4411(5) LEY 55 BOROUGH OF LEYTON THE HEALTH OF LEYTON 1961 G. T. CROOK M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health, Borough of Ley ton Area Medical Officer, County of Essex Divisional School Medical Officer Health Offices Sidmouth Road, Leyton, E.10 LEYtonstone 3650 CONTENTS I Introduction by Medical Officer of Health. II Vital Statistics and General Information. III Environmental Health Services. IV Personal Health Services. V School Health Service. Public Health Committee 1961 - 62 The Worshipful the Mayor: Councillor F. W. Marshall, J.P. (ex-officio) Chairman: Alderman Mrs. A. M. M. Burrell Vice-Chairman: Councillor P.W. Wigg Aldermen, G. S. Flack Mrs. J. Hammond, 0. B. E. ,J. P. Mrs. R. King Councillors: Mrs.E. Bartram R. W. Burlton Mrs. D. E. Collins W.H.Sanders E.J. Whiteley STAFF Medical Officer of Health: G.T.Crook, M.R.C. S., L.R.C.P.. D.P.H. Deputy Medical Officer of Health: Mary Lyle Gilchrist, M.D., M.B., Ch.B., D.P.H. Chief Public Health Inspector: B.J. Ashcroft, M. A. P.H.I., M. Inst.B.E. Deputy Chief Public Health Inspector: G.F. Downing, A. M. I. P. H. E., M. A. P. H.I. Chief Administrative Assistant: W. D. Softley TO THE MAYOR. ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LEYTON Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my report on the health of the people of Leyton during the year 1961 as required by the Minister of Health. This also includes sections on the County Health Services (National Health Service Act, 1946, Part III) and the School Health Service. There have been several developments in the services during 1961 which are described in the main body of the report in their appropriate sections. These are:- Atmospheric Pollution page 13 Compassionate Laundry Service " 10 Central Syringe Sterilising Service " 68 Health Visiting Service " 63 Toddlers' Play Sessions " 49 Community Health needs are by no means static. All sections of the department are closely integrated components of a service which is concerned with maintaining and improving community health, and are constantly adjusting to meet the changing local needs, as we have tried to indicate in this report. Environmental Health Services Public Health ever since its inception has been concerned with providing the community with a physical environment which is not harmful to health. A start has recently been made in cleaning the atmosphere of potentially injurious pollutants, but great progress has been made particularly in regard to the control of infectious diseases, housing, drainage, water supply and food supplies. The Public Health Inspectorate is the section of the Health Department mainly concerned with maintaining a healthy physical community environment. It is organised under the direction of the Chief Public Health Inspector and his deputy on a district basis; there are 7 District Inspectors and 3 Student Public Health Inspectors. The promotion of health education in many of its aspects forms an important part of the duties of the Public Health Inspectorate, but none is more important or indeed more effective than that carried out on the district; it is an accepted fact that people learn more rapidly and thoroughly by demonstration and participation than by theoretical instruction. Public Health Inspectors meet people at their places of work, for instance, food handlers and operators of industrial plant capable of causing air pollution, visit people in their homes and indeed are in contact with everyone in the community whose activities have a public health, significance. The Inspector has, therefore, extensive scope for effective health education by demonstrating on the spot how the principles and practices of environmental hygiene should be observed and pointing out faulty habits and practices as they occur. Although this aspect of his work is time-consuming, it is never-the-less an essential requirement of modern environmental health services. A comprehensive report on the work of the Public Health Inspectorate is given by the Chief Public Health Inspector each year, and is again included in the main body of my report. (2) Health Service Trends The practice of medicine was initially concerned with the immediate cure of physical manifestations of disease processes; psychiatry, a later branch of medicine is mainly concerned with the psychological disorders. Gradually it has been appreciated that human beings do not have two separate entities of physical body and mind with their own specific disorders and diseases; but that the psyche and soma are indivisable components of a whole person. This concept has enormous importance in the development of the medical services. It can perhaps be shown in an over simplified manner by considering peptic ulcerations. A doctor with his scientific training and skill is able to diagnose that the symptoms and signs of ill-health in a particular patient are caused by peptic ulceration. A strictly physical approach to therapy would be to alter (by the use of alkaline drugs and a regulated diet) the environment of the ulcer to assist healing to occur. As the effects of emotional tensions on physical processes of the body became appreciated, the so-called stress disorders, such as peptic ulceration were recognised and therapy progressed to include attempts at resolving the individuals emotional tensions. It has subsequently been realised that a person's emotional reactions are often largely determined in his family relationships. It is apparent therefore that medicine must not only treat physical diseases of bodily systems but relate treatment to the individual as a psychosomatic whole and as a component of his family. This carries broad implications in the future development of the health services. The influence of the family unit is the important background environment which must be considered in prevention and treatment of psychosomatic and mental disorders. Our existing services are organised in the main on a clinic team basis and it is your policy to maintain this pattern for present and future services so that as far as possible all of our medico-social workers concerned with any one family are from the same clinic team (e.g. report on clinic services, page 41). There are, however, many others in the health and allied social services who are also concerned in family health and welfare and it is to the public benefit if we actively co-operate with our colleagues in the medico-social services. This is one of the underlying reasons behind the establishment of a Leyton Medical Liaison Committee and a Leyton Social Workers Luncheon Club. Handicapped Pre-School Children Family counselling is of major importance in families who have young children with impaired physical or mental development. It seems important that an accurate assessment of the defects should be made as soon in the child's early life as possible so that adequate treatment and management can be planned. Experience is indicating, particularly with hearing defects, that early treatment gives substantially better results. It is also of prime importance that the parents should feel that skilled help and understanding is available to them. Towards the end of 1961 we began special clinic sessions for this purpose with the help of the consultant paediatrician, Dr.Hinden, but it is too early yet to properly (3) assess their value although the Indications are that this may well become regular features of the Maternity and Child Welfare services from each clinic. We are interested in the Day Centre which has been established in Dagenham for handicapped pre-school children. We already feel that some form of daytime care is of importance in assessment and management of the young handicapped child. At this stage we are uncertain of the best way of making provision for this need in Leyton. A similar day centre, or special sessions in clinics analogous to the Toddlers Play Sessions or perhaps some other provisions may be most appropriate and we shall in due course report to the appropriate committees when experience has shown us in more detail the size and nature of the local need. I am grateful to the senior officers for their contributions to this report, and to all the staff for their enthusiastic co-operation during the year; and to officers of other departments for their help in all matters in which they have come into contact with the Health Department. I would also like to express my appreciation of the helpful and constructive understanding which I have received from members of the Council. I have the honour to be, Mr.Mayor, Ladies and Gentlemen, Your obedient servant, G.T.CROOK, Medical Officer of Health. Health Offices, Sidmouth Road, Leyton, E. 10. Telephone: LEYtonstone 3650. (4) VITAL STATISTICS Area in acres 2,594 Population (Census 1961) 93,357 Population (Registrar-General's Estimate, 1961) 93,360 Assessable Value for General Rate purposes £1,373,638 General Rate in the £ (1961/62) 24s.5d The Registrar-General's mid-year 1961 estimate of population (viz., 93,360 has been used for the calculation of the following statistics:- Live Births 1, 342 Live Birth Rate per 1,000 population 14.37 Stillbirths 21 Stillbirth rate per 1,000 total (live and stillbirths) 15.41 Total Live and Stillbirths 1, 363 Infant Deaths 40 Infant Mortality rate per 1,000 live births 29.81 „ „ „ „ 1,000 legitimate births 30.35 „ „ „ „ 1,000 illegitimate births 22. 22 Neo-Natal Mortality Rate (first four weeks) Per 1,000 related live births 26.08 Early Neo-natal Mortality Rate (first week) per 1,000 related live births 23.85 Peri-natal Mortality Rate (stillbirths and deaths during the first week) per 1,000 total still and live births 38. 89 Percentage of illegitimate live births 6.71 Maternal Deaths (including abortion) 1 Maternal Mortality Rate (including abortion) per 1,000 total live births) 0. 75 Total Deaths 1,406 Death Rate 15.06 Natural Decrease of Population 64 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 RegistrarGeneral has issued the following comparability factors for Leyton. Area comparability factor for births 1.01 Area comparability factor for deaths 0.79 These factors, when applied to the crude rates, produce the following adjusted rates:- Live Births 14.51 Deaths 11.9. (5) COMPARATIVE STATISTICS OF BIRTHS, MORTALITY. ETC. LEYTON 1901-1961. Year Population Births Birth Rate Deaths Death Rate Deaths under 1 year Infantile Death Rate 1901 100.000 2,963 29.63 1,243 12.4 404 136 1902 100,000 3,152 31.52 1,183 11.8 336 106 1903 102,000 3,273 32.08 1,112 10.9 322 99 1904 104,000 3,198 30.07 1,370 13.1 444 138 1905 105,000 3,209 30.05 1,177 11.2 303 94 1906 108,000 3,344 30.9 1,327 12.2 382 114.5 1907 120,000 3,190 26.6 1,269 10.6 182 86.6 1908 121, 200 3.071 25.3 1,185 9.8 242 78.8 1909 121,200 2,979 24.6 1,208 9.9 244 81.9 1910 123, 300 3,011 24.4 1,112 9.0 191 63.4 1911 124,736 2,931 23.5 1,473 11.8 327 116.6 1912 126,700 2,797 22.1 1,343 10.6 223 79.7 1913 129,366 2,904 22.4 1,336 10.3 242 83.3 1914 130,847 2,800 21.4 1,363 10.4 219 78.2 1915 124.497 2,655 21.3 1,510 12.1 225 84.7 1916 B 132,107 * 2,560 19.4 1,471 12.1 197 76.9 D 121,420 * 1917 B 125,352 * 2,005 16.0 1,414 12.6 172 85.8 D 112,452 * 1918 B 125,352 * 1,791 14.3 1,723 15.3 161 89.9 D 112,452 * 1919 B 129,062 * 2,195 17.0 1,397 11.3 154 70.16 D 123,896 * 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 1,420 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 B 116,100 * 1,499 12.90 1,242 11.21 46 31.65 D 110,800 * 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 1957 99,670 1,160 11.64 1,228 12.32 17 14.65 1958 98,760 1,252 12.67 1,338 13.54 31 25.87 1959 97,830 1,204 12.30 1,388 14.18 13 10.79 1960 96,870 1,260 13.00 1,395 14.40 28 22.22 1961 93,360 1,342 14.37 1,406 15.06 40 29.81 * Population as estimated for purposes of B - Birth Rate; D - Death Rate. (6) (7) 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 1961 (1,406) compares with (1,395) 1960 the respective death rates per 1,000 population being 15.06 and 14.40. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE - 1961 AGE GROUPS - MALES AGE GROUPS - FEMALES CAUSES OF DEATH TOTAL O-1 1-5 5-15 1525 2545 45- 65 6575 75 + TOTAL MALES 0-1 1-5 5-15 1 525 2545 45- 65 6575 7 5+ TOTAL FEMALES 1. Tuberculosis, respiratory 9 _ _ _ _ _ 1 1 1 3 - - - - 2 3 - 1 6 2. Tuberculosis, other 1 _ _ _ _ _ _ _ 1 . 1 - - - - - - - - _ 3. Syphilitic disease _ _ _ _ _ _ _ _ _ _ - - - - - - - - _ 4. Diphtheria _ _ _ _ _ _ _ _ _ - - - - - - - - - 5. Whooping Cough _ - - _ _ _ _ _ - - - - - - - - - _ 6. Meningococcal Infections _ - _ . _ _ _ - - _ - - - - - - - - _ 7. Acute Poliomyelitis - - . _ _ _ - - . - - - - - - - - _ 8. Measles . - . - _ _ _ - - - -- - - - - - - - - 9. Other infective and parasitic diseases _ . - - - - - - - - - - -- - - - - - - 10. Malignant neoplasm stomach 29 10 1 8 19 - - - - - 5 3 2 10 11. Malignant neoplasm lung, bronchus 73 - - - _ 1 33 13 1? 59 - - - - - 7 5 9 14 12. Malignant neoplasm breast 27 - - - _ - - - - 1 11 8 7 27 13. Malignant neoplasm uterus 7 - - - _ _ _ _ _ - - - - - - 9 3 9 7 14. Other malignant and lymphatic neoplasms 112 _ 1 . 3 21 22 27 74 - - - - - 19 9 10 38 15. Leukaemia, aleukæa 12 _ _ 1 _ _ 2 1 _ 4 - - _ - - 3 3 2 8 16. Diabetes 9 - . - _ . 1 1 1 3 - - - - - 1 1 4 6 17. Vascular lesions of nervous system 175 - - - - - 9 19 31 59 - - - - 15 14 29 72 16 18. Coronary disease, angina 176 - - - - 1 45 28 30 104 _ _ _ - 10 19 43 72 19. Hypertension with heart disease 38 - - -- . - 3 4 5 12 - 1 7 18 26 20. Other heart disease 258 - - - - 1 1 14 54 70 _ _ _ _ 1 8 14 165 188 21. Other circulatory disease 62 - - - _ _ 9 5 13 27 _ _ - - - 7 7 21 35 22. Influenza 13 - - - _ 1 3 - 3 7 _ - - - - 1 1 4 6 23. Pneumonia 115 1 - - - - 9 13 30 53 2 1 1 - 2 4 11 41 62 24. Bronchitis ... 89 - 1 - . . 15 20 24 60 2 - - - - 3 7 17 29 25. Other diseases of respiratory system 11 - - - - - 4 4 2 10 - - - - - 1 - - 1 26. Ulcer of stomach and duodenum ... 12 - - - - - 3 4 2 9 - - - - 1 _ 1 1 3 27. Gastritis, enteritis and diarrhoea 9 - - - - - - 2, - 3 - - - - - _ 3 3 6 28. Nephritis and nephrosis 10 - - - - 1 2 1 1 5 - _ - - - 2 1 2 5 29. Hyperplasia of prostate 6 - - - - - 1 2 3 6 - - - - - - - - - 30. Pregnancy, childbirth, abortion 1 - - - - - - - - - - - - - 1 - - _ 1 31. Congenital malformations 10 7 1 - - - - - - 8 1 1 _ _ _ 2 32. Other defined and ill-defined diseases 100 13 1 . - 2 3 6 11 36 14 - - 1 1 8 19 21 64 33. Motor vehicle accidents 9 - - - - 2 2 2 - 6 - 1 _ 1 1 - _ 3 34. All other accidents 24 - - - - 4 2 3 1 10 - - - 1 1 - 2 9 14 35. Suicide 9 - - - 1 1 2 1 - 5 - - - - 2 1 - 4 36. Homicide and operations of war - - - - - - - - - - - - - - - - - - - TOTALS 1,406 21 4 1 1 17 182 167 260 653 19 2 1 3 13 114 154 447 753 BURIAL OF THE DEAD In accordance with Section 50 of the National Assistance Act, 1948, the Council is responsible for the burial or cremation of the body of any person who had died or been found dead within the Borough, and where no private arrangements are being made for the disposal of the body. Authority is given to recover from the estate of the deceased person, or from any person who, under the Act, was liable to maintain the deceased immediately prior to his/her death, the expenses incurred in carrying out the duty, in so far as these expenses are not covered by any grant under the National Insurance Act, 1946. During the year 7 burials were arranged by the Department. INTERNATIONAL CERTIFICATES OF VACCINATION AND INOCULATION Arrangements continued during the year for the authentication of Certificates of Vaccination and inoculation. These certificates are required by persons proceeding abroad from this country and the purpose of the authentication is to provide information to health authorities abroad that the signature of the person issuing the certificate is that of a registered medical practitioner. PUBLIC SWIMMING BATHS I am indebted to Mr. W.B.Dinn, Baths Superintendent, for the following report on the Public Swimming Baths in the Borough. "There are two indoor public swimming baths establishments in the Borough, (a) High Road Baths, and (b) Cathall Road Baths, Leytonstone. Further, there is an Open Air Bathing Pool at Whipps Cross, Leytonstone, administered by the Baths Superintendent for and on behalf of the Joint Committee elected from members of the Leyton and Walthamstow Borough Councils. Set out hereunder are the principal details of the establishment:- Baths Capacities in gallons Source of Water Supply Water Treatment Rate of Filtration in G.P.H. (approx.) Theoretical hours of "turnover" High Road Baths: Large 198,000 Principally deep well Coagulation, Filtration and Chlorination and Aeration Large 69,000 Large 2.87 Small 37,000 Small 13,000 Small 2.69 Cathall Road Baths: Large 90, 000 Principally deep well Coagulation, Filtration and Chlorinr ation and Aeration Large 22,000 Large 4.09 Small 70,000 Small 18,000 Small 3.33 Whipps Cross Pool: 1,300,000 M.W.B. Mains Coagulation Filtration and Chlorination and Aeration 80,000 or 160,000 or 240,000 according to number of pumps in use 16.25 or 8.125 or 4.06 (8) Regular bacteriological examinations are taken of the water and examined by Council's analysts, who record a high standard of purity. Frequent tests are made (at least daily) for the ascertainment of available chlorine content in the open-air pool at the Leyton County High School for Girls. In all cases the water samples were found to be of a high degree of bacterial purity and chemically satisfactory." SEWERAGE I am indebted to Mr.J.T.Lewis, M.I.C.E., M.I.Mun. E., Borough Engineer and Surveyor for the following notes on the present situation regarding sewerage and sewage disposal in the Borough: - "(1) The present dry weather flow of sewage from the Borough is approximately 3¼ million gallons in the 24 hours. (2) Disposal of sewage from the Borough is governed by appropriate sections of the London County Council (General Powers) Act, 1925, under which Leyton Borough Council are authorised to discharge sewage to the London County Council's outfall sewer in Hackney. Such discharge is restricted in amount and to a maximum rate and greater flow or flows arriving when the London County Council's outfall is itself full are stored in tanks in the Council's Auckland Road Depot until such time as the discharge is able to be recommenced. (3) A larger part of the present sewerage system in the Borough is some 70-90 years old, and is generally of an inadequate capacity and of poor structural condition. The Council have, however, embarked on a comprehensive programme involving the reconstruction of all main trunk foul and surface water sewers in the Borough over a period of approximately 15 years. For the purpose of this programme, the Borough has been divided into five sections or drainage areas, and the sewers in each section are to be reconstructed in turn. A contract for the first section, that is West Leyton, Section 1, is now in hand and new sewers have been laid through the Council's Crescent Road Redevelopment Area. Work is continuing in extension of this length and to connect these sewers with the outfalls at the Dagenham Brook, and also at the Council's Auckland Road Depot, where another contract has commenced to reconstruct the control and pumping arrangements for sewage from the whole of the Borough." LABORATORY FACILITIES (a) Pathological Department, Whipps Cross Hospital, E. 11. For pathological specimens. (b) Central Public Health Laboratory, Colindale. For special bacteriological investigations; supply of some vaccines. (c) Counties Public Health Laboratories, Thresh House, Verulum Street, Grays Inn Rd., W.C.1 For bacterial and chemical examination of water. (d) Public Analysts, Analytical Laboratory, 20 Eastcheap, E. C. 3. For chemical analysis under provisions of Food and Drugs Act, 1938. (e) Public Health Laboratory, Room 617, County Hall, London, S.E.I. For bacterial examination of milk and other foods and infectious disease specimens. (9) 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 James Lane Ambulance Station, Leytonstone, E. 11. (Telephone: LEYtonstone 6432). 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; (b) Langthorne Hospital. NURSING HOMES There are two nursing homes in the Borough registered under the provisions of the Public Health Act, 1936: - 1 Queens Road, Leytonstone, with accommodation for 69 patients; "Brooklands" 22 Pairlop Road, Leytonstone, with accommodation for 25 patients. HEALTH SERVICES CLINICS (See page 41 ). COMPASSIONATE LAUNDRY SERVICE Many families wish to nurse their elderly relatives at home, particularly if hospital specialist medical and nursing attention are not indicated. The sick person himself may also prefer to remain at home. Sometimes in these circumstances the sick person loses control of his bladder or bowels and for this reason alone admission to hospital may have to be arranged. In 1957 the special Compassionate Laundry Service was started to provide auxiliary community health service so that sick persons in these circumstances may, where appropriate, continued to be nursed at home. The service has grown year by year and during 1961 the drying facilities were improved and draw sheets provided for issue to the patients. It is anticipated that the provision of draw sheets will allow the patients to be nursed in greater comfort. In 1957 an agreement was entered into with the County Borough of West Ham whereby launderings are carried out in respect of West Ham patients. STATISTICS Year Articles Laundered West Ham Leyton Total 1957 _ 1,417 1,417 1958 3,072 2,780 5,852 1959 6,709 6,943 13,652 1960 8,094 9,078 17,172 1961 8,908 10,595 19,503 (10) INFECTIOUS DISEASE - NOTIFICATIONS DISEASE Number notified during Year 1958 1959 1960 1961 Scarlet Fever 106 156 50 44 Erysipelas 13 10 6 5 Whooping Cough 104 29 42 20 Measles 433 894 215 1195 Diphtheria - - - - Acute Poliomyelitis - Paralytic - 2 1 - - Non-paralytic - - - - Tuberculosis - Respiratory 41 46 40 32 - Meninges and C.N.S. - - ■ 1 - - Other 3 5 6 5 Meningococcal infection - - 1 1 Acute Encephalitis, Inf 1 2 - - Post-inf. - - - - Dysentery 38 88 31 60 Ophthalmia Neonatorum 2 - 3 - Puerperal Pyrexia 1 - 2 5 Pemphigus Neonatorum - - - - Typhoid Fever - 1 11 - Paratyphoid - 1 - - Food Poisoning 23 38 11 20 Malaria - - - - Pneumonia 132 167 47 59 Smallpox - - - - Anthrax . - _ 1 897 1439 451 1447 (11) TUBERCULOSIS The following is a statement of particulars appearing in the Register of Notifications of cases of Tuberculosis for the year ended 31st December, 1961. PULMONARY NON-PULMONARY TOTAL M F Total M F. Total Number on register at commencement of year. 535 412 947 38 52 90 1037 Number first notified during year 20 14 34 3 2 5 39 Number entered in register otherwise than by notification 11 7 18 . 1 1 19 Number removed during year 41 27 68 5 4 9 77 Number remaining at end of year 525 406 931 36 51: 87 1018 Died 9 7 16 - - - 16 Removed from district 24 16 40 4 - 4 44 De-notified - - - - - - - Cured 8 4 12 1 4 5 17 Of the cases first notified during the year the age group distribution was as follows: - Age Periods PULMONARY NON-PULMONARY M F. M F. Under 5 years - - - - 5-14 years 1 - l 15-25 " 3 4 1 - 26-45 " 4 7 1 - 46-65 " 12 3 1 - 65 and over - -1 - - TOTAL 20 14 3 2 (12) Public Health Inspection of the Area the work of the Public Health Inspectorate in relation to the environmental health services is set out in tabular and statistical form in the following pages. There are, however, a number of statistics which require summarising in order to present an intelligible picture, and other matters of a topical interest which are worthy of further elaboration. ATMOSPHERIC POLLUTION - SMOKE CONTROL AREAS Leyton's first Smoke Control Order, of which full details were given in last year's Annual Report, came into operation 1st October, 1961. At the time of the detailed survey of the area it was estimated that 1,655 fireplaces required some form of adaptation to ensure that smokeless fuel could be burned. Up to the time of preparing this report (December, 1961) 706 applications from owners/ tenants seeking the Council's approval of such works had been received, involving 1,093 separate conversions. Of these applications it is interesting to note 341 (48. 3%) were from owners, including L.B.C. properties, 268 (38.0%) from owner-occupiers, and the remaining 97 (13.7%) from tenants. Of the 1,093 conversion/adaptations, 932 (85.3%) were for solid fuel, 49 (4.5%) for conversion to gas, and 112 (10.2%) for conversion to electricity. Experience of this first Smoke Control Area has confirmed our opinion expressed on a number of occasions at meetings of the Joint Conference of Local Authorities and other Clean Air Associations that the procedure for the establishment of a Smoke Control Area is unnecessarily detailed and complex. Some idea of the vast amount of technical and administrative work involved in bringing this Order - comprising 295 acres and 1,776 dwelling units - into operation, may be gathered from the details given below of the procedure which must be operated following completion of the detailed survey of the area, report to Public Health Committee/Council and receipt of Ministry's Confirmation of the Order:- No. of Documents, Notices. Letters. Inspect ions, etc. STAGE 1 (SCA/1 - 2 & 3) Preliminary Notice to Owner/Owner-Occupiers (with copy and covering letter to tenants as appropriate) of dwelling houses, setting out the requirements of the Smoke Control Order, information as to the extent (if any) to which existing fireplaces require adaptation or replacement, and details of the conditions precedent to the payment of grant towards the expenditure involved. Enclosed with the preliminary notice is a form of application for use by Owners/Tenants when seeking the Council's approval for proposed work of adaptation/replacement 5,250 (13) No. of Documents. Notices, Letters. Inspect ions. etc. STAGE 2 (SCA/2) Receipts of form of application from Owners/Tenants seeking Council's approval of proposed works; these proposals, estimates etc. are checked/inspected against the information gained during the survey of the area, and are reported to the Public Health Committee with the appropriate recommendations 706 STAGE 3 (SCA/4) Notice to Owners/Tenants giving Council's approval of proposed works and information of the expenditure the Council considers should rank for grant. Enclosed with this notice is a claim form to be submitted upon completion of the work 706 STAGE 4 (SCA/5) Upon receipt of grant claim form the works of adaptation/conversion are finally inspected to ascertain whether they have been satisfactorily carried out, and the claim form endorsed accordingly and forwarded to the Borough Treasurer for payment of the grant 706 MISCELLANEOUS Incidental correspondence and statutory notices etc. in relation to Stages 1, 2, 3 and 4 (above) 1,630 Visits/Inspections 250 The above does not take into account some 1,519 visits of inspection by the Public Health Inspectorate during the detailed survey of the area prior to the Order being confirmed by the Minister or the publicity arrangements - mobile exhibitions and those at the shop premises, 280 High Road, E. 10. (Please refer to photographs on pages 19-20) The question of making representations to the Minister of Housing and Local Government regarding a simplification of the procedure for the establishment of Smoke Control Areas, and consideration of the possibility of introducing standard grants for certain types of fireplace adaptations, was first raised by Leyton at a meeting of the Joint Conference of Local Authorities held in 1959. The motion was eventually carried at a subsequent meeting held at Ilford in September, 1960, and representations were made to the Minister accordingly. Also, Leyton was requested to convene a Committee of Technical Officers to consider the technical implications of these recommendations. As Chairman of that Committee, the Chief Public Health Inspector, Mr. B.J.Ashcroft, submitted the following proposed scheme for consideration:- (14) ALTERNATIVE SIMPLIFIED PROCEDURE IN RESPECT OF SPECIFIED OPEN FIRE CONVERSIONS SUBJECT TO STANDARD GRANT. Stage 1. Preliminary Notice to Owner/Owner-occupiers (with copy and covering letter to Tenants as appropriate) of dwelling houses, setting out the requirements of the Smoke Control Order, details of the conditions precedent to the payment of grant, which will include information about authorised fuels, approved appliances, etc., etc. The notice will also contain detailed information regarding the standard grant which can be claimed for each specified open fire conversion as indicated on the notice; a grant claim form for use by the applicant after work is completed will be enclosed with the notice. N.B- Where an applicant desires NOT to instal an open fire but an alternative (i.e. gas or electric) he/she will be instructed on the preliminary notice to apply for a form of application for Local Authority's approval of the proposed alternative works, and thereafter the existing procedure, as laid down in the Clean Air Act, 1956, will be followed. Stage 2. Approval of the Local Authority for solid fuel conversions subject to standard grant will NOT be required. Stage 3. NOT required in respect of standard grant conversions, as the applicant will have already been informed on the preliminary notice. Stage 4. An existing procedure. Advantages Claimed. (i) The introduction of a standard grant for certain specified types of open fire conversions would automatically dispense with the need for the Local Authority's approval of the proposed works. This would simplify and greatly reduce the amount of technical work, correspondence etc. involved, having regard to the fact that such conversions constitute a large proportion of the adaptation works required in most Smoke Control Areas; (ii) The owner/tenant can be given details at the outset of the works required and of the standard grant which can be claimed; (iii) The detailed survey of the area would also be simplified in that, in the majority of cases, the required works would fall into a specified category. No further specification would be required, apart from provisional estimate for gas carcasing, which would be fixed at a standard rate per foot run. (15) The preliminary notice to the owner/tenant would consist of a stereotyped document containing full information as to the type of works covered by a standard grant and other details regarding requirements of the Smoke Control Order, authorised fuels, approved appliances, etc., etc. Adaptations/conversions of a more complicated nature not covered by a standard grant would be dealt with in accordance with the existing procedure laid down in the Clean Air Act,1956. Adoption of the above scheme, with appropriate safeguards, would, in our opinion, reduce the technical and administrative work involved by half, an important factor at a time when Local Authorities are experiencing extreme difficulty in recruitment of technical staff and are faced with reduced financial resources. It would also mean that the Smoke Control programme would be accelerated. It is to be hoped that in due course the Minister will persuade the Government to introduce legislation to amend the procedure on a more realistic basis than it is at present. Many applications are being received from owners/tenants of properties not actually situated within a confirmed Smoke Control Area for a grant towards the cost of fireplace adaptations which they propose to carry out ahead of the Council's phased programme. As the law stands at present grants cannot be made in such circumstances, and the Minister has again been requested by the Joint Conference to consider introducing legislation to modify the Clean Air Act so that any person in any area who incurs expense on adapting fireplaces in anticipation of the making of a Smoke Control Order may obtain a grant. The phased programme for establishing a series of Smoke Control areas covering the whole of the Borough is progressing satisfactorily. The Minister of Housing and Local Government has now confirmed Leyton's second Smoke Control Area made under the provisions of the Clean Air Act, 1956. The Order will come into operation on 1st October, 1962, and relates to an area of some 163 acres in the south-western part of the Borough, bounded by Windsor Road and Ruckholt Road to the north, High Road, E.10. and E.15. to the east, the Borough boundary and Oliver Road to the west, and the Borough boundary to the south. It affects some 1,069 householders, 8 industrial undertakings and 54 commercial concerns in the following roads (in some cases part only of the road is affected), namely: - Adelaide Road, Alexandra Road, Balmoral Road, Brisbane Road, Buckingham Road, Cranbourne Road, Dunedin Road (Nos.1 to 95 (odd) and 2 to 92 (even) only)), Etchingham Road, Gordon Road, High Road (Nos.101 to 401 (odd) only)), Lyttelton Road, Maud Road, Nut field Road, Oliver Road (part only), Osborne Road, Ruckholt Close, Ruckholt Road (Nos.1 to 111 (odd) and 2 to 78 (even) only)), Temple Mills Lane (Nos.48 to 86 (even) only)), Eton Manor, Westdown Road, Windsor Road (Nos.1 to 105 (odd) only)) and York Road.(Please refer to Map on page 18). Owners and occupiers of the premises affected should do nothing until they receive full information by letter from the Council, and should then at once liaise with each other, for the grant can be paid to whoever does the work. Persons affected by the Order will have at least nine months before the operative date in which to carry out any necessary adaptations to existing fireplaces. The Order itself specifies certain exemptions, and other exemptions are allowed by Government Orders already in force. (16) After the operative date it will be an offence, punishable by fine, for the occupier of any building of any kind in the Smoke Control Area to allow smoke to be emitted. The fuels authorised for use in Smoke Control Areas are gas cokes and hard cokes, anthracite, low-volatile steam coal, electricity, gas, Coalite, Phurnacite, Rexco and other so-called premium fuels. Oil-burning appliances may also be used on certain conditions. The total estimated cost of the works involved in replacing or adapting the 1,278 fireplaces at present in regular use in the area will be £14,750. 5s. 0d., of which the owner or occupier - whoever does the work - will bear three-tenths and the Leyton Borough Council seven-tenths, but the latter contribution will be the subject of Exchequer Grant. The letters to be sent by the Council to owners and tenants of affected premises will include full information as to the conditions under which grants will be made, together with a schedule of the works required at the particular premises and a form of application for the approval of works of adaptation which the owner or occupier wishes to carry out to enable that person to comply with the requirements of the Order. When the application has been approved by the Council the works may then be carried out, and upon their completion to the satisfaction of the Council the grant will be paid. It is important to note, however, that a grant may only be paid by the Council if the expenditure is incurred during the period between the confirmation of the Order and its coming into operation OR, alternatively, as a result of the service of a statutory notice by the Local Authority. Mobile exhibitions will be arranged within the Smoke Control Area for the purpose of displaying approved appliances, some of which will be shown in use. These exhibitions will be supplemented by similar displays at the shop premises at 280 High Road, Leyton, adjoining the Council's Public Health Department. For present-day national needs a detailed knowledge of atmospheric pollution arising from the distribution of smoke and sulphur dioxide in urban areas throughout the country is required, both in connection with 'Clean Air* legislation and for medical studies of the effect of air pollution on health. It is therefore pleasing to report that the Standing Conference of Local Authorities, of which Leyton is one, and other Organisations co-operating with the Department of Scientific and Industrial Research in the investigation of atmospheric pollution has accepted a recommendation from a specialist working Party, set up by the D.S. I. R. to advise on the details of the changes that should be introduced in its present co-operative scheme, for a national survey of air pollution. The aim of this national survey is to provide the objective standard we need by which we can judge the progress made towards Clean Air throughout the country. Leyton has been co-operating with the Department of Scientific and Industrial Research for twelve years, and the Council is represented on the Standing Conference and on the London and Home Counties Clean Air Advisory Council by the Chairman of the Public Health Committee, Alderman Mrs.Burrell, and the Chief Public Health Inspector. The results of the daily measurements of smoke and sulphur dioxide, as recorded by the volumetric apparatus installed in the department, are set out in detail in the statistical section of the report (pages 38-39). 6,038 visits and inspections were made under the Clean Air Act in connection with the establishment of Smoke Control Areas, observations of factory chimneys, inspection of boiler installations, advice to boiler operators on the best use of fuel and methods of stoking, and discussions with managerial staff. Special surveys are also in progress for the scientific measurement of grit and dust deposited in specially selected parts of the Borough. For this purpose five standard gauges are being used, the results of which are published monthly by the Department of Scientific and Industrial Research. (17) (18) Environmental Health Services Publicity in connection with the Establishment of Smoke Control Areas Environmental Health Services Publicity in connection with the Establishment of Smoke Control Areas HOUSING NUISANCE ABATEMENT AND SLUM CLEARANCE A substantial part of Leyton's housing was built round about the end of the nineteenth century. It is not surprising, therefore, that sub-standard housing accommodation constitutes one of the major problems confronting the Public Health Department. Many hundreds of these obsolete houses fail to conform to the minimum requirements of the modest standard of fitness for habitation prescribed by the Housing Act, 1957. During the year 1,822 complaints concerning unsatisfactory housing conditions were received and investigated and 813 notices specifying works to remedy defects such as dampness, general disrepair, leaking roofs, defective drainage, inadequate sanitary facilities etc. were served. Altogether 9,952 visits of inspection in connection with some aspect of housing were carried out by the Public Health Inspectorate under the Public Health Acts, Rent Act, Prevention of Damage by Pests Act, Housing (Consolidated) Regulations, etc. Legal proceedings arising from the failure of owners to comply with the requirements of the notices served under the nuisance abatement procedure were applied for in 29 cases. Such proceedings are not, however, always successful in enforcing successful repairs. In a number of instances the Public Health Committee were obliged to consider alternative procedures under the Housing Act. 627 detailed inspections under the Housing Act were made in connection with the Council's programme in relation to Slum Clearance and Re-development Areas. Survey of all properties in the second stage of the Beaumont Road Area was completed during the latter part of the year, and in October an official representation in respect of this area-comprising three Clearance Areas containing 157 unfit houses-was submitted to the Public Health Committee, together with a report setting out details of the reasonsunfitness for habitation and general bad arrangement-why demolition of all the houses and other buildings in the areas was considered necessary. At its November meeting the Public Health Committee recommended the Council to declare these areas to be Clearance Areas in accordance with the provisions of section 42 of the Act, and referred to the Housing Committee the question of steps to be taken to secure the clearance and re-development of the areas and the re-housing of the persons to be displaced. A Compulsory Purchase Order embracing 192 houses was subsequently confirmed by the Council at its meeting on 30th November, 1961. Five houses in Avenue Road were also recommended to be dealt with by way of clearance area procedure as a preliminary stage to a scheme of comprehensive development for the area as a whole. Further details of inspections and notices served under the Housing and Public Health Acts and other relevant legislation, 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, and information regarding the institution of legal proceedings and the administration of the Rent Act, 1957, are given in the statistical section of the report which follows. RODENT CONTROL A meeting of No.3 Workable Area Committee set up by the Ministry of Agriculture, Fisheries and Food for rodent control was held at Leyton on Friday, 29th September. The Committee, comprising some 16 neighbouring authorities, meets about three times a year to discuss problems related to rodent control on a regional basis. The Council is (21) represented on this Committee by the Chairman of the Public Health Committee, Alderman Mrs.A.M.M.Burrell, and the Chief Public Health Inspector. A full report of this meeting was submitted to the November meeting of the Public Health Committee. Some 467 complaints were received during the year concerning rodent infestation, involving treatment by rodent operatives of 394 private houses and 75 business premises. The total number of visits in connection with these complaints and treatment for disinfestation amounted to 3,970. The Council's sewers were disinfested in March and October and the Dagenham Brook and surrounding land, a natural reservoir of rodent infestation, was treated with hydrogen cyanide gas. NOTE: A detailed report on the Council's responsibilities under the Prevention of Damage by Pests Act, 1949, and of the Department activities in this connection was given in the 1960 Annual Report. BUSINESS PREMISES - GENERAL A system of regular inspection of business premises situated within the Borough has once again been the aim of the Department on the basis that early detection and action in relation to the infringement of the many statutory provisions affecting these premises is not only in the best interests of public health but also that much inconvehience to persons affected is thereby avoided. This is of particular importance in those cases where persons exposed to a nuisance caused by others may, for reasons of their own, hesitate to complain to the Public Health Department. The Department has a special responsibility to these people. The number of business premises in Leyton is 2,153, comprising factories,workshops, retail shops, catering establishments, food premises, etc., and despite staff shortages due in the main to an ever-changing complement of Public Health Inspectors, and also to the demands on their time of work in connection with special projects such as Slum Clearance and Smoke Control Areas, 2,447 inspections were carried out, 130 notices were served, and 236 new registrations and/or licences were dealt with. Attention is drawn to the statistical section, which gives detailed information as to the Acts, Orders and Regulations involved and the action taken. The Fabrics (Misdescription) Act was first introduced in 1913, but became of special significance when regulations governing the flammability of fabrics became operative in 1959. The number of premises dealing in fabrics for which a degree of noninflammability is claimed is steadily increasing, and the administration of these statutes includes regular sampling of materials to ensure that the general public can purchase flameproof clothing in the knowledge that it will comply with the tests laid down by the British Standards Institute. As a result of routine sampling of this nature, a child's christening dress, which was offered for sale in the Borough with a label describing it to be of low flammability, failed to meet the standards required by the British Standards Institute. The Council instituted proceedings, and the case is of interest in that it not only reveals the number of firms which may be involved in the manufacture and sale of a garment, but that it is probably one of the first cases taken by a Local Authority under the new regulations. The Council brought a prosecution against a retail shop for selling nylon net and viscose taffeta fabric which did not conform to the standard of non-inflammability prescribed by the Fabrics (Misdescription) Regulations, 1959 and the Fabrics (22) (Misdescription) Act, 1913. The retailers named their supplier as the second defendant in the case, who, in turn, brought in the 'maker-up' company as the third defendant, who, in their turn, brought in the manufacturer as the fourth defendant. The court discharged the manufacturer but found all the other defendants guilty. The third defendant was fined £10, and ordered to pay not only the Council's costs of the prosectuion, but also all the other defendants' costs, totalling £80.15.0d. In evidence, the original defendants told of the purchase from the second defendant of the garment with a label marked 'Nylon net, a fabric of low flammability B. S. 3121* attached. The second defendant in evidence stated that no previous complaint had been received. The dress, the subject matter of the proceedings, had been acquired as a made-up garment, and the label as to low flammability was already attached when the dress was received by his firm from the third defendants. The third defendant, a director of a Nottingham firm which makes up garments, in evidence admitted that his firm attached the label which appeared on the garment. The nylon net had been bought from the fourth defendants in quantities of one thousand yards, but only part of the firm's needs were supplied from this source. Since the institution of these proceedings, tests had been made by the third defendant on the nylon net supply, and it was discovered that it flared up more readily than other nylon net which he had in stock. During the period when the garment was made up, only net from the fourth defendants' factory was used. It had been the custom of nylon manufacturers in Nottingham for the past four years to use the 'non-flam' process, and he therefore assumed that the net supplied had been subjected to the process. In cross-examination the third defendant agreed that the material had to be submitted to the British Standards Institution, and passed by them, before the label could be attached. He agreed that no express warranty had been given by the manufacturer, and also that none had been asked for. Accordingly, on submission that there was no case for the fourth defendant to answer, the firm who manufactured the nylon was discharged from the case. A letter of congratulation on the successful outcome of the case, which had been reported in the 'Drapers Record', was subsequently received by the Town Clerk from the British Standards Institution. It is now some twelve months since the Noise Abatement Act, 1961, came into operation. Owing to the inextricable mixture of residential property and industry in the Borough - many factories are virtually situated in yards of dwelling houses - it is to be expected that many of the complaints received by the Department relate to noise and general disturbance caused by such business concerns. It is very essential, therefore, that close co-operation between the Department and industrial undertakings should be maintained, and this can only be achieved by systematic and regular inspection, which is not always possible because of the ever-increasing demands on the Public Health Inspectorate. It has been found from experience in dealing with such complaints that the difficulty of proving statutory nuisance within the terms of the Public Health Act is still a major obstacle to the taking of formal action, owing to the absence of a statutory standard of noise. This, coupled with the defence contained in section 2(3) of the Noise Abatement Act-"...that the best practicable means have been used for preventing and counteracting the effect of the noise or vibration..."-reduces the effectiveness of the new Act. Instances of noise complaints received by the Department are illustrated in the reply to a questionnaire sent to the Committee on the Problem of Noise set up by the (23) Ministry of Science to examine the nature, sources and effects of the problem of noise. The questionnaire covered the period November, 1960 - June, 1961. Quest ion Answer (a) The number of instances in which they have been able to secure abatement by using formal procedures provided in the Noise Abatement Act, 1960, and the source of noise in each instance. Nil (b) The number of instances in which they have been able to secure abatement without formal procedures and the source of noise in each instance. (1) Factory machinery at night. (2) Bakery lorries, early morning. (3) Motor-cycles at night. (4) Wholesale oil depot. (5) Concrete block manufacture. (6) Electric exhaust fan. (7) Air compressor at night. (8) Coal depot, early morning. (8) Vehicles at Ice-Cream depot at night. (c) whether in any instance in which the Council have been able to secure abatement of noise nuisance they felt that they would have been able to do so without the powers provided by the Noise Abatement Act. Examples (1) to (9) above. (d) Whether there have been any instances of noise nuisance in which the Council felt that their present powers under the Noise Abatement Act are inadequate. Those borderline cases, where although the noise is the cause of annoyance, there is difficulty in substantiating a statutory nuisance Many of the examples (1) to (9) above fall into this category. (e) Whether before the Noise Abatement Act, 1960, came into force they had similar Local Act or Bye-Law powers. The Leyton Corporation Act, 1950 Section 52. The Noise Abatement Act of 1960 has, however, strengthened the powers previously contained in the Leyton Corporation Act, in that the causal relationship between noise and vibration is now recognised, and the proviso that a noise must be excessive or unreasonable or unnecessary and prejudicial to health before action may be taken is removed. (24) FOOD PREMISES - INSPECTION Routine inspection of food premises in the Borough to ensure compliance with the Food Hygiene (General) Regulations, 1960 and other relevant legislation has continued. 102 notices were served during the year in connection with contraventions, and the total number of inspections was 1379. As usual it was found that the majority of food traders quickly complied with the provisions of such notices, and in only one case was it necessary to institute legal proceedings under the regulations. This case related to a butchers' premises, where, despite numerous visits and the service of a notice, conditions were found to be consistently bad. A further summons under the provisions of Section 8 of the Food and Drugs Act, 1955, was issued against the butcher as a result of the seizure of 4 cwt. of beef in an unfit condition, and fines totalling £18 and costs of £3.3. 0d. were awarded against him. The number of new registrations and/or licences dealt with during the year was 217. In accordance with recent practice, the Ministries of Health and Agriculture, Fisheries and Food have published jointly a further Food Hygiene Code of Practice this year entitled "Food Hygiene Code of Practice No. 5 - Poultry Dressing and Packing." An innovation this year has been the supply of school milk in the Borough in waxed cartons instead of the traditional one-third pint bottles. The advantages claimed are less noise in handling, no accident risk from glass splinters, with crates lighter and easier to carry. However, the introduction of cartons instead of bottles has not been completely free from teething troubles, and one drawback appears to be the difficulty in ascertaining the condition of the milk, due to the opacity of the carton. This, in the absence of an effective coding system, has resulted in the discovery of school milk in a sour and clotted condition, which was not noticed until the pupils opened the carton. Fortunately, however, few such incidents have so far occurred, and the possibility of coding is being investigated. Routine inspection of food stalls was again maintained at the Council's pleasure ground at Lea Bridge Road during the Easter, Whitsun and August Fairs, and the Cricket Festival held on the Sports Ground, High Road, E. 10., also received regular visits. FOOD - INSPECTION AND SAMPLING The number of complaints relating to unsound and/or adulterated food investigated and reported to the Public Health Committee during the year was 13. The foods concerned were:- Bread (6); Cake (2); Cheese (1); and Milk (4); while the reason for complaint was either the discovery of foreign bodies such as a nail, pin, glass, grease, tobacco, and a mouse, or that the food was stale and out of condition. Once again these complaints have included particles of lubricating grease found in loaves of bread which have been manufactured by machinery, and having regard to the enormous quantity of loaves baked in this way it would appear that a number of such complaints are inevitable despite the most stringent measures taken at the factory to avoid this nuisance. The problem of the dirty milk bottle is also one for which there appears to be no complete solution and two such complaints were dealt with during the year. The decision of the Public Health Committee in relation to the food contraventions reported were:- prosecutions (5); warning letter (7), no further action (1). (25) A total of 144 samples of food and drugs were taken by the Public Health Inspectorate for submission to the Public Analyst for chemical examination and 65 bacteriological samples were also taken and examined by the Public Health Laboratories. Once again the object of sampling has been to cover as wide a variety of food and drugs as possible and this year samples include sausages, ice-cream, bubble gum, spices, and a variety of drugs. Of the chemical samples 5 proved to be unsatisfactory; these included 4 samples of sausages which were found to contain added preservative without a label to that effect, in contravention of the Public Health (Preservatives, etc. in Food) Regulations and legal proceedings were instituted in these cases. The remaining sample comprised imported French boiled sweets encased in natural sea-shells, and although both chemical and bacteriological tests found no harmful ingredients it was thought that the sale of such sweets was undesirable and representations were made to the Ministry of Health and also to the Local Authority in whose area the wholesalers premises are situated. Attention is drawn to the statistical section of the report which gives details in tabular form of premises and businesses registered and/or licensed under the Food and Drugs Act, Orders and Regulations. Full details are also given of inspections, notices, sampling, legal proceedings, and improvements effected to business premises as a result of action taken by the Department. (26) Public Health Inspection of the Area STATISTICS Reference has been made in the preceding paragraphs to the following tables and charts giving details of the action taken and visits made by Public Health inspectors pursuant to their statutory duties and responsibilities. 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 Clean Air Act, 1956 74 6038 3218 424 706 - - Housing Acts, 1936/57 35 627 1 - - - 476 Public Health Acts, 1936/61, and Noise Abatement Act, 1960 1246 5355 489 262 676 - - Prevention of Damage by Pests Act, 1949 467 3970 10 - 3 - - Pood and Drugs Act, 1955, and Merchandise Marks Acts, 1926/53 52 1379 102 - 70 - - Shops Act, 1950 1 1369 2 - 1 - - Essex County Council Act, 1952 - 57 - - - - - Leyton Corporation Act, 1950 1 76 3 - - - - Factories Acts, 1937/59 7 222 12 - 6 - - Pet Animals Act, 1951 - 9 -£ - - - - Rag Flock and Other Filling Materials Act, 1951. - 8 - - - - - Rent Act, 1957 38 51 _ 52 - - _ Fabrics (Misdescription) Act, 1913, and Regulations, 1959. - 98 - - - - - (27) (b) DETAILED (i) Housing Act, 1957 (Sections 17/18) Housing Repairs and Rents Act, 1954 (Section 3) 1 Demolition Order was made under the Housing Act, 1957. (ii) Rent Act, 1957 Paragraph 4 of the First Schedule, Rent Act, 1957 Applications for certificates received 29 Decisions not to issue certificates Nil Decisions to issue certificates 13 Undertakings given by landlords under paragraph 5 of the First Schedule 9 Undertakings refused by local authority under proviso to paragraph 5 of the First Schedule. Nil Certificates issued 13 Applications by landlords for cancellation 3 Objections by tenants to cancellation Nil Decisions by local authority to cancel in spite of objection Nil Certificates cancelled by local authority 2 Applications for certificates (Form P) 6 Discrepancies in the above figures are caused by procedure in some cases extending over December - January. (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, and Food Hygiene Regulations, 1955, Ice-Cream (Heat Treatment Regs.) 1947/52, Shops Act, 1950, Factories Act, 1937, Leyton Corporation Act, 1950 Essex County Council Act, 1952, and relevant legislation. Type of Premises Number of Inspections Bakehouses 23 Bakers 58 Butchers 228 Catering Establishments 159 Clubs 3 Confectioners 94 Dairies and Distributors of Milk 16 Carried Forward 581 (28) Type of Premises Number of Inspections[/$$$] Brought Forward 581 Factory Canteens 56 Fish Friers 43 Fishmongers 68 Greengrocers 91 Ice-Cream Places 43 Itinerant Stalls, Vehicles and Food Storage Accommodation 35 Food Dealers Local Authority Canteens 17 Meat Depots 11 Miscellaneous 21 Multiple Stores 60 Off-Licences 4 Provision Shops 224 Public Houses 29 School Canteens 30 TOTAL INSPECTIONS 1313 (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 of Animals Acts and Orders; the Leyton Corporation Act, 1950; and the relevant legislation. Type of Premises Number of Inspections Clubs 3 Factories with Mechanical Power 201 Factories without Mechanical Power 21 Fairgrounds 5 Hairdressers and Barbers 75 Local Authority Properties 11 Miscellaneous Shops, etc. 31 Outworkers 13 Pet Animals Shops 19 Rag Flock 8 Schools 35 Workplaces 3 TOTAL INSPECTIONS 425 (29) (v) Prevention of Damage by Pests Act, 1949 - Rodent Control/Disinfestation Rats Mice Total Complaints received 339 128 467 Enquiries and visits made:- By Rodent Operatives 2406 719 3125 By Public Health Inspectors 748 97 845 Premises treated individually:- Dwelling Houses 286 108 394 Business/Industrial Premises 45 30 75 Premises re-treated:- Dwelling Houses 2 - 2 Business/Industrial Premises 8 3 4 Number of rooms treated (sprayed) - - 213 Eight "block treatments" of premises for rat infestation were carried out. 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 4 Choked drains cleared 8 Dampness remedied 326 Drains relaid or partly relaid 8 Floors repaired 97 Guttering repaired or renewed 61 Miscellaneous defects remedied 108 New W.C. pans and traps provided 8 Plaster repaired 129 Rainwater pipes repaired or renewed 21 (30) Roofs repaired or renewed 131 Rooms redecorated 8 Sashcords renewed 114 Sinks provided 2 Sink waste pipes repaired or renewed 23 Stoves repaired or renewed 35 Vent pipes repaired or renewed 38 W. C. cisterns repaired or renewed 43 Window sills, etc., repaired 92 Yards paved 1 (ii) POOD AND DRUGS ACTS/FOOD HYGIENE REGULATIONS/SHOPS ACT Nature of contraventions and improvements effected to food establishments business/industrial premises as a result of statutory and informal action. Walls/Doors/Windows not kept clean or repaired 60 Ceiling not kept clean or repaired 39 Floor not kept clean or repaired 14 Inadequate ventilation 1 Inadequate receptacles for refuse 8 Accumulation of refuse in room 12 Cleanliness of apparatus and fittings 11 Facilities for personal cleansing and/or washing food and equipment inadequate, i.e:- Wash-basins 7 Hot water 13 Soap/towels/nail-brush 28 Food not protected from contamination 9 Wash-hand notice 29 Artificial light in W.C. 11 Inadequate locker (clothing) accommodation 5 Name and address not displayed 1 Sills 3 Miscellaneous 19 First Aid Equipment 20 (31) 4. legal Proceedings (i) Public Health Act. 1936. Date of Hearing Nature of offence and address of premises concerned Result of Court Proceedings 22. 3.61 Statutory nuisance - 51 Leyton Park Road, E. 10. Abatement Order. 2 months. In 28 cases legal proceedings were instituted, and work was completed either before the Court hearing, or after adjournment of the hearing. (ii) Pood and Drugs Act, 1955, Pood Hygiene Regulations, 1955 Date of Hearing Nature of offence and address of premises concerned Result of Court Proceedings 11.1.61 Rolled stuffed Lamb containing cigarette end. Hopkins Bros. (Butchers) Ltd., trading as "Brentwood Economy Butchers". Pine £5.0.0. Court Costs 4s. 0d. 11.1.61 Mouldy Apple Tart, Mr. Albert E. Woods, trading as "Wood's Bakeries". Pine £2.0.0. Witnesses' expenses £2.2.6. 14.6.61 Metal in Cake. Aerated Bread Co. Ltd. Absolute discharge on payment of £5.5.0. costs. 13.9.61 Mr. A. Prldige, 150 Beaumont Road, E. 10. Contraventions of (1) Sect.8, Pood and Drugs Act, 1955, and (ii) the pood Hygiene Regs., 1960. Pines £10.0.0. and £8.0.0. Costs £3. 3. 0. 1 application for legal proceedings was pending at the end of the year. (iii) Milk & Dairies (General) Regulations, 1959 Date of Hearing Nature of offence and address of premises concerned Result of Court Proceedings 13.9.61 Dirty Milk Bottle. Hitchman's Dairies Ltd. Fine £5. 0.0. Costs £3. 3.0. 1 application for legal proceedings was pending at the end of the year. (32) 3. REGISTRATION AND/OR LICENSING OF BUSINESS PREMISES (i) Approximate numbers of business premises in the Borough and functions involved. Ice-cream Milk Preserved food Shell-fish Power factory Non-power factory Catering Off-licences Bakehouses Hairdressers Hawkers' storage Bakers 43 - - - - 21 - 1 - 18 - - Butchers 74 - - 39 - 4 - - - - - 1 Catering 81 42 1 - 1 - - 81 - - - 1 Chemists 32 - - - - - - - - - - - Confectionery 156 132 - - - 1 - - - - - 2 Dairies 3 - 3 - - - - - - - - - Fishmongers 41 3 - 2 9 - - 10 - - - 4 Greengrocers 97 1 - - - - - - - - - 6 Grocers 201 63 94 2 - 1 - 2 - - - 1 Ice-Cream 1 1 1 Multiple Stores 5 3 - - - - - 3 - - 1 - Rag Flock 6 - - - - 3 2 - - - - - Pet Animals 10 - - - - - - - - - - - Hairdressers 94 - - - - - - - - - 94 - Hawkers, food 120 1 - - - - - - - - - - Hawkers' storage 22 - - - - - - - - - 22 Public houses 36 9 - - - - - 11 32 - - - Off-licences 14 14 3 - - - - - 14 - - - Factories 428 2 - - - 371 57 24 - - - - Schools 18 - - - - - - 17 - - - - Council properties 4 2 - - - - - 3 - - - - Hospitals 2 - - - - - - 2 - - - - Miscellaneous shops 661 1 - - - - - - - - - - Vending machines, milk 3 - 3 - - - - - - - - - TOTALS 274 104 43 10 401 59 154 46 18 95 38 (33) (ii) Details of Registrations/Licences ACT OR REGULATION On Register 31.12.1960 Removed during 1961 Registered during 1961 On Register 31.12.1961 Pood and Drugs Act, 1955, Sec. 16 Ice-Cream Premises 302 40 12 274 Pood Preparation, etc, premises. 49 10 4 43 Milk and Dairies (General) Regulations, 1959 Distributors 97 4 11 104 Dairies 4 1 - 3 Milk (Special Designation) Regs. (Registration for 5 years from 1.1.61) Tuberculin Tested 23 - - 21 Pasteurised 55 - - 62 Sterilised 97 - - 95 Essex County Council Act, 1952 Hawkers of Pood 132 20 8 120 Hawkers' Premises 57 22 3 38 Leyton Corporation Act, 1950 Section 63 - Vendors of Shellfish 12 3 1 10 " 48 - Hairdressers' premises 93 6 8 95 Pet Animals Act, 1951 (Annual Licences) Pet Shops 11 - - 10 Rag Plock and Other Pilling Materials Act,1951 Registration of Premises 9 4 1 6 TOTAL 941 110 48 881 (34) 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 a result of routine inspection of food premises. The food condemned was destroyed by fire at the Council's Destructor Works. Commodity Cwta. Qtrs. Lbs. Commodity Units Bacon 1 2 11 Milk 55 tins Butter - - 23 Luncheon Meat 147 " Cheese _ - 24 Fruit 147 " Lard - 1 - Vegetables 70 " Beef 6 1 22 Fish 14 " Lamb - 1 6 Han 42 " Pork - 2 1 Jan 40 jars Offal 4 1 15 Gherkins 107 " Rabbits - 1 22 Beetroot 24 " Sliced Cucumbers 3 " Vinegar 7 bottles Chickens 55 Salmon 3 6. SAMPLING - FOOD AND DRUGS ACT. 1955 (i) Chemical Analysis Commodity Taken Satisfactory Unsatisfactory Milk 4 4 - Ice-Crean 5 5 - Miscellaneous 135 130 5 TOTALS 144 139 5 (ii) Bacteriological Examination Commodity Taken Satisfactory Unsatisfactory Milk 9 9 - Ice-Cream 15 15 - Ice-Lollies 10 10 - Water 17 17 - Bubble Gum 9 9 - Frozen Whole Egg 4 4 - Shell Sweets 1 1 - TOTALS 65 65 - 7. SAMPLING - FABRICS (MISDESCRIPTION) ACT, 1913 - FABRICS (MISDESCRIPTION) REGULATIONS, 1959. Four samples were obtained during the year, as follows:- Nylon net child's dress Unsatisfactory (see page ) Fibre Glass curtaining Satisfactory Child's Bri-Nylon nightgown Satisfactory Child's flame resistant nightgown Satisfactory (35) 8. FACTORIES ACTS, 1937 to 1959. The following are the prescribed particulars required by Section 128 (3) of th» Factories Act, 1937, to be included in annual reports. 1. Inspections. Premises Number on Register NUMBER OF Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 59 14 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 404 208 12 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers premises) - - - - TOTAL 463 222 12 - 2. Cases in which defects were found. Particulars (1) Number of cases in which defects were found Number of cases in which prosecutions were Instituted (6) Found (2) Remedied (3) Referred To H.M. Inspector (4) By H.M. Inspector (5) Want of cleanliness (S. 1) 1 - - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - Inadequate ventilation (S.4) - - - - • Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient 2 - - - - (b) Unsuitable or defective 3 2 - - - (c) Not separate for sexes - - • _ (d) Other 6 3 - 1 - Other offences against the Act (not including offences relating to Out-work 3 2 - - TOTAL 15 7 - 1 - (36) 3. Outwork Nature of Work SECTION 110 SECTION 111 No. of outworkers in August list required by Section 110 (l)(c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing apparel Making 83 Brushes 3 Artificial flowers 4 Umbrellas, etc. 17 Shoes 3 Boxes, etc, wholly or partly of paper Making 16 Trimmings 11 NIL NIL NIL NIL NIL Feathers 2 Christmas crackers, etc. 3 Lampshades 9 Metal seals 30 Toys 3 Dolls' clothes 2 Frame-making 1 Imitation jewellery 1 Belt fasteners 2 TOTAL 190 - - - - - (37) CLEAN AIR ACT. 1956 - INVESTIGATION OF AIR POLLUTION As from the commencement of the national survey of air pollution on the 1st April, 1961, the method of expressing concentrations of both smoke and sulphur dioxide was changed to "microgrammes per cubic metre". Prior to this date the amount of smoke was given in "milligrammes per 100 cubic metres" and that of sulphur dioxide in "parts per million by volume". In the following tables, which show the results recorded (to date) during the year ending 31st March, 1962, compared with those of the previous year and with the average of the 5 years ended 31st March, 1960, all figures are given in "microgrammes per cubic metre". It should be noted that, from available records, the smoke figures prior to April, 1961, can only be given correct to the nearest 10 microgrammes. As the D.S.I.R's statistical year does not end until 31st March, 1962, it is not yet possible to state how the current year's figures compare with those of previous years. For the six summer months ended 30th September, 1961, the average amount of smoke (51 microgrammes per cubic metre) showed a marked decrease compared with the amount for the summer of 1960 (70 microgrammes per cubic metre) and with the average for the 5 previous summers (80 microgrammes per cubic metre), whereas the average amount of summer sulphur dioxide has remained constant at about 100 microgrammes per cubic metre. It is too soon to make any valid comparison of winter results for 1961/62. (a) CONCENTRATION OP SMOKE EXPRESSED IN MICROGRAMMES PER CUBIC METRE MONTH MONTHLY AVERAGE HIGHEST DAILY AVERAGE LOWEST DAILY AVERAGE 1955/60 1960/61 1961/62 1955/60 1960/61 1961/62 1955/60 1960/61 1961/62 April 180 150 83 450 370 114 80 60 56 May 70 70 54 150 170 90 30 10 17 June 50 40 43 120 100 80 10 10 14 July 40 40 33 90 70 79 10 20 12 August 60 50 35 120 100 63 20 20 13 September 70 50 59 150 110 164 20 20 23 SUMMER AVERAGE 80 70 51 - - - - _ - October 230 190 128 690 510 519 70 80 57 November 430 230 249 1020 720 705 160 50 60 December 430 350 385 1190 800 852 130 80 74 January 400 260 1150 690 130 100 February 360 190 940 410 150 50 March 270 210 560 430 110 60 WINTER AVERAGE 350 240 - - - - - - YEARLY AVERAGE 210 150 - - - - - - (38) (b) CONCENTRATION OP SULPHUR DIOXIDE EXPRESSED IN MICROGRAMMES PER CUBIC METRE MONTH MONTHLY AVERAGE HIGHEST DAILY AVERAGE LOWEST DAILY AVERAGE 1955/60 1960/61 1961/62 1955/60 1960/61 1961/62 1955/60 1960/61 1961/62 April 186 180 147 441 369 197 83 86 102 May 109 143 105 223 363 177 37 31 34 June 94 83 108 189 255 266 37 17 52 July 83 77 79 157 112 169 34 49 39 August 97 100 79 177 203 194 40 43 30 September 106 103 127 217 155 285 43 57 54 SUMMER AVERAGE 113 114 108 - - - - - - October 235 200 178 566 340 484 106 86 82 November 338 277 236 707 641 611 160 129 50 December 381 337 303 1058 592 643 143 132 119 January 355 269 992 629 149 137 February 332 252 921 701 152 134 March 246 280 480 769 114 123 WINTER AVERAGE 315 269 _ - - - - - YEARLY AVERAGE 214 192 - - - - - - (39) Leyton Health Area Sub - Committee 1961 - 62 Representing:- Essex County Council: Alderman K.E.B. Glenny Councillors Mrs. S. M. Bovill Mrs.M.J.Harvey G. W. Mason P. R. Richards Mrs. V. L. Wilson (1 vacancy) Leyton Borough Council: Aldermen Mrs. A. M. M. Burrell Mrs. J. Hammond, 0. B. E., J. P. (Chairman) Mrs.R. King Councillors Mrs.E.Bartram (Vice-Chairman) R. W. Burlton Mrs. D. E. Collins J.H.L. Field G. W. Hales C. H. Hicks Mrs.E.V.Pearson Mrs. N. M. Plunkett W. H. Sanders J. J. Walsh E.J. V»hiteley P. W. Wigg Voluntary Organisations: Mrs.A.M.Clewer Mr. G. A. Dicker Miss H. Harford, 0. B. E. Mrs. T. A. Quelch Forest Group Hospital Management Committee: Miss D. Wrigley, B. A. Executive Council for Ess.ex: Mrs.A. E. Prendergast Local Medical Committee for Essex: Dr. J.P.B.Hill. (40) Personal Health Services (Leyton Health Area Sub - Committee) SECTION 21 - HEALTH CLINICS The Sub-Committee have no health centres as such; however, there are three excellent health services clinics serving the borough:- Dawlish Road Clinic; Granleigh Road Clinic" and Leyton Green Clinic. During 1961 it has been possible to complete the phased programme of complete redecoration of the Health Services Clinics in the area and part of the modernisations of the clinic premises needed to meet changing demands on accommodation. 1961 was a year in which this work has been carried out at Dawlish Road Clinic where we have had erected two interviewing cubicles in the waiting hall so that mothers and other members of the public may have privacy in their discussions and interviews with members of the staff. At Park House Clinic a new perambulator shed has been erected on the right-hand side of the main entrance to the clinic and the old shed which spoilt the aesthetic look of the premises has been demolished. PRESENT CLINIC SERVICES The health services administered locally which are provided from the clinics consist of; - Maternity and Child Welfare: Ante-Natal Clinics Post-Natal Clinics I.W.Clinics Toddlers' Clinics (and play sessions) Welfare Poods Relaxation Classes, and Health Education Vaccination and Immunisations Protection against: Diphtheria Whooping Cough Small Pox Poliomyelitis Tuberculosis (B.C.G.) in schools arranged. School Medical Service Minor Ailment Clinics Development Clinic Sessions for Handicapped Pupils (41) School Medical Service (Cont) Specialist Clinics - E.N.T. - Ophthalmic - Orthoptic - Orthopaedic Speech Clinics Medical Inspections in schools arranged. Dental Service Dental Surgeons Clinic Sessions Dental Hygienist Clinic Sessions Dental Inspections in schools arranged. Chiropody Service Clinics Domiciliary visits arranged. Much of the value and strength of Leyton's Health Services is dependent on their staffing and organisation. The policy has evolved of creating a team of workers at each clinic consisting of medical officers, dental officers, health visitors, school nurses, chiropodist and others. This results in continuity of care for families in the clinic catchment areas, and as a large and increasing amount of modern public health is concerned with family health it is important that wherever possible all those working with the family should themselves be part of an active team. Experience has shown that liaison and co-operation between Medical Officers, Dental Officers, Chiropodists, Health Visitor/School Nurses is greatly facilitated when they work as a team from a clinic with a common catchment area. The only field service for which this Committee is at present responsible which is not operated from the clinic is the Domestic Help Service and there would be many advantages to be gained if it were organised as a more integral part of the services which are based at the clinic, and the committee decided to operate the Domestic Help Service from the clinics early in 1962 on a trial basis. POSSIBLE FUTURE SERVICES Some services are already provided from the clinics for handicapped children, problem families and the elderly which no doubt will be further developed in the future. When dental auxiliaries become available it will probably be possible to provide an improved child dental care service. Additional health services, mainly including mental health and home nursing will become a local administrative responsibility at some future date either as a result of some form of delegation under the Local Government Act, 1958 or by some form of implementation of the recommendation of the Royal Commission on Local Government in the Greater London Region. Welfare Services similarly will also, no doubt, be administered locally; and it is hoped that they will be organised so as to co-operate closely with the health services. (42) PROPOSED PATTERN OF FUTURE CLINIC SERVICE DEVELOPMENT In Outline The existing organisation of a team of field workers serving catchment areas from well equipped clinics has proved, in this type of urban area, to give the best service to the community. It was agreed that as far as possible all the field services for which this Committee has, or will have a responsibility should be organised and administered on a clinic team basis. The long term effects of this would be towards:- (i) Minimising the size of the central office; (ii) Each of the three clinics providing a basic number of co-ordinated health services for its catchment area; (iii) Those services such as Specialist Ophthalmic, E.N.T. Child Guidance etc., which cannot be reduced to less than a Borough Service being sited at one of the clinics which would be a main clinic for the whole area. Broad Detail - Clinics Each of the three clinics may require on a long term basis the under-mentioned accommodation to provide the following services:- Service Accommodation Maternity and Child Welfare Weighing Room (available for Toddlers Play Sessions and Group Occupational Therapy). Consulting Rooms (Medical Staff) Consulting Cubicles (H.V., P.S. Ws.) Welfare Foods issuing office Demonstration kitchen. Dental Services Surgeries (minimum of 3 at each clinic) Recovery Room. Home Nursing Medical Treatment Room (interchangeable with School Minor Ailment Treatment Room). Chiropody Services Treatment cubicles (minimum of three at each clinic) Mental Health Services Space for Psychiatric Social Worker Duly Authorised Officer Occupational Therapist Domestic Help Service Organisers Space (43) Service Accommodation[/$$$] General Services Reception Waiting Hall Admin, and clerical office and records Health Visitors Space Staff Room Stores for sickroom equipment Health Education Materials, etc. Kitchen Cleaners accommodation and stores. In addition one of the clinics would need accommodation to provide those services which cannot be reduced to clinic catchment area unit size. These are:- Main Clinic Speech Therapy Consultation and Play Room Child Guidance Reception Space Child Psychiatrist Educational Psychologist Play Therapist Psychiatric Social Workers (2) Specialist Services Suite (Ophthalmic, Orthoptic, E. N. T. Orthopaedic) 2 Consulting Rooms (One sound-proof for audiology work) Eye testing and Nurse Attendants Room Orthoptists Room Dental Services Dental Work Shop SECTION 22 - CARE OF MOTHERS AND YOUNG CHILDREN BIRTHS During the year the following births were registered:- Male Female Legitimate 659 593 Illegitimate 43 47 Total 702 640 Still-Births: Legitimate 14 6 Illegitimate 1 - In the same period 1,378 notifications were received under Section 203, Public Health Act. 1936. (44) CHILD WELFARE AND TODDLERS' CLINICS In agreement with the experience recorded by other areas the expected fall in the number of children attending at child welfare clinics has not yet materialised. Several of these clinics were becoming overloaded with cases and it was decided in January, 1961 to re-open morning toddlers' sessions at Leyton Green and Park House Clinics; once a month at Park House and twice a month at Leyton Green. The Dawlish Road Clinic had continued to have a fortnightly toddlers' session and no change was made there. At these sessions all cases are seen by appointment and are mainly children who present problems of one kind or another or children who have not attended at the welfare clinic for a long time. The essence of good preventive medicine is time; time to listen to a mother as well as to talk to her and this has proved the great advantage of these special sessions. Not only has the mother been more relaxed but so is the child and he or she is more receptive to being examined by the Medical Officer than in a rather busy bustling infant welfare clinic. While waiting to see the Medical Officer the children have room to play in the waiting room with books and toys and the Health Visitor conducting the toddlers' session can report to the Medical Officer any unusual behaviour revealed there. The toddlers' sessions are proving very useful in detecting and helping early behaviour difficulties but the numbers seen at each session must be kept low or its usefulness deteriorates. Ten in a session of three hours is really the maximum unless some of the cases are there to report progress and can be dealt with in a shorter time than the rest. There are of course some children with no problems of behaviour but their mothers do seem to appreciate knowing that their children are developing normally and like to have this reassurance expressed to them. PREMATURE BIRTHS In 1961 the Ministry of Health and the Central Health Services Council issued a report by "The Sub-Committee on the Prevention of Prematurity and the care of Premature Infants" in which attention was drawn to the need of local authorities to provide special care for premature babies. Amongst several recommendations made it was suggested that nursing care of the infants in the home should be undertaken by midwives with special training in this work. In Leyton approximately 83% of births take place in hospital and very few cases requiring hospital care are likely to be confined at home. This area is very fortunate in that cases of toxaemia, ante-partum haemorrhage and multiple pregnancy, which account for 50% of premature births, are almost invariably admitted to hospital for their confinement. In the four years 1958 to 1961 44 premature babies were born at home. The following table reveals the type of cases we have:- (45) Birth Weight 5-5% lbs 4-5 lbs 3-4 lbs 2-3 lbs 2-1 lbs Not Weighed Number 30 9 1 2 1 1 Survived at least 4 weeks 30 8 1 1 0 0 Age at death. - 20 mins. - 10 hours 17 hours 2 hours Place of death - Home - Hospital Hospital Home There were 4 deaths among the 44. The one which died in 20 minutes was an encephalic and death was inevitable; the infant not weighed was so small and excessively premature that it was not considered fit to be removed to hospital. The baby which died at 10 hours was one of twins who were born at home and removed to hospital, one of whom survived; the one which died at 17 hours had been born at home. No reason for the premature births was found in these three cases. These figures did not appear to warrant the provision of a nurse specially trained to care for premature babies as she would not have had enough cases in any year to justify her appointment nor would the flying squad have had sufficient work to justify itself either. The majority of premature babies are capable of being dealt with by the midwives and extra care can be given by supplying the mother with domestic help where necessary. MISCARRIAGES The domiciliary midwife carries out work which rarely receives recognition in official reports. She attends cases of miscarriages which are dealt with by the general practitioner at home. During the last three years (1959 to 1961) 29 cases of miscarriage were attended and 171 visits were paid to them. (46) (47) HEALTH CLINICS - CLINIC SESSIONS HEALTH CLINIC MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY Leyton Green, Leyton Green Road, E. 10. (LEYtonstone 3650 Extn.267) A.M. Dental Minor Ailment Foot Dental Orthoptic (Alt.) Minor Ailment Toddlers (Alt.) Foot Dental Minor Ailment Orthoptic Ophthalmic Foot Dental Minor Ailment Ante-natal and Post-natal Foot Dental Minor Ailment Ophthalmic Orthoptic Foot Dental (Alt.) Foot (Alt.) Minor Ailment P.M. Dental Infant Welfare Foot Dental Infant Welfare Orthoptic (Alt.) Foot Dental Orthoptic Infant Welfare Foot Dental A.N.Exercises Orthopaedic Foot Dental Orthoptic Special Meds. Foot Immunisation Evening Foot & Dental Dental Mothers Club Dental Foot Park House, Granleigh Road, E. 11. (LEYtonstone 3650 Extn.268) A.M. Dental Minor Ailment Ante-natal and Post-natal Foot Dental Minor Ailment Foot Dental Minor Ailment Play Session Toddlers Foot Dental Minor Ailment Foot Dental Minor Ailment Aural Foot Dental (Alt.) Minor Ailment Foot (Alt.) P.M. Dental A.N.Exercises Foot Remedial Exercises Dental Infant Welfare Foot Dental Infant Welfare Foot Remedial Exercises Dental Infant Welfare Foot Dental Foot Evening Foot & Dental Dental Dental Foot & Dental Dawlish Road, Dawlish Road, E. 10. (LEYtonstone 3650 Extn.287) A.M. Dental Minor Ailment Foot Speech Dental Minor Ailment Foot Speech Dental Minor Ailment Ante-natal (Alt.) Toddlers (Alt.) Foot Dental Minor Ailment Foot Speech Dental Minor Ailment Foot Dental (Alt.) Minor Ailment Foot (Alt.) P.M. Dental Infant Welfare Foot Speech Dental Foot Ante-natal Exercises (Alt.) Speech Dental Foot Speech Dental Infant Welfare Foot Speech Dental Foot Immunisation Development Speech Evening Foot & Dental Dental Dental Foot Emmanuel Hall, Hitcham Road,E.10. P.M. Weighing Session In addition there are evening sessions for Poliomyelitis Vaccination. Child Welfare - Clinic Attendances Leyton Green Park House Dawlish Road Bmnanuel Hall UNDER 1 YEARFirst attendances 648 684 591 56 Subsequent attendances 4501 5182 4584 936 Total attendances 5149 5866 5175 992 1-5 YEARS First attendances 444 370 334 48 Subsequent attendances 1608 1336 1594 345 Total attendances 2052 1706 1928 393 Total attendances (both age groups) 7201 7572 7103 1385 Number examined by Clinic Doctor 2030 2307 2235 Number weighed 7199 7566 7042 1368 CARE OF PREMATURE INFANTS (weighing 51bs. 8ozs. or under) Born at Home 8 Born in Hospital or Nursing Home 101 CONVALESCENT HOME TREATMENT Numbers sent to Convalescent Home Children 2 Mother and Children 1 mother with 1 child WELFARE FOODS There was no change during the year in the general arrangements for the distribution of welfare foods. Issues - The total issues during 1961 were:National Dried Milk (Tins) 13,090 Cod Liver Oil (Bottles) 3,569 Vitamin A & D Tablets (Pkts.) 2,926 Orange Juice (Bottles) 24,556 (48) TODDLERS' PLAY SESSIONS A pilot scheme of Toddlers' Play Sessions has been operating in Leyton for several months, and the scheme will be extended, still in an experimental phase during 1962. The local health authority's child health services were originally designed to prevent physical ill-health and in their development they have played an enormous part in reducing the morbidity and mortality in childhood. This preventive work must continue, but preventive medicine must also be constantly assessing the nature of community health and disease. The major community health problem in this country today is mental ill-health and we have, therefore, a clear duty to re-orientate our health services to meet this community need. It is generally accepted that the foundations for neurotic illnesses are often laid in childhood, when a child's genetically determined mental inheritance is moulded by his family emotional environment. A family in which there are emotional tensions may adversely affect the developing emotional stability of the young child. Our teams of medical officers and health visitors recognise families in which these emotional problems exist and try to help, relieve or resolve the families' difficulties. The toddlers' play sessions are designed to provide a therapeutic and preventive tool for the clinic teams; for example a young mother and toddler perhaps living in an appartment or a flat, without play space for the toddler and no relatives nearby, are in a potentially stressful situation which can react adversely on the emotional stability of the family. In this type of situation some relief to the family by the toddler coming to a play session before emotional tensions have arisen is a preventive mental health service. When tensions have already arisen which have resulted in some emotional disturbance in the toddler, attendance at the play sessions is therapeutic and by resolving these early emotional tensions prevents more serious disturbances in the future. The Pilot Scheme The sessions began on 22nd February, 1961, and consisted of one session; per week held at Granleigh Road Clinic on Wednesday mornings from 9.30 a.m. to 12 noon and staffed by the Warden and a senior nursery nurse from Ellingham Road Day Nursery under the supervision of the nursery matron. All the toddlers attending the group have been selected on medico-social grounds by the Park House Clinic team and during 1961 thirty-seven toddlers have attended. The average sessional attendance is ten and there is already a waiting list of thirtyeight whom it is felt would benefit from attendance at these play sessions. Experience so far indicates that these sessions may provide a valuable additional therapeutic and preventive mental health measure to the maternal and child health services, particularly when organised on a clinic team basis as in Leyton. (49) Extension of the pilot scheme during 1962 to include one session per week at Leyton Green Clinic will give further opportunities for assessing the value of this service and will be reported to the appropriate committees in due course. It has soon become apparent that these, to be more than a simple child minding service, require a high degree of skill and understanding and maturity on the part of the nursery nurses and very close co-operation with the medical officers and health visitors at the clinic. All the staff concerned have shown great enthusiasm and skill in developing this form of preventive mental health service. TODDLERS' PLAY SESSIONS No. of Sessions 45 No. of children admitted 37 Total attendance 573 Average attendance per session 15 A summary of the cases who have attended these sessions, giving a brief report of the background and progress of each of the children, who have attended, may help to give a clearer indication of the re-orientation of the health services. SUMMARY OP CASES TO 31ST DECEMBER, 1961. Initials and Date of Birth History prior to Admission Observat ions following at tendances at the Session G.B. 22.8.56 After this child's birth the mother had been admitted to hospital for treatment for iritis. She has recently returned home but still has difficulty with her vision and consequently easily loses patience with the child. The mother realises that this is unfair to the child. At her first visit the child appeared very eager and interested in everything. Her conversation was reasonably intelligent and she drew some letters of the alphabet on the blackboard. She appeared to co-operate well with other children and thoroughly enjoyed herself at the Centre. The mother states that she herself is able to relax more since she has had the help of the Play Centre, and therefore is more patient with the child. She has now started school and enjoys it thoroughly. C.B. 3.7.57 Since birth of the child there has been marital disharmony. As a baby the child was very cross and has developed into a somewhat spoilt and peevish child needing the companionship of other children. On admission this child appeared to be quiet and looked very anxious. She was interested in the play equipment and made some advances to other children. Talks sensible and willingly but it took nearly 2 months for this child to settle down. She plays well within the group and has derived great help from being with other children and not always the centre of attraction. J.B. 14.11.56 This is the youngest child of a large family where the brothers and sisters are either at work or school. She is very lonely and would benefit from the play centre before commencing school in September. The child was very nervous and anxious on admission and refused to leave nurse or speak to other children. She became more relaxed on her third visit and was able to play constructively. On her (50) Initials and Date of Birth History prior to Admission Observations following at tendances at the Session[/$$$] J.B. 14.11.56 (Cont.) fifth visit she made good use of the equipment but preferred to play on her own. She started school in September, 1961 and made contact easily with other children through her attendance at the Play Session. J.B. 8.1.58 This child was spoilt until the arrival of his sister when he was 3 years of age. To gain attention from his mother he reverted to babyish ways. His speech was backward. He is very aggressive towards his baby sister. This child showed real terror when his mother left him at the Play Centre, but responded immediately to the individual care of the warden. He is apt to be aggressive towards other children. After three sessions he appeared to have settled down and now co-operates much more with both children and staff. He is now no longer aggressive towards other children, including his young sister, and is therefore happier at home. P.B. 3.2.57 Since the arrival of a baby sister in April, 1961 this little boy became very unhappy. He resented the baby and was anxious to start school. His mother complained that he bit his nails. On admission he appeared timid at first but quickly became excited and talkative. He is very co-operative and shows much confidence in his approach to new children. He listens intelligently to stories read by nurse and now shows no signs of nail biting. He is greatly helped by mixing with his own age group and is also able to play better at home. He will start school in January, 1962. R.B. 25.6.57 This child is the middle child of the family. He has a brother of six years and a sister of seven months. Since the birth of the sister and his brother* s admission to school this child has had many difficult phases, i.e., returning to his bottle, then becoming wet day and night and now he has sleep difficulties. His mother has managed fairly well with the difficulties as they have arisen but there is no doubt she needs an occasional relief from the care of this child. The child appeared shy and withdrawn upon his admission and mother stayed for approximately half an hour. He claimed the nurses attention continuously and only on the third visit made very good use of the play equipment. He now no longer has any objections to leaving his mother and enjoys playing with sand and water. He is also able to play happily with other children. Since he has been coming to the centre his behaviour difficulties have diminished considerably and the mother is able to enjoy his company more. B.C. 26.9.56 This child is the eldest of three children, and he is a very bright child. However, the father rejects him. His parents are very young and the mother who is 23 years of age maintains a poor standard of health and finds it difficult to cope. On admission he was very eager to try all equipment and friendly towards other children. On his second visit he was very quiet and made little contact and has not attended the centre since. The Health Visitor visited the mother who says she prefers to keep him at home. Mother has been sent an appointment to discuss this matter with the Clinic Medical Officer, but did not co-operate with any suggestion made. (51) Initials and Date of Birth History prior to Admission Observations following attendances at the Session[/$$$] S.E. 9.4.57 Both mother and father attended the school for the educationally sub-normal. They have very poor housing conditions and the father is very jealous of the new baby. On attending the centre the child settled in well and used all equipment but was particularly interested in playing with dolls and prams. This mother requires a great deal of help to understand the child's needs and like many educationally sub-normal mothers she finds coping with a toddler exceedingly difficult. The staff are spending a great deal of time during and out of the session in showing the mother how best to help her daughter. This family have been re-housed and the child is now in the care of a daily minder who knows this child well and has noted the improvement in the child since she has attended the play centre. A. P. 1.2.58 This is a mischievous intelli^ gent child who had thyroid treatment from the age of 2 months. She has a smaller sister and her mother is overanxious and is being treated by her private practitioner for a nervous condition. It would appear that both mother and child would benefit from play sessions. On admission the child was completely withdrawn and ignored all other children but watched adults very keenly. She is still very reserved but is beginning to make good use of the equipment and has established some contact with one or two children. The mother states that the child is much easier to handle since she has attended the centre and is learning how to play. Unfortunately the child contracted measles and found it difficult to re-establish relationships. She has now settled in well and shows a marked improvement in her attitude towards other children and adults. J.G. 28.9.58 This little girl would pass for a four year old child. She lives in a flat over a shop in High Road, Leyton and has no play area. The child is extremely aggressive at home. On admission the child appeared to be friendly and co-operative and she played energetically and sensibly. The mother complained that in the afternoon of her first attendance at the Play Centre in the morning, she was extremely difficult and demanded to be taken back to the boys and girls. The mother is now able to understand the child's needs and has supplied her with some sand play and is now able to talk to her more easily. Recently the mother had to start work and the child is now in the care of a daily minder who says she is "No trouble at all". Family shortly moving from the district. V.H. 23.8.58 This child is mongol and her mother has been agitating to get her into an Occupational Centre. As this is not possible it is hoped that the Play Session will relieve the home situation. On the first attendance the mother stayed 20 minutes, however, the child screamed when she left and then sobbed convulsively so that she had to be nursed for a time. She fell asleep at 10.30 a.m. and slept for one hour. It would appear that this child cannot Initials and Date of Birth History prior to Admission Observations following attendances at the Sessions V.H. 23.8.58 (Cont.) benefit from a Play Session as her mental age is so much below the chronological age. and she was so distressed by the absence of her mother. She has not attended the sessions since and the Health Visitor is following up the case. L.H. 6.3.57 This child has a mother who suffers from a nervous condition and a father who is 'over strict' and has a bad temper. It would appear that the parents do not understand the needs of the child. She seems an ordinary little girl in need of an outlet for her energies and the mother would benefit from a relief from the child. On admission she was a silent and anxious looking child only able to relax after attendance of ¾ of an hour and then played happily with sand and water. On subsequent visits she was found to be well able to co-oprate with children and adults. The mother states she is benefitting from the rest, she is in her late forties and finds the child a great strain. She will need help over long periods to understand the needs of the child. Recently the mother had a leucotomy performed and is less able to devote time to the child. L. enjoyed the play centre and this helped her to adjust to school life which she started in January, 1962. J.M. 30.9.56 This child is due for school after the summer holidays. At present she is rather lost as her baby sister is not one year old. The mother is most anxious for the child to have some play companions of her own age. On admission she appeared to be a friendly co-operative child who uses all the play equipment constructively. Has only made two attendances owing to illness.. She is now at school and thoroughly enjoys it. C.P. 24.12.56 This child is the second child of the family and has a sister of 9 years who has been referred to the Child Guidance Clinic. The child (C.P.) is completely beyond his parents control and is fast becoming 'the terror of the neighbourhood'. He has a slight speech defect and is eneuretic. On admission he played constructively with bricks and on subsequent attendances co-operated in all types of play and appeared to thoroughly enjoy his morning attendance. As there is little parental control at home he has been recommended for full-time admission to the day nursery as he needs intensive help. He did not settle down at the Day Nursery as the parents were unco-operative. He is now at school. Mother thinks he is better but staff find him difficult. He also attends the Child Guidance Clinic. C.B. 5.6.58 The mother has recently moved to Leyton and has few friends in this district. The child needed companionship of her own age. She also resented her baby brother and was extremely aggressive towards him. The child was at first distressed when her mother left, but after a few sessions she settled down well. She now plays happily with other children and joins in all activities. (53) [Initials and Date of Birth History prior to Admission Observations following at tendances at the Sessions J.S. 18.8.58 The mother of this child has been an in-patient at Warley Hospital. She has now been discharged and is working. The child is left in the care of his grandmother during the day. He is not so far habit trained and his speech is very backward. On admission he appeared to be an average 2½ year child interested in sand and water and dough play but ignored all other children. After his fourth visit he was able to co-operate more with other children and his speech had slightly improved. He needed to attend more frequently in order that we may promote habit training as he still refused to use the toilet. He developed bladder control during his time at the play session. Family has recently moved to another district. J.T. 9.5.57 This child has a brother of 21 years of age who lives in Harlow and a sister of 6 years of age. His mother is now 38 years old and it appears she cannot control the child. He lives in a new block of flats and is not allowed to play out of doors as he wanders off to the main road. On admission he appeared to be a bright active child who played intelligently with the equipment and listened eagerly to stories told by the nursing staff. He is amenable to all adults. The mother is learning a great deal about children's play since the boy has attened the sessions and is finding it much easier to manage him. C.B. 24.1.58 C. is an only child and his mother was not aware of his needs. He became very aggressive and difficult to manage. On admission he was most aggresive but now plays well with other children. He responds to firm handling and enjoys the company of other children. The mother is now more aware of his needs. V.B. 21.9.58 This child's father committed suicide when V. was a baby. The mother has 2 children. She is over anxious and possessive especially when the elder child went to school it was found necessary for this little girl to have companionship of her own age. This child settled in quickly, ieven though she had no opportunity for play at home she soon learned to play constructively with toys at the centre. She is never ready to go home and thoroughly enjoy these sessions. J.F. 20.11.57 This is the child of professional parents who have provided a wellequipped nursery for their son, but the mother, who is a teacher felt that J. needed the companionship of other children. J. is very demanding. Very intelligent child who settled down quickly. He co operates well and uses all the equipment constructively. He enjoys the company of other children and his mother too is benefiting from the short break of this demanding toddler. (54) Intrial and Date of Birth History prior to Admission Observations following attendances at the Sessions L.H. 8.7.58 This is an only child who lives with his parents in a small first floor flat of a terraced house with no opportunities for play. She is a very quiet and shy child and was distressed when leaving her mother. It took 6 weeks before she parted from her mother without crying. She now enjoys the centre and plays well with all equipment. The mother is delighted to see that L. can now play with other children and is able to co-operate. D.L. 26.3.57 This child has a brother of 10 and a sister of 8 years of age. He disliked the company of children of his own age group and upset the activities of his brother and sister thus causing friction in the home. Unable to play at first with children in his own age group. Mother had to stay with him for long periods during the first two weeks. He has settled down well now and is very happy playing with other children. The mother states that he is easier to handle at home and is well prepared for school which he will attend in January, 1962. D. M. 17.3.57 Mother is divorced and is a business woman. She therefore cannot devote much time to her children. D. is very mischievous and needs guidance in play and is inclined to be boisterous. This little boy settled down quickly but still needs firm handling. He enjoys active play and is benefiting from regular attendances at the session. S.N. 20.7.58 The parents are elderly, the mother is mentally disturbed and attending a psychiatrist. The mother's mental state is having an adverse effect on the child's development. He is not habit trained and in need of companionship of other children. This child enjoys the play centre and settled down quickly. He is now habit trained at the play session but reverts to his babyish habits at home. This child would benefit by admission to a day nursery but at present the parents do not see this need. K.N. 18.6.57 This family live with the maternal grandparents and there is no opportunity for play. There is friction in the home and parents and grandparents do not agree concerning the children's management. K. became aggressive since the arrival of a baby brother in March,1961. K. enjoys the play sessions and is not aggressive towards children at the centre. She plays with all equipment. Parents report she is still aggressive at home. D.St. P. 26. 3. 58 This child's father is physically handicapped. The family lives on the first floor of a terraced house and there are no play facilities. This is a bright and active little girl who settled down quickly. She is interested in different types of play and benefits greatly from these sessions. The family situation is already showing signs of improvement. (55) Initials and Date of Birth History prior to Admission Observations following attendances at the Sessions M.B. 26.1.57 This child's mother is unable to cope with him, she herself is very inadequate and apt to be tearful. The child therefore became completely out of control. This little boy was most aggressive and tried to spoil the play activities of other children. He was admitted to Ellingham Road Day Nursery but unfortunately the mother did not co-operate and attendances were irregular. He has now started school and an I.Q. test has been arranged. M. G. 4 years This is the youngest of four children and he is spoilt. The mother is middle-aged and over-worked as she is also caring for an invalid relative. The mother requested admission to Play Session. Attended once only as he did not like the other children. The Health Visitor called on the mother and the advantages of the play centre were discussed with her. She agreed for him to come but he did not attend again. The Health Visitor is keeping contact with this family. T.W. 12.4.58 Since the birth of his baby brother this child became very jealous and difficult to handle. The mother and child relationship deteriorated. At first the child settled in well and was happy playing with other children. When the mother and child relationship improved the child became unhappy at the play sessions and is now no longer attending. S. R. 3 years This is a physically handicapped child. She has hydrocephalus and had a spinal operation. She also suffers from asthma. This child is too emotionally disturbed to make relationships with other children. She clung to her mother, who had to stay for the session. At present the child will not benefit from the sessions but a vacancy will again be offered at a later date. The health visitor is calling regularly to assist the family. N. B. 5.8.56 This is an only child who lives with his parents in a flat over a shop in a busy main road. There are no play facilities at home. He is a shy intelligent child, who makes full use of all the equipment. The play sessions have prepared him to mix with children of his own age groups. He is now at school which he enjoys. G.H. 5.9.56 This is an only child, who is very shy and quiet. The parents too are very reserved and wanted companionship for their daughter. This little girl is friendly and active. She thoroughly enjoyed the play sessions which have prepared her for school. (56) Initials and Date of Birth History prior to Admission Observat ions following attendances at the Sessions P.S. 14.10.56 This family lives in a flat over business premises in a busy thoroughfare and as he had no outlet for his energies he became aggressive, destructive and disobedient and was referred to the Child Guidance Clinic. He was aggressive and upset most of the children. No one would play with him and he was unable to use the equipment intelligently. He eventually benefitted by the firm discipline, and the friendly companionship of other children. He was also happy playing with constructive toys. He has now left the district. H.S.16. 9. 56 T.s. 16:1; 58 These are the eldest of a family of four and the mother had great difficulty in coping. The children were admitted to ease the strain and tension in the family. These children enjoyed the play centre. Since the older child, who presented the main difficulty, started school the mother was able to manage. I.C. 2.2.59 The home conditions are cramped and the child was not allowed free play and was always told to be quiet. The mother reports that he nearly lost his power of speech and became withdrawn. He was extremely interested in all the play material and especially sand and water. He eventually spoke when he got to know the staff and children. He attended regularly for a time but when he improved the mother no longer brought him to the sessions. (57) Toddlers Play Sessions In Clinic Premises The Board decides to build And now to work ! Hey ! look out it's falling TESTS FOR PHENYLKETONURIA In 1961, 756 children were tested at the clinics and another 92 were tested in their homes. ANTE-NATAL CLINIC The recommendation of the Cranbrook Committee on Maternity Services that it was desirable that all women who were to have their confinement at home should book their own doctor or a doctor on the obstetric list, as well as a midwife resulted in a reduction of the number of cases requiring ante-natal care at the Local Authority Clinics. The clinic mainly affected was the Lady Rayleigh Home and the few cases being seen there by the Assistant County Medical Officer did not justify its continuation and from October, 1960 those cases requiring supervision by the doctor were transferred to the Ante-Natal Clinic at Park House Health Centre. The number of cases attending at the Ante-Natal Clinic are rising again. Many expectant mothers find it more convenient to attend there rather than make the longer journey to hospital and the hospitals' ante-natal departments have requested supervision during the ante-natal period at the Local Authority Clinic for many of their cases. A few mothers still prefer to book a midwife for their confinement without booking a doctor in addition and these patients also attend the local clinic for their supervision. 195 patients made 775 attendances for ante-natal examination and treatment and 59 patients attended 77 times for post-natal examinations during 1961. MOTHERCRAFT AND RELAXATION CLASSES These classes are held by the Health Visitors at each of the three Health Centres and they are well attended. We receive many letters of appreciation of the help that these classes give. The main benefit received from these classes is a psychological one, giving women expecting their first baby a feeling of confidence which is so valuable to them at the time of the birth of the baby, whether the confinement is to be at home or in hospital. The Mothers' Hospital at Clapton has a close liaison with the Health Visitors taking these relaxation classes and the class goes to the hospital with the Health Visitor to see the labour ward and meet the staff and are made to feel that they will not be among strangers when the time comes for admittance to hospital. DENTAL CLINICS The Area Dental Officer reports as follows:- "Approximately l/10th or 1 session per week is devoted to this work by the fulltime dental officers, and comprises all those forms of treatment necessary for complete dental fitness. It is pleasing to report that the number of very young children attending for dental examination before any operative work is necessary continues to increase, and this is all to the good since they are introduced to these very strange surroundings at a time when it is unnecessary to detain them for many minutes and the visit is unaccompanied by unpleasant experience. (59) Three-monthly visits are essential however, if the loss of temporary teeth are to be avoided as dental decay proceeds so quickly at this age that some teeth untreated by five years of age will probably be found to be unsaveable by the time the first dental examination is held in school. Treatment of expectant mothers is on the whole disappointing for it is among those women where the need for treatment is most urgent that the acceptance of treatment is likely, especially in the absence of pain. However, the number of mothers in the younger age groups who have had dental treatment when at school, either at a clinic or privately, is increasing and it is usual for such people to accept examination and treatment and to bring their children for dental examination from about years of age. The co-operation of Medical Officers and Health Visitors has been most valuable in securing the attendance of man" of these patients. " DENTAL TREATMENT Types of Treatment Gfven Expectant Mothers Nursing Mothers Children under school age Extractions- (a) Permanent teeth 64 74 - (b) Temporary teeth - - 285 Fillings- (a) Permanent teeth 69 111 - (b) Temporary teeth - - 495 Inlays provided - - - Crowns provided - - - Anaesthetics administered- (a) Local 13 41 9 (b) General- (i) by Medical Officers on County Staff - - - (ii) by Others 19 22 116 (a) Scaling 14 15 1 (b) Prolonged scaling and gum treatment 25 13 22 Silver nitrate treatment 1 4 278 Dressings 57 110 136 X-ray examinations 13 11 1 Dentures provided- (a) Full 4 9 - (b) Partial 6 - Dentures repaired - 1 - Dentures remade- (a) Pull - - - (b) Partial - - - Orthodontic appliances- (a) Fixed - - - (b) Movable - - - Prophylactic treatment and other operationsPolishing - - 6 Number of treatments (scaling and prophylactic carried out by Oral Hygienists) 20 18 19 (60) Patients inspected and treated during the year Expectant Mothers _ Nursing Mothers Children under school age' (1) Patients examined 56 68 457 (2) Patients found to require treatment 49 55 332 (3) Patients who have commenced treatment 49 55 332 (4) Patients who have completed treatment 30 39 252 (5) Patients awaiting treatment - - - (6) Attendance for treatment 139 240 808 SPECIALIST CLINICS Specialists allocated by Leytonstone Group (No.10) Hospital Management Committee attend at the health services clinics in the area and deal with pre-school children as well as scholars. Dr.A.Logan Adam ophthalmic consultant attends at Leyton Green Clinic on Wednesdays and Fridays. During the year 10 pre-school children were referred to her and 11 infants were provided with spectacles. Mrs.Box, Orthoptist accepted 56 new cases for treatment, who made 106 attendances. Mr.H.A.Oatley, Orthopaedic Consultant attends Leyton Green Clinic on Thursdays and the clinic medical officers referred 37 new cases to him. Set out hereunder is a summary of the work:- Re— inspection. 47 Minor alterations to footwear 73 Surgical appliances supplied 8 12 children under 5 years were seen by the Consultant, Mr.Morrison, at the Ear, Nose & Throat Clinic. DAY NURSERIES There are two Day Nurseries in the area, each having accommodation for 60 chiI3ren. (1) Ellingham Road Day Nursery, Ellingham Road, Leyton, E. 15. (Telephone: MARyland 3683) (2) Knotts Green Day Nursery, Leyton Green Road, E. 10. (Telephone: 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 and of year 15 35 15 35 30 70 Number of children on register at end of year 12 46 15 39 27 85 Total attendances during year 2649 8738 2732 7953 5381 16691 Number of days open 254 254 - (61) SECTION 23 - MIDWIFERY Cases attended by Council Midwives MIDWIVES TOTAL Domiciliary Midwife Training Home Cases attended- (a) as Midwives 65 164 229 (b) as Maternity Nurses 7 64 71 Ante-natal Visits 323 642 965 Ante-natal Examinations 577 2834 3411 Post-natal Visits 1063 6074 7137 Administrations of Gas and Air Analgesia 68 137 205 Administration of Pethidine 38 107 145 Administration of Trilene - 53 53 Gas and Air Analgesia Percentage of administrations 88.33 Medical Aid Where the Medical Practitioner had arranged to attend the patient 57 Others 35 Fees paid to Doctors Number of Accounts received 17 Total amount paid to Medical Practitioners- £69. 9.0d. Maternity Outfits Number of outfits issued to Expectant Mothers 338 (62) SECTION 24-HEALTH VISITING This has been a busy year for the health visiting staff as the scope of the work has increased; the distinction between physical and mental health is no longer so marked and to cope with these wider aspects of health visiting health visitors were in need of further training and only in recent years has there been a trend to include in the syllabus of Health Visitor Training Centres lectures on the subject of Mental Health. Some schools have also made it possible for students to attend Mental Hospitals, the aid of this additional training being in the main to acquire a wider knowledge of the nature of mental illness which will enable the practising health visitor to recognise early signs of deviations from the normal. Most of the health visitors in Leyton have been qualified for several years and were, therefore, most anxious to undergo some form of mental health training to equip them for this aspect of their duties. MENTAL HEALTH TRAINING FOR HEALTH VISITORS An approach was made to Claybury Hospital, and the Area Medical Officer and Superintendent Health Visitor were invited to a meeting, which was also attended by the Physician Superintendent of the hospital, senior medical and nursing staff and social workers, to discuss ways and means of providing mental health training for health visitors in Leyton. The hospital staff were most anxious to help and it was agreed with subsequent Committee approval that as many health visitors as could be spared from their duties should be allowed to attend the psychiatric lectures given by a consultant psychiatrist to senior student nurses over a period of one year. In addition to this course of lectures practical training is given by permitting the health visitors to attend for periods of 3 - 6 months at weekly patients and staff group meetings which take place in a day room attached to a ward. Following these meetings there is a discussion by the staff concerning the patients' treatment and the possibility of discharge home. It is in this sphere that the health visitor will be able to help by giving reports on the patient's home and by advice on the facilities available in the district. The health visitors who were chosen to attend this course had all been working in the public health field for many years, and were able to contribute to the discussion after the meetings and lectures. This two-way exchange of ideas is also of benefit to the members of the hospital staff and one of the results has been that the Superintendent Health Visitor has been asked to lecture to the student nurses on the work of the Health Visiting Service. These contacts with this Mental Hospital have thus already resulted in closer cooperation between the Hospital and the Public Health Department in our area. I am sure that the training which is being provided and the resulting liaison with the Hospital, will bring nearer the day when we are able to provide a comprehensive service to the community. LIAISON WITH GENERAL PRACTITIONERS The knowledge and experience gained under the above scheme, however, cannot in itself be complete without closer contact with the General Practitioner who is a key figure in after-care work. (63) Much discussion has taken place in our area on the problem of co-operation of health visitors with general practitioners in order to promote good mental health in families who need help. In 1959 arrangements were made with one of the most experienced general practitioners in the area and his partner to hold weekly meetings with a small group of health visitors. The family doctor kindly offered his home for this purpose in order to ensure an informal atmosphere for discussion and one hour a week was spent in discussing the problems of those families in whom these doctors and health visitors had a common interest. Occasionally a health visitor was most anxious to discuss a case which did not concern these two general practitioners and when this happened the doctor concerned was invited to join a meeting. A great deal was learned from these discussions and not only the families benefitted but the health visiting in general has become more thorough as the health visitors knowledge of the family widened and she became better able to understand their particular needs. The general practitioners are of the opinion that the health visitors are often able to notice signs of emotional disturbance before any physical symptoms are apparent for which help might be sought from the Family Doctor. The ability on the health visitor's part to recognise such emotional crisis and the co-operation with the General Practitioner at an early stage, may well prevent a complete breakdown in health. Indeed, in the relatively short period in which these discussions have taken place we have already had many cases where this close co-operation has proved beneficial to the patient and his family. Other general practitioners in the area are now realising how the health visitor may be of help in their practice and are contacting them. Furthermore, three of the health visitors take it in turn to attend at the surgery of another family doctor who has reserved one morning for mothers and children. The health visitors assist with advice on social problems and in particular help with feeding difficulties. PREVENTIVE WORK WITH PARENTS There was a marked increase in the number of mothers asking health visitors' advice on their children's behaviour problems. No doubt the realisation that such problems do in fact exist and that they are capable of treatment is due to a large extent to the considerable publicity given to psychiatry in all its aspects particularly on television and in the more popular women's weekly journals. In order to enable helpful advice to be given a closer contact with the Local Child Guidance Centre was established. Apart from the obvious benefits to the community resulting from such co-operation, it was felt that health visitors who had some knowledge of preventive psychiatry could play a part in reducing the ever-growing waiting lists at the Child Guidance Centre. Since September, 1959, the health visitors have met at regular intervals with the psychiatric social workers to discuss cases. The meetings at the Child Guidance Clinic have helped considerably in finding solutions to the problems of parentss AGED AND CHRONIC SICK Levton has a high proportion of elderly people and approximately 1,400 were visited by the health visiting staff. These visits are intended to help old people to lead a useful life at home and keep them aware of the many services available in the Borough that assist not only the elderly themselves but also their relatives. (64) HEALTH EDUCATION The teaching of physical, emotional and social health is the health visitors' main job and about two-thirds of that teaching must be done individually - largely in the home, as post people in familiar surroundings are able to discuss their problems more easily, but often it is of help for a person to realise that other people too have similar difficulties. The health visitors organise group discussions in the Health Clinics and at one clinic there is a very active Mother's Club which has a varied programme of activities. Some of the most successful meetings have been those held jointly with the Nursery School Association. The mothers enjoy meeting the teachers and health visitors, and perhaps the greatest benefit of these meetings was the realisation by the parents that all had a common aim in helping the children to grow up and become useful citizens. The health visitors work in close co-operation with the teaching staff in the local schools. The teachers not only approach us for help if a child needs physical care but are also aware of the contribution that a satisfactory home life makes to the child's physical and emotional development. Group discussions are held in all secondary modern schools - the syllabus is flexible to meet the particular needs of the groups and includes citizenship, problems of adolescence, community and public health services. There is still a long way to go before it will be possible to provide a fully integrated service but the above innovations in addition to the more usual services provided at the Health Clinics are an essential step towards this objective. It is becoming increasingly apparent that final success is essentially based upon our closest possible co-operation with general practitioners, hospitals, psychiatric and other social workers, statutory and voluntary associations. HEALTH VISITORS During the year the Health Visitors made 18,220 visits to homes:- (a) To expectant mothers:- First visits 341 Subsequent visits 670 (b) To children under 1 year of age:- First visits 1327 Subsequent visits 4929 (c) To children between the ages of 1 and 2 years 2038 (d) To children between the ages of 2 and 5 years 3720 (e) To the aged (over 65 years of age) 2400 (f) To other cases 2033 (65) Health Education Health visitors in Group discussion with mothers Health Education with Secondary Modern School pupils on importance of balanced diet Health visitor demonstrating baby care SECTION 26-VACCINATION AND IMMUNISATION VACCINATION AGAINST POLIOMYELITIS Outbreaks of poliomyelitis at Ipswich, Liverpool and West Bromwich during the year remind us that these still occur amongst population groups where the level of immunisation is low. The estimated vaccinal rates for primary injections in Leyton early in 1961 were as follows:- 6 months to 5 years 58.1% 6 years to 15 " 84.06% 16 " to 25 " 57. 06% 26 " to 40 " 11.00% In an endeavour to increase the immunity rates in the adults between 16 years and 40 years arrangements were made for the mobile vaccination unit to be sited at various points in the area during the period 4th - 8th July for the first injections and for the period 1st - 5th August for the first and second injections. I set out hereunder the sites and attendances at the mobile unit:- First Visit Second Visit TUESDAY July 4th and August 1st Trelawn Road Leyton (Nr. Leyton Station, Central Line) 255 293 WEDNESDAY July 5th and August 2nd "The Bakers Arms", Lea Bridge Road, Leyton, E. 10. 423 429 THURSDAY July 6th and August 3rd Staffa Road, Flempton Road, (off Lea Bridge Road.E. 230 150 FRIDAY July 7th and August 4th Leytonstone Station (Central Line) 553 580 SATURDAY July 8th and August 5th Aylmer Road (off High Road, Leytonstone, E. 11.) 389 358 Total 1,850 1,810 The visit of the unit gave some 2,500 people the opportunity of having a first injection. It was unfortunate that the week of the second visit of the unit coincided with the most popular holiday week of the year. However, in the circumstances the number of attendances was extremely good. It is interesting to record that during the visit of the unit the Central Syringe Sterilising Unit was able to meet all the demands made upon it, which entailed the sterilising of some 2,000 syringes a week extra to our normal requirements. (67) CENTRAL SYRINGE STERILISING UNIT A Central Syringe Sterilising Unit was established in Leyton as a pilot scheme for Essex County Health Services and began operating on the 4th October, 1960. As a result of advances in medical knowledge there are an increasing number of preventive inoculations available for use in a community. Medical treatments which require to be given by injections are also increasing. These are great advances and their proper implementation is resulting in improved health of the community. It does mean, however, that a large and increasing number of persons are receiving injections. It is important that the injected material should not be contaminated with diseaseproducing organisms during the injecting procedure. It is essential that the syringes and needles which are used are clean and sterile. The controlled sterilisation of the large numbers of needles and syringes which are used in the local authority's health service requires detailed organisation, and it was recommended that a central syringe sterilisation unit be set up to provide clean and sterile syringes and needles for use in the health services operating under the Leyton Health Area Sub-Committee. Medical Considerations Needles and syringes before use must be sterilised to remove any pathogenic organism which might cause local disease at the site of the injection (e.g.abscess formation) or more generalised disease (e.g. septicaemia). In 1945 the Medical Research Council's War Memorandum was published and, in the light of what was then known, suggested that mass inoculations might be done by changing the needle for each new patient but using the same syringe for more than one. A working party of the Medical Research Council indicated, in the February, 1960, issue of the Monthly Bulletin of the Ministry of Health and the Public Health Laboratory Service, that the next edition of the Memorandum on sterilising syringes will certainly recommend the use of a separate syringe and needle for each inoculation; it will also emphasise that the safest syringes and needles are those produced by a well-organised central syringe service. The reasons for these recommendations are based on the unmeasured but wellestablished risk of post-inoculation hepatitis. Between two and five months after inoculation with a syringe or needle that has previously been used for someone else without being subsequently sterilised, a person may develop hepatitis (a form of jaundice). The practice of using a clean, sterile needle for each person to a syringe used for inoculating 5, 10 or 20 patients, does not eliminate the risk of hepatitis. It has been shown that the small amount of fluid which always enters a needle in the tissues will be aspirated on to the nozzle of the syringe when the needle is taken off. In this way the whole contents of the syringe are likely to become infected. Part of the premises at the rear of 280 High Road were converted and adapted for use as a central syringe sterilising unit. During 1960 it provided sterile syringes and needles for all the services (68) stered by the Leyton Health Area Sub-Committee. The advantages over the previous practice of boiling in the clinics are: - (a) it provides with assurance against the risk of using unsterile syringes; (b) it provides a clean, dry sterile syringe and needle for each inj ection; (c) it provides the staff and patients with sharp needles; (d) it relieves doctors and nurses of time-consuming tasks at periods when they are hard pressed; (e) it allows greater flexibility of programming for immunisation sessions. Disposable sterile syringes and needles are now becoming available, and one naturally must consider their relative merits. It would appear that there can be little to choose between a disposable syringe and needle and one from the central syringe unit. Each provides a safe sterile syringe and needle. Other factors will however require consideration in relation to local factors:- (a) Disposal:- the actual disposal of large numbers of used syringes and needles may produce problems. (b) Transport:- In geographically compact Health Area(s) where transport facilities to clinics, etc. already exist the transport of needles and syringes from a central syringe unit does not present any problems. In a larger and perhaps rural area however, transport could be a serious difficulty in operating a central syringe unit and disposal syringes which can be sent by the postal service would have great advantages. (c) Cost:- At the moment the running cost of the central syringe unit is approximately 2d per syringe compared with about 6d per disposable syringe. The cost of the disposable syringe may however, be reduced if production and their distribution increases. It would seem that these are at least some of the factors which authorities not already providing sterile syringes and needles will have to consider where developing their own services in this respect. At the moment of writing consideration is being given to providing some neighbouring parts of Essex County Council's Health Services with sterile needles and syringes from the Leyton Central Syringe Unit. (69) Central Syringe Sterilising Unit Dismantling bay and needle sharpening Cleansing bay and hot air oven Assembly bay Poliomyelitis Vaccination The following persons in the various age groups received a complete immunising course. CATEGORIES PRIMARY BOOSTER FOURTH Male Female Male Female Male Female Born 1943 to 1961 937 940 623 598 1704 1637 Born 1933 to 1942 552 586 195 347 2 10 Born 1920 to 1932 968 1235 539 720 - 3 Over 40 years 142 198 27 57 - - Hospital Staff 4 134 21 90 - - Total Vaccinated during year 1961 2599 2959 1384 1722 1706 1650 " " " " 1960 1533 1922 3464 4387 - - " " " " 1959 4718 5378 4783 4870 - - " " " " 1958 3244 3116 520 517 - - " " " " 1957 1359 1303 - - - - " " " " 1956 179 168 - - - - " " to end of 1961 13632 14846 10151 11496 1706 1650 Expectant Mothers Vaccinated during 1961- 45 Primary 105 Third 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 666 106 49 28 50 91 990 Number re-vaccinated - - - 2 7 113 122 (71) 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 1 468 390 - - 1 62 122 1 - 2 31 25 1 1 3 24 22 2 - 4 16 22 76 96 5-9 38 36 179 200 10-14 47 35 69 87 Total 686 652 328 384 • Including temporary residents Protection against Whooping Cough Age at time of final injection Children who completed a full course under the County Scheme Records of combined diphtheria-pertussis immunisations received By General Practitioners By County Staff Under 6 months 62 108 120 6-12 months 76 314 162 1 year 7 44 28 2-4 years 18 12 39 5 years and over 7 2 17 Total (primary courses) 170 480 366 Reinforcing injections 22 1 60 (72) SECTION 27 - AMBULANCE SERVICE This section of the National Health Service Act is administered centrally and is the responsibility of the County Council. I am indebted to the County Medical Officer of Health for supplying the following statistics of the work carried out during 1961. The undermentioned figures refer to the operation of the Leyton Ambulance Station for the three-quarters of the year up to 28th September, 1961:- Leyton Station Ambulance vehicles 6 Dual purpose vehicles 3 Stretcher cases 3,610 Other cases 25,421 Total cases conveyed 29,031 Total mileage 102,098 Total emergency cases 3,424 The James Lane Ambulance Station came into operation on the 29th September, 1961 and gave service to both Walthamstow and Leyton Health Areas. The undermentioned figures, therefore, refer to the combined areas for the three months period ending on 31st December, 1961:- James Lane Station (3 months only) Ambulance vehicles 12 Dual purpose vehicles 8 Stretcher cases 2,555 Other cases 22,896 Total cases 25,451 Total mileage 77,037 Total emergency cases 2,658 SECTION 28 - PREVENTION OF ILLNESS AND AFTER CARE Foot Clinic The shortage of staff has continued throughout the year and it is obvious that, until service in local health authority clinics is as rewarding to the chiropodists as is private practice, there will be a shortage of chiropodists to fill the vacant posts. During the year we averaged approximately the equivalent of 5-4/11 full-timers out of an approved establishment of eight. In January we commenced domiciliary treatments and as the demand for this increased more sessions were allocated for this purpose. The conveyance of non-ambulant patients by County Council Ambulances was discontinued in June as it was found impracticable to arrange transport when the chiropodial staff were available. The number of treatments given to Ambulance patients up to cessation of the service was 57 - Males 10; Females 47. (73) Semi-permanent appliances This service began in 1959 is proving very successful. Over 100 patients have been supplied with a semi-permanent padded insole, made to the individual need of the patient. Not only is it beneficial from the hygienic aspect but it affords relief from pressure much longer than padding. Puller details will be found in the statistical section. Domiciliary Chiropody As from 1st January. 1961 the Leyton Health Area assumed the full responsibilities for domiciliary chiropody; this service was formerly financed by the Borough of Leyton Welfare Services Committee. Approximately 190 elderly house-bound patients received treatment during the year, and it has been possible to attend to these patients without delay. No. of Patients Total Treatments 190 (approximately) 764 Attendances and Treatments During the year a total of 6, 645 patients attended the foot clinics, these included 1, 205 new patients, there were 22,263 treatments. It was possible to discharge 171 adults and 325 children patients. The following defects were treated:- Bursitis 54 Callosity 243 Hard Corns 315 Soft Corns 30 Claw Toes 6 Hallux Rigidus 21 Hallux Valgus 61 Hammer" Toe 3 Hyperidrosis 12 Metatarsalgia 19 Nail Club 37 Nail Hypertropied 15 Nail Ingrowing 44 Nail Involuted 17 Pernio 10 Pes Planus 28 Planter Fascititis 8 Sepsis 11 Septic Condition 11 Strain 15 Subungual-Exostosis 1 Tenosynovitis 3 Tinea Pedis 10 Trigger Toe 6 Verruca Pedis 236 (74) 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 12 (b) Extra Nourishment- Number of new cases supplied with free milk 14 Total number being supplied with free milk at end of year 15 Loan of Sick Room Equipment The undermentioned Sick Room equipment was newly loaned during the year:- Air Beds 2 Air Rings 69 Bed Back Rests 94 Bed Blocks 1 Bed Cradles 16 Bed Pans 142 Commodes 52 Crutches 7 Feeding Cups 2 Invalid Chairs 57 Mobile Lifting Pole 1 Plastic Sheets 36 Rubber Sheets 107 Sputum Mugs 1 Urinal Bottles 42 Fracture Splints 18 647 Convalescence for Adults Number of applications during year 64 Length of stay:- One week 3 Two weeks 42 Three weeks 18 Four weeks 1 (75) SECTION 29 - DOMESTIC HELP During the past year the Domestic Help Service has continued to give help to all categories of the sick, in particular the aged, of whom Leyton has a large preponderance. There has been a slight increase in respect of help given to the tuberculous and acute sick, and the number of chronic aged patients continues to rise. The Night Attendance Service has now become an integral part of the Domestic Help Service, and a small panel of attendants is maintained. This service is of considerable help to those people nursing sick relatives in their homes, thus saving much-needed hospital beds. Help for problem families, care of children and harassed mothers has been adequately given by specially selected domestic helps and they continue to give valuable assistance in cleaning up exceptionally dirty cases. Recruits to the Domestic Help Service have been of an extremely good standard generally. A number of helps have now undergone a course of in-service training organised centrally by E.C.C. health services and has proved of value and is much appreciated by the Helps. It is hoped perhaps to extend and supplement these courses by additional 1nr»ol "In-cprvinp t.rn "i nine Number of Helps and hours worked:- Number of domestic helps enrolled at end of year:- Whole-time helps 7 Regular part-time helps 157 Number of domestic helps actually employed at end of year 150 Number of hours worked during the year 177,955 Work of Domestic Help Organisers (1) (2) Total (1) First Visits 234 331 565 (2) Revisits to beneficiaries:- (a) Domestic help present 197 190 387 (b) Domestic help not present 1045 1087 2132 (3) Other Visits 1521 409 930 Total Visits 1997 2017 4014 (76) Help Provided Maternity Acute Sick Tuberculosis Chronic Sick Aged not Sick Others Total Aged Others Requests for help from new cases during the year 86 33 5 394 51 7 5 581 New cases helped during the year 67 29 5 319 51 8 8 487 Total cases completed during the year (a) 70 20 4 331 37 4 7 473 Cases being helped at end of year who have received help for Under 3 months 1 7 - 42 9 1 2 62 3-6 months - - 49 10 1 - 60 6-12 months - 1 2 98 12 3 - 116 Over 12 months - - 3 479 49 14 2 547 Total (b) 1 8 5 668 80 19 4 785 Total cases helped during the year (a) plus (b) 71 28 9 999 117 23 11 1258 Hours of help provided during the year 3,735 1,084 2,159 146,823 17,095 3,668 3,391 177,955 MEDICAL EXAMINATION OF STAFF County Council employees:- Number of medical examinations- (a) Entrants to County Council's service 160 (b) Retirement on Superannuation 2 (c) Other purposes (including entrants to Teaching Profession and Training Colleges 17 No. of medical examinations Leyton Borough Council 95 Others 1 (77) School Health Service LEYTON COMMITTEE FOR EDUCATION 1961-1962 Chairman: Councillor A.L. Chamberlain Vice-chairman: Councillor Mrs. E.V. Pearson Aldermen: Mrs.A.M.M.Burrell G. S. Flack Mrs. J. Hammond, O.B.E., J. P. Mrs. R.King W. J. Low C.J.Mills, J.P. Councillors: G. S. Bentley I. A. Brown E. F.Meacock F. C. Newman Mrs. N. M. Plunkett J. A. Punshon G. W. A. Robinson J.J. Walsh Nominated Members; County Councillor G. W. Mason Councillor W.O.J. Robinson Co-optative Members: Mrs. E. M. Dare Mrs.E.Edwards H. W. Matthews E. G. Morgan L. Walklett J. D. Watson Staff All the staff employed on school health service duties (with the exception of the Speech Therapist) also carry out duties in respect of Part III Services. The following table shows the whole-time equivalent of staff employed in the school health service as at 31st December, 1961:- Medical Officers 2.55 Dental Officers 4.35 Dental Attendants 4. 5 Nursing Staff 6.96 Remedial Gymnast .1 Speech Therapist 1.00 Administrative and Clerical 5.05 Clinic Clerks 1.4 25.91 (78) School Clinics Aural Clinic Sessions as required Park House Clinic Child GuidanceMonday to Friday 10 a. m - 1 p.m 2 p.m - 5 P.m Child Guidance Clinic, Monoux Building, High Street, E.17. Dental ClinicsMonday to Friday 9 a.m. - 5 p.m Park House Clinic, Dawlish Road " Leyton Green " Saturday (.alternate) 9 a. m - 12 noon Park House Clinic Dawlish Road " Leyton Green " Foot Clinics#Mondays to Fridays and alternate Saturdays 9 a.m. - 12 noon 2 p.m. - 5 p.m. Park House Clinic Dawlish Road " Leyton Green " #Minor Ailment ClinicsMonday to Friday Saturday 9 a. m - 11 a. m 9 a. m - 11 a. m Dawlish Road Clinic, Leyton Green " Park House " #Doctors' Consultation Clinics Monday, alt. Friday and Saturday Tuesday, Friday and alt. Saturday Tuesday, Thursday and alt. Saturday 9 a. m - 12 noon 9 a. m - 12 noon r 9 a. m - 12 noon Leyton Green Clinic Dawlish Road " Park House " Ophthalmic ClinicWedesday Friday 9.30 a.m - 12 noon 9.30 a.m - 12 noon Leyton Green Clinic Orthopaedic ClinicThursday 2 p.m - 5 p.m Leyton Green Clinic Orthoptic ClinicTuesday (alternate) Wednesday Friday 9 a.m - 12 noon 2 p.m - 5 P.m 9 a.m - 12 noon 2 p.m. - 5 P.m 9 a.m - 12 noon 2 p.m - 5 p.m Leyton Green Clinic Remedial ExercisesMonday Wednesday 4.45 p.m - 5.30 p.m 4.45 p.m - 5.30 p.m Park House Clinic Speech ClinicMonday to Friday 9 a.m - 12 noon 2 p.m - 5P.m Dawlish Road Clinic Vaccination and Immunisation Vaccinations and Immunisations of school children at all Clinics by appointment. #Attendances at all Clinics, except Minor Ailment Clinics and Doctors Consultation Clinics are by appointment. (79) School Medical Inspection SCHOOL POPULATION Designation of School Number of Schools Number of Pupils Primary 19 5,453 Secondary 10 6,005 Special 3 230 Total 32 11,688 ROUTINE MEDICAL INSPECTIONS Group Number of Pupils Examined Percentage of Parents Present 5 year 795 94.1 10-12+ year 760 83.5 14 year 1,608 21.4 Other 176 4.2 3,339 REINSPECTIONS - ALL GROUPS 3,525 PHYSICAL CONDITION OF PUPILS AT ROUTINE MEDICAL INSPECTIONS Age Group (by year of birth) Number Inspected Condition Classified Satisfactory Unsatisfactory 1957 and later - - - 1956 305 305 - 1955 490 487 3 1954 16 16 - 1953 5 5 - 1952 517 517 - 1951 243 243 - 1950 35 35 - 1949 18 18 - 1948 4 4 - 1947 491 491 - 1946 and earlier 1,215 1,212 3 TOTAL 3,339 3,333 6 (80) FINDINGS 01 MEDICAL INSPECTION (a) Individual children found to require treatment Age Group (by year of birth) Pupils Inspected Defective Vision (excluding sauint} Any other Condition Total Pupils with Defects 1957 and later – – – – 1956 305 6 36 40 1955 490 19 62 73 1954 16 – 3 3 1953 5 2 – 2 1952 517 55 64 111 1951 243 31 23 50 1950 35 7 7 14 1949 18 3 5 8 1948 4 – 1 1 1947 491 124 48 162 1946 and earlier 1,215 225 75 267 TOTAL 3,339 472 324 731 (b) Pupils found to have undergone tonsillectomy Age Group Number Inspected Number found to have undergone tonsillectomy Boys Girls Boys Girls 5-year 409 386 11 20 10-12 + year 378 382 67 63 14-year 811 797 152 170 Other periodic 65 111 10 18 TOTAL 1,663 1,676 240 271 <(c) Hygiene Inspection in Schools The Nursing Staff carried out 15,524 inspections during»the year, and 33 cases of infestation were found. The number of cases of head lice remains low but any hope that we can cease to carry out some form of inspection must be abandoned. One family in a junior school, with a previous clean record, who has no mother were sent by the father to spend their summer holiday with an Aunt in the country. When they returned to school after the holiday, the girl was discovered by the school nurse, (81) on the 2nd day of the term during a hygiene inspection to be grossly infected with head lice, with septic sores all over her scalp and masses of enlarged glands in her neck. The other members of the family were infected though not so badly. The father had not noticed anything the matter, though to the School Nurse and the School Medical Officer who saw her, the girl looked ill and miserable. If the case had not been so quickly found by this routine inspection the remainder of the 40 children in the class would have soon been infected and a great deal of trouble caused to parents and scholars alike. In another junior school just after the Easter holidays the headmaster asked for an inspection as a mother of one of his pupils had discovered her child to have headlice. Two children from families who had previously given trouble were the cause of this recent outbreak. Also for the first time for many years in the secondary schools, grammar, technical and modern, several quite severely infected cases of head lice were discovered at the first inspection after the summer holiday and gave us concern for a week or two. The numbers infected were small but if the cases had not been picked up quickly at the beginning of term their class mates would soon have been infected. Parents have had so little to worry about in this district in the past few years with head lice that the children at risk would probably have been quite heavily infested before the cases were discovered. It would seem that constant vigilance is the price for cleanliness. (82) (83) DEFECTS FOUND BY PERIODIC AND SPECIAL INSPECTIONS DURING THE YEAR Defect or Disease Periodic Inspections Special Inspections Entrants Leavers Others * Total Treatment Observation Treatment Observation Treatment Observation Treatment Observation Treatment Observation Skin 6 10 23 3 6 (3) 1 (-) 35 14 95 27 Eyes - (a) Vision 25 50 349 10 98 (81) 41(14) 472 101 178 9 (b) Squint 17 8 8 1 7 (6) 4 (2) 32 13 8 – (c) Other 3 2 3 - 1 (-) 3 (1) 7 5 63 9 Ears - (a) Hearing 10 47 6 9 9 (2) 24 (13) 25 80 37 1 (b) Otitis Media 1 13 4 1 3 (-) 3(2) 8 17 16 5 (O Other 2 2 2 1 4 (2) 3 (1) 8 6 121 20 Nose and Throat 20 46 8 4 6 (2) 25 (13) 34 75 54 4 Speech 8 32 2 3 5 (2) 9 (2) 15 44 30 5 Lymphatic Glands 1 22 - 1 - (-) 18 (2) 1 41 6 - Heart 5 14 2 8 1 (1) 3 (-) 8 25 3 1 Lungs 8 18 1 6 3 (1) 6(2) 12 30 26 1 Developmental- (a) Hernia 3 4 - 1 2 (1) 1 (1) 5 6 1 _ (b) Other 1 13 3 3 3 (1) 4 (1) 7 20 28 - Orthopaedic- (a) Posture 2 10 5 13 12 (5) 12 (2) 19 35 5 • (b) Feet 17 16 15 4 19 (9) 11 (5) 51 31 72 7 (c) Other 9 34 39 20 15 (5) 20 (5) 63 74 38 1 Nervous System- (a) Epilepsy – 3 3 4 – (–) – (–) 3 7 1 - (b) Other 1 7 3 – – (–) 4 (1) 4 11 17 2 Psychological- (a) Developmental 1 5 2 2 2 (2) 9 (4) 5 16 57 4 (b) Stability 4 34 5 13 5 (3) 27 (17) 14 74 106 32 Abdomen – 2 1 2 2 (2) 1 (1) 3 5 9 5 Other 7 11 2 - 6 (3) 8 (5) 15 19 407 81 * Numbers in brackets are those children who are already known, i.e. Total in column minus number in brackets equals new cases found. Medical Treatment MINOR AILMENT CLINIC A doctor attends each Clinic for two morning sessions and alternate Saturday mornings for consultations. A school nurse is on duty every morning for dressings and minor injuries, etc. During 1961, 1,350 children attended 1,562 times to see the doctor and 1,091 children attended 2,078 times for advice and treatment from the nurse. SPECIAL CLINICS SUMMARY FOR 1961 Orthopaedic Aural Ophthalmic Orthoptic Sessional Programme 1 a week 1 a month 2 a week 6 a week Total Sessions 42 12 86 246 New Cases 258 94 228 104 Attendances 1,001 175 1,455 1,884 ORTHOPAEDIC CLINIC This clinic is under the supervision of Mr. H.A.Oatley, P.R.C.S. Orthopaedic Consultant. During 1961 the following numbers of children were referred to Whipps Cross Hospital by Mr.Oatley. 10 Radiological investigation 5 Physiotherapy 5 Operative treatment 26 pitting of surgical appliances AURAL CLINIC The following children were referred to hospital during 1961 for treatment or further investigation: Removal of Tonsils and Adenoids 17 Removal of Tonsils only 1 Removal of Adenoids only 7 Bilateral Antral Lavage 1 (84) Mastoidectomy 1 Myringotomy 1 Myringoplasty 1 Examination under Anaesthetic 1 X-ray Sinuses 5 Removal of Polypus 1 OPHTHALMIC CLINIC AND ORTHOPTIC CLINIC Dr.A.Logan Adam, Ophthalmologist, Mrs. S. Box, Orthoptist and Mr.J.L.Boscoe, Ophthalmic Optician, continued to investigate and treat all those children referred by Assistant County Medical Officers. REMEDIAL EXERCISE CLASSES 89 children made 358 attendances at the classes which were under the supervision of Mrs. W. Davis. Dental Inspection and Treatment EQUIPMENT AND STAFFING The policy of providing each dental officer, be he full or part-time, with modern equipment was continued during the year, and to this end three additional high speed air-rotors were installed in the dental surgeries so that each one is now so equipped. Dental Surgeons coming from the training schools and hospitals find that all modern methods for diagnosis and treatment are provided for them, and that no reasonable request for a particular instrument is refused. The employing Authority can therefore be sure that dental staff will not be lost to other areas giving better working conditions. Notwithstanding the natural shortage of dental surgeons it has been possible during the year under review to have the equivalent of 5-3/11 full-time dental officers working out of an establishment of 6 (this figure has been possible by the inclusion of eight evening sessions a week by the day-time staff). ROUTINE DENTAL INSPECTIONS Periodic inspection of children in the schools was carried out in 77.2% of the schools in the area and in addition treatment of one school inspected late in December, 1960. This is not as good as one could wish for, but when it is remembered that in some areas it has not been found possible to visit the schools due to staff shortage there is some cause for a measure of satisfaction. A degree of selection for treatment is practised in order to bring regular treatment to those who appreciate it, and only emergency treatment to'those who only call upon the service when in pain. (85) To this end, therefore, all children whose mouths have been made dentally fit have it brought to their attention in no uncertain manner that regular six monthly inspection, followed by treatment where necessary, is absolutely essential and that they are not to wait until the dentist visits the school. In this way the limited staff is ensuring that as many as possible leave school dentally fit, trained in the care of the teeth, and without the loss of permanent teeth. DENTAL HYGIENIST Unfortunately the Dental Hygienist (Mrs. Thurston) left the Service during the year to take up a teachers training course. Lecturing and demonstrating the care of the teeth having been one of her strong points, she is greatly missed on that account. The clinical side of her work is now carried out by the dental officers who also give a talk to the child on mouth care at the time of treatment. DIETETIC HABITS For some considerable time now the dental profession has been concerned about the amount of fermentable carbohydrate taken by children in the form of sweets and sugary cakes, much of it eaten between meals, and some of it obtained from School Tuck Shops and eaten during the 'break*. School dental officers have periodically remarked upon the impossibility of accurate examination of the teeth following the mid-morning break, when for anything up to an hour the occlusal and interstitial surfaces of the teeth - particularly the molars, are covered by a soft, sticky, pabulum. A factor of importance arising from between meal snacks is the longer time taken by the saliva to regain its maximum 'Cuffering* effect, that is, its ability to counter-, act the additional acid production in the dental plaques after the injestion of carbohydrates where the snack is rich in sugar. During the year, therefore, the co-operation of head teachers and their staff was sought to ensure that as far as possible, and within reason those articles less harmful to a child's teeth should be stocked in the school tuck shops. Such articles as salted and/or roasted nuts- particularly for the older children, raisins, raw fruit and vegetables such as carrots being the least harmful, but also if desired potato or cheese crisps. To this end a meeting of head teachers with members of the School Medical Staff was held to air views,to hear one anothers point of view and to agree upon a common policy. Much goodwill having been shown on both sides, many advantages should follow from the new agreements. From the dental health point of view it should be noted in passing that it is the apples eaten as dessert which are so valuable for general oral hygiene and that this Country consumes only about half the quantity of apples per head of the population compared with Europe as a whole, and only about one quarter compared with Switzerland. i The last published figures were for 1958 and showed that the United Kingdom consumed 291bs. per head, against the average for Europe of 591bs. per head, whilst Switzerland's average consumption stood at 1201bs. per head. (86) ORTHODONTICS The arrangements made with the North East Metropolitan Regional Hospital Board for cases to be referred to their orthodontist (Mr.ffillcocks) for a second opinion is working well, and several cases have been referred to him at ffhipps Cross Hospital during the year. The child is provided with study models and X-rays and where the case is of some complexity Mr. Willcocks advises the dental officers on the best line of treatment. He is also available to them from time to time as the case proceeds. Ectopic teeth and unerupted teeth buried deep in the jaw where more suitable for in-patient treatment, are admitted to hospital and treated. So great is the demand for orthodontic treatment that some measure of selection of cases has become necessary. Firstly, to be sure that the child and his parents will attend regularly as required, for without this regularity successful results are not likely. Secondly, to be sure that it is those cases most needing treatment from a health, and in some cases, from an aesthetic point of view, which are undertaken. The tables in this report are largely self-explanatory and from them it will be seen that much has been done. Much however remains to be done and in the light of the staff-patient ration the recommendations contained in the Buillebaud Report of 1956 still have great importance. The most important of these recommendations were the following:- 1. The value of fluoridation of the water supplies. 2. Desirability of increased dental health education. 3. More research work into the causes of and prevention of dental disease. 4. More efficient dental service for the priority classes. 2 and 4 above depend very largely upon the ability to secure more dentists and in the near future possibly ancilliary workers. The Ministry of Health investigations under heading 1 in their special test areas are due to finish this year and the Ministry's opinions and recommendations are awaited with interest. DENTAL INSPECTION AND TREATMENT Periodic Specials (a) Number of pupils inspected 9,317 511 (b) Number found to require treatment 5,465 511 (c) Number offered treatment 4,757 511 (d) Number actually treated 3,237 511 (e) Number awaiting treatment 67 - (f) Attendances made by pupils for treatment 11,026 762 (g) Half-days devoted by:- No. (a) Dental Officers to - (i) Periodic (school) inspection 89 (ii) Treatment 1,670 (b) Dental Hygienist to - (1) Treatment 92 (ii) Other purposes ... ... ... 35 (87) No. (h) Number of X-ray examinations 641 (i) Fillings - (i) Permanent teeth 5,823 (ii) Temporary teeth 2,108 (j) Number of teeth filled - (i) Permanent teeth 5,023 (ii) Temporary teeth 1,997 (k) Extractions - (i) Permanent teeth - (a) on account of caries 727 (b) for other purposes 1,074 (ii) Temporary teeth - (a) on account of caries 1,364 (b) for other purposes 357 (1) Anaesthetics administered - (i) Local 2,112 (ii) General - (a) by Medical Officers on County Staff – (b) by others 1,306 (iii) Average number of general anaesthetic cases per general anaesthetic session 14,4 (m) Orthodontics - (i) Cases commenced during year 75 (ii) Cases carried forward from previous year 206 (iii) Cases completed during year 70 (iv) Cases discontinued during year 18 (v) Pupils treated with appliances 126 (vi) Removable appliances fitted 122 (vii) Fixed appliances fitted 4 (viii) Total attendances 1,326 (ix) Number of sessions devoted to treatment 138 (n) Number of - (i) Pupils supplied with artifical dentures 30 (ii) Dentures fitted 30 (o) Other operations - (i) Permanent teeth 2,915 (ii) Temporary teeth 1,058 (p) Number of other operations in (o) carried out by Dental Hygienist - (i) Permanent teeth 426 (ii) Temporary teeth – (q) Analysis of figures in (o) - (i) Silver Nitrate Treatment 407 (ii) Scaling, Polishing & Cleaning 759 (iii) Gum Treatment 45 (iv) Dressings 1,561 (v) Crowns fitted 13 (vi) Other operations 1,188 (88) DENTAL INSPECTIONS IN SCHOOLS School No. of children inspected No. requiring treatment No. referred for treatment No. accepting treatment Percentage of acceptances Leyton County High, Boys 634 275 267 97 36.4 Tom Hood Secondary Technical 419 182 177 66 37.1 Connaught Secondary Modern 378 231 231 91 39.4 George Mitchell „ „ 600 350 350 100 32. Goodall „ „ 225 181 181 140 77.3 Lake House „ „ 537 372 364 124 34.1 Leyton Manor„ „ (Two visits) 491 322 197 56 28. 465 315 196 60 30.6 Ruckholt " " 579 296 296 93 31.4 Barclay Primary Junior 541 270 176 103 58. Church Mead „ „ (Two visits) 357 228 172 78 45. 379 222 145 86 59.3 Davies Lane „ „ 265 162 162 99 61.1 Downsell „ „ 305 279 279 144 51.6 George Tomlinson " " 261 160 158 88 55.6 Mayville " " 267 200 195 62 31.8 Sybourn „ „ 353 198 148 69 46.5 St.Josephs „ „ 234 140 140 96 68.6 Barclay Primary Infants 280 177 146 97 66.4 Church Mead „ „ (Two visits) 261 187 141 75 53. 186 115 91 31 34. Davies Lane „ „ 128 67 67 44 65.7 Downsell „ „ 159 109 109 63 57.7 George Tomlinson „ „ 123 54 54 33 61.1 Mayville „ „ 155 85 84 55 65.5 Sybourn „ „ (Two visits) 214 162 131 75 57. 148 115 94 43 45.7 Harrow Green E.S.N. 92 67 62 28 45.2 (89) Child Guidance Clinic TABLE I ANALYSIS OF FIGURES FOR 1961. I. Cases on the books of the clinic at the end of the Year (i) Cases awaiting first appointment 29 (ii) Cases diagnosed and awaiting treatment Nil (iii) Cases under treatment 48 (iv) Other cases 78 II. Cases referred during the Year (a) Under fives - Boys 9 - Girls 1 (b) Over fives - Boys 52 - Girls 29 III. Source of referral General Practitioners 6 Head Teachers 11 Consultants 4 Children's Officer Nil School Medical Officers 44 Probation Officer 2 Health Visitors 5 Magistrates Nil Educational Psychologist 16 Parents 3 IV. Cases closed during Year and other cases for which treatment ceased (i) Treatment completed and case closed 21 (ii) Other treatment, cases closed 19 (iii) Other (untreated) cases closed 28 V. Treatment carried out during Year Psychiatrists 456 Psychotherapists 213 Psychiatric Social Workers 803 Educational Psychologist 111 (90) TABLE II ANALYSIS OF CASES REFERRED 1. Nervous disorders, e.g. fears; depressions; apathy; excitability 23 2. Habit disorders and physical symptoms; e.g. enuresis; speech disorders; sleep disturbances; tics; fits, etc. 7 3. Behaviour disorders; e.g. unmanageable; tempers, stealing, lying; sex problems, etc. 42 4. Educational; e.g. backwardness; failure to concentrate 16 TABLE III ANALYSIS OF CASES DIAGNOSED 1. Nervous disorders, e.g. fears; depressions; apathy; excitability 44 2. Habit disorders and physical symptoms; e.g. enuresis; speech disorders; sleep disturbances; tics; fits, etc. 3 3. Behaviour disorders; e.g. unmanageable; tempers; stealing, lying; sex problems, etc. 10 4. Educational, e.g. backwardness; failure to concentrate 7 5. No basic disturbance of child, e.g. mainly parental over- anxiety – TABLE IV ANALYSIS OF CASES CLOSED DURING 1961 1. Improved and recovered after treatment 26 2. Improved after partial service, i.e. before diagnosis 1 3. Diagnosis and advice only 2 4. Interrupted, e.g. on parents* initiative 23 5. Closed for miscellaneous causes, removed from area, placement at E. S. N. School, etc. 12 6. Spontaneous Improvement 11 (91) I am indebted to Dr.H.Gillespie, Consultant Psychiatrist for the following report:"COMMENTS ON ASSESSMENT OF FIGURES After a great deal of discussion with all the Child Guidance Clinics in Essex the County School Medical Officer has now asked all child Guidance Clinics to submit their returns in a new form and at the end of each quarter. The figures for Leyton are therefore given under these revised headings. The section headed 'Source of Referral' is a good illustration of the difficulties that beset anyone trying to summarize the kind of work that the Child Guidance Clinics do. Owing to the gradual development of the network of inter-relations between all the various people concerned with the mental health of children, it is often difficult, if not positively misleading, to say who was responsible for bringing the child's problems to the Child Guidance Clinic. For instance the Head teacher may ask a parent to call to discuss a child's school work. From this discussion the Educational Psychologist may be brought in, the Health Visitor, or Probation Officer and School Medical Officer. Or alternatively, a parent may discuss his child's difficulties with his family doctor who may then write to the Psychiatrist at the Child Guidance Clinic or send the child to the out-patients at the hospital or telephone the Head Teacher, with so many 'routes' to the Child Guidance Clinic who is to say which person was the 'Source of Referral'? TRAINING Or STUDENTS Four students in the London School of Economics Mental Health course sent to us for. part of their practical training 1959/1960 have since been qualified and four more students will be supervised during this academic year. Two students, training to be Educational Psychologists at the Tavistock Clinic did their practical work "in the field" at our clinic. Also we had a teacher training to work with maladjusted children at the University of London Institute of Education attached to our clinic for practical work for a year. Lea Bridge Day School for Maladjusteds continues to extend the work of the Child Guidance Clinic in a new field. Close links between teachers, Educational Psychologists, and Psychiatric Social Workers have been established. Psychiatric sessions were started at the school for the purpose of giving support to the school staff but had to be interrupted on account of administrative difficulties. There are 31 children on the school roll, of whom 30 were placed there on recommendation of the psychiatrists at this clinic. Nine of these children are from the part of the Forest Division which is served by this clinic. The Psychiatric Social Workers continue to attend case conferences with the school staff, when their work with the parents is discussed. ACTIVITIES OF STAFF OUTSIDE THE CLINIC One discussion group for Health Visitors in Leyton continues, participants numbering 68. The other one, originally taken by Miss Court will restart as soon as the newly (92) appointed Pyschiatric Social Worker has gained sufficient experience in the field. In addition case work is being done by the Psychiatric Social Workers with the children at Lea Bridge Road day school for maladjusteds and at Nazeing Park School. Such work mostly necessitating visits to the parents homes which are scattered over a wide area. With an increase of Psychiatric Social Worker staff we are glad to record that many more home visits have been made during the year, when, for various reasons, the parents were not able to attend the clinic premises. Forty-nine such visits were paid during the year. STAFFING Miss Court, Psychiatric Social Worker at the clinic, left on 2nd June to take up work in a research project at the Institute of Criminology of the University of Cambridge. We welcome to the clinic two new Psychiatric Social Workers, Mrs. P. A. Pearmain and Miss J.D.Ford. Miss Ford received her practical training in the Mental Health Course at this clinic. Mrs. J. Elkan was appointed as child psychotherapist last March for two sessions per week. The total number of sessions now worked by the child psychotherapists is eight out of a total of ten. " B.C.G. Vaccination (i) No. of schoolchildren skin tested 1,007 (ii) No. found positive 63 (iii) No. found negative 944 (iv) No. vaccinated with B.C.G 903 (93) Speech Clinic CHILDREN HAVING RECEIVED TREATMENT DURING 1961. Under 5 years Primary School Secondary School Special School TOTAL Cases commenced before 1961 and continuing after December, 31st 1960. Articulation Defect 6 24 3 18 51 Stammer – 2 6 – 8 Articulation Defect and Stammer – 3 2 1 6 Total 6 29 11 19 65 Articulation Defect 15 43 1 6 65 Cases commencing treatment during 1961. Stammer – 7 2 – 9 Articulation Defect and Stammer – 1 – – 1 Total 15 51 3 6 75 Therefore total cases receiving treatment during 1960 - 140 Total new cases - 75. Boys Girls Total Children at present undergoing treatment 76 40 116 Children discharged 30 19 49 On Waiting List Nil Average number of cases treated daily 23 Homes visited 6 School departments visited 31 Parents interviewed 100 Children referred to other clinics 4 Number of children leaving before cure or discharge 25 Total number of attendances 2,769 Number of children not at present attending but names on list 70 Number of children referred found not to require treatment 2 (94) Chiropody Clinics Chiropody treatment for school children is provided at each of the Health Clinics in the area at the request of the staff of the Minor Ailment Clinic or the private practitioner. 311 children were accepted for treatment and 325 were discharged and a total of 2,397 attendances were made by children at the clinics. The new cases were treated for the follovang conditions:- Condition Under 5 yrs. 5-7 7-9 9-11 11-13 13 + TOTAL M F M F M F M F M F M F Verrucae 2 1 4 5 3 9 22 32 31 58 21 39 227 Callous – 1 – – – – – 1 – – 1 4 7 Corns 2 3 1 4 2 3 1 4 8 12 9 11 60 Hallux Valgus – – – – – – – – – 1 – 3 4 Ingrowing Nail – – – – – – – 1 – 1 1 2 5 Club Nail – 1 – 1 - 1 - - 1 - - 1 5 Sub-lingual – – – – – – – 1 – – – – 1 Claw Foot – – – – – – – – – – 1 – 1 Hammer Toe – – – – – – – – – – – 1 1 TOTAL IN AGE GROUPS 4 6 5 10 5 13 23 39 40 72 33 61 311 PLANTAR WARTS IN SCHOOLGIRLS DOES BARE-FOOT PHYSICAL EDUCATION WORK AFFECT THEIR INCIDENCE? In an attempt to answer the above question a survey was carried out in Leyton over a period of 12- 13 months from February, 1960 - March, 1961. Two schools took part in the survey and the most vulnerable age groups 12-13 and 13-14 years were chosen. It was agreed with the Head Teachers, Physical Education Mistresses and Physical Education Organiser, that each class should be divided into two groups, one half to wear shoes and the other half to be bare-footed for all physical education work. (95) The children were inspected by the same School Medical Officer during the survey. They were seen four times in all, at the beginning of the survey, once each term and at the end of the survey. If a girl developed a verruca between the Medical Officer's inspections the Physical Education Mistress recorded the fact on the inspection sheet. The great majority of verrucas were treated at the local clinic, very few girls going to their own doctor. Girls who developed verrucas during the survey wore shoes afterwards unless they were in the bare-feet group and expressed a desire to continue the activities bare-footed. The Physical Education Organiser tested the girls feet for flexibility at the beginning and the end of the survey. This attribute was marked on a four-point scale taking into account:- (a) Degree of mobility of the bones in the foot and ankle. (b) Strength and muscle tone of the foot and ankle. At the final test no reference was made to the marks given in the first test. SUMMARY OF TOE INCIDENCE OF VERRUCAS School A - Girls' Grammar School Eight classes in the second and third year were inspected, 230 girls in all. At the first inspection 11 girls were found to have verrucas, i.e. just under 5%. Three of these children were under treatment at the first inspection and eight were found by the Medical Officer. One hundred and twelve girls continued to work bare-foot for the period of the survey, 13 months in all. Seven girls wearing shoes developed verrucas during the period of the survey. Six girls without shoes developed verrucas during the same period. At the final inspection 206 girls were seen, six having left the school, four having dropped out of the experiment because of intercurrent illness and 14 being absent on the day of the inspection. At the final inspection six girls were found to have verrucas, (four already under treatment and two were discovered on that day). This gives a rate of just under 3%. The results of enquiry at the school after the survey and investigation of verrucas treated at the local foot clinic did not suggest that the 24 absentees could have had verrucas on the day of the inspection so that the figure of less than 3% is not an under estimate of the incidence at the final survey. At the initial inspection the percentage of cases found was almost 5% and at the end of the survey slightly less than 3% of the girls had verrucas. It would seem, therefore, that the conclusions to be drawn are that whereas (96) barefoot work does not affect the incidence of verrucas in anyway, inspection and the focussing of attention on the problem may reduce the number of cases. School B - Secondary Modern Mixed School The girls in this school do Physical Education separate from the boys who were not included in the survey. Eight classes in the second and third year were inspected, 146 girls in all. At the first inspection nine verrucas were found (four already under treatment and five discovered), giving a rate of just over 6%. Seventy-two girls continued to work barefoot for the next 13 months. Three girls wearing shoes developed verrucas during this period. Five girls without shoes developed verrucas during this period. At the final inspection three verrucas were found (two under treatment and one being discovered at the inspection). By the final inspection only 113 girls were seen so that this gives a rate of 2.6%. The numbers fell so much because almost a whole form left school a few weeks before the final inspection and there were a few absentees. Follow-up enquiries at school and the local foot clinic revealed no record that any of the absent children developed verrucas so that 2.6% cannot be considered as an under estimate of infection at the final inspection. As in school 'A* it would appear that inspection and the focussing of attention on the care of the feet improves the incidence of this infection. FLEXIBILITY OF THE FEET No girl had feet in good condition and approximately 50% had feet in fair condition, i.e. flexibility but with poor muscle tone. Approximately 50% had feet in poor condition, i.e. stiff joints and poor muscle tone. The results also did not suggest that the feet of the girls who did barefoot work were any better at the end of the survey than those who wore shoes. Indeed there was some evidence that the feet were in a poorer condition. Both the Physical Education Organiser and the Medical Officer were appalled at the poor condition of the girls feet (apart from orthopaedic defects) and both these observers consider that the type of shoes the girls wear and the very little walking that they appear to do have adverse affects on the muscle tone. It is hoped to write up this survey in much greater detail and if possible publish it in one of the medical journals. Although the figures are perhaps not significant the evidence such as it is does not suggest that the wearing of shoes affects the incidence of verrucas one way or the other. (97) (98) HANDICAPPED PUPILS CATEGORY Number of children of school age on 31st December, 1960, formally ascertained as handicapped pupils and requiring special educational treatment (s.e.t.) Children of school age on register of handicapped pupils but not requiring s.e.t. and attending ordinary schools Children aged 2-5 years ascertained as handicapped pupils Children aged 2-5 years on register but not formally ascertained Attending day special school Awaiting placement in day special school Attending residential special school Awaiting placement in residential special school Attending boarding homes Awaiting placement in boarding homes Attending independent schools Awaiting placement in independent schools Attending hospital schools Awaiting placement in hospital schools Receiving Education in hospital under Section 56 Receiving home tuition under Section 56 Awaiting home tuition under section 56 Total number of children of school age requiring s.e.t. Receiving Special Education Awaiting Special Education Blind – – – – – – 2 – – – – – – – 2 – – – – Partially sighted 1 – – – – – – – – – – – – – 1 6 – – 5 Deaf 3 – – – – – – – – – – – – – 3 – 1 – – Partially deaf 5 – 1 – – – – – – – – – – – 6 10 3 – – Delicate 1 – 2 – – – 5 – – – – – – – 8 – – – – Physically Handicapped 23 – – – 1 – 1 – – – 4 2 – - 31 34 – 1 18 E.S.N 86 – 1 2 – – 3 – – – – – – – 92 – – – 14 Maladjusted 23 – 7 4 – – 9 4 – – – – – – 47 1 – – – Epileptic 1 – – – – – 1 – – – – – – – 2 2 - - 4 Speech defect – – – – – – – – – – – – – – – – – – – Dual defects 2 – – 2 – – – – – – – – – – 4 – – – 1 TOTAL 145 – 11 8 1 – 21 4 – – 4 2 – – 196 53 4 1 42 Leyton Special E.S.N. Schools The Special Schools in Leyton are regularly visited by one Assistant Medical Officer, which ensures continuity of medical supervision within the schools. Number on Roll in 1961 Varied from 194 to 203 Leyton 83 - 87 Forest 113 - 119 Number admitted 1961 54 Number left 1961 44 Reasons for leaving:- 1. Attained age of 16 - (a) Reported as requiring Community Care 13 (b) Not reported 8 2. No longer in need of special education 5 3. Notified as unsuitable for education under section 57 3 4. Removal to other areas 12 5. To Residential School (E.S.N.) 1 6. Returned to Normal School 1 7. To Spastic Unit 1 LEYTON GREEN PRIMARY (E.S.N.) SCHOOL Specials Boys Girls No. inspected 66 40 Parents present 16 6 Unsatisfactory 4 4 Code No.4 Skin 2 1 (99) Specials Boys Girls 5 (a) Vision 4 7 (b) Squint 2 4 (c) Others – 2 6 (a) Hearing 11 4 (b) 0.Media 2 1 (c) Others 2 – 7 Nose and Throat 5 – 8 Speech 4 2 9 Lymphatic glands – – 10 Heart 1 1 11 Lungs 1 - 12 Developmental- (a) Hernia – – (b) Others 2 1 13 Orthopaedic- (a) Posture – – (b) Feet 7 2 (c) Others 1 – 14 Nervous System- (a) Epilepsy – 3 (b) Others – – 15 Psychological- (a) Development 10 1 (b) Stability 7 3 18 Abdomen 11 2 HARROW GREEN SECONDARY (E. S. N.) SCHOOL 1945 Routine 1946 Routine Specials Boys Girls Boys Girls Boys Girls No. inspected 9 14 11 2 36 15 Parents present 3 13 3 2 4 3 Unsatisfactory – – 2 1 3 2 Code No.4 Skin – 1 1 1 – – 5 (a) Vision 2 5 – – 6 2 (b) Squint – 1 – – – 1 (c) Others – – – – 1 1 6 (a) Hearing – 2 1 – 8 2 (b) 0.Media – 2 – – 2 – (c) Others – – – – – 1 (100)  1945 Routine 1946 Routine Specials Boys Girls Boys Girls Boys Girls 7 Nose and Throat – 1 1 1 1 – 8 Speech 1 – – – 2 – 9 Lymphatic glands 1 – – – 1 – 10 Heart – – – – 1 1 11 Lungs 2 2 2 2 3 1 12 Developmental - (a) Hernia – – – – – – (b) Others – – – 1 – – 13 Orthopaedic - (a) Posture – – 1 – – – (b) Feet 1 2 1 2 2 2 (c) Others 1 2 – – – – 14 Nervous system - (a) Epilepsy – – – – 1 2 (b) Others – – – – 2 – 15 Psychological - (a) Development – – – – 3 1 (b) Stability 3 6 2 1 5 5 18 Abdomen – – – – 1 1 LEYTON SPECIAL E.S.N. SCHOOLS A full report was submitted on both these schools in 1960 and there is no fresh comment to be made on either school. The School Medical Officer visits each school on an average of 3 sessions per month all through the year and sees with or without parents, all children who require attention. Those with defects found at previous examinations are also re-inspected each term. The School Health Visitor visits each term for cleanliness and general survey and children attend the school clinics which are nearby, within a few minutes walk of the school, if any minor ailments require attention. The Headmaster consults with the School Medical Officer or the School Health Visitor if any problems arise at any time. Any parent who wishes to see the School Medical Officer can do so and are sent an appointment to suit them. All school leavers are medically examined and a report is sent to the Juvenile Employment Officer on the child's potential abilities for employment as well as on physical condition. The Juvenile Employment Officer comes to the school before the child is due to leave and discusses with the headmaster, parent, and if appropriate, the School Medical Officer before deciding what type of work the child should take up. Many of the children in the E.S.N. School have emotional problems and we try to deal with these as well. Ocassionally the help from an educational psychologist from the Child Guidance Clinic is invoked. At the present moment in Leyton Green School there are two children who may be considered as much maladjusted as E. S. N. and these are being referred to the Child Guidance Clinic for consideration. (101) A very helpful addition to the educational team has been Mr.Head, the peripatetic teacher of the deaf. He supervises the children who wear hearing aids and has been particularly helpful in the case of a boy who came into this area from another special school a few months ago. The boy has a considerable degree of deafness but he was extremely difficult over wearing his hearing aid and was badly behaved in school and not making progress at his school work. Mr. Head was able to have his hearing aid altered and a much more acceptable type of aid has now been given to the boy. The improvement in the boy's behaviour and general happiness is quite extraordinary and he never comes without his aid now and is making good progress at school. LEA BRIDGE SCHOOL FOR MALADJUSTED CHILDREN Number of children on the role at end of 1961 - 30 Boys - 24 Girls - 6 Age range from 7% to 13-9/12 years - Primary - 24 Secondary - 6 Number of special inspections carried out in school - 41 Defects found:- Otitis Media 1 Visual Defects 3 Unsatisfactory general condition 4 Enuresis 1 Heart Lesion 1 All the children had a Sweep Pure Tone hearing test carried out. No hearing loss sufficient to require treatment was discovered. From the beginning of the summer term the school had a full staff so that the headmaster was able to organise it to the best advantage for the children's progress and it was felt by the beginning of the schools third year that the school was well established and making good progress. A full report was submitted last year and no fresh observations can be made on the points outlined in that report but comment must be made on the need for psychiatric sessions to take place at the school. Dr.Gillespie, the Psychiatrist, from the Child Guidance Clinic visited the school one day a month during the summer term. She interviewed parents and children and also discussed with school staff the many problems brought to her by them. Unfortunately this valuable help has been interrupted owing to certain difficulties which have arisen over the allocation of psychiatric sessions but it is hoped that the education authority and the Regional Hospital Board will be able to resolve the difficulties and the sessions resumed. The school for children with emotional and behaviour problems requires continual psychiatric help and it is a great pity that at the moment it is not available as freely as we would like. The School Medical Officer visits the school two to three sessions each term and (102) the headmaster is also in telephone communication when occasion warrants it. Mr.Head, the peripatetic teacher of the deaf has also visited the school and has been especially helpful to a girl with a hearing aid. Again, this child appeared to dislike wearing the hearing aid in school. She is not severely deaf and she should have been able to manage. The audiology unit, under whose care she was, suggested that she should attend a partially deaf school, but because her degree of deafness was not severe Mr.Head and the School Medical Officer were rather reluctant to agree to this. However, arrangements were made with the local partially deaf school for the child's transfer for three months to their school. She is now wearing her hearing aid continuously and making very good progress in the partially deaf school and the experiment has been extended for another six months. Although this child is seriously maladjusted it looks as if she is making a better adjustment in the partially deaf school than she would have done in the maladjusted school, but we will wait to see what the end of the experiment will reveal. The Educational Psychologist visits the school frequently and gives valuable help. She has a close liaison with the medical and teaching staff. HEARING AIDS There are fifteen children wearing hearing aids who are resident in Leyton, seven of whom are attending Special Schools outside the borough. AUDITORY TRAINING I wish to thank Mr.B. R. Head, Peripatetic Teacher of the Deaf, for the following report:- "There are eight partially deaf children with hearing aids in Leyton schools placed as follows: - Primary School 3 Secondary School 2 Nursery School 1 E.S.N. School 2 The two children in primary school are being visited weekly for Auditory Training, as is the child in the nursery school. The children in the other schools are less handicapped and do not need to be visited so frequently. The pre-school child mentioned in my last report has been placed in the William Morris School for the Deaf as has a child who was formerly placed in the Unit for Maladjusted children. In the latter case this placement is only temporary and the child concerned will probably leave the William Morris School at the end of this term. Her future placement has not yet been decided. One boy has been issued with a Philips' hearing aid after protracted trials to establish which type of aid would be most suitable for him. His teacher reports that he has far less difficulty in class since this aid was supplied. All, except one, of the children in normal schools are making adequate progress and give no cause for concern at present. The exception is a girl aged six years with a severe high tone loss. She is making progress, particularly in reading,her vocabulary (103) is growing and her understanding of speech is improving. Her mother is worried about; the quality of the child's own speech and it was agreed with the School Medical Officer that the work of the peripatetic teacher should be augmented by speech therapy as this child is so shy that she needs the individual attention of as many sympathetic adults as possible. May I, once more, express my appreciation for all the assistance I have received from the School Health Service during the year." OUTBREAKS OF INFECTIOUS DISEASE 1961 There have been no noticeable outbreaks ol infectious diseases except the increase in measles during the first half of 1961 which! followed the national pattern. I set out below a table showing the number of notifications of measles for children up to 15 years of age for the last 6 years: - Quarter ending 30 th June Quarter ending 30th September Quarter ending 31st December Quarter ending 31st March Year ending 31st March, 1957 146 85 576 624 Year ending 31st March, 1958 384 17 8 3 Year ending 31st March, 1959 6 72 352 667 Year ending 31st March, 1960 181 44 2 3 Year ending 31st March, 1961 3 66 203 718 Period to 31st December, 1961 433 21 22 – (104) TUBERCULOSIS IN SCHOOL CHILDREN One boy aged 14 years was notified as having tuberculosis of the lungs while in hospital; he has now been discharged to the care of the Chest Clinic. One boy 10 years of age with tuberculosis of the lungs removed into Leyton from another area and is now under the care of the Chest Clinic. One girl aged 8 years was notified by Queen Elizabeth's Hospital as having a tubercular infection of her left leg and is under the care of the hospital. DEATHS OF CHILDREN OF SCHOOL AGE During the year two children of school age died. The deaths were due to the following: - Broncho Pneumonia, Spastic Onadrlplegia Female aged 7 years Broncho Pneumonia, Acute Lymphatic Leukemia Male aged 12 years HEALTH EDUCATION The Health Visitors gave 182 lectures in schools at which the children made 3,048 attendances. Improvements to School Premises carried out during year ended 31st December, 1961 CONNAUGHT COUNTY SECONDARY GIRLS SCHOOL New annexe at Madeira Road comprising Gymnasium, Showers, Changing Rooms, Kit Stores, Sanitary and Washing accommodation on ground floor and two Science Rooms, Preparation Room and Lecture Room on first floor. Heating and Domestic hot water by oil-fired boilers. TOM HOOD COUNTY SECONDARY TECHNICAL SCHOOL Additional W.C. provided for male staff. NEWPORT PRIMARY SCHOOL Washup for meals service provided in Junior School. The undermentioned schools were redecorated Internally:- Tom Hood County Secondary Technical School - Assembly Hall Block. Church Mead County Primary Infants. Downsell County Primary Junior and Infants. (105) Printed by LEYTON BOROUGH COUNCIL