LEY 50 Borough of Leyton HEALTH REPORT FOR THE YEAR 1956 MELVILLE WATKINS M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health, Borough of Leyton Area Medical Officer, County of Essex Divisional School Medical Officcr CONTENTS Page 1. Index 2 2. Opening Remarks 3 3. Local Sanitary Authority 9 4 County Health Services 34 5. School Health Service 58 2 INDEX Page Accidents in the Home 9 Acreage 6 Ambulance Services 55 Ante-natal Clinics 38, 49 Atmospheric Pollution 21, 32 Aural Clinic 66 Bacteriological Examinations 32 B.C.G. Vaccination 67 Birth Notifications 48 Birth Rate 6, 9 Birth Registrations 48 Births, Illegitimate 6 Burial of the Dead 10 Business and Industrial Estab lishments Inspection of 18, 24, 28 Care Association 43 Chemical Analysis 31 Child Guidance Clinic 66 Child Welfare Clinics 49 Clinic Sessions 52 Convalescent Home Treatment 56 Day Nurseries 39, 51 Death, Causes of 8 Death Rate 6, 9 Dental Treatment 49, 71 Diphtheria Immunisation 54 Dirty Premises 10 Diseases of Animals, Acts and Orders 21 Disinfestations 18, 26 Domestic Help Service 44, 56 Domiciliary Midwives 53 Extra Nourishment 56 Factories Acts, 1937/48 25 Food, Clean 19 Food, Condemned 19, 31 Food Premises 24 Food and Drugs Act, 1955 18, 24 Foot Clinic 42, 55 Gas and Air Analgesia 53 Handicapped Pupils 62 Health Centres 38, 48 Health Education 62 Health Visiting 40, 53 Home Nursing 41, 54 Hospitals 15 Housing 15 Housing Repairs & Rents Act, 1954 23 Ice Cream 24, 29, 32 Immunisation 41, 54 Infant Mortality 51 Infectious Diseases 9, 12 Page Laboratory Facilities 15 Laundry for Incontinent 11 Legal Proceedings 30 Leyton Corporation Act, 1950 23 Local Sanitary Authority 9 Maternal Mortality 38 Maternity Nursing 53 Maternity Outfits 53 Meals for Old People 44 Medical Aid 53 Medical Examination of Staff 57 Meteorological Conditions 5 Midwifery 53 Minor Ailments Clinics 65 Mortuary 10 Mothers' Club 39 National Assistance Act, 1948 (Sections 47 and 50) 10 National Health Service Act, 1946 (Part III) 34 Neo-Natal Mortality 51 Notices, Sanitary 23 Nursing Homes 15 Occupational Therapy 43 Open-Air Shelters 55 Ophthalmic Clinic 65 Orthopædic Clinic 65 Orthoptic Clinic 65 Pet Animals Act, 1951 29 Post-Natal Clinic 49 Premature Infants 51 Problem Families 48 Rag Flock Act, 1951 32 Redevelopment Areas 16 Rodent Control 17, 26 Routine Medical Inspection 59, 64 Sanitary Circumstances 15, 22 Scabies Clinic 10 School Dental Service 60 School Health Service 58 Shops Act, 1950 18, 23 Sick Room Equipment 43, 56 Slum Clearance 16 Smoke Abatement 21, 32 Speech Therapy 66 Statistics, Vital 6 Student Public Health Inspectors 12 Tuberculosis 10, 14 Uncleanliness 59 Vaccination 41, 54 Vital Statistics 6 Welfare Foods, Distribution of 39, 51 Whooping Cough Immunisation 55 3 TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LEYTON Mr. Mayor, Ladies and Gentlemen, I have the honour to submit this, my second Annual Report, as required by the Ministry of Health ; and, for the convenience of Members, this also includes sections on the Health Services (National Health Service Act—Part III) and the School Health Service. The Report is being issued later than is usual due to extra duties carried out by the medical and administrative staff, viz. vaccination against poliomyelities, the shortage of public health inspectors, and the great amount of work performed by all the staff in presenting the Health Exhibition in May, 1957. The year 1956 was a good year in Leyton's health, not so much by what was achieved but rather that the foundation was laid for schemes that have since come to fruition, viz. Crescent Road Re-development Area, Housing for the Aged, Laundry for the Incontient, and a progressive interest in the Care of the Elderly, both by the statutory authorities and the voluntary organisations in the Borough. These are dealt with more fully in the body of the Report. I take the opportunity of recording my appreciation of the support of the Council, the co-operation of officers of other departments and the loyalty and industry of the staff of the Health Department. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, MELVILLE WATKINS Medical Officer of Health. 4 PUBLIC HEALTH COMMITTEE 1956-57 The Worshipful the Mayor—Councillor H. E. Martin, J.P. (ex-officio) Chairman Councillor F. W. Marshall Vice-Chairman Councillor Mrs. A. M. M. Burrell Alderman G. S. Flack B. G. Rayner. Councillor W. A. Cross „ Miss V. D. Gostling E. L. Sanders. W. H. Sanders „ J. D. Watson F. W. Wigg STAFF Medical Officer of Health Melville Watkins, m.r.c.s., l.r.c.p ., d.p.h. Deputy Medical Officer of Health Mary Lyle Gilchrist, m.d., ch.b., d.p.h. Chief Public Health Inspector B. J. Ashcroft, m.a.p.h.i., M.inst.b.e. a, b, c, d Deputy Chief Public Health Inspector R. A. Reeves, m.a.p.h.i. a, b Public Health Inspectors A. E. Barnes a, b C. Pomfret, m.a.p.h.i., a.r.s.h. a, b, c P. W. Edwards, m.a.p.h.i. (to 31.12.56) a, b L. F. Joyce, m.a.p.h.i. a, b R. J. Davies, m.a.p.h.i. (to 2.7.56) a, b E. A. C. Kottman, m.a.p.h.i. (to 18.2.56) a. b A. J. Page, m.a.p.h.i. a, b a. Certificate of the Royal Society for the Promotion of Health and Public Health Inspector's Education Board. b. Royal Society for the Promotion of Health—Meat and Food Inspector's Certificate. c. Royal Society for the Promotion of Health—Smoke Inspector's Certificate. d. Gold Medallist—Ollett Trust Competition. 5 Student Public Health Inspectors D. F. Yarrow C. B. Sharratt Chief Clerk *W. D. Softley Clerical Staff N. R. Gray, a.i.c.d. J. Burt Mrs. V. L. Hatwell L. Williams (to 2.4.56) T. Crute Mrs. A. L. Dowries Mrs. J. E. Auger (from 22.5.56) Public Analysts G. Taylor, f.r.i.c. J. H. Hammence, m.sc., Ph.d., f.r.i.c. *Part-time. METEOROLOGICAL CONDITIONS 1956 I am indebted to the Director of the Meteorological Office of the Air Ministry for the following summary of the main features of the weather during 1956. January. Wet and changeable. Rainfall totals about twice normal. Much fog in first week. Sunshine slightly above average. February. Exceptionally cold. Snow or sleet was frequent but falls were light. Sunshine was near normal and there was little fog. March. Dry and sunny. Temperatures a degree above normal. Rainfall about half normal. Sunshine well above average. April. Rather cold. Sunshine slightly below normal. May. Very dry and sunny. Sunshine well above normal. No completely sunless days. No fog. June. Cold and dull. There were several thunderstorms and the first half of the month was particularly wet and thundery. Sunshine totals were well below normal. July. Cool, rather dull and very wet. Rainfall mostly more than twice normal with thunderstorms on several days. Sunshine was between 80% and 90% of normal. . August. Very cool ; mostly very wet. Some parts of London had 20 "wet days." Sunshine was between 80% and 90% or normal. September. Dull, very wet at first. Sunshine was only about 75% of normal and it was the fourth successive dull month. October. Rather cold ; mainly dry. Despite the rapidly shortening days there was rather more sunshine than in September. Several days with thunder. November. Very dry and cold towards the end of the month. Very dense fog in the suburbs on two occasions. Sunshine little above normal. December. Changeable but exceptionally dull. First ten days of the month were very dry. Very little sun. 6 Vital Statistics Area in Acres 2,594 Population (Census 1951) 105,978 Population (Registrar-General's Estimate, 1956) 100,900 Assessable Value for General Rate purposes £1,315,378 General Rate in the £ (1956/57) 17s. 8d. The Registrar-General's mid-year 1956 estimate of population (viz., 100,900) has been used for the calculation of the following statistics :— Live Births :— Legitimate—Males 598 Females 536 Illegitimate—Males 23 Females 28 Totals 1,185 Birth-rate per 1,000 of population 11.74 Stillbirths :— Males 15 Females 10 Rate per 1,000 total (live and still) births 20.66 Deaths — Males 624 Females 672 Totals 1,296 Death-rate per 1,000 12.84 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) birth 0.00 Death-rate of infants under one year of age :— All infants per 1,000 livebirths 22.78 Legitimate infants per 1,000 legitimate live births 23.81 Illegitimate infants per 1,000 illegitimate live births 0.00 The natural decrease of population (i.e., excess of deaths over births) was 111. 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 0.98 Area comparability factor for deaths 0.88 These factors, when applied to the crude rates, produce the following adjusted rates :— Live births 11.50 Deaths 11.29 7 Comparative Statistics of Births, Mortality, Etc. LEYTON, 1901-1956 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 3 36 106 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 b125,352* 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 33.06 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 1956 100,900 1,185 11.74 1,296 12.84 27 22.78 * Population as estimated for purposes of B, Birth Rate ; D, Death Rate. 8 Deaths. The Registrar-General's classification of causes of death by sex totals are shown in Table I on this page. The total number of deaths in 1956 (1,296) compares with 1258 in 1955, the respective death rates per 1,000 population being 12.84 and 12.33. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE—1956 AGE GROUPS—MALES AGE GROUPS—FEMALES Causes of Death Total 0-1 1-5 5-15 15-25 25-45 45-65 65-75 75 + Total Males 0-1 1-5 5-15 15-25 25-45 45-65 65-75 75 + Total Females 1 Tuberculosis, respiratory 15 3 5 2 10 4 1 5 2 Tuberculosis, other 1 1 1 3 Syphilitic disease 7 3 2 1 6 1 1 4 Diphtheria — 5 Whooping Cough — 6 Meningococcal Infections — 7 Acute Poliomyelitis 1 I 1 8 Measles — 9 Other infective and parasitic diseases 1 1 1 10 Malignant neoplasm stomach 30 6 10 3 19 2 8 1 11 11 Malignant neoplasm lung, bronchus 65 2 26 24 5 57 1 1 3 3 8 12 Malignant neoplasm breast 23 2 12 5 4 23 13 Malignant neoplasm uterus 9 2 4 3 9 14 Other malignant and lymphatic neoplasms 119 1 21 19 14 55 1 1 24 18 20 64 15 Leukaemia, aleukæmia 8 1 1 2 1 5 6 16 Diabetes 8 1 3 3 7 1 1 17 Vascular lesions of nervous system 172 10 26 31 67 1 18 29 57 105 18 Coronary disease, angina 154 6 33 28 24 91 1 9 24 29 63 19 Hypertension with heart disease 30 7 7 5 6 12 23 20 Other heart disease 217 2 10 9 42 63 1 10 21 122 154 21 Other circulatory disease 57 3 9 10 22 1 7 15 12 35 22 Influenza 4 2 2 2 2 23 Pneumonia 85 1 8 14 26 49 2 1 1 12 20 36 24 Bronchitis 107 11 30 31 72 6 8 21 35 25 Other diseases of respiratory system 9 1 4 1 2 8 1 1 26 Ulcer of stomach and duodenum 20 1 5 1 5 12 1 5 2 8 27 Gastritis, enteritis and diarrhoea 6 1 1 2 1 2 1 4 28 Nephritis and nephrosis 6 2 1 1 4 1 1 2 29 Hyperplasia of prostate 7 1 3 3 7 30 Pregnancy, childbirth, abortion — 31 Congenital malformations 8 1 3 1 5 1 1 1 3 32 Other defined and ill-defined diseases 90 12 1 1 3 6 4 6 33 8 4 10 14 21 57 3 3 Motor vehicle accidents 7 4 2 1 7 34 All other accidents 15 1 1 2 2 6 2 7 9 35 Suicide 15 1 4 2 3 10 1 1 3 5 36 Homicide and operations of war — TOTALS 1,296 15 4 1 3 22 161 204 214 624 12 1 2 1 20 114 186 336 672 9 Local Sanitary Authority The Registrar-General's estimate of population in the Borough for 1956 is 100,900. As in the previous year, it shows a decline in population of 1,100 persons. The excess of deaths over births is 97, as compared with 122 in 1955. In my Report for 1955 I made observation to the effect that 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. At the time of writing the Council have acquired three large houses for the accommodation of elderly people and, although it is not with the idea of releasing larger housing units, it is possible that some may become available and thus retain some of the larger families instead of them having to find accommodation in the new towns. Birth-rate. The birth-rate of 11.74 per thousand of population shows a slight increase as compared to the figure for 1955, i.e., 11.13, but is still a good deal below the figure for England and Wales, viz., 15.6. Death-rate. The death-rate for the year is increased from 12.33 per thousand of the population in 1955 to 12.84 in 1956, the actual deaths being 1,258 and 1,296, respectively. The rate is higher than the rate for England and Wales (12.84 compared to 11.7) due in part to the large numbers of persons in the elderly age-group residing in the Borough in private residences or Langthorne Hospital as semi-permanent residents. The causes of death, as set out in the statistical table, do not show any special feature. The number of deaths from all forms of tuberculosis has increased from 12 in 1955 to 16 in 1956, cancer of the lung from 62 to 65. The largest increases are in deaths due to the circulatory systems and various forms of cancer—the increases being 31 and 24, respectively. There is a decrease in the number of deaths from coronary diseases and other heart diseases. Accidents in the Home. Of the 15 deaths classified as due to "all other accidents," 13 occurred in the homes. Six females and three males died as a result of falls in the home, two females died as a result of accidental coal-gas poisoning and one due to burns from a hot-water bottle. An infant of 11 months died as a result of " inhalation of a foreign body." Of the deaths due to falls, eight were over 70 years of age. I am pleased to report that early in 1957 a voluntary Committee was set up to disseminate propaganda on Home Safety. Infectious Diseases. In spite of the large number of cases of Measles (831) and Whooping Cough (163) notified during the year the incidence of infectious disease was very low. There were two cases of paralytic Poliomyelitis in adults and both had residual paralysis. The number of cases notified 10 was three, compared to 21 in 1955. There is a general decline in the notified cases of infectious diseases and having seen the almost complete elimination of Diphtheria it is hoped that similar success will be obtained with the preventive measures against Whooping Cough. Scarlet Fever is still with us in a mild form and sporadic cases of Food Poisoning, Dysentery and Paratyphoid occur from time to time. Tuberculosis. For the second year it is gratifying to report that the incidence of tuberculosis in all forms is the lowest ever recorded in Leyton. National Assistance Act, 1948—Section 47. No applications were made to a Court of Summary Jurisdiction for orders under this section of the above Act during the year. Visits were made to quite a number of cases where it was considered that such action might be necessary ; however, with the co-operation of the personal health services it was possible to keep the patients at home, where, in all conscience, they are at least happier. National Assistance Act, 1948—Section 50. During the year arrangements were made for the carrying out of nine burials under this section of the Act. Mortuary Facilities. The arrangements entered into between the Council and the Hospital Management Committee (Leytonstone, No. 10, Hospital Group) in September, 1949, for the provision of mortuary facilities at Whipps Cross Hospital mortuary have continued during the year. Seventy bodies were admitted, and a further 92 bodies were removed to Queen's Road mortuary, Walthamstow, on the instructions of H.M. Coroner. 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 13 residents attended for treatment and made 21 attendances. Steam Disinfection of Bedding. Following a report that the Steam Disinfestor at the Depot was unserviceable, arrangements were made with Walthamstow Borough Council for the disinfection of bedding to take place at the Walthamstow Disinfecting Station on a financial agreement. Dirty Premises. Section 83, Public Health Act, 1936.—During the year a number of cases were referred by the Public Health Inspectors, health visiting staff and Domestic Help Organiser regarding premises which are filthy within the meaning of the above Section of the Act. In the main premises of this nature consist of one room occupied by a sub-tenant who is aged and either "cannot be bothered" to keep the premises clean or has a mania for storing old papers, rags and any other old junk. These are cases where there is no justification for a domestic help to be in attendance and it is apparent that the Council will have to carry out the cleaning in default. To do this it is evident that a tangible reward should be made to the person who carries out such cleansing. In two cases the work has been carried out in default and as the 11 patients were on National Assistance the Council assumed financial responsibility. Laundry Service for the Incontinent. In November, 1955, I submitted a report to the Public Health Committee recommending that consideration be given to the need for laundry facilities for certain old people in the area whose condition is such that they cannot attend to elementary human needs ; and further recommended that this Service could be set up under the provisions of Section 84 of the Public Health Act, 1936. The Committee endorsed my recommendation and in December, 1956, the premises situated at the rear of 280 High Road, Leyton, were adapted for the purpose. An Electrolux Washing Machine taking a load of 22lb, a hydro-extractor and laundry truck were installed, together with a gas drying-cabinet. The cost of the scheme including equipment was approximately £765. The Service came into operation in January, 1957, and is operated by the Handymen attached to the Department. There is no doubt that the Service is of inestimable value to the relatives or friends of patients who have difficulty with the laundering of fouled linen and personal clothing. Under the provisions of the Act it is obvious that the Service is only available for the incontinent and is not a general laundry service. Staff—Medical. There have been no changes in the medical personnel of the Local Sanitary Authority during the year. Assistant County Medical Officers of Health—Experience in the Duties of a Medical Officer of Health. During the year the Council approved my suggestion that Dr. T. M. Childs, an Assistant County Medical Officer on the Health Area establishment, be given the opportunity to gain experience in the duties of a Medical Officer of Health by accompanying the Medical Officer of Health and Public Health Inspectors on routine and special visits. Staff—Sanitary Inspectors/Public Health Inspectors. The Sanitary Inspectors (Change of Designation) Act, 1956, receiving royal assent on 2nd August, 1956. This Act provides that Sanitary Inspectors shall in future be designated Public Health Inspectors. The Council's authorised establishment comprises the Chief Public Health Inspector, Deputy Chief Public Health Inspector, and eight District Public Health Inspectors. For the past three years the Council has had difficulty in filling and maintaining its establishment of Public Health Inspectors, and at the time of preparing this report there were four vacancies. With a district staff, half of what is officially recorded as adequate, and with each district inspector responsible for a population double that of the officialy recorded average for the country as a whole, it is impossible to operate a comprehensive sanitary service. Your depleted staff are now almost fully employed dealing with complaints and other matters requiring urgent day-to-day attention, leaving little, if any, time for less urgent work and special duties. The national shortage of Public Health Inspectors has been 12 aggravated considerably over the past two years because local authorities are endeavouring to increase their establishments of Public Health Inspectors to be able to implement the Government's direction to local authorities to take up, as a matter of urgency, the campaign of slum clearance which the war interrupted, and to cope with other heavy commitments, imposed on them by recent legislation, for example the Food Hygiene Regulations, 1955, and the Clean Air Act, 1956. It is indeed lamentable that the shortage of Public Health Inspectors is being felt most severely by the population of urban areas, whose need for the sanitary service is greatest, having regard to the age and type of district in which they live, and consequent acute problems of slum housing, air pollution, etc. The reason for this is obvious ; few, if any, urban authorities (especially metropolitan and extra-metropolitan boroughs) are able to offer the attraction of working conditions such as can be expected in a rural or semi-rural district or in an urban district of recent development, nor are they able, in the majority of instances, to offer applicants additional inducements, such as housing accommodation, car allowances, etc. In 1954, the Council approved and adopted a scheme for recruiting and training of Student Public Health Inspectors, full details of which were given in my report for that year. Two Student Public Health Inspectors were appointed last year and the Council has recently approved the appointment of a third. Prevalence and Control of Infectious and Contagious Diseases The following cases of infectious and contagious disease were notified during the year :— Disease Notifications Received Removed to Hospital Smallpox — — Diphtheria — — Erysipelas 15 2 Scarlet Fever 58 8 Pemphigus Neonatorum — — Tuberculosis, Pulmonary 50 — Tuberculosis, Other forms 6 — Pneumonia 141 27 Ophthalmia Neonatorum 1 — Typhoid Fever 1 1 Paratyphoid Fever 14 14 Puerperal Pyrexia 12 7 Meningococcal Infection 5 5 Poliomyelitis, Paralytic 2 2 Poliomyelitis, Non-paralytic 1 1 Acute Encephalitis, Infective — — Acute Encephalitis, Post Infectious — — Measles 831 18 Whooping Cough 163 3 Dysentery 49 9 Food Poisoning 46 6 Totals 1,395 103 13 Diphtheria. No case was notified during 1956. The last case notified was in 1951, a very mild throat infection not confirmed bacteriologically. Information regarding immunisation against diphtheria is to be found on page 41. Dysentery. During the year 49 notifications of dysentery were received. Nine of the cases were treated in hospital ; 12 of them were confirmed bacteriologically and none of the persons notified had the disease in a serious form. Food Poisoning. Cases of this disease to the number of 46 were notified, as compared with 43 in the previous year. These included nine "outbreaks" involving 24 cases of undiscovered cause ; and of the 22 single cases in only two was the agent identified (Salmonella organisms). Only in six cases was hospitalisation necessary. Measles. 1956 was expected to be an inter-epidemic year. However, 831 cases were notified, compared with 717 cases in 1955. Only 18 cases were admitted to hospital, and no child died from this disease. Poliomyelitis. Two cases of paralytic poliomyelitis, and one non-paralytic, were notified during the year. The paralytic cases were in male adults, one aged 20 and the other, 32. In both cases there is still some residual paralysis. The non-paralytic case occurred in a local hospital in the person of a child patient not normally resident in this area. The death from poliomyelitis in the Causes of Death table occurred in a child who was notified in 1955 and died early in 1956 from lobar pneumonia with poliomyelitis as a contributing factor to her death. The annual incidence for the last 10 years commencing with 1947 is : 14, 2, 20, 14, 0, 12, 8, 1, 21, 3. Whooping Cough. 163 cases were notified, compared to 48 during 1955. There appears no logical reason why the number of notifications has increased. Eighteen of the cases occurred in infants of one year or under. There were no deaths from this disease during the year. Information regarding protection against whooping cough will be found on page 41. Scarlet Fever. This disease is still with us in a mild form, and of the 58 cases only eight were removed to hospital. Pneumonia. 141 cases were notified ; and as no action is taken it is doubtful whether notification serves any useful purpose other than statistically except, perhaps, when there is reason to expect an influenza epidemic. An undue rise in notifications may be a useful pointer to the advent of such an epidemic. Many medical practitioners do not trouble to notify such manifestations, and for some years one medical practitioner in the Borough has reported the majority of cases in which notification has been received. 14 Tuberculosis. The following is a statement of particulars appearing in the Register of Notification of Cases of Tuberculosis for the year ended 31st December, 1956 :— Pulmonary Non-Pulmonary total M. F. Total M. F. Total Number on Register at commencement of year 486 402 888 33 53 86 974 Number first notified during the year 31 19 50 4 2 6 56 Number of cases entered in Register otherwise than by Notification 23 13 36 — 1 1 37 Number removed from the Register during the year 10 10 20 — 1 1 21 Number remaining at the end of the year 530 424 954 37 55 92 1,046 Details of cases removed from the Register during the year:— Died 6 3 9 — — — 9 Removed from the district 3 3 6 — — — 6 De-notified — — — — — — — Cured 1 4 5 — 1 1 6 New Cases.—The following table gives particulars regarding the new cases which have occurred during the year: — Age Periods New Cases Pulmonary Non-Pulmonary M. F. M. F. 0 — — — — 1 — — 1 1 5 1 — — — 10 1 — 1 — 15 1 3 — — 20 8 3 — — 25 5 2 — — 35 4 7 1 — 45 1 1 — 1 55 6 — — — 65 and upwards 4 3 1 — Totals 31 19 4 2 15 LABORATORY FACILITIES. (a) Pathological Department, Whipps Cross Hospital, E.ll. For pathological specimens. (b) Central Public Health Laboratory, Colindale. For special bacteriological investigations ; supply of lymph for vaccination ; supply of diphtheria toxin (A.P.T.). (c) Counties Public Health Laboratories, Queen Victoria Street, London. For bacterial and chemical examination of water, milk and other foods. (d) Public Analysts, Analytical Laboratory, 20, Eastcheap, E.C.3. For analysis under provisions of Food and Drugs Act, 1938. 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 : 974 beds. (b) Langthorne Hospital. Accommodation : 707 beds. NURSING HOMES. There are two nursing homes in the Borough registered under the provisions of the Public Health Act, 1936 :— 1, Queen's Road, Leytonstone, with accommodation for 60 patients; " Brooklands," 22 Fairlop Road, Leytonstone, with accommodation for 25 patients. Sanitary Circumstances of the Area PART I—COMMENT Housing and Nuisance Abatement. Broadly speaking, the work of the Public Health Department in relation to housing is concerned with the repair, demolition and closure of unfit houses and slum clearance. Dwelling-houses are inspected as a general routine or on complaint, and statutory action taken as appropriate to secure the remedying of defects and abatement of nuisances. One of the major responsibilities of the local sanitary authority is that of maintaining in habitable condition existing housing accommodation. The importance of the task confronting the sanitary department may be gathered from the fact that during the 12-month period under review some 15,360 inspections and reinspections were made by Public Health Inspectors under the Public Health Act, Housing Acts and relevant legislation, and 2,288 complaints regarding unsatisfactory housing conditions were investigated. As a result of these inspections 16 1,452 notices specifying works to remedy defects such as dampness, general disrepair, defective drainage, leaking roofs, etc., were served. 1,025 houses were surveyed for the purpose of classification to determine the extent to which they fall short of the standard of fitness prescribed by the Housing Acts and the possibility or otherwise of their being included in a slum clearance scheme or dealt with by demolition or closing order procedure. In 19 instances it was found necessary to institute legal proceedings because of the failure of owners to comply with the requirements of notices served under the nuisance abatement procedure of the Public Health Acts. There were also a number of insanitary houses (8) where, despite statutory action, it was not possible to enforce essential repairs, and the Public Health Committee were obliged to operate the demolition/closing procedure under sections 11 and 12, Housing Act, 1936. The deferred demolition procedure as provided by section 3 of the Housing Repairs and Rents Act, 1954, was used to deal with two of these cases. This decision resulted in the Council acquiring the houses at site value and maintaining them in a tolerably habitable condition until the occupants can be re-housed. Slum Clearance and Redevelopment Areas. Consequent upon the Government's direction to local authorities to take active steps to review housing conditions in their areas and resume full exercise of their powers and statutory responsibilities under the Housing Acts in relation to slum clearance (curtailed during the war and post-war periods), the Council instructed its officers to complete the necessary preparatory work in respect of two areas in the Borough selected for redevelopment. Between May, 1955, and January, 1956, every house in the Crescent Road Area was surveyed in detail by the Public Health Inspectorate to determine the extent to which the houses were defective in relation to disrepair, stability, dampness, natural lighting, ventilation, water supply, drainage, sanitary facilities and bad arrangement in relation to other buildings. In February, 1956, the Medical Officer of Health submitted to the Public Health Committee an official representation in respect of four Clearance Areas, and a report prepared jointly with the Chief Public Health Inspector on the main and material conditions existing in the Areas which in their opinion rendered demolition of all houses and other buildings necessary, either by reason of their unfitness for human habitation, or because they were by reason of their bad arrangement or the narrowness or bad arrangement of the streets, dangerous or injurious to the health of the inhabitants of the Areas. At its meeting on 10th April, 1956, the Public Health Committee recommended the Council to declare the afore-mentioned areas to be clearance areas in accordance with the provisions of section 25 of the Housing Act, 1936, and referred to the Housing and Town Planning Committee the question of the steps to be taken to secure the clearance and re-development of the areas and the re-housing of persons to be displaced. At its meeting on 12th April, 1956, the Housing and Town Planning Committee supported the recommendation of the Public Health Committee and recommended the Council to make a compulsory Purchase 17 Order to purchase lands in the Clearance Areas and additional lands considered necessary to secure a site of convenient shape and dimensions for satisfactory development. The above-mentioned recommendations were confirmed by the Council at its meeting on 26th April. Having prepared the Compulsory Purchase Order and carried out legal and procedural formalities the Town Clerk subsequently submitted the Order and relevant documents to the Minister of Housing and Local Government for confirmation. The Minister ordered a public local inquiry to be held to enable persons making objections to the Order to be heard. The inquiry was duly held, when the Town Clerk presented the case for the Council, and at the time of preparing this report it was known that the Leyton Housing (Crescent Road Area) Compulsory Purchase Order, 1956, was confirmed by the Minister without any material modification. The Council has good reason to be satisfied with the successful outcome of its first slum clearance inquiry. The Crescent Road Area marks the beginning of a long-term programme of slum clearance and re-development in the Borough and as many years must elapse before its fulfilment it is inevitable—owing to the shortage of alternative housing accommodation and the scarcity of land on which to build new houses—that a substantial proportion of the 1,500 or more houses reported to the Minister pursuant to section 1 of the Housing Repairs and Rents Act, 1954, as being unfit for habitation and liable to be dealt with under section 11 (demolition) and/or section 25 (clearance areas) of the Housing Acts will have to be retained and maintained for housing purposes for many years to come. The Public Health Committee will therefore be faced for an indefinite period with the problem of enforcing essential repairs to insanitary properties. Details of inspections and notices served under the Housing and Public Health Acts and relevant legislation are set out in the section of this report entitled "Sanitary Circumstances of the Area, Part II— Statistics." 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 Chairman of the Public Health Committee, Councillor F. W. Marshall, and the Chief Public Health Inspector continued to be the Council's representatives on the No. 8 Workable Area Committee set up by the Ministry of Agriculture, Fisheries and Food, for rodent control. The Committee, comprising some 11 neighbouring Authorities, meets about three times per year and apart from discussing general methods of rodent control and topical forms of treatment, investigate the results of the simultaneous treatment of interconnected sewers carried out bi-annually by adjacent authorities. The Council's sewers were treated in June and December, each treatment being of 4 to 5 weeks duration and involving some 1,000 manholes. All surface infestations are investigated by the Public Health Inspectorate and arrangements are made, where applicable, in liaison with the Borough Engineer Surveyor for drainage systems to be 18 tested and repaired. During the year under review 33 drainage systems from private houses were wholly or partly repaired or reconstructed, 527 complaints were received concerning rodent infestation involving treatment by the rodent operatives of 458 private houses and 70 business premises. The total number of visits in connection with these investigations and subsequent disinfestation amounted to 5,360. Business Premises. In the Borough there are some 2,350 business premises, made up of factories, industrial undertakings, food premises—catering establishments, shops, etc.—involving some 3,052 activities including registration and licensing. All these premises are subject to routine inspection by the Public Health Inspectors to ensure compliance with the provisions of the Acts, Orders and Regulations controlling them, and for the welfare 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. Nevertheless, 3,255 inspections were carried out, 391 notices were served and 250 new registrations and/or licences were dealt with. Attention is drawn to the statistical section (Part II) immediately following, which gives detailed information as to the Acts, Orders and Regulations involved and the action taken in relation thereto. Food and Drugs and Shops Acts Administration. The Council is the Food and Drugs authority for the district and the Public Health Inspectors are authorised under the Food and Drugs Act, 1955, to procure samples of food and drugs for chemical analysis or for bacteriological or other examination. 162 samples of a variety of foods and drugs were submitted to the Public Analyst for chemical analysis. In 5 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. 1. Sliced Bread and Butter. In December, 1955, a formal sample of sliced bread and butter taken from a local cafe was found to contravene section 3 of the Food and Drugs Act, 1938, by reason of the fat on the bread consisting of margarine and not butter. Legal proceedings were authorised and the proprietor fined £2, with £2 2s. Od. costs. 2. Buttered Rolls. This sample of buttered rolls obtained from a local mobile canteen in January, 1956, was found to constitute a contravention of section 2 of the Food and Drugs Act, 1955, in that the rolls were spread with margarine and not butter. Legal proceedings were authorised in this case and the proprietor fined £1. 19 3. Pork Sausages. A formal sample of pork sausages obtained from a local grocer's shop in March was found to be deficient in meat, having regard to the amount claimed, a contravention of section 6 of the Food and Drugs Act, 1955. A warning letter was sent to the purveyor in this case. 4 and 5. Ice Cream. On 12th June an informal sample of ioe cream was found to be deficient in fat content. A further formal sample was obtained on 18th June and this was deficient in both fat and milk solids. This constituted a contravention of the Food Standards (General Provisions) Order, 1944, Food Standards (Ice Cream) Order, 1953, and section 4 of the Food and Drugs Act, 1955. Legal proceedings were authorised and the manufacturers fined £1. 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 in the statistical section which follows. Meat and Food Condemned. The statistics table in Part II immediately following gives information as to foodstuffs in respect of which condemnation certificates were issued as a result of routine inspection of food premises. In addition, 17 complaints regarding unsound and/or adulterated food were investigated by the Public Health Inspectors and reported to the Public Health Committee. In four cases the Committee authorised legal proceedings (details of which are also given in Part II—Statistical section) in 10 instances the Committee resolved to send warning letters to the retailers and/or manufacturers concerned ; 2 cases were noted with a resolve for no further action and in the remaining case, which concerned a belt in a tin of pineapple, representations were made via the Board of Trade to the packers in Formosa. Clean Food. The national campaign for cleaner food took an appreciable step forward with the introduction of the Food Hygiene Regulations at thie beginning of the year. The Regulations add a number of new provisions for securing the observance of sanitary and hygienic conditions and practices in connection with the preparation, transport, storage, handling and sale of food. To ensure uniformity of administration in applying the new standards, it was necessary for the Public Health Inspectorate to undertake a detailed survey of the 1,500'odd food premises in the Borough, made up of shops, factories, catering establishments, clubs, schools, staff canteens, stalls, etc., falling within the scope of the new legislation. The survey (which is still in progress) is being carried out on a systematic (premises to premises, shop to shop) basis, according to priority, starting with cafes, dining rooms and catering establishments generally. It was also necessary to visit the Council's pleasure ground, Lea Bridge Road, during Bank Holidays so that food traders operating from stalls could be included. An abstract setting out the principal requirements of the Regulations was circulated to the occupiers of all 20 premises concerned. Of the 1.571 visits to food premises made by the Public Health Inspectors during the year 556 were detailed inspections recorded on special inspection cards designed and introduced for the purpose and 376 notices drawing attention to contraventions of the Regulations in respect of construction and maintenance, provision of separate facilities for personal cleansing and for washing food and equipment, provision of hot and cold water, first-aid kit, locker accommodation, etc., were served. Because several important provisions of the Regulations have to be interpreted according to the type of premises and functions involved the practical application of the new standards to the wide variety of food premises in the Borough has not been easy, especially in regard to small shops where business and domestic activities are combined. Notices served on the occupiers of such premises specify maximum requirements with the object of securing the highest possible standard attainable. The recipient of a notice may apply to the local authority for a certificate exempting his premises from certain requirements because of restricted accommodation or other special circumstances. No exemption certificates have so far been granted. A report on the progress of the detailed survey is given to the Committee each month by the Chief Public Health Inspector. It should be appreciated, however, that its success will depend on the ability of the staff to follow-up and enforce notices already served to ensure full compliance with the Regulations. It will not be possible, with the limited staff available, to concentrate on systematic follow-up procedure until the balance of the 1,500 premises in the Borough have been subjected to detailed inspection and properly recorded. Although substantial progress has been made, unless the rate of inspection and re-inspection can be speeded up, it will be some time before this is achieved. It is pleasing to place on record once again appreciation of the co-operation received from food traders in the Borough, but it should be realised that the Food Hygiene Regulations are not wholly concerned with premises, apparatus and equipment ; they also lay down requirements in respect of the cleanliness of persons engaged in the handling of food and of their clothing and habits. In order that food handlers and the public may always have before them the importance of good food hygiene practice the application of the statutory provisions should be supplemented with publicity and education. Unfortunately the depleted staff of Public Health Inspectors is fully employed in dealing with routine day-to-day matters and there is little margin to enable this important aspect to receive adequate attention. Attention is drawn to the statistics contained in Part II immediately following this section of the report giving details in tabular form of premises and persons registered and/or licensed under the Food and Drugs Act, 1955, and associated legislation. Full details are also given of inspections, notices, legal proceedings and improvements effected to business premises as a result of action taken by the Department. 21 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 Leyton, Public Health Inspectors are the authorised officers under the various Acts and Orders. 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 54 inspections were made and three notices served. Atmospheric Pollution. The Clean Air Act received royal assent on 5th July, 1956 and its passing has been hailed as the most important administrative step forward in the prevention of air pollution since the Public Health Act of 1875. Whether it will prove to be as successful as is hoped in achieving clean air will depend very largely on the local authorities who administer it. Although some of the most important provisions (control of dark smoke and of grit and dust, etc.) will not come into force until early in 1958, a number of sections became effective from the last day of 1956. The functions and responsibilities of the Public Health Committee are extended by the new legislation, which forms part of the Public Health code. The provisions now in force deal, inter alia, with the establishment of smoke control areas. Preliminary survey work in this connection will involve much detailed investigation, being similar in many respects to a survey under the Housing Acts, and should now be in progress. Before consideration can be given by the Council to the question of the establishment of a smoke control area, a survey of the Borough as a whole will have to be undertaken by the Public Health Inspectorate, to obtain the information necessary to formulate proposals for submission to the Ministry of Housing and Local Government. As this is only the beginning of a long-term attack on the causes of air pollution, as envisaged by the new Act, it is reasonable to assume that two Inspectors could well be engaged on this work alone for an indefinite number of years. Leyton is still co-operating with the Department of Scientific and Industrial Research in the investigation of air pollution. The recording apparatus from which the Public Health Inspectors make a daily determination of the concentration of smoke and sulphur dioxide in the atmosphere is situated at the Public Health Offices, Sidmouth Road. The tables which follow show the results recorded during the 12 months ended March, 1957, divided into summer and winter periods. The average results for the 6-year period ended March, 1956, are also shown for comparison. Concentration of smoke is expressed in milligrams per 100 cubic metres and sulphur dioxide in parts per 100 million. 22 The average concentration of smoke for the year ended 31st March, 1957, was 23.3 milligrams per 100 cubic metres, compared with 21.0 milligrams for the previous six years—an increase of 11%, whilst the concentration of sulphur dioxide for the same period was 7.3 parts per 100 million, compared with 6.7 parts for the previous six years—an increase of 9%. The Department of Scientific and Industrial Research is studying possible relationships between air pollution and mortality during the periods of persistent fog, and in this connection additional observations at three-hourly intervals were carried out. During the period under review, a fog occurred, which persisted with variable density from the early hours of 19th December to the afternoon of 20th December ; five special observations were made and the peak concentrations reached 93.2 milligrams of smoke per 100 cubic metres and 32.3 parts of sulphur dioxide per 100 million. A fog also occurred for a short time in the early morning of 14th November; an average concentration of 101.1 milligrams of smoke per 100 cubic metres was recorded on this date— the highest reading of the year. The Chairman of the Public Health Committee, Councillor F. W. Marshall, and the Chief Public Health Inspector are the Council's representatives on the Standing Conference of Co-operating Bodies, which meets twice a year. The practical measures taken by Public Health Inspectors to mitigate pollution of the atmosphere by smoke and grit include the taking of smoke observations of factory chimneys ; inspection of boiler installations ; advice to boiler operatives on proper use of fuel and methods of stoking, and discussions with managerial staff. Thirty-two such investigations were carried out during the year. SANITARY CIRCUMSTANCES OF THE AREAPART II—STATISTICS Reference has been made in the preceding paragraphs to the following tables and charts giving details in tabular form of the action taken and visits made by the Public Health Inspectors pursuant to their statutory duties and responsibilities in connection with environmental hygiene and the legislative powers in force. 23 1. INSPECTIONS, RE-INSPECTIONS, ACTION, (a) General. Statutory Provisions Complaints Received Inspections and Re-inspections 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 2053 16 9 18 1025 Housing Repairs and Rents Act, 1954 23 108 Public Health Acts. 1936 1713 11823 968 457 928 33 058 .252 556 59 Prevention of Damage by Pests Act, 1949 552 1376 10 5 Food and Drugs Act, 1955 32 1562 361 15 65 Shops Act, 1950 12 197 3 Essex County Council Act, 1952 2 83 1 1 Leyton Corporation Act, 1950 28 Factories Acts, 1937/48 21 285 11 10 Pet Animals Act, 1951 41 Rag Flock and Other Filling Materials Act, 1951 5 Diseases of Animals Acts 54 3 2 (b) Detailed. (i) Housing Act, 1936 (Sections 11/12) Housing Repairs and Rents Act, 1954 (Section 3). 8 houses were dealt with under the demolition/closing procedure of the Housing Act, 1936 and/or the deferred demolition procedure of the Housing Repairs and Rents Act, 1954. (ii) 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 23 22 1 10 10 — 24 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. (iii) Food and Drugs Act, 1955—(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, 1955 and Food Hygiene Regulations, 1955, 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 Insp. Det. Surv. Insp. Routine Total Number of Inspections Bakehouses 10 29 39 Bakers 20 33 53 Butchers 74 100 174 Catering Establishments 93 151 244 Confectioners 22 15 37 Corn Chandler 1 2 3 Dairies and Distributors of Milk 14 24 38 Factories 17 31 48 Factory Canteens 23 20 43 Fish Friers 6 27 33 Fishmongers 7 27 34 Game Dealers 3 2 5 Greengrocers 23 43 66 Horse-flesh Dealers 1 3 4 Ice-cream Places 7 17 24 Itinerant Food Dealers Stalls and Vehicles 20 72 92 Food Storage Accommodation Local Authority Canteen 5 8 13 Meat Depots — 17 17 Miscellaneous 14 17 31 Multiple Stores 1 1 2 Off-Licences 6 6 12 Provision Shops 126 202 Public Houses 19 30 49 School Canteens 38 25 63 Shell-fish Vendors 5 4 9 Slaughterhouses (Poultry) 1 95 96 Street Markets — 24 24 Total Inspections 556 1025 1581 (iv) 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 25 of Animals Acts and Orders, the Leyton Corporation Act, 1950 ; and relevant legislation. Type of Premises Insp. Det. Surv. Insp. Routine Total Inspection Clubs 1 1 2 Factories with Mechanical Power 221 221 Factories without Mechanical Power — 33 33 Fairgrounds — 10 10 Hairdressers and Barbers 3 16 19 Local Authority Properties 1 5 6 Miscellaneous Shops, etc. — 11 11 Nursing Homes 1 — 1 Outworkers — 247 247 Pet Animals Shops 4 37 41 Public Conveniences — 24 24 Rag Flock 2 5 7 Retail Shops — 34 34 Schools — 9 9 Stables — 4 4 Warehouses — 1 1 Workplaces 1 5 6 Total Inspections 13 663 676 (v) 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 34 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 394 251 10 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers premises) — — — — TOTAL 454 285 10 — 26 (iv) Prevention of Damage by Pests Act, 1949—Rodent Control/ Disinfection. Rats Mice Total Complaints received 372 155 527 Enquiries and visits made: By Rodent Operatives 2,879 1,105 3,984 By Public Health Inspectors 1,298 78 1,376 Premises treated individually : Dwelling houses 346 112 458 Business/Industrial Premises 33 47 70 Premises Re-treated : Dwelling houses Business/Industrial Premises 16 3 9 3 25 6 Number of rooms treated 279 Number of sites/tips treated 5 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 53 Choked drains cleared 29 Dampness remedied 730 *Drains relaid or partly relaid 18 Floors repaired 178 Guttering repaired or renewed 253 Miscellaneous defects remedied 748 New W.C. pans and traps provided 55 Plaster repaired 632 Rainwater pipes repaired or renewed 96 Roofs repaired or renewed 443 Rooms redecorated 67 Sashcords renewed 190 Sinks provided 7 Sink waste pipes repaired or renewed 78 Stoves repaired or renewed 48 Vent pipes repaired or renewed 36 W.C. cisterns repaired or renewed 68 Window sills, etc. repaired 403 Yards paved 71 * In 33 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. 27 (ii) Food and Drugs Acts/Food Hygiene Regulations/Shops Act. Nature of contraventions remedied and improvements effected to food establishments, business/industrial premises as a result of statutory and informal action. Rooms adjoining sanitary convenience/sleeping place 2 Drain outlet/inlet within room 1 Wall/doors/windows not kept clean or repaired 385 Ceiling not kept clean or repaired 295 Floor not kept clean or repaired 142 No ventilation 35 No lighting 11 No receptacles for refuse 39 Accumulation of refuse in room 10 Cleanliness of persons employed 15 Cleanliness of apparatus and fittings 116 Washing facilities inadequate, i.e.: Wash-basins 122 Hot water 153 Soap/towels/nail-brush 105 Food not protected from contamination 53 Dirty wrapping paper 1 First-aid equipment 123 Wash-hand notice 201 Artificial light in W.C. 46 Urinal unsuitable 4 No W.C., or inadequate 8 No sink, or inadequate 52 No clothing, etc., accommodation 52 Provision for control of temperature of food 1 Yard paving defective 18 Sink waste-pipe defective 6 Fireplace defective 3 Name and address not displayed 3 Roof defective 6 General defects 12 (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 4 2 Sanitary Conveniences (S.7) : (a) Insufficient 2 — (b) Unsuitable or defective 6 1 Other offences against the Act (not including offences relating to Outwork) 11 7 TOTAL 23 10 28 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 Premi' ses 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 Preaerved 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 46 5 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 80 1 2 H Multiple Store 5 3 2 3 1 I Milk 12 1 2 J Ice Cream 113 K Rag Flock 9 7 2 L Pet Animals 14 1 M Horse Flesh 2 N Hairdresser 79 43 O Hawker 104 54 P Public House 35 10 32 Q Off Licence 45 4 3 2 R Factory 454 58 3 6 S School 18 1 17 T Council Property 4 2 2 U Hospital 2 2 V Miscellaneous Shops 754 Total Premises 2350 Totals Additional Functions 702 73 84 47 13 40 60 80 32 28 2 29 15 43 54 1 1 29 (ii) Details of Registrations/Licences. Act or Regulation On Register 31.12.1955 Removed during 1956 Registered during 1956 On Register 31.12.1956 Food and Drugs Act, 1955— S.16 Ice-Cream Premises 282 6 10 286 S.16 Butcher's Premises 48 1 — 47 Milk and Dairies Regs., 1949—Distributors 109 19 6 96 Milk (Special Designations) Regs. (Annual Licences)— 108 105 105 Sterilised Sterilised—supplementary 7 — 7 7 Pasteurised 50 — 62 62 Pasteurised—supplementary 5 — 5 5 Tuberculin Tested 26 — 17 17 Tuberculin Tested—Supplementary 5 — 6 6 Essex County Council Act, 1952— Hawkers of Food 94 4 14 104 Hawkers Premises 57 4 1 54 Leyton Corporation Act, 1950— S.63 Vendors of Shell Fish 13 — — 13 S.48 Hairdressers and Barbers . 77 — 3 80 Pet Animals Act, 1951 (Annual Licences) — Pet Shops 15 3 14 14 Rag Flock and Other Filling Materials Act, 1951— Registration of Premises 9 — — 9 TOTAL 905 37 250 905 30 4. LEGAL PROCEEDINGS. (i) Public Health Act. Resulting from the 457 statutory notices served on owners under the nuisance abatement procedure of the Public Health Act, 1936, in eight 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 1.2.56 Statutory nuisance—152 Crownfield Road, E.15 Abatement Order, 28 days. £2 2s. costs. 22.2.56 Statutory nuisance — 54 Michael Road, E.ll Owner fined £5. 22.2.56 Statutory nuisance—7 Trinity Street, E.ll Owner fined £5. 22.2.56 Statutory nuisance, 9 Trinity Street, E.ll Owner fined X5. 22.2.56 Statutory nuisance—34 Acacia Road, E.ll Owner fined £5. 18.4.56 Statutory nuisance—7 Trinity Street, E.ll Owner to pay maximum daily penalty of £2 as from 22.3.56. 18.4.56 Statutory nuisance—9 Trinity Street, E.ll Owner to pay maximum daily penalty of £2 as from 22.3.56. 2.5.56 Statutory nuisance—152 Crownfield Road, E.15 Owner fined 40s. 30.5.56 Statutory nuisance—122 High Road, Leytonstone, E.15 Abatement Order, 28 days. £1 Is. costs. 20.6.56 Statutory nuisance—7 Trinity Street, E.ll Abatement Order, 28 days. 20.6.56 Statutory nuisance—9 Trinity Street, E.ll Abatement Order, 28 days. 5.9.56 Statutory nuisance — 19 Stanley Road, E.10 Abatement Order, 28 days. £2 2s. costs. 26.9.56 Statutory nuisance—34 Acacia Road, E.ll Abatement Order, 28 days. £2 2s. costs. 10.10.56 Statutory nuisance — 54 Michael Road, E.ll Abatement Order, 28 days. £2 2s. costs. 24.10.56 Statutory nuisance—58 Wallwood Road, E.ll Abatement Order, 28 days. 24.10.56 Statutory nuisance — 21 Fairlop Road, E.ll Abatement Order, 28 days. 24.10.56 Statutory nuisance—3 Lynton Road, E.ll Abatement Order, 28 days. £1 1s. costs. 21.11.56 Statutory nuisance—4 Crownfield Road, E.15 Abatement Order, 28 days. £2 2s. costs. 19.12.56 Statutory nuisance — 19 Stanley Road, E.10 Owner fined £5. £2 2e. costs. 31 (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 8.2.56 Unsatisfactory sample of bread and butter. Contravention of Section 3 of the Food and Drugs Act, 1938 Proprietor fined 40s. £2 2s. costs. 7.3.56 Unsatisfactory sample of buttered roll. Contravention of Section 2 of the Food and Drugs Act, 1955 Owner fined £l. 29.8.56 Unsound sausage rolls. Contravention of Section 8 of the Food and Drugs Act, 1955 Retailer fined 40s. 5.9.56 Unsatisfactory sample of Ice-cream. Contravention of Article 1 of Food Standards (General Provisions) Order, 1944, Food Standards (Ice-Cream) Order, 1953, and of Section 4 of the Food and Drugs Act, 1955 Manufacturer fined 40s. 12.9.56 Unsound cake. Contravention of Section 2 of the Food and Drugs Act, 1955 4s. costs. 12.9.56 Unsound Meat Pie. Contravention of Section 8 of the Food and Drugs Act, 1955 4s. costs. 5. MEAT AND FOOD CONDEMNED. Condemnation certificates were issued in respect of the under' mentioned 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 C wts. Qrs. Lbs. Commodity Units Cheese — 1 8 2 Hindquarters Lamb Fish 2 2 14 1 Heart Meat 8 2 2 Sprats 60 boxes Ham — — 12½ Milk 129 tins Offal 1 1 3 Luncheon Meat 182 Sausages — 1 16 Vegetables 165 ,, Currants — — 18 Fish 56 ,, Potatoes 6 — — Fruit 234 ,, Ham 27 Frozen Eggs 28 Celery Hearts 8 .. Gherkins 21 ,, Gherkins 3 jars 8 .. Onions Miscellaneous Foodstuffs 77 pkts. 6. SAMPLING. (a) Food and Drugs Act, 1955. (i) Chemical Analysis. Commodity Taken Satisfactory Unsatisfactory Milk 15 15 — Ice Cream 19 17 2 Ice Lollies 10 10 — Miscellaneous 118 115 3 TOTAL 162 157 5 32 (ii) Bacteriological Examination. Commodity Taken Grade I II III IV Ice Cream 19 10 5 3 1 Ice Lollies 11 — — — — Water 17 — — — — Miscellaneous 3 — — — — TOTAL 50 10 5 3 1 (b) Rag Flock and Other Filling Materials Act, 1951. (i) Samples taken. Eight 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 5 6 7 8 Samples Nos. 1 2, 3, 5, 7, 8—Rag Flock; Impurities test (in tripli' cate), Oil and Soap test ; Chlorine test Not to contain more than 1.8% of soluble im' purities, 5% of oil and soap or 30 parts per 100,000 of soluble chlo' rides. Soluble impuri' ties averages. Oil content. Soap content. Chlorine content in parts per 100,000. 1.1 1.0 0.9 1.0 1.0 1.1 2.5 1.7 2.0 1.0 2.1 2.4 0 7 0 9 0.9 0 8 0 9 0 8 12 7 12 10 11 12 Sample No. 4 — Woollen Mixture Felt. Animal Fibre test; Oil and Soap test ; Chlorine test. To contain not less than 60% animal fibre. Not to contain more than 1.8% soluble impurities, 5% of oil and soap or 30 parts per 100,000 of soluble chlo' rides. Animal fibre on' tent. Chlorine content. Oil content. Soap content. Soluble impurities averages. 66.5 5 2.1 1.1 0.7 Sample No. 6— Cotton felt. Oil test; Trash con' tent test; Dust index test. Not to contain more than 2% oil, 7£% trash. To be not more than index 3. Oil content. Trash content. Dust index. .2 5. 4 1.8 7. ATMOSPHERIC POLLUTION. (i) Smoke Abatement. 32 observations were made as to quantities of smoke emitted from chimneys of industrial and commercial premises. Written intimations were sent to the managements of a number of business undertakings regarding excessive smoke and grit emission. (ii) Daily Records. The following tables show the results recorded during the twelve months ended March, 1957, divided into "Summer" and "Winter" periods. The average results for the 6-year period ended March, 1956, are also shown for comparison. 33 CONCENTRATION OF SMOKE EXPRESSED IN MILLIGRAMS PER 100 CUBIC METRES Month Monthly average Highest daily average Lowest daily average 1950/56 1956/57 1950/56 1956/57 1950/56 1956/57 April 17.1 19.1 39.8 42.7 6.8 9.7 May 8.5 4.8 23.9 10.0 2.6 2.1 June 4.5 5.4 8.8 12.6 1.2 1.1 July 3.7 4.6 8.0 10.3 1.0 1.1 August 5.0 6.7 9.1 10.7 2.0 4.1 September 7.7 7.7 18.5 14.0 2.9 2.1 Summer Average 7.8 8.1 18.1 16.7 2.8 3.4 October 24.1 29.8 80.5 69.0 6.2 8.4 November 36.4 46.1 100.8 101.1 10.8 20.1 December 43.0 43.0 126.3 88.1 12.1 14.5 January 39.6 34.5 116.2 72.6 13.6 16.3 February 34.7 44.1 78.8 74.8 16.5 13.5 March 28.0 33.3 84.8 74.5 11.3 11.0 Winter Average 34.3 38.5 97.6 80.0 11.8 14.0 CONCENTRATION OF SULPHUR DIOXIDE EXPRESSED AS PARTS PER 100 MILLION Month Monthly average Highest daily average Lowest daily average 1950/56 1956/57 1950/56 1956/57 1950/56 1956/57 April 5.5 7.0 13.4 14.7 1.7 3.7 May 2.9 3.7 6.5 6.0 1.1 1.5 June 2.4 3.3 4.7 5.5 0.9 1.3 July 2.1 2.8 4.4 5.4 0.7 0.8 August 2.8 3.1 4.8 5.0 1.1 1.9 September 3.7 3.7 7.3 8.8 1.6 1.5 Summer Average 3.2 3.9 6.9 7.6 1.2 1.8 October 7.5 8.7 17.9 18.3 3.0 3.6 November 11.2 11.8 26.5 22.4 4.8 5.2 December 12.9 12.6 33.7 24.8 4.4 4.5 January 11.8 9.2 34.2 18.1 5.0 5.5 February 10.1 11.5 24.4 19.7 5.0 4.7 March 8.0 9.6 17.4 20.9 3.3 3.6 Winter Average 10.3 10.6 25.7 20.7 4.3 4.5 8. RECORDS. In connection with the undermentioned enquiries received during 1956 involving some 2,707 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 sections 4 and 20 of the Housing Acts, 1949/54, an inspection is made by the Public Health Inspector and the property classified. 34 (i) Local Land Charge Enquiries 1905 (ii) Housing Act, 1949, section 4—Enquiries 421 (iii) Town and Country Planning Act, 1954, section 33—Enquiries 315 (iv) Housing Act, 1949/54, section 20—Improvement Grants 66 Part III—Services National Health Service Act, 1946 Leyton Health Area Sub-Committee of the Health Committee of the Essex County Council, 1956-57. 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 Alderman H. Reynolds, J.P. County Councillor Mrs. S. M. Bovill (ex-officio) (Vice-Chairman, County Health Committee). County Councillor H. Burton. „ G. W. Mason. „ „ Mrs. G. M. Chamberlin. (1 vacancy) Representatives of Leyton Borough Council Aldermen : G. S. Flack. Mrs. R. King. Councillors: G. S. Bentley. W. A. Cross. Miss V. D. Gostling. G. W. Hales. F. W. Marshall. P. A. Parry. Mrs. E. V. Pearson. E. L. Sanders. W. H. Sanders. C. B. Underwood, m.b.e., j.p. J. J. Walsh. 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. D. E. Sayer (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. George Trevor McKinnell Childs, b.a., m.b., b.ch., d.p.h. (from 1.8.56) Samuel C. Lovell, m.r.c.s., l.r.c.p. (to 27.7.56) 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.g., d.p.h. Specialist Part-time Medical Officers. (Regional Hospital Board Appointments) Ophthalmologist 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. (to February only) C. J. Scott, m.b., ch.b., d.l.o. Area Dental Officer A. E. Hall, l.d.s. (Liverpool). Dental Officers *Mr. D. E. Robinson, l.d.s., r.c.s. (to 31.1.56) *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, l.d.s., r.c.s. *Miss S. Rogart, l.d.s., r.c.s. (to 7.2.56) *Mr. T. D. H. Millar, l.d.s., r.c.s. Mr. J. A. Edmond, l.d.s., r.c.s.(from 18.10.55). Mr. K. Robinson, l.d.s., r.c.s. (from 19.3.56 to 22.6.56) Non-Medical Supervisor of Midwives Miss E. M. Wearn a, b, c, e Midwives Miss E. Daines a, b Mrs. C. L. Wackett b 36 Superintendent Health Visitor Miss E. M. Franklin Health Visitors/School Nurses Miss L. Acton a, b, d Miss I. D. Appledore a, b, c Mrs. D. E. Chatfield a (to 14.4.56) Miss E. O. Corby a (to 13.10.56) Miss K. Dolan a, c 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 a, b, 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 *Miss M. Walling a, b, c, Miss D. M. Archer (from 9.4.56—31.10.56) Miss T. James (from 6 2.56) Mrs. S. Muston (from 1.11.56) Mrs. J. Wenzell (from 12.11.56) Tuberculosis Visitors Miss C. G. Teale (to 19.1.56) a, b, c, e Mrs. L. M. Abbott a, f Mrs. H. Johnson (from 1.3.56) a Matrons of Day Nurseries Knotts Green Day Nursery— Mrs. E. M. White a, d Ellingham Road Day Nursery- Mrs. D. M. McStay (a) S.R.N. (b) S.C.M. (c) H.V.Cert. (d) S.R.F.N. (e) Q.N. (f) T.A. Cert. a, b 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. *R. Sadowski, M.Ch.S. *G. E. Fenn, M.Ch.S. *G. V. Ledger, M.Ch.S. *F. Miller. *G. Reminton. *Miss J. King. Domestic Help Organiser Mrs. E. M. Saxby. Oral Hygienist Mrs. J. Thurston (nee Watts). 37 Dental Attendants Mrs. D. Blundell (to 31.1.56) Miss E. Corcoran Mrs. A. Lewis. *Mrs. Ayres. *Mrs. Ferris Miss B. Watts (from 13.2.56) Clinic Cler\s Miss F. C. Cheetham. Mrs. L. Neville Miss E. Nichols (Foot Clinic) Mrs. J. Price Chief Administrative Assistant *W. D. Softley Administrative and Clerical Staff F. C. Ware. E. R. Price L. 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. This 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. It is of great advantage that Alderman Mrs. Hammond is also Chairman of the Borough of Leyton Welfare Services Committee and, in consequence, there has been a close integration between the two committees especially with the welfare of the aged. The Borough of Leyton Welfare Services Committee have assumed financial responsibility for domiciliary chiropody, the meals on wheels service, and extra nourishment to old people, and as will be appreciated with the duties of the health visitors embracing the care of the aged and the majority of the beneficiaries of the Domestic Help Service being also aged persons, great benefits have accrued from this close integration of the services. 38 Health Centres. There are three modern and well situated Health Service Clinics at which the major part of the health services' and school medical services' work is carried out. When the Essex County Health Services clinics at Leyton Green Road and Granleigh Road were opened in 1933/35 respectively they were designed for two separate functions, i.e. School Health Services and the Maternity and Child Welfare Services of the Borough Council. These separate functions were clearly defined and it was found that the parts of the buildings assigned for child welfare work were used on only four afternoons a week and, similarly, the parts assigned for school health services' work were used, in the main, for the mornings only. Since that time, with the inception of the Education Act, 1944 and the National Health Service Act, 1946, the clinics are now all-purpose clinics and much of the work is integrated. With the introduction of the National Health Service Act, whereby every person was able to sign on with a general medical practitioner, the numbers of children attending the minor ailment clinic sessions of the School Health Service decreased ; and apart from the two mornings when doctors are in attendance, these sessions now terminate at 10.30 a.m. Clinic premises are costly to build and to maintain and therefore the most economical use should be made of them. Since I commenced my term of duty at Leyton I have carefully considered the use of clinics and, in consequence, during 1956 recommended to the Committee that the foot clinics and speech therapy clinic should be assigned to the Health Services Clinics and that there should be one all-purpose doctor's room at each of these premises instead of two as formerly. Early in 1957, following the acceptance of my recommendations by the Committee, the disposition of these clinic sessions was carried out and the clinic premises are now fully used and we have been able to terminate the renting of the premises at High Road Baths formerly used for these purposes. Care of Mothers and Young Children. The registered births were 1,185 and the birth-rate of 11.74 continues to be much below the national average of 15.6. The ante-natal Clinics and the Child Welfare Clinics continue to serve a most useful purpose, and it is of interest to note that the attendances at the Child Welfare Clinics are 11% higher than the previous year, in spite of the birth-rate in 1955 being the lowest ever recorded in the Area. There were no deaths of Leyton residents due to maternal causes during 1956. Dental services for nursing and expectant mothers and children under five years of age are carried out by all the dental officers. Ante-Natal Relaxation Exercises. Each health visitor holds her own classes and teaches the mother the ante-natal exercises. But the great value of these classes is an educational one. The health visitor is very careful to ensure that the 39 mother does not get a distorted idea of her labour. The process of labour is explained and the mother is shown how she can help herself. The health visitor quietly and without fuss educates the mother in her role as a parent after the birth of her child giving her confidence that she will be able to manage. Some hospitals, early pioneers in ante-natal exercises, are discontinuing them because they do not think they are of much value. This may be because physiotherapists took the classes. But the Local Health Authority ante-natal exercise classes, with which is allied mothercraft, are organised on quite different lines and all who take part in them are convinced of their usefulness. Mothers' Club. Following the ante-natal relaxation classes a number of mothers expressed the wish that there should be a continuation of the chance to meet other mothers after the child was born. They wished to meet together in the evenings to share their experiences with other mothers and learn how the others deal with little problems which arise with a young child. One of the health visitors at Leyton Green Clinic commenced a Mothers' Club there in February, 1956. The first attendance was 12 and at this meeting the mothers expressed a desire to discuss their children's problem, and so the first three meetings of the Club were of the seminar type at which one of the medical officers and Miss Laquer, Psychiatric Social worker at Walthamstow Child Guidance Clinic, discussed behaviour problems with mothers. It is hoped to continue from time to time meetings stressing the importance of the earlier years of a child's life and the promotion of their future mental health. At other meetings they had lectures and film shows on foot health, home safety, toy-making and outings to places of general interest were arranged. Since that time keep-fit classes have been organised in connection with further activities of the Education Committee. There is no doubt that this extension to the normal services is of immense value to the mother, child and the health visitor inasmuch as they all get to know each other so well and health education is welcomed and not forced upon them. Distribution of Welfare Foods. During the year the distribution of welfare foods continued at five centres on 17 sessions per week. Three of these sessions were manned by members of the Women's Voluntary Services but they left to take up other duties. In consequence it was necessary to take on staff for these sessions. The "take up" of Welfare Foods shows a steady decline with the exception of Orange Juice. This is strange when it is considered that the attendances at the Child Welfare Clinics show a rise of 11% over the previous year. Day Nurseries. It is interesting to record the changes that are taking place in the types of admissions to day nurseries. When the day nurseries were first opened during the War it was with the express purpose of releasing 40 mothers for work of National importance. Now the day nurseries are taking a share in the field of preventive medicine by admission of medicosocial cases and more especially in the sphere of mental health. An analysis of admissions at one of the day nurseries in the area shows that 14 maladjusted children were admitted on recommendations by the Child Guidance Clinic or the medical officers. All these were admitted for a period of not less than three months and progress reports were submitted. Eleven children were admitted due to the illness of mother; these children would almost certainly have had to be taken into care if the day nurseries were not available. Seven children were admitted owing to the illness of the father. A typical case is as follows :— The mother had a very disturbed and insecure family background. She married in her teens and had two children in 18 months, and lived in cramped surroundings with the maternal grandmother. The family were a constant problem and when the older boy was 3½ years of age the children were referred to the Child Guidance Clinic. At this time the mother was extremely unstable. The children were undernourished and maladjusted whilst the father was weak and defeated by his unhappiness. The mother alternately rejected her children or became over indulgent. Both children were admitted to the nursery and after four months the younger child is making excellent physical and mental progress. However, the older boy is still giving cause for anxiety. He is still anti-social and has a very real anxiety neurosis. The mother's general condition is much improved and the psychiatrist is hopeful of the general outcome. Midwifery. The number of confinements taking place in hospital seems to have settled down at a figure representing just over 80% of all confinements. There does not appear to be any undue shortage of maternity beds in the hospitals that cater for the Leyton cases. This preference for hospital confinement makes it difficult for pupil midwives to obtain the practical domiciliary training that is necessary. The two local health authority midwives assist in the training of the pupils from The Lady Rayleigh Training Home. Health Visiting. The health visitors in the Area have carried out more health education during the year, and the visiting of old people still takes a considerable amount of time. The number of old people on the Register has increased by 50% during the year and there are now 750 who are receiving visits and advice from the health visiting staff. Attention is drawn in the relevant sections of the Report to the work of the health visiting staff on health education in schools and the introduction of a Mothers' Club. 41 Co-operation with Hospitals. For some years it has been the practice for members of the health visiting staff to visit the wards of the two hospitals in the Area for a half-day each week. One of the health visitors who has been visiting the modern and up-to-date geriatric unit of Langthorne Hospital reports as follows : — "Contact with the staff at Langthorne Hospital is most helpful inasmuch as it enables one to see their attitude towards helping the aged, and it is worthy of notice that great importance is attached to keeping the patient mobile. The system of relieving patients' relatives by taking the patient into hospital for six weeks and then sending them home for six weeks appears to have worked very well. In one case this has appertained happily for three years. Each week the Almoner gave me a list of discharges with a note of the domiciliary services that the doctor had recommended. These were then passed on to the district health visitor and special reports on home conditions were dealt with in a similar fashion." This co-relation between the hospital services and the local health authority staff is a practical form of co-operation which has a tot to commend it. Home Nursing. It is pleasing to recall the co-operation that exists between the staff of this Department and The Lady Rayleigh Training Home. As I have stated before in this Report, 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 this acute problem in the most economical way. Vaccination and Immunisation. The vaccination of infants against smallpox continues to be carried out at the Child Welfare Centres, and it is pleasing to be able to record that there is almost a 100% increase in the number of children under the age of six months who were vaccinated as compared with the previous year. The figures for diphtheria immunisation also show a 100% increase in respect of primary immunisations and the figure for "booster" doses is 1892 as compared with 214 in 1955. Immunisation against whooping cough shows only a slight increase over the previous year. In January, 1956, the Ministry's scheme for protection against poliomyelitis was announced. Registrations were invited in respect of children born in the years 1947-1954 inclusive. 3,371 registrations were received representing over 27% of the eligible children. The vaccinations were commenced in May and before the end of the year 347 children had the full course of vaccination and 21 children the first injection only. 42 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. Foot Clinic. The Foot Clinic at High Road Baths was opened in 1936 and since that time has proved of inestimable value to persons suffering from foot conditions. Originally there was one chiropodist; however, over the years there is now an establishment of six. Following the opening of the Essex County Health Services Clinic at Dawlish Road it was decided to convert the dental workshop at these premises to a one-cubicle foot clinic in order to serve the needs of patients in the Dawlish Road area and to obviate undue travelling to High Road Baths. This experiment had proved so worthwhile that it prompted me to make the following observations to the Committee : Patients and the Present Foot Clinic Facilities. The High Road Baths Foot Clinic is very convenient of access from most parts of the Area ; however, with the recent public service vehicles fares increases, the travelling expenses of patients are heavy. The Public Health Committee of the Borough Council and, since the "appointed day," the Health Area Sub-Committee, have been cognisant of the lack of foot clinic facilities in the eastern part of the Area. In the case of patients attending the Dawlish Road Foot Clinic, as they are all resident within a reasonable distance of the Clinic, there is no expense of fares and appointments are kept to time. Patients who live in the Cann Flail area have to pay as much as l/4d. in fares to attend the Foot Clinic at High Road Baths. In the case of many of the older patients an escort is necessary, so that the fares are doubled. There is also the occasional delay in public transport which makes patients late for appointments and thus defeats the objects of the appointment system. General Observations. There is no doubt that there are many advantages in having a Foot Clinic in the Health Service clinics, viz.: (a) The medical and nursing staff are able instantly to refer a child with foot conditions to the chiropodists and discuss the matter with them; (b) The chiropodist thus becomes an integral part of the Health Services team rather than an isolated unit; (c) A great proportion of the patients at the Chiropody Clinics are in the older age groups and the health visitor would have further opportunities to get to know them. Therefore, on the grounds of bringing the chiropody services nearer to the patients' homes, and to make fuller and more economical use of the Health Services Clinics in the area, I made the following recommendations :— (1) That the present Foot Clinic held at High Road Baths, be closed and the staff distributed to the three Health Services Clinics in the Area. (2) That the accommodation at the Health Services Clinics be re-allocated to make available sufficient room for the purpose. These recommendations were approved by the Committee and early in 1957 the Foot Clinics were so disposed. 43 Occupational Therapy Mrs. S. Wiltshire, Occupational Therapist, reports as follows on the Centre's activities in 1956. Five students were attending at the beginning of the year and another five joined soon afterwards. In August we attended the Borough Show, selling and taking orders for goods displayed, and again won an award for weaving. We had a stand at Woodford in September and took orders for many of the articles on show. We again assisted at the Council of Social Service Christmas Sale, and here again sales and orders were very satisfactory. Our Christmas Sale at the Centre was a great success, the new lines—soft toys and waxed paper flowers—were in great demand and subsequent orders will keep the class busy for several months in the New Year. Thanks also to getting more generous use of one of our windows this year for display we have had a steady trickle of orders from passers-by. At present two men students are in hospital, and two women students absent owing to illness in their homes. The remainder of the class still take a keen interest in the work. I have had to bring to the notice of the Committee that there does not appear to be the need for this branch of rehabilitation for tuberculosis patients as existed when the Centre was set up in 1950. At the time of writing the attendance is down to two patients which shows that there is not the waiting time for admission to sanatorium, and the success of the new drugs in treating the disease which obviate the longterm rehabilitation prior to the patient recommencing work. Further, the patient is anxious to restore his earning capabilities as soon as possible. Convalescence. 74 adults were sent away for period of convalescence and the majority of them stayed for three weeks. Loan of Sickroom Equipment. The loan of sickroom equipment is another service that will increase with the ageing population, and this entailed the loan of 428 articles during 1956. Tuberculosis Care Association. The Leyton, Wanstead and Woodford Tuberculosis Care Association have continued to make good progress during the year in assistance to patients and the raising of funds to finance this purpose. Miss R. Carrington, the Secretary of the Association, reports that the total income was £1,840 of which two-thirds was raised by Seal sales and other activities. The assistance to patients involved an expenditure of £1,475 in extra nourishment, payment of fares, financial grants, clothing and convalescence. 44 Altogether it has been a very successful year, but it is apparent that the raising of funds by voluntary effort must continue at the present level to meet the commitments that arise during the year. Domiciliary Meals for Old People. In December, 1956 I reported to the Committee regarding a scheme that had been put into effect with the Borough of Leyton Welfare Services Committee, and I quote from my report regarding this matter: The problem of ensuring that Old People have an adequate diet is one which has had quite a considerable amount of attention in recent years with the increasing longevity of life. It has been found that when old people are examined, twenty per cent, of them are under-nourished, and that many cases of anaemia are caused by nutritional defects. The reason for an inadequate diet is often apathy and, particularly with old people living alone, the diet is often mainly bread, margarine and tea. Local Authorities and Voluntary Services in many parts of the country have tackled this problem by providing a Meals on Wheels Service, but owing to transport difficulties the old people in this Area at that time received meals only twice a week, and the number of meals supplied is consequently limited. Voluntary Services supply a meal at the Town Hall, but this facility is only of help to old persons who are ambulant. Neither of these Services cater for the individual likes and dislikes of the person concerned. With the Co-operation of the Borough of Leyton Welfare Services Committee a pilot scheme of this nature is being tried in the area for six months with twelve selected cases, and in these selected cases the beneficiary will be given a sum of 6/3d. per week with which to purchase supplementary food for one, two or more weekly lunches. The Domestic Helps will be issued with specimen menus as a general line of guidance in order to achieve a balanced diet, and the beneficiaries should be encouraged to suggest items for their lunch so that their individual likes and dislikes may be respected. The general practitioner in charge of the patient will be informed of the scheme. I am sure there will be an enthusiastic response by the Domestic Helps in the working of this scheme as every woman enjoys cooking a satisfying meal, especially one which she knows a recipient will enjoy. The Domestic Help Organiser has arranged a panel of Domestic Helps whom it is considered will be suitable persons to deal with the cases selected, and the Health Visitors concerned have been notified so that they may keep observation and report regarding the effect the improved diet has had on the patient. Domestic Help Services. During the year it was evident that the estimates in respect of the Domestic Help Service would be considerably exceeded and I made a comprehensive report to the Committee regarding the calls on the Service. As so much of this report was of interest in the problem of the care of old people I set out hereunder the relevant extracts: 45 At the 1st November, 1955, the number of new cases totalled 364, whereas at the 1st November, 1956, the new cases amounted to 444; and it will be seen that this represents a 22% rise in cases. Since the commencement of the financial year 171 old cases already receiving help, on the recommendation of the General Medical Practitioner or Hospital Consultant, and subsequent investigation by the Domestic Help Organiser, have had to receive additional help. Further to this, the bad summer of 1956 meant that fires were continued over the greater part of the summer in the case of many old people confined to their rooms. More and more Geriatric units are viewing the problem of old people from the preventive aspect. The local unit in Langthorne Hospital has been a pioneer in this respect. This, in effect, means the treatment of the aged in their own home on an out-patient basis ; and I understand that this has necessitated as many as 1,200 domiciliary visits by the Consulting Geriatricians. Thus an increase in the number of cases which would normally have been Hospital In-patients have had to be allocated Domestic Help, as they are treated at home. Furthermore a great number of bed-fast patients are admitted to the Chronic Sick wards over a period of six weeks, to be returned home for six weeks and re-admitted for six weeks, and so on. This is done to relieve relatives. However, most of these cases would in the past be in-patients, but now become, for these periods, beneficiaries of the Domestic Help service. The effect of this additional work enumerated above has been to cause a rise in the estimated hours of 24% during the first half of the financial year. I have, with the Chairman and the Domestic Help Organiser, carried out a complete survey of all the cases, and, of the 700 cases being helped, it was possible only to reduce help in 9 cases, with a saving of approximately 30 hours per week. Another aspect which was apparent from this review is that there were approximately 270 cases who would have to be Hospital in-patients but for the Domestic Help service. Analysis of cases and hours. Following the complete review of cases by the Chairman in connection with the Supplementary Estimates, I was requested to present to the Committee an analysis of cases and hours. At the last meeting of the Committee, held on 15th October, I presented in statistical form the following return for the quarter ended 30th September. 1956. Category No of Cases Helped during the quarter Hours of Help provided during the quarter Maternity 14 1,203½ Acute Sick 10 444¾ Tuberculosis 20 1,064¼ Chronic Sicl;—Aged 512 26,710½ —Others 78 4,185½ Aged—Not Sick 23 1,794¾ Others 2 175½ TOTALS 659 35,578¾ 46 For the information of Members, these cases and hours have been analysed in the categories, and I beg to submit the following report : Maternity.—There were 14 cases in this category. Of these, 11 were normal cases which did not require assistance other than during the confinement period and the following two weeks. Three cases due to complications or other causes have been assisted since April; one for 27 hours per week, one six hours per week, and the remaining case for 10 hours per week. Acute Sick.—This category includes those cases having haemorrhages, fractures, or cases of post-operative convalescence at home. There were 10 cases assisted during the quarter, at a total expending of 444¾ hours. One case had two hours a week, one three hours, two four hours, one five hours, two six hours and three 12 hours. Normally cases in this category do not require help of over three months. Tuberculosis.—Twenty of these cases have been assisted. One case commenced in 1950, one in 1951, two in 1952, four in 1953, three in 1954, and nine in 1955. Three of the cases have two hours per week, ten four hours per week, six six hours per week, and one twenty-six hours per week. Chronic Sick (Aged).—This category of beneficiary represented 77.69% of the total cases receiving assistance during the quarter ended 30th September, 1956. The cases in this category totalled 512. However, this represents 560 persons, inasmuch as in 48 of the cases there were husband and wife, both of whom would have qualified for help. Analysis of Cases. On analysis of the cases, two commenced in 1948, seven in 1949, seven in 1950, 17 in 1951, 23 in 1952, 47 in 1953, 83 in 1954, 131 in 1955, and 195 in the first nine months of this year. The Beneficiaries fall within the following age groups :— 65—70 years 61 75—80 years 145 70—75 years 142 80-plus 164 It is interesting to note that 18 of the 80-years plus age group are over 90 years of age, and that, of the 512 cases assisted, 164 (32%) were over 80 years of age. Analysis of Hours. During the quarter 26,710 hours of help were allocated to the Chronic Sick (Aged) category, an average of 2,054 hours per week. The average amount of help supplied to beneficiaries per week is between five and six hours. 47 The following shows the cases and weekly hours of help allocated to them :— No. of Hours of Help Granted p.w. No. of Cases No. of Hours of Help Granted p.w. No. of Cases 2 hours 60 9—10 hours 22 3—4 „ 209 11—12 „ 16 5—6 „ 176 13—14 „ 4 7—8 „ 23 17 plus ,, 2 Total 512 cases. 445, i.e., almost 87%, received an average amount of help of less than one hour per day. The remainder of the cases had additional help due to being bed-fast or completely unable to assist themselves. Present Position. At the end of the quarter 450 cases were being assisted. Sixtytwo cases had ceased either temporarily or permanently, either by relatives taking care of their parent, transfer to hospital, death, etc., etc. At the time of preparation of this report there are 449 cases in this category being assisted. Chronic Sick (Others).—In the main the cases in this category are under 65 years of age, and include those suffering from heart conditions, rheumatoid arthritis, hypertension, disseminated sclerosis, etc. There have been 78 cases assisted during the quarter. One of the cases commenced in 1948, one in 1949, two in 1950, four in 1951, three in 1952, six in 1953, nine in 1954, 16 in 1955, and 36 in 1956 (first nine months). The number of weekly hours allocated to the cases was made up as follows 13 had two hours per week, 24 three to four hours per week, 23 five to six hours per week, and the remainder eight to 12 hours per week. The average help granted to these cases is about five hours per week. Aged (not sick).—The 23 cases in this category are senility patients. The age groups are as follows :— 75—80 yrs. 5 cases; 80—90 yrs. 14 cases; 90-plus 4 cases. Two of the cases commenced in 1950, four in 1951, three in 1952, three in 1954, seven in 1955 and four in 1956. The total hours expended was 1,794¾, giving a weekly total of 138 hrs. As will be seen, this gives an average of six hours per case each week, or one hour daily. Others.—These two cases were assisted due to illness of mother. One case was assisted for 22 hrs. weekly for a period of four weeks and the other 42 hours weekly for two weeks. It is apparent that there is no "ceiling" to this very important branch of the Health Services in this Area having regard to the great 48 work carried out by the Geriatric Unit at Langthorne Hospital both as concerns in-patients and out-patients, and the steadily increasing proportion of elderly. However, it is more economical to supply a measure of home help than to take up hospital beds for long periods. Problem Families. The Problem Families Committee which was dealt with fully in last year's Report met four times during the year, and once again it was apparent that the co-ordination of the Local Health Authority, Education and Welfare Authorities, together with the Housing Department of the Borough Council is most essential to deal with this type of case. MEDICAL STAFF In July, 1956, with the retirement of Dr. S. C. Lovell, the Committee interviewed applicants for the post of Assistant County Medical Officer of Health. As a result of the interviews, Dr. G. Trevor Mackinnell Childs was appointed and commenced duty on 1st August, 1956. Acknowledgements. I pay tribute to the valuable help that has been so willingly given during the year by the officers of the Hospital Management Committee ; Mr. S. Read of the National Assistance Board, and the Duly Authorised officers of the County Mental Health Services. It is by such co-operation that action can be taken without the officiousness that appertains when it is lacking. COUNTY HEALTH SERVICES—STATISTICS SECTION 21 HEALTH CLINICS : Leyton Green Road, Leyton, E.10 (Opened in 1933) Granleigh Road, Leytonstone, E.11 ( „ „ 1935) Dawlish Road, Leyton, E.10 ( ,, „ 1951) SECTION 22 CARE OF MOTHERS AND YOUNG CHILDREN Births Registered During Year Male Female Legitimate 598 536 Illegitimate 23 28 Births notified 1,219 49 CLINICS: Ante-Natal— First Attendances 504 Subsequent Attendances 3,422 Post-Natal— Lady Rayleigh Leyton Green Training Home New Cases 96 88 Total Attendances 183 96 Child Welfare— Leyton Green Park House Dawlish Road Emmanuel Hall Under 1 year— First Attendances 360 440 259 27 Subsequent Attendances 5,501 5,665 3,203 867 Total Attendances 5,861 6,105 3,462 894 1-5 years— First Attendances 46 104 39 — Subsequent Attendances 2,464 2,228 1,105 446 Total Attendances 2,510 2,332 1,144 446 Total Attendances (both age groups) 8,371 8,437 4,606 1,340 Number examined by Clinic Doctor 2,351 2,509 1,782 — Number Weighed 8,330 8,623 4,804 1,395 Dental Clinics Patients inspected and treated during the year— Expectant Mothers Nursing Mothers Children under School Age (1) Patients examined 91 69 402 (2) Patients found to require treatment 91 69 371 (3) Patients who have commenced treatment 101 70 358 (4) Patients who have completed treatment 75 72 284 (5) Patients awaiting treatment — — 13 (6) Attendances for treatment 280 315 734 50 Types of treatment given. Expectant Mothers Nursing Mothers Children under school age Extractions— (a) Permanent teeth 95 117 — (b) Temporary teeth — 327 Fillings— (a) Permanent teeth 107 119 1 (b) Temporary teeth — — 475 Inlays provided — 2 — Crowns provided — — — Anaesthetics administered (a) Local 15 25 11 (b) General (i) by Medical Officers on County staff (ii) by others 22 25 158 (a) Scaling 49 34 1 (b) Prolonged scaling and gum treatment 29 12 — Silver nitrate treatment 8 4 282 Dressings 94 159 213 X-ray examinations 19 4 — Dentures provided (a) Full 7 11 — (b) Partial 8 19 — Dentures repaired — 1 — Dentures re-made— (a) Full — (b) Partial — — — Orthodontic appliances— (a) Fixed — (b) Movable — — — Prophylactic treatment and other operations— Gum treatment 33 23 1 Cleaning and polishing 1 4 Oral hygiene instruction 1 hr. 1 hr. — Number of treatments (scaling and prophylactic carried out by Oral Hygienists) 113 72 2 Orthopaedic Clinic New Cases 31 Re-inspections 53 Minor alterations to footwear 54 Surgical appliances supplied 3 Ophthalmic Clinic Children referred 8 Attendances 19 51 WELFARE FOOD Issues.—The total issues during 1956 were :— National Dried Milk 34,374 Cod Liver Oil 8,518 Vitamin A ξ D Tablets 3,962 Orange Juice 69,088 CARE OF PREMATURE INFANTS (weighing 5 lbs. 8 oz. or under) Born at Home 8 Born in Hospital or Nursing Home 73 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 16 44 16 44 32 88 Total attendances during year 2,937 8,690 2,950 8,355 5,887 17,045 Number of days open 254 254 — CONVALESCENT HOME TREATMENT: Numbers sent to Convalescent Home Children 7 Mother and children 7 INFANT, NEO NATAL AND FOETAL MORTALITY— Live Births 1,185 Deaths under 1 year 27 Deaths under 4 weeks 21 MORTALITY RATES— Infantile 22.78 Neo natal 17.72 STILLBIRTHS— Number 25. Rate per 1,000 20.66 52 HEALTH CLINICS—CLINIC SESSIONS Health Clinic Monday Tuesday Wednesday Thursday Friday Saturday Leyton Green, Leyton Green Road, E.10. (LEYtonstone 3650, Ext. 267) A.M. Dental Minor Ailment Dental Orthoptic Minor Ailment Dental Minor Ailment Orthoptic Ophthalmic Dental Minor Ailment Ante-natal Dental Minor Ailment Ophthalmic Orthoptic Minor Ailment Dental P.M. Infant Welfare Dental Infant Welfare Dental Orthoptic Infant Welfare Dental P.N. (2nd) A.N. Exer. Orthopaedic Dental Orthoptic Special Medicals A.N. Exer. (Alt. Fridays) Immunisation Park House, Granleigh Road, E.ll. (LEYtonstone 3650, Ext. 268) A.M. Dental (1) Minor Ailment Ante-natal (2nd and 4th) Dental (1) Oral Hygiene Minor Ailment Dental (1) Minor Ailment Aural Clinic Dental (1) Oral Hygiene Minor Ailment Dental (1) Oral Hygiene Minor Ailment Dental (1) alternate Minor Ailments P.M. Dental (1) Ante-natal Exercises Dental (1) Oral Hygiene Infant Welfare Dental (1) ξ (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) Foot Clinic Oral Hygiene Dental (1) Minor Ailment Foot Clinic Dental (1) Minor Ailment Ante-natal Toddlers Foot Clinic Dental (1)6 ξ (2) Minor Ailment Dental (1) Minor Ailment Foot Clinic Minor Ailment Oral Hygiene Dental (1) (Alternate) P.M. Dental (1) Infant Welfare Foot Clinic Dental (1) Immunisation Foot Clinic Ante-Natal Exercises Dental (1) Foot Clinic Infant Welfare Foot Clinic Dental (1) ξ (2) Dental (1) Foot Clinic Evening Foot Clinic Foot Clinic Emmanuel Hall, Hitcham Road, E.10. P.M. Weighing Session 53 SECTION 23 MIDWIFERY Cases attended by Council Midwives. Midwives Essex County Council Attached to the Lady Rayleigh Training Home Beachcroft Road Total Cases attended :— (a) As Midwives 85 119 204 (b) As Maternity Nurses 2 19 21 Ante-natal Visits 385 1,335 1,720 Ante-natal Examinations 757 1,804 2,561 Post-natal Visits 1,174 5,530 6,704 Administrations of Gas and Air Analgesia 81 65 146 Administrations of Pethidine 32 59 91 Gas and Air Analgesia Percentage of administrations 64.8 Medical Aid Where the Medical Practitioner had arranged to attend the Patient 21 Others 129 Fees paid to Doctors Number of accounts received 81 Total amount paid to Medical Practitioners £229 6 6 Maternity Outfits Number of outfits issued to Expectant Mothers 235 SECTION 24 HEALTH VISITING Health Visitors. During the year the Health Visitors made 18,925 visits to homes. (a) To expectant mothers :— First visits 190 Subsequent visits 178 (b) To children under 1 year of age :— First visits 1,221 Total visits 4,677 (c) To children between the ages of 1 and 5 years :— First visits 362 Subsequent visits 5,550 54 (d)Other visits :— Whooping cough — Measles — Ophthalmia neonatorum 12 Discharging eyes 1 Diarrhoea 5 Puerperal Pyrexia 4 Children's Act 12 After deaths 16 After stillbirths 26 Miscellaneous 1,235 Ineffective 3,124 Old people 2,292 Hospital follow-up 20 Pemphigus neonatorum — SECTION 25 HOME NURSING Number of new cases 1,582 Number of visits paid to above 50,940 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 1 year 2-4 years 5-14 years 15 years and over Total Number Vaccinated 437 137 39 23 29 61 726 Number re-Vaccinated — — — 7 6 142 155 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 1 322 310 — — 1 157 247 24 3 2 41 25 34 5 3 35 14 42 16 4 27 7 85 61 5-9 116 39 591 424 10-14 75 17 276 331 Total 773 659 1052 840 Including temporary residents. 55 PERCENTAGE OF SCHOOL CHILDREN IMMUNISED (1956) 5-year age group Number examined 967 Number immunised 760 Percentage immunised 78.5 10-12+ age group Number examined 3,321 Number immunised 2,666 Percentage immunised 80.3 14-year age group Number examined 949 Number immunised 740 Percentage immunised 77.9 Protection against Whooping Cough Age at time of final injection Children who completed a full course under the County Scheme Records of combinec diphtheria-pertussis immunisations received By General practitioners By County Staff Under 6 months 10 8 32 6-12 months 78 323 184 1 year 48 206 54 2-4 years 12 40 25 5 years and over 5 12 13 Total (primary courses) 153 589 308 Reinforcing injections 33 — 66 SECTION 27 AMBULANCE SERVICE Patients conveyed— Stretcher Cases 4,860 Emergency Cases 3,460 Other Cases 29,908 Total mileage 152,590 miles SECTION 28 PREVENTION OF ILLNESS, CARE AND AFTER CARE Foot Clinic Male Female Children First attendances 212 694 226 Total attendances 3,800 17,033 1,837 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 9 56 (b) Extra Nourishment Number of new cases supplied with free milk 26 Total number being supplied with free milk at end of year 43 Loan of Sickroom Equipment. Air Beds 1 Air Rings 81 Bed Back Rests 64 Bed Blocks 4 Bed Cradles 14 Bed Pans 89 Crutches 3 Invalid Chairs 24 Rubber Sheets 68 Urinal Bottles 52 Feeding Cups 3 Sputum Mugs 2 Steam Kettles — Commodes 23 Bed Tables 1 Diabetic Scales — Sandbags 2 431 Convalescence for Adults. Number of applications during year 74 Length of stay— One week 2 Two weeks 33 Three weeks 34 Four weeks 5 SECTION 29 DOMESTIC HELP Number of helps and hours worked :— Number of domestic helps enrolled at end of year— Whole-time helps 8 Regular part-time helps 107 Number of domestic helps actually employed at end year 109 Number of hours worked during year 147,065¾ Work of the Domestic Help Organiser :— (1) First Visits 635 (2) Re-visits to beneficiaries— (a) Domestic help present 468 (b) Domestic help not present 455 (3) Other visits 324 57 Help Provided :— Maternity Acute Sick Tuber- culosis Chronic Sick Aged Not Sick Others Total Aged Others Requests for help from new cases during the year 64 46 3 405 96 14 7 635 New cases helped during the year 52 37 — 328 70 6 2 495 Total cases completed during the year (a)— 51 29 6 287 81 13 3 470 Cases being helped at end of year who have received help for— Under 3 months 1 6 — 51 11 1 — 70 3.6 months 1 — 46 4 — 51 6.12 months 1 2 — 117 7 3 — 130 Over 12 months — — 7 242 29 14 — 302 Total (b) 2 9 17 456 51 18 — 553 Total cases helped during the year (a) plus (b)] 53 38 23 743 132 31 3 1023 Hours of help provided during the year 4397* 1434 4681 1105953 187834 6829 345 1470651 MEDICAL EXAMINATION OF STAFF County Council employees— Number of medical examinations for : (a) Entrants to County Council's service 72 (b) Retirement on Superannuation 2 (c) Other purposes 1 No. of medical examinations Leyton Borough Council 65 Others 4 Entrants to teaching profession and training colleges 28 58 School Health Service Leyton Committee for Education 1956 - 57 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. G. S. Bentley 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 R. F. Drew J. Fairfax J. A. Powell M. Rayner L. W. Turp Nominated Members : County Councillors E. C. Hardy G. W. Mason SCHOOL HEALTH SERVICE The aim of the School Health Service is to ensure that each school child is regularly kept under medical supervision in order that he or she may take full advantage of the educational facilities made available under the Education Act 1944. This Service has been quietly developed over the year and, like all preventive work, is very seldom news. Routine medical inspections are carried out by the medical officers in the schools and these take place (a) in the child's first year at the primary infant school; (b) the third year in the primary junior school and (c) the last year in the secondary school. Parents are given the opportunity to attend at the routine medical examinations and the medical officers bring to their notice any medical defects detected, and advice is given as to obtaining the necessary treatment from their own private doctors or through the Specialist Services at the hospitals. The medical officers refer those needing treatment to the dental officers or the consultants of the Specialist Clinics set up by the Local Hospital Management Committee at the 59 Health Services Clinics. These Specialist Clinics comprise ophthalmic, orthopædic, orthoptic and ear, nose and throat sessions. In addition to the routine medical inspections, nursing staff visit the schools each year to carry out hygiene inspections, vision tests and heights and weights, and defects noticed at these inspections are referred to the Medical Officer at the Minor Ailment Clinic. Parents, teachers and general practitioners all co'operate in bringing defects to the notice of the medical and nursing staff of the School Health Service. It is interesting to note that with almost an identical school population the attendances at the Minor Ailment Clinics in the years 1936 to 1956 reduced from 13,937 in 1936 to 4,956 in 1956. This is due to several factors chief of which are the availability of free medical treatment by the family doctor since the introduction of the National Health Service Act of 1946 and to the better health of the school child. It is a gratifying trend as the minor ailment clinic can now become more and more a consultative clinic which entails more time spent on each child. This is very necessary as the problems differ greatly from those of 20 years ago and are more time consuming. To obtain the maximum benefit to the child it is essential that there should be complete co-operation betwen the teaching and the medical and nursing staff, and it is of great value if the staff of the Health Service have full access to see the child in the school environment and given an opportunity to discuss the child's emotional and physical problems with the class teacher. No unnecessary visits are made to schools and I feel that, if the members of the teaching staff fully appreciated that the child can only take full advantage of the educational facilities if he or she is physically fit, the visits of the medical and nursing staff would be welcomed more than they sometimes appear to be, especially so, now that there is an endeavour to carry out the education of more handicapped children in the ordinary schools. The School Health Service has become a well established integral part of the educational system assisting the teachers in their tasks and duties towards each child thus enabling them to obtain within their capacity the maximum benefit from education. Routine Medical Inspection. Routine Medical Inspection has been carried out in all schools in the Division, and the findings of the inspection remain about the average. The examinations in the 10-12 plus year age-group have increased from 2,173 in 1955 to 3,321 in 1956. This is due to the high birth rate and the change in the year of examination from 11 plus to 10 plus. The others shown in the statistics refer to children in the Junior Occupational Centre at Capworth Street. This has now been transferred to Wanstead. Uncleanliness and Verminous Conditions. Of the 25,163 hygiene examinations carried out in schools only 79 children were found to be unclean, i.e. a percentage of 0.31. This compares favourably with 1955 when the percentage of children found to be unclean was 0.67. Medical Treatment. The number of attendances at the Minor Ailment Clinic was more than double that of 1955 although the number of children attending was 60 substantially reduced. As mentioned earlier in this Report these clinics are now consultative rather than treatment clinics. The Local Hospital Management Committee continue to be responsible for the provision of consultants for Specialists Clinics. It was possible during the year to reduce the attendance of the Ophthalmic Consultant by one session per week. The Orthoptic Clinic is held under the supervision of Mrs. K. S. Box. As Mrs. Box also attends Whipps Cross Hospital the co-operation between Mr. Klein, the Ophthalmic Surgeon at Whipps Cross Hospital, and the Orthoptic Clinic is of great value in the case of referrals for operative treatment. I am indebted to Mr. C. J. Scott, the Ear, Nose and Throat Consultant, for the statistics regarding the Ear, Nose and Throat Clinic. School Dental Service. Mr. A. E. Hall, the Area Dental Officer, reports as follows on the School Dental Service: — The year 1956 opened with the equivalent of 3 3/11 full-time dental officers of an authorised establishment of six, made up of one full-time and nine part-time dentists. This number fluctuated slightly during the year but was the same at the year end as at the beginning. The number of dental officers has been almost static since the last war and, in view of the declared shortage of qualified dentists, it would appear unlikely that any improvement can be envisaged for some considerable time. Long term improvement may occur with the adoption of ancillary workers as provided for in the Dentists' Act, 1956. A limited number of evening sessions have been worked since February, 1956 to meet the convenience of those patients who prefer to attend at that time. A notable event during the year was the installation of Sterling Junior Units at the two surgeries in Dawlish Road, being the first part of a general modernisation of the dental equipment in the area. Apart from the practical value of modern equipment as an aid to speedy and skilful operating, its appearance suggests good work, and it is surprising how this is noted and commented upon by patients. School Inspections. Routine dental inspection has been carried out in eleven schools. In the schools it was not possible to visit all children, however, those referred by medical officers, nurses or teachers were advised or treated. The value of periodic examination in school cannot be too strongly stressed as it is by such careful examination that early decay in the permanent dentition can be found and reported at a time when it is not obvious to the parents, and also long before it reaches the painful stage. Unfortunately, one has still to record a vast amount of dental decay in school children, some of it of a very rapid type affecting the second dentition shortly after eruption. Bearing these facts in mind the recommendation in the " Report of the Committee of Enquiry into the cost of the National Health Service," 61 i.e. the Guillebaud Report of 1956 assume great importance. Among the foremost of these were the following 1. The fluoridisation of water supplies. 2. Increased dental health education. 3. Increased research work into the causes and possible prevention of dental disease. 4. More efficient dental services for the priority classes. Unfortunately, 2 and 4 above depend in a large measure for their success upon the engagement of sufficient dentists to bring the dental staff up to establishment instead of, as it is in the Leyton area, little more than 50 per cent, of establishment. The aim of all workers in the School Dental Service should be to ensure that, as far as possible, children should leave school without the loss of permanent teeth, free from dental disease and irregularity, and trained in the care of the teeth. Any or all methods which will help towards that end should, therefore, be pursued. Orthodontic Clinic. The work of this department continues to be very popular as the results of successful treatment are so obvious as to be widely commented upon with resultant requests for treatment by neighbours who see such finished cases. The main difficulty in an understaffed dental scheme is to try to limit this work to those cases most likely to benefit from it and so ensure that too much of the total time available is not given up to orthodontia to the detriment of routine conservative dentistry. Many cases can be treated by judicious extraction, perhaps followed by the use of a simple appliance, but long and difficult cases needing up to two or three years for completion should only be undertaken following careful consideration of many factors such as the child's age relative to the school leaver's age, past history as regards regular acceptance of conservative dental surgery, the state of the dental tissues themselves, and probably other factors which might militate against a successful result following the expenditure of a great amount of time. Oral Hygienist. Mrs. Thurston continues to devote 7/llths of her time to oral hygiene work in Leyton, and while the incidence of tartar deposits in children's mouths is low, the opportunities presented to talk to the children and to interest them in oral hygiene and correct tooth brushing are many and valuable. A good proportion of the children who have had their conservative work done and subsequently referred to the hygienist for instruction request appointments at three or six-monthly intervals for routine checkup without receiving a reminder from the dental department. Some part of this is undoubtedly due to the interest stimulated by the hygienist's work. 62 Health Education in Schools. The Health Visitor spends a considerable amount of her time in providing health education for mothers with young children. The school leaver provides a fertile ground for education of a kind which will be of benefit to him or her when he or she in time becomes a parent. A course of lessons on mothercraft for girl leavers was started this year in Goodall Road School through the kind co-operation and interest of the Head Teacher. The course consisted of ten lessons per term and the syllabus covered all the aspects of preparation for motherhood and the care and management of the infant, with practical demonstrations and visits to clinics and day nurseries. The Health Visitors' curriculum includes Health Education. Even so two of our Health Visitors undertook, at their own expense, a special course in health education which was organised by the Association of Women Public Health Officers and entailed one evening lecture a week for three terms. With the help of the Health Visitors and the interest of Head Teachers, it is hoped to extend the facilities to other schools during the coming year. Handicapped Pupils. Delicate. In 1956, 11 boys and 9 girls were ascertained as delicate pupils and all were recommended for residential school. Only one boy was awaiting a vacancy at the end of the year. Physically Handicapped. The following children were ascertained as physically handicapped during 1956 Recommendation Boys Girls Special educational treatment in ordinary school 8 8 Recommendation to attend a day school for the physically handicapped 1 - To attend a residential school for physically handicapped 1 - 10 8 An analysis of the Leyton children ascertaind as physically handicapped and still attending school is set out below:— Special School Ordinary School Day Boarding Boys Girls Disability Boys Girls Boys Girls Cerebral Palsy 4 - - - Cerebral Diplegia 1 - - - Muscular Dystrophy - 1 - - Congenital Cerebellar Ataxia 1 - - - 63 Disability Boys Special School Ordinary School Day Boarding Boys Girls Girls Boys Girls A.P.M. - - - 1 4 1 Erb's Palsy - - - - 2 - Asthma 1 - - - - - Bronchiectasis 1 - - - - 1 Congenital Heart 1 - - - 2 2 Diabetes - - - - - 1 Nephritis - - - - - 2 Congenital Malformed Foot - - - - - 1 Double Talipes - - - - - 1 Gross Scoliosis - - - - 1 - 7 2 1 1 9 9 Educationally Subnormal. 12 boys and 6 girls were ascertained as educationally subnormal and 1 boy was recommended for transfer from Harrow Green to a residential school. On 31st December 5 boys and 4 girls were at residential schools. Maladjusted. 4 boys and 2 girls were recommended for admission to residential schools. On 31st December 8 boys and 4 girls were at residential schools. 1 boy was awaiting admission. Deaf Pupils. No child was newly ascertained in 1956 and at 31st December 3 boys were attending residential schools and 1 girl and 2 boys were at a special day school. Partially Deaf. 1 boy as ascertained as partially deaf and recommended to attend a day special school. There were 2 boys at a day special school and 1 girl at a residential school at the end of the year. 7 boys and 2 girls were ascertained as partially deaf and recommended to remain in ordinary schools with special treatment. Blind. 1 boy was so ascertained in 1956. 2 boys were at residential schools. Partially Sighted. 2 boys were ascertained in 1956 and recommended to stay at an ordinary school with special treatment. 1 boy was attending a day special school in the year. 64 Epileptic. 1 girl was newly ascertained in 1956, and at the end of the year 2 boys and 1 girl were at residential schools and 1 girl was attending a day special school. 5 girls and 1 boy were so ascertained and recommended to stay in ordinary schools with special treatment. Section 57, Education Act, 1944. 9 children were excluded from school under section 57(3) and 5 were recommended for supervision. In addition 4 children from the Forest Division entered Harrow Green and were referred for supervision after leaving school. Section 56, Education Act, 1944. At the end of the year 12 children were receiving tuition in Whipps Cross Hospital as in-patients. Tuberculosis in Children of School Age. Four cases of tuberculosis in children of school age were notified during the year. Pulmonary Male 12 years „ 9 „ „ Female 12 „ Non-pulmonary Male 11 „ There was no death in the 5-15 age group due to tuberculosis. This is especially gratifying inasmuch as in 1906 tuberculosis was the main cause of death in school children. Causes of Death in School Children. Three deaths were registered in respect of school children. The deaths were due to the following causes:— Cerebral coma Male 9 years Subarachnoid haemorrhage Female 12 ,, Acute suppurative pneumonia „ 12 „ Taking the total school population at 13,769 the deaths represent a death rate of .21 per 1,000. In 1955 the national death rate in the school age groups was .409. School Health Service STATISTICS ROUTINE MEDICAL INSPECTION. Number of Inspections : Percentage of Parents present 5-year age group 967 88.11 10—12+ year age group 3,321 87.22 65  Percentage of Parents present 14 year age group 949 25.07 Others 60 55.00 Total 5,297 Other Inspections: Special Inspections 2,214 Re-Inspections 5,631 The Findings of Medical Inspection: Age Groups 5 year 10—12 + 14 yr. Ors. Number of children inspected 967 3,321 949 60 Number found to require treatment 137 507 88 19 Percentage found to require treatment 14.17 15.26 5 9.27 31.66 Uncleanliness and Verminous Conditions: Number of examinations 25,163 Number found to be unclean 79 Percentage found to be unclean 0.31 MEDICAL TREATMENT. Minor Ailments Clinic: Number of children attending 1,235 Number of attendances 4,956 Specialist Clinics—Ophthalmic: Number of children referred 259 Number of attendances 1,897 Orthoptic: Number of sessions held 235 Number of cases investigated 368 Number of cases treated 328 Number of new cases seen 111 Referred for tests only 40 Referred to hospital for operation 7 Total number of attendances for the year 1,529 Specialist Clinics—Orthopaedic: Number of first attendances 153 Number of subsequent attendances 270 Number referred for radiological examination 18 Number referred for physiotherapy 43 Number admitted to hospital for operative treatment 4 Number of surgical appliances supplied 36 Number of alterations to footwear 216 66 Specialist Clinics—Ear, Nose and Throat: Number of sessions 21 Total attendances 287 New cases seen 97 163 First visit during 1956 66 Follow-up visits 124 Referred for hearing survey 25 Other cases defective hearing 22 Referred for pure tone audiometry 20 Hearing aids issued 1 Hearing improved with treatment 17 Hearing restored with treatment 6 Hearing still impaired after treatment 8 Referred for operation: Mastoidectomy 1 Tonsils and adenoids 21 Adenoidectomy only 4 Bilateral antral lavage 12 Admitted to hospital from clinic 4 E.U.A. 1 Speech Clinic: Boys Girls Total Number of children at present undergoing treatment 61 23 84 Number of children discharged during 1956 15 11 26 Number of cases treated daily (average) 15 Number of homes visited 36 Number of School Departments visited 31 Number of parents interviewed 120 Number of children referred to other clinics 8 Number of new cases 43 Number of children re-admitted 1 Number of children who left before cured or discharged 12 Total number of attendances 2,337 Number of children referred who were found not to require treatment - Number of children under observation but not attending 91 Child Guidance Clinic: Number of cases referred to the Clinic 60 Number of cases diagnosed at the Clinic 32 (a) Psychiatrists: Diagnostic interviews 32 Cases taken on for treatment 28 Treatment interviews 144 Other interviews 6* No. of Psychiatric sessions per week 4½* 67 Child Guidance Clinic—cont. (b) Psychologists: Clinic cases tested 38 Cases given remedial education 4 Treatment interviews (rem. educ.) 42 School visits on behalf of clinic cases 32 Other interviews at clinic 39 (c) School Psychological Service: Individual cases seen 101 Number referred to clinic 13 (d) Play Therapists : Cases treated 10 Treatment interviews 154 (e) Psychiatric Social Workers: Interviews at clinic 239 Interviews elsewhere 18 (f) Waiting List: Cases for diagnosis 23 Awaiting treatment 1 (g) Total cases treated during year 67 *For Leyton and Forest cases. B.C.G. Vaccination—School Leavers: Approximate number of children eligible for vaccination 1,257 Number accepted 377 Number Mantoux positive without vaccination 67 Number vaccinated 320 B.C.G. Vaccination—Medical Research Trial: This was fully reported on in 1955. 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 967 10—12 year age group 3,321 14 year age group 949 Total 5,237 B. OTHER INSPECTIONS Number of Special Inspections 2,214 Number of Re-inspections 4,074 Total 6,288 68 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 27 112 137 14.17 10—12+ year age 208 320 507 15.27 14 year age 41 49 88 8.21 TOTAL 276 481 732 13.97 TABLE II A. RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1956 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 37 55 54 1 5 Eyes— (a) Vision 283 187 271 25 (b) Squint 29 7 26 1 (c) Other 14 50 17 1 6 Ears— (a) Hearing 20 41 143 15 (b) Otitis Media 18 15 43 2 (c) Other 56 54 18 1 7 Nose and Throat 68 31 162 3 8 Speech 9 20 39 3 9 Lymphatic Glands 1 — 28 — 10 Heart 4 — 34 — 11 Lungs 37 16 133 16 12 Development— (a) Hernia 2 — 12 — (b) Other 12 8 87 2 13 Orthopaedic— (a) Posture 20 — 74 — (b) Feet 55 18 68 — (c) Other 85 45 118 5 14 Nervous System— (a) Epilepsy 1 — 8 1 (b) Other 5 5 36 — 15 Psychological— (a) Development 10 16 45 1 (b) Stability 23 15 74 10 16 Abdomen 1 — 7 1 17 Other 12 535 39 27 69 B. CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS INSPECTED DURING THE YEAR IN THE AGE GROUPS Age Group Pupils Inspected NUMBER CLASSIFIED AS Satisfactory Unsatisfactory No. % No. % 5 years 967 916 94.73 51 5.27 10—12+ years 3,321 3,266 98.35 55 1.55 14 years 949 943 99.37 6 .63 Other periodic 60 60 100 — — TOTAL 5,297 5,185 97.89 112 2.11 TABLE III RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1956 TREATMENT TABLE GROUP I.—Minor Ailments (excluding Uncleanlincss, for which see Table V) Disease or Defect Treatment at County Council Clinics Skin— Ringworm— Scalp — Body — Scabies — Impetigo 16 Other skin diseases 66 Eye Diseases 92 Minor Ear, Nose and Throat Defects 142 Miscellaneous— e.g., minor injuries, bruises, sores, chilblains, etc. 919 Total 1,235 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) — 328 Other defect or disease of the eyes (excluding those recorded in Group I) — — Total — 328 Number of Pupils for whom Spectacles were— (a) Prescribed — 997 (b) Obtained — 998 70 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 — 35 (b) For other nose and throat conditions — 5 Received other forms of treatment 142 2 142 42 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 353 TABLE IV DENTAL INSPECTION AND TREATMENT Periodic Specials (a) Number of pupils inspected 3,900 811 (b) Number found to require treatment 3,044 811 (c) Number offered treatment 2,947 811 (d) Number actually treated* 2,434 811 (e) Number awaiting treatment 178 — (f) Attendances made by pupils for treatment 11,567 1,208 (g) Half-days devoted by— (a) Dental Officers to— (i) Inspection 31 (ii) Treatment 1,349 (b) Oral hygienists to— (i) Treatment 187 (ii) Other purposes 62 (h) Fillings— (i) Permanent teeth 4,611 (ii) Temporary teeth 2,201 (i) Number of teeth filled— (i) Permanent teeth 4,079 (ii) Temporary teeth 2,164 (j) Extractions— (i) Permanent teeth— (a) On account of caries 892 (b) For other purposes 187 (ii) Temporary teeth— (a) On account of caries 4,412 (b) For other purposes 391 (k) Anaesthetics administered— (i) Local 785 (ii) General 2,079 71 (1) Other operations— (i) Permanent teeth 3,034 (ii) Temporary teeth 1,831 (m) Number in (1), carried out by oral hygienists 1,150 (n) Analysis of figures in (1)— Type of Operation— Number X-rays 220 Silver Nitrate Treatment 783 Scaling and Polishing 1,122 Dressings 2,249 Other operations 491 Orthodontic Clinic : Study models for progress 58 Removable appliances included screw plates, finger springs, apron springs and combina' tions 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 Barclay Infants 276 191 185 118 - 63.8 County High, Boys* 593 378 354 164 - 46.32 Church Mead Infants 315 245 241 114 - 47.0 Downsell— Infants 294 264 264 165 - 62.50 Juniors 601 567 567 364 - 64.19 Lea Bridge Infants 98 88 86 39 - 47.0 Mayville Infants 299 181 169 122 - 72.18 Norlington Secondary 491 368 329 136 - 41.34 Ruckholt Manor Secondary 366 329 329 192 - 58.36 Sybourn Infants 228 163 163 96 - 58.0 Lake House Secondary 339 270 267 140 - 52.44 TABLE V INFESTATION WITH VERMIN (a) Total number of examinations of pupils in schools by school nurses and other authorised persons 25,163 (b) Number of cases of infestation found 79 (c) Number of forms S.H.54(a) sent 2 (d) Number of cleansing notices issued (Section 54(2)—Education Act, 1944) —