Ac 4411 (1) LEY 57 BOROUGH OF LEYTON THE HEALTH OF LEYTON 1963 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 1963 - 64 The Worshipful the Mayor: Councillor A.L.Chamberlain, J.P. (ex-officio) Chairman: Alderman Mrs. A. M. M. Burrell Vice-Chairman: Councillor Mrs.E.Bartram Aldermen: G. S. Plack Mrs. J. Hammond, O. B. E. ,J.P. Mrs.R.King Councillors: Mrs.D.E.Collins A. H. Mackay F.W.Marshall, J.P. 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 Adninistrative 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, as requested by the Ministry of Health, on the factors affecting the health of the people of Leyton during 1963, and on the health of the population as individuals, including reference to the work of the School Health Service. The health of the public is promoted by engineering, by the deployment of special knowledge and skills, and by making the widest possible use of the spirit of care for others which is so plentiful in the many voluntary organisations. In all three of these fields there has been progress and each new venture promises an exciting and rewarding future. The reconstruction of the main outfall system and new sewage pumping station at the Auckland Road Depot which the Borough Engineer reports in these pages (p.8) reminds one that the engineering component in the promotion of health must be radical and expensive, as do the impressive new housing projects, for good housing is without doubt a major need for the health of many Leyton residents. The new day nursery in Epsom Road (p.37) - one of the first of its kind in Essex provides almost all that physical environment can in respect of the benefits of air, light and space so necessary for children. Though major construction will always catch the public imagination, the constant systematic work of the Public Health Inspectorate - so easily taken for granted - does more for health than could be guessed. The absence of an epidemic is not news. The months of detailed work behind the Avenue Road and Morris Road slum clearance enquiry (p.15) in June will be forgotten long before young families are learning, in fine new dwellings on the site, what life is like free of damp, darkness and family tension. The timeconsuming routine which is connected with the introduction of Smoke Control Areas 3 and 4 (p.18), approved in February, will never be appreciated by those chronic bronchitics who have extra years of life and freedom from bouts of gasping and coughing due entirely to this work. The routine complaints and enquiries by the public will continue and the intriguing variety of foreign substances found in food must be followed up, but new responsibilities are ahead. The inspectorate will soon have the duty of ensuring that employees in offices, shops and railway premises are working under conditions where their health and safety are protected. The Chief Public Health Inspector refers to the new Offices, Shops and Railway Premises Act in his section of this report (p.12). The knowledge and skills of the staff of the personal health services - medical, dental, nursing, medical auxiliary and others - can never be of too high quality and courses of specialist instruction will always be essential to maintain those services for which only local authority staff have the experience and qualifications. In addition to the courses attended by doctors, health visitors and others from the Health Department, an innovation this year was the introduction of courses for training for the Home Helps, including them all in two local courses. These courses (p. 50) did a great deal to improve the quality of the service. There is also advantage to be gained from new knowledge, and research must always be part of a Health Department's activities. Four local items of research were started during the year by individuals on the staff (on bronchitis, ante-natal psychological factors, educationally sub-normal school leavers, and wind in babies). It will not be possible to report on these until further work has been done. In addition we have been co-operating with a number of national research projects. We are particularly pleased to welcome the Medical Research Council Unit studying environmental factors in Mental and Physical Illness (p.40) and give such help as we can in the study of families and conditions in Leyton. (2) Another new project has been the "At Risk" register (p.34) started in the early part of the year which promises to be of great value in finding handicaps in children at an age when little if any faulty training has developed. A modern Medical Officer of Health is ever increasingly aware of the work of voluntary bodies. The once clear division of church and state in helping those unable to help themselves has become an inextricably complicated tangle of associations, officers, committees and visitors; some statutory, some voluntary, some full-time, some part-time, trained and untrained with broad vision or sectional interest. And to complicate the picture the numbers in need grow and grow as the age structure of the population changes. The problem of the aged is very pressing, especially in Leyton. According to the 1961 Census, of the borough's 16,524 old age pensioners, 3,299 live alone and 6,846 live in two person households (in two-thirds of these both are pensioners). To make some impact on this problem the Borough appointed in April a full-time Elderly Citizens Liaison Officer. He has already done much to find outlets for the genuine eagerness to help displayed by all sorts of organisations, channelling this energy to where it could have most effect. In particular I should like to pay tribute to the enthusiasm of a small but energetic band of young volunteers from schools and youth clubs. August saw the opening of the luncheon club at Davies Lane which is the first of several which the Committee have planned. It rapidly grew until it is now taking an average of 37 a day. Food and fellowship do more to prevent a decline in physical and mental health in old age than anything else, and this is preventive medicine of the highest order. Decline because of age is inevitable, but because of it many people accept illness in later years that they would not tolerate if they were younger. This is misguided. We all expect to grow old; we need not all expect to grow ill as well. A new attitude of mind is needed and luncheon clubs do much to spread it. With so many points of growth in their work members can feel proud and look forward with optimism, but would be wrong to be complacent, for there is still much to be done. Improvement of the environment still has far to go, provision for the aged is hardly past the beginning and there is no shortage of suggestions as to how the present services could be further exploited to the benefit of the public. I have pleasure in recording my thanks to the staff for their work, their loyalty and their enthusiasm during the year, and to the helpfulness of those of other departments where the function of the Health Department have needed their co-operation. My thanks are also due to the Council and the two Health Committees for their support and in particular to Alderman Mrs.A.M.M.Burrell, Chairman of the Public Health Committee and Councillor F.W.Marshall, J.P., Chairman of the Leyton Health Area SubCommittee whose constructive interest has been much valued. I have the honour to be, Mr.Mayor, Ladies and Gentlemen, Your obedient Servant, Medical Officer of Health. May, 1964 (3) VITAL STATISTICS Area in acres 2,594 Population (Census 1962) 93,357 Population (Registrar-General's Estimate, 1963) 92,550 Assessable Value for General Rate Purposes £3,727,747 General Rate in the £ (1963/64) 10s. l1d The Registrar-General's mid-year 1963 estimate of population (viz., 92,550 has been used for the calculation of the following statistics:- Live Births 1,504 Live Birth Rate per 1,000 population 16.25 Stillbirths 26 Stillbirth rate per 1,000 total (live and stillbirths) 16.99 Total Live and Stillbirths 1,530 Infant Deaths 29 Infant Mortality rate per 1,000 live births 19.28 " " " " 1,000 legitimate births 19.27 " " " " 1.000 illegitimate births 19.41 Neo-Natal Mortality Rate (first four weeks) per 1,000 related live births 13.96 Early Neo-natal Mortality Rate (first week) per 1,000 related live births 12.63 Peri-natal Mortality Rate (stillbirths and deaths during the first week) per 1,000 total still and live births 29.41 Percentage of illegitimate live births 6.84 Maternal Deaths (including abortion) 1 Maternal Mortality Rate (including abortion) per 1,000 total live births 0.67 Total Deaths 1,370 Death Rate 14.80 Natural increase of Population 134 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 1.02 Area comparability factor for deaths 0.79 These factors, when applied to the crude rates, produce the following adjusted rates:- Live Births 16.57 Deaths 11.69 (4) COMPARATIVE STATISTICS OP BIRTHS, MORTALITY, ETC. LEYTON 1901-1963 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 1963 92,550 1,504 16.25 1,370 14.80 29 19.28 * Population as estimated for purposes of B - Birth Rate; D - Death Rate. (5) CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE - 1963 AGE GROUPS - MALES AGE GROUPS - FEMALES CAUSES OF DEATH TOTAL UNDER 1 1-4 5-14 1524 2544 45- 64 6574 75+ TOTAL MALES UNDER 1 1- 4 5- 14 1524 2544 4564 6574 75+ TOTAL FEMALES 1. Tuberculosis, respiratory 6 - - - - 1 3 1 - 5 - - - - - 1 - - 1 2. Tuberculosis, other 1 - - - - - - - 1 1 - - - - - - - - - 3. Syphilitic disease 3 - - - - - - 1 1 2 - - - - - - 1 - 1 4. Diphtheria - - - - - - - - - • - - - - - - - - - 5. Whooping Cough - - - - - - - - - - - - - - - - - - - 6. Meningococcal Infections 2 1 - - - - - - - 1 - - - - - - - 1 1 7. Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - 8. Measles - - - - - - - - - - - - - - - - - - - 9. Other infective and parasitic diseases 1 1 - - - - - - - 1 - - - - - - - - - 10. Malignant neoplasm stomach 23 - - - - - 7 6 5 18 - - - - - 2 - 3 5 11. Malignant neoplasm lung, bronchus 76 - - - - 2 37 22 6 67 - - - - 2 5 1 1 9 12. Malignant neoplasm breast 21 - - - - - - - - - - - - - 2 8 4 7 21 13. Malignant neoplasm uterus 8 - - - - - - - - - - - - - 1 7 - - 8 14. Other malignant and lymphatic neoplasms 94 - - - - 3 15 9 16 43 - - 1 - 4 12 14 20 51 15. Leukaemia, aleukaemia 7 - - - - 1 2 -. 1 4 - - - - - 2 1 - 3 16. Diabetes 7 - - - 1 . 1 - - 2 - - - - - 1 ?. 2 5 17. Vascular lesions of nervous system 180 - - - - 3 12 17 32 64 - - - - - 11 27 78 116 18. Coronary disease angina 210 - - - - 4 39 36 40 119 - - - - - 18 28 45 91 19. Hypertension with heart disease 33 - - - - 1 1 8 2 12 - - - - 1 - 3 17 21 20. Other heart disease 210 1 - - - - 9 7 54 71 - - - - - 11 17 111 139 21. Other circulatory disease 84 - - - - - 8 12 25 45 - - - - 1 2 10 26 39 22. Influenza 11 - - 1 - - - - 1 2 - - - - - - 1 8 9 23. Pneumonia 136 2 2 - 1 - 6 14 30 55 2 - 1 - 1 3 12 62 81 24. Bronchitis 84 - - - - 2 17 18 22 59 - - - - 1 3 5 16 25 25. Other diseases of respiratory system 14 - - - - 1 3 5 3 12 - - - - - - - 2 2 26. Ulcer of stomach and duodenum 9 - - - - - 1 2 3 6 - - - - - - - 3 3 27. Gastritis, enteritis and diarrhoea 4 - - - - - - - - - 1 - - - - - 1 2 4 28. Nephritis and nephrosis 8 - - - - 1 3 1 - 5 - - - - 2 - - 1 3 29. Hyperplasia of prostate 3 - - - - - 1 - 2 3 30. Pregnancy, childbirth, abortion 1 - - - - - - - - - - - - - 1 - - - 1 31. Congenital malformations 11 3 - - - - 2 1 - 6 3 - - - - 2 - - 5 32. Other defined and ill-defined diseases 83 8 - - - 4 10 4 8 34 7 1 - 2 1 7 13 18 49 33. Motor vehicle accidents 17 - - - 8 2 4 1 2 12 - - - - - 3 1 1 5 34. All other accidents 11 - - - - 1 1 - 2 4 - - - - - 1 2 4 7 35. Suicide 11 - - - - - 4 - 2 6 - - - - 4 - 1 - 5 36. Homicide and operations of war 1 - - - - - 1 - - 1 - - - - - - - - - TOTALS 1,370 16 2 1 5 26 187 165 258 660 13 1 2 2 21 99 144 428 710 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 1963 (1,370) compares with (1,394) in 1962 the respective death rates per 1,000 population being 14.80 and 14.99 (6) BURIAL OF THE DEAD During the year 11 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. J. Lanagan, Acting Baths Manager,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 Chlorineation 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 (7) 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:- "The larger part of the present sewerage system is some 70-90 years old, and the Council have embarked on a programme of redrainage, treating each area in turn. The contract for the first stage of the West Leyton Area, part of which serves the Crescent Road Redevelopment Area, is completed, and the second stage is in progress. It is hoped to commence construction on the third stage of this area in 1964. Reconstruction of the main outfall system at the Auckland Road Depot, which controls the flows from the whole Borough, has been completed within the year." 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. 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). (8) HOSPITALS The following hospitals, administered by the Forest 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. 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. STATISTICS Year Articles Laundered West Ham Leyton Total 1957 - 1,417 1,417 1958 3,072 2,780 5,852 1959 6,709 6,943 13,652 1960 8,094 9,078 17,172 1961 8,908 10,595 19,503 1962 8,643 20,626 29,269 1963 8,387 24,126 32,513 NATIONAL ASSISTANCE ACT, 1948 (SECTION 47) One of the tragedies concerning the aged is that they often outlive their contempories and become estranged from their relatives; the result of this can be loneliness almost to the point of complete isolation. In such cases the stage can be reached when even with the support of domiciliary health and welfare services persons are just not able to care for themselves in their own homes. Fortunately it is usually possible to persuade a person in these circumstances to agree to enter hospital or welfare accommodation, but in exceptional cases it is necessary to take action for compulsory removal under this act. I am pleased to report that it was not necessary to take legal action in respect of any case during the year. (9) INFECTIOUS DISEASE-NOTIFICATIONS DISEASE Number notified during Year 1960 1961 1962 1963 Scarlet Fever 50 44 29 27 Erysipelas 6 5 9 5 Whooping Cough 42 20 34 62 Measles 215 1195 281 1069 Diphtheria - - - - Acute Poliomyelitis-Paralytic 1 - - - - Non-paralytic - - - - Tuberculosis-Respiratory 40 32 35 44 - Meninges and C.N.S. 1 - - 1 - Other 6 5 6 5 Meningococcal infection 1 1 1 2 Acute Encephalitis, Inf. - - - 2 - Post-inf. - - - 1 Dysentery 31 60 97 40 Ophthalmia Neonatorum 3 - 2 - Puerperal Pyrexia 2 5 2 3 Pemphigus Neonatorum - - - - Typhoid Fever 11 - - - Paratyphoid - - - 1 Food Poisoning 11 20 22 - Malaria - - - - Pneumonia 47 59 35 102 Smallpox - - - - Anthrax - - - - 451 1447 553 1364 (10) TUBERCULOSIS The following is a statement of particulars appearing in the Register of Notifications of cases of Tuberculosis for the year ended 31st December, 1963. PULMONARY NON-PULMONARY TOTAL M F Total M F Total Number on register at commencement of year. 499 392 891 37 53 90 981 Number first notified during year 34 10 44 3 3 6 50 Number entered in register otherwise than by notification 23 20 43 1 - 1 44 Number removed during year 196 138 334 18 17 35 369 Number remaining at end of year 360 284 644 23 39 62 706 Died 19 11 30 - - - 30 Removed from district 41 22 63 3 1 4 67 De-notified 129 96 225 15 11 26 251 Cured 7 9 16 - 5 5 21 Of the cases first notified during the year the age group distribution was as follows:- Age Periods PULMONARY NON-PULMONARY M F M F Under 5 years - - - - 5-14 years - - - •• 15-25 " 6 5 1 2 26-45 " 8 2 1 - 46-65 " 15 3 - - 65 and over 5 r 1 1 TOTAL 34 10 3 3 (11) Public Health Inspection of the Area -1963 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 matters of a topical interest which are worthy of further elaboration and certain statistics which require summarising in order to present an intelligible picture. 'Such vapid and flat daylight as filtered through the groundglass windows and skylights, leaving a black sediment upon the panes, showed the book and papers, and the figures bending over them, enveloped in a studious gloom, and as much abstracted in appearance from the world without as if they were assembled at the bottom of the sea, while a mouldy little strong room in the obscure perspective, where a shady lamp was always burning, might have represented the cavern of some ocean monster looking on with a red eye at these mysteries of the deep.' --Charles Dickens. 1843. When Charles Dickens wrote that penetrating description of the cheerless atmosphere of a nineteenth-century business house some hundred and twenty years ago, he was in fact drawing attention to the need for legislation to improve and control working conditions of those engaged in office and other non-manual employment. The extension of the framework of welfare legislation which has long been enjoyed by factory workers to include hitherto unprotected office workers, and certain other classes of employment, has at long last been achieved in the Offices, Shops and Railway Premises Act introduced in December of this year. The declared objective of the Act is "to set standards of health, welfare and safety of employees in office, shop and railway premises". Thus its provisions relating to offices and certain kinds of railway premises are the first of their kind. At the same time existing protection for shop workers is extended. In so extending health and welfare legislation into new fields of non-industrial employment the Act has succeeded where other attempts over the years have failed. Taking the country as a whole, its provisions will apply to over 1,000,000 premises-650,000 shops and 400,000 offices-eight million workers will be brought under its protection. All workers will be within its scope whether they work in separate office buildings or in offices forming part of other buildings, as, for example, in the offices belonging to schools, factories, hospitals, clubs, hotels, etc. The definition of an office includes rooms or premises which are used for the wide variety of purposes normally encountered in offices, for example writing, filing, duplicating, telephone operating, etc. The aim is to protect all who are office workers in the ordinary sense. The Act does not apply to premises where only self-employed persons work. The Shops, Offices and Railway Premises Act is an impressive piece of legislation. It affects vast numbers of the working population; it shows an approach to detail favourably comparable to any other legislation in the same field. Its substantive provisions can be immeasurably reinforced by delegated legislation; the Act can become (12) an effective implement by which the standard of health and welfare of workers may be advanced. This will not be achieved, however, without active and enlightened enforcement, The local authority should not under-estimate the dimensions of the task confronting it, and in this connection, the Council has authorised the public health inspectorate to administer and enforce the provisions of the Act, and regulations made thereunder, which come within the Jurisdiction of the local authority. A detailed survey of all offices, business, and other premises in the borough will have to be undertaken before the number of premises to be inspected can be accurately stated, but, as a modest estimate, this figure is likely to be in the region of at least 2,500. Existing staff cannot hope to undertake such a task without reinforcement, and the local authority will need to recognise the inevitability of increase in the establishment of the public health inspectorate. The work will be arduous and will call for tact, diplomacy and firmness, and demand legal and technical efficiency. The main provisions of the Offices, Shops and Railway Premises Act will not be effective until 1964, and until the Minister has made regulations as provided for in the Act. 1963 will occupy an important place in the history of environmental health legislation, as being the year in which a charter for the health and welfare of office workers was born. Certainly the period of gestation has been a long one; let us hope that it will develop into a vigorous and sturdy infant, and thence to full maturity as yet another major step in the progress of environmental health. 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 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. 1,101 inspections of business premises were made during the year, 104 notices were served, and 27 new registrations and/or licences were dealt with. FOOD PREMISES - INSPECTION A total of 1,897 inspections were made at food premises during the year to ensure compliance with the Food Hygiene (General) Regulations. 87 notices were served in connection with contraventions, and in one case it was necessary to institute legal proceedings against the proprietor of a cafe. A fine of £10 and costs of £3 were imposed in relation to the failure to maintain premises and equipment in a clean condition. The food hygiene inspections included visits to outdoor events such as the Easter, Whitsun and August Fairs and the August Cricket Festival at the Leyton Sports Ground. (13) FOOD - INSPECTION AND SAMPLING Complaints regarding foodstuffs purchased by members of the public in 1963 which were reported to the Public Health Committee totalled 26. A wide variety of foodstuffs was implicated, i.e. Bread and Confectionery (10), Fruit (5), Meat (2), Sausages (2), Pies (2), Milk (2), Fish (1), Pickles (1) and Cream (1). The reason for complaint was either the presence of foreign matter or the appearance of mould growth on the food indicating lack of supervision and care at retail premises. A somewhat unusual food complaint concerned a piece of haddock purchased from a local shop which receives its supplies from Billingsgate Fish Market. The purchaser discovered three nematode worms in the musculature of the fish, which upon identification proved to be of the Anisakis family, a natural parasite of live haddock. Although no formal action is required in a case such as this, the complainant at least had the satisfaction of knowing that his complaint was fully investigated and that he was informed of the result. The decisions of the Public Health Committee in relation to the food complaints mentioned were:prosecutions (7), warning letter (13), and no further action (6). A total of 133 samples of food and drugs were taken for submission to the Public Analyst for chemical examination and 27 bacteriological samples were examined by the Public Health Laboratories. The bacteriological samples comprised routine checks of milk and ice-cream, and although five of the ice-cream samples were found to be unsatisfactory, in accordance with the provisional standard recommended by the Ministry of Health, subsequent check samples proved satisfactory. Only six unsatisfactory chemical samples were found during the year, and five of these concerned proprietary canned meat foods which in the opinion of the public analyst were low in meat content. As there is no statutory standard for this type of commodity, the Committee decided to draw the attention of the manufacturer to the analyst's report in two cases and take no further action in the remaining three. The other unsatisfactory sample consisted of cooking apples which were on sale in a poor condition. In this case a warning letter was sent to the retailer concerned. Attention is drawn to the statistical section of the report, which gives details of premises and businesses registered and/or licensed under the Food and Drugs Act, Orders and Regulations. Full details are also given of inspections, notices, sampling, legal proceedings, and improvements effected to business premises as a result of action taken by the Department. HOUSING - SLUM CLEARANCE - NUISANCE ABATEMENT In spite of technological advancement and scientific achievements of this modern age, one of the paramount needs of mankind - "somewhere to live"- still remains unfulfilled; possession of a house of one's own, or the chance to rent a house, is for many people as remote today as it ever was. In my report last year I drew attention to the precarious plight of such people, who are forced to find accommodation in lodging houses or-to use the terminology of the Housing Act, 1961- "houses in multiple occupation." I pointed out that, because of the absence of rent control and security of tenure tenants 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 encorcing the owner to provide essential facilities, in case their action or their complaints should lead to eviction. I also spotlighted certain deficiencies in the law available to the local authority for the control of such houses. Since then the problem has received much (14) publicity; the term "Rachmanism" has been added to our vocabulary to symbolise in a word how the serious shortage of housing accommodation in London and other conurbations is being exploited by the type of person who seeks to cash in on the accommodation needs of a desperate population by acquiring large, obsolete houses and letting off rooms to individuals or families, and often without any adaptation to the structure or the provision of additional facilities and amenities to meet the basic needs of the occupants. Reports in the national press depict situations where it is alleged that tenants, with the object of the landlord securing vacant possession, are being subjected to assault, threats, intimidation, ill-treatment, annoyance, persecution, unfair persuasion, and interference with personal possessions and accommodation, services,etc. Such reports aroused the national conscience to such an extent that in November of this year the Minister of Housing and Local Government set up a special Committee to survey the housing situation in Greater London, with particular reference to this aspect of the problem. A new Housing Bill is also being considered by Parliament. The Bill contains provisions which, if they become law, will considerably strengthen the powers available to local authorities. Of the statutory duties and responsibilities confronting the local authority,none is more important or, indeed, more onerous, than that which concerns obsolete housing. The duties of the public health inspectorate in relation to the existing housing accommodation are 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. Dwelling houses are inspected as general routine, or on complaint, and statutory action taken as appropriate to secure the remedying of defects and abatement of nuisances. Over the past twelve months some 11,147 inspections and re-inspections were made under the Public Health Acts, Housing and Rent Acts, Prevention of Damage by Pests Act, and other legislation. 1, 956 complaints regarding unsatisfactory conditions were investigated and 1,177 notices specifying works to remedy defects such as dampness, general disrepair, leaking roofs, defective drainage, etc. were served. In addition 526 houses were surveyed under the Housing Consolidated Regulations 1925/32 to ascertain their fitness for human habitation, having regard to the standard prescribed by the Housing Acts and the possibility or otherwise of their being included in a slum clearance scheme or dealt with by demolition or closing order procedure. 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 38 cases. Such proceedings are not, however, always successful in enforcing essential repairs, and in a number of instances the Public Health Committee were obliged to consider alternative procedures under the Housing Act. During the year under review nine applications under the Rent Act, 1957, for certificates of disrepair, and 19 applications for certificates as to the remedying of defects etc. were received and dealt with by the public health inspectorate; eight notices (Form J) of the Council's proposal to issue such certificates were served on landlords, arising out of which one undertaking (Form K) to remedy defects specified thereon within a period of six months was submitted by the owner and accepted by the Council, and five certificates of disrepair were issued. The Council's programme in relation to slum clearance and re-development is proceeding satisfactorily. A public local inquiry in respect of the Leyton Housing (Avenue Road and Morris Road) Compulsory Purchase Order, 1962, was held in the Town Hall on Wednesday, 5th June, (15) 1963. 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 habitation, or because of personal or other business reasons, to be heard. The decision of the Minister has since been received and the Order has been confirmed, subject to minor modifications. The remainder of the Avenue Road Area will be proceeded with in due course. A detailed inspection of properties included in the third of the Council's main re-development areas is in progress and nearing completion. Altogether some 1,277 inspections under the Housing Acts have been carried out during the course of the year. It may be of interest to recall some of the points included in the report submitted to the Public Health Committee detailing the main and material conditions affecting properties in the Avenue Road/Morris Road Clearance Area and to illustrate certain of these features with photographs. (Please refer to photographs between pages 16 and 17 when reading the outline report which follows). BOUNDARIES OF THE CLEARANCE AREA AND NUMBER OF BUILDINGS The area includes all the houses in Morris Road and the odd numbers in Avenue Road. Altogether there are 36 dwelling houses, with a total population of 64 families, comprising 193 persons. The average number of persons per house is 5.4 TYPE AND DESCRIPTION OF DWELLING HOUSES Nos. 1 to 25 (odd) Avenue Road form part of a terrace of two-storey properties of similar type situated on the easterly side of the road; No. 1 being at the southern end of the terrace. The rear of this terrace backs on to the rear of a terrace of similar properties in Morris Road - numbered 2 to 38 (even). Nos.37 to 43 (odd) Avenue Road form a separate terrace at the northern end of the road. All houses in the area have through ventilation and yard space at rear, and with the exception of Nos.37 and 39 Avenue Road, the back addition structures contain two storeys. Avenue Road properties have forecourts about six feet deep, but there are no forecourts to the Morris Road houses, the front doors opening direct on to the street; frontages of all properties are approximately 15 feet. Access is at the front only, except at No.37 Avenue Road, which has side access to main and rear entrances. The construction is traditional-brick walls, central valley gutter roofs on the main structures and pitched roofs on the back additions; roof coverings on houses in Avenue Road are mainly of tiles; those in Morris Road mainly corrugated asbestos. Timber floors (except where replaced by concrete) and Joinery work; plaster walls and ceilings. W.Cs are entered externally. With a few exceptions, internal accommodation consists of three rooms and small "L" shaped scullery (floor area approximately 30 sq.ft.) on the ground floor, and three rooms and scullery on the first floor. Nos. 37 and 39 Avenue Road, each have two rooms and scullery on the ground floor and two rooms on the first floor. Mains water supply is provided over sinks in both ground floor and first floor sculleries. Four houses have fixed baths in separate bathrooms (converted from sculleries) and three others have fixed baths in sculleries. All houses have ground floor passages from which staircases and rooms are entered. 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 (16) Plate No. I. AVENUE ROAD/MORRIS ROAD SLUM CLEARANCE AREA. Front elevation of houses in Avenue Road showing structural uneven settlement and general disrepair. Plate No. 2. AVENUE ROAD/MORRIS ROAD SLUM CLEARANCE AREA. Rear elevation of houses in Avenue Road showing bad site arrangement and obstruction of natural light. Plate No. 3. AVENUE ROAD/MORRIS ROAD SLUM CLEARANCE AREA. Rear elevation of houses in Avenue Road showing bad site arrangement, obstruction of natural light, structural uneven settlement and inadequate roof drainage. Plate No. 4. AVENUE ROAD/MORRIS ROAD SLUM CLEARANCE AREA. Front elevation of houses in Morris Road showing rising and penetrating dampness and general disrepair. Plate No. 5. AVENUE ROAD/MORRIS ROAD SLUM CLEARANCE AREA. General view of houses in Morris Road. Plate No 6. AVENUE ROAD/MORRIS ROAD SLUM CLEARANCE AREA. Rear elevation of houses in Morris Road showing bad site arrangement, obstruction of natural light, structural uneven settlement and general disrepair. of the under-mentioned defects exist in varying degrees at all houses. Repair and Stability 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. General disrepair internally and externally. Freedom from Damp Dampness rising in walls due to absence of effective damp proof coursesdampness penetrating walls and ceilings due to porous brickwork; defective sills and window connections; leaking roofs, eaves gutters and rainwater pipes and valley gutters. Natural Lighting Insufficient natural light in ground floor back and back addition and first floor back addition rooms, due to obstruction or overshadowing caused by close proximity of adjoining buildings. Staircases, passages and W.Cs 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.Cs. Water Supply 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. Drainage and Sanitary Conveniences Surface drainage impeded by broken and sunken paving of yards, and roof drainage inadequate. W.Cs are situated externally and badly sited in yards with little privacy. At 25 houses the only available W.C. is shared by more than one family. General Observations The houses are about a hundred years old. They are obsolete in design, outworn, badly arranged internally and 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 area is demolition of all buildings in the area. The confirmation of the Morris/Avenue Road Compulsory Purchase Order marks a further stage in the Council's long-term programme of slum clearance; it is inevitable-owing to the shortage of alternative housing accommodation and the scarcity of land on which to build new houses-that many hundreds of sub-standard houses will have to be retained, and maintained for housing purposes for many years to come. The public health inspectorate will therefore be faced for an indefinite period with a problem of enforcing essential repairs to insanitary properties which may be considered beyond satisfactory repair and improvement. 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 (17) 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. AIR POLLUTION-SMOKE CONTROL AREAS Meetings of the Joint Conference of Neighbouring Authorities, first convened by Leyton, in 1956, for the purpose of discussing matters of common interest in regard to air pollution and the establishment of Smoke Control Areas, and to give consideration to the desirability of joint action, have now been held at all the constituent authorities - Walthamstow, Wansteadm & Woodford, Chingford, Ilford, Barking, East Ham, West Ham, and Hackney. It has become an established forum for the exchange of information, and has provided valuable opportunity for delegates to discuss problems and progress and to raise questions about quality, availability and distribution of smokeless fuels from representatives of the Coal Board, Gas Board and Fuel Distributors. Leyton were again hosts for the twelfth session of the Conference held in April of this year, when delegates indicated by an overwhelming majority their desire for its continuance. Another meeting was held later in the year at the Borough of Wanstead & Woodford. Perhaps it may be regarded as more than a coincidence that of the wide variety of matters discussed and on which the Joint Conference made recommendations and representations to the Ministry of Housing and Local Government, many have since appeared in Ministerial circulars on the administration of the Act, and have subsequently been accepted as desirable additions and amendments in the procedure for the establishment of Smoke Control Areas. Ministerial approval of two more Smoke Control Areas was given during 1963, with the result that the department was extremely active in the service of notices, inspection of properties, and the general administration of the fireplace Grant scheme. The approval of Smoke Control Area No.3 in February and Area No. 4 in October, both to become operative on the 1st October, 1964, has added some 450 acres, containing 4,000 houses and 300 industrial and commercial premises to the part of the Borough which is already smokeless; this means that by the endof 1964 approximately one quarter of the Borough - 900-odd acres, 7,000 houses and 400 industrial premises, will be under smoke control. Area No.3 is the largest area to be approved in Leyton and is of particular importance as it contains most of the heavier industries in the Borough and many large boiler and furnace installations will be affected by the passing of the Smoke Control Order. These include a number cf wood-burning installations as well as coal and oilfired plant and every effort has been made to ensure that factory managements are fully aware both of the general implications of the Order and the adaptations or replacements which are necessary to their plant before the operative date. The success of a Smoke Control Order depends to a large extent upon the co-operation of all concerned, particularly of those people who live or work in the area, and to this end considerable time and effort has been spent in health education within the area. Exhibitions dealing with all aspects of Smoke Control, combined with an Advice Bureau, were staged at the Sybourn County Primary School and the Lea Bridge Branch Library for periods of four weeks; whilst the Mobile Exhibition Van from the Solid Smokeless Fuels Federation also visited the area on two occasions, each of one week's duration. In addition, meetings of the Lea Bridge Tenants' Association and the Lea (18) Bridge Women's Co-operative Guild were addressed by the Chief and Deputy Chief Public Health Inspectors. Altogether some 6,000 notices and other documents in connection with Smoke Control have been sent to householders, landlords and occupiers of industrial and commercial premises during the year. Some 290 visits/investigations associated with the mitigation of air pollution were made by the public health inspectorate in connection with such matters as smoke observations on factory chimneys, inspection of boiler installations, discussions with managerial staff, and advice to boiler operatives on the proper use of fuels and the method of stoking. A further 2,000-odd visits and inspections were made in connection with the establishment of Smoke Control Areas. Pour standard deposit gauges are sited in various parts of the Borough for the scientific measurement of dust and grit deposits. The analytic results from these gauges are published in the Bulletin of the Department of Scientific and Industrial Research. The Chairman of the Public Health Committee, Alderman Mrs.Burrell, and the Chief Public Health Inspector, are the Council's representatives on the London and Home Counties Clean Air Advisory Council, and the Standing Conference of Co-operating Bodies set up by the D.S.I.R. with which Leyton is co-operating in the investigation of atmospheric pollution; daily observations continued throughout the year. (19) 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 88 3367 6181 - 1649 102 - Housing Acts, 1936/61 and Regulations 78 1277 27 38 32 - 526 Public Health Acts, 1936/61, and Noise Abatement Act, 1960. 1501 5999 713 392 572 _ - Prevention of Damage by Pests Act, 1949. 377 3839 7 - 7 - - Pood and Drugs Act, 1955, and Pood Hygiene (General) Regulations, 1960. 49 1897 _ 87 105 - - Shops Act, 1950 - 1839 - - - - - Essex County Council Act, 1952. - 80 - - - - - Leyton Corporation Act, 1950. - 8 - - - - - Factories Act, 1959. 8 120 10 - 9 - - Pet Animals Act, 1951. - 8 - - - - - Rag Flack and Other Filling Materials Act, 1951. - 7 - - - - . Rent Act, 1957. 32 43 - 53 - - - Fabrics (Misdescription) Act, 1913, and Regulations, 1957. - 8 - - - - - (20) (b) DETAILED (i) Rent Act. 1957 - Para. 4, First Schedule Application for certificates received 9 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 5 Applications by landlords for cancellation 3 Objection by tenants to cancellation l Decisions by local authority to cancel in spite of objection Nil Certificates cancelled by local authority 4 Applications for certificates (Form P) 19 Discrepancies 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 (General) Regulations, 1960, Ice-cream (Heat Treatment) Regulations,1947/52, Shops Act. 1950, Factories Act, 1961, Leyton Corporation Act, 1950, Essex County Council Act, 1952, and relevant legislation. Number of Type of Premises Inspection. Retail Food Shops 1261 Catering establishments (including factory canteens, hospitals, nursing homes) 402 Food Hawkers 46 Food Manufacturers/Depots, Dairies 48 Off-licences 51 Public Houses 65 School Meals 59 1932 (21) (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 Inspections Non-Power Factories 2 Factories with Mechanical Power 95 Fairgrounds 7 Hairdressers 8 Building Sites 13 Miscellaneous Shops, etc. 23 Outworkers 9 Pet Animal Shops 8 Rag Flock 7 Schools 59 Places of entertainment 5 TOTAL 236 (iv) Prevention of Damage by Pests Act. 1949 - Rodent Control/Dlsinfestation Complaints received 377 Enquiries and visits made: By Rodent Operatives 3,342 By Public Health Inspectors. 497 Premises treated: Dwelling houses 214 Business/industrial premises 48 Seven "block treatments" of premises for rodent infestation were carried out. (22) 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 2 Choked drains cleared 12 Dampness remedied 473 Drains relaid or partly relaid 2 Floors repaired 88 Guttering repaired or renewed 192 Miscellaneous defects remedied 173 New W.C. pans and traps provided 43 Plaster work repaired 222 Rainwater pipes repaired or renewed 43 Roofs impaired or renewed 203 Rooms redecorated 5 Sashcords renewed 113 Sinks provided 4 Sink waste pipes repaired or renewed 42 Stoves repaired or renewed 46 Vent pipes repaired or renewed 30 W.C.cisterns repaired or renewed 61 Window sills, etc., repaired 133 Yard paved 7 (ii) 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 53 Ceilings not kept clean or repaired 42 Floors not kept clean 25 Inadequate ventilation 4 Inadequate receptacles for refuse 5 Accumulation of refuse in room 12 Cleanliness of apparatus and fittings 22 Facilities for personal cleansing and/or washing food and equipment inadequate, i.e. - Wash basins 4 Hot water 4 Soap/Towel/Nail brushes 11 Sinks 2 Food not protected from contamination 9 First-aid equipment 16 Wash-hand notices 22 Inadequate locker (clothing) accommodation 4 Redecoration 37 Miscellaneous 22 Artificial light in W.C. 2 (23) 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 85 5 - - - - - 85 - - - - Chemists 37 - - - - - - - - - - - Council properties 4 - - - - - - 1 - - - - Dairies 3 - 3 - - - - - - - - - Factories 421 2 - - - 366 55 41 - 14 - - Pood Factories, depots, etc. 6 2 4 - - - - - - - - 1 Pood Hawkers 118 - - - - - - - - - - - Pood premises, retail 576 203 95 44 10 27 - 13 1 - - 11 Food storage, hawkers 13 1 - - - - - - - - - 12 Hairdressers 86 - - - - - - - - - 86 - Hospitals 2 - - - - - - 2 - - - - Milk vending machines 3 - 3 - - - - - - - - - Multiple stores 5 3 - - - - - 3 - - - - Non-food retail premises 535 1 - - - - - - - - - - Off-licences 41 24 - - - - - - 41 - - - Pet Animals 8 - - - - - - - - - - - Public Houses 36 1 - - - - - - 32 - - - Rag Flock 6 - - - - 3 2 - - - - - Schools 18 - - - - - - 17 - - - - Miscellaneous shop premises 127 - - - - - - - - - - - TOTALS 242 105 44 10 396 57 162 74 14 86 24 (24) (ii) Details of Registrations/Licences ACT OR REGULATION On Register 31.12.1962 Removed during 1963 Registered during 1963 On Register 31.12.1963 Food and Drugs Act, 1955 Ice-Cream Premises 238 - 4 242 Food Preparation, etc. premises 43 1 1 43 Milk and Dairies (General) Regulations, 1959 Distributors 104 2 3 105 Dairies 3 - - 3 Milk (Special Designation) Regulations, 1960 Tuberculin Tested 26 2 3 27 Pasteurised 66 2 2 66 Sterilised 94 1 3 96 Essex County Council Act, 1952 Hawkers of Food 117 4 5 118 Hawkers' Storage Premises 24 1 1 24 Leyton Corporation Act, 1950 Section 63 - Vendors of Shellfish 10 - - 10 Section 48 - Hairdressers' Premises 93 12 5 86 Pet Animals Act, 1951 Annual Licences 8 - - 8 Rag Flock and Other Filling Materials Act,1951 6 - - 6 TOTAL 832 25 27 834 (25) 4. LEGAL PROCEEDINGS (i) Public Health Act. 1936. 38 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 18.9.63 A.J.Gibson, Ltd., 583 Lea Bridge Road, E. 10. Mould growth on Pork Pie. Pine £5. £5. 5s. 0d. costs 2.10.63 Chas.Phillips & Co. Ltd.. 822 High Road. E. 10. Mould growth on Pork Pie. Pine £5. £5. 5s. 0d. costs 9.10.63 Mr.H.S. Spelling, 70 High Road, E. 15. Contravention of Pood Hygiene Regulations. Pine £5. on two summonses; absolute discharge on third summons. £3. 3s. 0dcosts 6. 11.63 Mr.H.Wysling, 383 High Road. E. 10. Maggots in Sausages. Absolute discharge. £6.15s.6d. costs 5. HEAT 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 - 2 8 Cheese - 3 3 Fish - - 0½ Beef 3 25% Lamb 2 5 Pork ... - 26 Offal - 11% Sausages 2 1254 Cockles 20 gals. Kidneys 6 boxes Biscuits 34 pkts. (26) Commodity Units Cherries 15 pkts. Ground Almonds 16 " Raisins 12 Peel 27 " Milk 114 tins Luncheon Meat 113 " Vegetables 236 " Fruit 132 " Pish 13 " Ham 45 " Soup 88 " Heinz Strained Foods 9 " Pickles 31 jars Chickens 8 " Puddings 35 Meat Pies 54 SAMPLING - FOOD AND DRUGS ACT, 1955. (i) Chemical Analysis Commodity Taken Satisfactory Unsatisfactory Milk 2 2 - Ice-Cream 5 5 - Miscellaneous 126 120 6 TOTALS 133 127 6 (ii) Bacteriological Examination Commodity Taken Satisfactory Unsatisfactory Milk 8 8 - Ice-Cream 19 14 5 TOTALS 27 22 5 7. SAMPLING - FABRICS (MISDESCRIPTION) ACT, 1913 - FABRICS (MISDESCRIPTION) REGULATIONS. 1959. Eight samples were obtained during the year and were all found to be satisfactory. (27) 8. FACTORIES ACT. 1961 The following are the prescribed particulars required by Section 153 (1) of the Factories Act, 1961, to be included in annual reports. 1. Inspections Premises (1) Number on Register (2) NUMBER OF Inspections (3) Written notices (4) Occupiers prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 57 2 1 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 396 96 9 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) _ 13 - - TOTAL 453 111 10 - 2. Cases in which defects were found Particulars (1) Number of cases in which defects were found Number of cases in which prosecutions were instituted (6) Found (2) Remedied (3) Referred To H.M. Inspector (4) By H.M. Inspector (5) Want of cleanliness (S.1) 2 1 - 1 - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient 2 2 - 1 - (b) Unsuitable or defective - - - - - (c) Not separate for sexes - - - - - (d) Other - - - - - Other offences against the Act (not including offences relating to out-work) 11 6 - 6 - TOTAL 15 9 - 8 - (28) 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 55 Upholstery trimmings 2 Umbrellas, etc. 4 Artificial flowers 5 Boxes, etc. wholly or partly of paper Making 14 Brushes 1 Feathers 2 Buttons, carding 1 Christmas crackers, etc. 12 Lampshades 10 TOTAL 106 (29) Leyton Health Area Sub - Committee 1963 - 64 Representing:- Essex County Council: Aldermen K.E.B.Glenny, O.B.E., J.P. (ex-officio) G. W. Mason (ex-officio) Councillors Mrs. M.J.Harvey P.R.Richards Mrs.V.L.Wilson P. A. Wortley Leyton Borough Council: Aldermen Mrs.A.M.M.Burrell Mrs.J.Hammond, O.B.E., J.P. Mrs.R.King Councillors Mrs.E.Bartram (Vice-chairman) Mrs.D.E.Collins Mrs. E. M. Dare, J.P. J.H. L. Field C.H. Hicks A. H. Mack ay P.W.Marshall, J.P. (Chairman) F. C. Newman W.H.Sanders C. E. Tucker J.J.Walsh F.W.Wigg Voluntary Organisations: Mr.J.Barker Mrs. A.M.Clewer, M.B.E. 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. (30) Personal Health Services (Leyton Health Area Sub - Committee) SECTION 21 - HEALTH CENTRES 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 1963 the following special works were carried out. DAWLISH ROAD CLINIC Renovation works to the wood block floor of the Health Visitors Room. Improved lighting to Speech Therapy Clinic and Health Visitors Room. Installation of new boiler to replace one which was outworn and defective. LEYTON GREEN CLINIC The floors in the corridors and remaining clinic rooms were laid with thermoplastic Marley tiles and this has greatly improved the appearance of the clinic which is now much brighter. The rewiring of the electric power and lighting circuits was completed. One of the rooms was soundproofed so that hearing tests could be carried out there more efficiently. GRANLEIGH ROAD CLINIC Floor renovations similar to those carried out in other parts of the clinic previously and in Leyton Green clinic this year were completed in thermoplastic Marley tiles. Improved lighting was installed in the Domestic Help office and Dental Surgeries. ELLINGHAM ROAD DAY NURSERY These premises are of prefabricated structure which were erected in 1942 at the same time as Knotts Green Day Nursery - replaced this year. It is scheduled for replacement itself in the year 1965/6 and, in the meantime, only essential first aid repairs and decorations are being carried out. EPSOM ROAD DAY NURSERY This was opened on 25th April, 1963 as a replacement for Knotts Green Day Nursery. SECTION 32 - CARE OF MOTHERS AND YOUNG CHILDREN BIRTHS - During the year the following births were registered:- Male Female Legitimate 740 661 Illegitimate 60 43 Total 800 704 Still-Births:Legitimate 13 11 Illegitimate 1 1 In the same period 1,529 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. (31) 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 Foot Dental Minor Ailment Orthoptic (alternate) Foot Dental Minor Ailment Orthoptic Ophthalmic Optician (monthly) Toddlers Foot Dental Minor Aliment Child Development Foot Dental Minor Ailment Orthoptic Ophthalmic Optician Toddlers(monthly) Foot Dental (alternate) Doctor's Consultation Minor Ailment Immunisations) alternating Foot P.M. Dental Infant Welfare Foot Dental Infant Welfare Orthoptic (alt.) Foot Dental Infant Welfare Orthoptic Foot Dental Ante-natal Post-natal Ante-natal Exs) Orthopaedic alternating Foot Dental Immunisations) Doctors) Consultation) Orthoptic alternating 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 Foot Dental Minor Ailment Ante-natal/ Post natal Foot Dental Minor Ailment Child Development Toddlers (monthly) Foot Dental Minor Ailment Foot Dental Minor Ailment Child Development Toddlers(monthly) Foot Dental Doctor's Consultation Minor Ailment) alternating Foot P.M. Dental Remedial Exercises Foot Dental Infant Welfare Foot Dental Infant Welfare Remedial Exs. Aural (monthly) Foot Dental Infant Welfare Foot Dental Immunisations) Doctor's Consultation alternating Foot Evening Dental / Foot Dental Dental Dawlish Road, Dawlish Road, E. 10. (LEYtonstone 3650 Extn.287) A.M. Dental Minor Ailment Speech Foot Dental Doctor' s Consultation Child Development Foot Dental Minor Ailment Ante-natal/) Post-natal) Toddlers) alternating Foot Dental Minor Ailment Speech Foot Dental Minor Ailment Speech Dental (alternate) Doctor's) Consultation) Minor Ailment) alternating P.M. Dental Infant Welfare Speech Foot Dental Ante-natal Exercises (alt.) Speech Foot Dental Speech Foot Dental Infant Welfare Speech Foot Dental Immunisation) Doctor's Consultation) alternating Speech Foot Evening Dental / Foot Dental Foot Emmanuel Hall, Hitcham Road, E. 10. P.M. Weighing Session Child Guidance, 133 Dawllsh Road, E. 10. (LEYtonstone 3650 Ext.288) Psychiatrist Educational Psychologist Psychiatric Social Worker by appointment only Attendances at all clinics by appointment except Infant Welfare, Minor Ailment and Doctor's Consultation Clinics. (32) Child Welfare - Clinic Attendances Year of Birth Leyton Green Park House Dawllsh Road Emmanuel Hall Children who attended for the first time in 1963. 1958 28 50 68 13 1959 66 99 121 10 1960 96 95 110 22 1961 118 166 183 30 1962 366 372 293 64 1963 391 503 462 62 Total first attendances 1065 1285 1237 201 Total attendances 6425 7268 6945 1260 Number seen by Doctor 1579 2089 2129 - Number referred for special treatment 40 89 73 - CARE OF PREMATURE INFANTS (weighing 5lbs.8ozs. or under) Born at Home 17 Born in Hospital or Nursing Home 90 CONVALESCENT HOME TREATMENT Arrangements were made for one child and one mother and her two children to receive convalescent home treatment. WELFARE FOODS There was no change during the year in the general arrangements for the distribution of welfare foods. Issues - The total issues during 1963 were: National Dried Milk (Tins) 12,170 Cod Liver Oil (Bottles) 2,214 Vitamin A&D Tablets (Packets) 1,598 Orange Juice (Bottles) 19,173 (33) CHILD DEVELOPMENT SESSIONS As these sessions enter their fourth year with the prospect of increasing to nine sessions a week, the experimental phase is passing, and they may now be said to be an established feature of the Leyton Health Service. They provide relief of tension and positive help to mothers and children whose mutual adjustment has become strained. They have a high staffing ratio of more than usually experienced staff with backing from the Child Psychiatrist, which enables assessment and help of a high quality to be given to children who are showing signs of difficulty in the very important formative years. During the year there have been many visitors from other areas who have heard of this pioneer effort and there is no doubt that others will now follow the Leyton example. Park House Leyton Green Dawlish Road Total number of sessions 128 51 40 Total attendances 1,507 667 351 Children who attended in the year 45 33 20 Average attendance per session 11.7 13.1 8.8 Average attendances per child 33.5 20.2 17.5 Children on roll 31.12.63 21 16 15 Children on waiting list 31.12.63 38 15 25 Dawlish Road Clinic commenced 1 session per week on 1st April, 1963, Park House Clinic increased to 3 sessions per week on the same date. AT RISK REGISTER Following a lead from one or two authorities the Minister has required local health authorities to set up "At Risk" registers. The idea is simple but the working of it is fraught with pitfalls. It is well-known that the very great majority of children with handicaps that are not immediately apparent at birth (e.g. deafness or slight spasticity) have a history which should have made one look out for these defects. The history might be of a difficult labour, prematurity, blood group incompatibility, familial traits, or any of some twenty to thirty conditions. It is also now realised that it is of the first importance to detect these "hidden" defects as early as possible if their ill effects are to be minimised or overcome fully. The "At Risk" register is a register of all children born who have a history which should make one suspect a "hidden" defect. It is up to the administrative machine to see that all these children are properly examined at intervals until the possibility of a defect has been confirmed or ruled out. The pitfalls arise because with the best will in the world from midwives, hospitals, general practitioners and health visitors some cases do not get notified and constant detailed vigilance is required. An incomplete list is better than none but the danger of thinking it is complete when it is not must never be forgotten. The other matter which has been a major difficulty in all areas, such as Leyton, who have successfully compiled a register, is to cope with the volume and quality of work which it throws up. Owing to the long list of factors which mean that a child should be on the register, anything from a fifth to half of all children born may be involved according to the standards adopted. Nothing less than detailed assessment by doctors specially trained for this work should be the aim for these children, and to provide this requires more facilities than we have at present. (34) At present this scheme is still in the trial stages and a few more months of experience are required before we can assess just what staff and facilities will be required. At the end of the year 394 children were on the register and 135 examinations had been done. Appointments for examination were two months in arrears. The examinations have picked up two children at very early ages with degrees of deafness, both of whom have been provided with hearing aids. This will do much to ensure that they will develop normally with normal speech and understanding, and gives one confidence that the whole scheme is worth while. TESTS FOR PHENYLKETONURIA In 1963, 1,553 children were tested at the clinics and another 48 were tested in their homes. COMBINED ANTE-NATAL AND POST-NATAL CLINIC 411 patients made 1,926 attendances for ante-natal examination and treatment and 63 patients attended 68 times for post-natal examinations during 1963. MOTHERCRAFT AND RELAXATION CLASSES These classes, held by Health Visitors, proved as popular and as helpful to the mother as ever. There were 94 sessions held during the year at which mothers made 510 attendances. DENTAL CLINICS The Area Dental Officer reports as follows:- "Much of what is said in the School section of this report applies equally well to the younger children, but in their case regular inspection at not longer than three monthly intervals is desirable from the time that the temporary dentition has erupted. It is in this sphere that I consider the services of our dental auxiliary so valuable as she can make friends with these children before any operative treatment becomes necessary, familiarise them with the new and strange surroundings, instruct them in tooth brushing and dental hygiene from an early age and do any necessary conservative work in the earliest possible stage of decay. In addition ante, and post-natal mothers referred by the Medical Officers or Health Visitors were seen and treated where necessary. The Council's School Dental Officers devote about 1/10th of their time to this work. It is pleasing to see that some of these mothers were themselves treated in the Authority's Clinics when at school in this Area." (35) DENTAL TREATMENT Types of treatment given Expectant and Nursing Mothers Children under School Age Scaling and gum treatment 100 29 Fillings 204 602 Silver nitrate treatment 30 160 Crowns and inlays provided 2 - Extractions 97 250 General Anaesthetics (a) by Medical Officers 5 23 (b) by Others 19 79 Dentures provided (a) full upper or lower 2 - (b) partial upper or lower 16 - Dentures repaired 3 - Dentures remade (a) full upper or lower - - (b) partial upper or lower - - Radiographs 40 6 Prophylactic treatment and other operations 144 179 Patients inspected and treated during the year Expectant and Nursing Mothers Children under School Age (1) Patients examined 127 421 (2) Patients found to require treatment 113 301 (3) Patients who have commenced treatment 109 231 (4) Patients who have completed treatment 85 276 (5) Attendance for treatment 357 807 (36) SPECIALIST CLINICS Specialists allocated by the Forest Group 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 26 pre-school children were referred to her and there were 39 attendances by infants. Mrs.Box, Orthoptist accepted 46 new cases for treatment, who made 113 attendances. Mr.H.A.Oatley, Orthopaedic Consultant attends Leyton Green Clinic on Thursday and the clinic medical officers referred 92 new cases to him. Set out hereunder is a summary of the work:- Re-inspection 227 Minor alterations to footwear 206 Surgical appliances supplied 22 Three 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) Epsom Road Day Nursery, Epsom Road, E.10. (Telephone: LEYtonstone 4100) EPSOM ROAD ELLINGHAM ROAD TOTAL 0-2 yrs. 2-5 yrs. 0-2 yrs. 2-5 yrs. 0-2 yrs. 2-5 yrs. Number of approved places at end of year 15 35 15 35 30 70 Number of children on register at end of year 16 46 16 42 32 88 Total attendances during year 2954 9060 3281 7986 6235 17046 Number of days open 254 254 - On the 25th April, 1963 the new Day Nursery at Epsom Road was officially opened by the Mayoress of Leyton (Councillor Mrs.D.E.Collins) and I set out hereunder some notes on the building, and the service that is carried out in our Day Nurseries. (37) The Building: The construction of the building is of load-bearing brick walls with timber joists or lattice trussed roofs according to span, lined with fibre-board ceilings and covered with compressed strawboard slabs with three layers of roofing felt. The baby nursery is a completely self-contained unit with its own lavatory, babies' bath and milk room for preparation of feeds. Lavatories and ablutions are provided separately for toddlers and tweenies with a communal bathroom between the two units. A laundry is provided together with separate rooms for drying and airing washed articles during inclement weather. There is a heated perambulator store where perambulators and the bedding therein are kept adequately aired and warm. This, together with the baby nursery encompasses a sheltered area where babies can be put out in fair weather in their perambulators. All floors are thermoplastic tiles apart from lavatories and laundry which are clay tiled. The lavatory and kitchen walls are decorated with a plastic spray finish and the building is heated by oil-fired central heating system through fan assisted convectors in the nurseries, and radiators elsewhere. The building was designed by the County Architect, and constructed by S.G.Cobban and Co. Ltd., of Ilford. The Service: This new day nursery has been erected to replace the existing one which was built in 1942 adjoining the Leyton Green School. The nursery is designed as a 50 place nursery i.e. there will normally be 50 children in attendance and these are divided into three groups: Babies (0-2 years), Tweenies (2-3 years), and Toddlers (3-5 years). Each of these categories has its own nursery, toilets and washing facilities within the new building. The normal opening times of the nursery will be 8 a.m. -5.30 p.m. on Mondays to Fridays inclusive, and the children are provided with breakfast, dinner and tea. The nursery is a training nursery and the staff consists of a matron, deputy matron, warden, six nursery nurses, nine student nurses, and domestic staff. The training of the students is by theoretical work at the South-West Essex Technical College and practical work in the day nursery, and normally four students at the nursery qualify each year. Children are admitted on a priority system and approximately one-third of the places are taken up by the children of mothers who do not have the support of the father and the remaining two-thirds almost entirely by children whose admission is recommended because of social or economic need. In this socio-economic group (Priority 2) help is given to young children for whom parental care is proving inadequate. This failure of parental care can be due to a variety of reasons, e.g. Physical or mental inadequacy of mother; Poor health or irregular employment of father; (38) Knotts Green Day Nursery Opened— 13th July, 1942 Closed — 6th April, 1963 Epsom Road Day Nursery Opened — 8th April, 1963 Inadequate housing, e.g. highly priced furnished rooms often with no water on same floor and no playing space; Lack of basic knowledge of child care often resulting in serious maladjustment in the child. For these children, who are clearly 'at risk' the Day Nursery provides amongst other things, a stable background, good diet, space and facilities for the child to develop naturally and to use his growing skills and a healthy outlet for his energies. Typical examples of children admitted in this group are:- Case A - Girl, aged 2 years, an illegitimate child whose mother is mentally sub-normal and unemployable; her physical care of the child was deplorable since she frequently did not get up before 11 a. m. She loves the child possessively but no attempt had been made towards habit training and the child was still almost entirely bottle fed; she did not speak at all. After six months in the Nursery the child eats normally, is reasonably clean, tolerates other children and has a small vocabulary; she has put on 12 lbs. Case B - Boy, aged 1 year and 4 months, Mother totally blind aged 42 years. Father aged about 50 years and almost blind. These handicapped parents can manage their own lives but quite unable to cope with an increasingly active child. For this boy the Nursery provides a safe background for his normal growth and development. Case C - Girl aged 3½ years. The only child of older parents who had been married 17 years when she was born; she has been possessively loved since birth with consequent maladjustment demonstrated by temper tantrums, excessive dependence alternating with defiance. After 6 months this child has made excellent progress, the tension in the home has been relieved and the mother's health greatly improved. It is thought likely that very soon this child can discontinue attendance at the Nursery. Short-term Admissions: Short-term admissions include the children of mothers who are confined, acutely ill or who are affected by other domestic crises. Alternative arrangements for such children would often be residential care. Training: Both nurseries are training nurseries offering valuable training to girls who, after two years training take the examination of The National Nursery Examination Board. Many of these girls go on to further training in the field of social service. (39) MEDICAL RESEARCH COUNCIL - UNIT FOR THE STUDY OF ENVIRONMENTAL FACTORS IN MENTAL AND PHYSICAL ILLNESS The Head of the Unit, Dr.J.W.B.Douglas has kindly given the following report concerning two studies in Leyton:- "We have been encouraged by the Co-operation of the health authorities in Leyton to go ahead with our plans for two related studies. The first study will be concerned with women expecting their second babies, who already have a toddler, and who are married and living with their husbands. We are hoping to see two social groups - one manual and one non-manual, and shall be interested in comparing the everyday patterns of experience both of the toddlers and of the new babies in these two social groups. We are concentrating our attention on the amount and kind of handling and of social contacts, and on the patterns of sleep and play, which these very young children experience, because there is increasing evidence that these factors are of importance for both intellectual and emotional development. The women are being contacted through the ante-natal clinics, general practitioners, midwives and health authorities, cards being completed and returned to us by the health visitors and midwives for every mother expecting a second child, so that we may select women who fulfil our sample requirements for interviewing. We shall be seeing them regularly over an 18 month - 2 year period, and are concerned to find useful and valid techniques for investigating these problems. At the same time, for our second study, the health visitors have been selecting women from their list whom they suspect fulfil our requirements for a study of obsessionality. Certain of these women are being interviewed in an attempt to work out symptoms, and assess how patterns of obsessional behaviour may affect their family lives. Where there are young children, they can be compared with 'normal' families included in the first study. We have now begun to interview the first families for both studies." CLINICAL TRIAL During the year the medical officers at infant welfare clinics have been co-operating with Dr.Hinden, the consultant paediatrician at Whipps Cross in a clinical trial. The substance being tried is Polymethylsiloxane which may be a cure for wind in babies. The trial is still in progress. SECTION 23 - MIDWIFERY Cases attended by Council Midwives MIDWIVES TOTAL Domiciliary Midwife * Training Home Cases attended - (a) Doctor not booked 10 42 52 (b) Doctor booked 13 288 301 Ante-natal visits 165 3239 3404 Ante-natal examinations 308 2319 2627 Administration of Gas and Air Analgesia 22 89 121 Administration of Pethidine 18 139 157 Administration of Trilene - 154 154 (40) Ante-Natal Examinations and Domiciliary Births TEAR ANTE-NATAL EXAMINATIONS TOTAL Domiciliary Births (Live ft 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 1963 308 2319 2627 353 * The domiciliary midwife resigned 31.7.63. Trllene and Gas and Air Analgesia Percentage of administrations 75.07 Medical Aid Where the Medical Practitioner had arranged to attend the patient 63 Others 42 Fees paid to Doctors Number of Accounts received 14 Total amount paid to Medical Practitioners- £52.14s. Od. Maternity Outfits Number of outfits issued to Expectant Mothers 343 (41) SECTION 24-HEALTH VISITING The improvement in Community health has made for changes in the health visitor's work. The home visiting is not less, but the change is in working in depth with particular families, making the work more exacting; it is a long term process and its success is dependent on the building up of sound relationships. The number of births has risen and the visiting of families with young children is the main concern of the health visitor. In Leyton the proportion of old people is well above the average (17% of the population of Leyton as against the national average of 13%) and therefore more time is being devoted to help our senior citizens. In a changing society there is less neighbourliness. Young people live away from their own families and during a crisis there is often no one to whom to turn. Couples marry at an earlier age and are sometimes not ready to accept their responsibilities when the baby has arrived. The health visitor who is known and trusted may, by listening to the problems and discussing them, be able to prevent a breakdown in social relationships which may affect the family's physical and mental health. The work is mainly preventive which in its wider sphere includes after-care of patients discharged from hospital. LIAISON WITH HOSPITALS For several years the health visitors have worked closely with the staffs of Whipps Cross and Langthorne Hospitals. The health visitors take it in turn to visit the paediatric ward at Whipps Cross Hospital twice a week to supply information about the children's background to the consultant and his staff and in turn learn about treatment so as to be able to advise the parents how best to care for the child when he is discharged home to their care. The health visitors visit the wards at Langthorne Hospital each week to discuss new admissions, discharges and the best way to assist with rehabilitation of patients. This year Leyton has come into the catchment area of Claybury Hospital, the large mental hospital. The health visitors have since 1959 received training in the principles of mental health at this hospital to enable them to assist with the prevention of emotional breakdown and to help patients who have been discharged home. The student and trained nursing staff of Claybury Hospital also wanted to know more about the health visiting service and the Superintendent Health Visitor has given a series of lectures to them. By knowing about each others work close co-operation for the benefit of the patient at the hospital and in the community, has already been achieved. LIAISON WITH GENERAL PRACTITIONERS For some time now one health visitor has attended a family doctor's weekly 'well baby' clinic to give advice to mothers on social problems and particularly help with feeding difficulties. Another general practitioner has recently started a similar clinic and a health visitor is also attending at these sessions. These services are part of our constant endeavour to increase the present close co-operation with the general practitioner service. (42) AGED AND CHRONIC SICK The health visitors form part of the team concerned with the care of the elderly. In view of the many other demands on the health visitor's time and the large number of old people in the borough, visits have to be restricted to cases of particular need and especially those which require the health visitor's special skills. Visits are made to widows and widowers as soon after the bereavement as possible to offer any necessary help and support. SOCIAL WORKERS LUNCHEON CLUB These monthly meetings which take place at the Leyton Green Clinic are now well established. The medico-social workers and others concerned with welfare work in the area have the opportunity to meet and discuss mutual problems. We are still learning a great deal about each others work and talks this year have included the work of the Youth Employment Officer, The Employment Exchange, The Children's Department, The Mental Welfare Officer, The Child Guidance Centre and Moral Welfare Work. HEALTH EDUCATION This is an important aspect of all health visiting work. It may be carried out individually in homes or by giving talks in clinics, clubs, schools and other associations such as church groups. CLINICS The three health services clinics provide regular mothercraft and relaxation classes. These and film shows especially the films, "The Triumph of Childbirth" and "To Janet a Son" have been well attended. The Mothers Club held at Leyton Green Clinic continues to be successful with the promotion of lectures, discussions and "Keep Pit" classes. SCHOOLS Talks and discussion groups with pupils in their last term continue in the secondary modern schools and in the syllabus emphasis is again put on the close correlation between ill-health, particularly lung cancer, and smoking. TRAINING OF STUDENTS The staff continued to assist with the practical training of student health visitors, public health nursing administrator students, student district nurses, pupil midwives, student teachers, student social workers and student nurses from Claybury and Whipps Cross Hospitals. (43) HEALTH VISITS During the year the Health Visitors made 16,826 visits to homes:- (1) Cases visited for the first time in the curreilt year- (a) Children born in 1958 324 “ “ “ 1959 541 “ “ “ 1960 500 " " " 1961 920 " “ “ 1962 2217 “ “ 1963 1649 (b) Persons aged 65 or over 1325 (c) Others (excluding school nursing cases) 1592 (2) Number included in item (1) - (a) Mentally disordered persons 251 (b) Persons discharged from hospital (other than mental hospitals) 249 (3) Number included in item (1) and where appropriate item (2) who were visited at the special request of a G.P. or hospital- (a) Persons aged 65 or over 311 (b) Mentally disordered persons 60 (c) Persons discharged from hospital (other than mental hospitals) 144 (4) Total number of effective visits to- (a) Children under 5 years of age 10694 (b) Persons aged 65 or over 3119 (c) Others (excluding school nursing cases) 3313 Total effective visits 16826 (5) Total number of ineffective visits to- (a) Children under 5 years of age 1884 (b) Persons aged 65 or over 671 (c) Others (excluding school nursing cases) 354 Total ineffective visits 2909 (44) SECTION 26 - VACCINATION AND IMMUNISATION The following tables show the number of persons who were immunised during the year NATURE OF VACCINATION/IMMUNISATION RECORDS RECEIVED PROM GENERAL PRACTITIONERS VACCINATIONS BY COUNTY STAFF Primary Courses Reinforcing Doses Primary Courses Reinforcing Doses Diphtheria, Pertussis & Tetanus 319 140 310 341 Diphtheria and Tetanus 5 35 16 25 Diphtheria 47 54 - 74 Pertussis 40 20 14 - Tetanus 941 7 2049 - Poliomyelitis - (1) Salk Vaccine 222 557 23 126 (2) Sabin Vaccine 485 492 739 584 Smallpox 357 333 43 2 B. C. G. - - 517 - Others - Quadrilin 71 2 - - TOTALS 2487 1640 3711 1152 Poliomyelitis Vaccination TOTAL VACCINATED DURING: - PRIMARY BOOSTER FOURTH Salk Oral Salk Oral Salk Oral 1956 347 - - - - - 1957 2662 - - - - - 1958 6360 - 1037 - - - 1959 10096 - 9653 - - - 1960 3455 - 7851 - - - 1961 5558 - 3106 - 3356 - 1962 1080 593 2769 1245 636 1283 1963 202 1043 349 386 233 591 TOTAL VACCINATED TO END OP 1963 29,760 1636 24,765 1631 4225 1874 (45) CENTRAL SYRINGE STERILIZING UNIT The Central Syringe Sterilizing Unit sterilized 18,658 syringes during the year. This is an average of 357 syringes per week. Prom 1st January, 1964 the service is being extended to supply syringes to the Barking Health Area and the Essex County Council District Nursing Home, Ilford. This should increase the average weekly number of syringes sterilized to over 500 per week. SECTION 27 - AMBULANCE SEBVICE 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. I am indebted to the County Medical Officer of Health for supplying the following statistics relating to the operation of the County Ambulance Service in the area of Whipps Cross during the year:- Ambulance vehicles 12 Stretcher cases 10,173 Dual purpose vehicles. 8 Other cases 82,422 Total cases conveyed 92,595 Total mileage 282,612 Total emergency cases. 10,625 SECTION 28 - PREVENTION OF ILLNESS AND AFTER CARE Foot Clinic I am indebted to the Chief Chiropodist for the following report on the work of the Chiropody Service:- "Owing to shortage of chiropodial staff at the beginning of the year it was necessary to introduce a system of priorities within the service and in the main treatment was restricted to those of over 60 years of age with the exception of a few cases who, by virtue of their employment, are required to stand for long periods. As a result of this the period between treatment of chronic cases has been reduced from about 14 weeks to just over 8 weeks. In November the staff situation improved with the appointment of Mr.C.K.Brown as senior chiropodist at Dawlish Road Health Services Clinic and about the same time we were successful in obtaining more sessional chiropodists. In consequence, late in the year we were able to offer treatment to some of the patients who had been put off earlier in the year as a result of the introduction of priorities. As and when possible more patients will again be offered treatment. Semi-Permanent Appliances During the year we have continued with the making of semi-permanent appliances and 134 of these have been made, 97 being for females and 37 for males. (46) Alterations to Foot-wear Arrangements have been made with the officers of the National Assistance Board for the Board to meet the cost of alteration to foot-wear for persons in receipt of supplementary pensions. The majority of persons for whom this is necessary are in the advanced age groups and many suffer from acquired deformities resulting in painful lesions developing on joints and pressure points. Palliative rather than curative treatment is called for and by minor alterations to foot-wear much relief can be maintained and the high cost of supplying bespoke surgical foot-wear almost eliminated. " Domiciliary Chiropody The arrangements whereby non-ambulant patients are treated in their home by a visiting chiropodist have continued throughout the year. This service, which is provided almost entirely to the aged, is greatly appreciated by patients who are confined to their rooms on account of infirmity and who would otherwise have to bear the pain and inconvenience of foot disorders which they could not alleviate themselves. Patients have been successfully treated who previously could not bear the weight of bed clothes on their feet because of ingrowing toenails or some other painful condition. For these patients domiciliary chiropody treatment must rate as a.high priority both as a therapeutic service and a psychological stimulant. The following are the number of patients attended and treatments given during the year:- Number of patients - 333 Number of treatments - 1,194 Attendances and Treatments During the year a total of 4,365 patients attended the foot clinics, these included 672 sew patients. A total of 16,008 treatments were given. It was possible to discharge 166 adults and 214 children. The following defects were treated: - Bursitis 18 Callosity 123 Corns 198 Hallux Rigidus 12 Hallux Valgus 18 Hyperidrosis 7 Metatarsalgia 19 Nail Club 23 Nail Ingrowing 30 Pernio 14 Pes Planus 10 Tinea Pedis 11 Trigger Toe 4 Verruca Pedis 185 (47) Cases treated in clinics were as follows:- New Cases luring the year Cases being treated at the end of the year Attendances during the year Pre-school Children 10 1 36 School Children 219 104 1665 Expectant Mothers 7 2 22 Physically Handicapped 39 209 1161 Aged (over 65 years of age) 211 1675 7264 Others 186 1067 5860 TOTAL 672 3058 16,008 In addition to the above, 382 treatments were given in Welfare Establishments. 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 16 (b) Extra Nourishment - Number of new cases supplied with free milk 10 Total number being supplied with free milk at end of year 16 Loan of Sick Room Equipment The under-mentioned Sick Room equipment was newly loaned during the year:- Alr Beds - Air Rings 49 Bed Back Rests 70 Bed Blocks - Bed Cradles 25 Bed Pans 91 Bed Trays 2 Commodes 75 Crutches 1 Dunlopillo Mattress 1 Fracture Splints 2 Invalid Chairs 64 Mobile Lifting Pole and Chain 2 Plastic Sheets 105 Rubber Sheets 21 Steam Kettles 1 Urinal Bottles 38 Walking Aid 1 Convalescence for Adults Number of applications during year 63 Length of stay:- One week 2 Two weeks 41 Three weeks 20 (48) HEALTH EDUCATION Health Education and the most effective methods of presenting it are a constant challenge calling for frequent reviews of methods in the light of experience and achievements in the various medical fields. The technique of presentation is of course vitally important because if this is at fault it can have an adverse effect on a campaign or at least render the propaganda ineffective. Choosing the correct psychological approach to health hazards is not easy and indeed alternative ways and means may have to be tried before success is achieved. This is particularly true so far as the individual health education activities of health visitors are concerned as they must be able to deal with persons of completely different personalities and yet know the best method of approach. With regard to National efforts, the campaign against smoking, because of its association with lung cancer, heart disease and other illnesses, is an example of a campaign which achieved considerable success initially because people were shocked and scared. Thousands of people stopped smoking because they were frightened at the prospect of dying from lung cancer if they continued to smoke. On the other hand, young people particularly, although aware of the associated health dangers, smoke because in addition to finding it socially desirable are even glamourised by an aura of living dangerously. How to deal with this sort of attitude is a matter which concerns us now. What is really needed is something or somebody to present smoking as something which is socially unacceptable, old fashioned, just not 'with it', and for the weak-willed only. This is not going to be easy and continues to require nation wide publicity using national media such as television and radio and newspapers. Do we have to wait for a teenage idol to die in distressing circumstances before the message will ever go home? As far as Local Health Education activities are concerned efforts are made to make these interesting and varied and have included the following:- Health Education Talks in Schools By arrangement with the Divisional Education Committee and with the co-operation of the Borough Education Officer and Head Teachers, Medical Officers, Health Visitors, Dental Officers and the Chief Chiropodist attended at schools to give illustrated talks to pupils on various health topics including venereal disease. Shop Window Display The dressing of the shop window at 280 High Road, Leyton in connection with health campaigns has provided scope for the staff to exercise their initiative in original presentations. The following topics were illustrated in the window during the year:- January and February Accidents in the home March to June Clean Air July to September Holiday safety October to November Vaccination immunisation December Home safety and Road safety (49) Poster Displays in Clinics In order to make the greatest impact, poster displays in clinics are concentrated on one subject at a time and original presentations of posters, supported with other display materials, are changed at frequent intervals. Local Press Arrangements were made for an illustrated advertisement for vaccination immunisation to appear in the local newspapers for two weeks during the summer. The representatives of these newspapers have been most co-operative in giving publicity to health matters. SECTION 29 - DOMESTIC HELP The Domestic Help Service continues to give an enormous amount of practical help to the aged, chronic sick, and also the acutely ill, mentally ill, problem families, maternity cases and mothers suffering from toxaemia. LOCAL TRAINING COURSES The Domestic Helps provide practical help of a kind which is easily understood by everyone with whom they come in contact, and letters of appreciation from recipients are received almost by every post. Also the Domestic Helps are in closer touch with those they attend than any other local authority worker. For these reasons and also from a desire to keep morale high amongst a group of workers whose turnover is much higher than one would wish, it was felt that a course of training was likely to do much to improve the service and at the same time give the Helps the support that comes from realising that they are part of the health services team. It was therefore decided to arrange the course described below with a maximum amount of group discussion and visual presentation, as it was felt that pen and paper methods of instruction were inappropriate to a body of women whose way of life was strictly practical and who had left school many years ago. Two courses were in fact held - each for approximately 65 Helps - and the second was of. course modified to take advantage of the experience gained on the first. In those few instances where they differed the details found most successful are what are described. The course was confined solely to the subject of the Aged. Six two-hour sessions were held on successive Tuesday afternoons (a time when very few Helps were employed on their duties). The 65 were divided into groups of seven or eight each with a leader chosen from amongst them. Each session started with a discussion in groups of a specific question, and then in plenary discussion the leaders reported back to the person on the platform (usually the. principal speaker on the subject of the day). The first session began with group discussion on the question "What do you find most trying in dealing with old people?" which was followed by plenary discussion of this subject with the Area Medical Officer. Some of the subjects emerging included the way old people follow the Help about, how they do not understand present-day conditions or prices, forgetfulness, suspicion or general nastiness perhaps related to jealousy of the Home Help's health and strength, and a very wide variety of interesting and at times amusing difficulties. (50) An interesting discussion developed over the question of cleaning the front door step - not one of the normal jobs of a Home Help. Many experienced Helps felt that it could for some people be more important than giving them food, as it has a powerful status value, showing the neighbours that you qualify for help and showing them your door step is cleaner than theirs. Man does not live by bread alone. After a cup of tea two members of a local dramatic society acted a comedy sketch of a dialogue between an old lady and a Home Help, in which discussion points were highlighted as follows:- (a) The old lady wants things done in a particular way. (b) She is suspicious of theft. (c) she keeps too much furniture to make cleaning easy. (d) She is unwilling to accept the help of neighbours. (e) She will not eat what she is not used to and has to be persuaded. (f) Loneliness makes her talk so much it is difficult for the Help to get away. (g) Some old people are scroungers and feel they ought to get more than they do. (h) The Home Help gets priorities wrong (i.e. cleaning is more important than food). (i) The Home Help gets impatient with the old lady. This sketch promoted much discussion and effectively "broke the ice" for the rest of the course. The last 10 minutes of the first session were spent by the groups making arrangements among themselves for the provision of the display which was to be the discussion point for the second session. Each group was asked to arrive at the next session with a two-course meal, costing less than ls.6d., set out for a particular patient. The patients named were partially sited, had no teeth, had stroke of right arm, were convalescent, had Parkinsonism, facial paralysis, and the like. The second session began with group discussion of the question "How do you cook a meal for ls.6d.?" followed by a plenary discussion with a doctor on the LA staff, who then went on to comment on each of the displays which had been brought. The ingenuity and variety was really most impressive but there was room for a good deal of comment on how they might have been improved nevertheless. After the cup of tea, plenary discussion and a general talk by the doctor on nutrition concluded the programme. The opening question for the third session was "What do you think is the greatest danger to your own health as the result of being a Home Help?" Questions arising were put on paper and then dealt with by a two-man "Brains Trust" of a general practitioner with the Medical Officer of Health. The questions were in fact mainly directed at the Medical Officer of Health - what are the risks of infection from bedpans, from various skin diseases, shingles, TB, from dust - a large number had a real fear of cancer being infectious. Other questions dealt with the connection between fibrositis and lifting and whether mental illness was catching in any way. Others were: "What do you do if you find a patient unconscious, or if he gives you important medical information and asks you not to tell his doctor?" "What is the value of rubber gloves?" This was a most lively period and of very great value in correcting some very varied notions and fears. (51) The remaining time was used by one of the Domestic Help Organisers to deal with a number of administrative questions about which she felt there was some confusion, and also some practical problems such as the surprisingly common practice amongst old people of altering the clocks so that the Help stays over her time. On the fourth afternoon the opening question was "What are the priorities of housework in helping old people living alone?" followed by a talk by a Domestic Science teacher which proved of the greatest interest to the Helps and provoked many questions. For the second half they were divided into four groups, three of which were taken by three Home Nursing Tutors from the nearby training home. Each had a bed with which he or she demonstrated how to lift a patient further up the bed, and how to lift him out into a chair and back into bed again. The Helps then had practice at doing this. The fourth group was taken by the Domestic Science teacher for more intimate discussion of points to do with housework. At intervals the groups moved on until each had been with each instructor. The first part of the fifth session was a competition "Which group can think of the most causes of Home Accidents?" The lists produced were then discussed by the Home Safety Organiser. There were very few that he mentioned that had not already been raised by one of the groups, but they all felt they had learnt something. The Chief Clerk of the Health Department then, by discussion with the use of flannelgraphs, described the Domestic Help's place in the domiciliary team and the range of services, statutory and voluntary, which are available to the aged. Alderman Mrs.J. Hammond, O.B.E., J.P. gave an account of her life in the field of Public Health which in view of her long experience was of great interest. Two short films on Home Safety concluded the afternoon. For the final session each group was given the case history of an actual case in which some perplexing problem had arisen, with the question "What would you have done?" Each was a rare or unique problem and was dealt with in turn in plenary discussion by the Area Medical Officer, who then called each of the group leaders up to the platform for a few words from each as to what she had found of most value on the course. To close the proceedings the film "Guiseppina" was shown-a light-hearted picture of an attitude in which the desire to give service and meet the needs of others brings interest to life. This was perhaps superfluous but it made a most pleasant rounding off. Whether the course achieved its aim is most difficult to assess but undoubtedly there was virtue in meeting others with similar problems and a noticeable boosting of morale and confidence. All the Helps asked said they had learnt a few tips they had not known before, and a number have asked that another course should be held, as they had enjoyed this one. Certainly in the few months that have elapsed since the course the rate of resignation of Helps has dropped by half, though to what extent this is related to recent wage awards one cannot say. Perhaps one may fairly feel that esprit de corps and the feeling of being appreciated together with the realisation that you have many colleagues facing the same difficulties is at least as strong a force as a few extra shillings a week. TOXAEMIA OF PREGNANCY Following a trial period of 12 months commencing in May, 1961 the County Council (52) authorised the continuance of the provision of free domestic help for all certified cases of toxaemia of pregnancy requiring such assistance. The amount of help for these cases varies from full-time to two hours daily and the cases are referred by maternity hospitals, general practitioners, midwives, or clinic doctors. In all cases medical certificates are required at 28 day intervals. During the year there were six beneficiaries of this service. Number of Helps and hours worked:- Number of domestic helps enrolled at end of year - Whole-time helps 8 Regular part-time helps 176 Number of hours worked during the year 186,936 Work of Domestic Help Organisers:- (1) (2) Total (1) First visits 252 418 670 (2) Revisits to beneficiaries- (a) Domestic help present 372 257 629 (b) Domestic help not present 1352 929 2281 (3) Other visits 325 724 1049 Total visits 2301 2328 4629 Help Provided Aged 65 and over Maternity Chronic Sick under 65 Others under 65 TOTAL Requests for help from new cases during the year 492 64 67 59 682 New cases helped during the year. 420 51 54 42 567 Total cases completed during the year 342 51 43 37 473 Cases being helped at 869 3 80 17 969 Total cases helped during the year 1211 54 123 54 1442 Hours of help provided 167,768 1,814 12,141 5,213 186,936 MEDICAL EXAMINATION OF STAFF County Council employees:- Number of medical examinations- (a) Entrants to County Council's service 168 (b) Retirement on Superannuation 3 (c) Other purposes (including entrants to Teaching Profession and Training Colleges) 90 No. of/Medical Examinations Leyton Borough Council 165 Others 1 (53) School Health Service LEYTON COMMITTEE FOR EDUCATION 1963 - 64 Chairman: Alderman Mrs. J. Hammond, 0. B. E., J. P. Vice-Chairman: Councillor G.W.A.Robinson Aldermen: Mrs. A. M. M. Burrell G. S. Flack Mrs.R.King W. J. Low C.J.Mills, J.P. Councillors: J.T. Briley A.L.Chamberlain, J.P. Mrs.E.M.Dare, J.P. F.W.Marshall, J.P. H. W. Matthews E.F. Meacock, M. M. F. C. Newman J. A. Punshon, M. A. J.J.Walsh Nominated Members: County Alderman G.W.Mason Councillor W.O.J. Robinson, J.P. Co-optative Members: Mrs.E.V.Pearson I.A.Brown B. A. F. W.H.May 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, 1963:- Medical Officers 2.65 Dental Officers 3.78 Dental Auxiliaries 9 Dental Attendants 4.05 Nursing Staff 6.86 Remedial Gymnast 1 Speech Therapist 1.00 Administrative and Clerical 4.28 Clinic Clerks 1.15 24.77 (54) School Clinics Aural Clinic Second Wednesday in the month 2 p.m. - 5 p.m. Park House Clinic Child Guidance Clinic 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 alternate Saturdays 9 a.m. - 12 noon Park House Clinic Dawlish Road " Leyton Green " 2 P.m. - 5 p.m. # Minor Ailment Clinics Monday to Friday Saturday 9 a.m - 11 a.m Dawlish Road Clinic, Leyton Green " Park House " 9 a.m - 11 a.m # Doctors' Consultation Clinics Monday, alt. Friday and Saturday Tuesday, alt. Friday and Saturday Monday, alt.Friday and Saturday 9 a.m - 12 noon Leyton Green Clinic Dawlish Road " Park House " 9 a.m 12 noon 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 Speech 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. (55) School Medical Inspection SCHOOL POPULATION AS AT DECEMBER. 1963 Designation of School Number of Schools Number of Pupils Primary 19 5.392 Secondary 10 4.795 Special 2 223 Total 31 10.410 ROUTINE MEDICAL INSPECTIONS Group Number of Pupils Examined Percentage of Parents Present 5 year 908 92.2 10-12 + year 158 78.5 14 year 1,827 19.5 Other 88 54.6 2,981 PHYSICAL CONDITION OF PUPILS AT ROUTINE MEDICAL INSPECTIONS Age Group (by year of birth) Number Inspected Condition Classified Satisfactory Unsatisfactory 1958 and later 407 404 3 1957 501 500 1 1956 19 19 - 1955 9 9 - 1954 83 83 - 1953 75 73 2 1952 26 24 2 1951 19 18 1 1950 15 15 - 1949 819 818 1 1948 and earlier 1,008 1,005 3 TOTAL 2,981 2. 968 13 (56) REINSPECTIONS - ALL GROUPS - 1,660 FINDINGS OF MEDICAL INSPECTION (a) Individual children found to reauire treatment Age Group (by year of birth) Pupils Inspected Defective Vision (excluding sauintl Any other Condition Total pupils with Defects 1958 and later 407 12 40 50 1957 501 23 53 74 1956 19 1 1 2 1955 9 1 1 2 1954 83 6 1 1 1953 75 12 10 22 1952 26 2 1 3 1951 19 2 - 2 1950 15 2 - 2 1949 819 125 47 163 1948 and earlier 1,008 153 73 210 TOTAL 2,981 339 227 531 (b) Hygiene Inspection in Schools The Nursing Staff carried out 9,146 inspections during the year, and 38 cases of infestation were found. (57) (58) DEFECTS FOUND BY PERIODIC AND SPECIAL INSPECTIONS DURING THE YEAR DEFECT OR DISEASE PERIODIC INSPECTIONS SPECIAL INSPECTIONS ENTRANTS LEAVERS OTHERS TOTAL TREATMENT OBSERVATION TREATMENT OBSERVATl ON TREATMENT OBSERVATION TREATMENT OBSERVAT 1 ON TREATMENT OBSERVATION Skin 4 13 21 29 2 - 27 42 60 20 Eyes - (a) Vision 35 90 278 73 26 36 339 199 92 3 (b) Squint 13 9 5 3 2 2 20 14 3 (c) Other 2 5 5 4 - 1 7 10 47 5 Ears - (a) Hearing 5 36 9 13 1 7 15 56 94 4 (b) Otitis Media 3 23 8 10 - 2 11 35 11 4 (c) Other 1 - 3 3 - 2 4 5 21 2 Nose and Throat 17 128 10 15 1 11 28 154 32 - Speech 8 32 3 2 1 1 12 35 18 - Lymphatic Glands 1 53 - 2 - 4 1 59 5 2 Heart 3 18 4 19 1 2 8 39 4 - Lungs 2 29 7 12 1 6 10 47 19 6 Developmental - (a) Hernia 4 4 1 3 - 1 5 8 - - (b) Other 8 31 4 37 3 14 15 82 23 1 Orthopaedic - (a) Posture 3 12 7 20 3 4 13 36 2 2 (b) Feet 11 27 12 8 3 6 26 41 50 7 (c) Other 13 50 16 30 1 5 30 85 20 4 Nervous System - (a) Epilepsy 1 10 4 7 1 6 17 3 1 (b) Other 3 15 2 - 1 3 18 12 1 Psychological - (a) Developmental 2 57 3 7 - 9 5 73 57 13 (b) Stability 2 62 4 16 1 20 7 98 102 34 Abdomen - 8 - 1 - - - 9 14 7 Other 3 2 6 4 - 3 9 9 314 32 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 1963 1,133 children attended 1,287 times to see the doctor and children attended 1,678 times for advise and treatment from the nurse. SPECIAL CLINICS Orthopaedic SUMMARY FOR 1963 Orthoptic Psychiatric Child Guidance Lea Bridge Aural Ophthalmic Clinic School Sessional Programme 1 a week 1 a month 2 a week 6 a week 7 a week 1 a week Total Sessions 41 11 93 250 235 47 New Cases 49 72 224 132 100 8 Attendances 867 139 1525 1338 829 90 ORTHOPAEDIC CLINIC This clinic is under the supervision of Mr.H.A.Oatley, F.R.C.S. Orthopaedic Consultant. During 1963 the following numbers of children were referred to Whipps Cross Hospital by Mr.Oatley. 16 Radiological investigation 6 Operative treatment 106 Fitting of surgical appliances AURAL CLINIC The following children were referred to hospital during 1963 for treatment or further investigation: Removal of Tonsils and Adenoids. 11 " " and Bilateral Syringotomy 1 " " " " " and Bilateral Antral Washout 3 Removal of Adenoids and Bilateral Antral Washout 2 Bilateral Antral Washout.1 " " " and Paracentesis Tympani 1 Bilateral Antral Lavage 1 Removal Cholesteatoma and X-ray Sinuses 1 X-ray Sinuses. 2 Left paracentosis tympani and examination of nasopharynx 1 Removal of aural polypus 1 Removal of simple nodule, vocal cord 1 Right mastoidectomy 1 Investigation of hearing defect 2 (59) OPHTHALMIC CLINIC AND ORTHOPTIC CLINIC Dr. A.Logan Adam, Ophthalmologist, Mrs.S.Box, Orthoptist, and Mr.J.L.Boscoe, Ophthalmic Optician, continued to investigate and treat all those children referred by Assistant County Medical Officers. REMEDIAL EXERCISE CLASSES 23 children made 89 attendances at the classes. Unfortunately the remedial gymnast resigned at the end of March and it was not possible to get a replacement before the end of 1963. Dental Inspection and Treatment I am indebted to Mr. A.E.Hall, Senior Dental Officer, for the following comments on the work of the School Dental Service in Leyton during 1963. "There have been several staff changes during the year. One part-time dental officer left to work in private practice and two others to return to a dental school to take additional qualifications. On the credit side, one of the part-time dental officers asked to be employed fulltime and yet another was recruited for half-time service from another Authority. The final result left the staffing position at 4-6/llths dental officers, three of whom are full-time workers, and one dental auxiliary out of an authorised establishment of six full-time dental officers. A loss of 2/llths a week compared with the previous year, not in itself a serious loss but repeated staff changes are to be deplored from the patients point of view. The six dental surgeries in the Area are all modern and well-equipped with a good range of instruments Airotors and X-ray facilities. The Dental Auxiliary Experimental Scheme continues and Mrs.Purnell has now been in the post for 15 months, having established herself very successfully with the children parents and staff. The scope of her work was discussed in "The Health of Leyton 1962" page 63. (60) In addition to clinical work at Park House Mrs.Purnell has visited some of the schools in the Area to give talks on dental hygiene and with the aid of models loaned by the General Dental Council has given demonstrations on the care of the teeth. These talks have been very popular with the children who afterwards ask questions concerning the various points raised. Several Heads of the departments visited have required essays to be written on the subject and it is surprising how much some of the children have learned from these talks. These will be continued from time to time as the models become available." ORTHODONTICS The arrangements made some years ago with the North-East Metropolitan Regional Hospital Board for cases to be referred by the dental officers to the consulting Orthodontist (Mr.Willcocks) for his opinion, and in some instances, treatment, are invaluable and continue to be widely used. ROUTINE DENTAL INSPECTIONS These have been carried out in most of the schools in the area during the year but children whose parents have regularly accepted offers of treatment in the past are encouraged to write, or phone, for inspection appointments at three to six monthly intervals. On the other hand where offers of treatment have been refused, or ignored on two consecutive occasions only emergency treatment for the relief of pain is provided, the aim being to ensure that as many children as possible shall leave school trained in the care of the teeth, rendered dentally sound and without the loss of permanent teeth so far as that is possible. When all this has been done it is unfortunately true that dental decay remains as a disease of epidemic proportions and one must stress the continual need for dental health education and the hope that at some time in the not too distant future adjustment of the fluoride content of the water to the optimum level of 1 part per million of water will be an accomplished fact and thereby reduce the incidence of decay in young teeth. Figures relative to the Ministry of Health findings on fluoridation will be found in "The Health of Leyton 1962" pages 40-42. Figures relating to the work of the dental officers do not include work done by the dental auxiliary whose figures are returned to the General Dental Council. DENTAL INSPECTION AND TREATMENT Sessions (equivalent half-days) No. School dental inspections 75 School dental treatment (excluding orthodontics) 1,910 School dental orthodontic treatment 75 Administration (Area Dental Officer) 50 (61) School Dental Inspect ion Pupils inspected at periodic inspections 7,287 Pupils inspected as specials 1,641 Pupils found to require treatment 5,154 Pupils offered treatment 4,788 School Dental Treatment Pupils actually treated (for the first time this year) 3,186 Attendances by pupils for treatment 11,375 Appointments not kept 2,723 Fillings (a) permanent teeth 6,147 (b) temporary teeth 3,031 Number of teeth filled (a) permanent teeth 5,057 (b) temporary teeth 2,620 Extractions (a) permanent teeth - (i) for caries 306 (ii) otherwise 171 (b) temporary teeth - (i) for caries 2,048 (ii) otherwise 353 General anaesthetics - (a) by Medical Officers 135 (b) by others 1,067 Number of general anaesthetic sessions 134 Number of general anaesthetic cases at sessions 1,406 Number of pupils supplied with artifical dentures 13 Number of dentures fitted 13 Other operations (except orthodontics) - (a) permanent teeth 2,972 (b) temporary teeth 1,117 Operations included in previous items - (a) silver nitrate treatment 439 (b) scaling 912 (c) syringing sockets 16 (d) dressings 1,288 (e) inlays fitted 2 (f) crowns fitted 34 (g) radiographs 639 (h) other operations 756 Orthodontic treatment for Schoolchildren Cases commenced 86 Old cases treated for the first time in the current year 72 Cases completed 24 Cases discontinued 1 Pupils treated with appliances 98 Removable appliances fitted 40 Fixed appliances fitted 1 Total attendances .., 742 (62) Child Guidance Clinic ANALYSIS OF FIGURES FOR 1963, I. Cases on the books of the clinic at the end of the Year (i) Cases awaiting first appointment 52 (ii) Cases under treatment 98 (iii) Other cases 136 II. Cases referred during the Year (i) Under fives - Boys 9 - Girls 5 (ii) Over fives - Boys 122 - Girls 54 III. Source of referral General Practitioners 10 Head Teachers 32 Consultants 17 Children's Officer 1 School Medical Officers 80 Probation Officer 5 Health Visitors 1 Magistrates 3 Educational Psychologist 31 Parents 8 Others 2 IV. Cases closed during Year and other cases for which treatment ceased (i) Treatment completed and case closed 41 (ii) Other treatment, cases closed 20 (iii) Other (untreated) cases closed 36 V. Treatment carried out during Year Psychiatrists 884 Psychotherapists 35 Psychiatric Social Workers 893 Educational Psychologist 43 Remedial Teacher (from 25.11.63) 31 (63) THE CHILD GUIDANCE CLINIC The following report has been submitted by Dr. W. R.Little, the Consultant Child Psychiatrist, Leyton Child Guidance Clinic. "In the last quarter of 1963, as compared with the last quarter of 1962, the number of cases referred continued to increase from 45 to 62. We have increased our staff by a remedial teacher (15 hours a week), a part-time secretary (20 hours a week) both from December, 1963, and within the first quarter of 1964 we will have two fulltime psychiatric social workers, to replace Miss Morawetz, the social worker who left in December, 1963. Contacts with other services from the clinic continue. The team visits Lea Bridge Day School for maladjusted children each Wednesday and children referred for admission there are also investigated. The response of the parents to an open evening at the school was enormously encouraging. Discussion groups and lectures have been well attended and stimulating to both clinic staff and visitors alike. " THE PAEDIATRIC/PSYCHIATRIC UNIT AT THE WHIPPS CROSS HOSPITAL Dr.W.R.Little, Consultant Child Psychiatrist to the unit at Whipps Cross Hospital has submitted the following report on behalf of himself and Dr.Hinden, Paediatrician, at my invitation. "Since 1st October, 1962, 102 children have completed a course of treatment lasting for an average of 33 days in the paediatric/psychiatric unit. The education services co-operated by allowing 17 children to go out to local schools with great benefit to the children concerned. The teaching time of Mrs.Wrag bourne, the hospital teacher, was increased and a full-time occupational therapist's post had been advertised. It has become the policy of the unit to set aside an active ward where the children admitted for psychiatric reasons can be treated apart from the physically sick children. This will be put into effect as soon as certain alterations to one of the two wards can be completed. I have followed up the children admitted in the last quarter of 1962, and results for 18 children are as follows: of 3 only slightly improved, 2 improved further within a year of discharge. Of 9 definitely improved, one relapsed and one became much improved the remaining 7 were much the same. Of 4 much improved or cured, one relapsed and the remainder were still much improved. These results alone may be thought to justify the experiment of caring for children with these kind of difficulties, on a first aid basis, as the results persist over a short terra follow up of a year." B.C.G. Vaccination (i) No. of schoolchildren skin tested 582 (ii) No. found positive 65 (iii) No. found negative 517 (iv) No. vaccinated with B.C.G 517 (64) Speech Clinic CHILDREN HAVING RECEIVED TREATMENT DURING 1963. Under 5 years Primary School Secondary School Special School TOTAL Articulation Defect 1 25 2 14 42 Cases commenced before 1st January, 1963 . and continuing after 31st December, 1962. Stammer Articulation Defect and Stammer - 2 4 1 7 - 4 - - 4 Total 1 31 6 15 53 Articulation Defect 16 29 1 1 47 Cases commencing treatment during 1963. Stammer 1 5 - 2 8 Articulation Defect and Stammer 1 1 - - 2 Total 18 35 1 3 57 Therefore total cases receiving treatment during 1963 - 110 Total new cases - 57 Boy a Girl a Total Children at present undergoing treatment 50 21 71 Children discharged 33 12 45 On Waiting List - Average number of cases treated daily 14 Homes visited - School departments visited 27 Parents interviewed 81 Children referred to other clinics 3 Number of children leaving before cure or discharge 15 Total number of attendances 2,016 Number of children referred found not to require treatment - (65) 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. 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 1 2 4 1 5 16 38 19 48 13 35 183 Corns 3 3 3 2 1 6 - - - 4 6 2 30 Bursitis - - - - - - - - - - 1 - 1 Callosity - - - - 1 - - - - 1 1 3 Contraction of Toes - 1 - - - - - - - - - - 1 Nail Deformity 1 2 - - - - - - - - - 1 4 Sepsis - - - - - 1 1 - - - 4 1 7 TOTAL IN AGE GROUPS 5 7 5 6 3 12 17 38 19 52 25 40 229 HEALTH EDUCATION Following a request from the Headmaster of one of the Secondary Modern Schools in the Division, an experimental talk on foot health, illustrated with films, was given by the Area Chiropodist and as a result of this, requests were received from the headmasters of other schools for similar talks and the Leyton Committee for Education gave permission for the Area Chiropodist to visit schools and speak to school leavers. Seven of the secondary modern and grammar schools in the Borough were visited. In each school the children were attentive and the variety and number of questions asked gave the impression that they had been interested. Renewed visits to the schools were made in October and some headmasters would like talks on foot health to be given to their scholars annually. (66) (67) HANDICAPPED PUPILS CATEGORY Number of children of school age on 31st December, 1963, 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 Total number of children of school age requiring s.e.t. Receiving Special Education Awaiting Special Education Blind. - - - - - - 2 - - - - - - - 2 - - - - Partially sighted 3 - - - - - - - - - - - - - 3 3 1 - 1 Deaf 1 - - - - - - - - - - - - - 1 - - - - Partially hearing. 9 - - - - - 1 - - - - - - - 10 9 2 - 1 Delicate. - - 3 - - - 2 - - - - 2 - 7 - - - - Physically Handicapped 23 - 2 2 1 - 1 - - - 5 - - - 34 36 1 - 16 E.S.N 87 - 6 - - - 3 - - - - - - - 96 - - - 13 Maladjusted 22 - 10 - - - 9 - - - 4 - - - 45 - - - - Epileptic 1 - - - - - 1 - - - - - - - 2 2 - - 3 Speech defect - - - - - - - - - - - - - - - - - - - Dual defects 2 - 1 - - - 1 - - - - - - - 4 1 - - 1 TOTAL 148 - 22 2 1 - 20 - - - 9 2 - - 204 51 4 - 35 Leyton Special E.S.N. School The Special School in Leyton is regularly visited by one Assistant Medical Officer, which ensures continuity of medical supervision within the school. Number on Roll in 1963 Varied from 195 to 200 Leyton 83 - 87 Forest 106 - 113 Reasons for leaving:- 1. Attained age of 16- (a) Reported as requiring Community Care 6 (b) Not reported 5 2. No longer in need of special education 6 3. Notified as unsuitable for education under Section 57(4) 2 4. Removal to other areas 9 5. To Residential School (E.S.N.) 2 (0.A.) 1 6. Returned to Normal School 1 LEYTON GREEN PRIMARY DEPARTMENT Specials Boys Girls No. inspected 59 44 Parents present 15 7 Unsatisfactory 5 5 DEFECTS FOUND Code No.4 Skin 2 2 (68)  Specials Boys Girls 5 (a) Vision 5 7 (b) Squint 1 3 (c) Others - - 6 (a) Hearing 12 5 (b) 0.Media 1 1 (c) Others 3 2 7 Nose and Throat 1 1 8 Speech 4 2 9 Lymphatic glands 1 - 10 Heart 1 - 11 Lungs - 1 12 Developmental - (a) Hernia - - (b) Others 2 2 13 Orthopaedic - (a) Posture - - (b) Feet 2 3 (c) Others - - 14 Nervous System - (a) Epilepsy 2 3 (b) Others 2 2 15 Psychological - (a) Development 14 6 (b) Stability 9 9 18 Abdomen - - HARROW GREEN SECONDARY DEPARTMENT Born 1947 Born 1948 Routine Routine Specials Boys Girls Boys Girls Boys Girls No. inspected 12 6 9 2 27 17 Parents present 8 4 8 1 7 8 Unsatisfactory - - - 1 6 3 DEFECTS FOUND Code No.4 Skin - - 2 - 3 1 (69)  Born 1947 Born 1948 Routine Routine Spedals Boys Girls Boys Girls Boys Girls 5 (a) Vision 3 1 1 - 2 1 (b) Squint - 1 - - - 1 (c) Others - - - - - - 6 (a) Hearing - - 3 - 4 1 (b) 0.Media - - 1 - 3 1 (c) Others - - - - - - 7 Nose and Throat - - - - 2 - 8 Speech 1 1 - - - - 9 Lymphatic Glands - - - - 1 - 10 Heart - - - - - - 11 Lungs 1 - - - - 3 12 Developmental- (a) Hernia - - - - - - (b) Others 1 1 - - 1 - 13 Orthopaedic - (a) Posture 2 - - - - - (b) Feet 1 - 1 - 3 2 (c) Others 1 1 - - 3 - 14 Nervous System - (a) Epilepsy 2 - - - 3 2 (b) Others 2 - - - 2 - 15 Psychological- (a) Development 3 3 - 2 16 9 (b) Stability 5 3 2 2 8 4 18 Abdomen - - - - 2 1 LEYTON SPECIAL E.S.N. SCHOOL A full report was presented on the school last year and no change has been made In the medical coverage of the children as regards their physical and mental development, but I would like to comment on two matters concerning the school. The number of children to a class in a school for educationally retarded children is 20 and in my opinion it is too high. Many of these children have emotional difficulties as well as learning difficulties and require, and indeed demand, practically individual attention from their teacher. Also, as we take borderline educable children into the Leyton Green Department, great strain is imposed on the teacher who is asked to cope with the "nursery class" and it would be very helpful if this reception class could be reduced to half its present number. This would allow the children who are borderline to (70) remain in a group of comparable mental age and allow the retarded and definitely educable children to proceed at a somewhat faster pace. The other matter I wished to comment on is that there is a great need in the county for residential units for the few extremely difficult in fact psychotic adolescents that we. sometimes get in Harrow Green. These are mainly boys from the age of 14 upwards. In the past year Harrow Green has had to cope with an extremely disturbed boy. Attempts have been made by the psychiatrist who deals with this boy to find a suitable place where he could have treatment as well as education,but so far the quest has been unsuccessful. Another very distressed and pressed boy was sent to the school for a trial period a few weeks before the end of 1963 but it has been found impossible either to keep him or to help him. He urgently requires psychiatric treatment in a residential institution but again difficulty is found in placing him in a suitable treatment centre because of his age. LEYTON, LEA BRIDGE MALADJUSTED SPECIAL SCHOOL SPECIAL MEDICAL INSPECTIONS Boys Girls No. examined 18 2 Parents present 3 1 Unsatisfactory 6 2 DEFECTS FOUND - Code No. 4 Skin 3 5 Squint 1 6 Otitis 1 8 Stammer 1 12 Undescended Testes 1 13 Pes Planus 1 14 Migraine 1 18 Abdominal pain 1 Four children were recommended for recuperative holiday treatment but only one accepted the offer. The numbers at the school have remained around 32 during 1963. Four children recommended for admission in the autumn term, owing to illness or home difficulties, have so far failed to take up their places. Ten children were transferred during the year to other schools and there were ten new admissions. One boy returned to a junior school, one was admitted to an educationally sub-normal school, two girls and a boy returned to secondary modern schools and four boys and one girl were admitted to a residential school. The children recommended for admission have a medical examination before coming (71) to the school. It sometimes happens that a child is transferred urgently to Lea Bridge Road School before the medical examination can be arranged. This examination is carried out by the School Medical Officer at her next visit to the school. The School Medical Officer visits the school about 6 afternoon sessions each term. A full report on the school was submitted last year. The hope then expressed that the Psychiatrist from the Leyton Child Guidance Clinic would be holding a waekly session at the school has been realised and Dr.Little has attended one afternoon each week since the beginning of 1963. Dr.Little sees and advises on the children who attend there and is also able to see the parents who would be very unlikely to agree to attend at a Child Guidance Clinic. In November an open evening was held arranged by the school teaching staff and all the ancilliary staff attended from the psychiatric, psychological and medical side. A high percentage of parents attended including many of the fathers and it was very helpful indeed to be able to talk over a cup of tea and cakes about the special problems which these children present to their parents as well as to the school. TUBERCULOSIS IN SCHOOL CHILDREN There was no new case of tuberculosis in school children reported in 1963, DEATHS OF CHILDREN OF SCHOOL AGE During the year three children of school age died. The deaths were due to the following:- Acute Influenzal Pneumonia Boy aged 7 years Generalised cachexia, secondary carcinomomatosis, Osteo sarcoma of right thigh Girl aged 9 years Lobar Pneumonia, Developmental heart defects Girl aged 6 years HEALTH EDUCATION The Health Visitors gave 138 lectures in schools at which the children made 3,090 attendances. (72) Improvements to School Premises carried out during year ended 31st December, 1963 LEYTON COUNTY HIGH SCHOOL FOR GIRLS Conversion of Domestic Science classroom block in rear playground to provide Dining Rooms and Kitchen with new equipment. CHURCH MEAD COUNTY PRIMARY SCHOOL New stainless steel sinks provided in kitchen. THE UNDER-MENTIONED SCHOOLS WERE REDECORATED INTERNALLY Connaught County Secondary Davies County Primary Leyton County High School for Boys Newport County Primary Junior (73)