AC 4411 (1) LEY 58 BOROUGH OF LEYTON THE HEALTH OF LEYTON 1964 E. W. WRIGHT MB., Ch.B., D.P.H. Medical Officer of Health, Borough of Ley ton Area Medical Officer, County of Essex Divisional School Medical Officer Health Offices Sidmouth Road, Leyton, E.10 Leytonstone 3650 CONTENTS I Introduction by Medical Officer of Health. II Vital Statistics and General Information. III Environmental Health Services. IV Personal Health Services. V School Health Service. Public Health Committee 1964-65 The Worshipful the Mayor: Councillor T.C.Messenger,J.P. (ex-officio) Chairman: Alderman Mrs. A. M. M. Burrell Vice-Chairman: Councillor Mrs. E. Bartram Aldermen: G.S.Flack Mrs. J. Hammond, 0. B. E. ,J.P. Mrs. R.King Councillors: Mrs.D.E.Collins A. H. Mackay P.W.Marshall, J.P. W. H. Sanders P. 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. Chief Administrative Assistant: W. D„Softley TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE BOROUGH OF LEYTON Mr Mayor, Ladies and Gentlemen, I have the honour to submit my report, as requested by the Ministry of Health, on the factors affecting the health of the people of the borough of Leyton during 1964, its last full year, and on the health of the population as individuals, including reference to the work of the School Health Service When this report is published Leyton Borough will be a memory - a memory of 39 eventful years in the field of health services The first Annual Report for the year 1926 opens with the words of Dr. Francis Taylor, Medical Officer of Health of the time; "I am pleased to report that the health of the Borough has been satisfactory" and then goes on to report 104 deaths from tuberculosis, 35 from measles and enteritis and seven women dying in childbirth. He was very pleased that only 1,204 school children were verminous, about a third of the figure five years before. In that year Leyton won the Daily News first prize of £20 for the greatest reduction in the death rate of babies, for districts of over 100,000 population. That improved death rate was over three times what it is now. These figures have dramatically improved since then but there is another side to the picture. The death rate for lung cancer is now eight times as great (well over half the cases before normal retirement age) as in that year and deaths from Leukaemia doubled. The percentage of illegitimate births, with all the associated stress and distress, is over two-and-a-half times as high as it was then and we have now become aware that illness of the mind is as real and as widespread as any illness of the body and is on the increase. Am I to report that the health of the borough has been satisfactory? No one will deny that we must attack present ills forcefully but we can fairly gain encouragement from a review of past achievement. Past achievement is something in which Leyton can take pride. More than once Leyton has led the field and permissive powers as well as statutory duties have been exploited to the full. After its success in winning the "Daily News" prize, Leyton in 1931 started a Home Help scheme, preceding much of the country by fifteen or more years. In 1932 expectant mothers were given meals in the clinics - a health measure of vital importance in the depression. Leyton was one of the early authorities to combine the post of Health Visitor with that of School Nurse. Almost as soon as the audiometer for testing the hearing of school children was invented Leyton purchased one (1934) far ahead of most authorities. The foot clinic in 1936 was also one of the first by a local authority anywhere in the country. The child development sessions - now copied widely. - were a Leyton innovation in 1961, and the arrangement where the psychiatrist at the Child Guidance Clinic holds this appointment jointly with a hospital post, with a children's ward at Whipps Cross, has unique features which I am confident will one day be seen as another Leyton pioneer "first" . And so we come to the last year of Leyton's existence which, like the first, is marked by achievement - The Alice Burrell Centre - The first Local Authority purposebuilt luncheon club for old people anywhere in the country. This Centre has already become quite a show piece attracting many visitors from elsewhere. 2 Another innovation during the year was the appointment of three Welfare Assistants to undertake systematic house to house visiting. It is found that about half the old people visited can be given information which they did not know and which can add something to their lives, while about 80 - 90% of them really appreciate the visit which, amongst other things, is a sign of the concern of the local authority However, the outstanding value of the scheme is in the 7-8% found with one or more serious needs. The plight of many of these people is not known to anyone and in other cases where the need is known nobody has felt responsible for doing anything about it. Though Leyton has no shortage of the more striking triumphs of course the daily round is what matters to the individual members of the public, and Leyton can also be proud of the particularly close family atmosphere that has prevailed between the public and the clinics. The clinics have been centres for the people of the area in more than the purely physical sense and the staff have built up the friendliest liaison with the schools, the children, the mothers and indeed the old folk as well. It is invidious to mention names when so many have worked so hard, but I am sure that other staff will forgive me if, in thanking them all for their service throughout the year, I thank specially my deputy Dr. Mary Gilchrist who has not only been a tower of strength to me but also a friend and advisor to countless families in Leyton during 33 years of the most dedicated service. I should like to thank all the professional staff, the technical staff and the manual staff in all their so varied fields and also the administrative staff headed by Mr.W.D.Softley who has the special attribute of having been employed by Leyton Borough through its entire existence, being a clerk full time on infectious disease in its early days. The staff also owe their thanks to those of other departments who have always been so helpful when the functions of the health department have needed their co-operation, to the General Practitioners, and to the large number of volunteers and voluntary organisations. Finally, may I express ray thanks to the Council and to the two Health Committees for their support during the year - a support and Interest which has always been of the greatest encouragement through the years - 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 Sub-Committee for the interest they have shown personally. I have the honour to be Mr. Mayor, Ladies and Gentlemen Your obedient Servant, Medical Officer of Health (3) VITAL STATISTICS Area in acres 2,594 Population (Census 1962) 93,357 Population (Registrar-General's Estimate, 1964) 91,420 Assessable Value for General Rate Purposes 3,785,000 General Rate in the £ (1964/65 l1s. 2d The Registrar-General's mid-year 1964 estimate of population (viz., 91,420 has been used for the calculation of the following statistics:- Live Births 1,576 Live Birth Rate per 1,000 population 17.24 Stillbirths 15 Stillbirth rate per 1,000 total (live and stillbirths) 9.43 Total Live and Stillbirths 1,591 Infant Deaths 29 Infant Mortality rate per 1,000 live births 18.40 " " „ „ 1,000 legitimate births 19.71 " " „„ 1,000 illegitimate births 9.52 Neo-Natal Mortality Rate (first four weeks) per 1,000 related live births 13.32 Early Neo-natal Mortality Rate (first week) per 1,000 related live births 13.32 Peri-natal Mortality Rate (stillbirths and deaths during the first week) per 1,000 total still and live births 22.63 Percentage of illegitimate live births 7.13 Maternal Deaths (including abortion) 1 Maternal Mortality Rate (including abortion) per 1,000 total live births 0.63 Total Deaths 1,347 Death Rate 14.73 Natural increase of Population 229 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 17.58 Deaths 11.64 (4) COMPARATIVE STATISTICS OP BIRTHS. MORTALITY, ETC, - LEYTON 1901-1964 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 2,031 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 125,430 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 1964 91,420 1,576 17.24 1,347 14.73 29 18.40 * Population as estimated for purposes of B - Birth Rate; D - Death Rate. (5) (6) CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE - 1964 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 6 574 75+ TOTAL FEMALES 1. Tuberculosis, respiratory 5 – – – – – – 2 2 4 – – – – – – – 1 1 2. Tuberculosis, other 2 – – – – – 1 – – 1 – – – – – – – 1 1 3. Syphilitic disease 2 – – – – – 1 – – 1 – – – – – – – 1 1 4. Diphtheria – – – – – – – – – – – – – – – – – – – 5. Whooping Cough – – – – – – – – – – – – – – – – – – – 6. Meningococcal Infections – – – – – – – – – – – – – – – – – – – 7. Acute Poliomyelitis – – – – – – – – – – – – – – – – – – – 8. Measles – – – – – – – – – – – – – – – – – – – 9. Other infective and parasitic diseases 5 – – – – – 1 – 1 2 1 – 1 – – 1 – – 3 10. Malignant neoplasm stomach 30 – – – – – 8 4 1 13 – – – – – 5 2 10 17 11. Malignant neoplasm lung, bronchus 76 – – – – 3 30 17 11 61 – – – – – 4 5 6 15 12. Malignant neoplasm breast 29 – – – – – – – 1 1 – – – – 3 8 5 12 28 13. Malignant neoplasm uterus 10 – – – – – – – – – – – – – – 2 4 4 10 14. Other malignant and lymphatic neoplasms 114 1 – 1 – 3 18 21 9 53 – – – – 2 15 15 29 61 15. Leukaemia, aleukaemia 7 – – – – – 1 – – 1 – – – – – 1 3 2 6 16. Diabetes 12 – – – – – – – 4 4 – – – – – 4 1 3 8 17. Vascular lesions of nervous system 188 – – – – 1 13 13 32 59 – – – – – 12 24 93 129 18. Coronary disease, angina 211 – – – – 3 41 37 42 123 – – – – 2 10 27 49 88 19. Hypertension with heart disease 13 – – – – – 1 5 2 8 – – – – – 1 1 3 5 20. Other heart disease 185 – – – 1 – 6 l5 45 67 – – – – 1 3 9 105 118 21. Other circulatory disease 84 – – – – 1 13 7 18 39 – – – – – 6 11 28 45 22. Influenza 1 – – – – – – – – – – – – – – – – 1 1 23. Pneumonia 106 1 – – 1 – 4 13 27 46 – – – 1 – 2 12 45 60 24. Bronchitis 70 – – – – 1 8 15 23 47 – 1 – – – 2 8 12 23 25. Other diseases of respiratory system 7 – – – – – 2 – – 2 – – – – – – 1 4 5 26. Ulcer of stomach and duodenum 6 – – – – – – 2 2 4 – – – – – – 1 l 2 27. Gastritis, enteritis and diarrhoea 8 1 – – – – 2 – – 3 1 – – – 1 – – 3 5 28. Nephritis and nephrosis 4 – – – – – 2 1 – 3 – – – – – 1 – – 1 29. Hyperplasia of prostate 4 – – – – – 1 – 3 4 – – – – – – – – – 30. Pregnancy, childbirth, abortion 1 – – – – – – – – – – – – – 1 – – – 1 31. Congenital malformations 8 1 – – – – – – 2 3 1 – 1 – 1 1 – 1 5 32. Other defined and ill-defined diseases 117 8 – – 2 2 9 8 13 42 13 1 1 – 5 17 13 25 75 33. Motor vehicle accidents 4 – – – – 1 2 – 1 4 – – – – - - – – – 34. All other accidents 22 1 – 1 – 1 3 4 1 11 – – – – 1 1 3 6 11 35. Suicide 15 – – – – 5 3 – – 8 – – – – 2 3 – 2 7 36. Homicide and operations of war 1 – – – 1 – – – – 1 – – – – – – – TOTALS 1,347 13 – 2 5 21 170 164 240 615 16 2 3 1 19 99 145 447 732 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 (1,347) in 1964 the respective death rates per 1,000 population beinel4.80 and 14.73 BURIAL OF THE DEAD During the year 10 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 Chlorinr ation and Aeration Large 22,000 Large 4.09 Small 70,000 Small 18,000 Small 3.33 Whipps Cross Pool: 1,300,000 M.W.B. Mains Coagulation Filtration and Chlorinatlon 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.e.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 of the Borough is some 70 - 90 years old and the Council, several years ago, embarked on a programme of redrainage, treating each of the five drainage areas of the Borough in turn. Work in connection with the first and second stages of the West Leyton Area have been completed and the main outfall system at the Auckland Road Depot, which controls the flow from the whole of the Borough, has been substantially reconstructed. It is intended shortly to complete the remaining redrainage work necessary in the West Leyton Area. 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 administered the ambulance service from Chelmsford, the vehicles and staff for this area being accommodated at the James Lane Ambulance Station, Leytonstone, E. 11. (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 Year Articles Laundered 1957 1,417 1961 19,503 1958 5,852 1962 29,269 1959 13,652 1963 32,513 1960 17,172 1964 22,314 The Borough of West Ham commenced their own incontinent laundry service in 1964, and the contractual arrangements with Leyton Borough Council ceased. 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 1961 1962 1963 1964 Scarlet Fever 44 29 27 51 Erysipelas 9 9 5 – Whooping Cough 20 34 62 38 Measles 1195 281 1069 131 Diphtheria – – – – Acute Poliomyelitis - Paralytic – – – – - Non-paralytic – – – – Tuberculosis - Respiratory 32 35 44 31 - Meninges and C.N.S. – – 1 – - Other 5 6 5 3 Meningococcal infection 1 1 2 2 Acute Encephalitis. Inf. – – 2 – - Post-inf. – – 1 – Dysentery 30 97 40 65 Ophthalmia Neonatorum – 2 – – Puerperal Pyrexia 5 2 3 3 Pemphigus Neonatorum – – – – Typhoid Fever – – – – Paratyphoid – – 1 – Food Poisoning 20 22 – 6 Malaria – – – – Pneumonia 59 35 102 21 Smallpox – – – – Anthrax – – – – 1447 553 1364 351 (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, 1964. PULMONARY NON-PULMONARY TOTAL M F Total M F Total Number on register at commencement of year. 360 284 644 23 39 62 706 Number first notified during year 23 7 30 2 2 4 34 Number entered in register otherwise than by notification 15 16 31 1 – 1 32 Number removed during year 45 27 72 3 9 12 84 Number remaining at end of year 353 280 633 23 32 55 688 Died 8 3 11 1 - 1 12 Removed from district 13 11 24 – 3 3 27 De-notified 10 – 10 – 4 4 14 Cured 14 13 27 2 2 4 31 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 – – – 1 5-14 years – – – – 15-25 " 3 1 1 1 26-45 " 7 4 – – 46-65 „ 8 – – – 65 and over 5 2 1 1 TOTAL 23 7 2 3 (11) THE WELFARE OF THE ELDERLY The Alice Burrell Centre inSidmouth Road which was opened in June is a venture of which all concerned can be proud. Though based on other centres, and profiting from their experience it is the only local authority centre of its kind in the country and combines in one centre a kitchen, a dining hall and a lounge. Many visitors have come to see it. The kitchen provides the meals for the meals-on-wheels service and also for up to 90 old people to have lunch in the centre each day. The numbers attending there have steadily increased throuhgout the year and, though the careful selection of members by the social workers has slowed the increase, it has had the effect, as intended, of ensuring that all those who attend are people for whom the food and fellowship are a real need not obtainable elsewhere. The many gifts from well wishers have made both the hall and the lounge very welcoming places and the lounge in particular has a warmth and friendliness seldom met in centres of this kind. The clubs which meet at this centre have flourished and one or two experimental projects have been tried. One of these - a regular Wednesday evening entertainment has proved awinner and there is no doubt that this attractive centre has brought a joy to life that many old people must have felt had gone for good. The luncheon club at Davies Lane continues to flourish and the new one started in August, 1964 at Emmanuel Hall to coincide with the movement of the A. 1. club in Elm Park Road to these premises, continues to flourish. I do not think that anyone who has seen one of these clubs in action can doubt their worth and it is to be hoped that luncheon clubs for the elderly will hecome an ever increasing part of the community life. In April three visitors to the elderly began a systematic survey of the whole borough which will probably take about three years to complete. By systematic visiting they have found many old people who are unaware of facilities available to them and a number of cases where a serious need could be remedied. These latter alone justify the service but the putting of old people in touch with facilities that add a little extra to the interest in their lives also has a value not to be underestimated. In addition these visitors have been compiling a register of old people which has been of the greatest value in channelling an enormous amount of goodwill (expressed by the public as Christmas parcels, shows and outings) to the people for whom it means the most. (12) Plate No. I. THE ALICE BURRELL CENTRE Kitchen. Plate No. 2. THE ALICE BURRELL CENTRE Dining and Recreational Hall. Plate No. 3. THE ALICE BURRELL CENTRE Dining and Recreational Hall. Plate No. 4. THE ALICE BURRELL CENTRE The Lounge. Public Health Inspection of the Area -1964 Report of Chief Public Health Inspector The first need - and the first right of every family - is a place to live. Yet, incredibly, in this affluent society of 1964, the number of homeless is not going down. It is not even remaining steady, it is increasing at a disturbing rate. One estimate puts the total of homeless families in Britain well over ten thousand. In London alone, it is said that there are about one thousand families without a place of their own. As so often happens when a commodity vital to the community is in short supply, exploitation occurs. So widespread were reports of exploitation of the housing shortage in London and elsewhere that earlier this year the Government set up a special Committee, under the Chairmanship of Sir Milner Holland, Q.C., to investigate "Rachman type of abuses to tenants in rented accommodation," and from the questionnaire issued by that Committee it would seem that the underlying emotion of this sordid speculation in the accommodation needs of a desperate population is fear - fear of abuse, fear of persecution, fear of maltreatment, fear of the loss of one's possessions, fear of exorbitant rents, and, above all, fear of eviction. The unfortunate tenants of this type of accommodation may not readily understand the legal, administrative and technical ramifications of control orders, management orders, and the like, but what they do understand is, that any complaint they may make regarding their accommodation, and any action taken by the Local Authority to improve their lot, could, and so often does, result in eviction. In my reports of 1962 and 1963 I drew attention to the precarious plight of such people, and stressed the need for amending legislation to deal with the problem. Since then the matter has received much publicity, and on the 17th December this year Parliament passed the Prevention of Eviction Act, 1964. This Act empowers county courts to delay the eviction of tenants of most privately-owned flats or rooms. The Act provides that a landlord cannot evict a tenant without first getting an order from the county court. The county court may give the landlord an order for possession, but may also allow the tenant a period of grace before the landlord may act on the order. The period of grace may be any period up to twelve months, during which the court may impose conditions, including conditions about rent. The court may, if asked, review any order which it has already made. It can alter any conditions it has imposed; it can extend the period of grace (up to a total of twelve months but not more); or it can reduce or end it. Even if an order for possession has been made before the Act came into force, either by the High Court or by the county court, a tenant can ask the court to alter it. Before coming to a decision the court will offer both the landlord and the tenant an opportunity to state his case, and will take account of all the circumstances. Tenants of furnished premises now have the protection given by the new Act, whether or not they had, or still have, the right to refer to a rent tribunal. The powers available to local authorities to deal with unsatisfactory living conditions in houses in multiple occupation have also been strengthened and extended by the Housing Act, 1964, which was introduced in July of this year. (13) 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 are concerned generally with the repair, demolition or closure of unfit houses, slum clearance, multiple occupation, and other matters arising from the issue of certificates of disrepair under the Rent Act. Dwelling houses are inspected as a general routine, or on complaint, and statutory action taken as appropriate to secure the remedying of defects and abatement of nuisances. Over the past twelve months, some 14,685 inspections and re-inspections were made under the Public Health Acts, Housing and Rent Acts, Prevention of Damage by Pests Act, and other legislation; 2,104 complaints regarding unsatisfactory conditions were investigated, and 701 notices, specifying works to remedy defects such as dampness, general disrepair, defective drainage, leaking roofs, etc. were served. In addition, pursuant to the requirements of section 3 of the Housing Act, 1957, and the Housing Consolidated Regulations, 1925/32, some 414 houses were surveyed to ascertain their fitness for human habitation, having regard to the standard prescribed by the Act and the possibility, or otherwise, of their being included in a slum clearance scheme or dealt with by demolition or closing order procedure. Legal proceedings arising from the failure of owners to comply with the requirements of notices served under the nuisance abatement procedure of the Public Health Act were initiated in 64 cases, and in 51 cases the work was completed, either before the date of the hearing or after adjournment of the summonses. 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 3 applications under the Rent Act, 1957, for certificates of disrepair, and 3 applications for certificates as to the remedying of defects etc. were received and dealt with by the public health inspectorate; 4 notices (Form J) of the Council's proposal to issue such certificates were served on landlords, arising out of which 1 undertaking (Form K) to remedy defects specified thereon within a period of six months, was submitted by the owners and accepted by the Council, and 3 certificates of disrepair were issued. The Council's phased programme in relation to slum clearance and re-development continues to make satisfactory progress. Two further slum clearance schemes, consisting of six separate clearance areas, and comprising some two hundred unfit houses, were dealt with during the year and submitted to the Public Health Committee - the first stage of the Cathall Road Area, and the Temple Mills Lane Area. Also, a detailed inspection of a further two hundred dwelling houses in the second stage of the Cathall Road Area is nearing completion, and it is hoped to submit a report in respect of this area to the Public Health Committee early in the new year (1965). A public local inquiry in respect of the Leyton Housing (Cathall Road Area No. 1) Compulsory Purchase Order, 1964, was held in the Town Hall on Tuesday, 10th November. The inquiry was ordered by the Ministry 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 at the time of writing this report (January, 1965) had not been received. It may be of interest to recall some of the points included in the report submitted to the Public Health Committee, outlining the main and material conditions affecting (14) properties which were the subject of the inquiry, and to illustrate certain of these features with photographs. (Please refer to photographs between pages 15 and 16 when reading the outline report which follows). BOUNDARIES OF THE CLEARANCE AREAS AND NUMBER OF BUILDINGS The Compulsory Purchase Order embraces four Clearance Areas, comprising 183 unfit houses, in the following roads, or parts of roads - High Road, E.11., Holloway Road, Denmark Street, Wood Street, Temple Street, Angle Street, Argyle Street, Granville Street, Trinity Street and Short Street. TYPE AND DESCRIPTION OF DWELLING HOUSES Of the 183 dwelling houses in the clearance areas, all are situated in terraces, with the exception of three houses in High Road, E. 11 (Nos, 453, 455 and 457), which are semi-detached, and one large property in Temple Street (Temple House). Apart from three three-storeyed houses (Nos. 16 and 20 Temple Street and No. 40 Holloway Road), all the properties are of the two-storeyed type, with single or two-storey back additions. All houses have through ventilation and yard space at the rear. The majority of houses have frontages varying from 12ft. to 16ft. Four double-fronted houses (Nos. 453-457, High Road, E. 11 and 2, Temple Street) have frontages of over 30ft. "Temple House" has a frontage of 44ft. Seventy houses have no forecourts; the depth of forecourts to the remainder varies from 5ft. to 16ft. The construction is traditional - brick walls, slated or tiled pitched or central valley gutter roofs (with the exception of a few houses which still have corrugated asbestos roofs following war damage), timber floors (except some scullery floors which are of concrete) and joinery work, and plaster walls and ceilings. With the exception of 18 houses, W.C.'s are entered externally. Internal accommodation varies from 3 rooms including scullery to 8 rooms, with the exception of "Temple House;" this latter property comprises 13 rooms, each let as a separate tenancy to 1 old age pensioner. The 13 occupants of the house share one communal wash-room and 2 external W. C.'s. Eight houses have bathrooms. Mains water supply is provided over scullery sinks. Nineteen houses have no internal halls or passages, so that living-rooms are inter-communicating and entered direct from the street or forecourt. At 67 houses staircases rise from livingrooms. Many of the houses are badly arranged on the site, obstructing free admission of natural light and impeding the circulation of air. The majority of the houses are badly arranged internally, staircases often constitute a danger to the occupants by reason of their position, construction and inadequate lighting. Other typical forms of bad arrangement are rooms inter-communicating, ground floor rooms at different levels, fuel storage cupboards beneath stairs and entered from living rooms, and room accommodation cramped and congested. The houses are between 70 and 100 years old; they contain inherent structural defects, and fall short of the minimum requirements of the Housing Acts; the most satisfactory method of dealing with conditions in the areas is demolition of all buildings in the areas. (15) Included in the Cathall Road slum clearance areas are the Almshouses known as "Temple House." It is interesting to recall that these Almshouses were founded nearly four hundred years ago, as a result of an ancient East London Charity. The benefactor was a certain John Puller, described in official records as 'Judge Puller,' of Bishop Bonner's Hall, Bethnal Green, who, by his Will dated the 29th March, 1552, directed "that his wife, her heirs, or assigns, should after his death erect an Almshouse in Stepney, in the County of Middlesex, for twelve poor, single men, of good name, of the age of fifty years or above it, of the hamlets then comprised in the original mother-parish and manor of Stebonhith, and endowed the same with one yearly rent-charge of £50 per annum for ever, to issue out of lands in the county of Lincoln." They were originally situated in Eagle Place, Mile End Road, Stepney, and were then governed by eight elders of the Mercers Company, as directed by the donor's Will. In the year 1866 the Almshouses were demolished, and the building was sold; with the proceeds the present site in Temple Street, Harrow Green, Leytonstone, E.11., was purchased, and a new Almshouse erected, giving the twelve inmates a room each, with common sitting room, wash-house and other conveniences. One of the photographs on page shows the original pump and stone sink, which at that time were presumably the only available water supply and washing facilities. 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 public health inspectorate as part of their duties to ensure that the requirements of the many Acts, orders and regulations relating to such premises, and for the welfare of the people who work in them, are complied with. 1,363 inspections of business premises were made during the year, 115 notices were served, and 58 registrations and/or licences were dealt with. These duties have been considerably increased as a result of the Offices, Shops and Railway Premises Act, 1963, and Regulations, part of which became operative during the year. This Act extends health and welfare legislation into new fields of nonindustrial employment. Its declared objective is "to set standards of health, welfare and safety of employees in office, shop and railway premises." The extension of the framework of welfare legislation which has long been enjoyed by factory workers to include hitherto unprotected office workers is a major step forward, by which the standard of health and welfare of office workers may be advanced, but this will not be achieved without active and enlightened enforcement. Section 49(1) of the Act requires the notification by employers of the employment of persons in office, shop and railway premises. Such notification is generally referred to as "registration of premises," and although responsibility for making application for registration rests with the occupier, in order to facilitate registration arrangements Form 0SR.1 prescribed by the Ministry of Labour was sent to all known businesses in the Borough. The total number of premises registered up to the end of the year was 891, comprising 209 offices, 558 retail shops, 59 wholesale shops and warehouses, and 65 catering establishments. The total number of persons employed at these premises amounted to 2, 066 males and 2,699 females. In order to secure compliance with the varied requirements of the Act and Regulations, it will be necessary to undertake a detailed survey of some two thousand businesses and other premises in the Borough. I mentioned in my report last year that existing staff cannot hope to undertake such a task without reinforcement, and suggested that the Local Authority would need to recognise the inevitability of increasing the establishment of the public health inspectorate. (16) Plate No. 1. CATHALL ROAD SLUM CLEARANCE AREA (Stage 1). Front elevation of houses in Angle Street showing rising dampness and general disrepair. Note entrance to rooms direct from street. Plate No. 2. CATHALL ROAD SLUM CLEARANCE AREA (Stage 1). Rear elevation of houses in Holloway Road showing bad site arrangement, obstruction of natural light, and general disrepair. Plate No. 3. CATHALL ROAD SLUM CLEARANCE AREA (Stage 1). Dwelling Houses Temple Street (Cul-de-s3c) - corner of Angle Street. Plate No. 4. CATHALL ROAD SLUM CLEARANCE AREA (Stage 1). Rear elevation of houses in Temple Street showing general disrepair. Plate No. 5. CATHALL ROAD SLUM CLEARANCE AREA (Stage 1). Rear elevation of houses in Trinity Street showing bad site arrangement and general disrepair. Plate No. 6. CATHALL ROAD SLUM CLEARANCE AREA (Stage 1). Rear elevation of houses in Denmark Street showing structural uneven settlement, rising dampness and general disrepair. Plate No. 7. CATHALL ROAD SLUM CLEARANCE AREA (Stage 1). Rear of houses in High Road Leytonstone showing bad site arrangement. Note close proximity of houses in Wood Street causing obstruction of natural light. Plate No. 8. CATHALL ROAD SLUM CLEARANCE AREA (Stage 1). Rear elevation of houses in Holloway Road showing bad site arrangement, structural uneven settlement and general disrepair. Plate No. 9. CATHALL ROAD SLUM CLEARANCE AREA (Stage 1). Temple House, Temple Street. The communal wash-room. Plate No. 10. CATHALL ROAD SLUM CLEARANCE AREA. (Stage 1). Temple House, Temple Street. The first-floor landing showing communal sink. However, owing to vacancies on the existing establishment of Public Health Inspectors, it has not been possible to make any substantial progress on a detailed survey, although a limited number of inspections have been carried out. A total of 551 inspections were made under the Food Hygiene Regulations, 91 notices were served in connection with contraventions, and in one case it was necessary to institute legal proceedings against the proprietor of a cafe for failure to maintain the premises in a clean and satisfactory condition. Pood hygiene inspections included visits to out-door events such as Easter, Whitsun and August Fairs, and the August Cricket Festival at the Leyton Sports Ground. Thirtythree complaints regarding foodstuffs were investigated and reports submitted to the Public Health Committee. A wide variety of foodstuffs were implicated, i.e. milk, bread, cakes, tinned meat goods and confectionery. The reason for the complaint was either the presence of foreign matter, or the appearance of mould growth on the food, indicating lack of supervision or care at retail premises. A total of 140 samples of food and drugs were taken for submission to the public analyst for chemical examination, and 10 bacteriological samples were examined by the public health laboratories. The bacteriological samples comprised routine checks of milk and ice cream. Four unsatisfactory chemical samples were reported during the year, and three of these concerned proprietary canned foods which in the opinion of the public analyst were low in their meat content. Although there was no statutory standard for the commodities concerned, representations were made by the Public Health Committee to the manufacturers, who agreed to amend the descriptions on the lables. The Committee also authorised legal proceedings in respect of four of the food complaints and dealt with the remaining 29 by warning letters. Soon after the Clean Air Act came into operation the Council approved a phased programme for the establishment of 'Smokeless Zones,' which would ultimately bring the whole of the Borough under smoke control. This programme continues to progress satisfactorily; four areas have been declared, affecting some 9,000 dwelling houses and 400odd industrial and commercial premises. The Clean Air Act is often the subject of criticism for its failure to come to grips with the problem of sulphur dioxide gas, a harmful constituent of the combustion products stemming from chimneys and motor exhausts. "Why bother to check the visible smoke when the real villain is slipping through the net?" goes the argument. Without denying the harmfulness of this gas, the pollutants which are dealt with by the Act are well worth removing in the interests of health and amenity. While there is no single comprehensive panacea for entirely eliminating sulphur dioxide from the atmosphere, there are numerous ways in which its emission can be minimised or ameliorated. These include the installation of more efficient boiler installations and heating systems and the erection of high chimneys, and these are factors which should be borne in mind in planning all new or re-development areas. The success of a Smoke Control Order depends to a large extent on the co-operation of people who live or work in the area, and to this end considerable time and effort has been spent in health education. Static and mobile exhibitions dealing with all aspects of smoke control, combined with an advice bureau, were staged at various parts of the Borough on a number of occasions. (17) The practical measures taken by the Public Health Inspectors to mitigate pollution of the atmosphere by smoke and grit included the taking of smoke observations of factory chimneys, inspection of boiler installations, advice to boiler operatives on proper use of fuel and stoking, and discussions with manual staff. Pour such observations were carried out during the year, and a further 3,137 inspections were made in connection with the establishment of smoke control areas. Special surveys are also in progress for the scientific measurement of grit and dust deposit in specified parts of the Borough. For this purpose four standard deposit gauges are being used, the results from which are published monthly in the bulletin of the Department of Scientific and industrial Research, with whom the Department is also co-operating in the national survey of air pollution. The figures for the past three years are given in Table 3. The Joint Conference of Neighbouring Local Authorities, first convened by Leyton Borough in 1956 for the purpose of discussing matters of common interest in regard to air pollution and exchange of ideas, met twice during the year, at Barking and at Dagenham. 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, the National Society for Clean Air, and the Standing Conference of Co-operating Bodies set up by the D.S.I.R., and several meetings were attended during the year. As part of the National Survey of Air Pollution, daily observations are taken throughout the year at the Sidmouth Road recording station. The results of these volumetric measurements of smoke and sulphur dioxide are set out in detail later in the report. The statistical year of the survey ends on 31st March. Table No. 1 shows the monthly average concentrations of smoke and sulphur dioxide, together with their ratios (divided into summer and winter periods) for the year 1963/64. The figures for the previous year are also shown for comparison. The average concentration of smoke for the year 1963/64 was 136 microgrammes per cubic metre. This figure, together with that for the year 1961/62, was the lowest recorded at Leyton since observations began in 1950. Table No. 2 gives the yearly average figures for the past 14 years; it will be seen that the smoke figures show a marked reduction since the operation of smoke control orders under the Clean Air Act. The results are also shown graphically. Attention is drawn to the statistical section of the report which follows; it contains full details of inspections and notices served under the Housing and Public Health Acts, Rent Act, Food and Drugs Act, Orders and Regulations, the Offices, Shops and Railway Premises Act, Clean Air Act, and other relevant legislation. Details of improvements effected to dwelling houses and business premises as a result of informal and statutory action; information regarding the institution of legal proceedings; details of businesses and premises registered or licensed, sampling and inspection of foodstuffs, and general information regarding the varied and ever-increasing activities of the Department are also included. (18) 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 78 3427 - - - - - Housing Acts, 1936/61 and Regulations 45 1820 8 - 8 - 414 Public Health Acts, 1936/61, and Noise Abatement Act, 1960. 1207 4678 505 263 448 - - Prevention of Damage by Pests Act, 1949. 457 3860 25 - 17 - - Pood and Drugs Act, 1955, and Pood Hygiene (General) Regulations. 1960. 141 549 - 91 31 - - Shops Act, 1950 - 615 - - - - _ Essex County Council Act, 1952. - 48 - - - - - Leyton Corporation Act, 1950. - _ _ _ _ _ _ Factories Act, 1959. 10 130 24 - 22 - - Pet Animals Act, 1951. - 9 - - - - - Rag Flack and Other Pilling Materials Act, 1951. - 1 - - - - - Rent Act, 1957. 10 34 - 13 - - - Fabrics (Misdescription) Act, 1913, and Regulations, 1957. _ _ _ - - - - Litter Act. 9 _ _ _ - - - Landlord and Tenant Act. - . 4 - 4 - - Leyton Byelaws - - 1 - 1 - _ (19) (b) DETAILED (i) Rent Act, 1957 - Para.4, First Schedule Application for certificates received 3 Decisions not to issue certificates Decisions to issue certificates 4 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 Certificates issued 3 Applications by landlords for cancellation 4 Objection by tenants to cancellation 3 Decisions by local authority to cancel in spite of objection Certificates cancelled by local authority 3 Applications for certificates (Form P) 3 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. Type of Premises Number of Inspections Retail Food Shops 490 Catering establishments (including factory canteens, hospitals, nursing homes) 168 48 Food Manufacturers/Depots, Dairies 35 Off-licences 12 Public Houses 42 School Meals 58 853 (20) (iii) Inspection of Business Premises other than Food Premises Inspections were carried out at the under-mentioned business premises having regard to the requirements of the Public Health Act, 1936, the Shops Act, 1950, the Factories Act, 1961, the Pet Animals Act, 1951, the Rag Flock and Other Filling Materials Act, 1951, the Diseases of Animals Acts and Orders, the Leyton Corporation Act, 1950, and relevant legislation. Type of Premises No. of Inspections Non-Power Factories 6 Factories with Mechanical Power 109 Fairgrounds 12 Hairdressers 53 Local Authority Properties 1 Miscellaneous Shops, etc 60 Outworkers 9 Pet Animal Shops 9 Rag Flock 1 Schools 14 TOTAL 274 (iv) Prevention of Damage by Pests Act, 1949 - Rodent Control/Disinfestation Complaints received 402 Enquiries and visits made: By Rodent Operatives 3130 By Public Health Inspectors. 730 Premises treated: Dwelling houses 253 Business/industrial premises 52 Three "block treatments" of premises for rodent infestation were carried out. (21) 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 8 Choked drains cleared 8 Dampness remedied 436 Drains relaid or partly relaid 3 Floors repaired 75 Guttering repaired or renewed 59 Miscellaneous defects remedied 147 New W. C. pans and traps provided 10 Plaster work repaired 176 Rainwater pipes repaired or renewed 13 Roofs repaired or renewed 73 Rooms redecorated 9 Sashcords renewed 85 Sinks provided Sink waste pipes repaired or renewed 27 Stoves repaired or renewed 29 Vent pipes repaired or renewed 12 W.C.cisterns repaired or renewed 65 Window sills, etc., repaired 113 Yard paved (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 91 Ceilings not kept clean or repaired 84 Floors not kept clean 72 Inadequate ventilation 8 Inadequate receptacles for refuse 6 Accumulation of refuse in room 18 Cleanliness of apparatus and fittings 49 Facilities for personal cleansing and/or washing food and equipment inadequate, i.e. Wash basins 9 Hot water 13 Soap/Towel/Nail brushes 14 Sinks 10 Food not protected from contamination 24 First-aid equipment 12 Wash-hand notices 22 Inadequate locker (clothing) accommodation 4 Redecoration 21 Miscellaneous 50 Artificial light in W.C 10 W. C. Pans renewed 1 Yard paving 1 (22) 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 90 4 - - - - - 90 - - - - Chemists 37 - - - - - - - - - - - Council properties 4 - - - - - - 1 - - - - Dairies 3 - 3 - - - - - - . - - Factories 451 - - - - 369 50 24 - 14 - - Food Factories, depots, etc. 6 1 4 - - - - - - - - 1 Food Hawkers 120 - - - - - - - - - - - Food premises, retail 565 208 95 46 10 27 - - - - - 11 Pood storage, hawkers 8 1 - - - - - - - - - 8 Hairdressers 91 - - - - - - - - - 91 - Hospitals 2 - - - - - - 2 - - - - Milk vending machines 5 - 5 - - - - - - - - - Multiple stores 5 3 - - - - - 3 - - - - Non-food retail premises 570 1 - - - - - - - - - - Off-licences 45 23 - - - - - - 45 - - - Pet Animals 8 - - - - - - - - - - - Public Houses 34 1 - - - - - - 32 - - - Rag Flock 6 - - - - 3 2 - - . - - Schools 22 1 - - - - - 17 - - - - Miscellaneous shop premises 130 - - - - - - - - - - - TOTALS ... 243 107 46 10 399 52 137 77 14 91 20 (23) (ii) Details of Registrations/Licences ACT OR REGULATION On Register 31.12.1962 Removed during 1963 Registered during 1963 On Register 31.12.1963 Pood and Drugs Act, 1955 Ice-Cream Premises 242 11 12 243 Food Preparation, etc. premises 43 1 4 46 Milk and Dairies (General) Regulations, 1959 Distributors 105 3 5 107 Dairies 3 - - 3 Milk (Special Designation) Regulations, 1960 Tuberculin Tested 27 1 3 29 Pasteurised 66 - 4 70 Sterilised 96 4 5 97 Essex County Council Act, 1952 Hawkers of Food 118 3 5 120 Hawkers' Storage Premises 24 1 1 24 Leyton Corporation Act, 1950 Section 63 - Vendors of Shellfish 10 - - 10 Section 48 - Hairdressers' Premises 86 4 4 86 Pet Animals Act, 1951 Annual Licences 8 - - 8 Animal Boarding Establishments Act, 1963 - - 1 1 Rag Flock and Other Filling Materials Act,1951 6 - - 6 TOTAL 834 28 44 850 (24) 4. LEGAL PROCEEDINGS (i) Public Health Act, 1936. 64 applications were made for legal proceedings, 13 of which cases were subsequently heard by the Court and abatement orders made. (ii) Food and Drugs Acts, 1955 and Food Hygiene Regs., 1955. Date of Hearing Nature of offence and address of premises concerned Result of Court Proceedings 22.1. 64. Mouldy jam puff - Mrs. A.Pinagli, 292 High Road, E.10. Manufacturers F.W.Spiller & Son. Vendor not guilty. Manufacturers found guilty - absolute discharge. Costs £9.9.0. to Council. 22.1. 64. Mould on cake - Cox Bros. Foods Ltd., 196 Francis Road, E. 10. Absolute discharge. Costs 4s.0d. to Council. 19.2. 64. Maggots in dried fruit - Gunn & Co., Ltd., 342 High Road, E.10. Absolute discharge. Costs £5.5.0. to Council. 19.2. 64. Mould on apple pie - Stoll Bakeries Ltd., 499 High Road, E.11. Absolute discharge. Costs £5.5.0. to Council. 8.4. 64. Contraventions of Food Hygiene Regulations - Mr. H.S. Spelling, 70 High Road, E.15. Case dismissed. 1.7. 64. Contravention of Sec. 105, Food & Drugs Act, 1955 Mr. H.W. Andrews, 109 Harrow Road, E. 11. Fine £2. Costs £2 to Council. 1.7. 64. Contravention of Sec. 105, Food & Drugs Act, 1955 Mr. H.W. Andrews, 255 Cann Hall Road, E.11. Fine £2. Costs £2 to Council. 8.7. 64. Wood in cake - Mr. F. Cassitari, 595 High Road, E.11. Manufacturer Mr. F.W.Spiller. Vendor not guilty. Manufacturer found guilty. Fine £20. Costs £3.3.0. to Council. 7.10.64. Foreign body in bread - London Co-operative Society. Fine £3. Costs £3.3.0. to Council. 5. MEAT AND FOOD CONDEMNED Condemnation certificates were issued in respect of the under-mentioned unsound foodstuffs surrendered by various traders in the Borough as a result of routine inspection of food premises. The food condemned was destroyed by fire at the Council's Destructor Works. Commodity Tons Cwts. Qra. Lbs. Commodity Tons Cwts. Qrs. Lbs. Bananas 3 10 - - Offal - 5 3 2 Ham - - 9 Sausages - - - 6 Butter - - 2 20 Prawns - - - 4 Bacon - 1 2 22 Rabbits - - 3 4 Cheese - - - 10 Salmon - - 1 2 Fish - - 2 4 Veal - - 3 1 Beef - 5 - 14 Tongue - - - 15 Lamb - 3 3 27 Turkey - - - 20 Pork - 4 - 13 (25) Commodity Units Frozen Poods 278 pkts. Milk 42 tins Luncheon Meat 68 " Vegetables . 209 " Fruit . 120 " Fish 19 " Ham 38 " Soup 34 " Beetroot 3 jars Pies 31 Lambs 17 6. SAMPLING - FOOD AND DRUGS ACT. 1955. (i) Chemical Analysis Commodity Taken Satisfactory Unsatisfactory Milk 1 1 - Ice-Cream 7 6 1 Miscellaneous 132 129 3 TOTALS 140 136 4 (ii) Bacteriological Examination Commodity Taken Satisfactory Unsatisfactory Milk 1 1 - Ice-Cream 9 9 - TOTALS 10 10 - (26) 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 Number on Register NUMBER OF Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 52 26 12 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 399 107 11 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) _ 1 1 - TOTAL 451 134 24 - 2. Cases in which defects were found Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.1) 12 8 - 8 - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) 2 1 - 1 - Ineffective drainage of floors (S. 6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient 1 1 _ 1 - (b) Unsuitable or defective 9 9 - 3 - (c) Not separate for sexes 3 3 - - - (d) Other 13 9 - 6 - Other offences against the Act (not including offences relating to out-work) 1 - - - - TOTAL 41 30 _ 19 - (27) 3. Outwork Nature of Work i 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 153 Footwear 11 Umbrellas, etc. 8 Handbags 1 Artificial flowers 2 Garment bangers 2 Boxes, etc. wholly or partly of paper Making 20 Gents Neckwear 7 Upholstery trimmings 4 Brushes 3 Loose cover specialist 1 Toys 1 Watch straps 1 Buttons, carding 1 Christmas crackers, etc. 3 Belts for power Transmissions 1 Lampshades 11 TOTAL 230 (28) THE OFFICES,SHOPS AND RAILWAY PREMISES ACT, 1963 Prescribed particulars to be included in the Annual Report to be submitted under section 60 of the Act. TABLE 'A'. REGISTRATIONS AND GENERAL INSPECTIONS Class of Premises No. of premises registered during the year Total No. of registered premises at end of year No. of registered premises receiving a general inspection during the year Offices 209 209 - Retail shops 558 558 - Wholesale shops, 59 59 - Catering establishments open to the public, canteens 65 67 8 Fuel storage depots. - - - TABLE 'B'. NUMBER OF VISITS OF ALL KINDS BY INSPECTORS TO REGISTERED PREMISES Visits in connection with registration advice, publicity, etc 164 TABLE 'C'. ANALYSIS OF PERSONS EMPLOYED IN REGISTERED PREMISES BY WORKPLACE Class of Workplace Number of persons employed Offices 1,128 Retail shops 2,835 Wholesale departments, warehouses 453 Catering establishments open to the public 298 Canteens 51 Fuel storage depots - Total 4,765 Total Males 2,066 Total Females 2,699 (29) TABLE No. 1 MONTHLY AVERAGE CONCENTRATIONS OP SMOKE AND SULPHUR DIOXIDE (Expressed in Microgrammes per cubic Metre) Month Smoke Sulphur Dioxide Ratio Smoke/Sulphur Dioxide 1962/63 1963/64 1962/63 1963/64 1962/63 1963/64 April 94 93 137 159 .69 .58 May 64 52 121 110 .53 .47 June 30 31 81 73 .37 .42 July 34 31 83 87 .41 .36 August 35 33 79 75 .44 .44 September 63 61 117 104 .54 .59 SUMMER AVERAGE 53 50 103 101 .51 .50 October 154 97 230 170 .67 .57 November 242 187 298 239 .81 .78 December 270 283 491 293 .55 .97 January 314 313 379 387 .83 .81 February 302 278 364 303 .83 .92 March 114 174 196 175 .58 .99 WINTER AVERAGE 233 222 326 261 .71 .85 YEARLY AVERAGE 143 136 214 181 .67 .75 TABLE No. 2 YEARLY AVERAGE CONCENTRATIONS OP SMOKE AND SULPHUR DIOXIDE (Expressed in Microgrammes per cubic Metre) Year (Ending 31st March) Smoke Sulphur Dioxide Ratio Smoke/Sulphur Dioxide 1951 238 176 1.35 1952 225 169 1.33 1953 225 192 1.17 1954 176 186 .95 1955 185 223 .83 1956 208 209 1.00 1957 233 209 1.11 1958 222 217 1.02 1959 236 251 .94 1960 174 184 .95 1961 154 192 .80 1962 136 172 .79 1963 143 214 .67 1964 136 181 .75 (30) TABLE No. 3 OBSERVATIONS OF GRIT AND DUST-FALL BY STANDARD DEPOSIT GAUGES Sites of Deposit Gauges Weight of Deposited Matter expressed in Milligrammes per Square Metre per Day (average for 12 months ending 31st March) 1962 1963 1964 Leyton No.5 Gas Works, Lea Bridge Road, E.10. 281 206 206 Leyton No.7 "Hare and Hounds" P.H. Lea Bridge Road, E.10. 160 140 167 Leyton No.11 Park House Clinic, Granleigh Road, E.11. 112 102 109 Leyton No.12 Eaton Manor, Temple Mills, E.15. 100 95 98 (31) YEARLY AVERAGE CONCENTRATIONS OF SMOKE AND SULPHUR DIOXIDE LEYTON (SIDMOUTH ROAD) (32) Leyton Health Area Sub - Committee 1964-65 Representing:- Essex County Council: Aldermen K. E. B.Glenny, O. B.E., J. P. (ex-officio) Mrs. S M, Bovill G W Mason (ex-officio) Councillors Mrs. M.J.Harvey F.R.Richards Mrs.V.L.Wilson F. A. Wortley Leyton Borough Council: Aldermen Mrs. A.M. M.Burrell Mrs. J.Hammond, 0. 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 F.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. (33) Personal Health Services (Leyton Health Area Sub - Committee) SECTION 22 - CARE OF MOTHERS AND YOUNG CHILDREN BIRTHS - During the year the following births were registered:- Male Female Legitimate 731 740 Illegitimate 58 47 Total 789 787 Still-Births: Legitimate 5-8 Illegitimate 1 - 1 In the same period 1,622 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. Child Welfare - Clinic Attendances Year of Birth Leyton Green Park House Dawlish Road Emmanuel Hall 1959 26 39 79 8 Children who attended 1960 70 60 109 17 for the first time in 1964. 1961 80 93 164 25 1962 85 149 215 29 1963 289 305 305 67 1964 330 496 414 108 Total first attendances 880 1142 1286 254 Total attendances 7358 7419 8310 1947 Number seen by Doctor 1783 2304 2464 165 Number referred for snecial treatment 62 186 93 - CARE OF PREMATURE INFANTS (weighing 5lbs.8ozs. or under) Born at Home 11 Born in Hospital or Nursing Home 100 CONVALESCENT HOME TREATMENT Arrangements were made for two children and two mothers 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 1964 were: National Dried Milk (Tins) - 13,827 Cod Liver Oil (Bottles) - 2,532; Vitamin A&D Tablets (Packets) - 1,624 Orange Juice (Bottles) -21,367 (34) HEALTH CLINICS • CLINIC SESSIONS HEALTH CLINIC MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY Leyton Green, A.M. Dental Dental Dental Dental Dental Dental (alternate) Leyton Green Road, E. 10. (LEYtonstone 3650 Extn. 267) Doctor' s Consultation Foot Minor Ailment Child Development Foot Minor Ailment Orthoptic Ophthalmic Optician Toddlers Foot Minor Ailment Orthoptic Child Development Foot Minor Ailment Toddlers (monthly Foot Doctor's Consultation Minor Ailment Immunisations Foot alternating P.M. Dental Dental Dental Dental Dental Infant Welfare Foot Infant Welfare Orthoptic (alt.) Foot Infant Welfare Orthoptic Foot Ante-natal Post-natal Ante-natal Exs. Orthopaedic Foot alternating Immunisations Doctors Consultation Foot alternating Evening Foot. Dental (alt.) Mother's Club Dental (alt.) Foot Park House, A.M. Dental Dental Dental Dental Dental Dental Granleigh Road. E. 11. (LEYtonstone 3650 Ertn. 268) Doctor" s Consultation Child Development Foot Minor Ailment Ante-natal/ Post natal Foot alt. Minor Ailment Child Development Toddlers (monthly) Aural (monthly) Foot Minor Ailment Foot Minor Ailment Child Development Toddlers (monthly) Foot Doctor's Consultation Minor Ailment Foot alternating P.M. Dental Dental Dental Dental Dental , „ Ante-natal Exs. Remedial Exercises Foot Infant Welfare Foot Infant Welfare Remedial Exs. Foot Infant Welfare Foot Immunisations Doctor* s Consultation Foot alternatilng Evening Dental / Foot Dental Dental Dawlish Road, A.M. Dental Dental Dental Dental Dental Dental (alternatel Dawlish Road, E. 10. (LEYtonstone 3650 Extn.287) Minor Ailment Speech Foot Doctor" s Consultation Child Development Foot Minor Ailment Ante-natal Post-natal Toddlers Foot alter nating Minor Ailment Child Development Speech Foot Minor Ailment Speech Foot Doctor* s Consultation Minor Ailment alter nating P.M. Dental Dental Dental Dental Dental Infant Welfare Speech Foot Ante-nata 1 Exercises (alt.) Speech Foot Infant Welfare Speech Foot Infant Welfare Speech Foot Immunisation Doctor* s Consultation Speech Foot alter nating Evening Dental / Foot Dental Foot Emmanuel Hall, Hitcham Road, E. 10. P.M. Weighing Session Child Guidance, 133 Dawlish Road, E.10. (LEYtonstone 3650 Ext.288) Psychiatrist Educational Psychologist Psychotherapist Psychiatric Social Worke by appointment only /-N CO 01 •w Attendances at all clinics by appointment except Infant Welfare and Minor Ailment Clinics. CHILD DEVELOPMENT SESSIONS During the year the number of sessions at Leyton Green and Dawlish Road were increased to two a week. Park House continued with three sessions a week. The increase in the number of weekly sessions was greatly appreciated because, although children did improve on attending one morning a week, the progress made was slow and the waiting list lengthened so that the preventive aspect of the development sessions was reduced in effectiveness by the long delay in getting the children to attend. The waiting list is still long and it is hoped that eventually there will be five sessions a week at each clinic. There is no doubt that the children who go to the development sessions need the play therapy that is provided for them there. It was noticed at one of the Christmas parties how striking was the attitude of the mothers to the children, the majority of them seemed unable to "give out" much feeling towards their children and were in themselves rather withdrawn and depressed. All the mothers are asked to report back to the warden after they leave the development sessions to go to school as to how they have settled down in school. A very few of the children do not settle well; the majority do seem to be able to make a good adjustment when they go to school and the mothers themselves think that if they had not had the help of the development sessions there would have been quite marked difficulties when the child did first go to school. Dr. Little, the Consultant Psychiatrist of the Child Guidance Clinic, attends at each clinic once a month to discuss any problems with the Warden or with the children's mothers and in this way helps to resolve some of the difficulties being experienced by parents or children. The efforts of the local authority in this field will be augmented by the Nursery School Association branch in Leyton, which has been seeking accommodation for "play groups" . Although these will not necessarily be for children with problems they will allow children with minor disturbances or with very restricted play facilities in their own homes or in the neighbourhood of their homes, particularly the children who live in high flats, tobenefit from the release of their now aggressive instincts and allow them to express themselves in the free sort of play which we now know is very healthy for the emotional state of children at older years. Park House Leyton Green Dawlish Road Total number of sessions 151 67 66 Total attendances 1,960 816 661 Children who attended in the year 49 49 36 Average attendance per session 13.0 12.2 10.0 Average attendances per child 40.0 16.6 18.4 Children on roll 31.12.64 23 31 25 Children on waiting list 31.12.64 45 23 20 AT RISK REGISTER This register of children, who have a history either pre-natally or at birth which makes follow-up desirable, continues to function. By these administrative means a large number of children specially at risk are referred for medical examination in the first two years when defects which otherwise might be unsuspected are carefully sought. (36) The important factor remains the special skill of the doctor in detecting these defects at an age which a few years ago would have been thought impossible. The importance of ensuring that all our medical staff are continually kept up to date in new techniques must therefore always be kept clearly in mind. At the 31st December 1964, 822 were registered and during the year medical officers tested 259 children at 7 months and another 49 who are a little older were retested. TESTS FOR PHENYLKETONURIA In 1964, Health Visitors carried out 1,808 tests at clinics and 395 tests in childrens homes. DOCTOR'S COMBINED ANTE-NATAL AND POST-NATAL CLINIC 116 patients made 325 attendances for ante-natal examination and treatment, 31 patients attended 44 times for post-natal examinations during 1964. This is in addition to those clinics reported in the Midwifery section. MOTHERCRAFT AND RELAXATION CLASSES These classes, held by Health Visitors, proved as popular and as helpful to the mother as ever. There were 103 sessions held during the year at which mothers made 576 attendances. DENTAL CLINICS The number of expectant and nursing mothers treated has dropped considerably over recent years and more patients are seen who have had their dental work done within the General Dental Service Much good work continues to be done however among the pre-school children from about 2½ - 5 years of age. The services of our dental auxiliary are very useful in this sphere as she has managed to contact many young children (through our Health Visitors) who at the time of the first dental visit had naturally sound mouths. In such cases all that has been necessary has been to make friends with them, do a simple tooth brushing prophylaxis and recall them at three monthly intervals. At the same time taking the opportunity of talking about dental problems with the mother. All this is bound to have a beneficial effect on future attendances and dental awareness. (37) DENTAL TREATMENT Types of treatment given Expectant and Nursing Mothers Children under School Age Scaling and gum treatment 44 39 Fillings 115 438 Silver nitrate treatment 1 80 Crowns and inlays provided 1 - Extractions 94 250 General Anaesthetics (a) by Medical Officers 1 17 (b) by Others 14 84 Dentures provided (a) full upper or lower 9 - (b) partial upper or lower 15 - Dentures repaired 2 - Dentures remade (a) full upper or lower - - (b) partial upper or lower - - Radiographs 33 3 Prophylactic treatment and other operations 125 218 Patients inspected and treated during the year Expectant and Nursing Mothers Children under School Age (1) Patients examined 98 483 (2) Patients found to require treatment 86 351 (3) Patients who have commenced treatment 59 233 (4) Patients who have completed treatment 56 213 (5) Attendance for treatment 282 871 (38) 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. Mr. N.M.Laybourne, Ophthalmic consultant attends at Leyton Green Clinic on Wednesday and Thursday. During the year 25 pre-school children were referred to the clinic and there were 26 attendances by infants. Mrs Box; Orthoptist accepted 37 new cases for treatment, who made 75 attendances. Mr.H.A.Oatley, Orthopaedic Consultant attends Leyton Green Clinic on Thursday and the clinic medical officers referred 126 new cases to him. Set out hereunder is a summary of the work:- Re-inspection 212 Minor alterations to footwear 251 Surgical appliances supplied 18 Nine children under 5 years were seen by the consultant, Mr.R.T.Goodchild, at the Ear, Nose and Throat Clinic. I have to report with regret the death of the Eye Specialist Dr. Agnes Logan Adams and I refer you to the section "Ophthalmic Clinic and Orthoptic Clinic" in the report on the School Health Service. DAY NURSERIES There are two Day Nurseries in the area, each having accommodation for 50 children (10 Ellingham Road Day Nursery, Ellingham Road, Leyton, E.15. (Telephone: MARyland 3683) (2) Epsom Road Day Nursery, Epsom Road, E.10. (Telephone: I£Ytonstone 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 14 46 19 36 33 82 Total attendances during year 3134 9065 3205 8335 6339 17400 Number of days open 257 257 - The day nurseries continue to play a most valuable part in the life of the community, contributing in widely different ways to the needs of children and families. The cases given below illustrate how varied the work can be. (39) (1) Two children were admitted to the nursery for half day sessions during mother's last few weeks of pregnancy. When mother entered hospital for confinement father brought and collected them on his way to and from work. (2) Child admitted because mother was mentally unstable and unable to cope. On admission this child of 1 yr. 2 months had no idea how to eat even seived solids. Would walk around a cot but was terrified when placed on floor. She would sit without moving, did not attempt to pull herself up or reach out to simple play material placed near at hand, (3) Boy aged 3& yrs. Mother deserted 3 months before admission, child had been neighbour minded in four different homes during this period. Father has history of mental illness and has had two periods of in-patient treatment but he loves the boy and is determined to provide as stable a home as possible. On admission child was extremely disturbed, subject to temper tantrums of a most violent type and was completely anti-social. A relationship has been made with two senior staff but this is very tenuous. The child is always more disturbed after spending the week-end at home when he occasionally sees his mother. Progress has been slow and the father (most co-operative always) is awaiting an appointment with the Child Guidance Psychiatrist. (4) Boy aged 23 months. Admission recommended by the Consultant Paediatrician; child said to refuse all food except milk chocolate offered by father. Several periods of in-patient treatment for investigation and stabilisation of diet; on admission child weighed only 23 lbs, after 6 months he weighed 27 lbs and continues to gain at a slower rate; he takes a normal diet but every single item has had to be most patiently introduced. He now plays normally with his age group and appears to be very intelligent. Parents are both middle-aged and over anxious and insist that their four previous children (two of whom died in infancy from Malnutrition) have all presented similar problems. SECTION 23 - MIDWIFERY Domiciliary confinements attended under N.H.S. arrangements where - (a) a doctor was not booked 3 (b) a doctor was booked 340 Cases delivered in hospital and other institutions but discharged and attended before tenth day 92 Miscarriages attended 6 New cases booked 38 Cases on the books at the end of the period 169 Medical aid notices issued 40 Visits paid (as midwife) (a) Ante-natal 3,824 (b) Nursing 8,054 (c) Other post-natal 56 Total visits 12,934 (40) ADMINISTRATION OF ANALGESICS Cases in which Gas and Air was administered 2 Cases in which Trilene was administered 194 Cases in which Pethidine or a related compound was administered 139 CLINIC SESSIONS Number of sessions attended by midwife (a) Medical officer's clinics (b) General practitioner's clinics 313 (c) Midwife's clinics 144 Number of ante-natal examinations by the midwife (a) Medical officer's clinics (b) General practitioner's clinics 1,556 (c) Midwife's clinics 1,592 Number of women attending midwife's clinics who had not previously attended any ante-natal clinic in the current year 252 SECTION 24 - HEALTH VISITING The duties of the Health Visitors are closely related to the changing needs of the community and great emphasis is put on the individual requirements of the family. Therefore a great part of the work is carried out in the privacy of people's own homes and as will be seen from the following statistics the number of individual home visits, especially those to families with young children, have increased. The health visitors, however, are mainly concerned with health education and social advice to encourage and promote the attainment of complete health within the family group. To achieve this goal by home visiting alone would be impossible and we have concentrated this year on group education programmes with the following:- HEALTH EDUCATION (a) In Schools The importance of teaching the principles of healthy living to school children is well recognised, but for health education to be really effective the young and adolescents must be made fully aware of the dangers in the formative stages of their lives. We are therefore trying various experimental schemes of Health Education in schools in close co-operation with the teaching staff to make the children themselves aware of the importance of positive health. (b) Ante-Natal The ante-natal period has always been considered the period "par excellence" for health education of the mother and group teaching is continuing in the three health services clinics and at a general practitioner's surgery, the latter has been started at the special request of the general practitioner who already had a health visitor attending his weekly surgery for mothers and children. This has proved successful and we are endeavouring to extend this scheme to other G.P.s in the area. (41) (c) Mothers' Clubs During routine visiting the health visitor meets many lonely mothers - age appears to make no difference - the young girl with a small baby may be living far away from her own mother, or her mother is young enough to go to work, the older mother may be missing her colleagues at work but her sense of duty towards her family is too strong for her to return to her job and to the companionship which she enjoyed, before the baby was born. Many years ago a mothers' club was started at Leyton Green Clinic. It continues to thrive and is well attended every Wednesday evening when the fathers do the "Baby Sitting" , but there appeared to be a great need for an afternoon club and with the kind co-operation of the W.V.S., who have offered to take care of the children, a mothers' club was started at Park House Clinic. The mothers not only throughly enjoy their outing knowing that the children are in the good hands of two senior IV.V.S. members who are grandmothers themselves, but are anxious to learn about healthy living. The mothers choose their own programme with the help of the Health Visitor and have so far studied in great detail Nutrition, Child Development, Children's Illnesses, Care of Children's Teeth and Home Safety. Experts such as the Deputy Medical Officer, Home Safety Organiser and Dental Auxiliary have given talks to the club. THE AGED & CHRONIC SICK Team work is especially essential to meet the needs of the elderly and the health visitors work in close co-operation with the Family Doctors, Hospitals, District Nurses, Houe Helps, Officers from the National Assistance Board, Chiropodists and other social workers who may be concerned. LIAISON WITH GENERAL PRACTITIONERS Health Visitors are now attached in a part-time capacity to five family doctors and work in close contact with the large majority of G.P.s in Leyton. The scheme originally put forward by the health visitors has already been extended at the request of the G.P.s and it is hoped that this will result in an even more comprehensive service to the family. LIAISONS WITH HOSPITALS The health visitors continue to visit twice weekly the Children's ward at Whipps Cross Hospital and act as a link between the Home and the Hospital, supplying information to the consultant about the child's background and assisting the mother with helpful advice when the child is discharged home. Weekly visits are also carried out to Langthorne and Claybury Hospitals to discuss admissions and discharges and the best way to assist with the rehabilitation of patients. It is important for the Nursing staff to be aware of the Community Services available in the area for the patients and how they can co-operate with the health visitor for the benefit of the patient. At the request of the Matrons of these hospitals, lectures have therefore been given by the Superintendent Health Visitor to the trained nurses and a series of talks to student nurses on the Social Aspect of Disease, followed by a day's practical observations. (42) SOCIAL WORKERS LUNCHEON CLUB These monthly meetings at Leyton Green Clinic have continued to be well attended To achieve our aim of promoting the attainment of complete health within the family group, team work is essential and this can only be achieved by a deeper understanding of the needs of the family and by knowing personally the many social workers concerned with family care HEALTH VISITS During the year the Health Visitors made 19,532 visits to homes:- (1) Cases visited for the first time in the current year- (a) Children born in 1959 411 " " " 1960 724 " " " 1961 878 " " " 1962 1078 " " " 1963 1513 " " " 1964 1807 (b) Persons aged 65 or over 1554 (c) Others (excluding school nursing cases) 1786 (2) Number included in item (1) - (a) Mentally disordered persons 200 (b) Persons discharged from hospital (other than mental hospitals) 233 (3) Number included in item (1) and where appropriate item (2) who were visited at the special request of a GP or hospital- (a) Persons aged 65 or over 263 (b) Mentally disordered persons 61 (c) Persons discharged from hospital (other than mental hospitals) 114 (4) Total number of effective visits to- (a) Children under 5 years of age 12719 (b) Persons aged 65 or over 2792 (c) Others (excluding school nursing cases) 4021 Total effective visits 19532 (5) Total number of ineffective visits to - (a) Children under 5 years of age 2413 (b) Persons aged 65 or over 528 (c) Others (excluding school nursing cases) 487 Total ineffective visits 3428 (43) 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 531 199 1016 319 Diphtheria and Tetanus 8 50 44 69 Diphtheria 23 33 2 144 Pertussis 5 10 - - Tetanus 109 4 152 2 Poliomyelitis - (1) Salk Vaccine 116 78 5 8 (2) Sabin Vaccine 477 139 706 513 Smallpox 390 200 343 8 B.C.G. - - 293 - Others - Quadrllin 76 10 2 _ TOTALS 1735 723 2563 1063 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 1964 121 1183 66 68 20 584 TOTAL VACCINATED TO END OF 1964 29,881 2819 24,831 1699 4245 2458 (44) CENTRAL SYRINGE STERILIZING UNIT The Central Syringe Sterilizing Unit sterilized 30,080 syringes during the year. This is an average of 578 syringes per week. SECTION 27 - AMBULANCE SERVICE This section of the National Health Service Act wasthe responsibility of the County Council and was administered centrally. Leyton and Walthamstow combined use a station at James Lane, Leytonstone, E.ll. 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 8,695 Dual purpose vehicles 8 Other cases 88,689 Total cases conveyed 97,384 Total mileage 291,661 Total emergency cases 10,825 SECTION 28 - PREVENTION OF ILLNESS AND AFTER CARE Foot Clinic The staff situation still remains unsatisfactory and few sessional workers stay for long. The average strength during the year has been 55 sessions out of a permissable 88 per week. As this will be the last Annual Report for the Leyton Area, I would like to place on record and to draw the attention of the Area Committee to the valuable service Mr. R.Sadowski has given. He has for 12 years done uninterrupted'sessional work, in the earlier period at clinics,but for the last few years mainly domiciliary. In fact it is Mr.Sadowski who has been responsible for keeping this valuable service at its level of seven sessions per week. Domiciliary chiropody is exclusively for the aged and for house bound invalids who would otherwise have to suffer from foot disorders which they could not alleviate themselves. 1,463 treatments were given to 484 patients in 1964. One visit is made each week to one of the two old people's homes in the area. The attendances at the three clinics have been high. The average attendance of patients per chiropodist per session throughout the Area was 7.3 out of a possible 8. When inclement weather and the age of the majority of patients is considered, this is a high rate of attendance. ATTENDANCES AND TREATMENTS AT CLINICS During the yearatotal of 3,461 patients attended the foot clinics, these included 612 new patients. A total of 16,824 treatments were given. It was possible to discharge 107 adults and 276 children. (45) The following defects were treated:- Bursitis 21 Nail (Ingrowing) 22 Callosity 81 Pernio 16 Corns 155 Pes Planus 17 Hallux Rigidus 14 Tinea Pedis 11 Hallux Valgus 33 Trigger Toe 8 Hyperidrosis 4 Verruca Pedis 178 Metatarsalgia 7 Septic condition 10 Nail (Club) 35 Cases treated in clinics were as follows: - New Cases during the year Cases being treated at the end of the year Attendances during the year Pre-school Children 6 1 23 School Children 230 54 1685 Expectant Mothers 10 4 27 Physically Handicapped 44 269 1499 Aged (over 65 years of age) 214 1968 9297 Others 108 636 4293 TOTAL 612 2932 16,824 In addition to the above, 364 treatments were given in Welfare Establishment Tuberculosis (a) Open Air Shelters - Number in use at end of year 1 Total number of visits to shelters by health visitors or tuberculosis visitors 2 (b) Extra Nourishment - Number of new cases supplied with free milk 12 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:- Air Beds 1 Air Rings 60 Bed Back Rests 74 Bed Cradles 24 Bed Pans Ill Bed Trays 1 Commodes 90 Qrutches 6 Dunlopillo Mattress 1 Fracture Splints 3 sets Invalid Chairs 90 Mobile Lifting Pole and Chain 1 Plastic Sheets 141 Rubber Sheets 16 Sputum Mugs 4 Toilet Cushion 1 Toilet Cushion Covers 2 Urinal Bottles 36 Walking Aid 2 (46) Convalescence for Adults Number of applications during year 76 Length of stay:- One week Two weeks 62 Three weeks 14 HEALTH EDUCATION Though one cannot assess the success of one's efforts in Health Education the conviction remains that the persuasion of the public to adopt attitudes and actions which promote health is a very important part of modern Public Health practice, the County Council's decision to appoint Health Education Officers in the Health Areas was undoubtedly a major step forward. Unfortunately we were unable to implement this decision during the year under review but, nevertheless, were able by the use of professional staff to provide lectures in schools and to mothers on a variety of subjects. These varied from sex instruction to care of the feet, and included the whole range of subjects under the general name of "Mothercraft" . In addition to the professional talks and the films often associated with them, displays were arranged in clinics and other places of which the most noteworthy was the shop window at 280 Leyton High Road. During the year this shop window at different times urged the public to consider the ill effects of smoking, the causes and prevention of accidents of all sorts in the home and on holiday, including fireworks in November, and also the perils of driving after drinking. In addition it was used to demonstrate to the public the many ways the welfare services of all sorts could help the public, and in turn how the public could, with the Welfare Services, bring even wider benefit to the older people in the Borough. One particular project worthy of special mention was the Central Council for Health Education unit visited the area during the summer term to speak and demonstrate on the dangers of smoking. SECTION 29 - DOMESTIC HELP The domestic helps continue their valuable and so practical service. If the problem is one requiring practical help of a common sense kind, whether it be looking after children or keeping the household going for an old person who would otherwise be dead or in hospital, there is nearly always a home help who can meet the need. Occasionally a case crops up which is in such an overwhelming state of filth that the home help may refuse to cope with it, but the remarkable thing is how often she will take such a case in her stride and deal with it. I am sure if the general public were aware of some of the jobs which are tackled without complaint their regard for this service, already high, would rise even further. Another aspect of the service which is often overlooked is the purely human one of the light that some of the helps being into the lives of the old people they serve. This also may go well beyond the bounds of duty in a genuine care for the old person which is sincere and appreciated. Indeed this may become so important to a lonely old person that the visit of the help becomes a lifeline to them. In many cases it is not what they are but who they are that makes these particular members of the Health Department team so successful in their work. (47) Number of Helps and hours worked:- Number of domestic helps enrolled at end of year - Whole-time helps 12 Regular part-time helps 181 Number of hours worked during the year 197,857% Work of Domestic Help Organisers: - (1) (2) Total (1) First visits 190 406 596 (2) Revisits to beneficiaries - (a) Domestic help present 375 243 618 (b) Domestic help not present 1741 907 2648 (3) Other visits 276 601 877 Total visits 2582 2157 4739 Help Provided Aged 65 and over Maternity Chronic Sick under 65 Others under 65 TOTAL Requests for help from new cases during the year 501 56 43 47 647 New cases helped during the year. 399 42 36 33 510 Total cases completed during the year 340 44 36 35 455 Cases being helped at end of the year 932 1 78 13 1024 Total cases helped during the year 1272 45 114 48 1479 Hours of help prov-ided during the year 173,387 1632 17,351% 5487 197,857% MEDICAL EXAMINATION OF STAFF County Council employees:- Number of medical examinations - (a) Entrants to County Council's service 119 (b) Retirement on Superannuation 2 (c) Other purposes (including entrants to Teaching Profession and Training Colleges) 78 No. o f Medical Examinations Leyton Borough Council 262 Others- 3 (48) School Health Service LEYTON COMMITTEE FOR EDUCATION 1964-65 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 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.0.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, 1964: - Medical Officers 2.5 Dental Officer 3.54 Dental Auxiliaries 0.9 Dental Attendants 3.75 Nursing Staff 7.9 Remedial Gymnast Vacancy Speech Therapist 1.00 Administrative and Clerical 4.28 Clinic Clerks 1.15 25.02 (49) 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 - l p.m Child Guidance Clinic, 2 p.m - 5 p.m 133 Dawlish Road, Leyton, E. 10. Dental Clinics - Monday to Friday 9 a.m., - 12 noon Park House Clinic, 2 p.m. - 5 p.m. Dawlish Road „ Leyton Green „ Saturday (alternate) 9 a.m - 12 noon Park House Clinic Dawlish Road 11 Leyton Green „ Foot Clinics - Park House Clinic Monday to Friday and 9 a.m. - 12 noon Dawlish Road „ Saturday 2 p.m. - 5 p.m. Leyton Green „ 9 a.m. - 12 noon Leyton Green „ # Minor Ailment Clinics - Monday to Friday 9 a.m - 11 a.m Dawlish Road Clinic, Saturday 9 a.m - 11 a.m Leyton Green Park House „ Doctors' Consultation Clinics Monday, alt. Friday and Saturday 9 a.m - 12 noon Leyton Green Clinic Tuesday, alt. Friday aJQd Saturday 9 a.m - 12 noon Dawlish Road „ Monday, alt.Friday and Saturday 9 a.m - 12 noon Park House „ Ophthalmic Clinic - Wednesday and Thursday 9.30 a.m. - 12 noon Leyton Green Clinic Optician - Wednesday 9.30 a.m. - 12 noon Leyton Green Clinic Orthopaedic Clinic - Thursday 2 p.m - 5 p.m Leyton Green Clinic Orthoptic Clinic - Wednesday 9 a.m - 12 noon . . 2 p.m. - 5 p.m Leyton Green Clinic 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 - 5P.m Vaccination and Immunisation Vaccinations and Immunisations of school children at all Clinics by appointment. U Attendances at all Clinics, except Minor Ailment Clinics are by appointment. (50) School Medical Inspection SCHOOL POPULATION AS AT 31st DECEMBER,1964 Designation of School Number of Schools Number of Pupils Primary 19 5,481 Secondary 10 4,496 Special 2 227 Total . 31 10,204 ROUTINE MEDICAL INSPECTIONS Group Number of Pupils Examined Percentage of Parents Present 5 year 926 89.9 10-12 year 443 87.3 14 year 1,114 14.1 Other 135 65.2 2,618 REINSPECTIONS - ALL GROUPS - 1,460 PHYSICAL CONDITION OF PUPILS AT ROUTINE MEDICAL INSPECTIONS Age Group (by year of birth) Number Inspected Condition Classified Satisfactory Unsatisfactory 1959 and later 386 386 _ 1958 540 538 2 1957 29 29 - 1956 8 8 - 1955 4 4 - 1954 288 284 4 1953 155 154 1 1952 51 49 2 1951 43 43 - 1950 677 676 1 1949 and earlier 437 434 3 TOTAL 2, 618 2,605 13 (51) FINDINGS OF MEDICAL INSPECTION (a) Individual children found to require treatment Age Group (by year of birth) Pupils Inspected Defective Vision (excluding squint) Any other Condition Total Pupils with Defects 1959 and later 386 20 50 64 1958 540 27 74 96 1957 29 - 5 5 1956 8 - 1 1 1955 4 - - - 1954 288 28 71 95 1953 15!> 22 28 47 1952 51 10 8 16 1951 43 5 3 8 1950 677 99 61 149 1949 and earlier 437 108 43 137 TOTAL 2,618 319 344 618 (b) Hygiene Inspection in Schools The Nursing Staff carried out 7,424 inspections during the year, and 42 cases of infestation were found. (52) /-s en CO DEFECTS FOUND BY PERIODIC AND SPECIAL INSPECTIONS DURING THE YEAR DEFECT OR DlSEASE PERIODIC INSPECTIONS SPECI AL INSPECTIONS ENTRANTS LEAVERS OTHERS TOTAL TREATMENT OB SERVAT I ON TREATMENT OBSERVATl ON TREATMENT OBSERVATION TREATMENT OBSERVATION TREATMENT OBSERVATION Skin 4 15 20 7 13 5 37 27 61 40 Eyes - (a) Vision 47 71 207 27 65 22 319 120 137 7 (b) Squint 17 14 4 3 4 2 25 19 1 - (c) Other 2 7 1 3 3 3 6 13 23 2 Ears - (a) Hearing 6 26 4 14 6 12 16 52 127 8 (b) Otitis Media 7 44 4 7 5 19 16 70 3 - (c) Other 2 5 - 2 2 a 4 12 21 5 Nose and Throat 19 158 4 15 12 33 35 206 39 5 Speech 15 25 _ 5 5 1 20 31 20 1 Lymphatic Glands 3 83 - 3 _ 16 3 102 5 1 Heart 3 32 - 4 3 10 6 46 2 - Lungs 3 26 5 9 1 15 9 50 17 2 Developmental - (a) Hernia 3 10 - - 1 2 4 12 - - (b) Other 5 87 3 5 3 17 11 109 12 - Orthopaedic - (a) Posture 1 19 2 11 11 6 14 36 3 - (b) Feet 24 70 12 7 13 11 49 88 42 1 (c) Other 13 32 7 20 4 4 24 56 26 2 Nervous System - (a) Epilepsy 2 7 4 2 2 4 8 13 1 - (b) Other 2 9 3 4 6 13 11 17 2 Psychological - (a) Developmental 3 54 - 3 10 31 13 88 69 4 (b) Stability 8 106 - 25 24 59 32 190 66 16 Abdomen - 8 - 3 1 1 1 12 13 6 Other 7 10 19 3 1 8 27 21 343 63 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 1964 1,152 children attended 2,014 times to see the doctor and children attended 1,842 times for advice and treatment from the nurse. SPECIAL CLINICS SUMMARY FOR 1964 Orthopaedic Aural Ophthalmic Orthoptic Psychiat ric Child Guidance CI inic Lea Bridge School Sessional Programme 1 a week 1 a month 2 a week 2 a week 7 a week 1 a week Total Sessions 43 12 85 182 288 38 New Case 118 83 206 76 211 13 Attendances 643 153 1496 939 942 149 ORTHOPAEDIC CLINIC This clinic is under the supervision of Mr.H.A.Oatley, P.R.C.S. Orthopaedic Consultant. During 1964 the following numbers of children were referred to Whipps Cross Hospital by Mr. Oatley. 19 Radiological investigation 6 Operative treatment 113 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 37 " " " " " and Bilateral Antral washout 1 Adenoidectomy 4 Adenoidectomy and Lateral Antral washout 1 Adenoidectomy and Bilateral Antral washout 1 Under Observation 1 Hearing test 7 X-Ray Sinues 15 (54) OPHTHALMIC CLINIC AND ORTHOPTIC CLINIC It is with regret that I have to report that our Eye Specialist, Dr Agnes Logan Adams, died in April 1964 after a short acute illness Dr Logan Adams took over from Mr J DM Cardell in 1946 and she continued to work for us until a few weeks before her death. She had retired two years previously from her appointment as Chief Clinic Assistant at Moorfields Eye Hospital but had continued to conduct two eye clinic sessions at Leyton Green Clinic weekly. Dr. Logan Adams worked in accordance with the highest standards of her profession. She was a most skilled and capable specialist and took a great deal of trouble over her cases. She would never be content with any kind of sub-standard work and she particularly strove to see that the children with severe eye defects were given every help that could be obtained to reduce their handicap She was a most pleasant colleague and has been much missed. 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 1964. "To ensure that as far as possible, through dental health education, and a high degree of dental care children shall leave school free from dental disease and irregularity, with an understanding of the importance of good natural teeth and zealous in looking after them" . Such is the declared aim of the School Dental Service as laid down in the "Health of the School Child" 1962 and 1963. This also can well be said to have been the aim of the dental staff in this Area during 1964. At no time during the past thirty years has the department had the advantage of being staffed up to establishment, but the year finished with the equivalent of 44/11 dental officers, which was only 2/11 short of the number at the beginning of the year despite the loss of a full-time officer, an event much to be deplored as there are so few candidates for such posts. In view of the high standard of equipment to be found in these surgeries and the excellent working conditions one can only assume that it is the attractiveness of other branches of dentistry such as hospital work, the defence services or private practice which makes it so difficult to get full time workers in children's dentistry. In addition to the dental officers the dental auxiliary continues to give good service in both the operative and educational spheres. The educational field is extremely important, but the talks must be repeated at frequent intervals and continued throughout a child's school life by dentists and auxiliaries as well as other health educational workers both in the clinics and at school. (55) Our auxiliary (Mrs, Purnell) is exceptionally good in this sphere and particularly with small children. She has also made many posters on toothbrushing and diet for waiting room display For several years now special efforts have been made by schools to sell from their tuck shops only those items known not to be detrimental to teeth such as raisins, nuts, fresh fruit and in some instances raw carrots and during 1964 toothbrushes were sold at cost price to the children attending for dental treatment These have proved very popular. At first the dental officer recommended a purchase but many children now voluntarily seek replacements It is sad to have to report that we do not appear to be much nearer fluoridation of water in the London Area, but a few conclusions on fluoridation from the last issue of the "Health of the School Child" 1962, 1963 page 111 are worth consideration. They are as follows:- 1. Five years of fluoridation at one part per million in three study areas has brought about in each a substantial improvement in the teeth of young children. 2. The results of fluoridation obtained so far are in line with American experience. 3. No evidence of harm from fluoridation has been discerned despite continuous vigilance. 4. The addition of fluoride to water supplies at a specified level has presented no technical difficulties In addition to those children who have attended for periodic re-examination or have been referred by Medical Officers, headteachers or private doctors, a large number attended as a result of routine dental inspection in the schools. All but five of the schools in the area received a routine dental examination during the year, and of the five that did not, three of them had been inspected in December 1963 - one month before the period covered by this report - and some of the resulting treatment done during that month and the rest during the year under review. The arrangements made some years ago with the North East Metropolitan Regional Hospital Board for the services of its Orthodontic Consultant (Mr. Willcocks) to be available to the School Dental Officers in this Area continue to be widely used both for advice or actual treatment at Whipps Cross Hospital. DENTAL INSPECTION AND TREATMENT Sessions (equivalent half-days) No. School dentdl inspections 76 School dental treatment (excluding orthodontic 1,724 School dental orthodontic treatment 95 Administration (Area Dental Officer) 53 (56) School Dental Inspect ion Pupils inspected at periodic inspections 6,735 Pupils inspected as specials 1,900 Pupils found to require treatment 5,129 Pupils offered treatment 4,737 School Dental Treatment Pupils actually treated (for the first time this year) 3,049 Attendances by pupils for treatment 10,929 Appointments not kept 2,837 Fillings (a) permanent teeth 4,624 (b) temporary teeth 3,045 Number of teeth filled (a) permanent teeth 3,641 (b) temporary teeth 2,649 Extractions (a) permanent teeth - (i) for caries 274 (ii) otherwise 249 (b) temporary teeth - (i) for caries 2,234 (ii) otherwise 429 General anaesthetics - (a) by Medical Officers 158 (b) by others 949 Number of general anaesthetic sessions 104 Number of general anaesthetic cases at sessions 1,053 Number of pupils supplied with artificial dentures 22 Number of dentures fitted 22 Operations included in previous items - (a) silver nitrate treatment 437 (b) scaling 1,079 (c) syringing sockets 18 (d) dressings 1,443 (e) inlays fitted 4 (f) crowns fitted 50 (g) radiographs 499 (h) other operations 847 Orthodontic Treatment for Schoolchildren Cases referred to and treated by Hospital Orthodontists 40 Cases commenced 125 Old cases treated for the first time in the curr. year 48 Cases completed 104 Cases discontinued 3 Pupils treated with appliances 63 Removable appliances fitted 63 Fixed appliances fitted Total attendances 864 (57) Child Guidance Clinic ANALYSIS OF FIGURES FOR 1964 I. Cases on the books of the clinic at the end of the Year (i) Cases awaiting first appointment 27 (ii) Cases under treatment 110 (iii) Other cases 249 II. Cases referred during the Year (i) Under fives - Boys 3 - Girls 7 (ii) Over fives - Boys 117 - Girls 84 III. Source of referral General Practitioners 20 Head Teachers 45 Consultants 5 Children's Officer 3 School Medical Officers 109 Probation Officer 1 Health Visitors 1 Magistrates 2 Educational Psychologist 5 Parents 17 Others 55 IV. Cases closed during Year and other cases for which treatment ceased (i) Treatment completed and case closed 42 (ii) Other treatment, cases closed 23 (iii) Other (untreated) cases closed 46 V. Treatment carried out during Year Psychiatrists 942 Psychotherapists 208 Psychiatric Social Workers 1,278 Educational Psychologist 43 Remedial Teacher 333 (58) Psychiatric Service for Children Dr. W.R.Little, the Consultant Child Psychiatrist, has supplied the following comments on the work of the service in 1964. CHILD PSYCHIATRIST SERVICES IN LEYTON The staffing of the service and the work done remains constant, but has changed its character. The emphasis is now on the prevention of the development of intractable difficulties within families by early detection of children at risk. DETECTION AT AN EARLY AGE The Borough health services refer children to the Development Clinics for toddlers, where they can be supervised. Many more infant schools can be visited and more formal discussions arranged between the staff, as a school, and the child psychiatric team. DETECTION OF CRISIS WITHIN A FAMILY The health services are encouraged to take special interest in families undergoing a crisis (such as illness) and help to decide which families can be referred for further help. FOCUS ON CHILDREN WITH SPECIAL NEEDS Children attending special schools are helped by a close contact between the staff of these schools and the psychiatric team. EARLY DETECTION OF PERSONAL DIFFICULTIES IN ORDER CHILDREN The pilot scheme of discussion between junior and senior schools staff and psychiatric team has helped to define which individual problems need what kind of help. WHIPPS CROSS HOSPITAL CHILDREN' S UNIT Since June, 1964, the Children in need of active outlets of their energies in the Paediatric Unit have been admitted to a ward converted for the purpose to accommodate twelve children of school age, to which an additional part-time teacher has been appointed. In the first six months, fifty-nine children had been admitted, the majority of whom responded by improving. We were particularly pleased with the rate of return of children who found attending school difficult; with the co-operation of local schools, most of these children were back attending their regular day school within six weeks of admission. After an initial period of adjustment to the Unit Programme, most children seem to work out how to get the best out of themselves with the help of the staff. B.C.G. Vaccination (i) No. of schoolchildren skin tested 344 (ii) No. found positive 51 (iii) No. found negative 293 (iv) No. vaccinated with B C.G 293 (59) Speech Clinic CHILDREN HAVING RECEIVED TREATMENT DURING 1964. Under 5 years Primary School Secondary School Special School TOTAL Cases commenced before 1st January, 1964 and continuing after 31st December,1963 Articulation Defect 1 25 - 13 39 Stammer - - 4 1 5 Articulation Defect and Stammer - - 1 - 1 Total 1 25 5 14 45 Cases commencing treatment during 1964 Articulation Defect 17 56 5 8 86 Stammer 3 5 2 2 12 Articulation Defect and Stammer _ 3 3 Total 20 64 7 10 101 Therefore total cases receiving treatment during 1964 - 146 Total new cases - 101 Boys Girl s Total Children at present undergoing treatment 74 28 102 Children discharged 51 23 74 On Waiting List Average number of cases treated daily 20 Homes visited School departments visited 65 Parents interviewed 121 Children referred to-other clinics 1 Number of children leaving before cure or discharge 15 2,351 Total number of attendances Number of children referred found not to require treatment (60) Chiropody Clinics Chiropody treatment for school children is nrovided 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 P M P M P M P M P Verrucae 1 1 - - 17 8 17 23 23 50 13 17 170 Corns 2 4 5 4 1 4 1 4 1 2 7 7 42 Hallux Valgus - - - - - - - - - 1 - - 1 Callosity - - - - - 1 1 1 - 1 - 1 5 Hammer Toe - 1 - - - - - 1 1 - - - 3 Nail, Ingrowing - - - - - - 1 1 1 - 4 - 7 Septic Condition - - 1 - 1 1 - 1 - 1 1 - 6 Foot Strain - - - - - - 1 - - - 1 - 2 TOTAL IN AGE GROUPS 3 6 6 4 19 14 21 31 26 55 26 25 236 HEALTH EDUCATION The talks on Foot Health to children of school leaving age commenced in 1963 were continued. These were augmented by film strips, plaster casts (taken from patients attending the Council's Clinics) and exhibition of suitable footwear for teenagers. In some cases at the request of the Head Teacher, the talks were repeated for the younger classes at one of the Secondary Modern Schools for Girls. That the pupils found these interesting was evident from the number and variety of intelligent questions asked. The smallest group numbered about fifty and the largest (County High School for Girls) over two hundred. (61) 62 HANDICAPPED PUPILS BLIND PARTIALLY SIGHTED DEAF PARTIALLY HEARING PHYSICALLY HANDICAPPED DELICATE MALADJUSTED E.S.N. EPILEPTIC SPEECH DEFECTS TOTAL (a) Children newly assessed as Handicapped during the year ended 31st December, 1964 aged 5 or over _ _ _ 8 _ 20 25 _ _ 53 under 5 - - 3 - 3 - - - - - 6 (b) Children who, on or about 31st December 1964, were receiving Special educational treatment aged 5 or over - 3 4 11 26 2 54 97 2 - 199 under 5 - 1 3 1 3 - - - - 8 all ages - 4 7 12 29 2 54 97 2 - 207 (c) Number in (b) receiving special educational treatment at day special schools - 3 7 11 22 - 37 86 2 - 168 at residential special schools - 1 - 1 4 2 17 11 - - 36 at ordinary schools - - - - - - - - - - - elsewhere - - - - 3 - - - - - 3 (d) Children who, on or about 31st December 1964, were requiring but not receiving special educational treatment aged 5 or over ' - - - - 1 - - - - - 1 under 5 ~ ~ " ~ 1 ~ ~ — ~ ~ 1 (e) Children on register on or about 31st December, 1964 requiring special educational treatment aged 5 or over - 2 - 7 57 - 1 - 1 - 68 under 5 - 2 29 - - 12 4 " 38 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 1964 Varied from 195 to 200 Leyton 80 - 85 Forest 106 - 115 Reasons for leaving:- 1. Attained age of 16- (a) Reported as requiring Community Care 2 (b) Not reported 4 2. No longer in need of special education 10 3. Notified as unsuitable for education under Section 57(4) 4 4. Removal to other areas 7 5. To Residential School (E.S.N.) 6 (0. A. ) 3 6. Returned to Normal School 3 7. Emigrated 1 LEYTON GREEN PRIMARY DEPARTMENT Year of Birth B. 1954 B. 1953 Specials Group Routine Routine Sex B. G. B. G. B. G. No. inspected 5 7 8 5 18 28 Parents present 4 4 5 5 3 5 Unsatisfactory 2 2 - 1 - 4 DEFECTS FOUND Code No.4 Skin - - " " " ' (63) (64) 1954 Routine 1953 Routine Routine B. G. B. G. B. G. 5 (a) Vision 1 2 5 1 3 3 (b) Squint - - 2 1 2 - (c) Others - - - - - - 6 (a) Hearing 1 - - 1 - 3 (b) 0. Media - - - 1 2 - (c) Others - - 1 - - - 7 Nose and Throat 1 - - - - 4 8 Speech - 1 - 1 1 9 Lymphatic Glands 1 - - - 1 1 10 Heart - - - - 1 - 11 Lungs - - - - - - 12 Development (a) Hernia - - - - - - (b) Others 1 - 1 - - - 13 Orthopaedic (a) Posture - - - - - - (b) Feet - 1 - - - 1 (c) Others 1 2 - - - - 14 Nervous System (a) Epilepsy - - - - - 1 (b) Others - 1 - - - - 15 Psychological (a) Development 5 7 8 5 11 9 (b) Stability 1 1 5 3 3 4 HARROW GREEN SECONDARY DEPARTMENT Year of Birth Group Sex 1948 Rout ine 1949 Routine 1950 Routine 1951 Routine 1952 Routine Specials B. G. B. G. B. G. B G. B. G. B. G. No. inspected 10 5 7 19 12 10 8 2 5 10 17 11 Parents present 5 5 7 9 5 6 6 2 5 6 4 3 Unsatisfactory - 1 - 3 - - 1 - 4 1 1 1 DEFECTS FOUND Code No. 4 Skin 1 1 - 3 - - 1 - - 1 1 - 5 (a) Vision 1 - 1 6 4 2 - - - 2 - 1 (b) Squint - - - - - - - - 1 - - - (c) Others - - - - - - - - - - - - 6 (a) Hearing 1 1 - - - 3 - - - 2 1 - (b) 0.Media - - - 1 1 - - - - 1 - 4 (c) Others - - - - - 1 - - - - - - 7 Nose and Throat 1 1 - - - 1 1 - • 2 - - 8 Speech - - - - 1 - - - - - 1 - 9 Lymphatic glands - - - - - - - - - - - - 10 Heart - - - - - - - - - - - - 11 Lungs - - - 1 - - - 1 1 - - - 12 Developmental (a) Hernia - - - - - - - - - - - - (b) Others - - - - - - - - - - - - 13 Orthopaedic (a) Posture - - - 2 - - 1 - - - - - (b) Feet - - - - - - 1 - - 1 - - (c) Others - 1 - - - 2 - - - 1 - - 1948 Routine 1949 Routine 1950 Routine 1951 Routine 1952 Rout ine Specials B. G B. G. B. G B. G. B. G. B. G. 14 Nervous System (a) Epilepsy - 1 - 1 1 - - - - 1 1 - (b) Others - 1 - - - - - - 1 - - - 15 Psychological (a) Development 10 5 7 19 12 10 6 2 4 10 7 3 (b) Stability 1 2 1 2 2 2 2 - 2 2 6 1 18 Abdomen - - - - - - - - - 1 - - Others - - - - - - - - - 1 1 1 LEYTON SPECIAL E.S.N. SCHOOL There were no special difficulties in the schools this year in contrast to 1964 when two very disturbed adolescent boys had to be excluded from attendance at the school and found places elsewhere. Three boys, one of 11 years, one of 12 years and one of 14 years, were able to return to normal school and have made reasonable progress and settled down well. Two girls and eight boys were de-ascertained between the ages of 15 and 16 years as no longer requiring special educational treatment. All had achieved what appeared to be their limit in educational attainment, were socially mature and capable of earning their living. All had found suitable work for themselves and it was considered that the advantages of staying at school for a few months would be outweighed by the acute disappointment experienced in failing to take up work which, not only seemed suitable to them, but which was considered by the Juvenile Employment Officer also to be good placements for them. It has been found advantageous to allow these boys and girls of 15% to 16 years of age to take up a post before the bulk of the school leavers flood the market as they do now at the end of the Spring term and in July of each year. The jobs found by these school leavers are very varied and last year the list was extremely interesting. One boy got into British Railways, two in the Parks Department, two in horticulture, two in farms, one into a cycle works, one into a leather works, one into Woolworths, one a butcher's assistant, one in a laundry, one in paper making and one into tailoring. These school leavers frequently come back on their half days or when on holiday and report to the school staff how they are getting on. It is very re-assuring that they should feel that they can come back to the school. One boy who came to Harrow Green when he was 12 years old, not only being backward in school work but with a serious hearing defect for which he had to wear a hearing aid, had been difficult during all his school life. He had a disturbed home background and he had what appeared to be a permanent grudge against the world. He found himself a job on a farm looking after cows and we let him leave when he was about 15%. He has made a great success of this work, he is very happy, has lost his grudge against the world and it is quite (65) remarkable how his personality has improved. If he had lost this post because we insisted he stay at school till he was 16 a great deal of harm would have been done to him. He still does not wear his hearing aid which was one of the difficulties which we had with him at school but this does not seem to handicap him in looking after the cows. Dr. Little, the psychiatrist from the Child Guidance Clinic and Miss Marshall and any of the psychiatric social workers concerned in cases, visit the schools each term and discuss with the staff any of the children showing signs of maladjustment. These discussions are helpful to both sides, to the Child Guidance Clinic and to the school staff and we hope they are helpful to the children and their families as well. There has been an unusual number of recommendations this year for residential schooling at the two special schools. These were made mainly on social grounds because of different home circumstances or the loss of one parent making home care inefficient. We are fortunate in being within reasonable distance of the boys' school at High View, Chigwell and this does help us to place children whose parents would be reluctant to see them go a long distance from home. The children can get home for weekends and it is not too expensive for the parents to visit. We failed to get permission for one boy to go to a residential school as his guardian would not agree, although the school staff and the school medical officer considered that his home care was poor and that he was treated without imagination or understanding. The boy solved the problem for himself by running away and has now been placed away from the foster home and back with his mother. He did not live in this area and this is one of the difficulties of schools drawing children from a great distance, it is difficult to keep contact with their home background. It is pleasant to be able to report that, although the number of children to a class in Harrow Green and Leyton Green still stands at the maximum permitted, namely 20, at last after many years of asking for help in the "nursery class" at Leyton Green, a helper has been supplied and should make a great difference to the progress of the children in this age group. There are several children with unsatisfactory physique and poor home circumstances in the special schools but it is not always easy to persuade them to go for convalescence. However, some five children did go away from the two schools and greatly benefited from the regular life fresh air and good food which they get in the convalescent homes. LEYTON, LEA BRIDGE MALADJUSTED SPECIAL SCHOOL SPECIAL MEDICAL INSPECTIONS Boys Girls No. examined 12 4 Parents present 5 2 Unsatisfactory 4 DEFECTS FOUND - 1 Vision for treatment 1 Speech for treatment 2 cases of skin defects 2 cases for Orthopaedic Clinic (66) There are now 44 children attending this school. There are 6classes; two classes for the junior children are held at the old Knotts Green Nursery in the grounds of Leyton Green School. Plans are afoot for building two classrooms in the grounds of Leabridge Road school and it will be much more satisfactory to have all the school children on the same site. Each term there is an open evening for the parents and between 50% and 60% of the parents of the children attend, in many cases father as well as mother. All the school staff and the staff of the Child Guidance Clinic attend this open evening and the school medical officer as well. The school medical officer finds this extremely useful and discusses any medical problems with the parents at the open evening. It is very difficult to get parents to attend at the school during the day and the evening meeting provides an opportunity not to be missed, especially if the father as well as the mother can be seen. During the year 4 children were found to be in an unsatisfactory general condition and 2 were referred for four weeks convalescent treatment from which they greatly benefited. General tonics were provided for the others who refused the offer to send the children away. The new entrants to the school are medically examined if this has not been carried out before admission. No defect of importance was detected in any of them, although it is obvious when examining these children how tense and anxious, and in some cases depressed, they are. It appears impossible to see more than 5 or 6 children in a morning, the children require so much reassurance about everything that one does. TUBERCULOSIS IN SCHOOL CHILDREN There was no new case of tuberculosis in school children reported in 1964. DEATHS OF CHILDREN OF SCHOOL AGE During the year four children of school age died. The deaths were due to the following:- Cerebral Tumour, Myocardial degeneration Boy aged 14 years Broncho pneumonia, Chickenpox Girl aged 9 years Electrocution on Electric Railway Track Boy aged 9 years Status Asthmaticus, Spontaneous Pneumothorax Kyphoscoliosis of Spine Girl aged 7 years HEALTH EDUCATION The Health Visitors gave 53 lectures in schools at which the children made 1,960 attendances. (67)