in the school dental service appears to be that of finding sufficient scaling among school children to keep a hygienist fully occupied in operative work ; but this difficulty will be overcome to some extent when there are more dental officers at work in the area—the present number is only just over 50 per cent, of the approved establishment. 168 From examinations of large numbers of school children I have found approximately only 17 per cent, who require the services of an oral hygienist; and I therefore consider that the main scope for her activity lies in the educational field—group instruction for children of 12 years and over, but individual talks to younger children. This activity we hope to extend during the coming year. From time to time Miss Watts arranges small exhibits of posters, models and literature in the dental waiting room, and these give rise to many questions to the dental staff. Orthopaedic Clinic. Examinations by Orthopaedic Surgeon. Primary examinations 60 Re-examinations 149 The findings at primary examinations were:— Pes piano valgus 11 Genu valgum and pes piano valgus 1 Low arch 1 Hallux valgus 3 Tibial flexion deformity 2 Shortening of leg 1 Valgus deformity of heels 4 Hammer toes 2 Mid-tarsal varus 1 Genu valgum 4 Thickening, metatarsal shafts 1 Overriding toes 2 Pes cavus 1 Digitus varus 1 Valgus ankle 1 Torticollis 1 Varus deformity 4 Bowed tibia 1 Trigger thumb 1 Osteophytes 1 Elevation of rt. scapula 1 Flexion deformity-digit 1 Poor posture 1 Metatarsus primus varus 1 Kohler's disease 1 169 Rt. syndectomy 1 Referred to Whipps Cross Hospital for diagnosis 1 No disability 9 The following conditions were seen at re-inspections:— Valgus heels 2 Valgus ankles 3 Pes piano valgus 33 Low arch 1 Pes cavus 1 Hallux valgus 1 Spasmodic flat foot 1 Digitus varus 4 Pes piano valgus and digitus varus 1 Genu valgum 6 Genu valgum and pes piano valgus 6 Hammer toes 5 Congenital dislocated hip 2 Metatarsalgia 1 Congenital scoliosis 2 Elevation right scapula 1 Congenital synostosis radius and ulna 1 Hemiplegia 2 Bowed tibia 1 Poliomyelitis, left lower limb 2 Congenital amputation, right forearm 1 Congenital enlargement of limbs 1 Congenital shortening of limbs 3 Congenital talipes equinus 1 Talipes equinus 2 Spastic hemiplegia 3 Schlatter's disease 1 Spastic diplegia 1 Osteomyelitis 1 Fibula and flexion deformity 1 Kyphosis 1 Torticollis 1 Winged scapula 1 Loose body—knee 1 170 Physiotherapy. Twenty-one children were referred to Whipps Cross Hospital for corrective exercises. Admissions to Hospital. Eleven children were admitted to hospital, and the following operations performed:— Tenotomy digits 2 Flexor tendon transfer—hammer toes 5 Stretching of tendo achilles under G.A. 1 Tenotomy of tendo achilles and P.O.P. 2 Removal of loose bodies—knee 1 Surgical Appliances and Boots. Minor alterations to boots (wedges, etc.) 66 Valgus insoles 2 Walking caliper 2 High boot 1 Raised boot 1 Raised shoe 2 Catterhall spring 2 Hallux valgus night splint ... 3 Aural Clinic. Two-hundred and six individual children were seen by the E.N.T. Specialist at the 32 sessions held in 1953, 142 being new cases. Altogether 490 visits were paid to the clinic, giving an average attendance per session of 15 cases. The conditions dealt with by the E.N.T. Specialist were as follows:— Chronic nasal catarrh 31 Otitis media 21 Conditions involving tonsils and adenoids 21 Chronic tonsillitis 9 Nasal obstruction, mainly adenoids 12 Rhinitis 5 Deafness from various causes 29 Other conditions 14 It will be appreciated that some of the children had more than one defect but the above classification indicates the main presenting defect in each case. 171 Treatments and Investigations Recommended. Removal of tonsils and adenoids 34 X-ray of sinuses 19 Politzeration 14 Medication 31 Pure tone audiometry 3 Other types of treatment, observation and investigation 41 Investigations and Treatment carried out on other cases during the Year. Pure tone audiometry 10 Politzerations 12 X-rays of sinuses 7 X-rays of chest 3 Antral lavage 8 Polypi removed 2 Cauterisations 3 Hearing aid ordered 1 Total number of tonsillectomies and adenoidectomies recommended in the year 56 Number of operations performed by E.N.T. Specialist 23 Number of adenoidectomies recommended 8 Number of operations performed 2 18 cases of deafness were cured or improved. 11 cases of otitis media cured or improved. 33 cases discharged as requiring no further treatment. No report from the E.N.T. Specialist himself could be obtained owing to several changes of staff during the year. 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. 172 Delicate Pupils. Boys Girls Total No. of Delicate Pupils ascertained 25 30 55 No. admitted to Knotts Green Day Open Air School 8 2 10 No. admitted to Residential Open Air School 15 28 43 No. awaiting admission to Residential Open Air Schools at 31/12/53 3 3 Physically Handicapped. Fortunately the number in this category is small, and attention is drawn to those receiving residential treatment, which is three at the end of 1953. There were none awaiting admission to either Day or Resident Schools. Boys Girls Total No. attending at Knotts Green Open Air School 8 8 16 No. attending at Residential Schools 3 ... 3 No. ascertained in 1953 2 2 4 No. recommended Knotts Green Day Open Air School 1 1 2 No. recommended Residential School 1 1 2 No. recommended to continue at Ordinary School 4 3 7 Educationally Sub-normal. Boys Girls Total No. of Educationally Sub-normal Pupils ascertained 15 12 27 No. admitted to Harrow Green 13 9 22 No. admitted to Residential School 1 2 3 One child is awaiting admission to a Residential School. Three children who were ascertained in 1953 will attend Harrow Green in January, 1954. 173 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. No child was ascertained as maladjusted in 1953. One child ascertained in 1952, was placed in a Residential School. 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. No child was ascertained to be totally deaf in 1953. There are six children of school age attending Residential Deaf Schools. Seven 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. One child was ascertained as Partially Deaf in 1953, but was found to be fit to continue at an ordinary school with a hearing aid. There were three 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 1953. Three children attend Residential Schools for the Blind. Partially Sighted. These are children who cannot follow the ordinary curriculum without detriment to their sight or to their educational development, but can be educated by methods involving the use of sight. No child was so ascertained during 1953. There was one boy in this category attending a school for Partially Sighted pupils. 174 Epileptic Pupils. One child was ascertained as epileptic and admitted to a Residential School. There are now two children at Residential Schools and one attending a Day 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 1953 four boys and six girls were notified as being incapable of education in the Special School. Under Subsection 5 of Section 57 children who require supervision by the Mental Welfare Authority have to be notified. Four boys and six girls were so recommended in 1953 from Leyton and two boys and three girls from Forest Division attending Harrow Green School were referred for notification. 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 1953 some 86 children were sent away for from four to six weeks— 48 girls and 38 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 1953 one child received education at home, and on the 31st December, eighteen children were receiving tuition while long-term in-patients of Whipps Cross Hospital. 175 PROVISION OF MEALS. Average daily number of children fed under the Education Authority's arrangements during 1953 was :— Dinners Milk Meals Free 305 11,321 For payment 3,916 ... Totals 4,221 11,321 Number of meals supplied :— Dinners Milk Meals Free 65,602 2,183,206 For payment 760,391 ... Totals 825,993 2,183,206 SPEECH THERAPY. 1. Children at present Undergoing Treatment— Diagnosis of Defects— Boys Girls Total Stammer 44 9 53 Dyslalia 78 34 112 Disphonia 1 ... 1 Dyslalia and stammer 5 2 7 Cleft palate 1 1 2 Lisp 9 6 15 Lisp and stammer 2 ... 2 Hyporhinophonia 2 ... 2 Dislalia and Hyporhinophonia 2 1 3 Dislalia and hyperhinophonia 1 ... 1 Aphasia 1 ... 1 Disarthria 1 ... 1 Delayed speech 5 3 8 Careless speech 2 ... 2 No diagnosis ... 1 1 154 57 211 176 Incidence of speech defects among seniors, juniors, and infants— Seniors Juniors Infants Special Schools Total Stammer 21 17 13 2 53 Dyslalia 3 41 53 15 112 Lisp 4 5 6 ... 15 Hyporhinophonia 1 1 ... ... 2 Dyslalia and stammer ... 1 5 1 7 Lisp and stammer ... ... ••• 2 ... 2 Dislalia and rhinophonia ... 2 1 ... 3 Dislalia and hype- rhinophonia ... ... 1 1 Cleft palate ... 1 ... ... 1 2 Aphasia ... ... ... 1 1 Disarthria ... ... 1 1 Disphonia 1 ... ... ... 1 Delayed speech ... ... 3 5 8 Careless speech ... ... 1 1 2 No diagnosis ... ... 1 ... 1 31 67 85 28 211 2. Discharged—50. - Seniors Juniors Infants Special Schools Total Dyslalia 1 19 9 2 31 Stammering 5 4 4 1 14 Dyslalia and stammer ... ••• 2 ... 2 Retarded speech development ... ... ... 1 1 Lisp ... 1 1 ... 2 6 24 16 4 50 177 3. On Waiting List Nil 4. Average Number of Cases Treated Daily 12 5. Homes Visited 40 6 School Departments Visited 62 7. Parents Interviewed 185 8. Children referred to other Clinics 24 9 No. of New Cases 67 10. Children re-admitted 19 11 No. of Children who left before Cured or Discharged 9 12. Total No. of Attendances 2,407 13. No. of Children referred—No Treatment Necessary 5 CHILD GUIDANCE. Report of the Educational Psychologist to the Forest and Leyton Divisions (Miss M. Marshall). During the past year the Educational Psychologist has seen more children and given more individual tests than in any previous year. This is due partly to an increased number of requests from schools in the Forest Division where new schools have been opened during the year, and partly to the growth of the remedial teaching scheme in Leyton for children who are backward in reading. Total number of individual tests given : 412. Total number of individual tests given : 412. Boys Girls Totals Forest 153 56 209 Leyton 153 50 203 Total 306 106 412 (44 of these testa were given by a student psychologist) 178 The greatest number of the children seen come from the Junior Schools ; and it is satisfactory to netice that there were a larger number of Infants than Secondary School pupils referred to the psychologist, since the younger the child, the more chance there is of bringing about a re-adjustment. Pre-school Infants Juniors Secondary Forest Boys 1 45 94 13 Girls 1 12 31 12 Leyton Boys 0 14 128 11 Girls 1 4 38 7 Total 3 75 291 43 The I.Q. range of these children follows the usual pattern, except perhaps in the larger group of very dull children seen in the Forest Division. This is, however, only to be expected in an area where there has been such a large and rapid increase in school population. I.Q. RANGE. Below 70 71—90 91—110 111—130 131 + Totals Forest 21 80 72 29 7 209 Leyton 5 42 102 42 12 203 Total 26 122 174 71 19 412 One of the Psychologist's chief duties in the schools is to advise the teachers on children who are failing to make expected progress, and it is apparent from the figures given above that the largest number of these are children with below-average intellectual ability. The pressing need for smaller classes, where the slower children may receive more individual help, is constantly emphasized by the results of the tests given by the Psychologist. Various reasons lie behind the request for a psychological interview for any child. Sometimes the request comes from the teachers, sometimes from the parents via the school medical officer or head teacher. A broad survey of the reasons for the requests is given below, and it should be noted that sometimes a child is referred for more than one reason, e.g., a stammer and backwardness, or stealing from home and truancy from school. 179 Backwardness in school work (including reading problems) 61% Educational advice other than for backwardness ... 8% Behaviour problems : at home 16% at school 11% Physical symptoms, e.g., tics, enuresis, stammer, etc. 7% Requests from Probation Officers, Children's Officer, Juvenile Employment. Officers, etc 3% A good deal of attention by the Psychologist has been given to the problem of backwardness in reading during the year ; and very encouraging results are being maintained in the special remedial reading classes in the Leyton Junior Schools. In the summer term these were started in two additional schools, and altogether 88 children were given this extra help during the year. The selection of children who are most in need, and likely to benefit most from this help has taken up a great deal of the Psychologist's time ; and also the general supervision of the classes, the keeping of records and advice to the teachers. During the year two meetings of all the Heads of Junior Schools were arranged in the Forest Division, where facts and figures of backwardness in reading were discussed. Following this, both the psychologists from the Walthamstow Child Guidance Clinic gave courses of lectures on the teaching of reading in the Junior School, and the number of teachers who attended these courses was extremely high (nearly 300). The Psychologist also assisted in a County Survey of reading ability of all school leavers in the summer term. Reading quotients for some 630 boys and girls were obtained with the co-operation of the schools themselves. Comments on the results will have to await the completion of the County Survey. The number of school visits increased to 244, of which 125 were made to Leyton Schools and 119 to Forest Schools. In addition, there were visits to homes to see parents or to give tests to children unable to attend school. The Psychologist has also had more invitations to speak at gatherings of parents, teachers, speech therapists, etc. Twelve such meetings were addressed during the.year on various topics connected with problems of mental health, 180 In addition to work in the schools, the Psychologist also assisted in the work of the Child Guidance Clinic. Of the 412 children tested during the year, 106 were referred to the Psychiatrist (26.at the request of the Psychologist), and in some cases further tests were given by the Psychologist to these children. During the year 10 children (all boys) were given remedial teaching in reading or arithmetic at the Child Guidance Clinic at the request of the Psychiatrist. Altogether, these boys attended for 174 interviews or remedial education sessions with the Psychologist. Four of the ten have now been discharged as having reached a satisfactory standard, and the other six will continue in 1954. The Psychologist also had 41 interviews with parents or visitors to the clinic. ANALYSIS OF FIGURES FOR 1953. Walthamstow Out-Area W'stow C'ford Leyton Forest Number of Cases referred to the Clinic 93 19 52 57 Number of Cases diagilosed at Clinic 44 17 30 52 (a) Psychiatrists Diagnostic interviews 44 17 30 52 Treatment interviews 331 79 162 176 Other interviews ... ... ... ... (b) Psychologists Clinic Cases testod 54 17 36 46 Cases given remedial education 14 11 4 6 Treatment interviews (remedial education) 147 110 83 105 School visits on behalf of Clinic eases 31 11 34 49 Other interviews 44 8 18 23 (c) School Psychological Service Individual cases seen 221 84 203 209 Number referred to Clinic 12 7 11 15 Number of School Visits 107 33 123 121 (d) Play Therapists Treatment interviews 186 32 214 232 (e) Psychiatric Social Workers Interviews at Clinic 636 127 325 335 Interviews elsewhere 22 1 52 53 (/) Waiting List at 31.12.53 Cases for diagnosis 43 3 27 18 Awaiting treatment ... ... ... ... Cases suspended by agreement with School Medical Officer or parents ... ... 5 2 (g) Number of pupils treated during year 86 28 54 65 Number of pre-sehool children treated during year 3 (High St.) 8 (W. Ave) 2 1 181 RESEARCH WORK. Anti-tuberculosis Vaccine (B.C.G.). In collaboration with the Medical Research Council, there is being undertaken in Leyton schools a Trial of Anti-tuberculous Vaccine (B.C.G ). The trial involves at the outset children leaving secondary modern schools at the age of 15, and it is proposed to follow them up by regular examinations for at least three years. Participants in the trial are volunteers. The scheme is being operated by a Medical Research Council team especially assigned to this work, and comprises the following examinations:— (а) Penultimate school term : Initial tuberculin-testing and X-raying of volunteers ; inoculation with B.C.G. of those tuberculin-negatives selected for vaccination. (б) 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. 182 Progress in the Anti-Tuberculosis Vaccine Research Trial. Report by Dr. T. M. Pollock—Physician in charge of B.C.G. Trials. During 1953 the investigation into tuberculosis vaccines, in which the Leyton Public Health Authorities are co-operating with the Medical Research Council, continued. This scheme is being undertaken to discover the duration and degree of protection afforded by the vaccine in the general population ; and in Leyton it began in 1950. Twenty-four other London Boroughs, besides areas in Manchester and Birmingham, are taking part; and the 54,000 volunteers in the scheme, some of whom were vaccinated during their last term at school, are now being followed up to determine the value of the vaccine. Six-hundred and twenty-eight young people in Leyton are included. The follow-up consists mainly of a health visitor visit and annual chest X-ray ; and during 1953, as in the previous year, the health visitors concerned in the visiting played a great part in the successful progress of the trial. At these visits details of the scheme were explained to the parents, and encouragement given to the young people concerned to take advantage of the necessary X-ray examination. During these visits the health visitors also recorded data essential to the investigation. The X-ray Unit visited Dawlish Road Clinic in October, when invitations were sent to the group (numbering 217) who left school at Easter and Summer, 1951. About three-quarters of the invited young people attended for examination—a slight decline from the high figures of the previous year. The X-rays are a great health safeguard in adolescents at a time of life when tuberculosis is common, and it is hoped that as many of the young people concerned as possible will continue to take advantage of this health check and help in the investigation. 183 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 1,680 Second Age Group 1,271 Third Age Group 1,087 Total 4,038 b. Other Inspections. Number of Special Inspections 9 005 Number of Re-inspections 11,441 Total 20,446 184 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 17 198 211 12.5 Second Age Group 91 .133 210 17.3 Third Age Group 41 77 115 10.6 Total (Prescribed Groups) 149 408 536 13.2 Routine Inspections (Junior Occupation Centre) ... 3 3 4.7 TABLE II. A. Return of Defects found by Medical Inspection in the Year ended 31st December, 1953. Defect or Disease Routine Inspections Special Inspections Number requiring Treatment Observation Number requiring Treatment Observation (1) (2) (3) (4) (5) Skin 22 19 127 1 Eyes—(a) Vision 149 57 233 49 (6) Squint 26 16 22 5 (c) Other 13 6 288 5 Ears—(a) Hearing 17 90 17 5 (6) Otitis Media 20 72 27 ... (c) Other 66 15 169 6 Nose or Throat 95 8? 207 10 Speech 10 15 43 3 Cervical Glands 1 37 4 ... Heart and Circulation 14 57 1 10 Lungs 16 92 43 15 Developmental—(a) Hernia ... 1 5 ... (6) Other 2 52 42 2 Orthopaedic—(a) Posture 9 35 2 1 (6) Flat Foot 46 36 20 ... (c) Other 51 54 95 1 Nervous System—(a) Epilepsy 2 ... 5 l (6) Other 10 20 9 l Psychological—(a) Development 1 8 25 ... (6) Stability 8 12 15 4 Other 24 37 1,275 61 185 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 1,680 343 20.4 1,285 76.5 52 3.1 Second Age Group 1,271 419 32.9 818 64.4 34 2.7 Third Age Group 1,087 371 34.1 703 64.7 13 1.2 Other Routine Inspections 63 4 6.3 58 92.1 1 1.6 Total 4,101 1,137 27.7 2,864 69.8 100 2.5 TABLE III.—Return of Defects Treated during the Year ended 31st December, 1953. 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 1 Body ... ... Scabies 1 Impetigo 8 2 Other skin diseases 136 4 Minor Eye Defects— (External and other, but excluding cases falling in Group II) 226 3 Minor Ear Dejects 325 29 M iscellaneous— (e.g., minor injuries, bruises, sores, chilblains, etc.) 1,418 122 Total 2,115 160 186 TABLE 1X1.—contd. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as minor ailment8.—grocp I). TABLE III.—contd. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as minor ailments.–group i). Defect or Disease Number of Defects dealt with By the Authority Otherwise Errors of refraction (including squint) ... 407 Other defect or disease of the eyes (excluding those recorded in Group I) ... ... Total ... ... 407 No. of Pupils for whom Spectacles were— (a) Prescribed ... 879 (6) Obtained ... 887 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 109 (b) for other nose and throat conditions 16 Received other forms of treatment 325 29 325 154 Group IV.—Orthopedic and Postural Defects. (a) No. treated as in-patients in hospitals or hospital schools 19 (b) No. treated otherwise, e.g., in clinics or patient departments 137 Group V.—Child Guidance Treatment and Speech Therapy. No. of pupils treated— (a) Under Child Guidance arrangements 203 (b) Under Speech Therapy arrangements 211 187 TABLE IV. Dental Inspection and Treatment. (1) Number of pupils who were :— (a) Inspected by the Dentist 2,441 Specials (Casuals) 1,487 Grand Total 3,928 (b) Found to require treatment 3,367 (c) Actually treated 3,495 (2) Half-days devoted to Inspection 22 Treatment 1,571—Total 1,593 (3) Attendances made by children for treatment 9,193 (4) Fillings, Permanent Teeth 2,645 Temporary „ 479—Total 3,124 (5) Extractions, Permanent Teeth 981 Temporary ,, 5,080—Total 6,061 (6) Administrations of general anaesthetics for extractions 1,636 (7) Other operations, Permanent Teeth 3,882 Temporary ,, 2,191—Total 6,073 TABLE V. Infestation with Vermin. (1) Total number of examinations in the Schools by School Nurses 28,081 (2) Number of individual pupils found to be infested 306 (3) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2) Education Act, 1944.) 187 (4) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3) Education Act, 1944.) ...