AC 4411 (1) Library LEY 56 BOROUGH OF LEYTON THE HEALTH OF LEYTON 1962 E. W. WRIGHT M.B., Ch.B., D.P.H. Medical Officer of Health, Borough of Leyton 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 1962 - 63 The Worshipful the Mayor: Councillor J.A.E.Collins, J. P. (ex-officio) Chairman: Alderman Mrs.A. M.M. Burrell Vice-Chairman: Alderman Mrs.J.Hammond, O.B.E., J.P. Alderman: Mrs.R.King Councillors: Mrs.E.Bartram Mrs. D.E.Collins Mrs. E.M. Dare, J.P. A.H. Mackay F. W. Marshall W.H.Sanders F.W.Wigg STAFF Medical Officer of Health: E.W.Wright, M.B., Ch.B.. 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 1962 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. As I took up my appointment late in the year the services described in this report were in the first months under the direction of my predecessor Dr.G.T.Crook and then after he left of my deputy Dr.Mary Gilchrist, who once again carried the responsibility of the department as she has done for several quite lengthy periods in the past. I should like to record my appreciation of their work and in particular to Dr.Gilchrist for her help since I took up office. The rate of decrease in the total population of the borough slowed up a little to be 92,970 at mid-year but the birth rate at 14.99 per 1,000 population continued its rise of recent years. At the same time the increasing length of life has increased the number of old people in need of help, so that the two extremes of life which are the principle concern of the Health Department continue to put pressure on the services provided. In the case of some services this pressure forces itself upon one's attention because the patient seeks aid but in other cases all the initiative must be taken by the local authority. Examples of the first are the Midwifery and Chiropody Services both of which have been under strain. The over-pressed Maternity Hospitals are unable to book more mothers and urge the Local Authorities to take more of the work onto the district, providing for more mothers to be confined at home and more to be discharged from hospital early. The need must be met somewhere and the rising birth rate is forcing a choice between overworking the staff or allowing a less comprehensive standard of care. The desire of all of us to increase the amount of education in aspects of health of a type which the midwife is particularly suited to giving will have to remain a desire which cannot be fully met in the immediate future. Similarly the demand on the Chiropody Services due to increasing numbers of applications combined with shortage of staff is making a less comprehensive standard of care inevitable. The intervals between appointments have had to be increased further than the staff consider desirable and at the end of the year had reached a point at which the only possible answer was to restrict the service to priority groups. We are caught in a vicious circle as patients unable to obtain Local Authority treatment seek private treatment, which pushes up the amount of work available privately and makes the shortage of applications by chiropodists for Local Authority work even more acute. In cases where the initiative must be taken by the Local Authority a danger which must be watched at every turn is the possibility of a gradual falling off in the sensitivity of the department to those in need who do not seek aid. The aged and infirm, those under mental strain, or under temporary stress, can all be greatly helped by the staff of the Health Department. Though often the General Practitioner may initiate the provision of help, in many cases he has not been recently consulted by the patient and has no up-to-date knowledge of the situation. 2 For these reasons it is the policy of this department to maintain the highest possible degree of communication with all people who are in touch with those in need, and Leyton may indeed be proud of the excellent relationships which exist between the staff of the Health Services and the General Practitioners, the schools and with many voluntary organisations. Good though they are there is still much more to be achieved in increasing the number of links with the public at risk, and stimulating an even better flow of information and help along them. It is particularly to be hoped that progress will be made in this way in helping older people. It is the older person, frequently living alone, who more than any others is not receiving help. In the first place the decline in abilities and amenities has been so gradual that there is no awareness by the patient just how great their need is; how much anaemia or vitamin deficiency, failing senses, or lack of communication with others has taken the joy out of life. In the second place the very lack of communication has meant that no member of the public has felt it to be their business to take the necessary steps for help to be made available. Finally the state of mind of the old person may well have become that of not wanting help in any form, or at least not in the only forms in which it is possible to offer it. Everyone is entitled to their own point of view, but also compassion must take account of how much a point of view is conditioned by circumstances. One must allow for the desire to maintain a feeling of security by trying to prevent any change, the desire to keep up a facade of self-respect by appearing to be able to manage one's own affairs, jealousy of those who have full command of all their faculties, or even of those who are enjoying benefits of all kinds not available to the previous generation. It can be bitterly hard to cope with being old. It is the aim of all our staff, helped by other workers, statutory or voluntary, by neighbours, friends, and intimate family, to help in softening the distrust or false pride which makes an old person refuse help, until help is at first accepted and then welcomed and a new self respect emerges from the feeling of being wanted, however faint this feeling may be. A new feature during the year was the Child Guidance Clinic in Dawlish Road which has taken over the work done for Leyton by the walthamstow Clinic and taken on more beside. A point of particular interest about this is that the Child Psychiatrist has a joint appointment which includes part-time at Whipps Cross Hospital as well as parttime at the Clinic. This is a field in which Leyton is in the fore-front of progress as it has so often been in the past. Joint appointments of Psychiatrists partly in hospital and partly in the community are rare but there is no doubt that this is the pattern for the future. The mentally distressed and anxious patient more than any other needs continuity of care and it is highly desirable that the same person should have charge of treatment both in the community and in hospital. Even more is this true when the patient is a child. Progress in improving the environment continues. During the year the Leyton Smoke Control Order No.2 came into operation and Order No.3 was declared by the Council, the Leyton Avenue Road/Morris Road Clearance Area was represented and the Public Local Inquiry in respect of the second stage of the Beaumont Road Area completed the work of this department as far as the clearance of the area is concerned. Details of these and the many other facets of the work of the Public Health inspectorate are set out in the section by the Chief Public Health inspector which is included in this report. I am grateful to all members of the staff for their work during the year and to 3 those of other departments where the functions of the Health Department have needed their help ana co-operation. I would also like to express my appreciation of the support of the Council and in particular of Alderman Mrs.A. M.M.Burrell, Chairman of the Public Health Committee and Alderman Mrs.J.Hammond, 0. B.E., J. P., Chairman of the Leyton Health Area Sub-Committee whose constructive interest has been much valued. I have the honour to be, Mr.Mayor, Ladies and Gentlemen, Your obedient Servant, E.W.Wright 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, 1962) 92,970 Assessable Value for General Rate Purposes £1,377,915 General Rate in the £ (1962/63) 27s.2d The Registrar-General's mid-year 1962 estimate of population (viz., 92,970 has been used for the calculation of the following statistics- Live Births 1,394 Live Birth Rate per 1,000 population 14.99 Stillbirths 27 Stillbirth rate per 1,000 total (live and stillbirths) 19.00 Total Live and Stillbirths 1,421 Infant Deaths 34 Infant Mortality rate per 1,000 live births 24.39 ” ” ” ” 1,000 legitimate births 25.4 ” ” ” ” 1,000 illegitimate births 10.53 Neo-Natal Mortality Rate (first four weeks) per 1,000 related live births 19.37 Early Neo-natal Mortality Rate (first week) per 1,000 related live births 19.37 Peri-natal Mortality Rate (stillbirths and deaths during the first week) per 1,000 total still and live births 38.00 Percentage of illegitimate live births 6.81 Maternal Deaths (including abortion) - Maternal Mortality Rate (including abortion) per 1,000 total live births - Total Deaths 1,394 Death Rate 14.99 Natural decrease of Population - It will be seen that there is no natural increase or decrease of population as, for the first time since records were kept, the number of deaths exactly corresponds with the number of registered live births. Comparability Factor To make approximate allowance for the way in which the sex and age distribution of the Borough population differs from that for England and Wales as a whole, the Registrar-General has issued the following comparability factors for Leyton. Area comparability factor for births 1.01 Area comparability factor for deaths 0.79 These factors, when applied to the crude rates, produce the following adjusted rates:- Live Births 15.14 Deaths 11.84 5 COMPARATIVE STATISTICS OP BIRTHS, MORTALITY, ETC. LEYTON 1901-1962 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 1962 92, 970 1,394 14.99 1,394 14.99 34 24.39 * 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 1962 (1,394) compares with (1,406) in 1961 the respective death rates per 1,000 population being 14.99 and 15.06. CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE-1962 CAUSES OF DEATH TOTAL AGE GROUPS - MALES TOTAL MALES AGE GROUPS - FEMALES TOTAL FEMALES UNDER 1 1-4 5-14 15- 24 2544 4564 6574 75 + UNDER 1 1 - 4 5- 14 1524 2544 4564 6574 75 + 1. Tuberculosis, respiratory 12 - - - - 1 3 3 1 8 - - - - - 2 1 1 4 2. Tuberculosis, other - - - - - - - - - - - - - - - - - - - 3. Syphilitic disease 1 - - - - - - 1 - 1 - - - - - - - - - 4. Diphtheria - - - - - - - - - - - - - - - - - - - 5. Whooping Cough - - - - - - - - - - - - - - - - - - - 6. Meningococcal Infections - - - - - - - - - - - - - - - - - - - 7. Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - 8. Measles - - - - - - - - - - - - - - - - - - - 9. Other infective and parasitic diseases - - - - - - - - - - - - - - - - - - - 10. Malignant neoplasm stomach 32 - - - - - 6 6 5 17 - - - - - 1 3 11 15 11. Malignant neoplasm lung, bronchus 73 - - - - - 32 21 7 62 - - - - 1 5 5 - 11 12. Malignant neoplasm breast 26 - - - - - - - - - - - - - 1 10 3 12 26 13. Malignant neoplasm uterus 7 - - - - - - - - - - - - - - 3 3 1 7 14. Other malignant and lymphatic neoplasms 106 - 1 - 2 4 22 15 18 62 - - - 1 2 14 10 17 44 15. Leukaemia, aleukæmia 5 - - - 1 - 2 - 1 4 - - - - - 1 - - 1 16. Diabetes 8 - - - - - 1 3 - 4 - - - - - 2 1 1 4 17. Vascular lesions of nervous system 161 - - - - 2 12 15 33 62 - - - - - 11 16 72 99 18. Coronary disease, angina 226 - - - - 2 43 51 32 128 - - - - - 15 31 52 98 19. Hypertension with heart disease 32 - - - - - 1 4 5 10 - - - - - 1 6 15 22 20. Other heart disease 254 - - - - 2 7 12 49 70 - - - - 2 8 26 148 184 21. Other circulatory disease 58 - - - - - 4 12 11 27 - - - - - 7 6 18 31 22. Influenza 9 - - 1 - - 1 - 2 4 - - - - - 1 - 4 5 23. Pneumonia 102 3 - - - - 9 6 26 44 1 1 - - - 5 7 44 58 24. Bronchitis 86 - - - - - 12 27 28 67 - - - - 1 2 5 11 19 25. Other diseases of respiratory system 7 - - - - - 3 - 2 5 - - - - - - 1 1 2 26. Ulcer of stomach and duodenum 16 - - - - - 4 4 3 11 - - - - - - 4 1 5 27. Gastritis, enteritis and diarrhoea 5 - - - - - - 1 - 1 - 1 - - - - 3 - 4 28. Nephritis and nephrosis 7 - - - - - 1 1 2 4 - - - 1 - 1 - 1 3 29. Hyperplasia of prostate 5 - - - - - 1 2 2 5 - - - - - - - - - 30. Pregnancy, childbirth, abortion - - - - - - - - - - - - - - - - - - - 31. Congenital malformations 11 4 1 - - 1 1 1 - 8 1 - - - - - 2 - 3 32. Other defined and ill-defined diseases 98 7 - 1 - - 12 6 14 40 14 3 - 5 2 3 9 22 58 33. Motor vehicle accidents 7 - - - 1 - 2 - 1 4 - - 1 - - 1 - 1 3 34. All other accidents 22 - 4 - 1 3 3 1 3 15 - - - 1 - 2 - 4 7 35. Suicide 18 - - - 2 1 3 2 -1 9 - - - - 4 3 1 1 9 36. Homicide and operations of war - - - - - - - - - - - - - - - - - - - TOTALS 1,394 14 6 2 7 18 185 194 246 672 16 5 1 8 13 98 143 438 722 BURIAL OF THE DEAD During the year 14 burials were arranged by the Department, for persons who had died or been found dead within the Borough, and where no private arrangements were being made for the disposal of the body. 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 Chlorine 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.G.K.Barker, B.Sc. (Eng.), A.M.I.C.E., A.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 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 is 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 flows or flow arriving when the L.C.C. outfall is itself full are retained in tanks in the Council's Auckland Road Depot until such time as the discharge is able to be recommenced. (3) The larger part of the present sewerage system in the Borough is some 70-90 years old and the Council have embarked on a programme of redrainage, treating each drainage area in turn. The contract for the first section is nearly complete; this is the West Leyton Area, part of which serves the Crescent Road Redevelopment Area. Also nearing completion is another contract for reconstruction of the control and pumping arrangements for sewage from the whole of the Borough at Auckland Road Depot. 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 lymph for vaccination; supply of diphtheria toxin (F.T.) (c) Counties Public Health Laboratories, Queen Victoria Street, London. For bacterial and chemical examination of water, milk and other foods. (d) Public Analysts, Analytical Laboratory, 20 Eastcheap, E.C.3. For analysis under provisions of Food and Drugs Act, 1938. 9 AMBULANCE FACILITIES The County Council administer the ambulance service from Chelmsford, the vehicles and staff for this area being accommodated at the James Lane Ambulance Station, Leytonstone, E.11. Ambulances can no longer be obtained by telephoning the local station and all such requests must be made through ambulance control (Goodmayes 2311 or seven Kings 1023). 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 is one nursing home in the Borough registered under the provision of the Public Health Act, 1936:- 1 Queens Road, Leytonstone, E.11., with accommodation for 71 patients. HEALTH SERVICES CLINICS (See page 36) COMPASSIONATE LAUNDRY SERVICE The demand for this vital service, from people nursing incontinent patients in their own homes, continued to increase during the year and it would be difficult to exaggerate the appreciation of relatives for the regular collections and deliveries, which are a feature of this service. The growth of the service presented a problem in drying the large quantities of sheets, draw sheets and personal night clothing which were being laundered and this was resolved by the purchase and installation of a Hot Air Tumbler Dryer. STATISTICS Year Articles Laundered West Ham Leyt on 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 1962 8,643 20,626 29, 269 10 INFECTIOUS DISEASE - NOTIFICATIONS DISEASE Number notified during Year 1959 1960 1961 1962 Scarlet Fever 156 50 44 29 Erysipelas 10 6 5 9 Whooping Cough 29 42 20 34 Measles 894 215 1195 281 Diphtheria - - - - Acute Poliomyelitis - Paralytic 2 1 - - - Non-paralytic - - - - Tuberculosis - Respiratory 46 40 32 35 - Meninges and C.N.S. - 1 - - - Other 5 6 5 6 Meningococcal infection - 1 1 1 Acute Encephalitis, Inf. 2 - - - Post-inf. - - - - Dysentery 88 31 60 97 Ophthalmia Neonatorum - 3 - 2 Puerperal Pyrexia - 2 5 2 Pemphigus Neonatorum - - - - Typhoid Fever 1 11 - - Paratyphoid 1 - - - Food Poisoning 38 11 20 22 Malaria - - - - Pneumonia 167 47 59 35 Smallpox - - - - Anthrax - - - - 1439 451 1447 553 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, 1962. PULMONARY NON-PULMONARY TOTAL M F Total M F Total Number on register at commencement of year. 525 406 931 36 51 87 1018 Number first notified during year 20 15 35 2 4 6 41 Number entered in register otherwise than by notification 10 4 14 1 - 1 15 Number removed during year 56 33 89 2 2 4 93 Number remaining at end of year 499 392 891 37 53 90 981 Died 24 5 29 - - - 29 Removed from district 26 21 47 1 2 3 50 De-notified - - - - - - - Cured 6 7 13 1 - 1 14 Of the cases first notified during the year the age group distribution was as follows:- Periods • PULMONARY NON-PULMONARY M F M F Under 5 years - - - - 5-14 years - - - - 15-25 " 2 10 2 - 26-45 " 9 4 - 2 46-65 " 5 1 - 1 65 and over 3 1 - 1 TOTAL 19 16 2 4 12 Public Health Inspection of the Area -1962 Report of Chief Public Health Inspector 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. HOUSING - SLUM CLEARANCE - NUISANCE ABATEMENT The statutory duties and responsibilities of the Public Health inspectorate in relation to existing housing accommodation is concerned generally with the repair, demolition or closure of unfit houses, slum clearance and other matters arising from the issue of Certificates of Disrepair under the Rent Act, nuisance abatement and smoke control areas. Of these duties, none bring the Inspector closer to sociological problems of the community than those concerned with obsolescent housing, and more especially, houses which are "let in lodgings", or to use the terminology of the Housing Act, 1961, "Houses in Multiple Occupation". Multiple Occupation is a new name for an old problem, a problem which is concerned basically with the serious shortage of housing accommodation. The ever increasing number of people who for various reasons are unable to rent or purchase a house of their own seem to be fair game for the type of person who seeks to exploit the housing shortage by acquiring large obsolete houses, and letting off rooms to individuals or families, quite often without any adaptation to the structure, or the provision of additional facilities and amenities to meet the basic needs of the occupants. The plight of tenants occupying such accommodation is precarious, to say the least; because of the absence of rent control and security of tenure, they seem to be reluctant, if not afraid, to complain about the excessively high rents which may be charged, or to co-operate with the Local Authority in enforcing the owner to provide essential sanitary facilities, in case their action or their complaints should lead to eviction. In the circular (16/62) issued to Local Authorities in April of this year, the Ministry of Housing and Local Government drew attention to new powers contained in the Housing Act, 1961, and the Housing (Management of Houses in Multiple Occupation) Regulations, 1962. These powers fall into four main groups: (i) An entirely new power to apply a code of management to individual houses in which proper standards of management have not been observed. (ii) Stronger powers to require the provision of additional facilities and amenities essential to decent living conditions, and the provision of adequate means of escape from fire. (iii) A new power for Local Authorities to carry out works themselves in default, and recover the cost. (iv) A power, also new, to make a direction order limiting the number of persons who may live in a house or part of a house which is in multiple occupation. 13 Failure to comply with the Management Regulations or with a direction is punishable on summary conviction by penalties ranging from up to £20 for the first offence, to a maximum of £100 and three months imprisonment for second and subsequent offences. These are designed to deal primarily with the worst type of multi-occupied houses, where nothing less than strong action would be likely to achieve results. At the same time, the Minister relies on Local Authorities to make quite clear to the people concerned what it is that the regulations require to ensure the satisfactory management of these houses, and to give them every opportunity to put matters right before resorting to the new penalty provisions. As already suggested, the root of the problems associated with houses in multiple, occupation is the shortage of dwellings available for renting and the lack of security of tenure, and while the new powers are a step in the right direction, it is questionable whether they do, in fact, go far enough. The mere possession of these statutory provisions will not of itself, solve the problem. The new legislation neither prohibits the establishment of unsatisfactory houses, nor requires the owner or occupier to give notice to, or to seek permission from, the Local Authority, to let a house in lodgings. Planning powers also appear to be ineffective in preventing the establishment of houses of this type. At best, after considerable administrative procedure, they can be used to undo what has already been done, and penalise the persons responsible. To enforce minimal standards of amenity, and reduce overcrowding in houses in multiple occupation may also mean the displacement or eviction of some individuals or families for whom alternative accommodation will have to be found. A survey of housing accommodation in the Borough is at present being undertaken by the Public Health Inspectorate, to ascertain the extent of the problem of multiple occupations in Leyton, and appropriate action is being taken under the relevant statutory provisions. Over the past twelve months some 11,960 inspections and reinspections were made under Public Health Acts, Housing and Rant Acts, Prevention of Damage by Pests Act, Clean Air Act and other legislation; 1,729 complaints regarding unsatisfactory conditions were investigated, and 498 notices specifying works to remedy defects such as dampness, general disrepair, defective drainage, leaking roofs, etc. were served. In addition, pursuant to the requirements of Section 3 of the Housing Act, 1957, and the Housing Consolidated Regulations, 1925/32, some 795 houses were surveyed to ascertain their fitness for human habitation, having regard to the standard prescribed by the Act and the possibility or otherwise of their being included in a slum clearance scheme, or dealt with by demolition or closing order procedure. Legal proceedings arising from the failure of owners to comply with the requirements of notices served under the nuisance abatement procedure of the Public Health Act were initiated in 24 cases, and in all cases, the work was completed either before the date of the hearing, or after adjournement of the summonses. Such proceedings are not, however, always successful in enforcing essential repairs. In a number of instances, the Public Health Committee were obliged to consider alternative procedures under the Housing Acts. During the year under review 8 applications under the Rent Act, 1957, for certificates of disrepair, and 38 applications for certificates as to the remedying of defects etc. were received and dealt with by the Public Health Inspectorate; 8 notices (Form J) of the Council's proposal to issue such certificates were served on landlords, arising out of which 1 undertaking (Form K) to remedy defects specified thereon within a period of six months were submitted by the owners and accepted by the Council, and 7 certificates of disrepair were issued. 14 The statistical section of the report contains 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 and Clean Air Act, 1956. SLUM CLEARANCE AND REDEVELOPMENT AREAS The Council's programme in relation to slum clearance and re-development is proceeding satisfactorily. In October, an official representation in respect of a clearance area comprising 36 houses in Morris and Avenue Roads was submitted to the Public Health Committee, together with a report setting out details of the reasons- unfitness for habitation and general bad arrangement, etc.- why demolition of all the houses in the area was considered necessary. At its November meeting, the Public Health Committee recommended the Council to declare this area to be a clearance area 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 redevelopment of the area, and the re-housing of the persons to be displaced. A compulsory purchase order was subsequently confirmed by the Council at its meeting on 29th November, 1962. Detailed inspection of properties included in the third of the Council's main redevelopment areas is also in progress. Altogether some 795 inspections under Housing Acts have been carried out during the course of the year. A Public Local inquiry in respect of the second stage of the second area- The Leyton Housing (Beaumont Road Area) Compulsory Purchase Order, 1961, was held in the Town Hall on Wednesday, 23rd October. The order embraced three clearance areas, together with adjoining lands, the whole comprising a net area of 11.06 acres. The Inquiry was ordered by the Minister of Housing and Local Government to enable persons who objected to their properties being included in the Compulsory Purchase Order, either on the grounds that the houses were not unfit for human habitation, or because of other personal or business reasons, to be heard. At the time of preparing this Report, the Minister's decision had not been received. The Inquiry marked the final stage of a lengthy procedure which began in February, 1961, with a detailed inspection of all houses in the areas by the Public Health Inspectorate. An official representation, and full details of conditions existing in the areas was submitted to the Public Health Committee in November, 1961, when the Council was recommended to declare the areas to be clearance areas, in accordance with the provisions of Section 42 of the Housing Act, 1957. The Housing and Town Planning Committee dealt with the question of re-housing the persons to be displaced, and the manner in which the area was to be redeveloped. The Compulsory Purchase Order was subsequently confirmed by the Council at its meeting on 29th November. It may be of interest to recall some of the points included in the Report, detailing the main and material conditions affecting properties in the Beaumont Road Clearance Areas, which was submitted to the Public Health Committee, and to illustrate certain of these features with photographs (please refer to photographs between pages 16 — 17 when reading the outline report which follows). 15 BOUNDARIES OF THE CLEARANCE AREAS AND NUMBER OF BUILDINGS The three clearance areas are contained within an area bounded on the north-west by Capworth Street (odd numbers), on the southeast by Burchell Road and Skelton's Lane (odd numbers), on the south-west by Clyde Place, and on the north-east by the branch line of British Railways (London Midland Region). Altogether, there are 160 dwelling houses, including 8 dwelling houses which are used, or were formerly used, in part for business purposes. The total population of the 157 unfit houses in the clearance areas and three houses which were included on the grounds of bad arrangement only, consist of 202 families, comprising 553 persons. The average number of persons per houses is 3.5. Statutory overcrowding did not exist at any of the houses. TYPE AND DESCRIPTION OF DWELLING HOUSES The majority of houses in the Areas are situated in terraces, the exceptions being Nos. 108/110, 158, 160, 164, 166, 174/176, Beaumont Road; 115/117 Capworth Street; 78/80 and 88 Sophia Road which are semi-detached; Nos.207 Beaumont Road and la King Street which are detached; and Nos.186 Beaumont Road, 1 Clyde Place and 29 Sophia Road which are built in a block of three. Apart from nine three-storied houses (Nos.141-155 Capworth Street and No.1 Clyde Place), all the properties are of the two-storey type with single or two-storey back additions, except 21 houses which have no back additions. All houses have through ventilation, except Nos. 164, 166, 168, 170, 174, 176 Beaumont Road and la King Street, which are of the blank back type with through vent. on the ground floor only; all have yard space at rear, except la King Street which has space at the front and sides only. Frontages vary from 4ft. (106 Skelton's Lane) to 35ft. 13 houses (including 2 shops with living accommodation) have no forecourts; the depth of forecourts to the remainder varies from 4'6" to 23". The construction is traditional- brick walls, slated or tiled pitched or central valley gutter roofs, timber floors (with the exception of some scullery floors which are of concrete) and joinery work, plaster walls and ceilings. With the exception of 31 houses, W. C. s are situated externally. Internal accommodation varies from 3 rooms including scullery to 8 rooms. 18 houses have bathrooms, of which 2 are converted sculleries, 8 are lean-to's entered from sculleries, and 2 are externally entered out-buildings. Mains water supply is provided over scullery sinks. 13 houses have no internal halls or passages, so that living rooms are inter-communicating and entered direct from the street or forecourt. At 23 houses, staircases rise from living rooms. PRINCIPAL GROUNDS OF UNFITNESS FOR HABITATION Following is a summary of the principal grounds for being satisfied that the houses coloured pink on the map are unfit for habitation. The majority of the under-mentioned defects exist in varying degrees at all houses. Stability (See Plates Nos.3, 4, 7 and 12)- Evidence of uneven settlement- brickwork of rear and front elevations bulged and/or fractured out of plumb and alignment, brickwork courses out of level, window and door openings out of square, sills fractured, roofs sagging, floors out of level, excessive vibration in floors. 16 Plate No. 1. BEAUMONT ROAD SLUM CLEARANCE AREAS. Rear of houses in Sophia Road and Beaumont Road showing bad site arrangement, congestion and rising dampness. Plate No. 2. BEAUMONT ROAD SLUM CLEARANCE AREAS. Rear of terrace in Beaumont Road showing bad site arrangement. Note close proximity of back additions causing obstruction of natural light, also inadequate pitch of back addition roofs. Plate No. 3. BEAUMONT ROAD SLUM CLEARANCE AREAS. Rear elevation of houses in Beaumont Road showing bad site arrangement, evidence of structural settlement and defective roof drainage. Plate No. 4. BEAUMONT ROAD SLUM CLEARANCE AREAS. Detached cottage in King Street showing evidence of structural settlement and external disrepair. Plate No. 5. BEAUMONT ROAD SLUM CLEARANCE AREAS. Rear elevation of houses in Sophia Road showing bad site arrangement, rising dampness and defective roof drainage. Plate No. 6. BEAUMONT ROAD SLUM CLEARANCE AREAS. Rear of houses in Burchell Road showing sagging roofs, rising dampness and external sanitary convenience. Plate No. 7. BEAUMONT ROAD SLUM CLEARANCE AREAS. Rear of terrace in Burchell Road showing evidence of structural settlement, sagging roofs and external sanitary conveniences. Plate No. 8. BEAUMONT ROAD SLUM CLEARANCE AREAS. Rear of houses in Burchell Road showing bad site arrangement. Note close proximity of back additions causing obstruction of natural light. Plate No. 9. BEAUMONT ROAD SLUM CLEARANCE AREAS. Rear of houses in Beaumont Road showing bad site arrangement. Note close proximity of back additions and of railway viaduct, causing obstruction of natural light. Plate No. 10. BEAUMONT ROAD SLUM CLEARANCE AREAS. Rear of terrace in Skelton's Lane showing bad site arrangement. Note very close proximity of railway viaduct causing severe obstruction of natural light; also close proximity of back additions. Plate No. 11. BEAUMONT ROAD SLUM CLEARANCE AREAS. Rear elevations of houses in Capworth Street showing bad site arrangement and sagging roofs. Plate No. 12. BEAUMONT ROAD SLUM CLEARANCE AREAS. Rear of terrace in Beaumont Road showing evidence of structural settlement, sagging roofs and defective roof drainage. Repair - External (See Plates Nos.4. 6, 7. 11 and 12) Brickwork. Sills and Copings - Perished brickwork and pointing, and broken loose rendering to walls and chimney stacks. Badly weathered and defective sills and copings. Paving - Sunken and fractured paving of yards and passages. Roofs, Gutters - Main and back addition roofs sagging, slates and/or tiles missing, displaced or defective, eaves gutters and rainwater pipes perished and defective, valley gutters badly constructed and leaking. Woodwork - Sagging roof timbers, window and door frames decayed and/or badly worn or Ill-fitting. Repair - Internal - Woodwork generally - Badly worn and weak stair treads, badly fitting and defective doors and window frames, sashes decayed, badly worn and ill-fitting. Floors - Ground floor timbers decayed and/or sunken out of level and unstable, floorboards badly worn and/or worm Infested. Walls and Ceilings - Plaster loose and/or perished, scullery walls rough and unrendered. Generally - Broken and uneven solid floors, defective sink waste pipes, defective and/or obsolete fire grates, defective chimney flues, jambs and hearths. Freedom from Damp (See Plates Nos.l, 5 and 6) - Dampness rising in walls due to absence of effective damp proof courses, dampness penetrating walls and ceilings due to porous brickwork, defective sills and window connections, leaking roofs, eaves gutters and rainwater pipes and valley gutters. Excessive dampness below ground floors due to absence of site concrete. Natural Lighting (See Plates Nos.2. 8, 9 and 10) - Insufficient natural light in ground floor back rooms due to obstruction or overshadowing caused by close proximity of adjoining buildings, badly positioned small and/or low windows and in some rooms absence of direct natural lighting altogether. Staircases, passages and W. C.'s dark due to absence of windows to the external air. Ventilation - Rooms without permanent means of ventilation and/or ventilation impeded by reason of decayed or defective window woodwork, making sashes difficult, if not impossible to open. Inadequate ventilation to staircases and W. C.'s. Water Supply - Except in a few instances, the only water supply available for domestic and personal purposes is by cold water tap over scullery sinks; a number of tenants have provided their own water-heaters. In 16 houses, the only sink and water supply is shared by more than one family. (17) Drainage and Sanitary Conveniences (See Plates Nos.3, 5. 6. 7 and 12) - Surface drainage impeded by broken and sunken paving, of yards and roof drainage inadequate. At a number of houses the main drainage system is defective. With the exceptions already referred to, W.C.'s are situated externally and often badly sited in yards with little privacy. At 43 houses the only available W. C. is shared by more than one family. Facilities for Storage, Preparation and Cooking of Food and Disposal of Waste Water- Most houses are without food storage accommodation with ventilation to the external air, but in 25 cases tenants or owner-occupiers have provided refrigerators. Bad Arrangement (See Plates Nos. 1, 2, 3, 5, 8, 9, 10 and 11) Many of the houses are badly arranged on the site, obstructing free admission of natural light and impeding the circulation of air. The majority of the houses are badly arranged internally, staircases often constitute a danger to the occupants by reason of their position, construction and inadequate lighting. Other typical forms of bad arrangement are rooms intercommunicating, ground floor rooms at different levels, fuel storage cupboards beneath stairs and entered from living rooms, and room accommodation cramped and congested. General Observations - The houses are between 70 and 100 years old. They are obsolete in design, outworn, badly arranged internally and/or externally, and fall short of the minimum requirements of the Housing Act. In our opinion the most satisfactory method of dealing with conditions in the areas is demolition of all buildings in the areas. The speed at which the Council can proceed with its slum clearance and redevelopment proposals is related to the availability of alternative housing, which means that progress must necessarily be long term, and many years must elapse before it is possible to deal conclusively with a large number of sub-standard properties in the Borough. This throws a heavy burden on the Public Health Inspectorate, since it means enforcing essential repairs to insanitary properties which may be considered beyond satisfactory repair and improvement, for an indefinite period. BUSINESS PREMISES - GENERAL In the Borough, there are some 2,100 business premises, comprising factories, industrial undertakings, food premises, catering establishments, shops etc., involving 2,700 activities, including registration and licensing. All these premises come within (18) the province of the district public health inspectorate as part of their duties to ensure that the requirements of the many Acts, Orders and Regulations relating to such premises are complied with. An example of new legislation which came into force during the year, and which affects certain business premises, is the Factories Act, 1961, which is a consolidating Act, bringing previous Factories Acts from 1937 to 1959 under one cover. The Act, containing 185 sections, is made up of fourteen parts, and is administered by the public health inspectorate of the district councils and the factory inspectorate employed by the Ministry of Labour. I am pleased to report that at Leyton, excellent co-operation exists between the two departments and close liaison is kept on matters of mutual interest. 1,717 inspections of business premises were made during the year, 77 notices were served, and 72 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. FOOD PREMISES - INSPECTION 882 inspections were made during the year of food premises of all kinds to ensure that a high standard of cleanliness and hygiene is maintained. As usual, particular attention was given to the itinerant food vendors who regularly visit Leyton for the Easter, Whitsun and August fairs at the Council's pleasure ground at Lea Bridge Road. Visits were also made to the Cricket Festival held at the Sports Ground, High Road, Leyton, and to the Borough of Leyton Show. As a result of routine inspections, 80 notices were served during the year in connection with the contraventions of the Food Hygiene (General) Regulations. The number of new registrations and/or licences dealt with during the year was 68. An important new trend in the sale of ice-cream became apparent during the year, i.e. the return of soft ice-cream made in specially designed machines, which rapidly convert the ice-cream mix into a frozen, saleable product. It has been on sale for several years, but recently these machines have been installed in vehicles and, due to its increasing popularity with the general public, the machines are now appearing in retail shops. It quickly became apparent from requests for registration that the number of premises at Leyton installing these machines was on the increase, and to date six have been registered by the Council. If the demand for soft ice-cream continues, the number of these vendors is certain to increase within the next few years. The disturbing feature of this increase from the public health viewpoint is that the responsibility for producing a clean and bacteriologically pure ice-cream, necessitating scrupulous care, and sterilisation of complicated machinery, no longer rests with the large manufacturer, with the necessary equipment and personnel at his disposal, but with each individual machine operator, whether he be a vehicle driver-salesman or grocer. In many cases, shop-keepers will have had no previous experience of ice-cream manufacture or of the cleaning and sterilisation of plant used for this purpose. The results of early bacteriological samples at Leyton quickly showed the need for close supervision, and detailed instructions were given by the public health inspectorate to machine operators and cleaning and sterilising operations were carried out under supervision until satisfactory bacteriological results were obtained. To guarantee an ice-cream which will (19) satisfy the provisional grading recommended by the Ministry of Health, it is essential that the machine is cleaned and sterilised at least once per day. As soon as a retailer accepts that there is no short cut to cleanliness, his product will be satisfactory. Although representations have been made in the past to the Minister of Health, urging a statutory bacteriological standard of cleanliness for ice-cream, he has made it clear that no available bacteriological test is precise enough to be made statutory. The Minister recommends that Local Authorities should continue to look to the methylene blue test for provisional measurement of the bacteriological cleanliness of ice-cream. Should the demand for soft ice-cream increase, however, it is likely that further representations must be made for a legal bacteriological standard. It must be strange indeed for the general consumer to understand why it is a legal contravention when icecream contains only 4½% fat instead of 5% fat, but not when ice-cream fails the methylene blue test. FOOD - INSPECTION AND SAMPLING Complaints of members of the public regarding unsound and/or adulterated foodstuffs purchased by them were fully investigated and 16 cases were reported to the Public Health Committee during the year. The foodstuffs implicated were winkles in a sour condition, mould on cake (2), water in milk, dirty milk bottle, maggots in sweets, feather in minced chicken, mouse dropping in bread, cotton wool in cheesecake, fly in cheese, safety-pin in cake, dirt in bread roll, mould in steak pie, fly on sweets, bone fragment in marmalade, and dirt on cheese. The decisions of the Public Health Committee in relation to these food contraventions were:- prosecutions 3, warning letter 13. The results of the three prosecutions are given in the statistical section of the Report. The fact that in each of these three cases the complainants were asked, and consented, to attend court to give evidence in support of the Council's case, indicates a genuine desire on the part of the public to bring such incidents into the open rather than to ignore them, although the penalties imposed must often come as an anti-climax to them. A total of 155 samples of food and drugs were taken by the Public Health inspectorate for submission to the public analyst for chemical examination and 74 bacteriological samples were submitted to the public health laboratories. By selective sampling it has been the aim of the department to cover as wide a variety of foodstuffs as possible and to include new and little-known products. In addition to sampling from retail food premises, the department has given close attention to the sale of food from automatic vending machines, and the variety of samples thus obtained, including milk, orange drink, flavoured milk, biscuits, sandwiches, soup, hot chocolate, black and white coffee, and ice-cream, gives an indication of the recent increase in number and complexity of these machines. Bacteriological sampling of ice-cream was carried out during the year, particularly in the summer months, when the demand for this commodity is at its highest, and when attention to hygiene is, due to increased pressure of trade, likely to be relaxed. Sampling of soft ice-cream from newly-installed machines in retail premises in the Borough was given particular attention to ensure that machine operators were practising regular plant cleaning and sterilisation. Of the chemical samples taken during the year, seven adverse reports were received and considered by the Public Health Committee, concerning fried fish (2), sausage meat, tonic drink, apples, casserole steak and crisp bread. Legal proceedings were instituted in one case, concerning the sale of fish described as "fried haddock" at a fried fish (20) and chip shop which, upon examination, was found to be fried cod. The defendant was found guilty and fined £10, with £3.3s.0d. costs being awarded to the Council. The remaining adverse samples were dealt with by the Public Health Committee, either by warning letter to the retailer or representations to the manufacturer concerned. 1962 saw the introduction of new legislation of importance to Food and Drugs authorities dealing with preservatives in foodstuffs. This was the Preservatives in Food Regulations, 1962, which came into effect on the 26th July and which replace the original regulations which had been in use for almost forty years. The new regulations reflect the changes in methods of food processing of recent years, and permitted preservatives now include sodium and potassium nitrate and nitrite, sorbic acid," propionic acid, methyl and propyl, parahydroxybenzoate and orthophenylphenol, as well as the more familiar sulphur dioxide and benzoic acid previously allowed in the old regulations. Preservatives which up until now have been excluded are now permitted in a large number of foods, many of which are major items in the national diet, such as bread and flour confectionery, flour for biscuits, cheese, as well as in fresh fruit, sauce, and soft drinks, etc. already permitted. This will necessitate increased sampling and analysis to ensure that the requirements of the new regulations are not contravened. AIR POLLUTION - SMOKE CONTROL AREAS Leyton's second Smoke Control Order, covering 163 acres, came into operation on the 1st October, 1962, whilst the Order affecting Leyton's third area was made by the Council in June, 1962, and submitted to the Minister for confirmation. These areas, and that covered by the first Smoke Control Order, together cover some 800 acres, affect over 5,000 dwellings, some 300 commercial and industrial premises, and occupy the whole of the south-western border of the Borough. They adjoin similar Smoke Control areas in Hackney. As with the first area, considerable publicity has been given to the implications of the second Smoke Control Order - extensive use of exhibition material at the Council's shop at 280 High Road, E. 10., mobile exhibitions, the distribution of informative literature, and the co-operation of the local press have ensured that both owners and occupiers of affected premises are aware of their obligations and the financial aid available in the form of grants. The result has been gratifying, in that 574 applications have so far been approved by the Council, comprising some 760 fireplace adaptations. Most of the claims for payment of grant in respect of the No.1 Smoke Control Area have now been paid, and the total cost of such fireplace adaptations amounts to £9,540.5s.7d. This cost is met by owners and occupiers, Leyton Council, and the Exchequer in the following proportions:- The Leyton (No.1) Smoke Control Order £. s. d. Owners or occupiers 2,714 7 6 Leyton Borough Council 3,009 15 9 Exchequer Contribution 3,816 2 4 £9,540 5 7 (21) During the initial survey of the No.1 Smoke Control Area, it was estimated that 1,655 fireplace conversions would be required, at a total cost of £18,505. In fact, the number of conversions carried out with grant aid was 1,102, at the cost shown above. It can only be assumed that the remaining 553 fireplace adaptations have either been accomplished without a grant aid, by householders on their own initiative, or that a changeover of fuel supplies from coal to high-quality premium smokeless fuels, capable of burning in existing grates, has taken place. The discrepancy between the estimated and final figures is not peculiar to Leyton, as enquiries have shown that they compare with most Smoke Control Areas in and around London. However, the merits of a Smoke Control Order must be adjudged not only on the number of adaptations carried out with grant aid but also on the amount of visible smoke emitted during the heating season, and observations have shown that the time and expenditure on bringing Area No.1 into operation have been well spent. In the Annual Report for 1961, I stressed the need for simplification of the procedure for the establishment of Smoke Control Areas, and illustrated the vast amount of technical and administrative work involved. This matter was raised by Leyton at a meeting of the joint Conference of Local Authorities as early as 1959; and it is pleasing to report that, as a result of Ministry of Housing and Local Government Circular No.3/62, dated 30th January, 1962, the Minister has so changed the administrative procedure as to assist Local Authorities to carry through their Smoke Control programmes more quickly, but the Minister goes on to stress the need for the closest supervision of works of adaptation to ensure that they are strictly in accordance with the principles laid down in paragraph 26 of the Memorandum on Smoke Control Areas for determining what types of works, and what standards, are reasonably necessary. The practical measures taken by the Public Health inspectorate to mitigate pollution of the atmosphere by smoke and grit include the taking of observations of factory chimneys, inspection of boiler installations, advice to boiler operatives on the proper use of fuel and methods of stoking, and discussions with managerial staff. 208 inspections were carried out during the year and a further 1,217 visits and inspections were made in connection with the establishment of smoke control areas. Special surveys are also in progress for the scientific measurement of grit and dust deposits in specified parts of the Borough. For this purpose, four standard deposit gauges are being used, the results of which are published monthly in the bulletin of the Department of Scientific and industrial Research. The Chairman of the Public Health Committee, Alderman Mrs.A.M.M.Burrell, and the Chief Public Health inspector, are the Council's representatives on the London and Home Counties Clean Air Advisory Council, the Standing Conference of Co-operating Bodies set up by the Department of Scientific and Industrial Research, and the National Society for Clean Air, The Joint Clean Air Conference of neighbouring Local Authorities, first convened by Leyton Borough Council in 1956 for the purpose of discussing matters of common interest with regard to air pollution, met twice during the year at Chingford and Ilford. Matters discussed and forwarded to the Ministry of Housing and Local Government for consideration include the availability of supplies of smokeless fuel, the sale of bituminous coal in smoke control areas, Exchequer contributions towards cost of adaptations, and the high prices charged for pre-packed smokeless fuels sold in small quantities in local retail shops. The department continues to co-operate with the D.S.I.R. in the National Survey of Air pollution and daily observations are taken throughout the year. The results of these measurements of smoke and sulphur dioxide, as recorded by the volumetric apparatus installed in the department, are set out in detail later in the report. The statistical year of the survey ends on 31st March. Table No.1 shows the monthly (22) average concentrations (divided into summer and winter periods) for the years 1960/61, 1961/62 and, as far as possible, for 1962/63. Both smoke and sulphur dioxide figures for 1961/62 showed a reduction (about 10%) on the previous year. The results for the summer of 1962 are about the same as in 1961. Table No.II shows the highest daily average concentrations for the same periods as Table No.I. It will be noted that a sulphur dioxide reading of 3,437 microgrammes per cubic metre is shown as the highest daily average for December, 1962. This figure is, in fact, the highest recorded since observations began in March, 1950, and is about 10 times the normal figure at this time of year. It occurred on 5th December, 1962 during a period of persistent fog. The corresponding smoke figure on the same day was, however, relatively low (880 microgrammes per cubic metre), compared with results recorded during periods of fog in 1952 and 1957 (about 2,000 microgrammes per cubic metre). This reduction in the smoke content of the fogs of 1952 and 1962 is illustrated in the reproductions of the filter papers for 8th December, 1952 and 5th December, 1962, shown at Plates No.I and IIwhich follows. For the purpose of comparison a filter paper for an average December day (14.12.61) when there was no fog is shown (Plate No.3). The filter papers are those used in the volumetric apparatus used for the measurement of air pollution; a measured quantity of air is drawn through the filter upon which particles are collected and the darkness of the resulting stain is related to the weight of smoke on the filter. A reflectometer (a photo-electric device) measures the light reflected from the stain as a percentage of that reflected from a clean filter. A formula is then applied to determine the amount of smoke in the air. PLATE NO.1 Filter Paper for 5th December, 1962. (fog) PLATE No.2 Filter Paper for 8th December, 1952. (fog) PLATE No.3 Filter Paper for 14th December, 1961.(no fog) (23) TABLE No.I MONTHLY AVERAGE CONCENTRATIONS OF SMOKE AND SULPHUR DIOXIDE (Expressed in microgrammes per cubic metre) MONTH SMOKE SULPHUR DIOXIDE SMOKE/SULPHUR DIOXIDE RATIO 1960/61 1961/62 1962/63 1960/61 1961/62 1962/63 1960/61 1961/62 1962/63 April 150 83 94 180 147 137 .83 .56 .69 May 70 54 63 143 106 121 .49 .51 .52 June 40 43 30 83 108 81 .48 .40 .37 July 40 33 35 77 79 83 .52 .42 .42 August 50 34 35 100 79 79 .50 .43 .44 September 50 66 63 103 127 116 .49 .52 .54 SUMMER AVERAGE 70 52 53 114 108 103 .61 .48 .51 October 190 128 154 200 178 231 .95 .72 .67 November 230 248 243 277 236 298 .83 1.05 .81 December 350 382 258 337 303 456 1.04 1.26 .57 January 260 201 314 269 252 377 .97 .80 .83 February 190 148 300 252 191 364 .75 .77 .82 March 210 200 115 280 254 196 .75 .79 .59 WINTER AVERAGE 240 218 231 269 236 320 .89 .92 .72 YEARLY AVERAGE 150 135 142 192 172 212 .78 .78 .67 TABLE No.II HIGHEST DAILY AVERAGE CONCENTRATIONS OF SMOKE AND SULPHUR DIOXIDE (Expressed in microgrammes per cubic metre) MONTH SMOKE SULPHUR DIOXIDE 1960/61 1961/62 1962/63 1960/61 1961/62 1962/63 April 370 114 255 369 197 285 May 170 90 176 363 177 327 June 100 80 66 255 266 192 July 70 78 80 112 169 167 August 100 64 91 203 194 163 September 110 162 141 155 285 302 October 510 519 604 340 484 675 November 720 709 766 641 611 870 December 800 830 880 592 643 3437 January 690 556 996 629 560 1704 February 410 465 663 701 465 792 March 430 539 281 769 658 361 (24) 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/OCCUPIER NOTICES COMPLIED WITH BY LOCAL AUTHORITY HOUSES CLASSIFIED Clean Air Act. 1956 73 1425 540 319 - - - Housing Acts, 1936/61 44 1568 38 6 2 - 795 Public Health Acts, 1936/61, and Noise Abatement Act, 1960 1209 5592 448 204 386 - - Prevention of Damage by Pests Act, 1949 281 3028 10 - 7 - - Pood and Drugs Act, 1955, and Merchandise Marks Acts, 1926/53 56 882 - 80 55 - - Shops Act, 1950 - 936 - - - - - Essex County Council Act, 1952 - 417 - - - - - Leyton Corporation Act, 1950 3 23 - - 1 - - Factories Act, 1959 5 256 2 - 5 - - Pet Animals Act, 1951 - 7 - - - - Rag Flock and Other Filling Materials Act, 1951. - 9 - - - - - Rent Act, 1957 58 56 - 59 - - - Fabrics (Misdescription) Act, 1913, and Regulations, 1957. - 2 - - - - - (25) (b) DETAILED (i) Rent Act. 1957 - Para.4. First Schedule Application for certificates received 8 Decisions not to issue certificates Nil Decisions to issue certificates 8 Undertakings given by landlords under paragraph 5 of the First Schedule 1 Undertakings refused by local authority under proviso to paragraph 5 of the First Schedule Nil Certificates issued 7 Applications by landlords for cancellation 9 Objection by tenants to cancellation 4 Decisions by local authority to cancel in spite of objection 2 Certificates cancelled by local authority 8 Applications for certificates (Form P) 38 Descrepancies in the above figures are caused by procedure in some cases extending over December - January. (ii) Food and Drugs Act. 1955 (Inspection and Supervision of Food Premises) The following inspections were carried out at the under-mentioned 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, 1961, Leyton Corporation Act, 1950, Essex County Council Act, 1952, and relevant legislation. Type of Premises Number of Inspections Retail food shops 489 Catering establishments 208 Dairies 7 Ice-Cream places 26 Food hawkers 47 Food manufacturers/depots 29 Multiple stores 2 Off-licences 5 Public Houses 30 School meals 39 882 (26) (iii) Inspection of Business Premises other than Food Premises Inspections were carried out at the under-mentioned business premises having regard to the requirements of the Public Health Act, 1936, the Shops Act, 1950, the Factories Act, 1961, the Pet Animals Act, 1951, the Rag Flock and Other Filling Materials Act, 1951, the Diseases of Animals Acts and Orders, the Leyton Corporation Act, 1950, and relevant legislation. Type of Premises No of. Inspections Non-Power Factories 22 Factories with Mechanical Power 240 Fairgrounds 21 Hairdressers 23 Local Authority properties 2 Miscellaneous Shops, etc 45 Outworkers 4 Pet Animal Shops 8 Rag Flock 9 Schools 13 Places of entertainment 11 TOTAL 396 (iv) Prevention of Damage by Pests Act, 1949 - Rodent Control/Disinfestation Complaints received 281 Enquiries and visits made: By Rodent Operatives 2,284 By Public Health Inspectors. 744 Premises treated: Dwelling houses 191 Business/industrial premises 64 Eight "block treatments" of premises for rodent infestation were carried out. (27) 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 1 Choked drains cleared 10 Dampness remedied 302 Drains relaid or partly relaid 2 Floors repaired 60 Guttering repaired or renewed 67 Miscellaneous defects remedied 109 New W.C. pans and traps provided 11 Plaster work repaired 103 Rainwater pipes repaired or renewed 22 Roofs repaired or renewed 22 Rooms redecorated 10 Sashcords renewed 81 Sinks provided 3 Sink waste pipes repaired or renewed 29 Stoves repaired or renewed 41 Vent pipes repaired or renewed 43 W. C.cisterns repaired or renewed 43 Window sills, etc., repaired 73 Yard paved 1 (il) FOOD AND DRUGS ACTS/FOOD HYGIENE REGULATIONS/SHOPS ACT Nature of contraventions and improvements effected to food establishments and business/industrial premises as a result of statutory and informal action:- Walls/Doors/Windows not kept clean or repaired 76 Ceilings not kept clean or repaired 75 Floors not kept clean 31 Inadequate ventilation 2 Inadequate receptacles for refuse 1 Accumulation of refuse in room 5 Cleanliness of apparatus and fittings 22 Facilities for personal cleansing and/or washing food and equipment inadequate, i.e. - Wash basins 5 Hot water 3 Soap/Towel/Nail brushes 4 Sinks 2 Food not protected from contamination 7 First-aid equipment 15 Wash-hand notices 30 Inadequate locker (clothing) accommodation 4 Redecoration 8 Miscellaneous 19 (28) 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 Cafes 744 5 - - - - - 74 - - - - Chemists 34 - - - - - - - - - - - Council properties 4 - - - - - - 1 - - - - Dairies 3 - 3 - - - - - - - - - Factories 422 2 - - - 366 56 42 - - - - Pood Factories, depots, etc. 6 2 4 - - - - - - - - 1 Food Hawkers 117 - - - - - - - - - - - Food premises, retail 567 201 94 43 10 27 - 13 1 18 - 11 Food storage, hawkers 13 1 - - - - - - - - - 12 Hairdressers 92 - - - - - - - - - 92 - Hospitals 2 - - - - - - 2 - - - - Milk vending machines 3 - 3 - - - - - - - - - Multiple stores 5 3 - - - - - 3 - - - - Non-food retail premises 578 1 - - - - - - - - - - Off-licences 42 22 - - - - - - 41 - - - Pet Animals 8 - - - - - - - - - - - Public Houses 36 1 - - - - - - 32 - - - Rag Flock 6 - - - - 3 2 - - - - - Schools 18 - - - - - - 17 - - - - Miscellaneous shop premises 130 - - - - - - - - - - - TOTALS ... 238 104 43 10 393 58 152 74 18 92 24 (29) (ii) Details of Registrations/Licences ACT OR REGULATION On Register 31.12.1961 Removed during 1962 Registered during 1962 On Register 31.12.1962 Pood and Drugs Act. 1955 Ice-Cream Premises 274 59 23 238 Food Preparation, etc. premises. 43 2 2 43 Milk and Dairies (General) Regulations, 1959 Distributors 104 12 12 104 Dairies 3 - - 3 Milk (Special Designation) Regs. 1960:- Tuberculin Tested 21 1 6 26 Pasteurised 62 6 10 66 Sterilised 95 9 8 94 Essex County Council Act, 1952 Hawkers of Food 120 10 7 117 Hawkers' storage Premises 38 14 - 24 Leyton Corporation Act, 1950 Section 63 - Vendors of Shellfish 10 - - 10 " 48 - Hairdressers' premises 95 6 4 93 Pet Animals Act, 1951 Annual Licences 10 - - 8 Rag Flock and Other Filling Materials Act, 1951 6 - - 6 TOTAL 881 119 72 832 (30) 4. LEGAL PROCEEDINGS (i) Public Health Act. 1936. 24 applications were made for legal proceedings, all of which were withdrawn before the Court hearing or after adjournment, the work required by notices having been completed. (ii) Food and Drugs Act, 1955 and Food Hygiene Regs., 1955. Date of Hearing Nature of offence and address of premises concerned Result of Court Proceedings 30.5.62 Leyton Fisheries, Ltd., 377 High Road, E. 10. Fried Cod sold as fried haddock. Fine £10. £3. 3s. 0d. cost8 27.6.62 Mrs. A. K.M. West, 42 Crownfield Road, E. 15. Maggots in sweets. Absolute discharge. Nominal costs. 26.9.62 W.J.Barton, Ltd., 341 Lea Bridge Road, E. 10. Cotton-wool in Cheesecake. Fined £10. £3.3s.0d. costs 21.11.62 Birkett & Roberts, Ltd., 13 Beachcroft Rd. E. 11.Safety pin in cake. Absolute discharge. £6. 5s. 0d. costs 5. MEAT AND FOOD CONDEMNED Condemnation certificates were issued in respect of the under-mentioned unsound foodstuffs surrendered by various traders in the Borough as a result of routine inspection of food premises. The food condemned was destroyed by fire at the Council's Destructor Works. Commodity Cwts. Qrs. Lbs. Bacon - - 5½ Cheese - 3 11 Cod fat - 1 6 Ham - - 7½ Fish 2 3 26½ Beef 9 1 10 Lamb - 2 8 Pork 13 Offal 4 1 12 Rabbits 3 - 24 Sausages - 1 10 (31) Commodity Units Milk 57 tins Luncheon meat 91 " Vegetables 58 " Fruit 83 " Fish 7 " Ham 38 " Soup 42 " Celery hearts 19 " Heinz Strained Foods 1228 " Gherkins 6 " Gherkins 42 jars Beetroot 7 " Pickles 2 " Chickens 15 " 6. SAMPLING - FOOD AND DRUGS ACT, 1955. (i) Chemical Analysis Commodity Taken Satisfactory Unsatisfactory Milk 10 10 Ice-Cream 5 5 Miscellaneous 140 133 7 TOTALS 155 148 7 (ii) Bacteriological Examination Commodity Taken Satisfactory Unsatisfactory Milk 21 21 Ice-Cream 51 39 12 Ice-Lollies ... 2 2 TOTALS 74 62 12 7. SAMPLING - FABRICS (MISDESCRIPTION) ACT, 1913 - FABRICS (MISDESCRIPTION) REGULATIONS, 1959. Two samples were obtained during the year, each consisting of a child's nightdress, and both were found to be satisfactory. (32) 8. FACTORIES ACTS, 1937 to 1959. The following are the prescribed particulars required by Section 128(3) of the 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 58 21 1 - (ii) Factories not included in (1) in which Section 7 is enforced by the Local Authority 393 235 1 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - TOTAL 451 256 2 - 2. Cases in which defects were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred TO H. M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.1) 1 1 - 1 - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) 1 1 - 1 - Ineffective drainage of floors (S.6) - - - - - Sanitary conveniences (S.7) - - - - - (a) Insufficient - - - - - (b) Unsuitable or defective - - - - - (c) Not separate for sexes - - - - - (d) Other - - - - - Other offences against the Act (not including offences relating to Out-work 1 1 - - - TOTAL 3 3 - 2 - (33) 3. Outwork Nature of Work SECTION 133 SECTION 134 No. of outworkers in August list required by Section 133(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 216 Umbrellas, etc. 43 Artificial flowers 8 Boxes, etc. wholly or partly of paper Making 36 Brushes 3 Feathers 2 Toys 2 Christmas crackers, etc. 6 Lampshades 23 TOTAL 339 (34) Leyton Health Area Sub - Committee 1962 - 63 Representing: - Essex County Council: Aldermen K.E.B.Glenny, O.B.E., J.P. (ex-officio) G.ff.Mason (ex-officio) Councillors Mrs.S.M. Bovlll Mrs.M.J.Harvey F.R.Richards Mrs.V.L.Wilson P. A. Wortley 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) Mrs.D.E.Collins J.H.L. Field C.H. Hicks A. H. Mackay F.ff.Marshall Mrs.E.V.Pearson Mrs.N.M.Plunkett W. H. Sanders J.J.Walsh E. J.Whiteley F.W.Wigg Voluntary Organisations: Mr.J.Barker Mrs. A. M. Clewer Mr.W.A.Guittard Mrs.D.Studz Forest Group Hospital Management Committee: Alderman J.W.R.Nation Executive Council for Essex: Mrs. A.E. Prendergast Local Medical Committee for Essex: Dr. J. F.B.Hill. (35) Personal Health Services (Leyton Health Area Sub - Committee) SECTION 21 - HEALTH CLINICS AND OTHER PREMISES There are no Health Centres as such in the area. However, there are three excellent Health Services Clinics which serve the Borough. The phased programme of redecorating these premises was completed in 1961 and during 1962 the following special works were carried out. DAWLISH ROAD CLINIC Exterior redecorated and forecourt paved with neolite tiles. Two seats were included in this attractive new lay-out and these have been very much appreciated by the elderly people who make use of them. GRANLEIGH ROAD CLINIC (PARK HOUSE) Part of the forecourt of these premises was adapted as a play area for children attending the Child Development Sessions at this clinic and this was enclosed with fencing. LEYTON GREEN CLINIC The floor of the main hall and Dental and Chiropody suites were laid with Marley tiles giving the clinic a much brighter and more modern look. Due to the difficulty in recruiting chiropodists and the improved situation in obtaining dental officers a chiropody suite at this clinic was adapted as an additional dental surgery. CHILD GUIDANCE CLINIC The private dwelling at 133 Dawlish Road, Leyton, E.10., previously occupied by one of the County Council's Duly Authorised Officers, was converted to accommodate the Leyton Child Guidance Clinic, which opened there on 1st October, 1962. EPSOM ROAD DAY NURSERY The construction of this new 50 place Day Nursery, replacement for Knotts Green Day Nursery continued during the year and it is anticipated that this will be completed and ready for occupation in April, 1963. SECTION 22 - CARE OF MOTHERS AND YOUNG CHILDREN BIRTHS - During the year the following births were registered:- Male Female Legitimate 674 625 Illegitimate 41 54 Total 715 679 Still-Births: Legitimate 15 8 Illegitimate 1 3 In the same period 1,406 notifications were received under Section 203, Public Health Act, 1936, which requires that the Medical Officer of Health shall be notified of a birth within thirty-six hours. (36) (37) 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 Doctor' s Consultation Dental Minor Ailment Orthoptic (alternate) Dental Minor Ailment Orthoptic Ophthalmic Optician (monthly) Toddlers Dental Minor Ailment Child Development Dental Minor Ailment Orthoptic Ophthalmic Optician(monthly) Toddlers Dental (alternate) Doctor's Consultation Minor Ailment Immunisations alternating- Foot Foot Foot Foot Foot Foot P.M. Dental Infant Welfare Dental Infant Welfare Dental Infant Welfare Dental Ante-natal/ Post-natal Orthopaedic Dental Immunisations) Doctors ) Consultation) alternating Foot Orthoptic (alt.) Foot Orthoptic Foot Foot Orthoptic Foot Evening Foot Dental Mother's Club Dental / Foot Park House, Granleigh Road, E. 11. (LEYtonstone 3650 Extn.268) A.M. Dental Doctor's Consultation Child Development Dental Minor Ailment Ante-natal/ Post natal Dental Minor Ailment Child Development Toddlers (monthly) Dental Minor Ailment Dental Minor Ailment Child Development Toddlers (monthly) Dental Doctor's Consultation Minor Ailment alternating Foot Foot Foot Foot Foot Foot P.M. Dental Remedial Exercises Dental Infant Welfare Remedial Exercises Dental Infant Welfare Dental Infant Welfare Dental Immunisations Doctor's Consultation Aural (monthly) alternating Foot Foot Foot Foot Foot Evening Dental / Foot Dental Dental Dawllsh Road, Dawllsh Road, E. 10. (LEYtonstone 3650 Extn.287) A.M. Dental Minor Ailment Dental Doctor's Consultation Child Development Dental Minor Ailment Ante-natal/ Post-natal alternating Dental Minor Ailment Dental Minor Ailment Dental (altern Doctor's Consultation Minor Ailment alternating Speech Foot Foot Foot Speech Foot Speech Foot P.M. Dental Infant Welfare Dental Ante-nata 1 Exercises Dental Dental Infant Welfare Dental Immunisation Doctor's Consultation alternating Speech Foot Speech Foot Speech Foot Speech Foot Speech Foot Evening Dental / Foot Dental Foot Qnmanuel Hall, Hltcham Road, E. 10. P.M. Weighing Session Child Guidance, 133 Dawllsh Road, E. 10. LEY. 3988. Psychiatrist by appointment only Educational Psychologist Psychiatric Social Worker Attendances at all clinics by appointment except Infant Welfare, minor Ailment and Doctor's Consultation Clinics. Child Welfare - Clinic Attendances Leyton Green Park House Dawlish Road Emmanuel Hall UNDER 1 YEAR - First attendances 553 650 624 124 Subsequent attendances 4353 5169 4525 1201 Total attendances 4906 5819 5149 1325 1-5 YEARS - First attendances 315 307 330 40 Subsequent attendances 1380 1360 1318 374 Total attendances 1695 1667 1648 414 Total attendances (both age groups) 6601 7486 6797 1739 Number examined by Clinic Doctor 1851 2224 2228 - Number weighed 6598 7478 6795 1731 CARE OF PREMATURE INFANTS (weighing 51bs. 8ozs. or under):- Born at Home 17 Born in Hospital or Nursing Home 74 CONVALESCENT HOWE TREATMENT Numbers sent to Convalescent Home Children ... ... ... 2 Mother and Children ... 3 mothers with' 1 child each 1 mother with 2 children WELFARE FOODS There was no change during the year in the general arrangements for the distribution of welfare foods. Issues - The total issues during 1962 were:National Dried Milk (Tins) ... 13,557 Cod Liver Oil (Bottles) ... 1,907 Vitamin A & D Tablets (Pkts.) 1,658 Orange Juice (Bottles) ... 16,517 (38) CHILD DEVELOPMENT SESSIONS These were formerly called Toddlers' Play Sessions, and were started In 1961 as a pilot scheme one morning a week at Park House Clinic. The satisfactory results prompted the opening of a session in May, 1962 for one morning a week at Leyton Green Clinic and this year there are further extensions. The primary aims were two-fold. Firstly, it was hoped that emotional tension in families could be relieved in both mother and child by giving the children a few hours a week away from their mothers. There have been many successes in this field, and the doctors who have referred the cases, and the staff of the sessions, can cite many instances where the children have improved enormously after a period of attendance. There is no doubt that the sessions are of proved value as a therapeutic weapon for the alleviation or even cure of degrees of neurosis and tension which sometimes arise when mother and child are too closely on top of each other. Though more direct observation is made of the children the impression is gained that often the mothers have improved in stability and confidence even more than their children, and there is every reason to think that these sessions can take the credit for the restoration of happy relationships in many families. All the cases are referred on medical recommendation and further extension in 1963 will be a most valuable addition to the ways now available to the medical staff to alleviate mental ill-health. The second aim of the sessions at the time of their formation was the prevention of mental illness by admission of children who were quite healthy but who live in potentially stressful situations, such as flats without play space, where their emotional stability might be put under strain. This aim has not been achieved mainly because there were too many children showing symptoms to allow vacancies to those whose need was prevention only. There are so many children who come in this category and there will be more with the blocks of flats being built, that one must question whether it is reasonable to expect to cope with them all within the Health Services. It is of course to be hoped that those concerned with the lay-out of the new housing estates will bear the needs of young children for play space in mind, and the Education Authorities will press for measures to make enough Nursery Classes possible. In a field like this there is no division between Health, Housing or Education and it should be ensured that if one Local Authority power is not fully applicable another is used. Park House Leyton Green Clinic Clinic Sessions 51 34 Attendances 650 454 Children who attended 37 35 Average attendance 12.7 13.3 Average number of attendances per child 17.5 12.9 (39) TESTS FOR PHENYLKETONURIA In 1962, 710 children were tested at the clinics and another 48 were tested in their homes. COMBINED ANTE-NATAL AND POST-NATAL CLINIC 526 patients made 2,268 attendances for ante-natal examination and treatment and 51 patients attended 69 times for post-natal examinations during 1962. MOTHERCRAFT AND RELAXATION CLASSES These classes, held by Health Visitors, proved as popular and as helpful to the mother as ever. There were 122 sessions held during the year at which mothers made 804 attendances. DENTAL CLINICS The Area Dental Officer reports as follows:- "Approximately one session per week is devoted to expectant and nursing mothers and children under 5 years by each full-time dental officer. All forms of treatment necessary for complete dental fitness are undertaken at these sessions, which are sufficient to deal with the number of patients who are referred or apply for treatment. The sessions are very useful for introducing young children to the dental clinic, and gaining their confidence when they attend for dental examination, before any operative work is necessary. On these occasions the children are dealt with quickly and their visits are not marred by any unpleasant experience. The co-operation of Medical Officers and Health Visitors has been most valuable in securing the attendance of many patients. Probably the most important item of dental interest in 1962 was the publication of the Ministry of Health findings following five years test fluoridation of the water in certain areas. The background to this matter is briefly as follows:- Fluoride salts occur naturally in nearly all water supplies and many foodstuffs and where it is added the object is to bring a low fluoride water up to the optimum value of 1 part per million of water. Extensive investigations in the United States have shown that children born and brought up in an area with about 1 part per million fluoride occuring naturally in the water have up to 60% less dental decay than children brought up in areas where the water has only a trace of fluoride. In addition about 30% of children aged 12 to 14 years have completely sound teeth. There is also strong evidence that the benefit persists well into middle age. In 1952 on the recommendation of the Medical Research Council the British Government sent a mission tothetmited States and Canada to study fluoridation in operation (40) and to advise whether fluorides should be added to the water supplies in the United Kingdom. The report of the mission which was published in 1953 stated that the results emerging in the areas in North America where the water was being fluoridated were similar to those where fluoride occurs naturally. The mission concluded that fluoridation of water supplies was a valuable health measure through its effect in reducing the incidence, of dental caries, but recommended that in this Country fluoride should be added to the water supplies of some selected communities before its general adoption was considered. The British series of examinations commenced in 1955 and fluoride was added to waters late in 1955 and 1956. The report at present deals only with the deciduous teeth of children aged 3 to 7 years and on the full dentition for children 3 and 4 years old but on canines and molars only for children aged 5 to 7 years. The reduction in caries amounted to 66% in the 3 year old children and 57% at 4 years and 50% at 5 years. In children of 6 and 7 years whose teeth had not had the full benefit of fluoride the reductions were 26% and 14% respectively. All the 3 and 4 year old children in the fluoridation areas have had fluoride for the whole of their lives and during the whole period of foetal development. These children are likely, therefore, to have received the maximum benefit. The majority of the five year old children will have taken fluoridated water only since birth. Date for combined study areas, excluding Holyhead:- 1955/56 prior to fluoridation children aged 3 years had 3.80 carious teeth on average 1961 """""1.29"""" Corresponding figures for 4 year olds 5.39 and 2.31 " " " 5 " " 5.81 and 2.91 Reductions in caries equal 66% in 3 year olds " " " " 57% in 4 " " " " " " 50% in 5 " " To be fully effective fluorine must be absorbed continuously during the whole period of tooth formation and calcification. The teeth must then erupt and be exposed to the risk of caries for a reasonable period before any reliable assessment can be made of the extent of caries prevention. Pour conclusions have been arrived at:- 1. Five years of fluoridation at a level of 1 part per million in three study areas has brought about in each a substantial improvement in the teeth of young children. 2. The results of fluoridation obtained so far are in line with American experience. (41) 3. No evidence of harm from fluoridation has been discerned despite continuous vigilance. 4. The addition of fluoride to water supplies has presented no technical difficulties. See "The Conduct of the Fluoridation Studies in the U.K. and the results achieved after Five Years" Report on Public Health & Medical Subjects No.105 Para.VII, Conclusions page 13. The second matter of interest is the Dental Auxiliaries Experimental Scheme which the Privy Council have required the General Dental Council to carry out in accordance with Section 43 of the Dentists Act of 1957. The first batch of these Auxiliaries finished their training and were ready for employment with Local Authorities in August 1962 and Miss Cladingbowl commenced duties in this area on 10th September, 1962. An interim report on her work was made to the General Dental council in December. The scope of her work is to do simple extractions of temporary teeth under local anaesthesia, to fill temporary and permanent teeth with simple fillings, the topical application of certain medicaments, and the scaling and polishing of teeth. Lecturing and instructing children on dental hygiene and the general care of the teeth is an important part of her work, which has been appreciated both in schools and in the clinic. A second dental surgery was opened at Leyton Green in October of this year which means that we now have six dental surgeries in operation in the form of three, twosurgery suites. One surgery in use full-time by the dental auxiliary and dental surgeons equivalent to 4-8/llths full-time in the others. For many years it has been necessary to send all dental patients needing X-ray facilities to Park House Clinic but X-ray machines for Dawlish Road and Leyton Green are now on order and in future full dental X-ray units will be in operation at these centres. This is in accordance with the policy pursued in the area for many years that all the Council's surgeries should be modern, up-to-date units, able to offer full facilities for dental treatment. The course of lectures given by Mr. Arnold to the dental surgery assistants has been continued during the year and has been very helpful and much appreciated. The staffing position in respect of Dental Officers has only varied slightly during the year, remaining around the equivalent of 4-8/llths whole-time officers and this was the figure at the close of the year." (42) Dental Auxiliary teaching correct teeth brushing. DENTAL TREATMENT Types of treatment given Expectant Mothers Nursing Mothers Children under school age Extractions - (a) Permanent teeth 12 56 - (b) Temporary teeth - 2 243 Fillings - (a) permanent teeth 34 78 - (b) Temporary teeth - - 287 Inlays provided - - - Crowns provided - - - Anaesthetics administered - (a) Local 11 15 3 (b) General - (i) by Medical Officers on County Staff - - (ii) by Others 1 11 65 (a) Scaling 9 15 55 (b) Prolonged scaling and gum treatment 8 15 6 Silver nitrate treatment 25 5 92 Dressings 17 36 181 X-ray examinations 9 9 5 Dentures provided - (a) Full 1 9 - (b) Partial 5 5 - Dentures repaired 1 2 - Dentures remade - (a) Full - - - (b) Partial - - - Orthodontic appliances - (a) Fixed - - - (b) Movable - - - Prophylactic treatment and other operations Polishing 5 6 - Number of treatments (scaling and prophylactic carried out by Oral Hygienists) - - - Patients Inspected and treated during the year Expectant Mothers Nursing Mothers Children under school age (1) Patients examined 42 127 326 (2) Patients found to require treatment 36 41 203 (3) Patients who have commenced treatment 36 41 203 (4) Patients who have completed treatment 19 25 165 (5) Patients awaiting treatment - - - (6) Attendance for treatment 85 168 619 (43) 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 22 pre-school children were referred to her and 55 infants were provided with spectacles. Mrs.Box, Orthoptist accepted 69 new cases for treatment, who made 144 attendances. Mr.H.A.Oatley, Orthopaedic Consultant attends Leyton Green Clinic on Thursdays and the clinic medical officers referred 96 new cases to him. Set. out hereunder is a summary of the work:- Re-inspection 211 Minor alterations to footwear 255 Surgical appliances supplied 29 Eight children under 5 years were seen by the consultant, Mr.Morrison, at the Ear, Nose and Throat Clinic. DAY NURSERIES There are two Day Nurseries in the area, each having accommodation for 50 children: (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 end of year 15 35 15 35 30 70 Number of children on register at end of year 15 48 21 40 36 88 Total attendances during year 2581 8342 3603 8435 6184 16777 Number of days open 255 255 - Every effort is made, to notify and keep under observation babies and young children who may have a handicap requiring special educational treatment in an ordinary school or at a special school or referral to a training centre. All of the Local Authority Health Services participate in the assessment of these young children particularly backward children and the Day Nursery often plays a valuable part in this. It is interesting to record the following who were recommended for special treatment in 1962. (44) (1) A child with multiple disabilities was admitted to a school for the partially hearing from a day nursery at three years of age. Although this boy was admitted to the nursery because of his domestic circumstances his period of attendance there enabled the Assistant County Medical Officer, in co-operation with the Day Nursery Matron, to make an early and accurate assessment of the boy's educational needs. (2) Pour children approaching school age were notified as unsuitable for education at school. One of them had already been attending a training centre for some months and in fact final assessment was deferred on the recommendation of the training centre supervisor. Two of the other children had attended the day nursery and the matrons were able to make very useful observations on these children and assist the Medical Officer in making er final as essment. (3) One child approaching 5 years of age was admitted to the day nursery because of his domestic circumstances and although he will probably prove to be unsuitable for education he has been kept on at the day nursery beyond the age of 5 years because his immaturity prevented an accurate assessment of his ability being made at the present time. The Borough Education Officer is willing to co-operate in this scheme. Several other children who were known to have had emotional, physical or mental disabilities have, after a period of observation at the day nursery or the child development session, been admitted to ordinary day schools with every assurance that they will make satisfactory progress following their period of adjustment at these establishments. SECTION 23 - MIDWIFERY Cases attended by Council Midwives MIDWIVES TOTAL Domiciliary Midwife Training Home Cases attended - (a) as Midwives 95 161 256 (b) as Maternity Nurses 13 58 71 Ante-Natal Visits 842 695 1537 Ante-Natal Examinations 1017 3092 4109 Administrations of Gas and Air Analgesia 90 144 234 Administration of Pethidine 72 87 159 Administration of Trilene - 34 34 (45) Ante-Natal Examinations and Domiciliary Births YEAR ANTE-NATAL EXAMINATIONS TOTAL Domiciliary Births (Live & Still) Domiciliary Lady Raleigh Training Home 1959 596 2247 2843 247 1960 714 2265 2979 266 1961 577 2834 3411 305 1962 1017 3092 4109 338 Gas and Air Analgesia Percentage of administrations 70 15 Medical Aid Where the Medical Practitioner had arranged to attend the patient 26 Others 40 Fees paid to Doctors Number of Accounts received 16 Total amount paid to Medical Practitioners - £37.12s. 6d. Maternity Outfits Number of outfits issued to Expectant Mothers 381 (46) SECTION 24 - HEALTH VISITING This year the Health Visitors have undertaken a great deal of mental health work. The staff have now all received training in the principles of mental health at Claybury Hospital and are aware of the importance of preventing emotional breakdown. Health visiting has changed greatly in the last few years due to the wider concept of health and the realisation that it is a combination of physical, emotional and social well-being. To assist with classification the large case load of each health visitor has been divided into five groups:- 1. Socially sound family who seeks help and is amenable to advice. 2. Those requiring a good deal of visiting and support, but not in groups 3 and 4. 3. Potential problem families. 4. Hard core: problem families. 5. Old people. Of course these groups are not rigid and each health visitor uses her discretion. The largest group is No.1. Many of the mothers who come to the clinic appreciate the chance to discuss not only their children's health but also other personal matters. More provision has therefore been made for privacy in clinics. CASE WORK WITH POTENTIAL AND PROBLEM FAMILIES There are two units for homeless families in Leyton: one situated in Langthorne Hospital and the other in Whipps Cross Hospital. The families come to the unit for a variety of reasons such as low intelligence, prolonged and recurrent unemployment of the main wage earner, chronic family debt, or the husband may be serving a prison sentence. The causes are numerous but the families have one factor in common - they all need a great deal of help, as otherwise they will become long term social problems. The aim is to help these people not only in the management of their children but particularly in their approach to life. Many have a grudge against society and if they are able to establish a good relationship with the visitor and their immediate family they stand a better chance of becoming useful members of the Community. SOCIAL WORKERS LUNCHEON CLUB Health visitors must work as members of a team. This can only be achieved by knowing other workers personally. Social Workers now meet once a month at Leyton Green Clinic and at this meeting, over a sandwich lunch, short talks are given by a member about his or her work. Talks have been given by the Paediatrician and Head Almoner of Whipps Cross Hospital, the Chief Probation Officer, School Medical Officer, Chief Administrative Assistant, W.V.S.Organiser and National Assistance Board Manager. The chief value, however, is the personal acquaintance which each member makes with the others. (47) AGED AND CHRONIC SICK As Leyton has a large percentage of old people the staff find it more and more difficult to cover this group adequately. Voluntary organisations have given much help but there are still many needs which have not been met. Health Visitors continue to work closely with Langthorne Hospital and patients and relatives benefit greatly from the hospital and community scheme. HEALTH EDUCATION The three clinics have regular health education activities and the Mothers' Club at Leyton Green Clinic continues to thrive. All secondary modern schools have a series of talks given by a Health Visitor especially to school leavers. At Goodall School a link has been established with the Red Cross Society and about 80 pupils have obtained the Junior First Aid Certificate. Emphasis has been put on smoking and lung cancer. The film "Time Pulls the Trigger" was shown in several schools followed by discussion. TRAINING OF STUDENTS We have assisted with the practical training of Student Health Visitors, practical training of Public Health Administrator Students and Health Visitor Students from the Royal College of Nursing and South East Essex Technical College, also Student district nurses and pupil midwives, Student teachers, Student social workers and Student Nurses from Claybury and Whipps Cross Hospitals. HEALTH VISITORS During the year the Health Visitors made 13,762 visits to homes:- (a) To expectant mothers:- First visits 390 Subsequent visits 340 (b) To children under 1 year of age:- First visits 1317 Subsequent visits 2383 (c) To children between the ages of 1 and 2 years 1734 (d) To children between the ages of 2 and 5 years 3116 (e) To the aged (over 65 years of age) 2322 (f) To other cases 2160 (48) SECTION 26 - VACCINATION AND IMMUNISATION The following tables show the number of persons in the various age groups who were immunised during the year:- DIPHTHERIA, WHOOPING COUGH & TETANUS - PRIMARY BY CLINICS YFAR OF BIRTH 1962 1961 1960 1959 1958 1957- 1953 19521948 19471943 TOTAL Diphtheria, Whooping Cough & Tetanus 23 153 6 - - - - - 182 Diphtheria & Tetanus - 40 6 1 - 6 2 - 55 Diphtheria - 77 17 6 1 9 1 - 111 Whooping Cough - 92 16 2 - - - - 110 Tetanus - 1 - 1 3 756 827 313 1901 Diphtheria Total 23 270 29 7 1 15 3 - 348 Whooping Cough 23 245 22 2 - - - - 292 Tetanus 23 194 12 2 3 762 829 313 2138 DIPHTHERIA. WHOOPING COUGH & TETANUS - BOOSTER BY CLINICS YEAR OF BIRTH 1962 1961 1960 1959 1958 19571953 19521948 19471943 TOTAL Diphtheria, Whooping Cough & Tetanus - - 1 - - - - - 1 Diphtheria & Tetanus - 11 1 1 - 13 - 2 28 Diphtheria - - - - 1 90 10 3 104 Whooping Cough - - - - - - - - - Tetanus - - - 2 1 242 431 144 820 Diphtheria Total - 11 2 1 1 103 10 5 133 Whooping Cough - - 1 - - - - - 1 Tetanus - 11 2 3 1 255 431 146 849 DIPHTHERIA. WHOOPING COUGH & TETANUS - PRIMARY BY GENERAL PRACTITIONERS YEAR OF BIRTH 1962 1961 1960 1959 1958 19571953 19521948 19471943 TOTAL Diphtheria, Whooping Cough & Tetanus 86 149 15 6 5 11 4 2 278 Diphtheria & Tetanus - 5 - - - 11 5 - 21 Diphtheria 9 114 20 5 3 12 3 - 166 Whooping Cough 20 100 20 7 3 8 - - 158 Tetanus 5 21 13 15 14 322 324 112 826 Diphtheria Total 95 268 35 11 8 34 12 2 465 Whooping Cough 106 249 35 13 8 19 4 2 436 Tetanus 91 175 28 21 19 344 333 114 1125 DIPHTHERIA. WHOOPING COUGH & TETANUS - BOOSTER BY GENERAL PRACTITIONERS YEAR OF BIRTH 1962 1961 1960 1999 1958 19571953 19521948 19471943 TOTAL Diphtheria, Whooping Cough & Tetanus - 30 20 4 6 27 3 - 90 Diphtheria & Tetanus - 2 - - 1 7 2 - 12 Diphtheria - 1 6 - 6 74 11 3 101 Whooping Cough - - 2 - 6 15 3 - 26 Tetanus - - 4 1 - 84 105 25 219 Diphtheria Total - 33 26 4 13 108 16 3 203 Whooping Cough - 30 22 4 12 42 6 - 116 Tetanus - 32 24 5 7 118 110 28 324 (49) Poliomyelitis Vaccination The following persons in the various age groups received immunising doses:- CATEGORIES PRIMARY BOOSTER FOURTH Salk Oral Salk Oral Salk Oral Born 1943 to 1962 751 446 1112 462 623 1277 Born 1933 to 1942 160 35 452 223 6 1 Born 1920 to 1932 144 103 1045 455 7 4 Over 40 years 25 9 160 105 - 1 Hospital Staff 56 - 33 27 - - Total Vaccinated during year 1962 1080 593 2769 1245 636 1283 " " " " 1961 5558 - 3106 - 3356 - " " " " 1960 3455 - 7851 - - - " " " " 1959 10096 - 9653 - - - " " " " 1958 6360 - 1037 - - - " " " " 1957 2662 - - - - - " " " " 1956 347 - - - - - " " to end of 1962 29558 593 24416 1245 3992 1283 Salk Oral Expectant Mothers vaccinated during 1962 - Primary 14 2 Third 21 8 Vaccination against Smallpox NUMBER OP PERSONS VACCINATED (OR RE- VACCINATED) Age at date of Vaccination Under 1 Year 1 Year 2-4 Years 5-14 Years 15 Years and over Total Number vaccinated 467 524 481 2212 1486 5170 Number re-vaccinated - 39 144 1252 1759 3194 (50) POLIOMYELITIS VACCINATION METHODS OLD and NEW "Are you sure it won't hurt?' 'Yes please, I like sugar' CENTRAL SYRINGE STERILIZING UNIT The Central Syringe Sterilizing Unit sterilized 11,336 syringes during the year. This is an average of 218 syringes per week. It will be appreciated, however, that the average weekly output increased from 1st April, 1962, when the service was extended to the Ilford and Walthamstow Health Areas and to the Lady Rayleigh Training Home. As a result of this the weekly average during the last four months has been 350 syringes. This is still less than the original estimate of 400-500 syringes weekly for the period of the pilot scheme, and is accounted for by the introduction of oral poliomyelitis vaccine, it is hoped to extend the service to the Barking Health Area next year. This would increase the average weekly number of syringes sterilized to the original estimate of 500. SECTION 27 - AMBULANCE SERVICE This section of the National Health Service Act is the responsibility of the County Council and is administered centrally. Leyton and Walthamstow combined use a station at James Lane, Leytonstone, E.11, which opened on 29th September, 1961. I am indebted to the County Medical officer of Health for supplying the following statistics relating to the operation of the County Ambulance Service from this station during the year:- Ambulance vehicles -12 Stretcher cases - 8,982 Dual purpose vehicles - 8 Other cases - 83,377 Total cases conveyed - 92,359 Total mileage - 292,625 Total emergency cases- 10,073 SECTION 28 - PREVENTION OF ILLNESS AND AFTEK CABE Foot Clinic I am indebted to the Chief Chiropodist for the following report on the work of the Chiropody Service: - '"Staff has been and continues to be the greatest problem. In July Mr.D.Waters resigned after sixteen years service and Mrs.Levy and Mr.Evans, both sessional workers, transferred to clinics outside the area which are nearer their homes. Mrs.A.Tong resigned for domestic reasons. We were fortunate in securing the services of Miss J. Thorne, M.Ch.S. who comnenced duty on 1st September for nine sessions a week. Domiciliary sessions have had to be increased to six a week and from 18th September Mr.R.Sadowski has been seconded to Wessex House for one session a week. This has left thirteen sessions a week less than last year for clinical work and the waiting list for treatment and between visits now up to four months and increasing, presents serious problems. Since the inception of the National Health Service it has been increasingly appreciated that a chiropody service for the aged is essential if serious attempts are to be made to keep the ageing population mobile. This has been stressed by the Guillftbard Report, the B.M.A. Geriatric Sub-Committee and Professors Hobson, Pemberton McKeown (51) and Dr.J.H. Sheldon in his presidential address to the Third Congress of the International Association of Gerontology to mention only a few. In the aged the skin often tends to become dry and inelastic, coupled with deformities usually found this leads to lesions over pressure points, the nails become hard and thickened with accumulation of debris in the sulci. In particular is this seen in osteoarthritic and rheumatoid patients. Here in old age it is not the primary lesions which cause the main disability but the secondary lesions arising from deformity of dysfunction. In my report for 1954 I wrote:- I mentioned earlier the waiting period between treatments is seven weeks. This is too long to leave the majority of old people with bad feet. A chronic corn can cause breakdown of tissue and consequent ulceration, an uncut nail pierce an adjoining toe, or the matrix become infected through backward pressure, numerous other minor conditions through want of attention, assume proportions beyond the sphere of chiropodist and become a burden on the doctor or a hospital which more frequent chiropodial attention could have prevented.* In "Chiropodial Co-ordination in Geriatric Practice" (Chiropodist Vol.8 No.6) it states:- 'The advantage of examining and treating these patients at an interval of three weeks was the means by which early indentification of the more serious conditions such as ulcerations, arterio-sclerotic and diabetic gangrene and other forms of circulatory disturbances, was made.' In "Schemes for the Elderly" published by the Society of Chiropodists 1959 we read:- 'Chiropodists cannot be expected to accept the responsibility for treating old people, with perhaps a serious peripheral vascular disturbance if they cannot see them as frequently as they wish.' I am hoping that the registration of Chiropodists under The Council for Professions Supplementary to Medicine, which begins in January, 1963, may admit into the Health Service many at present excluded by the 1954 Regulations and this may help to alleviate our acute staffing difficulties. However, with nearly every Authority in the Country needing chiropodists whether we will benefit or not remains to be seen. If more staff is not available in the near future I feel the Committee will have to consider very seriously limiting treatment to children, physically handicapped and the elderly." Semi-permanent appliances With this service patients are supplied with semi-permanent padded insoles, made to the individual needs of the patient. This is beneficial from the hygienic aspect and also affords relief from pressure for a much longer period than just padding. The supply of these, which began in 1959, continues to be very successful. 182 semi-permanent appliances were issued during the year as follows:- Males - 54 Females - 126 Children - 2 (52) Domiciliary Chiropody Since January 1961, when the Leyton Health Area assumed full responsibility for domiciliary chiropody, the number of patients seen in their own homes has increased four-fold. Approximately 369 housebound patients received treatment during the year, but the difficulty in recruiting chiropodists, has resulted in an increase in the intervals at which patients are treated. Attendances and Treatments During the year a total of 4,837 patients attended the foot clinics, these included 911 new patients, there were 19,104 treatments. It was possible to discharge 215 adults and 238 children patients. The following defects were treated:- Bursitis 20 Nail Ingrowing 26 Callosity 239 Pernio 4 Hard Corns 230 Pes Planus 4 Soft Corns 49 Septic Condition 6 Hallux Rigidus 6 Subungual - Exostosis 2 Hallux Valgus 21 Tinea Pedis 14 Hyperidrosis 12 Trigger Toe 5 Metatarsalgia 8 Verruca Pedis 203 Nail Club 62 Number of Patients - 369 Total Treatments - 1203 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 19 (b) Extra Nourishment- Number of new cases supplied with free milk 9 Total number being supplied with free milk at end of year 13 (53) Loan of Sick Room Equipment The undermentioned Sick Room equipment was newly loaned during the year:- Air Beds 2 Air Rings 64 Bed Back Rests 75 Bed Blocks 1 Bed Cradles 18 Bed Pans ill Bed Trays 1 Commodes 47 Crutches 7 Fracture Splints 3 Invalid Chairs 61 Plastic Sheets 132 Rubber Sheets 31 Steam Kettles 2 Urinal Bottles 45 600 Convalescence for Adults Number of applications during year 69 Length of stay:- One week 1 Two weeks 45 Three weeks 13 Pour weeks 2 SECTION 29 - DOMESTIC HELP The Domestic Help Service has continued to deal with the monumental task of meeting the demands on its services from the various categories of entitled applicants. There has been a general increase in assistance given to the chronic sick and particularly amongst the aged. Assistance to acutely ill persons and to mentally ill cases showed a slight increase. The cases under the category of OTHERS include help to harassed mothers and problem families and eleven cases were helped during the year as compared with four during 1961. In May 1961 the County Council adopted a recommendation that for a trial period of 12 months, free domestic help be provided (irrespective of income) in all cases (54) where a doctor certifies that an expectant mother is suffering from toxaemia of pregnancy and such assistance is medically necessary. From the commencement of this scheme until June 1962 - the trial period - there were seven beneficiaries and two further cases were assisted up to the end of 1962. The amount of help received varies from full-time to two hours daily. The cases have been referred by either Maternity Hospitals, General Practitioners, Midwives or Clinic Doctors and in all cases Medical Certificates have been requested at 28 day intervals. The domestic helps continued to give valuable assistance in cleaning up particularly dirty cases and the cheerful manner in which they tackle these unpleasant tasks is an inspiration to all. Applicants for the posts of domestic helps were of a good standard generally throughout the year. A number of domestic helps have now attended a course of in-service training and such training has proved of great value and is much appreciated by helps concerned. It is hoped during 1963 to extend these courses locally so that most of the domestic helps employed will be able to undergo a short course of training. Number of Helps and hours worked:- Number of domestic helps enrolled at end of year:- Whole-time helps 8 Regular part-time helps 162 Number of domestic helps actually employed at end of year 165 Number of hours worked during the year 185,640 Work of Domestic Help Organisers:- (1) (2) Total (1) First Visits 242 500 742 (2) Revisits to beneficiaries:- (a) Domestic help present 346 218 564 (b) Domestic help not present 1183 920 2103 (3) Other Visits 453 515 968 Total Visits 2224 2153 4377 (55) Help Provided Maternity Acute Sick Tuberculosis Chronic Sick Aged not Sick Others Total Aged Others Requests for help from new cases during the year 71 41 6 435 59 9 22 643 New cases helped during the year 51 38 5 382 48 6 17 547 Total cases completed during the year (a) 49 39 4 303 45 9 10 459 Cases being helped at end of year who have received help for - Under 3 months 3 4 - 64 12 1 4 88 3-5 months - - 2 64 5 1 - 72 6-11 months - - 1 128 9 4 4 146 12months and over - — 2 497 55 10 3 567 Total (b) 3 4 5 753 81 16 11 873 Total cases helped during the year (a) plus (b) 52 43 9 1056 126 25 21 1332 Hours of help provided during the year 2,097 1,468 1,420 153,592 18,890 4,103 4,070 185, 640 MEDICAL EXAMINATION OF STAFF County Council employees:- Number of medical examinations - (a) Entrants to County Council's service 170 (b) Retirement on Superannuation (c) Other purposes (including entrants to Teaching Profession and Training Colleges) 27 No. of medical examinations Leyton Borough Council 177 Others 4 (56) School Health Service LEYTON COMMITTEE FOR EDUCATION 1962-63 Chairman: Councillor A.L.Chamberlain, J,P. 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 Mrs.E,M.Dare, J.P. F.W.Marshall F. C. Newman J. A. Punshon, m.A. G.W. A.Robinson J. J, Walsh Nominated Members: County Alderman G.W.Mason Councillor W.0.J.Robinson Co-optative Members: H.W.Matthews F. W.H.May E.G.Morgan A. R. Summers J.D.Watson, J.P. S.J.White Staff The following table shows the whole-time equivalent of staff employed in the school health service as at 31st December, 1962:- Medical Officers 2.55 Dental Officers 4.27 Dental Auxiliaries .9 Dental Attendants 5.58 Nursing Staff 6.56 Remedial Gymnast .1 Speech Therapist 1.00 Administrative and Clerical 4.79 Clinic Clerks 1.33 27.08 (57) School Clinics Aural Clinic - Last Friday in the month 2 p.m. - 5 p.m. Park House Clinic Child Guidance - Monday to Friday 10 a. m - 1 p.m Child Guidance Clinic, 133 Dawlish Road, Leyton, E. 10. 2 p.m - 5 p.m Dental Clinics - Monday to Friday 9 a.m. - 12 noon Park House Clinic, Dawlish Road " Leyton Green " 2 p.m. - 5 p.m. Saturday (alternate) 9 a.m - 12 noon Park House Clinic Dawlish Road " Leyton Green " Foot Clinics - Mondays to Fridays and 9 a.m. - 12 noon Park House Clinic Dawlish Road " Leyton Green " alternate Saturdays 2 P.m. - 5 p.m. # Minor Ailment Clinics - Monday to Friday 9 a. m - 11 a. m Dawlish Road Clinic, Leyton Green " Park House " Saturday 9 a. m - 11 a. m # Doctors' Consultation Clinics - Monday, alt. Friday and Saturday 9 a. m - 12 noon Leyton Green Clinic Dawlish Road " Park House " Tuesday, It. Friday and Saturday 9 a. m - 12 noon Monday, alt.Friday and Saturday 9 a.m - 12 noon Ophthalmic Clinic - Wednesday and Friday 9.30 a.m. - 12 noon Leyton Green Clinic Optician - Wednesday and Friday 9.30 a.m. - 12 noon Leyton Green Clinic Orthopaedic Clinic - Thursday 2 p.m - 5 p.m Leyton Green Clinic Orthoptic Clinic - Tuesday (alternate) 9 a.m - 12 noon Leyton Green Clinic 2 p.m - 5 p.m Wednesday 9 a.m - 12 noon 2 p.m. - 5 p.m Friday 9 a.m - 12 noon 2 p.m - 5 p.m Remedial Exercises - Monday and Wednesday 4.45 p.m - 5.30 p.m Park House Clinic SDeech Clinic - Monday to Friday 9 a.m - 12 noon Dawlish Road Clinic 2 p.m - 5 P.m 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. (58) School Medical Inspection SCHOOL POPULATION Designation of School Number of Schools Number of Pupils Primary 19 5,429 Secondary 10 5,275 Special 3 229 Total 32 10,933 ROUTINE MEDICAL INSPECTIONS Group Number of Pupils Examined Percentage of Parents Present 5 year 922 92.6 10-12 + year 782 84.7 14 year 1,283 17.1 Other 122 59.0 3,109 REINSPECTIONS - ALL GROUPS - 1,617 PHYSICAL CONDITION OF PUPILS AT ROUTINE MEDICAL INSPECTIONS Age Group (by year of birth) Number Inspected Condition Classified Satisfactory Unsatisfactory 1958 and later - - - 1957 378 376 2 1956 544 541 3 1955 19 18 1 1954 8 8 - 1953 482 479 3 1952 300 298 2 1951 53 50 3 1950 22 22 - 1949 12 12 - 1948 8 7 1 1947 and earlier 1,283 1,280 3 TOTAL 3,109 3,091 18 (59) FINDINGS OF 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 1958 and later - - - - 1957 378 19 61 68 1956 544 23 68 82 1955 19 1 3 4 1954 8 1 1 2 1953 482 61 54 98 1952 300 43 35 67 1951 53 11 14 23 1950 22 4 — 4 1949 12 4 - 4 1948 8 2 - 2 1947 and earlier 1,283 243 128 339 TOTAL 3,109 412 364 693 (b) Pupils found to have undergone tonsillectomy Age Group Number Inspected Number found to have undergone tonsillectomy Boys Girls Boys Girls 5-year 498 424 27 19 10-12 + year 412 370 59 45 14-year 725 558 179 56 Other periodic 54 68 6 12 TOTAL 1,689 1,420 271 132 (c) Hygiene Inspection in Schools The Nursing Staff carried out 15,639 inspections during the year, and 17 cases of infestation were found. The present arrangements for the carrying out of cleanliness inspections in schools remains the same as reported in the last two years and the percentage incidence of infestation remains much the same at 0.22%, but although this over all annual figure remains fairly consistent there were, during 1962, one or two minor 'outbreaks' which have indicated the need for continued and systematic surveillance in schools. (60) (61) DEFECTS FOUND BY PERIODIC AND SPECIAL INSPECTIONS DURING THE YEAR DEFECT OR DISEASE PERIODIC INSPECTIONS SPECIAL INSPECTIONS ENTRANTS LEAVERS OTHERS TOTAL TREATMENT OBSERVATION TREATMENT OBSERVATlON TREATMENT OBSERVATION TREATMENT OBSERVATION TREATMENT OBSERVATION Skin 10 13 22 12 10 6 42 31 100 23 Eyes- (a) Vision 42 94 243 37 127 41 412 172 163 2 (b) Squint 20 3 5 - 1 1 26 4 16 1 (c) Other 3 4 3 - 2 - 8 4 48 15 Ears- (a) Hearing 8 44 4 4 4 10 16 58 43 6 (b) Otitis Media 3 24 6 1 4 7 13 32 10 2 (c) Other 4 4 2 - 3 3 9 7 16 2 Nose and Throat 26 62 7 11 6 16 39 89 27 4 Speech 17 21 2 1 6 7 25 29 33 2 Lymphatic Glands - 51 - 8 2 9 2 68 5 - Heart - 10 4 4 - 8 4 22 2 - Lungs 8 - 4 - 6 7 18 7 20 7 Developmental- (a) Hernia 3 5 - - 3 2 6 7 2 - (b) Other 4 17 3 15 1 14 8 46 37 2 Orthopaedic- (a) Posture 2 8 12 7 6 17 20 32 3 - (b) Feet 22 19 12 4 20 9 54 32 54 9 (c) Other 14 38 31 14 14 16 59 68 15 4 Nervous System- (a) Epilepsy - 2 2 - 1 - 3 2 - - (b) Other 1 6 - 1 3 3 4 10 9 2 Psychological- (a) Developmental - 19 4 10 10 28 14 57 40 - (b) Stability 4 49 6 17 13 53 23 119 107 29 Abdomen - 6 1 6 2 6 3 18 9 8 Other 2 - 6 2 3 2 11 4 364 51 Medical Treatment MINOR AILMENT CLINIC A doctor attends each Clinic for one morning session and alternate Saturday mornings for consultations. A school nurse is on duty every morning for dressings and minor injuries, etc. During 1962, 1,292 children attended 1,471 times to see the doctor and 857 children attended 1,758 times for advice and treatment from the nurse. SPECIAL CLINICS SUMMARY FOR 1962 Orthopaedic Aural Ophthalmic Orthoptic Psychiatric Sessional Programme 1 a week 1 a month 2 a week 6 a week 5 a week Total Sessions 38 11 88 240 65 New Cases 68 51 228 95 36 Attendances 570 113 1,380 1,521 126 ORTHOPAEDIC CLINIC This clinic is under the supervision of Mr.H.A.Oatley, P.R.C.S. Orthopaedic Consultant. During 1962 the following numbers of children were referred to Whipps Cross Hospital by Mr. Oatley. 15 Radiological investigation 11 Operative treatment 89 Pitting of surgical appliances AURAL CLINIC The following children were referred to hospital during 1962 for treatment or further investigation: Removal of Tonsils and Adenoids... 5 Removal of Tonsils only 1 Removal of Adenoids only 1 Bilateral Antral Lavage, Tonsils and Adenoides 2 (62) Bilateral Antral Washout and Intra Nasal Antostomy 1 Bilateral Paracentosis Tympanie 1 Bilateral Adenoidectomy and Bilateral A.W. 1 Myringotomy 1 X-ray Sinuses 2 Removal of polypus - Left Ear 1 OPHTHALMIC CLINIC AND OBTHOPTIC 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 28 children made 165 attendances at the classes. Dental Inspection and Treatment I am indebted to Mr.A.E.Hall, the Senior Dental Officer, who has submitted the following comments on the work of the School Dental Service in Leyton during 1962:- "The Dental Auxiliaries Experimental Scheme which the Privy Council have required the General Dental Council to carry out in accordance with Section 43 of the Dentist's Act of 1957:- The first batch of these auxiliaries finished their training and were ready for employment with Local Authorities in August 1962 and Miss Cladingbowl commenced duties in this Area on 10th September, 1962. An interim report on her work was made to the General Dental Council in December. The scope of her work is to do simple extractions of temporary teeth under local anaesthesia, to fill temporary and permanent teeth with simple fillings, the topical application of certain medicaments, and the scaling and polishing of teeth. Lecturing and instructing children on dental hygiene and the general care of the teeth is an important part of her work, which has been appreciated both in schools and in the clinics. A second dental surgery was opened at Leyton Green Clinic in October of this year (63) which means that we now have six dental surgeries in operation in the form of three two-surgery suites, one surgery in use full time by the dental auxiliary and dental surgeons equivalent to 4-8/llths full time in the others. For many years it has been necessary to send all dental patients needing X-ray facilities to Park House Clinic but X-ray machines for Dawlish Road Clinic and Leyton Green Clinic are now on order and in future full dental X-ray units will be in operation at these clinics. This is in accordance with the policy pursued in the area for many years that all the Council's surgeries should be modern, up-to-date units able to offer full facilities for dental treatment. The course of lectures given by Mr.Arnold to the dental surgery assistants has been continued during the year and has been very helpful and much appreciated. The staffing position has only varied slightly during the year, remaining around the equivalent of 4-8/llths whole time Dental Officers and one Dental Auxiliary, and this was the figure at the close of the year." DENTAL INSPECTION AND TREATMENT Periodic Specials (a) Number of pupils inspected 8,087 542 (b) Number found to require treatment 4,756 542 (c) Number offered treatment 4,365 542 (d) Number actually treated 2,413 542 (e) Number awaiting treatment 176 - (f) Attendances made by pupils for treatment 9,775 902 (g) Half-days devoted by:- (a) Dental Officers to- (i) Periodic (school) inspection 77 (ii) Treatment 2,040 (h) Number of X-ray examinations 652 (i) Fillings- (i) Permanent teeth 5,723 (ii) Temporary teeth 2,409 (j) Number of teeth filled- (i) Permanent teeth 4,910 (ii) Temporary teeth 2,432 (k) Extractions- (i) Permanent teeth- (a) on account of caries 685 (b) for other purposes 196 (64) (k) Extractions (cont.)- (ii) Temporary teeth- (a) on account of caries 2,148 (b) for other purposes 216 (1) Anaesthetics administered- (i) Local 1,004 (ii) General- (a) by Medical Officers on County Staff - (b) by others 1,237 (iii) Average number of general anaesthetic cases per general anaesthetic session 13.4 (m) Orthodontics- (i) Cases commenced during year 52 (ii) Cases carried forward from previous year 193 (iii) Cases completed during year 38 (iv) Cases discontinued during year 4 (v) Pupils treated with appliances 66 (vi) Removable appliances fitted 45 (vii) Fixed appliances fitted 1 (viii) Total attendances 689 (ix) Number of sessions devoted to treatment 69 (n) Number of- (i) Pupils supplied with artificial dentures 29 (ii) Dentures fitted 30 (o) Other operations- (i) Permanent teeth 2,794 (ii) Temporary teeth 1,274 (q) Analysis of figures, in (o)- (i) Silver Nitrate Treatment 447 (ii) Scaling, Polishing and Cleaning 924 (iii) Gum Treatment - (iv) Dressings 1,747 (v) Crowns fitted 22 (vi) Other operations 874 (65) 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, Girls 541 258 239 42 17.6 Connaught, Secondary Modern 486 220 220 52 23.6 George Mitchell " " 440 287 287 91 31.7 Goodall " " 416 251 251 61 24.3 Lake House " " 436 312 298 87 29.2 Leyton Manor " " 341 121 95 24 25.3 Norlington " " 479 297 297 88 29.6 Ruckholt " " 493 201 201 79 39.3 Barclay Primary Junior 517 268 189 105 55.6 Cann Hall " " 360 223 215 80 37.2 Church Mead " " 363 246 238 74 53.6 Davies Lane " " 219 147 136 58 42.7 Mayville " " 245 181 160 82 51.25 Newport " " 434 259 259 150 57.9 Sybourn " " 326 182 137 78 56.9 St.Josephs junior & Infants 207 120 120 90 75.0 Barclay Primary Infants 342 213 165 94 57.0 Cann Hall " " 321 106 104 45 43.3 Davies Lane " " 124 72 72 43 59.7 Newport " " 244 219 219 150 68.5 Sybourn " " 148 115 94 44 46.8 Harrow Green E.S.N. 101 76 70 20 28.6 Leyton Green E.S.N. 66 47 47 24 51.1 Lea Bridge Road 29 17 17 10 58.8 (66) Child Guidance Clinic TABLE I ANALYSIS OP FIGURES FOR 1962. I. Cases on the books of the clinic at the end of the Year (i) Cases awaiting first appointment 22 (ii) Cases under treatment 71 (iii) Other cases 122 II. Cases referred during the Year (a) Under fives-Boys 10 -Girls 4 (b) Over fives-Boys 78 -Girls 43 III. Source of referral General Practitioners 4 Head Teachers 17 Consultants 11 Children's Officer - School Medical Officers 73 Probation Officer 2 Health Visitors 3 Magistrates 3 Educational Psychologist 9 Parents 12 Others 1 IV. Cases closed during Year and other cases for which treatment ceased (i) Treatment completed and case closed 20 (ii) Other treatment, cases closed 20 (iii) Other (untreated) cases closed 48 V. Treatment carried out during Year Psychiatrists 468 Psychotherapists 223 Psychiatric Social Workers 771 Educational Psychologist 94 (67) TABLE II ANALYSIS OF CASES REFERRED 1. Nervous disorders, e.g. fears; depressions; apathy; excitability 35 2. Habit disorders and physical symptoms; e.g. enuresis; speech disorders; sleep disturbances; tics; fits, etc. 16 3. Behaviour disorders; e.g. unmanageable; tempers, stealing, lying; sex problems, etc. 55 4. Educational; e.g. backwardness; failure to concentrate 19 125 TABLE III ANALYSIS OF CASES DIAGNOSED 1. Nervous disorders, e.g. fears; depressions; apathy; excitability 32 2. Habit disorders and physical symptoms; e.g. enuresis; speech disorders; sleep disturbances; tics; fits, etc. 5 3. Behaviour disorders; e.g. unmanageable; tempers; stealing, lying; sex problems, etc. 4 4. Educational, e.g. backwardness; failure to concentrate 2 5. No basic disturbance of child, e.g. mainly parental overanxiety 4 47 TABLE IV ANALYSIS OF CASES CLOSED DURING 1962 1. Improved and recovered after treatment 35 2. Improved after partial service, i.e. before diagnosis 3 3. Diagnosis and advice only - 4. Interrupted, e.g. on parents' initiative 34 5. Closed for miscellaneous causes, removed from area, placement at E.S.N.School, etc. 23 6. Spontaneous Improvement 4 99 (68) PSYCHIATRIC SERVICES FOR CHILDREN Dr.Little who holds a joint appointment which includes being Psychiatrist to the Leyton Child Guidance Clinic and to the Paediatric/Psychiatric unit at Whipps Cross Hospital reports as follows:- "The Leyton Child Guidance Clinic was opened 1st October, 1962. Until then, Leyton children had been treated at the Walthamstow Child Guidance Clinic, but some Leyton children were put on the waiting list for the clinic to open. In the last quarter of 1962, as compared with the mean of the first three quarters, the number of cases referred increased by 50% (from 30 to 45) and the psychiatric time increased by over a 100% (from 90 to 198 treatment sessions). Investigation and treatment carried out by other members increased in proportion. Most children were sent to the clinic by school medical officers, but others (such as G.P. s, teachers, etc.) have been encouraged to send children. Priority was given according to the needs of the children as assessed from the account of their problems. Regular contacts between the clinic staff and other health and welfare workers in Leyton were planned and carried out-by formal and informal meetings, discussion groups and lectures. In particular the clinic team will be visiting Lea Bridge Day School for maladjusted children weekly, to supervise these children and to discuss with the staff how they can best be helped." Whipps Cross Hospital Children's Unit: Also on 1st October, 1962, difficult or nervous children were accepted into the children's wards to be supervised by the same part-time psychiatrist who works in the Leyton Child Guidance Clinic. Thirteen beds were set aside for children of any age up to puberty. The development of this unit affects Leyton services in two main ways:- (1) Leyton children have an equal right to admission with children from other areas in the north-east metropolitan region. They have the added advantage of being under the same doctor in hospital and clinic, and their admission can be planned as part of their total treatment. (2) Children from outside Leyton can make use of local services during their admission to hospital (this has helped particularly in the treatment of children who find it difficult to go to school from home, who can be offered local school from hospital). Further development of the hospital unit is planned with the object of increasing the contacts between hospital and local health and welfare services, including the Child Guidance Clinic. B.C.G. Vaccination (i) No. of schoolchildren skin tested 967 (ii) No. found positive 130 (iii) No. found negative 780 (iv) No. vaccinated with B.C.G 786 (69) Speech Clinic CHILDREN HAVING RECEIVED TREATMENT DURING 1962. Under 5 years Primary School Secondary School Special School TOTAL Articulation Defect 1 19 3 17 40 Cases commenced before 1st January, 1962, and continuing after 31st December, 1961. Stammer - 2 7 - 9 Articulation Defect and Stammer - 2 1 - 3 Total 1 23 11 17 52 Articulation Defect 18 52 2 2 74 Cases commencing treatment during 1962. Stammer 2 4 6 - 12 Articulation Defect and Stammer - 2 1 3 Total 20 58 9 2 89 Therefore total cases receiving treatment during 1962 - 141 Total new cases - 89. Boys Girls Total Children at present undergoing treatment 69 33 102 Children discharged 68 21 89 On Waiting List Nil Average number of cases treated daily 20 Homes visited - School departments visited 38 Parents interviewed 116 Children referred to other clinics 4 Number of children leaving before cure or discharge 19 Total number of attendances 2,928 Number of children referred found not to require treatment Nil (70) 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. 240 children were accepted for treatment and 238 were discharged. A total of 1,848 attendances were made by children at the clinics. The new cases were treated for the following 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 1 3 3 3 4 8 14 28 33 44 17 30 188 Callous - - - - - 1 - - - - 1 - 2 Corns 6 - 3 - - - 1 1 4 5 6 6 32 Hallux Valgus - - - - - - - - 1 3 - 1 5 Ingrowing Nail - - - - - - - - 1 1 4 1 7 Club Nail 1 1 - - - - - - 1 - - - 3 Septic Condition - - - - - - - - - - - 1 1 Tailors Bunion - - - - - - - - 1 - - 1 2 TOTAL IN AGE GROUPS 8 4 6 3 4 9 15 29 41 53 28 40 240 (71) (72) HANDICAPPED PUPILS CATEGORY Number of children of school age on 31st December, 1962, 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 2 - - - - - - - - - - - - - 2 2 1 - 4 Deaf 3 - - - - - - - - - - - - - 3 - 1 - - Partially hearing. 8 1 - - - - - 1 - - - - - - 10 10 3 - - Delicate - - 2 1 - - 2 - - - - - - - 5 - - - - Physically Handicapped 22 - 1 - 1 - - - - 5 3 - - 32 34 1 - 38 E.S.N. 87 - 6 1 - - 3 - - - - - - - 97 - - - 17 Maladjusted 29 - 7 1 - - 6 3 - - - 1 - - 47 - - - - Epileptic 1 - - - - - 1 - - - - 1 - - 3 2 - - 4 Speech defect - - - - - - - - - - - - - - - - - - - Dual defects 3 - 1 - - - - 1 - - - - - - 5 - 1 - 2 TOTAL 155 1 17 3 1 - 14 5 - - 5 5 - - 206 48 7 65 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 1962 Varied from 195 to 200 Leyton 83 - 87 Forest 106 - 113 Number admitted 1962 49 Number left 1962 49 Reasons for leaving:- 1. Attained age of 16- (a) Reported as requiring Community Care 8 (b) Not reported 13 2. No longer in need of special education 10 3. Notified as unsuitable for education under section 57 (4) 1 4. Removal to other areas 7 5. To Residential School (E.S.N.) 6 (0. A.) 1 6. Returned to Normal School 2 7. Home tuition l LEYTON GREEN PRIMARY (E.S.N.) SCHOOL Specials Boys Girls No. inspected 45 30 Parents present 13 13 Unsatisfactory 5 7 Defects found Code No.4 Skin 2 1 (73)  Specials Boys Girls 5 (a) Vision 5 2 (b) Squint 2 1 (c) Others 1 1 6 (a) Hearing 2 4 (b) O.Media 3 1 (c) Others 2 - 7 Nose and Throat 1 1 8 Speech 5 1 9 Lymphatic glands 1 - 10 Heart 1 1 11 Lungs - - 12 Developmental- (a) Hernia 1 - (b) Others 2 1 13 Orthopaedic- (a) Posture - - (b) Feet 2 2 (c) Others 1 1 14 Nervous System- (a) Epilepsy 1 3 (b) Others - - 15 Psychological- (a) Development 7 3 (b) Stability 7 4 18 Abdomen 1 2 HARROW GREEN SECONDARY (E.S.N.) SCHOOL Born 1946 Routine Born 1947 Routine Specials Boys Girls Boys Girls Boys Girls No. inspected 16 13 9 4 24 20 Parents present 7 11 7 4 4 2 Unsatisfactory 1 - 2 - 4 2 Defects foundCode No. 4 Skin _ 2 2 - 3 1 5 (a) Vision 2 2 3 - - 3 (b) Squint - 1 - - - 1 (c) Others - - - - - 1 (74)  Born 1946 Routine Born 1947 Routine Specials Boys Girls Boys Girls Boys Girls 6 (a) Hearing 1 4 1 - 4 1 (b) O. Media 2 2 - - 2 - (c) Others - - - - 1 1 7 Nose and Throat - 1 - - 1 2 8 Speech 1 1 - - 2 - 9 Lymphatic Glands 1 - - - 1 - 10 Heart 1 1 - - 1 - 11 Lungs 1 2 - - 1 1 12 Developmental- (a) Hernia - 1 - - - - (b) Others 1 1 - - - - 13 Orthopaedic- (a) Posture 1 1 1 - 1 - (b) Feet 1 1 1 - 1 1 (c) Others 1 1 - - - - 14 Nervous System- (a) Epilepsy 2 2 - - 3 2 (b) Others - - - - 2 - 15 Psychological- (a) Development - - - - 3 7 (b) Stability 3 4 4 - 2 3 18 Abdomen - - - - 1 1 LEYTON SPECIAL E.S.N. SCHOOLS The School Medical Officer visits each school two to three sessions a month throughout the school year. Routine medical inspections are carried out in the last year of the senior school and wherever it is thought necessary for other children in either school. All new admissions are seen by the School Medical Officer and their health history noted and any defects discussed with the head and class teacher. During the year those children who are failing in any way or giving concern to the teaching or medical staff or to their parents are examined, if possible when the parent can attend. Parents can request an appointment with the Medical Officer at any time. It is unfortunate that the children whose parents one is most anxious to see either live too far away to contemplate the journey, or go to work and won't consider taking time off, or belong to the group of problem families who seem unable to co-operate and just do not come, if the family live locally the school medical officer visits the home and did in 20 cases in 1962 where special problems had arisen. One boy with severe (75) and chronic ear troubles aggravated by lack of parental care was sent to a residential open air school in an effort to improve his general condition and ensure regular treatment for the otorrhoea. This family requires visits from either the school medical officer or the school health visitor before any co-operation can be obtained. Two families with behaviour difficulties were visited at home. One child required an operation for an orthopaedic defect. She saw the consultant without her parent and the home was visited later. The c-hildren who come from long distances in Essex and where parents are difficult or neglectful, are referred to the Forest Division Health Department and their co-operation in seeing that treatment is secured for the children concerned is most helpful. EPILEPSY This is not a cause of much anxiety in the school generally as the cases are all well controlled with the exception of one girl who was recommended for home tuition after the summer term. Her fits became so frequent and so prolonged that she spent most of her time in the sick bay, and the almost daily occurence was very disrupting to her school mates and the teaching staff. This girl has been in hospital several times and is under constant medical care, but she has steadily deteriorated mentally and seems to be resistant to treatment. She makes a little progress with the home teacher but the outlook is not a very happy one. One boy admitted some weeks before the end of 1962 on trial has settled down fairly well and the staff are hopeful that he will be able to stay. He has temporal lobe epilepsy, possibly brain damage of some kind, and has been a difficult boy since the age of 5 years. Dr.Barnardo's Homes requested that he be given a trail in Harrow Green as no one else would keep him. It looks as if it might be a success though he can be excessively difficult at times. COMMUNITY CARE Now that the parents' consent has to be obtained before a child can be referred for Community Care to the Local Mental Welfare Authority there have been several children leaving school who, because of parental opposition, have been without the safeguard for the future that this referral could give. One boy whom school and medical staff alike knew would not keep in work has been drifting around for 6 months now. He could be in the Senior Training Centre if his parents could have been persuaded to agree. He has been recommended for the Disabled Persons Register but this does not really cover his difficulties. Four other children were also recommended for the Disabled Persons Register, one spastic girl, one girl partially sighted and partially deaf, one boy with epilepsy and one girl with epilepsy. (76) MALADJUSTMENT The E.S.N, child has many problems besides his educational failure and some of them need help with these problems from other sources than the school. Three children have started treatment at the local Child Guidance Clinic and one is attending at the psychiatric children's unit at ffhipps Cross Hospital. Already the school and parents report an improvement in two of the children. This new service is very much appreciated. FOLLOW-UP AFTER LEAVING SCHOOL Our liaison with the Juvenile Employment Officer is good. He visits the school ~ach term and sees children, parents and staff: if he cannot see the school medical officer cases are discussed over the telephone and a written report is also given. 1962 has been a more difficult year than for many years past as regards employment and some children who were expected to do well have not been in regular work. The type of work obtained is very varied - butcher, baker, bootmaker, machinist, factory work, dressmaking, assistant in veterinary surgery and kennels, shop assistant in a furniture store. One boy who has relatives in the printing trade was given a chance as an apprentice. The headmaster follows-up the children after they leave school and a number of children return to the school to report how they are getting on or if they are in difficulties, to ask for help. A few children approach the Health Department too when difficulties arise and advice is given. LEA BRIDGE ROAD SCHOOL FOR MALADJUSTED CHILDREN The numbers at the school for maladjusted children have remained around 30 for the past year: still showing the same pattern of a preponderance of boys over girls as has been noted elsewhere. Some children who very much require treatment at this school have not been admitted because of parental opposition: coercion is not the answer as to do much good in these disturbed cases the co-operation of the parents is essential. The parents of some children who are attending are not co-operative but at least they do not obstruct and though this makes the task of the staff much harder the children do get some benefit from the school. Two problems are causing concern, one is the age at which to admit children so that the child himself can benefit and also least disturb the children already in the school. The other is how to prepare the older child for return to normal educational stream. Newly admitted children can be disruptive to a class already settling down and coping with their problems to some extent. Especially disturbing is the older child over 10 years of age - who may have to be put into a class almost ready for discharge and he or she can cause much anxiety to children and staff alike. If there was another class, slightly separate from the main school, which would take in older new admissions this difficulty would be solved. Now that the school is three years old there are a number of children of secondary (77) school age, not yet established securely enough to return to the normal educational system, who could benefit from the transition class. That this is needed has been shown by the fact that several children who have left have visited the school and longed to return. They are coping up to a point with their difficulties but would have benefited from a longer time to stabilise themselves before venturing into the rather difficult world of the secondary school. Consideration of various solutions to the problem is being given and it is hoped that 1963 will see the difficulties cleared away. There is no doubt that one class to cater for the older child who is not quite ready for transfer back to normal school and another for the 10-11 year old newly admitted child would enlarge and consolidate the value of the school to these disturbed and difficult children. The school medical officer visits the school several sessions each term and sees icw admissions and follows up any children with physical defects requiring attention. She also consults with the staff on any problems of mutual interest. The School Health Visitor also sees the children for general hygiene and well-being and does vision testing once a year. If necessary visits are paid to the parents of local children. Two boys were discovered to have congenital heart lesions but after investigation by a heart specialist neither child required to have his activities curtailed in any way and no treatment has been necessary. Psychiatric Sessions The difficulties described in the 1961 report regarding the attendance at the school of the Consultant Psychiatrist were not satisfactorily resolved during 1962 and caused much frustration to medical and teaching staff. It is hoped that these difficulties have now been resolved and Dr.Little the psychiatrist attheLeyton Child Guidance Clinic hopes to attend weekly at the school. The Educational Psychologist and the Psychiatric Social Worker have weekly sessions after school hours with the teaching staff and although the school medical officer has not so far been able to attend at the same time as close liaison as possible is kept by personal visits at other times or by telephone. The school has many activities which encourage the children to enlarge their experience and their interest as well as overcoming some of their inhibitions about learning. Class music, physical education, swimming and dancing are some of their activities. The children converted a part of the school into their own cinema. During the summer months they and their teachers and ancillary staff from the school spent a week-end camping in the Essex countryside. The amount of their leisure time that the teaching and ancillary staff devote to the welfare of the children in Lea Bridge Road School is very considerable and I would like to record my appreciation of the fine work that is being done by all connected with the running of the school. Follow-up of Children who have left 29 children have left the school. Thirteen have gone to Secondary Modern School and all have made satisfactory progress. One boy who is doing well in school is however not making a satisfactory adjustment out of school. He is a boy with very difficult home circumstances and little parental support. (78) Five children returned to Junior School. One of these who was very retarded found he could not cope with the school work but he has settled well in the E.S.N. School and his parents are satisfied with him. Pour children were transferred to other special schools; one to a school for physically handicapped, one to a school for partially deaf, though if she had been co-operative over wearing her hearing aid she need not have gone. She is making good progress there however and will probably stay till the end of the school year. Two have gone to E.S.N. Schools. Two children have gone to residential schools for maladjusted children, one to a residential school for E.S.N, children and one child had to have home tuition before he eventually recovered enough to attend a junior school. He has now settled without incident in a Secondary Modern School. Two children moved away from the district and one child was withdrawn by the parents. She still fails to make progress but her parents are mcst unco-operative. TUBERCULOSIS IN SCHOOL CHILDREN There was no new case of tuberculosis in school children reported in 1962. DEATHS OF CHILDREN OF SCHOOL AGE During the year three children of school age died. The deaths were due to the following:- Influenzal Pneumonia - Congenital Hydrocephalus - Boy aged 5 years. Sub-acute Bacterial Endocarditis (Post Rheumatic) - Boy aged 12 years. Fractured skull and contused brain (road accident) - Girl aged 13 years. HEALTH EDUCATION The Health Visitors gave 180 lectures in schools at which the children made 3,230 attendances. (79) Improvements to School Premises carried out during year ended 31st December, 1962 LEYTON MANOR COUNTY SECONDARY GIRLS SCHOOL Remodelling of existing main three-storey building to provide internal sanitary and washing accommodation on each floor, kitchen, gymnasium with changing rooms and showers, library and art rooms. New administration wing erected at north-east end of main building together with new buildings in the playground containing two science rooms, domestic science room and needlework room. The under-mentioned schools were redecorated internally Leyton Manor County Secondary Norlington County Secondary (part only) Ruckholt County Secondary Barclay County Primary Infants George Tomlinson County Primary Junior & Infants Harrow Green Special (main building) Redecoration for School Meals Service Davies County Primary - two dining rooms and scullery Lea Bridge - scullery Sybourn County Primary - scullery and portion of dining room St.Josephs R.C. - kitchen and dining room (80)