AC 4411(1) LEYTON Borough of Lepton HEALTH REPORT FOR THE YEAH 1955 MELVILLE WATKINS M.R.C.S , L.R.C.P., D.P.H, Medical Office of Health. Borough of Leyton Area Medical Officer, County of Essex Divisional School Medical Officer CONTENTS Page 1. Index 2 2. Opening Remarks 4 3. Local Sanitary Authority 7 4 County Health Services 34 5. School Medical Service 52 2 INDEX Page Acreage, 16 Ambulance Services 49 Ante-natal Clinics 43 Area Health Sub-Committee 34 Atmospheric Pollution 32 Aural Clinic 63 Bacteriological Examinations 23 B.C.G. Vaccination 55 Birth Notifications 42 Birth Rate 17 Birth Registrations 42 Births, Illegitimate 17 Births, Institutions 38 Burial of the Dead 9 Business and Industrial Establishments, Inspection of 29 Care Association 40 Chemical Analysis 23 Child Guidance Clinic 61 Child Welfare Clinics 43 Chiropody 49 Clinics Ante-Natal 43 Aural 63 Child Guidance 61 Child Welfare 43 Chiropody 49 Minor Ailment 63 Opthalmic 63 Orthopaedic 63 Orthoptic 63 Post-Natal 43 Scabies 9 Speech Therapy 64 Clinic Sessions 46 Convalescent Home Treatment 50 Day Nurseries 45 Death, Causes of 18 Death Rate 17 Dental Treatment 69 Diphtheria Immunisation 48 Diseases of Animals, Acts and Orders 15 Disinfestations 27 Distribution of Welfare Foods 38 Domestic Help Service 51 Domiciliary Midwives 47 Education, Leyton Committee for 52 Extra Nourishment 50 Factories Acts, 1937/48 26 Food, Clean 15 Food Condemned 31 Food Premises 25 Food and Drugs Act, 1938 25 Foot Clinic 49 Gas and Air Analgesia 47 Page Handicapped Pupils 56 Harrow Green E.S.N. School 59 Health Centres 42 Health Education 40 Health Visiting 47 Home Nursing 48 Hospitals 23 Housing 9 Ice Cream 29 Immunisation 48 Infant Mortality 45 Infectious Diseases 8 Knotts Green Special School 58 Laboratory Facilities 23 Legal Proceedings 31 Leyton Corporation Act, 1950 24 Mass Radiography 40 Maternal Mortality 38 Maternity Nursing 47 Maternity Outfits 47 Medical Aid 47 Medical Examination of Staff 52 Meteorological Conditions 6 Midwifery 47 Minor Ailment Clinics 63 Mortuary 9 National Assistance Act, 1948 (Sections 47 and 50) 9 National Health Service Act, 1946 (Part III) 34 Neo-Natal Mortality 45 Notices, Sanitary 24 Notification of Births 42 Notification of Infectious Diseases 8 Nursing Homes 23 Occupational Therapy 40 Old People Living at Home 38 Open Air Shelters 49 Opthalmic Clinic 63 Oral Hygiene 55 Orthodontic Treatment 54 Orthopaedic Clinic 63 Orthoptic Clinic 63 Pet Animals Act, 1951 30 Population 17 Post-Natal Clinic 43 Premature Infants 45 Public Health Committee 5 Problem Families 41 Rag Flock Act, 1951 32 Rateable Value 17 Rodent Control 27 Routine Medical Inspection 53 3 Page Sanitary Inspection 24 Scabies Clinic 9 School Dental Service 54 School Health Service 52 Shops Act, 1950 24 Sick Room Equipment 50 Smoke Abatement 32 Social Conditions 16 Speech Therapy 64 Staff 9 Staff, Medical Examinations 52 Statistics, Vital 17 Student Sanitary Inspectors 9 Tuberculosis 8 B.C.G. Immunisation 55 Care Association 40 Page Deaths 23 Extra Nourishment 50 Mass Radiography 40 Notifications 22 Occupational Therapy 40 Open Air Shelters 49 Uncleanliness 53 Vaccination 48 Vital Statistics 17 Welfare Foods, Distribution of 38 Whooping Cough Immunisation 49 4 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LETT OH Mr. Mayor, Ladies and Gentlemen, I have the honour to submit this, my first Annual Report, as required by the Ministry of Health, and for the convenience of Members this also includes sections on the County Health Services (National Health Service Act—Part III) and the School Health Service. My predecessor, Dr. A. W. Forrest, retired from duty in May, 1955, after a period of twenty-seven years' service with the Borough Council. From the date of his retirement, Dr. M. L. Gilchrist, Deputy Medical Officer of Health, served as Acting Medical Officer of Health until I commenced duty on 1st August, 1955. As this Report constitutes a review of a year during which three different officers have been responsible for the work of the Health Department, it cannot be otherwise than fragmentary. In the body of the Report attention is drawn to the problems regarding food hygiene, atmospheric pollution, housing, population trends and the care of the elderly. The latter problem will increase rather than decrease in the future. However, it is pleasing to note the interest taken in the old people, both by the statutory authorities and the various voluntary organisations in the Borough. The duties of a new Medical Officer of Health cannot meet with success without the support of the Council, the co-operation of the Chief Officers of other departments, and the loyalty of the staff of the Health Department. To all these my thanks are due for their much valued assistance. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, MELVILLE WATKINS 5 PUBLIC HEALTH COMMITTEE 1955-56 The Worshipful the Mayor—Councillor H. Steer, j.p. (ex'officio) Chairman Councillor H. E. Martin Vice'Chairman Councillor F. W. Marshall Alderman G. S. Flack „ B. G. Rayner Councillor W. A. Cross „ Miss V. D. Gostling W. Hook, m.p.s. „ W. H. Sanders „ J. D. Watson F. W. Wigg STAFF Medical Officer of Health Andrew Walker Forrest, m.a., m.d.,ch.b., d.p.h. (to 31.5.55) Melville Watkins, m.r.c.s., l.r.c.p ., d.p.h. (from 1,8.55) Deputy Medical Officer of Health Mary Lyle Gilchrist, m.d., ch.b., d.p.h. Chief Sanitary Inspector B. J. Ashcroft, m.s.i.a., m.inst.b.e. a, b, c, d Deputy Chief Sanitary Inspector R A. Reeves, m.s.i.a. a,b Sanitary Inspectors A. E. Barnes a, b P. W. Edwards, m.s.i.a. a, b D. J. Davies (to 9.2.55) a, b, c C. Pomfret, m.s.i.a., a.r.s.i. a,b,c L. Joyce (from 12.4.55) a,b R. J. Davies (from 6.6.55) a, b E. Kottman (from 2.8.55) a,b A. Page (from 1.9.55) a a. Certificate of the Royal Sanitary Institute and Sanitary Inspector's Examination Joint Board. b. Royal Sanitary Institute—Meat and Food Inspector's Certificate. c. Royal Sanitary Institute—Smoke Inspector's Certificate. d. Gold Medallist—Ollett Trust Competition. 6 Student Sanitary Inspectors C. Sharratt (from 13.6.55) D. Yarrow (from 21.3.55) Public Analysts G. Taylor, f.r.i.c. J. H. Hammence, m.Sc., Ph.d., f.r.i.c. Chief Cler\ *W. D. Softley Clerical Staff N. Gray J. Burtt Mrs. V. Hatwell L. Williams T. Crute Mrs. A. L. Downes *Part-time. METEOROLOGICAL CONDITIONS, 1955 Summary of Temperature, Rainfall and Sunshine Records These figures—supplied by the Director of the Meteorological Office of the Air Ministry—summarise the official records of temperature, rainfall and sunshine made at Kew Observatory during the year 1955. January. Frequent frosts in mid-month. Eleven days with snow or sleet. Snow lying up to eight inches deep in parts of London on 14th. There were no prolonged thick fogs, and sunshine was about average. February. Coldest since 1947. Month was remarkably fog free, and sunshine was above average. March. Sunny, but very cold ; wet and mild 23rd-26th. Sunniest since 1938 ; only 1917 colder since 1892. Temperature below average on 26 days. Little fog or snow, and little rain except between 23rd and 26th. April. Unusually dry and sunny ; rather warm. Rainfall less than thirty per cent, of average. No snow and no fog. Easter holidays dry and warm. May. Cold and wet, but above average sunshine. Wettest May at Kew since 1932 and coldest since 1941. Whitsun holidays sunny. June. Changeable. Third successive June with substantial deficit of sunshine. Period 7th-12th particularly dull, wet and cold. July. Dry, warm and sunny. Driest July since 1921. Sunshine above average, but not to the same extent in London as in many parts of the country. August. Dry and warm. Rainfall in most parts was less than half normal. Sunshine was about average. August holidays sunny. 7 September. Sunny and mostly dry. The warmest day was the 2nd, when temperature reached 80°F. October. Rather cold. Sunshine was slightly above normal. November. Dry ; very mild at first. Driest November since 1945 at Kew. First fortnight was particularly mild and changeable ; second fortnight rather cold and cloudy. December. Mild month, with temperatures about 4°F. above average. As mild as in the previous year. Average month for sunshine. Christmas holidays very mild. Local Sanitary Authority The Registrar General's estimate of population in the Borough for 1955 is 102,000. This shows a reduction of 1,100 as compared with the previous year. Apart from the 1,000 persons who have removed from the area there was a disconcerting trend of excess of deaths over births by 122. The present population figure of 102,000 is the same as the population in 1903, and in that year there were 17,995 dwelling houses, whereas at the end of 1955 there were 27,674, an increase of 53.78 per cent. It is apparent that there are less occupants per housing unit and in consequence there is less overcrowding. There is evidence that a number of the properties are now under-occupied, and it is found that in some cases there are one or two aged persons occupying a house which is too large for them to manage and maintain on their own. Better use of the accommodation in the Borough could be attained if a larger number of small dwelling units were available in which to re-house some of the aged people and, at the same time, release houses for the larger families. Birth Rate. It will be seen from the vital statistics that the birth rate is the lowest ever recorded, being 11.13 per thousand of population in contrast to the national figure of 15.00 per thousand. The disparity between the Leyton and the national birth rates is, in the main, due to the greater percentage in the older age groups and the removal from the Borough of large numbers of people who are in the reproductive age groups. Death Rate. The death rate for the year is increased from 10.99 in 1954 to 12.33 in 1955, the actual deaths being 1,133 and 1,258 respectively. With an ageing population there will, of necessity, be a slight increase in the death rates that have appertained since 1946. The causes of death, as set out in the statistical table, do not show any special features. However, it is pleasing to note that the total number of deaths for all forms of tuberculosis during the year is as low as 12. No deaths from other infectious disease occurred during the year. The major killing diseases are those due to the circulatory systems and various forms of carcinoma. Cancer of the lung deaths show an increase of 8 over the previous year. 8 Infectious Diseases. The total number of notifications of all infectious diseases is lower than last year. One disquieting feature, however, is the increase in poliomyelitis cases ; the highest number recorded in Leyton. The proportion of paralytic to the non-paralytic form of this disease is shown on page 21, together with the age groups affected. There is world wide interest in the results of the field trials carried out on the vaccine against polio myelitis in the United States. Their findings seems highly favourable towards this vaccine. This may well be the answer to this dreaded disease, formerly known as ' infantile paralysis.' Seventeen of the cases notified in 1955 were of school age or under. No cases of diphtheria occurred, but there should be no complacency. Immunisation must be kept at high level to ensure its suppression, especially amongst infants. The percentage of infants so protected is disappointing. Measles still claims the highest numbers of any of the infectious diseases. Although only 63 cases of food poisoning were notified, there is no doubt that several times this number of cases occurred where the persons concerned did not seek medical attention. Of the three cases of typhoid fever, one was not a Leyton resident. Another was found to be a carrier and was undoubtedly the infecting source of the third, a child of two. Fortunately no deaths occurred. Dysentery and Food Poisoning. It is hoped that a reduction of the incidence of food poisoning will result when the Food Hygiene Regulations of 1955 come into force next year. Apart from specifying hygienic standards of premises and equipment, it is gratifying to note that there are requirements relating to persons engaged in handling food. The owner or occupier will be obliged to notify the Medical Officer of Health when he becomes aware that a person is suffering from, or is a carrier of, an infection likely to cause food poisoning. These regulations can do much, but however strictly they are observed a food handler with unhygienic habits can do untold harm. Tuberculosis. It is gratifying to note that the incidence of tuberculosis of all forms is the lowest recorded in Leyton. The number of deaths remained low thanks to earlier diagnosis, vigorous case finding and improved methods of treatment. Even so, they still exceed fatal motor vehicle accidents. Although B.C.G. vaccination has proved its value in affording considerable protection against tuberculosis, it is the maintenance of good nutrition, general hygienic measures, and the constant pursuit of the infecting source that we must look to in order to reduce still further the number of cases. There are still too many unknown infectors whose symptoms are so mild that they live an active life but constitute a dangerous reservoir of infection. They seem reluctant to avail themselves of the excellent services of miniature mass radiography units. Mass radiography surveys have revealed that a comparatively high incidence of undiscovered infectious cases occur in the adult male group of 50 and over. 9 National Assistance Act, 1948—Section 47. In February application was made to a court of summary jurisdiction for orders under Section 47 of the above Act, to remove to hospital compulsorily three old people physically incapacitated and living in insanitary conditions, who were unable to devote to themselves proper care and attention. The orders were granted, and one person (aged 82) died on the following day, another (aged 83) died two weeks later, and the third (aged 78) returned to her home after three weeks in hospital. National Assistance Act, 1948—Section 50. During the year arrangements were made for the carrying out of 18 burials under this -section of the Act. Public Mortuary. The arrangements 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 have continued during the year. Forty-eight post mortem examinations were performed. Scabies Clinic. With the co-operation of Hackney Borough Council facilities for Leyton patients are made available at the Cleansing Centre, Millfields Road, Hackney, and during the year 11 residents attended for treatment and made 12 attendances. Staff—Medical. Dr. A. W. Forrest, Medical Officer of Health, retired after twentyseven years' service on 31st May, 1955. There have been no other changes in the medical personnel, either of the Local Sanitary Authority or the Local Health Authority during the year. Staff—Sanitary Inspectors. The authorised establishment comprises the Chief Sanitary Inspector, Deputy Chief Sanitary Inspector and eight District Sanitary Inspectors, and although this establishment may be considered to be adequate to deal with routine day-to-day requirements it is not sufficient to compensate for vacancies which occur from time to time. During most of 1954, and for the first six months of 1955, the technical staff was reduced to five. This depleted staff was almost wholly employed in dealing with complaints and other matters requiring day to day attention, which left little time for less urgent work and special duties. At the time of preparation of this report there are still two vacancies on the establishment. Details of a scheme in the recruitment and training of student sanitary inspectors, as approved by the Council, were given in the report for 1954. One student was appointed in March and one in June, and I am pleased to report that both are making good progress. Housing. The satisfactory housing of its people is the most rewarding task of any Local Authority. Nothing can be more conducive to the physical and mental wellbeing of a family than a decent home. 10 The year under review has been an important one in the field of housing. The Government directed local authorities to take active steps to review housing conditions in their areas, and forthwith resume full exercise of their powers and statutory responsibilities under the Housing Acts, 1936/54, in relation to slum clearance and the enforcement of essential repairs to defective dwelling-houses, and to resume the practice, curtailed owing to wartime conditions, of keeping records in accordance with the Housing Consolidated Regulations, 1925/32. Section 5 of the Housing Act, 1936, requires local authorities to cause inspection of their districts to be made from time to time in order to ascertain whether any house therein is unfit for human habitation. This duty is supplemented by section 1 of the Housing Repairs and Rents Act, 1954, which requires local authorities to submit to the Ministry of Housing and Local Government proposals for dealing with houses in their districts which appear to be unfit for human habitation and with any other houses which they consider should be included in clearance areas. The specified duties under the above statutory provisions carry with them the implied duty of making a housing survey. The nature, scope and findings of the preliminary survey of the ten areas in the Borough previously selected for redevelopment was reported to, and considered by, the Council in 1954. A further survey was undertaken in the early part of 1955 to provide information required by section 1 of the Housing Repairs and Rents Act. The Council's proposals in this respect were submitted to the Ministry of Housing and Local Government in August. This survey was carried out on a block basis and confined to districts known to contain aggregations of houses likely to be dealt with under slum clearance procedure, and whereas the information obtained was sufficient for the purpose, a large number of the inspections made could not, because of their hurried and cursory nature, be properly recorded as inspections under the Housing Consolidated Regulations. The work of the District Sanitary Inspectors was re-organised in accordance with the Government's direction to local authorities to resume full exercise of their powers and statutory responsibilities under the Housing Acts. Inspection cards were introduced to facilitate housing inspections during the course of routine district work. Houses visited as a result of complaint, applications for certificates of disrepair, housing applications, overcrowding, etc., are now being recorded on forms provided and broadly classified in three categories:— Cat. A : Houses which appear to be unfit for habitation to such a degree as to justify their being dealt with under section 11 or 12 (demolition or closure) or section 25 (slum clearance) of the Housing Acts, 1936/54. 11 Cat. B : Houses which appear to be in certain respects substandard but are nevertheless reasonably suitable for occupation and outside the scope of slum clearance or demolition/closing procedure at the present time. Cat. C : Houses which appear to be modern or comparatively modern in design and structually sound. The above classifications are determined having regard to the requirements of section 25 of the Housing Act, 1936, and the standard of fitness for human habitation prescribed by section 9 of the Housing Repairs and Rents Act, 1954. It is hoped to extend the scope of district housing inspection on a house-to-house basis, dependent on the staff of Sanitary Inspectors available. Inspection forms were also introduced to facilitate action resulting from such inspections in connection with the issue of certificates of disrepair and the service of notices under the Public Health and Housing Acts to enforce essential repairs and compliance with relevant statutory provisions. 2,234 complaints in respect of dwelling-houses were received and dealt with. The majority of complaints concerned items of disrepair which had given rise to defective conditions, such as dampness, leaking roofs, broken wall plaster, decayed floor timbers, etc. During the course of the year 10,260 housing inspections and reinspections were carried out, resulting in the service of 1,253 formal and informal notices. These inspections revealed that of the 1,369 families affected by notices served 460 (34.3%) were without the exclusive use of a W.C., and 134 (9.8%) were without separate water supply. It would appear from the comparatively small number (36) of applications received from tenants for certificates of disrepair under section 26 of the Housing Repairs and Rents Act, 1954, that this Act has failed in its primary object of encouraging owners to renovate their properties. This may be due to the high initial repair expenditure necessary in certain types of substandard houses to justify a rent increase. Details of the number of applications received, certificates of disrepair issued and revoked, are given in the statistical tables. On 22nd June a special meeting of the Public Health Committee was convened to give consideration to a joint report by the Medical Officer of Health and Chief Sanitary Inspector on Future Housing Development, and on 15th July a joint meeting with the Housing and Town Planning Committee was arranged when agreement was reached on a number of important aspects of the Borough's housing problem—vide Council Minute 751, July, 1955. Paragraph (c) of that minute contained instructions to the Officers to complete the necessary preparatory and survey work in respect of two areas in the Borough selected for redevelopment. This work started in August and continued throughout the year. As this is the beginning of a long term programme of redevelopment in the Borough, it is reasonable to assume that at least two Inspectors will be engaged on this work for an indefinite number of years. 12 As many years must elapse before the fulfilment of plans which may be made for future redevelopment of the Borough and for the clearance of slum houses, it is inevitable that a substantial proportion of the thousand or more houses which, as a result of the preliminary survey referred to earlier, were provisionally classified as unfit for habitation, will have to be retained and maintained for housing purposes for many years to come. The Health Committee will, therefore, be faced for an indefinite period with the problem of enforcing essential repairs to insanitary properties. The problem of maintaining existing houses in a habitable state is likely to become progressively more difficult, and this, coupled with a resumption of statutory duties, in relation to district inspection under section 5 of the Act, will result in an increase in the number of " problem " cases where, despite statutory action, it is not possible to bring about any improvements in the insanitary conditions in which the occupants are living. When this stage has been reached the Council will be faced with the problem of demolishing or closing the houses and re-housing the occupants, or alternatively, with the problem of incurring expenditure in repairing and/or acquiring them with little, if any, hope of recovering in full the cost involved. The implications—financial, administrative and technical—of either course are very great. Details of inspections and notices served under the Housing and Public Health Acts and relevant legislation are set out in the statistical section of the report. Information under this heading also includes the number of houses classified as a result of inspections under the Housing Consolidated Regulations, 1925/32, details of improvements effected to dwelling-houses as a result of informal and statutory action (including the institution of legal proceedings), and records. Rodent Control. The Chief Sanitary Inspector is the Council's representative on No. 8 Workable Area Committee set up by the Ministry of Agriculture, Fisheries and Food for rodent control. This Committee comprises representatives of 11 neighbouring local authorities, and meets about three times per year. The Ministry places great value on the results achieved by Workable Area Committees, especially in dealing with such problems as simultaneous treatment of interconnected sewers which are the responsibility of adjacent authorities. The benefit of co-operation thus built up between neighbouring authorities has proved very useful. The Council's sewers were disinfested in August and December, 1955. Each treatment was of four to five weeks' duration, involving over 1,000 manholes, which were baited on three successive days. The staff required for sewer treatments comprises four employees of the Borough Engineer's Department (two sewermen and two labourers) and two rodent operatives. During these periods the remaining rodent operative endeavours to deal with complaints and other essential duties in the Public Health Department. Poisoned baiting of sewers is 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 migration of rats from defective sewers and drains to adjoining buildings. All infestations are carefully investigated 13 by Sanitary Inspectors, who then arrange for drainage systems suspected of being the source of trouble to be smoke-tested and repaired, in liaison with the Borough Engineer. Some indication of the extent of this work may be gathered from the fact that during the year the drainage systems of some 37 houses were wholly or in part, repaired or reconstructed. 599 complaints relative to infestation by rats and mice were investigated and 580 private houses and 122 business premises were dealt with. The total number of visits in connection with these investigations and subsequent disinfestation work amounted to 6,294. Business Premises. In the Borough there are 1,586 business premises—factories, food premises, shops, industrial undertakings, etc.—involving 2,311 activities and subject to registration or licence under various Acts and Orders. These premises should be inspected regularly by Sanitary Inspectors to ensure compliance with the provisions of the Acts controlling them and the health of those who work in them. Because of staff shortages it was not possible to maintain throughout the year a regular and systematic inspection of all business premises. 3,241 inspections were carried out, 97 notices were served and 266 new registrations and/or licences were dealt with. Attention is drawn to the statistical section of the report for further deails. Food and Drugs and Shops Acts Administration. The Council is the Food and Drugs authority for the district and the 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. 100 samples of a variety of foods and drugs were submitted to the Public Analysis for chemical analysis. In eight instances adverse reports were received. The circumstances relating to these samples were reported to the Public Health Committee, and are summarised hereunder. The decision of the Committee is given in each case. Milk In February, 1955, a complaint was received regarding a bottle of milk alleged to have been adulterated by the addition of water. On investigation it was discovered that about half the milk had been used, so it was not possible to obtain a representative sample. The remaining portion of the milk was, however, deficient in milk fat to the extent of at least 50% of the normal quantity proper to natural milk. Because the top fatty portion of the milk had been removed prior to analysis, it was to be expected that the sample would show a milk fat deficiency, but the fact that the milk solids other than milk fat (8.83%) were above the prescribed minimum of 8.5% indicates that the milk had not been adulterated by the addition of water. It was resolved that no statutory action was justified in this case. Ice Cream In August an informal sample of ice-cream was found to be slightly deficient in milk solids other than fat, namely, 6.5% instead of 7.5% as required by the Food Standards (Ice Cream) Order, 1953. The percentage of fat was 5.2% in excess of the minimum 5% specified in the Order. Representations were made to the manufacturers and further samples obtained found to be satisfactory. 14 Milk (Hot) The Public Analyst's report in respect of a formal sample of hot milk indicated that the milk was adulterated by the addition of 6% of water. Legal proceedings were authorised in this case and the cafe proprietor concerned was convicted and fined 40s. with £2 2s. Od. costs. Orange Drink Two complaints regarding orange drink were received and upon examination one bottle was found to be dirty with black debris adhering to the bottom. In the other case fragments of glass were found in the bottle. In both cases the bottle had been opened prior to complaint being made. Warning letters were sent to the suppliers and distributors. Butter In October a complainant brought ½ lb. butter (Dutch), unsalted, alleged to be unfit for food. The butter was sold at half-price for cooking purposes. Upon examination it was found to contain several patches of black diecoloration. The Public Analyst reported that the blackened areas were due to a mould growth and that in his opinion the butter was unfit for human consumption in its raw state. Representations were made to the retailer in this case. Milk (Hot) Sliced Bread and Butter In December formal samples of hot milk and of sliced bread and butter were obtained from a local cafe. In the case of the hot milk the Analyst's certificate revealed that it was deficient in milk fat to the extent of at least 3½% of the normal quantity proper to natural milk. The cafe proprietor was warned in this instance. With regard to the sliced bread and butter the Analyst reported that the fat on this bread consisted not of butter but of margarine. Legal proceedings were authorised and the cafe proprietor was convicted and fined 40s. with £2 2s. Od. costs. Further information regarding samples of milk, ice cream, ice lollies, water, and sampling carried out under the Rag Flock and Other Filling Materials Act are given elsewhere. Meat and Food Condemned. Details of foodstuffs in respect of which condemnation certificates were issued as a result of routine inspection of the premises are given in the statistics table. In addition 17 complaints regarding unsound food were investigated by the Department. In 11 instances no action was justified and details of the remaining six were reported to the Public Health Committee. In respect of five of these cases the Committee resolved to send warning letters to retailers and/or manufacturers concerned. The sixth case concerned a leg of lamb which was found to be heavily infested with fly larvae and in an advanced stage of decomposition. The meat was seized in accordance with the provisions of the Food and Drugs Act, 1938, and subsequently condemned by a Justice of the Peace. The Committee authorised legal proceedings, the case was proved, and the defendants were fined £10 with £3 3s. Od. costs. Fcod Hygiene and Health Education. The campaign for cleaner food continues to receive special attention. All types of premises where food is prepared, handled, stored or sold, were inspected as frequently as possible to ensure compliance with the various Acts, Orders and Regulations, and the Council's Byelaws for "securing the observance of sanitary and cleanly conditions and practices 15 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." The number of inspections made amounted to 2,038. 67 notices were served and 38 applications were dealt with for registration of food premises under section 14 of the Food and Drugs Act, 1938, and food hawkers under section 103 of the Essex County Council Act, 1952. The Council's pleasure ground, Lea Bridge Road, was visited when fairs were operating during public holidays and as a result a number of itinerant food vendors were found not to be registered. Reports on this matter were submitted to the Public Health Committee, and the question as to the best practical means of exercising appropriate control over travelling vendors of food who enter the Borough only when fairs, circuses and like functions are operating, was discussed. Full details as to inspections, notices, registrations, improvements effected to food premises, etc., are given later in this report. 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 the structural condition of premises. The most important and unpredictable factor in the campaign for cleaner food is the worker. Carefully designed and elaborate food premises are not proof against the careless food handler who fails to observe the elementary principles of personal hygiene. It is often said that "one man's meat is another man's poison." In relation to food handling it could be said that one man's poison may be another man's meat. This is the crux of the problem. 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 could be taken in producing cleaner food. The Medical Officer of Health and Chief Sanitary Inspector have given a number of lectures on food hygiene to food handlers at school canteens and catering establishments and to local organisations. Unfortunately the existing staff of Sanitary Inspectors is 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. Diseases of Animals Acts and Orders. The administration of the law relating to diseases of animals is carried out partly by officers of the Ministry of Agriculture, Fisheries and Food and partly by officers of County Councils and local sanitary authorities. In this Borough Sanitary Inspectors are officers authorised under the various Acts. The Diseases of Animals Acts and Orders deal generally with the prevention and control of outbreaks of scheduled diseases and protection of animals against unnecessary suffering, and in this connection 77 inspections were made. Atmospheric Pollution. The year under review has been marked by the introduction by the Minister of Housing and Local Government of the Clean Air Bill, following the recommendations of the Air Pollution Committee (Beaver 16 Report). This Bill has aroused considerable discussion, and there is a great difference of opinion as to whether its provisions (if and when they become law) are likely to provide local authorities with an effective weapon for dealing with the problem of atmospheric pollution. There is, however, general agreement on one point, namely, that the proposed new statutory provisions will create a great deal of extra work. The Chairman of the Public Health Committee and the Chief Sanitary Inspector are the Council's representatives on the Standing Conference of Co-operating Bodies set up by the Department of Scientific and Industrial Research, with which Leyton is co-operating in the investigation of atmospheric pollution. Daily observations continued throughout the year. The recording apparatus operated by the Sanitary Inspectors is situated at the Public Health Offices, Sidmouth Road. A summary of these observations is reported to the Public Health Committee quarterly. The tables on page 33 shows the results recorded during the 12 months ended March, 1956, divided into Summer and Winter periods. The average results for the 5-year period ended March, 1955, are also shown for comparison. Concentration of smoke is expressed in milligrams per 100 cubic metres and sulphur dioxide in parts per 100 million. The average concentration of smoke for the period ended 31st March, 1956, was 20.8 milligrams per 100 cubic metres, compared with 21.1 milligrams for the previous 5 years—a reduction of 1.4%, whilst the concentration of sulphur dioxide for the same period was 7.3 parts per 100 million, compared with 6.6 parts for the previous 5 years—an increase of 10.6%. At the request of the Director of Fuel Research, the Council agreed to co-operate in a scheme for obtaining additional information about air pollution during periods of persistent fog, involving three-hourly observations. During the period under review, two warnings of persistent fog were received, one on 30th November, 1955, and one on 4th January, 1956. During the November fog, which lasted about 12 hours, three special observations were made, the peak concentrations reaching 127.8 milligrams of smoke per 100 cubic metres and 52.5 parts of sulphur dioxide per 100 million. The January fog lasted nearly three days ; six special observations were made and the peak concentration reached 197.5 milligrams of smoke per 100 cubic metres and 53.0 parts of sulphur dioxide per 100 million. The practical measures taken by Sanitary Inspectors to mitigate pollution of the atmosphere by smoke and grit include the taking of smoke observations of factory chimneys, which is usually followed by an inspection of the boiler installation and advice to boiler operatives and the management on proper use of fuel and methods of stoking, and in this respect 158 inspections were made. STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area in Acres 2,594 Population (Census 1951) 105,978 Population (Registrar-General's Estimate, 1955) 102,000 Number of private householders (Census 1951) 34,720 Number of structurally separate dwellings occupied (Census 1951) 27,134 17 Number of rooms occupied (Census 1951) 137,763 Number of persons per room (Census 1951) 0.75 Number of dwellings occupied by one private household 20,012 Number of dwellings occupied by two private households 6,728 Number of dwellings occupied by three or more private households 394 Assessable Value for General Rate purposes (1955/6) £785,391 Sum represented by a Penny Rate for General Rate purposes (1955/56) £3,170 Vital Statistics Population 102,000 Live Births:— Legitimate Males 539 Females 561 Illegitimate Males 16 Females 20 Totals 1,136 Birth rate per 1,000 of population 11.13 Stillbirths:— Males 8 Females 7 Rate per 1,000 total (live and still) births 13.03 Deaths:— Males 638 Females 620 Totals 1,258 Death Rate per 1,000 12.33 Number of women dying from diseases and accidents of pregnancy and childbirth:— From sepsis 0 From other causes 0 Rate per 1,000 total (live and still) births 0.00 Death rate of infants under one year of age:— All infants per 1,000 live births 24.64 Legitimate infants per 1,000 legitimate live births 25.45 Illegitimate infants per 1,000 illegitimate live births 0.00 The natural decrease of population (i.e. excess of deaths over births) was 122. 18 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 These factors, when applied to the crude rates, produce the following adjusted rates:— Live births 10.68 Deaths 11.22 Deaths. The Registrar-General's classification of causes of death by sex totals are shown in Table 1 on this page. The total number of deaths in 1955 (1,258) compares with 1,133 in 1954, the respective death rates per 1,000 population being 12.33 and 10.99. Causes of Death as given by the Registrar-General, 1955. Causes of Death Males Females Total 1. Tuberculosis (Respiratory) 7 3 10 2. Other forms of Tuberculosis 1 1 2 3. Syphilitic Disease 1 3 4 4. Diphtheria 0 0 0 5. Whooping Cough 0 0 0 6. Meningococcal Infections 0 0 0 7. Acute Poliomyelitis 0 0 0 8. Measles 0 0 0 9. Other Infective and Parasitic Diseases 2 0 2 10. Malignant Neoplasm—Stomach 22 13 35 11. Malignant Neoplasm—Lung and Bronchus 55 7 62 12. Malignant Neoplasm—Breast 0 31 31 13. Malignant Neoplasm—Uterus 0 5 5 14. Other Malignant and Lymphatic Neoplasms 41 54 95 15. Leukaemia and Aleukaemia 4 1 5 16. Diabetes 7 7 14 17. Vascular Lesions of Nervous System 53 88 141 18. Coronary Disease, Angina 110 60 170 19. Hypertension with Heart Disease 13 15 28 20. Other Heart Disease 83 160 243 21. Other Circulatory Disease 31 28 59 22. Influenza 5 2 7 23. Pneumonia 41 41 82 24. Bronchitis 62 28 90 25. Other Diseases of Respiratory System 10 1 11 26. Ulcer of Stomach and Duodenum 13 6 19 27. Gastritis, Enteritis and Diarrhoea 2 2 4 28. Nephritis and Nephrosis 1 4 5 29. Hyperplasia of Prostrate 9 0 9 30. Pregnancy, Childbirth, Abortion 0 0 0 31. Congenital Malformations 5 4 9 32. Other Defined and Ill-defined Diseases 41 44 85 33. Motor Vehicle Accidents 7 2 9 34. All Other Accidents 5 6 11 35. Suicide 7 4 11 36. Homicide 0 0 0 Totals, 1955 638 620 1,258 Totals. 1954 566 567 1,133 19 Comparative Statistics of Births, Mortality, Etc. LEYTON, 1901-1955. Year Population Births Birth Rate Deaths Death Rate Deaths under 1 year Infantile Death Rate 1901 100,000 2,963 29.63 1,243 12.4 404 136 1902 100,000 3,152 31.52 1,183 11.8 336 106 1903 102,000 3,273 32.08 1,112 10.9 322 99 1904 104,000 3,198 30.07 1,370 13.1 444 138 1905 105,000 3,209 30.05 1,177 11.2 303 94 1906 108,000 3,344 30.9 1,327 12.2 382 114.5 1907 120.000 3,190 26.6 1,269 10.6 182 86.6 1908 121,200 3,071 25.3 1,185 9.8 242 78.8 1909 121,200 2,979 24.6 1,208 9.9 244 81.9 1910 123,300 3,011 24.4 1,112 9.0 191 63.4 1911 124,736 2,931 23.5 1,473 11.8 327 116.6 1912 126,700 2,797 22.1 1,343 10.6 223 79.7 1913 129,366 2,904 22.4 1,336 10.3 242 83.3 1914 130,847 2,800 21.4 1,363 10.4 219 78.2 1915 124,497 2,655 21.3 1,510 12.1 225 84.7 1916 B132,107* 2,560 19.4 1,471 12.1 197 76.9 D121.420* 1917 B125,352* 2,005 16.0 1,414 12.6 172 85.8 D112,452* 1918 Bl25,352* 1,791 14.3 1,723 15.3 161 89.9 D112,452* 1919 B129,062* 2,195 17.0 1,397 11.3 154 70.16 D123,896* 1920 128,832* 3,168 24.6 1,330 10.3 207 63.54 1921 128,432 2,679 20.86 1,290 10.04 182 67.94 1922 131,600 2,416 18.36 1,420 10.79 155 64.16 1923 132,800 2,328 17.53 1,228 9.25 106 45.53 1924 133,500 2,101 15.74 1,325 9.92 110 52.36 1925 132,700 2,091 15.76 1,349 10.16 114 54.51 1926 130,000 2,022 15.55 1,261 9.7 131 64.79 1927 128,920 1,826 14.16 1,322 10.25 80 43.81 1928 130,300 1,853 14.22 1,290 9.90 91 49.10 1929 128,300 1,731 13.49 1,510 11.76 100 57.77 1930 128,300 1,757 13.69 1,222 9.52 81 46.09 1931 128,600 1,812 14.09 1,365 10.61 71 39.18 1932 127,140 1,666 13.10 1,341 10.54 89 53.43 1933 125,700 1,499 11.91 1,468 11.67 76 50.70 1934 123,430 1,454 11.78 1,317 10.67 64 44.02 1935 121,690 1,493 12.26 1,225 10.06 60 40.18 1936 119,900 1,421 11.85 1,272 10.61 74 52.07 1937 118,100 1,420 12.02 1,349 11.42 75 52.81 1938 117,200 1,509 12.87 1,148 9.79 70 46.38 1939 Bl16,100* 1,499 12.90 1,242 11.21 46 31.65 Dl10,800* 1940 96,500 1,353 14.02 1,563 16.2 50 39.03 1941 84,790 1,129 13.31 1,142 13.46 37 38.30 1942 86,960 1,452 16.69 1,123 12.91 73 50 27 1943 87,880 1,595 18.14 1,248 14.20 57 35.73 1944 85,440 1,613 18.87 1,285 15.04 68 42.15 1945 87,330 1,474 16.87 1,147 13.13 52 35.27 1946 101,910 2,223 21.81 1,181 11.58 64 28.78 1947 105.550 2,359 22.35 1,278 12.10 78 3 3.06 1948 106,100 1,810 17.06 1,118 10.53 38 20.99 1949 106,700 1,630 15.27 1,232 11.54 43 26.38 1950 106,600 1,447 13.57 1,134 10.64 29 20.04 1951 104,700 1,311 12.52 1,362 13.00 27 20.59 1952 104,200 1,355 13.00 1,220 11.70 37 27.30 1953 103,200 1,279 12.39 2,029 19.66 30 23.45 1954 103,100 1,232 11.95 1,133 10.99 18 14.61 1955 102,000 1,136 11.13 1,258 12.33 28 24.64 * Population as estimated for purposes of B, Birth Rate ; D, Death Rate. 20 Infectious Diseases Table showing the number of notified cases of infectious diseases and their disposal. Disease Notifications Received Removed to Hospital Smallpox — — Diphtheria — — Erysipelas 61 2 Scarlet Fever 73 13 Pemphigus Neonatorum — — Tuberculosis, Pulmonary 54 — Tuberculosis, Other forms 11 — Pneumonia 236 53 Ophthalmia Neonatorum 1 — Typhoid Fever 3 — Paratyphoid Fever — — Puerperal Pyrexia 25 24 Meningococcal Infection 2 2 Poliomyelitis, Paralytic 16 15 Poliomyelitis, Non-paralytic 5 5 Acute Encephalitis, Infective — — Acute Encephalitis, Post Infectious — — Measles 717 8 Whooping Cough 48 6 Dysentery 23 10 Food Poisoning 43 — Totals 1,318 138 On consulting the records I find that the number of notifications during the year 1955 is the lowest number since records became available, except for a period during the war years when a large proportion of the population was evacuated to the reception areas. 21 Poliomyelitis (Infantile Paralysis). Sixteen cases of paralytic and five non-paralytic cases of poliomyelitis were notified during the year. Most of the paralytic cases continue to attend physiotherapy departments as out-patients. Annual Incidence since 1947. The following list shows the annual number of cases of acute poliomyelitis notified in the Borough from 1947-1955 inclusive. Year Year Year 1947 14 1950 14 1953 8 1948 2 1951 — 1954 1 1949 20 1952 12 1955 21 One child died early in 1956 from lobar pneumonia having had poliomyelitis in 1955 and this was a contributing factor to her death. Summary of Notified Cases of Acute Poliomyelitis, 1955. No. Date of Notification Sex Age Paralysis as at May, 1956 1 24. 6.55 Female 11 Right leg and left leg. Wears calipers. 2 27. 6.55 Female 6/12 None. 3 21. 7.55 Male 6 Left arm and hand. 4 21. 7.55 Male 2 Slight deformity of right shoulder. 5 5. 8.55 Male 7 None. 6 5. 8.55 Female 40 Both legs—walks with crutches. 7 8. 8.55 Male 30 Right foot. 8 9. 8.55 Male 5½ None. 9 13. 8.55 Female 5/52 (Died 17.3.56). 10 30. 8.55 Male 9 None. 11 7. 9.55 Female 4 None. 12 16. 9.55 Female 6 Muscles of back. 13 16. 9.55 Female 2½ Right side of face. 14 23. 9.55 Male 8 Loss of tone of abdominal muscles. 15 28. 9.55 Female 34 Right lower leg and foot. 16 29. 9.55 Female 8 None. 17 18.10.55 Male 52 Left arm and diaphragm. 18 3.10.55 Female 7 None. 19 29.10.55 Male 4½ Removed from area. 20 28.10.55 Female 32 Left leg from the hip. 21 1.11.55 Male 2 2/12 Slight paralysis of right leg. Whooping Cough. Of the 48 children who developed whooping cough during the year, only six had to be removed to hospital. There were no deaths from this disease. Information regarding Protection against Whooping Cough will be found on page 49. 22 Tuberculosis. The following is a statement of particulars appearing in the Register of Notification of Cases of Tuberculosis for the year ended 31st December, 1955:— Pulmonary Non-Pulmonary TOTAL M. F. Total M. F. Total Number on Register at commencent of year 491 401 892 33 58 91 983 Number first notified during the year 36 18 54 4 7 11 65 Number of cases entered in Register otherwise than by Notification 14 17 31 1 2 3 34 Number removed from the Register during the year 55 34 89 5 14 19 108 Number remaining at the end of the year 486 402 888 33 53 86 974 Details of cases removed from the Register during the year:— Died 17 5 22 2 2 24 Removed from the district 20 14 34 — 3 3 37 De-notified 1 — 1 — — — 1 Cured 17 15 32 3 11 14 46 New Cases.—The following table gives particulars regarding the new cases which have occurred during the year:— Age Periods New Cases Pulmonary Non-Pulmonary M. F. M. F. 0 — — — — 1 1 2 1 — 5 — 3 — — 10 — — — — 15 1 1 — 1 20 5 2 — 1 25 4 7 — 1 35 7 1 1 2 45 6 — 1 1 55 8 1 — 1 65 and upwards 4 1 1 — Totals 36 18 4 7 23 The following table shows the annual number of new cases and deaths over a period of 10 years. Year Pulmonary Non-Pulmonary Total Notifications Deaths Notifications Deaths Notifications Deaths 1946 91 44 17 3 108 47 1947 89 41 9 4 98 45 1948 130 47 14 5 144 52 1949 118 33 9 4 127 37 1950 130 31 15 4 145 35 1951 100 35 14 5 114 40 1952 114 29 13 2 127 31 1953 78 35 13 4 91 39 1954 70 10 7 1 77 11 1955 54 10 11 2 65 12 LABORATORY FACILITIES. (a) Pathological Department, Whipps Cross Hospital, E.ll. For pathological specimens. (b) Central Public Health Laboratory, Colindale. For special bateriological 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. 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). 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 : 924 beds. (b) Langthorne Hospital. Accommodation : 636 beds. NURSING HOMES. During the year the Essex Association for the Blind requested permission to amalgamate the nursing homes at 1, Queen's Road and 61, Wallwood Road, with part of 63, Wallwood Road, into one unit. This request was granted, and there are now two nursing homes in the Borough registered under the provisions of the Public Health Act, 1936. 24 1, Queen's Road, Leytonstone, with accommodation for 60 patients; " Brooklands," 22, Fairlop Road, Leytonstone, with accommodation for 25 patients. Sanitary Inspection The following tables and charts give details in tabular form of the action taken and visits made as a result of complaints received and the statutory responsibilities in connection with environmental hygiene and the legislative powers in force. The administrative, professional and technical reports concerned are given elsewhere. 1. INSPECTIONS, RE-INSPECTIONS, ACTION. (a) General. Statutory Provisions Complaints Received Inspections and Reinspections Informal Notices Served Formal Notices Served Notices Complied with by Owner Notices Complied with by Local Authority Houses Classified No. of Separate Lettings Affected No. of Families in Occupation Families without Separate W.C. Separate Water Supply Housing Acts, 1936/54 334 534 Housing Repairs and Rents Act, 1954 57 198 Public Health Acts, 1936 1588 8089 924 329 902 36 1183 1369 460 134 Prevention of Damage by Pests Act, 1949 599 1439 4 4 Food and Drugs Act, 1938 27 2038 67 67 Shops Act, 1950 3 331 8 8 Essex County Council Act, 1952 2 ???56 2 2 Leyton Corporation Act, 1950 65 1 1 Factories Acts, 1937/48 8 506 19 17 Pet Animals Act, 1951 38 Rag Flock and Other Filling Materials Act, 1951 7 Diseases of Animals Acts 77 25 (b) Detailed. (i) Housing Repairs and Rents Act, 1954. The undermentioned return giving details of action taken as a result of applications received under Section 26 (i) of Part II of the above Act was submitted to the Ministry of Housing and Local Government in compliance with Circular No. 53/54. Number of Applications for Certificates of Disrepair Number Granted Number Refused Number of Applications for Revocation of Certificates of Disrepair Number Granted Number Refused Dwelling houses which have been the subject of a notice of repairs increase of rent under Part II of the 1954 Act 36 34 1 (1 with drawn) 39 39 — No applications were received in respect of dwelling-houses which have not been the subject of a notice of repairs increase of rent under the 1954 Act, or in respect of which permitted increases of rent are recoverable under Section II (i) (c) and (d) of the Increase of Rent and Mortgage Interest (Restrictions) Act, 1920. (ii) Food and Drugs Act, 1938—(Inspection and Supervision of Food Premises). The following inspections were carried out at the undermentioned food premises, in accordance with the requirements of the Public Health Act, 1936, Food and Drugs Act, 1938, and associated Orders and tions, Clean Food Bye-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. Type of Premises Number of Inspections Bakehouses 55 Bakers 74 Butchers 196 Catering Establishments 187 Confectioners 131 Corn Chandler 4 Dairies and Distributors of Milk 96 Factories 18 Factory Canteens 27 Fish Friers 38 Fishmongers 59 Game Dealers 9 Greengrocers 113 Horse-flesh Dealers 22 Ice-cream Places 149 Itinerant Stalls and Vehicles Food Dealers Food Storage Accommodation 239 Local Authority Canteen 3 Meat Depots 12 Miscellaneous 9 Multiple Stores 4 Off-Licences 25 Provision Shops 429 Public Houses 23 School Canteens 29 Shell-fish Vendors 12 Slaughterhouses (Poultry) 77 Street Markets 12 Total Inspections 2052 26 (iii) Inspection of business premises other than food premises. Inspections were carried out at the undermentioned 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 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 Number of Inspections Factories with Mechanical Power 419 Factories without Mechanical Power 67 Fairgrounds 27 Foster Mothers 2 Hairdressers and Barbers 53 Hospitals 9 Local Authority Properties 26 Miscellaneous Shops, etc. 75 Nursing Homes 11 Offices 2 Outworkers 263 Pet Animals Shops 38 Places of Entertainment 7 Public Conveniences 12 Rag Flock 7 Retail Shops 238 Schools 12 Stables 7 Warehouses 9 Workplaces 4 Total Inspections 1,288 (iv) Factories Acts, 1937/48. The following is an extract from a Statutory Return made annually to the Ministry of Health under the provisions of Part I of the above Acts. Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 60 67 4 (ii) Factories not included in (i) in Section 7 is enforced by the Local Authority 393 419 15 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers premises) 3 TOTAL 453 486 19 27 (v) Prevention of Damage by Pests Act, 1949—Rodent Control/ Disinfection. Rats Mice Total Complaints received 453 146 599 Infestation otherwise discovered 3 3 6 Enquiries and visits made: By Rodent Operatives 3710 1145 4855 By Sanitary Inspectors 1290 149 1439 Premises treated individually: Dwelling houses 379 168 547 Business/Industrial Premises 62 41 103 Blocks of premises treated: Dwelling houses 4 — 4 Business/Industrial Premises 2 — 2 Premises Re-treated: Dwelling houses 25 4 29 Business/Industrial Premises 10 7 17 Number of rooms treated — — 372 Number of sites/tips treated — — 6 2. NUISANCES ABATED, DEFECTS REMEDIED, IMPROVEMENTS EFFECTED. (i) Public Health Acts. Nature of work carried out to dwelling houses and other premises: Cement work to sink waste gullies repaired 30 Choked drains cleared 28 Dampness remedied 556 *Drains relaid or partly relaid 37 Floors repaired 182 Guttering repaired or renewed 225 Miscellaneous defects remedied 468 New W.C. pans and traps provided 36 Plaster repaired 529 Rainwater pipes repaired or renewed 119 Roofs repaired or renewed 550 Rooms redecorated 220 Sashcords renewed 233 Sinks provided 6 Sink waste pipes repaired or renewed 56 Stoves repaired or renewed 86 Vent pipes repaired or renewed 70 W.C. cisterns repaired or renewed 98 Window sills, etc. repaired 390 Yards paved 23 * In 36 cases the public sewer was involved, the work was carried out on behalf of the owners by the Council under the supervision of the Borough Engineer and Surveyor, the expenses incurred thereby being recovered from the owners. 28 (ii) Food and Drugs Acts/Shops Act. Nature of contraventions remedied and improvements effected to food establishments, business/industrial premises as a result of statutory and informal action. Rooms connecting directly with sanitary convenience 3 Walls, doors, windows, not kept in a proper state of repair or cleanliness 60 Ceiling not kept in a proper state of repair or cleanliness 56 Floor not kept in a proper state of repair or cleanliness 9 Suitable and sufficient ventilation not provided and maintained 3 Suitable and sufficient receptacles for refuse not provided 2 Cleanliness not observed by persons employed in the room 1 Facilities for personal cleansing inadequate in respect of: Suitable and sufficient wash-hand basins 6 Suitable and sufficient hot water 11 Suitable and sufficient soap, clean towels 7 Food not protected from contamination 2 Accumulation of refuse in yard 3 Defective cement dishing to sink waste gully 2 Suitable storage facilities not provided 3 Suitable and sufficient sanitary convenience not provided 8 General defects 5 (iii) Factories Acts. The undermentioned details were submitted to the Ministry of Health in accordance with the provisions of Part I of the above Act. Nature of Contravention Number of factories in which defects were found Found Remedied Want of cleanliness 10 8 Unreasonable temperature (S.3) 1 1 Sanitary Conveniences (S.7): (a) Insufficient 2 1 (b) Unsuitable or defective 8 2 (c) Not separate for sexes 2 1 Other offences against the Act (not including offences relating to Outwork) 6 4 TOTAL 29 17 29 3. REGISTRATION AND/OR LICENSING OF BUSINESS PREMISES. (i) Approximate numbers of business premises in the Borough and functions involved. Nature of Trade/Business carried on No. of Premises ADDITIONAL LICENCES, REGISTRATIONS AND OTHER FUNCTIONS INVOLVED 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 42 28 1 28 2 B Butcher 76 47 3 4 1 C Catering 103 54 1 D Confectionery 147 55 E Fish 47 13 10 29 F Greengrocer 80 1 3 G Grocer 205 52 93 1 2 H Multiple Store 5 3 2 3 1 I Milk 12 1 2 J Ice Cream 109 K Rag Flock 9 7 2 L Pet Animals 15 2 M Horse Flesh 2 N Hairdresser 77 43 O Hawker 94 57 P Public House 35 10 32 Q Off Licence 45 4 3 2 R Factory 459 64 36 S School 18 1 17 T Council Property 4 2 2 U Hospital 2 2 V Miscellaneous Shops 754 Total Premises 1586 Totals Additional Functions 725 173 97 48 13 40 66 80 32 28 2 29 15 43 57 1 1 30 (ii) Details of Registrations/Licences. Act or Regulation On Register 31.12.1954 Removed during 1955 Registered during 1955 On Register 31.12.1955 Food and Drugs Act, 1938— S.14 Ice Cream Premises 279 4 7 282 S.14 Butcher's Premises 47 — 1 48 Milk and Dairies Regs., 1950—Distributors 102 5 12 109 Milk (Special Designations) Regs., 1949 (Annual Licences)— Sterilised 92 — 108 108 Sterilised—supplementary 7 — 7 7 Pasteurised 43 — 50 50 Pasteurised—supplementary 5 — 5 5 Tuberculin Tested 25 — 26 26 Tuberculin Tested—Supplementary 5 — 5 5 Essex County Council Act, 1952— Hawkers of Food 80 4 18 94 Hawkers Premises 50 5 12 57 Leyton Corporation Act, 1950— S.63 Vendors of Shell Fish 13 — — 13 S.48 Hairdressers and Barbers 79 2 — 77 Pet Animals Act, 1951 (Annual Licences) — Pet Shops 15 — 15 15 Rag Flock and Other Filling Materials Act, 1951— Registration of Premises 9 — — 9 TOTAL 851 20 266 905 31 4. LEGAL PROCEEDINGS. (i) Public Health Act. Resulting from the 329 statutory notices served on owners under the nuisance abatement procedure of the Public Health Act, 1936, in 8 instances it was necessary to institute legal proceedings to secure compliance therewith. The results of such action are given hereunder. Date of Hearing Nature of offence and address of premises concerned Result of Court Proceedings 9.11.55 Statutory nuisance—7/9 Trinity Street, E.l1 Abatement Orders, 28 days £2 2s. costs in each case 9.11.55 Statutory nuisance—54 Michael Road, E.ll Abatement Order, 28 days. £2 2s. costs. 16.11.55 Statutory nuisance—14 Denmark Street, E.ll Abatement Order, 28 days. £2 2s. costs. * 7.12.55 Statutory nuisance-34 Acacia Road, Road, E.ll Abatement Order, 28 days, £2 2s. costs. 7.12.55 Statutory nuisance — 5 Downsell Road, E.l5 Abatement Order, 28 days. 10s. 6d. costs. 7.12.55 Statutory nuisance—33 Frith Road, E.ll Abatement Order, 28 days. £2 2s. costs. 7.12.55 Statutory nuisance — 20 Nuffield Road, E.l5 Abatement Order, 28 days. £3 3s. costs. (ii) Food and Drugs Act and Relative Legislation. Legal proceedings were instituted in three instances under the provisions of the Food and Drugs Act and relative legislation. The following are the results of such action. Date of Hearing Nature of Contravention Result of Court Proceedings 19.10.55 Unsatisfactory sample of milk. Contravention of Section 9 of the Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950 Proprietor fined 40s. £2 2s. costs. 10.1.56 Unsound leg of lamb. Contravention of Section 13 of the Food and Drugs Act, 1938 Proprietor fined £10. £3 3s. costs. 8.2.56 Unsatisfactory sample of bread End butter. Contravention of Section 3 of the Food and Drugs Act, 1938 Proprietor fined 40s. £2 2s. costs. 5. MEAT AND FOOD CONDEMNED. Condemnation certificates were issued in respect of the undermentioned unsound foodstuffs surrendered by various traders in the Borough as result of routine inspection of food premises. The food condemned was destroyed by fire at the Council's Destructor Works. Commodity Cwts. Qrs. Lbs. Commodity Units Bacon 2 — 14 Bacon 10 sides Biscuits — 2 24 Cakes 92 Butter 2 — 14 Chickens 462 Cheese 1 2 26 Eggs 240 Cooking Fat 1 3 5 Fish 419 tins Dried Fruit — 1 4½ Fruit 356 ,, Fish 4 1 — Ham 80 ,, Ham — 2 13 Jam 4 ,, Margarine 1 — 5 Legs of Pork 2 Meat 19 2 1 Luncheon Meat 234 tins Offal 1 2 9 Milk 102 ,, Sausages 1 — 18 Miscellaneous Foodstuffs 1459 pkts/boxes Sugar 1 2 8 Pig 1 Vegetables 314 tins 32 6. SAMPLING. (a) Food and Drugs Act, 1938. (i) Chemical Analysis. Commodity Taken Satisfactory Unsatisfactory Milk 11 8 3 Ice Cream 24 23 1 Ice Lollies 8 8 — Miscellaneous 57 53 4 TOTAL 100 92 8 (ii) Bacteriological Examination. Commodity Taken Grade I II III IV Ice Cream 24 13 5 4 2 Ice Lollies 8 — — — — Water 24 — — — — TOTAL 56 13 5 4 2 (b) Rag Flock and Other Filling Materials Act, 1951. (i) Samples taken. On 4th October, 1955, four formal samples of filling materials were taken in accordance with the requirements of the Rag Flock and Other Filling Materials Act, 1951. Set out below are the findings of the Prescribed Analyst. All samples were of a satisfactory standard. Type of material and appropriate tests Standard prescribed by R.F. & O.F.M. Regs. 1951 Actual results of analysis Samples 1 2 3 4 Samples Nos. 1 and 3 — Rag Flock : No. 2— Woollen Mixture Felt. Impurities test (in triplicate), Oil and Soap test; Chlorine test. Not to contain more than 1.8% of soluble impurities, 5% of oil and soap or 30 parts per 100,000 of soluble chlorides. Soluble impurities averages. 1% 1.5% 1% Oil content. 2.6% 1.5% 1.9% Soap content. .9% .7% .8% 18 10 9 Sample No. 4— Grey Algerian 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. Chlorine content in parts per 100,000. Insoluble matter. 1.3% 7. ATMOSPHERIC POLLUTION. (i) Smoke Abatement. Sixty-three 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. 33 (ii) Daily Records. The following tables show the results recorded during the twelve months ended March, 1956, divided into "Summer" and "Winter" periods. The average results for the 5-year period ended March, 1955, are also shown for comparison. CONCENTRATION OF SMOKE EXPRESSED IN MILLIGRAMS PER 100 CUBIC METRES Month Monthly average Highest daily average Lowest daily average 1950/55 1955/56 1950/55 1955/56 1950/55 1955/56 April 17.5 15.1 36.4 56.7 6.9 6.1 May 8.7 7.7 25.2 17.1 2.2 4.6 June 4.5 4.2 8.2 12.0 1.2 1.0 July 4.0 2.4 8.3 6.2 1.1 0.2 August 5.3 3.7 9.1 9.1 2.3 0.6 September 8.0 6.4 19.4 14.1 2.9 2.8 Summer Average 8.0 6.6 17.8 19.2 2.8 2.6 October 23.8 25.8 77.7 94.4 6.4 5.1 November 35.9 38.6 103.0 89.5 10.3 13.0 December 44.3 36.6 130.2 106.7 12.6 9.6 January 37.8 48.5 105.2 171.1 12.9 16.8 February 34.3 36.6 71.5 115.4 16.0 19.2 March 29.0 23.1 93.8 39.8 11.5 10.0 Winter Average 34.2 34.9 96.9 102.8 11.6 12.3 CONCENTRATION OF SULPHUR DIOXIDE EXPRESSED AS PARTS PER 100 MILLION Month Monthly average Highest daily average Lowest daily average 1950/55 1955/56 1950/55 1955/56 1950/55 1955/56 April 5.2 6.8 12.4 18.4 1.5 2.4 May 2.7 3.9 6.2 7.7 1.0 1.8 June 2.3 2.9 4.6 5.1 0.9 0.8 July 2.2 1.8 4.4 4.1 0.7 0.4 August 2.8 2.8 4.6 5.9 1.2 0.6 September 3.7 3.8 7.4 7.0 1.5 2.2 Summer Average 3.2 3.7 6.6 8.0 1.1 1.4 October 7.2 8.9 17.6 19.4 2.9 3.6 November 11.0 12.0 26.0 28.9 4.6 6.0 December 13.3 11.1 34.9 27.8 4.3 5.1 January 11.3 14.3 31.7 46.7 4.8 6.1 February 9.9 11.0 22.9 32.1 4.9 5.3 March 8.0 8.0 18.4 12.4 3.0 4.5 Winter Average 10.1 10.9 25.3 27.9 4.1 5.1 8. RECORDS. In connection with the undermentioned enquiries received during 1955 involving some 2,054 properties a search is made of office records to ascertain whether any sanitary notices (statutory or informal) have been served in respect of the premises concerned and to what extent (if any) the notices have been complied with. In respect of enquiries under the provisions of section 4 of the Housing Act, 1949 an inspection is made by the Sanitary Inspector and the property classified. 34 (i) Local Land Charge Enquiries 1674 (ii) Housing Act, 1949, section 4—Enquiries 138 (iii) Town and Country Planning Act, 1954, section 33— Enquiries 242 Part III—Services National Health Service Act, 1946 Leyton Health Area Sub-Committee of the Health Committee of the Essex County Council, 1955-56. Chairman: Alderman Mrs. J. Hammond, o.b.e., j.p. Vice-chairman: Councillor T. C. Messenger Representatives of Essex County Council County Alderman K. E. B. Glenny (ex-officio) (Chairman, County Health Committee). County Councillor Mrs. S. M. Bovill (ex-officio) (Vice-Chairman, County Health Committee). County Councillor H. Burton. „ „ G. W. Mason. ,, ,, Mrs. G. M. Chamberlin. (2 vacancies) Representatives of Leyton Borough Council Aldermen : G. S. Flack. Mrs. R. King. Councillors : G. S. Bentley. W. A. Cross. Miss V. D. Gostling. W. Hook, m.p.s. F. W. Marshall. P. A. Parry. Mrs. E. V. Pearson. W. H. Sanders. C. B. Underwood, m.b.e., j.p. J. J. Walsh. J. D. Watson. Representative of Local Medical Committee Dr. J. F. B. Hill. Representative of Hospital Management Committee Alderman The Lady McEntee, o.b.e., j.p. Representative of Executive Council for Essex County Councillor Mrs. A. M. M. Burrell. 35 Representatives of Voluntary Organisations Mrs. A. M. Clewer (Leyton, Wanstead and Woodford Care Association). Mr. G. A. Dicker (Leyton, Wanstead and Woodford Care Association). Mrs. E. Gardner (British Red Cross Society). Mrs. A. E. Sampson (St. John Ambulance Brigade). ESSEX COUNTY COUNCIL Staff Area Medical Officer and Divisional School Medical Officer Melville Watkins, M.R.C.S., L.R.C.P., D.P.H. Assistant County Medical Officers *Mary L. Gilchrist, M.D., CH.B., D.P.H. Samuel C. Lovell, M.R.C.S., L.R.C.P. Ethel R. Emslie, m.d , ch.b., d.p.h., d.c.h. Elsie Lilian Peet, m.d., m.b.l.d.s. *Anne S. Clark, m.b., ch.b. Rachel Jacobs, m.d., D.obst., r.c.o.c. Specialist Part-time Medical Officers. (Regional Hospital Board Appointments) Opthalmologist A. Logan Adam, m.r.c.s., l.r.c.p., m.b., b.s., d.o.m.s. Orthopaedic Surgeon H. A. Oatley, m.b., b.s., f.r.c.s. Aural Surgeon H. Ho, m.r.c.s., l.r.c.p., d.l.o., d.o.m.s. Area Dental Officer A. E. Hall, l.d.s. (Liverpool). Dental Officers *Mr. D. E. Robinson, l.d.s., r.c.s. *Mr. D. G. Gould, l.d.s., r.c.s. *Mrs. D. M. Powell, l.r.c.p., l.r.c.s., l.r.f.p.s., l.d.s., r.c.s. *Mr. C. Shamash, b.d.s., l.d.s., r.c.s. *Mr. P. G. Arnold, l.d.s., b.d.s. *Mr. R. B. Pitts (5.9.1955). *Miss S. Rogart, l.d.s., r.c.s. *Mr. T. D. H. Millar, l.d.s., r.c.s. Mr. J. A. Edmond, l.d.s., rc.s.(from 18.10.55). Tsion-Medical Supervisor of Midwives Miss E. M. Wearn Midwives Miss E. Daines Mrs. C. L. Wackett Superintendent Health Visitor Miss E. M. Franklin a, b, c, e a, b b a, b, c 36 Health Visitors/School 7\[urses Miss L. Acton a, b, d Miss I. D. Appledore a, b, c Mrs. D. E. Chatfield a Miss E. O. Corby a Miss G. W. Craddock a, c (to 12.11.55) Miss J. M. Denman a, b, c (to 18.8.55) Miss R. M. Edward a, e (to 31.3.55) Miss C. B. Ferguson a, b, c (to 28.5.55) Miss K. Dolan a, c (from 1.6.55) Miss M. K. Greene a, b, c, e Miss B. D. Jukes a, c Miss B. King a, c, d Miss K. M. Munday a, c Miss M. H. Roger a, b, c Mrs. M. Sims a, b Mrs. J. H. Souter a, b, c Miss O. Phillips a, c Mrs. K. M. Rich a, c Mrs. J. Henslow a, b, c (from 16.8.55) *Miss M. Walling a, b, c, (from 23.11.55) Tuberculosis Visitors Miss C. G. Teale Mrs. L. M. Abbott a. b, c, e a, f Matrons of Day T^urseries Knotts Green Day Nursery— Mrs. E. M. White Ellingham Road Day Nursery— Mrs. D. M. McStav a, d a, b * Part-time. (a) S.R.N. (b) S.C.M. (c) H.V.Cert. (d) S.R.F.N. (e) Q.N. (f) T.A. Cert. Orthoptist 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. A. H. Parker, M.Ch.S. (from 23.5.55). *R. Sadowski, M.Ch.S. *G. E. Fenn, M.Ch.S. *G. V. Ledger, M.Ch.S. Domestic Help Organiser Mrs. E. M. Saxby. Oral Hygienist Miss J. Watts. 37 Dental Attendants Mrs. D. Blundell Miss E. Corcoran Mrs. A. Lewis. *Mrs. Ayres. *Mrs. Ferris Clinic Clerks Miss F. C. Cheetham. Mrs. L. Neville Miss E. Nichols (Foot Clinic) Mrs. J. Price Chief Administrative Assistant W. D. Softley * Part-time. Administrative and Clerical Staff F. C. Ware. E. R. Price L. C. Goodbun G. A. Thurlow E. Lamb A. Keeys Miss E. Beckley Mrs. F. Wright Miss R. Carrington Miss B. G. Johnson. Distribution—Welfare Foods Mrs. D. Gray *Mrs. H. Coleman. * Part-time. NATIONAL HEALTH SERVICE ACT, PART III The Local Health Authority have delegated most of the Part III Services to the Leyton Health Area Sub-Committee. The Committee, under the Chairmanship of Alderman Mrs. J. Hammond, O.B.E., J.P., has evinced a keen interest in the work of the Health Services and there has been much thoughtful discussion at their meetings. Health Centres. Although there are no Health Centres in the area, as envisaged under the Act, there are three modern and well situated Health Service Clinics, at which the major part of the Health Service and School Medical Services work is carried out. Care of Mothers and Young Children. The registered births were 1,136 and the birth rate of 11.13 is the lowest ever recorded in the area. The Ante-natal Clinics continue to be held at the four centres and at the homes of the two Municipal Midwives. The Child Welfare Clinics are well attended and are invaluable for the mothers to meet the medical and nursing staff and discuss the problems of parenthood and child care. During the year a weighing session has 38 been instituted at Emmanuel Hall to coincide with the distribution of Welfare Foods on Monday afternoons, which obviates the need for mothers resident in the Lea Bridge area to make a long journey to Leyton Green Clinic unless they are specially recommended to see the doctor there. Early in 1956 a Mothers' Club was commenced at one of the Health Clinics and is proving a great success. The distribution of Welfare Foods coincides with Clinic sessions and thus saves the mothers extra journeys for the collection of milk and vitamin products. It is apparent that there is a decrease in the "take-up" of these commodities. During January to October, monthly Post-natal Clinics were held at the Lady Rayleigh Training Home. Subsequent to this, owing to a decrease in the numbers attending, post-natal examinations were carried out at Ante-natal Clinics. There were no deaths of Leyton residents due to maternal causes during the year. This is the third year since 1950 that no deaths of this nature have occurred in the area. Dental services for nursing and expectant mothers and children under five years of age are carried out by all the Dental Officers. The patients are referred by the medical staff and receive advice or treatment including the supply of dentures where necessary. Many of the expectant mothers have received treatment from the oral hygienist, and subsequent periodical inspection has been arranged where necssary. Pre-school children are seen from about two to two-and-a-half years of age, and although no treatment may be considered necessary the visit serves a useful purpose in introducing the patient to the atmosphere and surroundings of the dental surgery. Notes on the Infant Mortality, Neo-natal Mortality and Still-birth rates are referred to in the section of the Report on the Local Sanitary Authority work. The Day Nurseries in the area continue to be fully occupied, and their necessity is proven by the numbers of medico-social cases that have been dealt with during the year. Midwifery. It is significant to note that over eighty per cent, of confinements take place in hospital, and this shows there is not the shortage of maternity beds which appertained for the first few years after the war. The preference for hospital confinments entails difficulties in the training of pupil midwives owing to the small number of domiciliary confinements, in which they should carry out their practical training. The two Municipal Midwives assist in the training of the pupils from the Lady Rayleigh Training Home. Health Visiting. Now that the duties of Health Visitors embraces the "care of the whole family," further duties have been allocated to the nursing staff in the visiting of old people. My predecessor, Dr. A. W. Forrest, submitted a comprehensive report on the problems of old people living at home, and subsequently a register of persons of this category was compiled. At the end of the year there were 439 persons on the register and, of these, 284 had been visited by the Health Visiting staff. Of these, nine only were 39 co-operative to the visit, and it is pleasing to know that these old people, many of them living lonely lives at home, some neglected by their own children living nearby, welcome the visit and are glad to have someone interested in them. As a result of the visits made so far more people have been brought into the sphere of the services available (e.g. domestic help, chiropody, meals on wheels, etc.) and it is apparent that there is a need to co-ordinate in the area all the different ways in which we are endeavouring to help the aged—so that whatever we do shall be done intelligently and as well as we can do it. In November, 1955, the North-Eastern Metropolitan Branch of the Royal College of Nursing held an open meeting at the Essex County Health Services Clinic, Dawlish Road, Leyton, to which were invited the medical and nursing staff of the adjoining areas, together with general medical practitioners in the area. The speaker was J. C. Ballantyne, Esq., F.R.C.S., M.R.C.S., L.R.C.P., Assistant Director, Audiology Unit, Royal National Throat, Nose and Ear Hospital, who lectured on " The Early Detection of Deafness." Over 120 persons attended this interesting meeting, and it is pleasing to record that a number of the general medical practitioners were present. Home Nursing. In this area we are fortunate to have the Lady Rayleigh Training Home, with its efficient staff of Home Nurses. Every day we are in contact with them, and are constantly reminded by thankful patients of their ability. They give general nursing care to any sick person as instructed by the family doctor. This includes insulin injections, enemas as required, post-operative dressings and blanket baths for aged and infirm patients. The Home Nurses and Domestic Helps do much to enable aged persons to be cared for at home, thus relieving pressure on hospital beds and at the same time dealing with the problem in the most economical way. Vaccination and Immunisation. For the convenience of mothers in the Child Welfare Clinics vaccination of infants is carried out at these sessions. This saves the mother unnecessary visits and helps to increase the vaccination rate, which has fallen considerably in the past few years. The incidence of diphtheria continues to fall, in the country as a whole, but only if an adequate level of immunisation is maintained can the country be rid of diphtheria altogether. Under thirty per cent, of new babies in the year are presented for diphtheria immunisation and parents are being lulled into a false sense of scurity by the rarity of diphtheria among the children of friends and neighbours. Arrangements for whooping cough immunisation continue in the area, and it is recommended that this should be given when the child is as young as two months, inasmuch as the mortality for the disease is highest in the first six months of life. Ambulance Services. I am indebted to the County Medical Officer for the statistics relating to the work carried out from the Ambulance Station, Auckland Road, Leyton. 40 Prevention of Illness ; Care and After-Care. The Chiropody service continues to endeavour to fulfil the demands from persons with foot conditions. The surgery at Essex County Health Services Clinic, Dawlish Road, is now fully manned, and has helped to alleviate the demands in that part of the area. The waiting list for appointments at all surgeries still remains at between eleven and thirteen weeks. The figures of attendances are set out in the statistics. To assist with the problem of old persons who are non-ambulant and suffer with foot conditions, the Borough of Leyton Welfare Services Committee have kindly set aside a sum of money to pay the fees of a chiropodist to carry out domiciliary chiropody in cases recommended by the medical and nursing staff and the Domestic Help Organiser. Although it does not affect a gteat number of persons it is of inestimable value to those concerned. Seventy-two adults were sent away for periods of convalescence varying between one and four weeks. Careful scrutiny has to be made of such medical recommendations, as some patients endeavour to use these services as a means of obtaining an annual holiday.' In the sphere of health education there is a lot to be done. The County Health Education Organiser has 'dressed' the shop windows at 280, High Road, Leyton, with topics on Care of the Feet, Mobile Mass X-ray, Health Visiting, Clean Food, and Tuberculosis. Four lectures, illustrated by film shows, were held during the year, and these were attended by 210 persons. The health visitors gave 16 informal talks to groups of mothers at the Health Clinics in the area. These talks were illustrated by the projection of film strips. The results of the mass radiography survey, as set out in the statistical tables, show that active tuberculosis was discovered in 1.18 per thousand examined. These figures are the lowest ever recorded in the area. The Medical Director of the unit is of the opinion that the fall in the rate per thousand for active tuberculosis may be accounted for by the fact that the unit has visited the area annually and a large proportion of the examinees are regular attenders. For the same reason he also records that there was a decrease in the number of bronchial carcinomata discovered (3), compared with (8) the previous year. The loan of sick room equipment to people who are ill has risen from 147, in 1954, to 329 in 1955. With an ageing population there will be greater demands on the service, and further expansion will be necessary. The work at the Occupational Therapy Centre has continued under the therapist, Mrs S. Wiltshire. Twenty-six students attended, and by the end of the year 14 had returned to full employment and three had commenced a period of rehabilitation training. At the time of preparation of th s report the number of students attending the centre had steadily decreased and, following consultations with the Chest Physcians of Leyton, Wilthamstow, and Wanstead and Woodford, it would appear that, owing to earlier diagnosis, the success of modern treatment, and the patients' anxiety to restore their earning capacity as quickly as possible, that the demand exists for sheltered workshops rather than diversional therapy facilities. The Leyton, Wanstead and Woodford Tuberculosis Care Association made continued progress in both assistance to patients and the 41 raising of funds. Mr. F. C. Ware, the Secretary, reports that more funds were raised during 1955 than in any year previously. The most successful activity was the Christmas Seals campaign; total sales were over £608 and the net income to the Association £509. The provision of extra nourishment vouchers to patients continues to be the largest item of assistance, and the total value of vouchers issued during the year was £1,202 10s. Od. It is gratifying to report that the Association now raises more funds by its own efforts than it receives by grants, and it would appear that the Association is one of the most active and progressive in the country. Domestic Help. In 1948, when the County Council became the Local Health Authority, there were 32 Domestic Helps attending on 247 cases. In 1955 there were over 100 Domestic Helps and, during that year, 893 cases were assisted. There does not appear to be any "ceiling" to this branch of the Health Services, and, as has been quoted before in these notes, care of the aged at home is an essential part of the preventive services. The Hon. Major Villiers, a Freeman of the Borough, made available for the aged persons a number of oil convector stoves, and these were supplied to domestic help beneficiaries who needed supplementary heating due to their medical condition. The stoves were greatly appreciated, and it is by such public-spirited action that comfort is brought to people in the evening of their lives. During the winter there were reported in the Press a number of fatalities due to faulty connections (mostly rubber tubing) to gas appliances. With the co-operation of the North Thames Gas Board and the Domestic Helps on the Health Area establishment arrangements were made for the cases where gas appliances were connected in this manner to be visited by an inspector of the Board, who made arrangements for proper connections to be made at no cost or a small charge to the person concerned. The Borough of Leyton Welfare Services Committee have reorganised the Meals on Wheels service, and approximately 70 persons are receiving meals twice weekly. The meals are cooked at the School Canteens and transported to the homes of the recipients, who are charged 9d., and the Borough of Leyton Welfare Services Committee subsidise each meal at a cost of Is. As all the applicants are beneficiaries of the Domestic Help service, a certain amount of the administration of the Meals on Wheels service is carried out in the Domestic Help Office. Problem Families. In 1950 a joint Circular issued from the Home Office, Ministry of Education and the Ministry of Health suggested that effective use should be made of available resources, statutory and voluntary, to see what could be done to help children neglected or ill-treated in their own homes. To put this into practical effect an informal invitation was issued to the Children's Officer, the Education Officer, the Welfare Officer, the Probation Officer, the National Assistance Board, the local branch of the N.S.P.C.C., local Child Guidance Clinic personnel, the Housing Officer and the Superintendent Health Visitor and, after many delays and disappointments in arranging it, the first meeting was held in March, 1955, under the chairmanship of the Medical Officer of Health. 42 At this first meeting a number of well-known problem family case papers were discussed and it was soon apparent just how useful the Committee was going to be, perhaps not so much in producing wonderful ideas of how to get quick results for those involved and difficult cases but in showing to each representative just how much other services knew of the cases. The case was known to almost each one and a new light thrown on a facet hidden from one group but already revealed to another. There was one point that had to be made quite clear at the beginning and that was that those cases which were purely housing difficulties should not be the province of this Committee, but where housing was one of the many strands in the case we found that the co-operation and knowledge of the Housing Officer was invaluable. The Committee met five times, and 27 cases have been dealt with, with what success it is too early to judge. One thing is clear, however, that the co-ordination of all sections of the local Health, Education and Welfare Authorities is necessary, but that the preventive and remedial measures to deal with the cases are very difficult to put into action. It seems abundantly clear, even after a year's functioning of this Committee, that we must prevent the cases from getting into the hopeless situation that the problem family reveals. Often the assistance of a Domestic Help is declined owing to the cost to the applicant. If specially trained Domestic Helps, paid for by the Welfare Department or the Health Department, could help with the practical side of housework ; if Health Visitors had more time to spend in such homes training the mothers not only in hygiene but in simple budgeting, cooking and child management ; if the day nurseries or the nursery school could be used to put young children in whose mothers fail to manage them properly ; and the prevention of unsuitable marriages by better training and education of adolescents ; much of the work of the problem family Case Committee would eventually almost disappear. COUNTY HEALTH SERVICES—STATISTICS SECTION 21 HEALTH CLINICS: Leyton Green Road, Leyton, E.10 (Opened in 1933) Granleigh Road, Leytonstone, E.ll ( „ „ 1935) Dawlish Road, Leyton, E.10 ( „ 1951) SECTION 22 CARE OF MOTHERS AND YOUNG CHILDREN Births Registered During Year Male Female Legitimate 539 561 Illegitimate 16 20 Births notified 1,166 43 CLINICS : Ante-Natal— First Attendances 443 Subsequent Attendances 3,189 Post-Natal— Leyton Green Lady Rayleigh Training Home New Cases 57 52 Total Attendances 93 63 Child Welfare— Leyton Green Park House Dawlish Road Emmanuel Hall* Under 1 year— First Attendances 320 377 238 6 Subsequent Attendances 4,822 5,526 3,101 91 Total Attendances 5,142 5,903 3,339 97 1-5 years— First Attendances 70 81 30 — Subsequent Attendances 2,371 2,205 1,255 59 Total Attendances 2,441 2,286 1,285 59 Total Attendances (both age groups) 7,583 8,189 4,624 156 Number examined by Clinic Doctor 2,083 2,248 1,489 — Number Weighed 7,581 8,143 4,616 156 * Commenced 14th November, 1955. Dental Clinics Patients inspected and treated during the year— Expectant Mothers Nursing Mothers Children under School Age (1) Patients examined 104 79 481 (2) Patients found to require treatment 102 79 467 (3) Patients who have commenced treatment 102 79 467 (4) Patients who have completed treatment 90 72 376 (5) Patients awaiting treatment — — — (6) Attendances for treatment 290 346 1,026 44 Types of treatment given. Expectant Mothers Nursing Mothers Children under school age Extractions— (a) Permanent teeth 160 143 — (b) Temporary teeth — — 373 Fillings— (a) Permanent teeth 117 164 — (b) Temporary teeth — — 645 Inlays provided 1 — — Crowns provided 1 — — Anaesthetics administered (a) Local 53 32 18 (b) General (i) by Medical Officers on County staff — (ii) by others 37 31 170 (a) Scaling 35 53 1 (b) Prolonged scaling and gum treatment 2 4 — Silver nitrate treatment 27 1 417 Dressings 104 155 215 X-ray examinations 28 19 2 Dentures provided— (a) Full — 3 — (b) Partial 14 20 — Dentures repaired 1 2 — Dentures re-made— (a) Full 1 4 — (b) Partial — — — Orthodontic appliances— (a) Fixed — — — (b) Movable — — — Prophylactic treatment and other operations— Gum treatment 7 22 — Cleaning and polishing 22 33 — Oral hygiene instruction 5 hrs. 1½hrs. — Number of treatments (scaling and prophylactic carried out by Oral Hygienists) 66 102 — 45 Orthopaedic Clinic New Cases 24 Re-inspections 55 Minor alterations to footwear 60 Surgical appliances supplied 3 Ophthalmic Clinic Children referred 16 Attendances 50 WELFARE FOOD Issues.—The total issues during 1955 were:— National Dried Milk 39,022 Cod Liver Oil 10,508 Vitamin A & D Tablets 4,180 Orange Juice 69,392 CARE OF PREMATURE INFANTS (weighing 5 lbs. 8 oz. or under):— Born at Home 16 Born in Hospital or Nursing Home 74 DAY NURSERIES There are two Day Nurseries in the area, each having accommodation for 60 children. (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) Knotts Green Ellingham Road Total 0-2 yrs. 2-5 yrs. 0-2 yrs. 2-5 yrs. 0-2 yrs. 2-5 yrs. Number of approved places at end of year 15 35 15 35 30 70 Number of children on register at end of year 10 50 16 44 26 94 Total attendances during year 3,050 8,382 3,377 8,609 6,427 16,991 Number of days open 254 254 — CONVALESCENT HOME TREATMENT: Numbers sent to Convalescent Home Children 5 Mother and children 4 INFANT, NEO NATAL AND FOETAL MORTALITY— Live Births 1,136 Deaths under 1 year 28 Deaths under 4 weeks 19 MORTALITY RATES— Infantile 24.64 Neo natal 16.72 STILLBIRTHS— Number 15. Rate per 1,000 13.03 46 HEALTH CLINICS—CLINIC SESSIONS Health Clinic Monday Tuesday Wednesday Thursday Friday Saturday Leyton Green, Leyton Green Road, E.10. (LEYtonstone 3650, Ext. 267) A.M. Dental Minor Ailment Dental Orthoptic Minor Ailment Dental Minor Ailment Orthopitc Ophthalmic Dental Minor Ailment Ante-natal 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 3650, Ext. 268) A.M. Dental (1) & (2) Minor Ailment Ante-natal (2nd and 4th) Oral Hygiene Dental (1) Oral Hygiene Minor Ailment Dental (1) & (2) Minor Ailment Aural 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) Infant Welfare Dental (1) Oral 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) Foot Clinic Dental (1) Dental (2) Minor Ailment Foot Clinic Dental (1) Dental (2) Minor Ailment Ante-natal Toddlers Foot Clinic Dental (1) & (2) Minor Ailment Dental (1) & (2) Minor Ailment Foot Clinic Minor Ailment P.M. Dental (1) & (2) Infant Welfare Foot Clinic Dental (1) & (2) Immunisation Foot Clinic Dental (1) & (2) Foot Clinic Infant Welfare Foot Clinic Dental (1) & (2) Dental (1) & (2) Foot Clinic Ante-natal Exercises Evening Foot Clinic Foot Clinic Emmanuel Hall, Hitcham Road, E.10. P.M. Weighing Session 47 SECTION 23 MIDWIFERY Cases attended by Council Mid wives. Midwives Total Essex County Council Attached to the Lady Rayleigh Training Home Beachcroft Road Cases attended:— (a) As Midwives 96 118 214 (b) As Maternity Nurses 3 12 15 Ante-natal Visits 428 463 891 Ante-natal Examinations 626 1015 1641 Post-natal Visits 1406 4684 6090 Administrations of Gas and Air Analgesia 94 89 183 Administrations of Pethidine 38 52 90 Gas and Air Analgesia Percentage of administrations 85.5 Medical Aid Where the Medical Practitioner had arranged to attend the Patient 7 Others 81 Fees paid to Doctors Number of accounts received 56 Total amount paid to Medical Practitioners £413 3 6 Maternity Outfits Number of outfits issued to Expectant Mothers 238 HEALTH VISITING Health Visitors. During the year the Health Visitors made 18,295 visits to homes. (a) To expectant mothers:— First visits 150 Total visits 291 (b) To children under I year of age:— First visits 1,140 Total visits 6,115 (c) To children between the ages of 1 and 5 years 7,255 48 (d) Other visits:— Whooping cough — Measles 2 Ophthalmia neonatorum 1 Discharging eyes 11 Diarrhoea — Puerperal Pyrexia 14 Children's Act 14 After deaths 11 After stillbirths 17 Miscellaneous 1,014 Ineffective 3,239 Old people 553 Hospital follow-up 31 Pemphigus neonatorum — SECTION 25 HOME NURSING Number of new cases 1,470 Number of visits paid to above 58,784 SECTION 26 VACCINATION AND IMMUNISATION Vaccination against Smallpox. NUMBER OF PERSONS VACCINATED (OR RE-VACCINATED) Age at date of Vaccination Under 6 months 6-12 months i year 2-4 years 5-14 years 15 years and over Total Number Vaccinated 223 95 19 16 21 82 456 Number re-Vaccinated — — — 3 15 229 247 Diphtheria Immunisation. Age (in years) at final injection Children* who completed a full course of primary immunisation during the year Children* who were given a reinforcing injection during the year By General Practitioners By County Staff By General Practitioners By County Staff Under 1 240 189 — — 1 91 84 — — 2 23 6 — — 3 9 3 3 — 4 5 5 19 21 5-9 11 6 56 109 10-14 2 2 3 3 Total 381 295 81 133 *Including temporary residents. 49 percentage of school children immunised (1955) 5-year age group Number examined 1,192 Number immunised 739 Percentage immunised 62.0 10-12+ age group Number examined 2,173 Number immunised 1,711 Percentage immunised 78.7 14-year age group Number examined 543 Number immunised 452 Percentage immunised 83.2 Protection against Whooping Cough Age at time of final injection Children who completed a full course under the County Scheme Records of combined diphtheria-pertussis immunisations received By General practitioners By County Staff Under 6 months 14 4 8 6-12 months 91 228 130 1 year 21 89 45 2-4 years 16 18 15 5 years and over 7 6 5 Total (primary courses) 149 345 203 Reinforcing injections 2 20 SECTION 27 AMBULANCE SERVICE Patients conveyed— Stretcher Cases 1,833 Emergency Cases 3,624 Other Cases 32,007 Total mileage 146,876 miles SECTION 28 PREVENTION OF ILLNESS, CARE AND AFTER CARE Foot Clinic Male Female Children First attendances 278 953 265 Subsequent attendances 3,841 17,189 1,579 Tuberculosis (a) Open Air Shelters Number in use at end of year 2 Total number of visits to shelters by health visitors or tuberculosis visitors 24 50 (b) Extra Nourishment Number of new cases supplied with free milk 48 Total number being supplied with free milk at end of year 81 Loan of Sickroom Equipment. Air Beds 3 Air Rings 57 Bed Back Rests 40 Bed Cradles 8 Bed Pans 71 Crutches 9 Invalid Chairs 27 Rubber Sheets 64 Urinal Bottles 27 Feeding Cups 3 Steam Kettles 1 Commodes 15 Bed Tables 1 Diabetic Scales 1 Sandbags 2 Convalescence for Adults. Number of applications during year 72 Length of stay— One week 3 Two weeks 39 Three weeks 17 Four weeks 13 Mass Radiography. Result of the Survey undertaken by Mass Radiography Unit 6.B in June, 1955. Males Females Total Number of attendances for miniature X-ray 3,812 4,626 8,438 Number recalled for Large Film examination 196 144 340 Number showing some abnormality 188 134 322 Percentage showing some abnormality 4.93 2.90 3.82 Failed to attend for Large Film examination 26 3 29 Tuberculous lesions. Active tuberculosis 7 3 10 Inactive tuberculosis 43 33 76 Other abnormalities revealed Abnormalities of bony thorax 37 21 58 Bacterial virus infection of lungs 4 4 8 Bronchiectasis 10 7 17 Emphysema 6 2 8 Pulmonary fibrosis (non T.B.) 19 15 34 Bronchial carcinomata 3 3 Sarcoidosis 1 2 3 Pleural thickening 36 20 56 Abnormalities of the diaphragm 5 2 7 Congenital cardio-vascular lesions 1 – 1 Acquired cardio-vascular lesions 10 20 30 Benign tumour of lungs 2 2 4 Pneumoconiosis 2 — 2 Miscellaneous 2 3 5 Total 188 134 322 51 Active Tuberculosis—Rates per 1,000. Mass Radiography Survey Males Females Combined 1951 2.24 3.07 2.64 1952 2.26 1.82 2.03 1953 1.96 2.68 2.36 1954 1.75 1.17 1.44 1955 1.94 0.65 1.18 SECTION 29 DOMESTIC HELP Number of helps and hours worked:— Number of domestic helps enrolled at end of year— Whole'time helps 9 Regular part-time helps 93 Number of domestic helps actually employed at end year 97 Number of hours worker during year 120,143¾ Work of the Domestic Help Organiser:— (1) First Visits 534 (2) Re-visits to beneficiaries— (a) Domestic help present 252 (b) Domestic help not present 470 (3) Other visits 392 Help Provided:— Maternity Acute Sick Tuberculosis Chronic Sick Aged Not Sick Others Total Aged Others Requests for help from new cases during the year 64 37 13 330 62 24 4 534 New cases helped during the year 50 30 10 288 52 18 2 450 Total cases completed during the year (a)— 50 31 8 227 46 23 2 387 Cases being helped at end of year who have received help for— Under 3 months — 1 2 5 54 11 6 — 79 3-6 months — — — 1 44 1 2 — 48 6-12 months — — 4 80 12 3 — 99 Over 12 months — — — 13 221 32 14 — 280 Total (b) 1 2 23 399 56 25 — 506 Total cases helped during the year [(a) plus (b)] 51 33 31 626 102 48 2 893 Hours of help provided during the year 3516½ 1138¾ 4195 86,193¾ 17,419¼ 7523½ 157 120.143¾ 52 MEDICAL EXAMINATION OF STAFF County Council employees— Number of medical examinations for: (a) Entrants to County Council's service 103 (b) Retirement on Superannuation 2 (c) Other purposes — No. of medical examinations Leyton Borough Council 88 Others 5 Entrants to teaching profession and training colleges 34 School Health Service Leyton Committee for Education 1955 - 56 Chairman: Councillor J. J. Walsh. Vice-chairman : Councillor A. L. Chamberlain. Representative Members (Leyton Borough Council)— Aldermen A. E. Bechervaise A. W. Bourne Mrs. J. Hammond, O.B.E., J.P. Mrs. R. King Councillors F. J. Abbott, J.P. Mrs. D. E. Barker Miss V. D. Gostling W. J. Low F. W. Marshall C. J. Mills Mrs. E. V. Pearson G. W. A. Robinson S. G. Shepherd, J.P. J. D. Watson Co-optative Members: Messrs. I. A. Brown J. Fairfax C. Hicks J. A. Powell M. Rayner L. W. Turp Nominated Members : County Councillors E. C. Hardy G. W. Mason 53 In the following pages is submitted a report, largely routine in nature, on the School Health Service in the Excepted District of Leyton. Routine Medical Inspection. Routine medical inspection has been carried out in all schools in the Division. It will be noticed that the code groups of children have been altered from Entrants, Second Age Group and Third Age Group, to 5 Years, 10-12+ Years and 14 Year Age Groups. It is significant to to note that in the 5 Year age group 94.55 per cent. of parents are present at the examination, whereas in the 14 Year age group the percentage of parents in attendance is 24.31. The findings of medical inspection in the Age Groups remain at about average. The "Others" shown in the statistical tables comprise those children seen at the Occupation Centre. Uncleanliness and Verminous Conditions. At the cleanliness inspections held by the nursing staff 176 children were found to be unclean, out of a total of 26,316 examinations. The percentage of uncleanliness is 0.67, which is, coincidentally, the same percentage as in 1954. It should be realised that the verminous child is still with us, and it is only by unremitting inspection, exclusion and treatment of the unclean, that the clean are protected against infestation. Annual Vision Test. All children attending Schools in the Division have their vision tested each summer term. When defective vision is suspected the nursing staff arrange for the child to attend the Minor Ailment Clinic, where the children are seen by the School Medical Officers. If the defect is confirmed the child is then referred to the Consultant Ophthalmic Surgeon. The annual eye test is well worth while, as the child who has defective vision in one eye rarely complains of poor vision and might be missed for three to four years if tested at only periodic medical inspection, and by then it may be too late to save any useful vision in the defective eye. By testing frequently, children with such defects are found before severe damage is done. Children with short sight, who do not report that they cannot see because they do not wish to wear spectacles, are also picked up before the defect has developed too seriously. The nursing staff who perform this testing also weigh and carry out a general survey of the child at the same time. This is found to be very useful in picking up other matters that may require attention. Specialist Clinics. It is now four years since the local Hospital Management Committtee assumed responsibility for the provision of consultants for specialist clinics. These clinics (Ophthalmic, Orthopaedic, Orthoptic and Ear, Nose and Throat) are held at the Health Services Clinics in the Division. Dr. A. Logan Adams, the Consultant Opthalmic Surgeon, had 1,644 children referred by the medical staff. These children made 2,267 attendances for examination and treatment. The Orthoptic Clinic, for children suffering from squint, is held under the supervision of the Orthoptist (Mrs. K. S. Box). Cases of squint 54 requiring operation are referred to the Ophthalmic Surgeon at Whipps Cross Hospital. The number of squint cases operated upon has shown a steady decline, due to early referral by the medical staff, and this early treatment is resulting in a decline in the number of children with amblyopia, and severe squints are now rarely seen. Mr. H. A. Oatley, the Orthopaedic Surgeon from Whipps Cross Hospital attends as Orthopaedic Consultant. Fourteen sessions have been held and, when children leave school, continuity of treatment is available at Mr. Oatley's Clinic at the Hospital. Ear, Nose and Throat. Fifteen sessions were held by the Ear, Nose and Throat Specialist, and, of the 186 children who visited the Clinic, 78 attended for the first time. As the sessions are three to four weeks apart, children who require urgent treatment are referred direct to hopsitals by the School Medical Officers. School Dental Service. The Area Dental Officer, Mr. A. E. Hall, reports as follows regarding this important branch of the School Health Service:— During the year there has been a considerable fluctuation in the number of dental officers employed, and the average for the year was 3.5 dental officers of the authorised establishment of six. This establishment is too low to make it possible to give regular inspection and treatment which is necessary to deal with the vast amount of dental decay at the present time. With a full establishment it would be possible to give early attention to all patients presenting themselves for treatment, or found at school inspections to require such treatment, and in addition a campaign to stimulate the acceptance of treatment rate by means of talks to children and parents could be undertaken. As it is the waiting list lengthens and patients when informed they have to wait for treatment become somewhat discouraged. Owing to staff changes it was possible to have a dentist on duty only eight sessions per week at Leyton Green Clinic from 12th May onwards. Orthodontic Clinics. With the shortage of dental officers reported above, orthodontic work is limited, if routine conservative dental surgery is not to suffer, and the way to ensure this is to make certain before any orthodontic work is commenced that both parent and child are aware of the exacting nature of the work, that some discomfort, and even pain, is likely, and that regular visits over a period of up to two years may be necessary to secure results. Unless this is fully appreciated and the parents co-operate successful results are not likely to be achieved. Conditions of a developmental nature (e.g. separate centrals, splaying of centrals and laterals) can, after suitable reassurance of the parent, be left until the time of eruption of the permanent canines. Orthodontic work is ill-advised in cases of rampant caries. Having taken all these factors into account, the orthodontist could then confine his attention to children with dento-facial irregularities which are interfering with the physical, mental or social wellbeing of the child. Mr. C. Shamash has carried out orthodontic work for one session a week, and the other dental officers undertake a small amount of this specialist work. 55 Oral Hygienist. Miss J. Watts, the oral hygienist, is employed in the area sevenelevenths of her time and carries out work in regard to expectant and nursing mothers, children under five years, and school children, and the amount of hygienic attention, in the form of removal of tartar and other deposits recommended by dental officers is not more than 17 per cent. of all cases needing dental treatment. One of the hygienist's most important spheres of usefulness is in the educational field, where she can bring to the notice of children and parents matters of vital interest to them if they are to grow up with good dentition free from decay and obviate the loss of permanent teeth. This is carried out by means of chairside talks illustrated by charts and followed by tooth-brushing under supervision. Dental Inspection. Dental treatment is given all children referred by the School Medical Service teaching or nursing staff, and routine dental inspection has been carried out at five schools. B.C.G. Vaccination. School Leavers. Dr. Ethel Emslie, one of the School Medical Officers, has been carrying out the vaccination of school children who are 13, and not yet 14 years of age. Dr. Emslie has shown particular interest in this phase of preventive medicine, and reports as follows:— B.C.G. vaccination has proved of value in other countries for as long as thirty years and now in this country the frst progress report of the investigation planned and directed by the Medical Research Council has been published, and it is most encouraging. In brief, the investigation has provided "clear evidence" of the efficacy of both B.C.G. and the vole bacillus vaccines in preventing tuberculosis in adolescents. Response to the offer of B.C.G. vaccination of school leavers has been disappointing, especially when it is remembered that there are in the region of 40,000 new cases of tuberculosis notified in a year in England and Wales, and that the disease is responsible for far more deaths than any other infectious disease and for prolonged periods of disability in those who recover. Eight meetings were held at the schools in an attempt to interest parents, and to explain to the the reasons for B.C.G. vaccination, and to given them the opportunity to ask questions. The meetings were very poorly attended, but those who did come showed themselves to be keenly interested, and there were several useful discussions. Thanks are due to the office staff who skilfully and at short notice prepared charts of figures to show at these meetings. There were no complications among those vaccinated, although three cases had slight enlargement of an axillary gland to the size of a pea. I have not heard of any of these giving trouble, although all cases were asked to report if any trouble should arise. Two cases failed to convert, one of them after a second vaccination. The other case refused a second vaccination. Of the 17 cases not Mantoux tested after vaccination, six have left school, two failed to keep appointments, and the others missed the first chance and were vaccinated later, one in December, and the rest in February, 1956. These have been included in the 1955 figures because 56 they applied in Spring, 1955, and they belong to the 1955 age group They are now due for re-testing. RESEARCH WORK. Anti-tuberculosis Vaccine (B.C.G.). In collaboration with the Medical Research Council, since October, 1950, there has been undertaken in Leyton Schools a Trial of Antituberculous Vaccine (B.C.G.). The trial involves at the outset children leaving Secondary Modern Schools at the age of 15 years and then a follow-up by regular medical examination over a period of three years. All participants in the trial are volunteers. The scheme is being operated by a Medical Research Council team especially assigned to this work, and comprises the following examinations:— (a) Penultimate School Term: Initial tuberculin-testing and X-raying of volunteers; inoculation with B.C.G. of those tuberculin-negatives selected for vaccination ; (b) Final School Term (12-16 weeks later) : Second tuberculin test and second X-ray of all children tuberculin-negative at first test (whether vaccinated or not) ; (c) All groups will be X-rayed and tuberculin-tested at regular intervals for at least three years. In addition, they will receive regular visits from a health visitor. The following letter was received from Sir Harold Himsworth, K.C.B., Secretary of the Medical Research Council, early in 1956:— "The Council have recently had before them the first report of their Tuberculosis Vaccines Clinical Trials Committee on the value of vaccination in adolescence. As you are aware, this report has now been published in the British Medical Journal. "I am now writing on behalf of the Council to thank you for your invaluable support in this assessment of the vaccines. I realise also how much the success of a project like this must owe to your nurses and my Council would like them to know that their help has been appreciated. "After seeing the report of the preliminary investigation the Council are in no doubt that the results which could be obtained by continuing the trial for a further period would more than justify the effort and expense required. I hope that w: may count upon your continued cooperation in this effort which premises to make such a substantial contribution to preventive medicine." An assurance has been given that the nursing staff will continue to assist in the home visiting of volunteers in the trial. HANDICAPPED PUPILS. Set out below, in tabular form, are observations regarding Handicapped Pupils in the Division. Delicate. In 1955, 16 boys and 17 girls were ascertained as delicate pupils and all were recommended for residential school; only two boys were awaiting vacancies at the end of the year. 57 Physically Handicapped. The following children were recommended as physically handicapped during 1955. Recommendation. Boys Girls Special educational treatment in ordinary school 1 5 To attend the West Ham spastic unit 3 1 To attend a day school for the physically handicapped – 1 Transferred from day to resident school for physically handicapped – 1 To receive tuition at home – 1 4 9 An analysis of the Leyton children ascertained as physically handicapped and still attending school is set out below:— Disability Special School Ordinary School Day Boarding Boys Girls Boys Girls Boys Girls Cerebral Palsy 4 1 — — — — Cerebral Diplegia — 1 — — — — Muscular Dystrophy 1 — — — — — Bronchiectasis l 1 — — — — Congenital Dislocated Hip — 1 — — — 1 Asthma l — — — — — Spina Bifida — — — 1 — — A.P.M — — — — 1 1 Total 7 4 — 1 1 2 Nephritis. 1 Girl received tuition at home. Note. Discrepancies in figures are due to children who have left the district, reached school leaving age, etc. Educationally Subnormal. Ten boys and nine girls were ascertained as Educationally Subnormal, and one girl was recommended for transfer from Harrow Green to a Residential School. On 31st December three boys and two girls were at Residential Schools. Maladjusted. One boy and two girls were recommended for admission to residential schools, and on 31st December eight boys and two girls were at residential schools. One boy and one girl were awaiting admission. Deaf Pupils. No child was newly ascertained in 1955, and on 31st December three boys were attending residential schools and four girls were at a special day school. 58 Partially Deaf. Two boys and two girls were ascertained as partially deaf and recommended to remain in ordinary schools with special treatment. There is one boy at a day special school and one girl at a residential school. Blind. No child was so ascertained in 1955. Two boys and one girl were at residential schools. Partially Sighted. One boy was ascertained in 1955 and recommended to stay at an ordinary school with special treatment. One boy was attending a day special school at the end of the year. Epileptic. Two boys were newly ascertained in 1955, and at the end of the year two boys and one girl were at residential schools. Section 57. Education Act 1944. Four children were excluded from school under Section 57(3) and seven were recommended for supervision. In addition 12 children from the Forest Division attending Harrow Green were referred for supervision after leaving school. Section 56. Education Act 1944. At the end of the year 16 children were receiving tuition in Whipps Cross Hospital, and during the year one girl received tuition at home. KNOTTS GREEN DAY OPEN AIR SCHOOL. This school catered mainly for handicapped pupils of the category "delicate ", with a few physically handicapped children. Prior to 1939 the school roll varied between eighty and a hundred children, but, at the end of the war there were only thirty to forty children in attendance. It was anticipated that the number of pupils would increase in the post-war period especially as it was agreed that children from Forest Division who were "delicate" or "physically hands capped " should be admitted. For a time the school roll increased, but with the improvement in the health of the school child and the general rise in the standard of living the expected increase of the school roll did not occur, and the number of children in attendance returned to about thirty. The school has a placement of approximately one hundred pupils, and it was not considered to be economic to continue to use the school for this type of handicapped pupil, especially as there was a long waiting list for admission to Harrow Green Educationally Sub-normal School, some forty children of all ages awaiting admission. After due consideration the Committe for Education decided to:— (a) Close the school as a Day Open Air School. (b) Re-distribute the present children to open air schools in adjacent areas. (c) Re-open the school as a junior annexe to Harrow Green Educationally Sub-normal School, and (d) Use Harrow Green Educational Sub-normal School as a Senior School for this type of case. 59 As a result of these decisions it was possible to admit all the children on the waiting list and approximately two hundred children are now attending the two E.S.N. Schools in the Division. HARROW GREEN EDUCATIONALLY SUB-NORMAL SCHOOL. Number on Roll: Leyton Forest Knotts Green 43 37 Harrow Green 46 60 89 97 Number admitted 1955 20 51 Number left 19 15 Reasons for leaving: 1. Attained age of 16 and (a) Notified under Sec. 57(3) 7 8 (b) Not notified 2 — 2. Notified as Ineducable 1 — 3. Removed to other areas 1 2 4. Notified for Residential E.S.N. School 1 2 5. To Lingfield Epileptic Colony 2 — As can be seen from the above particulars the Harrow Green E.S.N. School underwent a considerable increase in numbers during 1955. The opening in September of Knotts Green Open Air School as a Junior annexe to Harrow Green enabled practically all the children in the Forest Division who have been awaiting admission for some time to enter school in September. It is satisfactory to be able to give these children the education suitable to their "age, abilities, and aptitudes." The older children who have gone to Harrow Green have settled down well and are apparently happy to be there. One boy did not settle down well at first as his private doctor seemed to think he was making enough progress in the ordinary school. This boy is, however, correctly placed at present. He may eventually be able to return to a Secondary Modern School, but he was educationally illiterate when he came and is making good progress in the special conditions now provided for him. Since the 1944 Education Act allowed the ascertainment of children suffering from a disability of mind and body at a much earlier age than was possible under the 1921 Education Act, Harrow Green School has provided a "Nursery Class" for children from five years of age. It has been found most useful to be able to observe in this class the young child, the "borderline" cases where it is difficult to decide whether the child is going to be educable or not. The true educational subnormal child with no behaviour disorder or physical handicap can usually take his place in an infant school for the first year or two, the mental retardation not usually revealing itself clearly until formal education starts in the 6-7 age group. But the child seriously mentally retarded not able to try in an infant school can be admitted to the Nursery class, and it gives the School Medical Officer and the School Staff time to make a better assesment of the child's potentialities. At times children are so much helped 60 by the ordered freedom and opportunities of this class run on nursery school lines that they improve and can move out of the border-line group into the educable class. Conversely, of course, children who cannot cope even with this class have to be moved into the Occupation Centre, but at least a sounder judgment can then be made when time has been given to those concerned to see how they react. Children who have no educational ability but are forced into learning by over-zealous parents often develop quite serious behaviour problems, and are made very unhappy by being asked to do that for which they have no aptitude and will never use in after life. It is a mistaken kindness to put an ineducable child (in the sense of the Education Act) into anything but an Occupation Centre. These children should not be kept too long in E.S.N, schools and should not come to them at too old an age either. The entry to the Nursery Class at an early age would prevent many of the difficult problems we are faced with at ages 9-10 years. When children have been kept too long in ordinary schools and then the E.S.N. School is asked to take them in, at ages when the real E.S. child is beginning to make real progress in the 'three R's', difficulties of placement arise. If they had come at five to six years it would be easier for everyone concerned to come to the correct decision about the child's potentialities. The formation of the Nursery Class has been most useful in this respect. The "Junior Age Group" children are at Knotts Green School, though there is no rigid age limit, ability and mental age being decisive factors. Its very pleasant amenities are much enjoyed by the staff and children and it is hoped will help them later in their performance, too. Physical Handicaps. Epilepsy. From being a major worry in the School this trouble has recently receded to a very minor position. One severe epileptic child has left, we hope to be accommodated eventually in an adult colony. Two boys have gone to Lingfield, one of whom is doing very well. The other is on trial and may not manage to "make the grade." It is hoped he will as he is a difficult child at home. The other cases, all of very mild type, have given no signs of recurrence in the past twelve months. Hearing Defects. One boy has a hearing aid but his mental retardation is very severe and he is one of seven cases for whom permission to examine under section 57(1) has been sought. Three children suffer from intermittent attacks of deafness and have to be favourably placed in class. Much attention is paid to hearing and sight in children who find it difficult to learn but we do not always get the co-operation from the parents that we should get in this respect. Other Defects. Three children suffer from mild degrees of cerebral palsy and have adequate physiotherapy. Three children were sent away for recuperative holidays and benefited greatly. One boy, under observation for an unusual speech defect, was under consideration for possible admission to Moor House School, but he has 61 finally been turned down. He is, as a matter of fact, correctly placed in Harrow Green E.S.N. School and is making progress and is very happy there. CHILD GUIDANCE CLINIC. Miss M. Marshall, Educational Psychologist to both the Forest and Leyton Divisions, reports as follows:— Work in the School Psychological Service. It may be noticed that all the reports of the educational Psychologist to the Leyton and Forest Divisions in Essex during the last few years begin with a reference to expanding work. The report for 1955 is no exception. The school population continues to increase and has now reached the figure of approximately 44,000 in these two Divisions. (The total for the two Divisions is approximately 49,000, but the Chingford schools are served by the Walthamstow psychologist.) The rapidly increasing school population in Harlow and the eagerness of the teachers there to use the School Psychological Service has been largely responsible for the greater number of children seen in the Forest Division. Division Boys Girls Total Forest 202 95 297 Leyton 107 41 148 Total 309 136 445 This year all these children were interviewed and tested individually by the Educational Psychologist, who did not have any assistance from student psychologists. The reasons for referral to the psychologist were 1. Backwardness (including backwardness in reading) 257 2. Educational advice (other than for backwardness) 42 3. Behaviour problems at home 80 4. Behaviour problems at school 59 5. Requests from other agencies, e.g., Probation Officer, Children's Officer, etc. 5 6. Children with physical symptoms, e.g., Tic, Enuresis, Stammer, etc. 40 Some children, of course, are referred for two or more reasons, e.g., behaviour problems and backwardness. During the year the psychologist made 187 school visits, of which 69 were to Leyton schools and 118 to Forest Schools. Of these, 80 were concerned with children referred to the Child Guidance Clinic. Requests for lectures continued to come in and 21 talks were given during the year, 7 during the day and 14 in the evenings (8 in Leyton and 13 in the Forest Division. There were 9 "migrant" pupils this year, i.e., children with "Central" school places obtained in other areas. Interviews with parents and tests for the children were necessary to decide which kind of Secondary education was most suitable. Now that Bi-lateral Secondary schools have been opened in Harlow, this particular duty of the psychologist will not be necessary any longer in that area. 62 The scheme to help children who are backward in reading continues to work well in the Leyton Junior schools and is rapidly expanding in the Forest Division. The larger it becomes, the less is the psychologist able to take a personal part in it, and the testing and selection of the children for the remedial groups is now almost entirely in the hands of the Head teachers. Inconveniences of accomodation are numerous but are made light of by the remedial teachers, whose enthusiasm for their work is of great benefit to the schools in which they work. At the end of the year, Leyton had six remedial teachers working in 9 Junior schools and 135 children had received special help during the year (112 boys, 23 girls). The Forest Division had 10 remedial teachers working in 13 Junior schools. Meetings were held during the year for both groups of teachers, when the psychologist explained some of the difficulties in remedial work and showed new books, and there was a general discussion. In the Forest Division the teachers who do home and hospital teaching were also invited to the meeting. Work of the Educational Psychologist in the Child Guidance Clinic. As a result of this remedial work in schools, the psychologist has taken fewer children for remedial teaching in the Child Guidance Clinic. Six children were given this remedial help during the year, and there were 187 sessions. (Leyton 53, Forest 134). Of the 445 children tested during the year, 114 were also referred to the psychiatrist for further investigation and treatment. Enquiries about 52 children referred to the psychiatrist were made in their schools during personal visits by the psychologist and their problems were discussed with the teachers. At the end of the year, there were 40 children on the psychologist's waiting list and there were outstanding requests from Head Teachers for visits to at least a dozen schools. School Health Service STATISTICS ROUTINE MEDICAL INSPECTION. Number of Inspections: Percentage of Parents present 5-year age group 1,192 94.55 10—12+ year age group 2,173 83.39 14-year age group 543 24.31 Others 209 60.77 Total 4,117 Other Inspections : Special Inspections 1,854 Re-Inspections 5,631 63 The Findings of Medical Inspection: Age Groups 5-year 10—12 + 14 yr. Ors. Number of children inspected 1,192 2,173 543 209 Number found to require treatment 161 274 54 59 Percentage found to require treatment 13.51 12.10 9.94 28.23 Uncleanliness and Verminous Conditions: Number of children examined 26,316 Number found to be unclean 176 Percentage found to be unclean 0.67 MEDICAL TREATMENT. Minor Ailments Clinic: Number of children attending 1,606 Number of attendances 2,052 Specialist Clinics—Ophthalmic: Number of children referred 1,644 Number of attendances 2,267 Orthoptic: Number of sessions held 239 Number of cases investigated 379 Number of cases treated 340 Number of new cases seen 140 Number of cases discharged cured— After operation 7 Without operation 23 — 30 Number still under treatment 230 Number under observation 39 Number transferred to other clinics 70 Total number of attendances for the year 1,643 Specialist Clinics—Orthopaedic: Number of first atendances 189 Number of subsequent attendances 218 Number referred for radiological examination 16 Number referred for physiotherapy 63 Number admitted to hospital for operative treatment 15 Number of surgical appliances supplied 43 Number of alterations to footwear 194 Specialist Clinics—Ear, Nose and Throat: Number of sessions held 15 Attendances— Old New Number of children attending for deafness (including acute, chronic, secretory, otitis media and otalgia) 17 12 64 Number of children attending for "tonsils and adenoids " investigation 29 22 Number of children attending for nasal obstruction and catarrh 26 Number of children attending for sinusitis and deflected nasal septum 8 Number of children attending for other reasons (e.g. nose bleeding, hoarse voice, injury to nose, wax in ears, and allergic rhinitis) 10 Treatment and referrals— Referred for operation 25 Referred for X-ray of sinuses 26 Referred for antral lavage 8 Referred for pure tone audiometry 6 Referred for hearing aid 1 Referred for cauterisation 2 Referred for politzerisation 1 Follow up after removal of tonsils and adenoids, and adenoids 13 Follow up after other operations 5 Number of children for which no treatment required 27 Number of children discharged during year 27 Speech Clinic: Boys Girls Total Number of children at present undergoing treatment 47 25 72 Number of children discharged during 1955 24 13 37 Number of cases treated daily (average) 14 Number of homes visited 59 Number of School Departments visited 31 Number of parents interviewed 132 Number of children referred to other clinics 13 Number of new cases 62 Number of children re-admitted — Number of children who left before cured or discharged 8 Total number of attendances 2,052 Number of children referred who were found not to require treatment Number of children under observation but not attending 94 Child Guidance Clinic: Number of cases referred to the Clinic 47 Number of cases diagnosed at the Clinic 45 65 (a) Psychiatrists: Diagnostic interviews 45 Cases taken on for treatment 33 Treament interviews 182 Other interviews 4 No. of Psychiatric sessions per week 4½* (b) Psychologists: Clinic cases tested 35 Cases given remedial education 2 Treatment interviews (rem. educ.) 53 School visits on behalf of clinic cases 31 Other interviews at clinic 34 (c) School Psychological Service: Individual cases seen 148 Number referred to clinic 9 (d) Play Therapists: Cases treated 13 Treatment interviews 189 (e) Psychiatric Social Workers: Interviews at clinic 348 Interviews elsewhere 47 (f) Waiting List: Cases for diagnosis 11 (g) Total cases treated during year 52 * For Leyton and Forest cases. B.C.G. Vaccination—School Leavers: Approximate number of children eligible for vaccination 1,250 Number accepted 208 Number failed to attend 16 Number Mantoux positive without vaccina tion 26 Number vaccinated 166 Number Mantoux positive after vaccination 147 Number Mantoux negative 2 Number not re-tested 17 B.C.G. Vaccination—Medical Research Trial: Intake: Number of volunteers 570 Number Mantoux positive to OT 1/3000 or 1/100 on entry to trial 251 Number vaccinated 159 Number of unvaccinated controls 160 66 Follow Up: Average number returning postal forms 86% Average number of home visits carried out by health visitors 98% Average number attending for X'ray 75% TABLE I Medical Inspection of Pupils attending Maintained Primary and Secondary Schools A. PERIODIC MEDICAL INSPECTIONS Number of Inspections in the prescribed Groups:- 5 year age group 1,192 10—12 year age group 2,173 14 year age group 543 Total 3,908 B. OTHER INSPECTIONS Number of Special Inspections 1,854 Number of Re-inspections 5,631 Total 7,485 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 5 year age 35 161 186 15.60 10—12+ year age 107 274 365 16.79 14 year age 45 54 92 16.94 TOTAL 185 489 643 16.45 Special Schools 11 59 63 30.14 67 TABLE II A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1955 Defect Code No. Defect or Disease No. of Defects requiring Treatment No. of Defects requiring Obs. but not Treatment Periodic Inspection Special Inspection Periodic Inspection Special Inspection 4 Skin 39 80 21 1 5 Eyes— (a) Vision 196 228 113 23 (b) Squint 28 8 17 1 (c) Other 21 86 5 3 6 Ears— (a) Hearing 17 22 97 2 (b) Otitis Media 15 12 48 2 (c) Other 43 72 15 1 7 Nose and Throat 134 78 148 2 8 Speech 11 26 18 4 9 Cervical Glands 7 3 33 — 10 Heart and Circulation 16 5 22 2 11 Lungs 26 18 98 16 12 Development— (a) Hernia 4 1 1 – (b) Other 13 9 44 2 13 Orthopaedic— (a) Posture 22 1 44 1 (b) Flat Feet 56 24 38 4 (c) Other 155 74 92 — 14 Nervous System— (a) Epilepsyz 15 7 3 1 (b) Other 7 3 19 2 15 Psychological— (a) Development 4 15 26 1 (b) Stability 18 16 39 5 16 Other 26 672 32 19 B. CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS INSPECTED DURING THE YEAR IN THE AGE GROUPS Age Group Pupils Inspected NUMBER CLASSIFIED AS A (Good) B (Fair) C (Poor) No. % No. % No. % 5 years 1,192 482 40.44 686 57.55 24 2.01 10—12+ years 2,173 848 39.02 1,297 59.69 28 1.29 14 years 543 307 56.53 228 41.98 8 1.49 Other periodic 209 86 41.15 120 57.42 3 1.43 TOTAL 4.117 1,723 41.35 2,331 56.62 63 1.53 68 TABLE III RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1955 TREATMENT TABLE GROUP I.—Minor Ailments (excluding Uncleanlincss, for which see Table V) Disease or Defect Number of Defects treated or under treatment during the year Authority By the Otherwise Skin— Ringworm— Scalp 1 — Body — — Scabies 1 1 Impetigo 24 — Other skin diseases 103 4 Minor Eye Defects— (External and other, but excluding cases falling in Group II) 133 3 Minor Ear, Nose and Throat Defects 155 43 Miscellaneous— e.g., minor injuries, bruises, sores, chilblains, etc. 1,189 66 Total 1,606 117 GROUP II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments.—Group I) Disease or Defect Number of Defects dealt with By the Authority Otherwise Errors of refraction (including squint) — 411 Other defect or disease of the eyes (excluding those recorded in Group I) — — Total — 411 Number of Pupils for whom Spectacles were— (a) Prescribed — 1,030 (b) Obtained — 1,065 GROUP III.—Treatment of Defects of Nose and Throat Total number treated Received operative treatment — By the Authority Otherwise (a) For adenoids and chronic tonsilitis — 17 (b) For other nose and throat conditions — 20 Received other forms of treatment 155 142 155 179 69 GROUP IV.—Orthopaedic and Postural Defects (a) Number treated as in-patients in hospitals or hospital schools 16 (b) Number treated otherwise, e.g., in clinics or out-patients departments 212 TABLE IV DENTAL INSPECTION AND TREATMENT Periodic Specials (a) Number of pupils inspected 3,470 799 (b) Number found to require treatment 2,733 799 (c) Number offered treatment 2,702 799 (d) Number actually treated* 2,570 799 (e) Number awaiting treatment 418 — (f) Attendances made by pupils for treatment 10,724 1,281 (g) Half-days devoted by— (a) Dental Officers to— (i) Inspection 25 (ii) Treatment 1,603 (b) Oral hygienists to— (i) Treatment 149 (ii) Other purposes 26 (h) Fillings— (l) Permanent teeth 4,972 (ii) Temporary teeth 2,532 (i) Number of teeth filled— (i) Permanent teeth 4,841 (ii) Temporary teeth 2,530 (j) Extractions— (l) Permanent teeth— (a) On account of caries 1,050 (b) For other purposes 71 (ii) Temporary teeth— (a) On account of caries 3,795 (b) For other purposes 301 (k) Anaesthetics administered— (i) Local 2,057 (ii) General 1,896 (1) Other operations— (i) Permanent teeth 2,921 (ii) Temporary teeth 1,533 (m) Number in (1), carried out by oral hygienists 758 70 (n) Analysis of figures in (1)— Type of Operation— Number Orthodontic 526 Silver Nitrate Treatment 1,110 Scaling 364 Polishing 211 Dressings 1,535 Other operations 708 Orthodontic Clinic: Study models for progress 58 Removable appliances included screw plates, finger springs, apron springs and combinations of these. Oral screens and Andreson appliances. Appliances fitted 76 Repairs to appliances 8 Denture space retainers 48 Finished cases 45 Under treatment at year end 97 Dental Inspections in Schools: No. of children inspected No. requiring treatment No. approved for treatment No. accepting treatment No. refusing treatment Percentage of acceptances Canterbury Road 736 633 633 326 — 51.5 Mayville Road 564 401 383 289 8 75.4 Cann Hall Road 836 549 536 411 5 76.7 Newport Road 1,118 981 981 799 — 81.4 St. Joseph's 219 169 169 117 — 69.2 TABLE V INFESTATION WITH VERMIN (a) Total number of examinations of pupils in schools by school nurses and other authorised persons 26,316 (b) Number of cases of infestation found 145 (c) Number of forms S.H.54(a) sent 20 (d) Number of cleansing notices issued (Section 54(2)—Education Act, 1944) 23