BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1947 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. MEDICAL OFFICER OF HEALTH E. G. Ellis & Sons, Willow Street, E.4 67978 BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1947 INDEX page Section A.—Statistics and Social Conditions of the Area 7 Section B.—General Provision of Health Services in the Area 12 Section C.—Sanitary Circumstances of the Area 19 Section D.—Housing 24 Section E.—Inspection and Supervision of Food 27 Section F.—Prevalence and Control over Infectious Diseases 36 Section G.—Infectious Diseases Hospital 49 Section H.—Maternity and Child Welfare 56 Section I.—Thorpe Coombe Maternity Hospital 84 page Abortion 82 Adoption 70 Acreage 7 Adulteration 32 Ambulance Facilities 12 Ante-Natal Clinics 69, 87 Assessments 7 Bacteriological Analyses 29,33 Births 8, 10, 57 „ Notification of 57 „ Registration of 58 Birth Rate 8 Breast Feeding 67, 92 Cancer 11 Caravans 22 Care of Illegitimate Children 63 Cerebro-Spinal Meningitis 36, 37, 38, 46 Child Guidance 75 Child Life Protection 70 Child Welfare 66 „ „ Clinics 66, 70 Clinics 13 Committees 4, 56 Compensation (Midwives) 80 Confinements 76 Connaught Hospital 17 Cremation 52 Day Nurseries 59 Deaths 8, 9, 10, 11 „ Infants 8, 65 ,, Infectious Diseases 38 Death Rate 8 Dental Treatment 15,74 Diphtheria 36, 37, 38, 42 „ Immunisation 38 Diseases of Animals Acts 33 Disinfestation 23 District Midwifery 81 Domestic Help 53 Dysentery 36, 37, 38, 43 page Emergency Unit 85 Encephalitis Lethargica 36, 37, 38 Enteric Fever 36, 37, 38, 43 Erysipelas 36, 37, 38, 45 Evacuation of Expectant Mothers 78 Essex County Council Act 19 Exhibition, Health 53 Factories Act, 1937 35 Food 6? Drugs Act, 1938 32 Food Inspection 27 Foot Clinic 13 Gas and Air Analgesia 80 Grants 52, 73 Health Visitors 66 Home Helps 76 „ Visits 67, 68 Hospital Accommodation 77 „ Infectious Disease 49 Housing 24, 26 Act, 1936 26 „ Conditions 67 „ Inspections 24 Ice Cream 28 Immunisation 38 Infant Mortality 8,60,92 Infectious Diseases Clinic 38 „ „ Hospital 49 Infestation 69 Institutional Treatment 16, 76 Inquests 52 Invalid Children's Aid Assn. 75 Insulin 53 Laboratory Services 40 Malaria 36, 37, 38, 46 Massage 70 Maternal Mortality 83, 94 Maternity and Child Welfare 56 „ Homes 78 page Measles 36, 37, 38, 46 Meat Inspection 30 Medical Aid 79, 80 „ Examinations 53 Midwives 79 Milk, Assisted Scheme 76 „ Special Designations Order 28 „ Supply 27 Miscellaneous 52 Mortuary 52 Municipal Dental Service 15 „ Laboratory 40 ,, Ambulance Service 12 „ Midwifery and Maternity Service 81 National Health Service Act, 1946 53 Neo-Natal Mortality 62 Notices, Sanitary 20 Notification of Births 57 Nursing 13 „ Homes 18 Ophthalmia Neonatorum 36, 37, 38, 45, 82 Ophthalmic Treatment 75 Orthopaedic Treatment 74 Outworkers 36 Pneumonia 36, 37, 38, 45 Poliomyelitis 36, 37, 38,43 Population 7 Post-Mortems 52 Post-Natal Clinics 69, 87 Premature Infants 64, 92 Prevention of Blindness 40 Priority Sheet Dockets 76 Public Assistance 18 Puerperal Pyrexia 36, 37, 38, 81, 93 page Rateable Value 7 Rats and Mice Destruction Act 3 4 Rent Restriction Acts 33 Sanitary Inspection 20 Scabies Clinic 16 Scarlet Fever 36, 37, 38, 40 Schick Tests 38 Smallpox 40 Social Conditions 7 St. John Ambulance Brigade 13 Staff 6, 57 Statistics 7, 8, 9, 10, 11 Sterilised Maternity Outfits 76 Stillbirths 8 Sunlight Treatment 75 Swimming Baths 23 Thorpe Coombe Maternity Hospital 84 Total Infant Mortality 62 Tonsils and Adenoids 74 Tuberculosis 36, 37, 38, 47, 52 Training of Pupil Midwives 85 „ „ Probationers 60 Unemployment 7 Vaccination 40 Venereal Disease 18 Vital Statistics 8 Vitamins 59 Walthamstow Child Welfare Society 72 Walthamstow District Nursing Association 78 Water 19 Whooping Cough 36, 37, 38, 47 Women's Clinic 13 HEALTH COMMITTEE Chairman: Alderman Mrs. C. McEntee, J.P Vice-chairman: Councillor E. G. Baily. Ex'officio: The Worshipful the Mayor—Alderman S. N. Chaplin, J.P. The Deputy Mayor—Councillor Mrs. E. A. Smith, J.P. (deceased). Chairman of Finance Committee—Alderman Ross Wyld, O.B.E., J.P. Alderman T. Fitzpatrick. „ W. Gillett. „ A. E. Manning. Councillor C. J. Alford. „ Mrs. Candy. Mrs. Christy. „ Mrs. Frewin. L. J. J. Hodson. Councillor F. E. Nicoll. „ M. Sharland. „ W. H. Shaw. „ R. E. Simmons. Mrs. Tweed. Sanatorium (Hospital Management) Sub-Committee. Chairman: Councillor E. G. Baily. Alderman W. Gillett. Councillor Mrs. Candy. „ Mrs. Christy. Alderman Mrs. C. McEntee, J.P Councillor Mrs. Frewin. ,, Mrs. E. A. Smith, J.P. (deceased) Town Cler: G. A. Blakeley, Esq. TO THE CHAIRMAN AND MEMBERS OF THE HEALTH COMMITTEE Ladies and Gentlemen, I beg to present herewith a report on the Health Services in the Borough during the year 1947. This will be the last report for a complete year on the Health Services as now administered. The population still continues to increase, and the latest available figure is over 124,000. The vital statistics were again good. The birth rate was 21.8 and the death rate 10.7. The Infant Mortality rate at 29 shows a reduction of five from last year. The illegitimate rate at 13 was again excellent, and reflects the care given to such babies. There were no deaths from enteric fever, scarlet fever, diphtheria or whooping cough. The flooding and contamination of the Lea Bridge filter beds of the Metropolitan Water Board gave rise to acute discomfort and anxiety, but was, fortunately, followed by no obvious ill-health. The Ambulance Service was again fully used, the calls increasing by some 35 per cent. and the mileage by some 44 per cent. as compared with 1946. The Municipal Dental Service was further extended by the provision of a full-time dental team, and the provision of a dental workshop. The new housing provision made by the Council—particularly for old people—is very welcome. The general shortage of accommodation is so serious that there appears to be no adequate solution within the next few years. The Sanitary Inspectorate was again below establishment, and worked well under continuing and increasing difficulties. The Chief Sanitary Inspector, in his report, stresses the need for bye-laws regulating the sale of food in the open air. Your helpful consideration is again acknowledged, together with the good work of the staff, particularly in connection with the work done for the Health Section of the Local Government Exhibition. I am, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. 6 STAFF The following changes occurred in the Staff:— Resignations Miss S. Branigan (Clerical Assistant) 12. 7.'47 Mr. F. A. Barnes (Tempy. Rodent Operative) 21. 7.'47 Mr. W. Dunn (Ambulance Driver) 16.10.'47 Mrs. F. Gerdes (Female Auxiliary, Skin Clinic) 1. 1.'47 Mr. R. High (Ambulance Driver) 31.12.'47‡ Mr. S. S. Jordan (Ambulance Driver) 23. 4.'47 Miss V. M. Prime (Shorthand Typist) 27. 8.'47 Miss F. Posner (Junior Clerk) 8. 5.'47 Mr. G. Rowe (Male Auxiliary, Skin Clinic) 1. 5.'47 Mr. R. D. Wilshire (Junior Clerk) 7. 5.'47 ‡Retired. Appointments Mr. F. A. Barnes (Tempy. Rodent Operative) 19. 2.'47 Mr. D. A. Clark (Dental Officer, M.D.S.) 14. 4.'47 Mr. D. W. Flatman (Junior Clerk) 4. 3.'47* Miss S. Feldman (Junior Clerk) 6.10.'47 Miss M. Game (Shorthand Typist) 6.10.'47 Mr. G. H. Higgins (Dental Technician) 3. 2.'47 Mrs. C. M. Hall (Clerical Assistant) 24. 2.'47 Mr. L. N. Martin (Chiropodist) 10. 3.'47 Mr. G. McCart (Chiropodist) 17. 3.'47 Miss T. Pullen (Junior Clerk) 1. 5.'47 Mr. Lewiston (Driver/Disinfector) 27.10.'47 * Resumed after war service. 7 A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1947) 122,470 Number of Assessments, 1st April, 1947 35,348 Rateable Value £870,280 Sum represented by penny rate £3,520 Population.—The Registrar-General's Estimate of the population at mid-year, 1947, is 122,470, an increase of 4,420 on the previous figure. The graph given below shows the population during the last nine years. Unemployment.—According to information kindly supplied by Mr. Percy C. Graham, Manager of the Local Employment Exchange, approximately 900 men and 200 women were placed in employment every month during the year 1947, through the placing machinery of the Employment Exchange. The number of (insured persons employed in the whole area covered by the Exchange, comprising the boroughs of Walthamstow, Leyton, Chingford, Wanstead and Woodford, was 61,000 in July, 1947. Of these, it is estimated that about 31,000 were employed in Walthamstow. During 1947, the average number of persons unemployed in the whole area was 780 men and 100 women ; these included 150 disabled men and 20 disabled women. Apart from certain older men and some badly disabled persons, the majority of unemployed men and women were placed in suitable employment within a short period, and there was a steady demand for both male and female workers throughout the year. 8 Extracts from Vital Statistics.—The Registrar-General's mid' year, 1947, estimate of the population (viz., 122,470) has been used for the calculation of all vital statistics:— Total Males Females Live Births Legitimate 2,597 1,332 1,265 Birth rate per 1,000 of the estimated resident population 21.8 Illegitimate 73 36 37 Total 2,670 1,368 1,302 Stillbirths 59 Rate per 1,000 total (live and still) births 21.6 Deaths 1,315 Death rate per 1,000 of the estimated resident population 10.7 Deaths from puerperal causes:— Rate per 1,000 (live and still) births. Puerperal Sepsis Deaths — — Other Puerperal Causes 4 1.47 Total 4 1.47 Death rate of infants under one year of age:— All infants per 1,000 live births 29 Legitimate infants per 1,000 legitimate live births 29 Illegitimate infants per 1,000 illegitimate live births 13 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under two years of age) 6 Pulmonary Tuberculosis death rate 0.43 Non-pulmonary Tuberculosis death rate 0.04 (All death rates are per 1,000 of the estimated residential population.) 9 The natural increase of population, i.e., excess of births over deaths was 1,355. The usual comparison of vital statistics rates, with those for the whole country, is shown in the table on the following page. Births.—Births are dealt with under the Maternity and Child Welfare Section of the Report. Deaths.—The Registrar-General's classification of causes of death by sex totals is given. The total number of deaths in 1947 (1,315) compares with 1,331 in 1946, the respective death rates per 1,000 population being 10.7 and 11.2. 10 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and case Rates for certain Infectious Diseases in the year 1947. Diseases in the year 1947. Provisional figures based on weekly and quarterly returns. England and Wales. 126 County Boroughs and Great Towns (including London) 148 Smaller Towns (Resident Population 25,000-50,000 at 1931 Census London Administrative County. Walthamstow. Rates per 1,0 00 Civilian Population. Births:— Live 20.5* 23.3 22.2 22.7 21.8 Still 0.50* 0.62 0.54 0.49 0.48 Deaths:— All Causes 12.0 13.0 11.9 12.8 10.7 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Scarlet Fever 0.00 0.00 0.00 0.00 — Whooping Cough 0.02 0.03 0.02 0.02 — Diphtheria 0.01 0.01 0.01 0.01 — Influenza 0.09 0.09 0.08 0.08 0.09 Smallpox 0.00 0.00 0.00 — — Measles 0.00 0.02 0.02 0.01 0.01 Notifications:— Typhoid Fever 0.01 0.01 0.00 0.01 — Paratyphoid Fever 0.01 0.01 0.01 0.01 — Cerebro-spinal Fever 0.05 0.06 0.05 0.05 0.07 Scarlet Fever 1.37 1.54 1.37 1.31 1.89 Whooping Cough 2.22 2.41 2.02 2.80 1.82 Diphtheria 0.13 0.15 0.14 0.14 — Erysipelas 0.19 0.21 0.18 0.22 0.39 Smallpox 0.00 0.00 0.01 0.00 – Measles 9.41 9.13 9.58 5.29 8.82 Pneumonia 0.79 0.89 0.68 0.64 1.23 Rates per 1,000 Li ve Births. Deaths under 1 year of age 41† 47 36 37 29 Deaths from Diarrhoea and Enteritis under 2 years of age. 5.8 8.0 3.7 4.8 2.2 Rates per 1,000 Total Births (Live & Still) (a) Notifications:— 7.16 8.99 6.27 1.21 10.99 Puerperal Fever Puerperal Pyrexia ‡6.94 (b) Maternal Mortality:— No. 140. Abortion with Sepsis. No. 141. Abortion without Sepsis. No. 147 Puerperal Infections Nos. 142-6. 148-50. Other. England and Wales 0.10 0.06 0.16 0.85 Walthamstow — — — 1.46 *Rates per 1,000 Total Population. † Per 1,000 related births. ‡ Including Puerperal Fever. A dash (—) signifies that there were no deaths. 11 Causes of Death as given by the Registrar-General for the year 1947 Whole District Causes of Death. Males. Females. Total. 1. Typhoid and Paratyphoid Fevers – – – 2. Cerebro-spinal Fever — 1 1 3. Scarlet Fever — — — 4. Whooping Cough — — — 5. Diphtheria — — — 6. T.B. of Respiratory System 26 27 53 7. Other Forms of Tuberculosis 2 3 5 8. Syphilitic Diseases 6 2 8 9. Influenza 8 4 12 10. Measles 2 — 2 11. Acute Poliomyelitis and Polioencephalitis – – – 12. Acute Infectious Encephalitis — 1 1 C Cancer of buccal cavity and oeso13.^ phagus (Males) 11 – 11 Cancer of uterus (Females) — 10 10 14. Cancer of stomach and duodenum 22 17 39 15. Cancer of breast 1 28 29 16. Cancer all other sites 87 58 145 17. Diabetes 2 5 7 18. Intra-cranial vascular lesions 56 74 130 19. Heart Disease 191 167 358 20. Other Diseases of the Circulatory System 20 26 46 21. Bronchitis 61 50 111 22. Pneumonia 42 39 81 23. Other Respiratory Diseases 9 10 19 24. Ulceration of the Stomach or Duodenum 15 1 16 26. Diarrhoea (under 2 years) 4 2 6 26. Appendicitis 4 1 5 27. Other Digestive Diseases 11 15 26 28. Nephritis 12 9 21 29. Puerperal and Post-abortive Sepsis — — — 30. Other Maternal Causes — 4 4 31. Premature Birth 4 3 7 32. Congenital Malformation, Birth Injury, Infantile Disease 28 9 37 33. Suicide 6 7 13 34. Road Traffic Accidents 3 2 5 35. Other Violent Causes 16 5 21 36. All Other Causes 37 49 86 Totals, 1947 686 629 1,315 Totals, 1946 693 638 1,331 The age distribution of Cancer deaths was as follows:— Under l yr. 1-2 yrs. 2-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 yrs. & over – – – – 1 13 75 145 12 B.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA 1:—(i) Public Health Officers of the Authority:—Resignations and appointments during the year are given at the beginning of the Report and also in the Maternity and Child Welfare Section of the Report. (ii) (a) Laboratory Facilities:—(See I. D. Section.) (b) Ambulance Facilities:— Municipal Service. Removals. Accidents. Treatment. Maternity. Others. Total. Mileage. 1947 1,722 715 5,497 930 242 9,106 44,827 1946 1,522 543 3,760 739 98 6,662 31,123 The total number of calls is 2,444 more than for 1946, an increase of over 35 per cent. Mileage increased by 44 per cent. The considerable increase in maternity removals will again be noted. This reflects the continuing pressure caused by the increased birth rate. "Other calls" have increased on account of the transport facilities provided for District Midwives since 1st June, 1946. Transport is available at night when the public service is not available or is restricted and, of course, in emergencies. The ambulance fleet, staff and garage arrangements remain the same. Tenders for the supply of two new ambulances were obtained and orders placed. It was decided to provide free ambulance facilities within the Borough and to neighbouring hospitals. The voluntary assistance of members of the St. John Ambulance Brigade has continued and totalled 253 duties during the year. This assistance enabled extra vehicles to be available at night and at weekends. Reciprocal Arrangements.—During 1947 the position was as follows:— Authority Incoming calls. Outgoing calk. Leyton 37 41 Chingford 63 22 Woodford and Wanstead 2 4 Total 102 67 There were 35 more calls done for other areas than the total calls transferred out. 13 Whipps Cross Hospital. Removal of patients is carried out by ambulances attached to the Hospital. St. John Ambulance Brigade. Mr. V. G. Turner, Divisional Superintendent, kindly contributes the following report:— "Although we have not had as many members return to us from the Forces as we hoped for, active members have carried out their obligations in a very satisfactory manner. Public duties and Training Nights have been well attended. Many of our members are on shift' work and staggered hours, but in spite of this have given a good many hours' service. Apart from local duties, several London duties have been undertaken, and we were able to supply 14 members for the Royal Wedding. During the Autumn we ran a home nursing class for members, with very good results. Only those who had attended all the lectures were allowed to take the examination, and we had 100 per cent. passes." (c) Nursing in the Home. (i) General.—No change. (ii) Infectious Diseases.—No change. (d) Clinics and Treatment Centres. Foot Clinic.—Total attendances were 11,524 and of these 1,323 were by new patients, 10,201 were re-attendances by old patients. The receipts were £975 10s. 8d. Sessions are held at the Town Hall, as follows:— Monday 9 a.m. to 12 noon 1.30 to 4 p.m. 4.30 to 7 p.m. Tuesday do (Children only)– – Wednesday do. 1.30 to 4 p.m. — Thursday do. do. 4.30 to 7 p.m. Friday do. do. do. Saturday do. — — Chiropody treatment only is given—by appointment. Women's Clinic.—This clinic is held in Thorpe Coombe AnteNatal Block. It deals mainly with gynaecological conditions. Contraceptive advice is given when indicated on medical grounds. 14 Miss Helen Rodway, F.R.C.O.G., submits the following report:— No. of Sessions. No. of Attendances. Total. Average Attendance per Session. New Patients. Old Patients. (a) Tuesday Afternoon 62 429 1,422 1,851 35.6 (b) Saturday Morning 24 117 141 258 10.7 Totals . . 76 546 1,563 2,109 27.7 . (c) Tuesday Morning 24 60* 345+ 405 16.8 *These patients were transferred from the Post-natal or Gynecological Clinics, † A number of gynæcological patients' attendances are included in this figure. Summary of New Cases:— Tuesday afternoon. Saturday morning. Total. For diagnosis or complications of pregnancy 159 56 215 Sterility 31 7 38 Gynaecological 147 43 190 Post-natal 12 2 14 Medical 14 4 18 Surgical 9 — 9 Contraceptive 55 5 60 Not classified 2 — — Totals 429 117 546 The number of patients referred to the Clinic by medical practitioners was 144. The number of patients transferred to Hospital was 45. This figure does not include those transferred to Hospital for confinement. Comparison of attendances with previous years:— 1947. 1946. 1945. 1944. 1943. 1942. 1941. 1940. 1939. 1938. New Cases 546 610 616 444 524 424 299 260 329 319 Old Cases 1563 1,745 1,665 1,630 1,618 1,303 1,023 1,183 1,234 1,179 Totals 2109 2,355 2,281 2,074 2,142 1,727 1,322 1,443 1,563 1,498 15 Municipal Dental Service. Treatment is available, by appointment, for patients of all ages (except those attending grant aided schools which are dealt with through the School Dental Service) living in Walthamstow. Mr. L. W. Elmer, L.D.S., Senior Dental Surgeon, reports as follows:— "This service has now been in operation nearly four years, and, with the approach of the date upon which the National Health Service Act comes into operation, it would appear that the present is a suitable time to review its progress. "The service commenced in April, 1944, with two evening sessions weekly, for which three part-time dental surgeons were employed. Later a further dental surgeon was engaged for two evening and one afternoon sessions, and a dental clerk was appointed in September, 1945. "Until April, 1947, the prosthetic work was distributed between three outside dental mechanics, but by then it was found possible to open our own dental workshop, and a full-time technician was engaged. In May, Mr. Clark, L.D.S., commenced duty as full-time dental surgeon, with chairside and clerical assistants. Owing to the continued increase in the work it was found impossible to discontinue the employment of part-time dental surgeons, of whom three were employed up to the end of 1947. "Later in the year it was found necessary to employ a second dental technician. "At the time of writing, with continued expansion of the service, it has been decided to appoint a further full-time dental 'team,' i.e., dental surgeon, attendant and technician, and it is hoped to instal a dental X-rav machine. "Below is given a report of the main items of work undertaken during the year, with comparative annual figures since the inception of the service:— 1944 1945 1946 1947 Number of patients treated 143 379 585 805 Appointments made 633 2,234 3,719 5,614 Appointments kept 558 2,143 3,315 5,181 Fillings 135 1,005 786 1,065 Scalings 67 147 206 314 Dressings 71 228 207 451 Extractions 266 1,068 1,570 2,075 General anaesthetics 58 238 446 530 Local anaesthetics 54 112 182 278 Impressions 33 223 371 863 Bites 24 97 162 326 Try-ins 23 106 193 392 Dentures supplied 26 134 238 469 16 "This list is by no means comprehensive, and a great variety of other items of treatment have been given. These cannot be adequately classified, but it is really gratifying to note that it is now possible for patients to receive a comprehensive dental service. This includes not only treatment undertaken in the surgery, but also the provision of every type of prosthetic appliance. The only exceptions to this are the comparatively rare cases of dental and oral surgery requiring hospitalisation. Below is appended a list of the appliances completed in the dental laboratory during 1947:— Municipal Dental Service School Dental Service New dentures 390 — Remodels 15 — Orthodontic appliances — 61 Crowns 8 14 Repairs 39 6 Inlays 1 3 Scabies Clinic. The arrangements at the special treatment Centre detailed in previous reports were continued. Sessions are held as set out below at the Scabies Clinic premises, which are situated behind the Public Baths in High Street. Treatment is by appointment only (i.e., through a doctor or through the Health Department). Morning 9-12 Afternoon 2-5 Evening 5.30-8.30 Monday — — M/F Tuesday — F — Wednesday F — — Thursday — — M/F Friday F — — Saturday M/F — — M=Males. F=Females and Children. 399 cases were treated during the year, receiving 1,410 treatments. (e) Hospitals.—There were no changes during 1947 in the hospital services used by the inhabitants of the Borough. Public Assistance in Walthamstow is provided by the Southwestern Area Guardians' Committee of the Essex County Council which retains a certain proportion of beds in each of the local institutions provided by the County Boroughs of East Ham and West Ham. 17 Mr. Pegram, Clerk to the Committee, has kindly supplied the following particulars of Walthamstow residents admitted to the various institutions during the year ended 31st December, 1947:— Institutions Men Women Children Total Central Home 82 78 1* 161 Whipps Cross Hospital 595 779 328 1,702 Forest Gate Hospital — 13 — . 13 Harold Wood Hospital 1 6 — 7 Forest House 5 3 — 8 Aldersbrooke Children's Homes – – 107 107 *This child was ultimately transferred to Aldersbrooke. Nine infants were born to Walthamstow mothers in Forest Gate Hospital during the year. The number of patients from Walthamstow in Mental Hospitals was 342 on the 31st December, 1947. The Connaught Hospital. The Secretary to the Hospital has kindly supplied the following information:— "Of the total number of in-patients admitted during the year, 997 were residents of the Borough. "The following figures show the progress of the Hospital during 1947 as compared with the previous year:– In-Patients Out-Patients No. Admitted Average Stay Daily Average New Cases Attendances 1947 2,285 16.79 104.73 19,342 95,814 1946 1,940 18.77 99.13 17,139 90,274 "Particulars as to Staff, Beds and Departmental activities:— There are 118 beds, including 10 private wards. "Operations and Treatments:-During 1947, 1,356 major operations and 2,565 minor operations were performed, making a nett total 3,921. 20,864 radiographs were taken. There were 19,335 massage treatments, also 24,876 electrical treatments and 2,820 artificial sunlight treatments at the Comely Bank Clinic– a total of 47,031 treatments at this Clinic. "Facilities at Comely Bank:– The following facilities for electro-medical treatment are provided at Comely Bank: Massage, Radiant Heat, Electrical Treatment and Sun-Ray Treatment. 18 "Plans have been drawn up for the extension of the Hospital to a total of 300 beds, which would include the following:— Surgical 96 Children's 58 Orthopaedic 20 Ophthalmic 10 Gynascological 10 Single 41 "In addition, there would be a new X-ray Department, Operating Suite, Nurses' Home and Out-Patients' Department." Venereal Disease Treatment. Treatment is the responsibility of the Essex County Council and all the facilities of the London County Council are available. No special clinic facilities have yet been provided in Walthamstow. Outfits for taking specimens from patients are provided for practitioners, on request, by the Whitechapel (London County Council) Clinic, Turner Street, Whitechapel, E.l. 2. Social Welfare. Out-relief and institutional treatment is provided by the Essex County Council. Mr. Pegram, Clerk to the Essex County Council's South-Western Area Guardians' Committee, kindly states that the amount of relief provided in Walthamstow during the two years ended 31st December, 1947, was as follows:— 1947 1946 £ s. d. £ s. d. Total amount of out-door relief granted to Walthamstow residents during the year ended 31st December 48,012 3 9 41,915 3 7 Average weekly number of Walthamstow residents in receipt of relief during the year ended 31st December Men 223 225 Women 508 497 Children 285 261 Total 1,016 983 3. Maternity and Child Welfare.—See Section H of the Report. 4. Public Health Act, 1936.—Nursing Homes:— No. of Homes. No. of Patients provided for. Maternity Patients. Others. Totals. Homes first registered during the year – – – – Homes on register at the end of the year 3 12 18 30 There were no cancellations, refusals or appeals. Twenty-two inspections were made by the medical staff. 19 Routine enquiries are made with regard to unregistered homes. No difficulties in regard to supervision arose. 5. Essex County Council Act.—No new licence to practise chiropody was granted by your Council. C—SANITARY CIRCUMSTANCES OF THE AREA Water.—The authority responsible is the Metropolitan Water Board. Routine tests are carried out by the Board, and the usual practice was continued of notifying the Board of all cases of actual or suspected enteric fever. The Board then arranges special tests at the addresses concerned. All were negative in 1947. All dwelling houses in the area are supplied direct with water. Flooding of the Lee Bridge Works of the Metropolitan Water Board:—At 5.30 a.m. on 15th March, 1947, the Lee Bridge Works of the Metropolitan Water Board became flooded by the overflow of the River Lea and it became evident that some polluted water had entered the distribution system. As soon as the position became known on the Saturday afternoon measures were taken to supplement the somewhat inadequate warnings issued over the weekend by the B.B.C. Some 20,000 leaflets were printed in regard to the emergency flushing of water closets and the disposal of household sewage through household manholes or by digging trenches. These were circulated through schools and by qther means on 17th March, and medical practitioners were advised as to the" possibility of cases of typhoid fever. A check was made by the Sanitary Inspectors into the flushing of water closets at cinemas and factories, and ex-civil defence chemical closets were supplied to the schools. The Metropolitan Water Board organised an excellent service of tankers, but in the early days there were no adequate arrangements to notify householders when the water carts were in the streets. Special supplies were arranged for hospitals and Day Nurseries, etc. The supply to the Maternity Hospital was well arranged by the Borough Engineer and Surveyor by water carts supplied from the Town Hall artesian well. The supply was not fully restored for some ten days, and it is very gratifying to report that no case of typhoid fever or other intestinal disease due to contamination of water was notified. 20 SANITARY INSPECTION OF THE AREA During the greater part of the year the inspectorate was one below full strength owing to resignations and sickness. Mr. F. W. Kemp, Chief Sanitary Inspector, reports as follows:— No. of inspections made. No. of nuisances detected. No. of complaints received. No. of Informal Notices No. of Statutory Notices. Total Visits. Served. Complied with. Served. Complied with. 11,654 9,130 3,962 2,852 2,826 318 266 22,802 Of the 2,852 intimation notices served during the year, 88 were in respect of business premises, and of the 2,764 relating to the defects in houses, 2,450 were complied with without resort to statutory procedure. Owing to the failure of owners to carry out certain Statutory Notices, served under Section 9 of the Housing Act, 1936, the Council undertook the necessary work to five houses at a cost of £65 9s. 4d. It was found necessary to institute legal proceedings against 24 owners for non-compliance with Abatement Notices served under Section 93 of the Public Health Act, 1936. Orders were made by the Magistrates in eleven cases and Penalties or Costs were inflicted. In the remaining thirteen cases the Summons were withdrawn on payment of costs, the work having been commenced before the hearing. The nature and variety of the work executed in 1947 is shown in the following tables:— Drains tested, 480; Drains reconstructed or repaired, 678; Drains, obstructions removed, 393; Drains, means of access provided, 49; Drains, ventilation provided or improved, 73; Drains, ventilation repaired, 89; Soil pipes repaired or renewed, 32; Rain water pipes renewed, 301; Rain water pipes disconnected from drains, 4; Roofs repaired or renewed, 939; Gutterings repaired or renewed, 554; W.C. pans or traps provided, 525; Gully traps provided, 113; W.C. flush cisterns repaired or renewed, 296; W.C. floors concreted, 52; W.C.s repaired and cleansed, 217; W.C.s light and ventilation improved, 12; Waste pipes repaired, renewed or trapped, 237; New sinks provided, 97; Water supply re-instated, 23; Water supply taken off main, 27; Cisterns cleansed and covered, 28; Sculleries paved, 35; Yards and forecourts paved and repaired, 83; Dirty houses cleansed, 12; Dirty floors cleansed, 21 267 ; Floors repaired, 410 ; Ventilations under floors provided or improved, 98 ; New damp proof courses provided, 57 ; Sites concreted, 4 ; Offensive accumulations removed, 28 ; Animals improperly kept, removed, 3 ; Stables repaired and cleansed, 8 ; Manholes repaired or re-sealed, 121 ; Other cases of dampness remedied, 438 ; Miscellaneous repairs, 1,663. Infectious Diseases. Visits to premises, 428 ; Revisits to premises, 22. Disinfections. Rooms disinfected, 173 ; Articles disinfected at Low Hall Lane, 686 ; Articles destroyed at Low Hall Lane, 49. Dampness in Houses. Sites concreted, 4 ; Damp proof courses provided, 57 ; Yards and forecourts paved and drained, 83 ; Roofs made watertight, 939 ; Rain water pipes made good, 301 ; Guttering repaired or renewed, 554 ; Other cases of dampness remedied, 438 ; Ventilation under floors improved, 98. Special Premises. Number Visits paid Factories (a) Power 437 456 (b) Non-power 100 131 (c) Other premises 58 57 Outworkers 163 338 Slaughterhouses — — Butchers 75 306 Bakehouses 31 144 Fishmongers, Fish Fryers and Curers, etc. 39 220 Cafes and Caterers 107 290 Grocers, etc. 286 599 Ice Cream Manufacturers and Vendors 127 195 Cowsheds 1 4 Dairies and Milksellers 67 72 Laundries 3 6 Rag and Bone Dealers 3 22 Piggeries 2 10 Street Stalls Numerous 49 Greengrocers 67 121 Stables 45 76 Schools — 11 Conveniences — 13 22 As a result of the regular periodical visiting of the Special Premises the following works were carried out: — Butchers' Shops. Special cleansings, 42 ; Paving repaired, 4 ; Accumulations removed, 6 ; New Galvanised Bins provided, 18 ; Drains repaired, 7 ; W.C.s repaired and cleansed, 11 ; Other improvements, 19. Bakehouses. Special cleansings, 47 ; New ceilings fixed, 3 ; Floors repaired, 7 ; Light and Ventilation improved, 18 ; Roofs repaired, 3 ; Other repairs, 17. Fishmongers. Special cleansings, 30 ; Yards repaved, 3 ; Accumulations removed, 7 ; Drains cleared, 14 ; Other improvements, 21. Cafes and Caterers. Special cleansings, 57 ; Light and Ventilation improved, 4 ; Floors renewed, 10 ; Other improvements, 19. Ice Cream Manufacturers and Vendors. Special cleansings 23 ; Special cleansing of utensils, 2 ; Yard pavings repaired, 3 ; Other improvements, 4. Cowsheds and Milkshops. Special cleansings, 10 ; New fittings and other improvements, 2. Stable Premises. Cleansings, 18 ; Accumulations removed, 12 ; Roofs repaired, 1 ; Pavings repaired, 1 ; Other improvements, 2. Laundries. Special cleansings, 2 ; Other improvements, 3. Rag and Bone Dealers. Cleansings, 6 ; Accumulations removed, 4. Piggeries. Cleansings, 3. Camping Sites. There were no sites in the area used for camping. The van dwellers in the Higham Hill area still remain. Smoke Abatement. There was a slight improvement on last year, although the use of unsuitable fuel gave rise to several complaints which were investigated. Remedial measures were carried out as far as practicable. 23 Eradication of Bed Bugs, etc. The number of houses reported to be bug infested is satisfactorily low. Free insecticides were issued to tenants in respect of 66 premises. Fumigations or special sprayings of rooms by the Council's Disinfecting Staff amounted to the small total of 51. In addition to the above there would be a number of unrecorded cases where the Owners or tenants have carried out disinfections privately. Swimming Baths and Pools. The model bye-laws of the Ministry of Health were adopted in 1938. (a) Municipal Baths, High Street.—This is a covered swimming bath. Mr. W. Cantes kindly contributes the following report: — " From January 1st to December 31st, 1947, the swimming bath was open on 304 days. The number of bathers in this time was 88,201. "Maximum load was on June 7th, when we had 1,211 bathers." Four water samples were taken with satisfactory results. (b) Whipps Cross Bathing Pool.—This is a large open-air pool situated in Epping Forest, in the area of the Borough of Leyton and a few hundred yards from the Walthamstow boundary. It is administered by a joint Committee representing the two Boroughs. The pool is supervised by the Medical Officer of Health for Leyton, who kindly sends a copy of the analytical findings when samples are taken. (c) South-West Essex Technical College.—Sampling was carried out on two occasions, with satisfactory results. (d) Forest School.—This is a small swimming bath with a capacity of approximately 47,000 gallons, treated with " Voxsan " ' with frequent changes of water. Sampling was carried out on one occasion, with satisfactory results. (e) The Kingfisher Pool.—The Managing Director kindly gives the following particulars : — " The chlorination and filtration plant has a turnover of eight hours, with a possible speeding up to six hours. 0.2 parts per million of free chlorine are aimed at for the deep end and 0.6 at the shallow end. The plant was kept in operation all day and night over the week-ends, if found necessary. 24 " The approximate number of swimmers in 1947 was 34,000. " Bacteriological and chemical analyses were carried out on five occasions, with satisfactory results. " The following Essex championships were held at the Pool during the year: — 1. Schoolboys' Springboard Diving. 2. Schoolgirl's Springboard Diving. 3. Ladies' Springboard Diving." (f) Woodford County High School for Girls.—This is a covered bath with continuous chlorination and filtration. One sample was taken with satisfactory results. D.—HOUSING (a) Inspection The following information is given in the form required by the Ministry of Health, and is supplied by the Chief Sanitary Inspector :— I.—Inspection of Dwelling-Houses During the Year: — (1) (a) Total number of dwelling-houses inspected for housing defects (under the Public Health or Housing Acts) 4,302 (b) Number of inspections made for the purpose 11,616 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 Nil (b) Number of inspections made for the purpose Nil (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (N.B.—These comprise individual unfit houses) (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2,764 25 II.—Remedy of Defects During the Year Without Service of Formal Notices : — Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 2,453 III.—Action Under Statutory Powers During the Year: — A. Proceedings under Sections 9, 10, and 16 of the Housing Act, 1936: — (1) Number of dwelling-houses in respect of which notices were served requiring repairs 46 (2) Number of dwelling-houses which were rendered fit after service of formal notices: — (a) By owners 49 (b) By Local Authority in default of owners (at a cost of £65 9s. 4d.) 5 (c) Withdrawn—premises vacated and undertaking not to allow future occupation Nil B. Proceedings under the Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 272 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) By owners 211 (b) By Local Authority in default of owners 1 C. Proceedings under Sections 11 and 13 of the Housing Act, 1936: — (1) Number of dwelling-houses in respect of which Demolition Orders were made 1 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 D. Proceedings under Section 12 of the Housing Act, 1936: — (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil 26 (2) Number of separate tenements or under ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil (b) Housing Act, 1936 Unfit Houses One Demolition Order was made during the year. General The following is supplied by Mr. J. E. West, your Council's Housing Manager :— " Some progress was made during the year but only after meeting very many difficulties largely affecting problems of labour and material. " The provision of prefabricated bungalows did, however, achieve some progress as will be seen from the schedule appearing hereunder, but progress on the Countess Road site, where 414 flats are being erected, was not up to the standard anticipated. Practically 90 per cent, of applications received affected young married couples and families comprising from one to three children. " There was little assistance forthcoming in acquiring additional properties by exercising requisitioning powers as very few properties came into the market which were suitable for requisitioning. A property under the ownership of the Council at ' Clock House ' was adapted for the accommodation of those who are ' not so young.' Towards the end of the year the old people's flats on the Priory Court Estate were practically complete, and nothing but praise has been heard with regard to this type of accommodation which has, undoubtedly, not only given relief to the residents but to their immediate families who were, in very many instances, concerned as to the mode of living of their parents in the eventide of life. It has been one of the very few pleasant tasks of the Housing Department to receive the thanks and appreciation of what has been done for their welfare. "The report of progress up to 31st December, 1947, is as follows: — Prefabricated bungalows occupied 466 Housing applications received 11,491 Housing applications on the 'live register' 9,553 Personal interviews 11,407 Families rehoused 400 27 " The minimum amount of accommodation required to meet the housing needs as analysed from the list of Housing applications, is as follows : — % of Applications Single persons, etc. (Hostels) 2.7 318 Young married couples (2 rooms) 38.2 4,389 Families of 3 to 5 persons 41.3 4,748 Families of 6 to 7 persons 12.4 1,430 Families of 8 to 10 persons 2.01 231 Families of 12 to 14 persons 0.43 49 Families not stated 2.9 326 Number of properties requisitioned 1,062 Number of properties still held 616 Furniture Cash Sales amount to £1,744 18 8 Furniiure on loan amounts to £12,003 10 7 £13,748 9 3 Local Authority Furniture Cash Sales £1,140 7 9 " In considering these figures, however, it should be remembered that between the close of the year and the commencement of 1948, the whole of the applications were reviewed and a new * points ' scheme formulated with the intention of putting it into operation early in the new year." E.—INSPECTION AND SUPERVISION OF FOOD (a) Milk Supply. The following as contributed by the Chief Sanitary Inspector :— The number of samples of milk submitted to the Counties Laboratories for bacteriological examination, including Phosphatase and Methylene Blue tests, was 144. Samples, during the course of delivery, were taken twice monthly from the two firms holding Producers' Licences within the Borough and from other dealers in the district. 28 The following table gives details of samples taken :— Grade. No. of Samples. Results Satisfactory. Unsatisfactory in Methylene Blue test only. Pasteurised 92 88 4 Tuberculin Tested Pasteurised 31 31 — Tuberculin Tested 1 1 — Sterilised 7 7 — Heat Treated 13 11 2 Totals 144 138 6 The unsatisfactory samples were from a batch taken in the month of May. For the other months all were satisfactory. There is one cowshed in the District and the average number of cows kept is four. The number of Retail Purveyors of Milk is 67. The majority of these are the " general " shop type, and sell milk " as received " in bottles. Seventy-two visits were paid to registered dealers during the year and a satisfactory standard of cleanliness was maintained. The Milk (Special Designations) Order, 1936. The number of Licences granted for the sale of Milk under Special Designations classified in the above Order was as follows: — Dealers' Licences. In respect of:— Supplementary Licences. Pasteurised Milk 15 Pasteurised Milk 2 Tuberculin Tested Milk 10 Tuberculin Tested Milk 2 Bottling Licences. Pasteurised Milk 2 Tuberculin Tested Milk 2 (b) Ice Cream. Twenty-nine applications for Registration as Manufacturers or Vendors of this commodity were received. Licences were granted as follows :— Vendors 19 Transfers 8 Refused 2 29 Ice Cream (Heat Treatment, Etc.), Regulations, 1947. The attention of all manufacturers and vendors was called to the requirements of these Regulations. Several manufacturers are taking this opportunity of bringing their plant up to date. Medical Examination—Typhoid, Etc., Carriers. A letter was addressed to the trade offering facilities for a free medical examination to those employed in the manufacture or sale of ice cream. A reasonable response was received and of those examined none was found to be a " carrier." Bacteriological Quality and Grading of Ice Cream. Thirty-seven samples were submitted for bacteriological examination and grading in accordance with the Provisional Test of the Ministry of Health. The following is a comparative summary showing the results of the examination of 37 samples by the old standard test and the new (provisional) test. In the latter, Grades 1 and 2 are considered satisfactory. Old Standard Test New (Provisional) Test Plate Count Coliform Reaction (in 1/10 ml.) Bacterium coli (in 1/10 ml.) Very satis' factory Satis fac tory Not satis factory Methylene Blue Test Reduction time Grade 25,000 Absent Absent X 4½hours 1 1,000 ,, ,, X 4½„ 1 1,500 Present ,, X 4½ „ 1 500 Absent ,, X 4½ „ 1 40,000 ,, ,, X 4½ „ 1 3,000 Present ,, X 4½„ 1 9,000 Absent ,, X 4½„ 1 2,500 „ ,, X 4½„ 1 2,500 ,, ,, X 4 ,, 2 4,000 ,, ,, X 3½ „ 2 1,800 ,, ,, X 3½ „ 2 3,000 Present ,, X 3½ „ 2 2,800 Absent ,, X 3½ „ 2 600 ,, ,, X 3½ „ 2 5,000 ,, ,, X 2½ „ 2 38,000 ,, ,, X 3 ,, 2 8,000 ,, ,, X 2½ „ 2 30,000 ,, ,, X 2½„ 2 7,000 Present ,, X 2 „ 3 12,500 Absent ,, X 1 3 26,000 ,, ,, X 4½ „ 3 50,000 Present ,, X 1 3 20,000 Absent ,, X 1 3 600,000 Present ,, X 0 „ 4 270,000 Absent ,, X 0 „ 4 30 Old Standard Test New (Provisional) Test Plate Count Coliform Reaction (in 1/10 ml.) Bactcrium coli (in 1/10 ml.) Very satisfactory Satis factory Not satis factory Methylene Blue Test Reduction time Grade 30,000 Present Absent x 0 hours 4 160,000 Absent ,, x 0 „ 4 180,000 ,, ,, x 0 „ 4 120,000 Present ,, X 0 „ 4 18,000 ,, ,, x 0 „ 4 140,000 ,, ,, x 0 „ 4 75,000 ,, ,, x 0 „ 4 80,000 ,, Present x 2 ,, 3 80,000 ,, ,, x 1 ,, 3 60,000 ,, ,, x 1 ,, 3 150,000 ,, ,, x o „ 4 120,000 ,, ,, x o „ 4 It will be noticed that by the new test eighteen only are classified as satisfactory (Grades 1 and 2), whereas by the old standard no less than 30 come under this heading. As to whether the new standard will be adopted is a matter of conjecture. The absence of Bacterium Coli in 32 samples indicates that cleanliness and care in manufacture and handling predominates. The practice of local manufacturers in having samples taken privately for bacteriological examination helps them considerably in maintaining a high standard of cleanliness. (c) Meat and Other Foods. The Live Stock (Restriction of Slaughtering) Order, 1940, continued in force and no slaughtering was carried out during the year. The following is a list of the food condemned as unfit for human consumption. As in previous years, whenever possible, the food was salvaged either through the Ministry of Food Salvage Division or the local scheme. 4478 tins Evaporated Milk 195 „ Full Cream Milk 177 „ Machine Skimmed Milk 4 „ Dried Milk 301 „ Salmon 305 „ Herring Tit-Bits 172 „ Pilchards 130 „ Silds 59 „ Herring Spread 41 „ Shellfish (Various) 16 „ Whiting 19 „ Mackerel 41 „ Sardines 22 „ Hake 2 „ Cod 3 tins Shad 8 „ Herrings 3 „ Roe 7 „ Fish Paste 451 „ Beans 349 „ Peas 182 „ Tomatoes 79 „ Beetroot 62 „ Carrots 9 „ Mixed Vegetables 8 „ Turnips 6 „ Macedoine 6 „ Potatoes 4 „ Spinach 3 „ Rhubarb 31 3 tins Tomato Juice 3 „ Celery 118 „ Grapefruit 70 „ Plums 65 „ Peaches 15 „ Apples 10 „ Apple Jelly 10 „ Fruit Salad 37 „ Apricots 6 „ Pears 3 „ Blackberries 3 „ Prunes 2 „ Pineapple 2 „ Grapes 7 bott. Fruit 23 tins Grapefruit Juice 3 „ Orange Juice 125 „ Jam 72 „ Orange Marmalade 24 „ Grapefruit Marmalade 20 „ Pudding 19 „ Spaghetti 6 „ Pate Foie 1 „ Macaroni 1 Gall, tin Tomato Ketchup 1 bott. Sauce 72 „ Pickled Cabbage 40 „ Pickles 13 „ Gherkins 19 tins Mustard 11 pkts. Salt 13 drums Pepper 167 tins Soup 69 „ Irish Stew 20 „ Broth 3 „ Proprietary Foods 233 „ Stewed Steak 14 „ Casserole Steak 6 „ American Steak 31 „ Steak ? Kidney Puddg. 139 „ Sausages 78 „ Luncheon Meat 57 „ Meat ? Veg. Ration 21 „ Bacon 14 „ Meat Roll 12 „ York Ham 10 „ Tongue 9 „ Sausage Meat 6 ,, Potted Meat 7 tins Chopped Ham 5 „ Beef 6? Carrots 5 „ Corned Mutton 4 ,, Corned Beef 4 „ Anchovy 1 „ Fish Roll 1 „ Galantine 37 „ Beef Loaf 6 „ Veal Loaf 2 „ Pork Loaf 2 „ Ham Loaf 585¼ lbs. Beef 168 Corned Beef 81½ Bacon 26 „ Liver Sausage 24 „ tinned Roast Beef 24 „ tinned Tongue 45 „ Mutton 20 „ Meat and Bones 19 „ Sausages 14½ Luncheon Meat 4 „ Brisket 33/4 „ Sausage Meat 2½ „ Corned Beef Hash 2 „ Ham 13/4 „ Pork Brawn ¼ „ Meat Roll 145½ „ Prunes 25 „ Dried Peaches 12 „ Dried Peas 6½ „ tinned Peas 1523/4 „ tinned Tomatoes 2576 „ Potatoes 26 „ tinned Fruit Salad 14½ tinned Peaches 71 „ tinned Apricots 5 „ tinned Pineapple 5 „ tinned Plums 4 „ tinned Pears 4 „ tinned Apple Jelly 146 „ Sultanas 11 „ Figs 350½ ,, Jam 246 „ Orange Marmalade 24 „ Grapefruit 4 „ Syrup 14 „ Lemon Barley 110 „ Pearl Barley 43 „ Barley Flakes 32 24 lbs. Ground Barley 102 „ Macaroni 63 „ Semolina 119 „ Rolled Ooats 101 „ Oatmeal 37 pkts. Oats 5 „ Shredded Wheat 3 „ All Bran 1 „ Puffed Wheat 56 lbs. Cooking Fat 114 ½ ,, Butter 112 „ Lard 773/4 „ Margarine 12½ doz. Meat Cubes 169 pkts. Gravy Salt 3 lbs. Mincemeat 3½ „ Beef Suet 6 sacks Flour 112 lbs. Soya Flour 1 pkt. Dried Egg 560 lbs. Butter Beans 1 bott. Coffee 58 lbs. Tea 358¼ cwt. Sugar 14 lbs. Glucose 3 tubes Malt Milk Tablets 6 pkts. Chocolate Wafers *800 gross Mars Bars 6? Maltesers * 4 cwt. Lemonade Crystals *8247 lbs. Confectionery (various) 24 „ Nougat 24 bars Chocolate (assorted) 366 cartons Chocolate Malt Spread 1673/4 lbs. Cheese 493/4 „ Biscuits * Flood damage. 6 doz. Crumpets 5 pkts. Cream Crackers 403/4 lbs. Cake 1 „ Swiss Roll 85 Finger Rolls 100 Bread Rolls 17 boxes Chocolate Rolls 62 pkts. Pudding 6? Baking Powders 2 „ Dessert Sauce Powder 28 „ Dessert Mould 108 lbs. Chocolate Mould 38 pkts. Coldset Powder 16 „ Custard Powder 6 doz. Table Jellies 9 boxes Pate de Brie 723/4 stone Skate 43 „ Roker 29 „ Haddock 25 „ Dogfish 10 „ Soles and Dabs 10 „ Cod 11 „ Mixed Fish 12 „ Roe 6 „ Halibut 5 „ Witch 41 „ Turbot 4 „ Ray 2 „ Herrings 43 „ Kippers 73/4 lbs. Russian Salad 17 „ Vegetable Salad 2 boxes Tomatoes 1 tin Turkey 9 Chickens (44 lbs.) 1127 Eggs 44 Fishcakes (d) Adulteration, etc.—Food and Drugs Act, 1938. During the year 107 samples of food and drugs were submitted to the Public Analyst. Seven samples were found to be in some respect unsatisfactory. Particulars are given below : — Description of Article Result of Analysis Action Taken Barley Chips (Informal) Contained 6% of weed seeds, etc. Returned to millers. Sausages (Formal) Contained 42% of meat as against 50% speci- Interviewed and letter of fied. warning. 33 Description of Article Result of Analysis Action Taken Rum (Formal) 8% of added water. Court Proceedings bation of Offenders Act. Costs £5 5s. Od. Milk, 3 (Formal) 1, 2 & 6% added water, (a) Letter of warning to wholesaler concerned, (b) Employee discharged. Herring Tit-Bits (Informal) Contents not sterile. Stock surrendered. (e) Chemical and Bacteriological Examination of Foods. Chemical examination is carried out by the Public Analyst, Dr. Dyer, 20 Eastcheap, E.C.3, and bacteriological examination by the Counties Public Health Laboratories, 66 Victoria Street, S.W.I. (f) Circular letters were sent to all street traders directing special attention to their responsibilities regarding protection of foodstuffs against contamination by flies, dust, dirt, etc. All manufacturers and vendors of ice cream were circularised on two occasions, bringing to their notice topical matters. Bye-laws regulating the sale of food in the open air are still urgently needed. RENT AND MORTGAGE RESTRICTION ACTS During the year twenty-five certificates were granted to tenants and eight clearance certificates were issued to owners. One clearance certificate was refused. DISEASES OF ANIMALS ACTS, 1894-1938 The Sheep Scab Order, 1938.—No action necessary. Swine Fever Order, 1938.—No action necessary. Regulation of Movement of Swine Order, 1922.—No action necessary. Parasitic Mange Order, 1938. No action necessary. Foot and Mouth Disease (Infected Areas) Special Orders, 1947.—Three licences for movement of pigs countersigned. The following Orders were dealt with as necessary :— Fowl Pest (Amendment) Order, 1947, No. 1 6 ? No. 2. Sales of Live Poultry Orders, 1947 (Three). Live Poultry (Prohibition of Movement) Orders, 1947 (Two). Boiling of Animal Foodstuffs Order, 1947. 34 RATS AND MICE DESTRUCTION ACT, 1919 AND INFESTATION ORDER, 1943 (a) Rat repression was actively pursued during the year. The Sanitary Inspectors act in technical and supervisory capacity and operative treatment is carried out by the Council's trained Rat Catchers. (b) Local Authority Circular N .S.12—Special Inspection of District. The Council participated in the Ministry of Food's house to house scheme and received a financial grant towards the cost of the special work undertaken. One temporary rodent operative was engaged to augment the existing staff of two trained operatives. The following is a summary of the work carried out to meet the requirements of the Ministry : — Eleven " suspected " areas in the district were chosen for house-to-house visitation. In addition " spot checks " were carried out in three roads chosen at random. Statistics. Total number of investigations 8,094 Ineffective Visits 1,200 Premises reported clear 6,386 Premises reported rat infested 199 Premises reported mouse infested 309 Premises requiring poison baiting 116 Number of premises cleared by 1st treatment 97 ,, ,, ,, ,, ,, 2nd ,, 13 ,, ,, ,, ,, ,, 3rd ,, 3 113 The three remaining premises needed four, five and six treatments respectively before being cleared. Estimated kill of rats 600 RODENT OPERATIVES. (c) The year's work of the Rodent Operatives is indicated below: — No. of Infestations No. of Infestations Number reduced Estimated Treated Retreated Cleared. Major to Minor. Kill. 530 132 510 4 5,000 35 FACTORIES ACT, 1937 The following tables show the work carried out under this Act:— 1.—INSPECTION OF FACTORIES, ETC. Including Inspections Made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories with Machine 131 6 Nil Factories without Power 456 40 Nil Other Premises under the Act 57 6 Nil Totals 644 52 Nil 2.—DEFECTS FOUND IN FACTORIES, ETC. Particulars. Number of Defects. Number of offences in respect of which Prosecutions were instituted. Found. Remedied. Referred to h.m. Inspector. (1) (2) (3) (4) (5) Want of cleanliness 60 57 — Overcrowding 2 2 — — Unreasonable temperature 1 1 — — Inadequate ventilation 6 6 — — Ineffective drainage of floors 3 3 — — Sanitary Conveniences insufficient 13 8 — — unsuitable or defective 43 42 — — not separate for sexes 6 4 — — Other offences.. 17 17 6 — Totals 151 140 6 — 36 NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1947 Wearing Apparel, making of 140 Toys 2 Racquet ? Tennis Balls 5 Boxes 6 Brush making 10 Total 163 Outworkers were notified from the following areas : — Bethnal Green 3 Leyton 40 City of London 8 Shoreditch 6 Chingford 3 Stepney 2 Finsbury 26 Tottenham 3 Hackney 21 Walthamstow 32 Islington 5 Westminster 4 Kensington 5 Other areas 5 Total 163 338 visits were paid in connection with outworkers. F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES General.—The accompanying tables show the age and ward incidence of the various infectious diseases which are discussed separately in later pages of the report All ages. Under 1-5 5-15 15-25 25-45 45-65 65 & 1947 1946 l yr. yrs. yrs. yrs. yrs. yrs. over. Scarlet Fever 232 178 47 175 5 5 Diphtheria * 23 — — — — — — — Typhoid Fever — 3 Paratyphoid Fever — 2 — — — — — — — Pneumonia 151 82 5 15 20 12 38 34 27 Puerperal Pyrexia 30 33 — — — 12 18 — — Ophthalmia Neonatorum 5 4 5 — — — — — — Erysipelas 48 34 — — 2 1 15 21 9 Encephalitis Lethargica — — — — — — — — — Polio-encephalitis — — — — — — — — — Cerebro-spinalMeningitis 9 7 2 — 1 3 2 1 — Anterior Poliomyelitis 24 — 1 7 8 5 3 — — Measles 1081 503 47 636 388 9 1 — — Whooping Cough 223 197 22 133 62 4 1 — 1 Dysentery — 25 — — — — — — — Malaria — 1 — — — — — — — Tuberculosis 151 167 1 3 14 55 49 24 5 Totals, 1947 1,954 83 841 670 106 132 80 42 Totals, 1946 — 1,259 56 500 401 75 131 70 26 * There were 38 cases of Diphtheria (for observation), all of which were removed -to hospital, but none were confirmed. 37  St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Totals. Scarlet Fever 37 24 28 66 45 32 232 Diphtheria — — — — — — — Typhoid Fever — — — — — — — Paratyphoid Fever — — — — — — — Pneumonia 26 23 26 19 27 30 151 Puerperal Pyrexia 3 1 4 3 10 9 30 Ophthalmia Neonatorum 1 1 1 — 1 1 5 Erysipelas 8 9 6 2 9 14 48 Encephalitis Lethargica — — — — — — — Polio-encephalitis — — — — — — — Cerebro-spinal Meningitis 2 1 1 1 2 2 9 Anterior Poliomyelitis 8 2 2 2 5 5 24 Measles 184 164 161 108 188 276 1081 Whooping Cough 40 17 26 22 55 63 223 Dysentery — — — — — — — Malaria — — — — — — — Tuberculosis 21 17 20 12 43 38 151 Totals, 1947 330 259 275 235 385 470 1,954 Totals, 1946 233 203 183 158 182 300 1,259 The statistics given in the foregoing tables are those for the calendar year 1947. The Registrar-General gives the statistics for the 52 weeks ended 31st December, 1947, and these are given in the following table together with the case rates per 1,000 population both for England and Wales and for Walthamstow:— Disease. Scarlet Fever. Diphtheria. Enteric Fever. Pneumonia. Puerperal Pyrexia. Erysipelas Number 232 — — 151 30 48 Case rate:— Walthamstow 1.89 — — 1.23 0.24 0.39 England and Wales 1.37 0.13 0.02 0.79 Not available 0.19 The rate for Puerperal Pyrexia is better expressed in relation to the number of births (i.e., live and still-births) registered than to population. When calculated on this basis the rate is:— Walthamstow 10.99 England and Wales 7.16 38 Disease. Total notified. Removed to Hospital. Per cent, removed to Hospital. Deaths. Deaths per cent, of cases notified. Scarlet Fever 232 138 59.4 Nil Nil Diphtheria — — — Nil Nil Diphtheria Observation 38 38 100.0 Nil Nil Typhoid Fever — — — Nil Nil Paratyphoid Fever — — — Nil Nil Pneumonia 151 103 68.2 81 53.6* Puerperal Pyrexia 30 5 16.0 Nil Nil Ophthalmia Neonatorum 5 1 20.0 Nil Nil Erysipelas 48 9 18.7 Nil Nil Encephalitis Lethargica — — — Nil Nil Polio-encephalitis — — — Nil Nil Cerebro-spinal Meningitis 9 8 88.8 1 11.1 Anterior Poliomyelitis 24 17 70.8 Nil Nil Measles 1081 43 3.9 2 0.18 Whooping Cough 223 20 8.9 Nil Nil Dysentery — — — Nil Nil Malaria — — — Nil Nil Tuberculosis (all Forms) 151 148 — 58 38.4 * All cases not notified. †This figure also includes cases notified during previous years. Infectious Diseases Clinic.—The weekly clinic at 3.30 p.m. on Wednesdays was continued, and all children of school age who had been in contact with cases of infectious diseases were seen prior to their return to school. As in previous years all children discharged from the Isolation Hospital or after home isolation for infectious diseases were seen, and particular care was taken to refer all cases with any suspicion of rheumatism or of cardiac defect to the next Rheumatism Clinic. The following table shows the work done at the infectious diseases clinic, the large majority of patients being of school age :— Number of clinics held in connection with Infectious Diseases 52 Number of attendances made 380 Average attendance per session 7.3 Number of children referred to Rheumatism Clinic — Number of children referred to Aural Clinic 3 DIPHTHERIA IMMUNISATION Immunisation is carried out at the weekly clinic on Tuesdays at 2 p.m., at Schools, and at all Welfare Centres along the lines detailed in previous reports. The following summarises the work done :— Schick tested for the first time 15 Negative (including pseudo and negative) 9 Positive (including pseudo and positive) 6 Number of Schick tests following immunisation 67 Number negative60 Number positive 2 Number not seen5 Total number of immunisations completed during 1947 :— (a) School age 810 (b) Pre-school age 1,844 4 2,658 (d) Number already immunised having a reinforcing dose — - 3,541 The above total includes 152 children immunised at Brookscroft Child Welfare Centre and approximately 366 by Private Practitioners. Number of special clinics held for immunisation 52 Number of attendances made 1,795 Average attendance per session 34.5 Included in the total of 2,658 were :— (i) Number protected at Child Welfare Centres 574 (ii) Immunisation at Schools— Number completed immunised713 Number partly immunised 97 Number having re-inforcing dose, immunised in previous years 3,147 At the end of 1947, out of a total child population (i.e., 0 to 15 years) of 25,070, 18,122 or 72.2 per cent, had been immunised. The figure of 18,122 represents 52.4 per cent, of children under five years and 86 per cent, of children between five and fifteen years. The number of children (as adjusted by inward and outward transfers) immunised during 1947 was 3,141, an increase of 190 on the adjusted 1946 figure. Diphtheria Incidence (corrected diagnoses) :— 1944 13 1945 16 1946 23 1947 Nil General Practitioner Scheme.—This was extended in 1946 to cover all children up to the age of 15 years at a fee of 3s. per injection. 39 40 During 1947, 366 c.cs of alum precipitated toxoid were issued, a quantity sufficient to protect 366 children. Birthday Letters.—The arrangements detailed in the 1944 Report were continued. The following national assessment of Diphtheria Immunisation has recently been made by the Ministry of Health :— Costs £50,000 per annum. Saves 2,500 children from death each year and 40,000 from suffering from Diphtheria each year. Releases 2,500 nurses for other work and saves one and a half million pounds per annum in hospital costs. MUNICIPAL LABORATORY Eighty five swabs were examined at Walthamstow under the General Practitioners' Service and sent to the Epping Laboratory for further examination- and report. Owing to staffing difficulties this service was discontinued at the end of April, 1947, and daily collection is now effected by motor transport from Epping. Other swabs sent to the Epping Laboratory during the year: — School Medical Service 430 Health Department 166 VACCINATION Mr. E. Meddings, Vaccination Officer for the area, has furnished the following return for 1947 : — Births Registered Successfully Vaccinated Percentage Vaccinated Insus' ceptiblc Exemptions Deaths before Vaccination Post' poned 2,542 1,466 57.7 5 1,053 40 54 During 1947, the vaccinal condition of all school children examined at Routine Medical Inspections was recorded, and a summary of the findings for the year showed that 20.4 per cent, were vaccinated. PREVENTION OF BLINDNESS No action was necessary under Section 176 of the Public Health Act, 1936, for the prevention of blindness or the treatment of persons suffering from any disease of, or injury to, the eyes. SMALLPOX There were no notifications of this disease during the year. SCARLET FEVER A total of 232 cases of Scarlet Fever was notified during 1947 as compared with 178 in 1946. 41 The following tables show the incidence by months, ages and Wards. The incidence by months and Wards is given below :— January 30 July 23 February 30 August 10 March 18 September 9 April 13 October 17 May 12 November 29 June 10 December 31 Total 232 St. James Street 37 High Street 24 Hoe Street 28 Wood Street 66 Hale End 45 Higham Hill 32 Scarlet Fever is far better nursed at home unless conditions preclude this being done. The last fatal case of Scarlet Fever occurred in 1936, since when (up to the end of 1947) there were 3,150 non-fatal cases. SCARLET FEVER AT AN INSTITUTION A considerable outbreak of mild Scarlet Fever occurred at a residential Home for children with an associated elementary school. The outbreak started in November, 1946, the first 3 cases originating in school children. From November to the end of the year there were 8 cases (5 from the Home), in January 9 (5), in February 17 (13), in March 6 (4) and in April 1 (0). The total of persons at risk were about 150 in the Home (including 36 in the Nursery Wing) and 10 staff. There were about 333 on the school roll (including approximately 100 from the Home) with an attendance on the 4th February of 237 including 98 from the Home. Early in February the position was discussed with the Medical Branch of the Ministry of Health and it was agreed that the communities at the Home and the school (but particularly the former) were probably at this time " saturated " with streptococci and that the incidence of Scarlet Fever could be expected to diminish in the near future. In the meantime, there were to be no new admissions. The inspection of the children was arranged and all the young children in the Nursery and all others with rhinitis were swabbed —a total of 59. The results showed 12 of the persons swabbed to be infected with Group A. Streptococci, of which, 6 were type 14 (including one patient recently discharged from the I.D. Hospital). On the same day 6 of the patients in the I.D. Hospital admitted from the Home or school were swabbed and out of 5 Group A findings, 3 were type 14, which was evidently the epidemic strain. The Group Laboratory at Epping found the streptococci to be sulphonamide sensitive and mass medication was carried out at the Home and in the school with the help of the teaching staff. On March 4th, (i.e., after the course of sulphonamide medication), all staff and children were swabbed—a total of 150. The total of swabs positive to Hemolytic Streptococci was 99, of which no less than 54 were Group A, i.e., 35.9 per cent. The percentage of positives in the various dormitories of the Home varied from 22.2 to 58.3. By the time the final reports were received there was some evidence that the epidemic was abating and, in fact, only 1 case occurred in April, and then one each in July, August, October and 2 in November. It is of interest to compare the incidence of Scarlet Fever in the two halves of 1946/47 over the whole Borough. 1946 1947 First Half-Year 83 112 Second Half-Year 88 120 Thirty-two of the cases in this outbreak occurred in the first quarter of the year, followed by only 1, 2 and 3 cases respectively in the remaining three-quarters. Although all the cases were mild, there was naturally considerable anxiety during the outbreak. Grateful acknowledgement must be made of the help and co-operation received from Drs. Bradley and Allison of the Ministry of Health, Dr. Marsh of the Group Laboratory, Dr. O'Callaghan and the authorities concerned with the Home and the school. DIPHTHERIA During the year 38 cases were notified for admission to Hospital as cases of Diphtheria observation. None of these cases was confirmed as Diphtheria. 22 cases were admitted during 1946. No suspect or case is refused admission to hospital, as home treatment of Diphtheria can rarely be adequate unless the disease is extremely mild. Antitoxin continued to be available for free issue to medical practitioners at the Public Health Department during office hours 42 43 and at all times at the Infectious Diseases Hospital, the Fire Station, Forest Road, and at Mr. Gaze's, 10 The Avenue, Highams Park. During 1947, a total of 60 phials, each containing 8,000 units of Diphtheria antitoxin were issued. ENTERIC FEVER There were no cases of Typhoid or Paratyphoid Fever during the year. STAPHYLOCOCCAL FOOD POISONING Information was received on Sunday, 11th May, that some 35 out of 47 persons who had partaken of food at a private party and dance the previous evening had become violently ill within a few hours. Treatment was gliven at the Connaught Hospital which was fortunately nearby, and three of the patients were detained about 24 hours. Various patients, both in Hospital and at home, were seen and samples of all the remaining food were at once taken to the Epping Laboratory. By Monday morning some " liver-sausage " was found to be affected with Staphylococci. A small sample from an adjoining area was likewise affected and further implication was suggested from information received from another person also resident in the same area. The Ministry of Health, the Manufacturers and the Medical Officers of Health of the appropriate areas were at once informed and arrangements were made to collect all the " liver-sausage " as yet unsold. As far as is known all the patients recovered. Subsequently it became known that a carrier at the source of production in another area had apparently infected an ingredient of the fatty outlayer. This outbreak was apparently the most extensive yet recorded, and extended to many parts of the country. Public Health (Infectious Diseases) Regs., 1927. Typhoid Carriers.—Part compensation continues to be paid to a chronic carrier in order to prevent her from following her normal occupation as a cook and to make up her wages as a convenience attendant. DYSENTERY No cases were notified during 1947, as compared with 25 during 1946. ACUTE ANTERIOR POLIOMYELITIS The total notifications during the year were 24. The incidence by months, ages and wards is shown in the following table :— 44  All Under 1-5 5-15 15-25 25-45 45-65 65 & Month. ages. 1 yr. yrs. yrs. yrs. yrs. yrs. over. January — — — — — — — — February — — — — — — — — March 1 — — 1 — — — — April — — — — — — — — May — — — — — — — — June — — — — — — — — July 3 — 1 — 1 1 — — August 10 — 5 3 1 1 — — September 6 — — 3 2 1 — — October 3 1 — 1 1 — — — November 1 — 1 — — — — — December — — — — — — — — Total 24 1 7 8 5 3 — —  St. James High Hoe Wood Hale Higham Month. Street. Street. Street. Street. End. Hill January — — — — — — February — — — — — — March — 1 — — — — April — — — — — — May — — — — — — June — — — — — — July 3 — — — — — August 3 1 — 1 2 3 September — — 2 1 2 1 October 2 — — — 1 — November — — — — — 1 December — — — — — — Totals 8 2 2 2 6 5 Each case was followed up in an investigation sponsored by the Medical Research Council. The proportion of cases in the south-west portion of the Borough was considerable. None of the cases was fatal, but one very severe case of paralysis of all four limbs notlified in September still shows little hope of recovery and still has occasional recourse to an " iron lung." There were no cases of Encephalitis Lethargica, nor of Polioencephalitis. 45 OPHTHALMIA NEONATORUM Five cases were notified during the year, the details being as follows ?— Sex Age Ward Removed to Hospital Remarks F 3 weeks St. James Street Yes Recovered F 9 days High Street No ,, M 9 days Higham Hill No ,, M 11 days Hoe Street No ,, M 4 days Hale End No PUERPERAL PYREXIA See Maternity and Child Welfare Section. PNEUMONIA The indidence by months and Wards is given belqw :— January 20 July 8 February 30 August 3 March 13 September 2 April 13 October 12 May 16 November 11 June 8 December 15 Total 151 Your Council decided to continue the grant to the Waltham stow District Nursing Association, in return for which the Association was, amongst other services, required to provide home nursing facilities for cases of pneumonia. The local practice is for the District Sanitary Inspector to visit on receipt of a notification and to make the necessary enquiries, and opportunity is taken to deal with any obvious defects in sanitation which may be found. Otherwise there is little gained by notification. ERYSIPELAS The incidence by months and Wards is given below :— January 6 July 2 February 2 August — March 6 September 5 April 3 October 6 May 8 November 2 June 2 December 6 Total 48 St. James Stree26 High Street 23 Hoe Street 26 Wood Street 19 Hale End 27 Higham Hill 30 46 St. James Street8 High Street 9 Hoe Street 6 Wood Street 2 Hale End 9 Higham Hill 14 CEREBRO SPINAL MENINGITIS Nine cases were notified during the year, the details being as follows :— No. Ward. Age. Date notified. Hospital. Remarks. 1 H.E. 41 years 4. 3.47 Yes Recovered 2 H.H. 17 years 25. 3.47 Yes do. 3 Hi. St. 5 months 27. 4.47 No Died—P.M. 4 St. J. St. 17 years 18. 5.47 Yes Recovered 5 St. J. St. 45 years 29. 5.47 Yes do. 6 H.H. 30 years 29. 7.47 Yes do. 7 H.E. 15 years 15. 8.47 Yes do. 8 W. St. 9 years 13.12.47 Yes do. 9 Ho. St. 9 months 13.12.47 Yes do. MALARIA There were no cases notified during the year. MEASLES The incidence by months and Wards is given below :— January 14 July 29 February 34 August 7 March 28 September 1 April 188 October 3 May 553 November 1 June 215 December 8 Total 1081 St. James Street 184 High Street 164 Hoe Street 161 Wood Street 108 Hale End 188 Higham Hill 276 There were two deaths. 47 WHOOPING COUGH The incidence by months and Wards is given below:— January 4 July 12 February 8 August 16 March 22 September 27 April 18 October 15 May 17 November 16 June 10 December 58 Total 223 St. James Street . 40 High Street 17 Hoe Street 26 Wood Street 22 Hale End 55 Higham Hill 63 There were no deaths. TUBERCULOSIS The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1947:— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year 1 — — — — — — 2 1-5 years 2 — — 1 — — — — 5-10 „ 1 5 3 2 — 1 — — 10-15 „ — — — 3 — — — — 15-20 „ 8 12 2 3 1 2 — — 20-25 „ 18 10 1 1 2 4 — 1 25-35 „ 14 11 — 1 4 4 — 1 35-45 „ 14 7 1 1 9 10 — — 45-55 „ 10 2 — 1 3 1 — — 55-65 „ 9 2 — — 2 2 — — 65 and over 3 — 2 — 7 1 1 — 80 49 9 13 28 25 1 4 Totals 129 22 53 5 151 58 The 58 deaths represent a death rate of 0.47 per 1,000 population. New cases in 1946 were 167 with 58 deaths—a rate of 0.5. 48 The returns for the past two years are compared bdow:— Year. New Cases. Deaths. Pulmonary. NonPulmonary. Total. Pulmonary. NonPulmonary. Total. M. F. M. F. M. F. M. F. 1947 80 49 9 13 151 28 25 1 4 58 1946 82 60 14 11 167 30 16 10 2 58 The period elapsing between notification and death and the number of cases not notified were as follows:— Under 3 months. 3 to 6 months. 6 to 9 months. 9 to 12 months. Over 12 months. Not notified. Notified after death. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. 5 — 2 1 1 1 2 — 30 2 11 1 2 — The ratio of deaths in non-notified cases (i.e., columns to the right of the double line) to total deaths from tuberculosis was 14 to 44 or 1 to 3.1. Appropriate action was taken when necessary with regard to non-notification. The table given below shows the number of cases on the register at the beginning and end of 1947:— Pulmonary. Total. NonPulmonary. Total. Grand Total. M. F. M. F. No. on Register 1st January 1,009 887 1,896 490 397 887 2,783 Notified during 1947 80 49 129 9 13 22 151 Totals 1,089 936 2,025 499 410 909 2,934 Removed from Register, 1946 50 50 100 8 8 16 116 No. on Register 31st December 1,039 886 1,925 491 402 893 2,818 49 Removals from the Register were made up as follows:— Deaths. Removals. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 28 25 1 4 22 25 7 4 53 5 47 11 58 58 116 Treatment of Tuberculosis.—Treatment is given under the Essex County Council's Scheme. The admissions to Hospital during 1947 were as follows:— [ Pulmonary. Non-Pulmonary. Total, 1947. Total, 1946. M. F. M. F. Adults 52 59 8 12 131 139 Children 6 4 3 4 17 20 G.—INFECTIOUS DISEASES HOSPITAL General.— (i) The death rate per 100 admissions was 3.2. (ii) The following table shows the admissions, discharges and deaths during 1947:— Scarlet Fever. Diphtheria. Other Diseases. Tuberculosis. Totals. Remaining in Hospital 1st January, 1947 17 17 17 51 Admitted during year 241 4 257 26 528 Discharged during year 237 4 250 21 512 Died during year — — 12 5 17 Remaining in Hospital 31st December, 1947 21 — 12 17 50 DAILY AVERAGE NUMBER OF PATIENTS IN HOSPITAL (including Tuberculosis cases) January 47.1 July 40.7 February 54.8 August 39.6 March 47.8 September 35.2 April 46.8 October 39.2 May 45.5 November 42.2 June 39.1 December 47.8 Average whole year 43.8 50 The question of staffing, both nursing and domestic, gave rise to continued anxiety during the year, especially in regard to the recruitment of probationers. An illustrated brochure entitled "The Story of a Nurse" was prepared with a view to stimulating the recruitment of probationers. Unfortunately the position remains as grave as ever, and no real solution of the difficulty appears possible until conditions in regard to salary and hours are made comparable with those in industry and commerce. Training.—During 1947, four probationers passed the final examination for the Fever Nursing Certificate of the General Nursing Council. The examination fees of probationers are paid by the Council. CLINICAL REPORT Dr. M. Hamilton, Resident Medical Officer, reports as follows:— AGE AND SEX OF PATIENTS ADMITTED DURING 1947 Under 5 years. 5-10 years. 10-15 years. Over 15 years. Total. Grand Total. M. F. M. F. M. F. M. F. M. F. Scarlet Fever 30 30 41 84 16 25 8 7 96 146 241 Diphtheria 1 1 — 1 1 — — — 2 2 4 Measles 26 12 10 11 — — 1 1 37 24 61 Cerebro-Spinal Meningitis 1 — — — — — 1 2 2 2 4 Whooping Cough 12 8 4 2 — — — — 16 10 26 Dysentery 1 1 — — — — 2 1 3 2 5 Acute Poliomyelitis 6 4 3 3 4 — 5 4 18 11 29 Phthisis — — — — — — — 26 — 26 26 Other Diseases 32 16 9 4 4 3 17 32 62 55 117 Staff — — — — — — — 15 — 15 15 Totals 109 72 67 105 25 28 34 88 235 293 528 NUMBER AND NATURE OF OUTSIDE AUTHORITIES CASES ADMITTED DURING THE YEAR Measles. Diphtheria. Scarlet Whooping Others. Total. Fever. Cough. Leyton 26 4 93 12 55 190 Barking — — 3 — 2 5 Whipps Cross Hospital 3 — — — 7 10 Aldersbrooke Homes 2 — 1 — 4 7 H.M. Forces — — — — 1 1 Totals 31 4 97 12 69 213 51 SEX AND AGE AT DEATH Seventeen deaths occurred, details of which are given below:— 5 Pulmonary Tuberculosis Females, aged 24, 31, 31, 33 and 34 years. 3 Gastro-enteritis Males, aged 4½ months, 17 days and years. 2 Broncho-pneumonia Males, aged 13 months and 71 years. 1 Cerebral Haemorrhage complicating Whooping Cough Female, aged 5 years. 1 Broncho-pneumonia complicating Whooping Cough Male, aged 3½ years. 1 Broncho-pneumonia complicating Measles Male, aged 6 months. 1 Acute Poliomyelitis Male, aged 33 years. 1 Broncho-pneumonia complicating congenital heart disease Male, aged 4 months. 1 Pulmonary embolism complicating congenital heart disease Male, aged 2½ years. 1 Pyæmia Female, aged 37 years. Duration of Treatment.—The average duration of treatment in hospital was as follows:— Scarlet Fever 21.2 days Other diseases 16.4 days Diphtheria 58.3 days 52 The County Medical Officer has kindly furnished the following return of patients treated in the Tuberculosis Pavilion during 1947: — Classification in accordance with Ministry of Health Memorandum 37.T. (Rev.) In Hospital on 1st January, 1947. Admitted during year. Discharged during year. Died during year. In Hospital on 31st December, 1947. Observation — — — — — T.B. Minus 6 12 10 1 7 T.B. Plus Group I 2 7 4 2 3 T.B. Plus Group II 9 11 11 1 8 T.B. Plus Group III 1 — — 1 — Totals 18 30 25 6 18 15 of the 30 admissions were Walthamstow cases. MISCELLANEOUS 1. Grants—Your Council made the following grants during the year to voluntary organisations:— Invalid Children's Aid Association £100 Walthamstow Association of Tuberculosis Care Helpers £25 2. Mortuary.—A Coroner's Court, mortuary (with special provision for infectious disease cases) and a post-mortem room is provided by your Council at Queens Road Cemetery. The Cemetery Superintendent reports that the number of inquests and post-mortems were as follows:— Inquests only 67 Post-mortems 146 Post-mortems and Inquests (not included in above) 42 Total 255 3. Cremation.—Facilities for cremation are available at the Crematorium provided by the City of London at Manor Park, Little Ilford. 53 4. Medical Examinations.—During the year, 107 examinations were carried out by the Medical Staff in respect of the Superannuation and Sick Pay Schemes. 5. Domestic Help.—The total number of families assisted under this Scheme during 1947 was seven. There were eight additional applications eligible for financial assistance under the Scheme, but it was not possible to assist owing to lack of domestiic helpers. Also there were nine "overscale" applications. Names and addresses of helpers were given where possible. During the early part of the year there were a number of applicants for posts as Domestic Helpers, but in many cases they would not accept the few hours work required by householders. In the latter part of the year the number of applications for Domestic Help far outnumbered the helpers available. Separate particulars are given in regard to Home Helps. 6. Supply of Insulin.—Twelve patients were supplied with Insulin in accordance with Circular 2734/1943, at a total cost to the Council of £20 18s. 0d. 7. Health Centres.—At the request of the County Medical Officer the sites suggested for Health Centres were discussed with representatives of the medical, dental and pharmaceutical professions. 8. Local Government Exhibition.—Dr. M. Watkins has contributed the following report:— " A Local Government Exhibition was held in the Council's Assembly Hall from 27th September to the 4th October. The Health Section of the Exhibition portrayed the work carried out by the Council's Health Department and also the medical services for which the Essex County Council were responsible. The whole occupied 48 linear feet and was divided up into four sections:—(i) Maternity and Child Welfare, (ii) School Health Services, (iii) Other Health Services and (iv) Essex County Council Medical Services. (i) Maternity and Child Welfare. "The work carried out at Thorpe Coombe Maternity Hospital was fully illustrated with charts, photographs and models. A Synchrophone livened the exhibit and was a great source of attraction. "Domiciliary midwifery was illustrated in the form of a model of a bedroom prepared for confinement. There were also displayed a gas and air apparatus for analgesia, a midwife's bag and a layette. 54 "The work of the Health Visitors was shown in photographs, statistical charts, models of weaning diets and tweenie diets, and nutrition trays were on view. "Day Nursery activities were attractively displayed in models and photographs. "A Ministry of Food exhibit was included in this section. "The whole was set off by a beautiful array of baby clothes which the mothers are taught to make in the mother craft classes. (ii) School Health Services. "The greater part of this section was taken up by the Dental Services, whose display of ancient and modern dentures and illustrations of good and bad teeth aroused much interest. "The remainder was devoted to depicting the special clinics run in conjunction with School Health work. "The Eye Clinic was represented by the various instruments used for remedial ocular exercises. The Aural Clinic displayed an audiometer for testing hearing and various instruments used in the conservative treatment of ear, nose and throat defects, e.g., ionisation for chronic otorrhoea. "The activities of the Speech Clinic was cleverly portrayed in a series of figures. "The Child Guidance Clinic contributed a very useful pamphlet detailing the kind of work carried out. Copies of literature on the subject were on view. "The Orthopædic Clinic had a series of X-ray films on view showing anatomical deviations from the normal of various parts of the body, and also photographs of remedial therapy. "Attention was directed to the work of the Foot Clinic by models of the perfect foot and the ideal foot-wear. "The Rheumatism Clinic, Minor Ailment Clinic and Skin Clinic were also illustrated. (iii) Other Health Services. "The biggest part of this section was taken up by the Sanitary Inspectorate with exhibits of an ideal dairy, drains rodent control, food and drugs, milk sampling outfits, sound and unsound food, etc. These were amplified by posters and photographs. "Focus on infectious disease was attained by a live exhibit of a Nuffield artificial respirator in action with a life size model of a patient. This attracted a great deal of attention as it was topical—at the time we were in the middle of the Poliomyelitis epidemic. It served to reinforce the exhibit and the propaganda for Diphtheria immunisation (located nearby). 55 "Photographs and statistical charts showed the work of the Ambulance Service. "Space was alloted to the Blood Transfusion Service in this section. (iv) Essex County Council Services. "The medical services operated by the Essex County Council were attractively displayed, considering the shortage of space. Films. "Various films covering many aspects of health were shown in one of the Committee rooms in the Town Hall throughout the week. "The whole exhibition was a marked success, over 20,000 people having visited it during the course of the week. "From the aesthetic point of view the Health Section left much that was to be desired owing to woefully inadequate space allocated to it as compared to some other sections. There was so much material that had to be packed into such a small space which could have been attractively displayed. "In spite of this it was really gratifying to note the intense interest displayed by the public in our sectlion and there always seemed to be a concentration of people around the stands eagerly asking questions. "The co-peration of the staff of the department in assembling the exhibits and giving their time to answer questions put to them is a matter for congratulation." 56 SECTION H MATERNITY AND CHILD WELFARE COMMITTEE Chairman: Councillor Mrs. E. A. Smith, J.P. (deceased). Ex-officio: The Worshipful the Mayor—Alderman S. N. Chaplin, J.P. Chairman of Finance Committee—Alderman Ross Wyld, O.B.E., J.P. Alderman Mrs. C. McEntee, J.P. Alderman Mrs. E. M. Miller. Councillor E. G. Baily. „ Mrs. R. Baily. „ W. E. Barnes. „ Mrs. L. P. Bailey. „ Mrs. Bottomley. „ Mrs. Candy. Councillor Mrs. Christy. „ Mrs. Frewin. „ Mrs. Flint. „ E. G. Richards „ Mrs. Tillyer. ,, Mrs. Tweed. Co-opted Members: Miss A. Bowers. Mrs. Cooper. Dr. M. Ercolani. Mrs. Holsworth. Mrs. M. H. Jarman. Mrs. G. E. Nicholls. Mrs. Riley. Mrs. Williams. 57 TO THE CHAIRMAN AND MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE Ladies and Gentlemen, The work of your Maternity and Child Welfare Services during 1947 is reported in the following pages—and for the last complete year under your direct control. It is good to be able to report that the year has been very noteworthy, i.e., new low records of 29 in infant mortality, of 21.6 in the stillbirth rate and of 13.1 in the death rate of the newly born. These new low records were scored in a year with a very high number of births—2,781 were notified as compared with 2,564 in 1946. Of these 2,781 births, 2,670 took place in the Borough— also a new record. The high birth rates of previous years were reflected in the welfare attendances of nearly 73,000 at all welfare centres, including "Brookscroft." These achievements reflect the highest credit on all concerned in Maternity and Child Welfare work in your Borough—the staff at Thorpe Coombe Maternity Hospital, the District Midwifery Sisters and the staff at all Welfare Centres, both Municipal and voluntary. The table of comparative statistics on page 61 shows the very favourable rates in Walthamstow. I would once more wish to record your help and consideration. I am, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. STAFF Resignations Friel, Mrs. E. C Health Visitor 28.6.47 Mitchell, Miss I. V. Health Visitor 31.4.47 Ramsay, Miss M. C Health Visitor/School Nurse 31.1.47 Appointments Cunnington, Miss E. L Health Visitor/School Nurse 6.1.47 duRaridt, Miss E Health Visitor/School Nurse 1.5.47 NOTIFICATION OF BIRTHS 2,781 births (92 of which belonged to other areas) were notified during the year under the Public Health Act, 1936. Notifications were received as follows:—Doctors and Parents, 272; Midwives, 2,509. Included in the above are 292 births which were notified as having occurred outside the Borough. Also included are 49 stillbirths, 48 of which were notified by Midwives. Of the total, two occurred outside the area. 58 REGISTRATION OF BIRTHS The Registrar-General's returns show the following registrations during the calendar year:— (a) Live Births. Males. Females. Totals. Legitimate 1,332 1,265 2,597 Illegitimate 36 37 73 1,368 1,302 2,670 (b) Stillbirths. Males. Females. Totals. Legitimate 31 24 55 Illegitimate — 4 4 31 28 59 The stillbirth rate per 1,000 population was 0.48. Of the 2,489 birth registrations received in the Department between 4th January, 1947, and 27th December, 1947, a total of eighteen were not notified in this area, but some may possibly have been notified elsewhere. Appropriate action was taken when necessary. Of the 2,489 local registrations, 163 belonging to other areas are excluded, leaving a nett total of 2,326. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Total. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Totals 177 176 138 147 192 196 173 150 236 225 287 229 1,203 1,123 Grand Totals 353 285 388 323 461 516 2,326 The following figures show the registrations of births during the past 18 years :— 1930 1,959 Average for 10 years 1,736 1940 1,575 Average for 8 years 1,906 1931 1,947 1932 1,789 1941 1,304 1933 1,670 1942 1,718 1934 1,715 1943 1,828 1935 1,670 1944 1,915 1936 1,715 1945 1,713 1937 1,675 1946 2,544 1938 1,617 1947 2,650 1939 1,606 During the first six months of the current year 1,163 births have been notified. This would give an approximate total for the year of 2,326. 59 VITAMINS The facilities for the distribution of vitamins outlined in the 1942 Report were continued at all Welfare Centres. The average position of Walthamstow out of a total of 95 distributing centres in the Greater London Area during the year is shown below:— Percentage of Potential Orange Juice Cod Liver Oil A. & D. Tablets 47.09 33.27 41.02 There is room for considerable improvement in these percentages and every effort is being made to increase the demand. DAY NURSERIES The following table shows the average attendances at the Nurseries during 1947 (Mondays to Fridays only). Month. Nurseries. Over 2 yrs. Under 2 yrs. Total. January Higham Hill 31.4 10.8 42.2 Handsworth Ave. 38.9 6.9 45.8 February Higham Hill 29.6 6.5 36.1 Handsworth Ave. 34.0 8.8 42.8 March Higham Hill 36.5 9.1 45.6 Handsworth Ave. 36.1 6.8 42.9 April Higham Hill 36.4 11.5 47.9 Handsworth Ave. 25.8 4.0 29.8 May Higham Hill 23.2 7.3 30.5 Handsworth Ave. 36.4 6.4 42.8 June Higham Hill 41.3 10.9 52.2 Handsworth Ave. 37.6 7.9 45.6 July Higham Hill 39.8 10.3 50.1 Handsworth Ave. 32.6 7.2 39.8 August Higham Hill 40.5 12.4 52.9 Handsworth Ave. 33.8 8.7 42.5 September Higham Hill 45.9 12.0 57.9 Handsworth Ave. 40.2 10.8 51.0 October Higham Hill 43.1 11.5 54.6 Handsworth Ave. 40.4 13.1 63.5 November Higham Hill 42.9 12.6 55.5 Handsworth Ave. 41.8 11.6 53.4 December Higham Hill 42.6 12.6 55.2 Handsworth Ave. 41.5 11.5 53.0 Whole Year Higham Hill 37.8 10.6 48.4 Handsworth Ave. 36.6 8.6 45.2 60 Training.—Six probationers obtained the Nursery Nurses Certificate. The Council agreed to pay the examination fees of probationers. Hours of Opening.—The Nurseries were open Monday to Friday from 8 a.m. to 5.30 p.m. throughout the year. INFANT MORTALITY The deaths of infants under one year were:— Males. Females. Totals. Legitimate 52 24 76 Illegitimate — 1 1 Totals 52 25 77 The death rate of infants under one year of age per 1,000 live births when calculated on the totals given by the RegistrarGeneral are therefore:— Legitimate, 29; Illegitimate, 13; Total, 29. The total rate constitutes a new low record, which, in addition, was scored with a very much increased number of total births. The previous lowest rate was just over 29 in 1939, but in that year there were only 1,606 births as compared with 2,670 in 1947. The Infant Mortality Rate for other areas during 1947 was as follows:— England and Wales 41 126 County Boroughs and Great Towns (including London) 47 148 Smaller Towns (25,000 to 50,000) 36 London 37 Statistics—The statistics shown on the page overleaf are quoted to compare the Infant Mortality rates in Walthamstow with those for the whole country. The Walthamstow rates are considerably lower and the rate of 29 for 1947 is particularly favourable, especially having regard to the large increase in total births during the year. 61 SOME STATISTICS FOR ENGLAND AND WALES AND WALTHAMSTOW Period Population Per 1,000 population Infant Mortality per 1,000 Live Births Still Birth Rate per 1,000 Total (Live and Still) Births Maternal Mortality Rate Death Rate Birth Rate Under one month One month to one yr. Total E.W. W. E.W. W. E.W. W. E.W. W. E.W. W. E.W. W. E.W. W. E.W W. 1911-20 35,682,000 127.400 14.4 11.1 21.8 21.4 38 33 62 46 100 79 — — 3.84 3.15 1921-30 38,960,000 127,000 12.1 10.0 18.3 17.6 33 25 39 28 72 53 — — 4.26 3.38 1931-40 40,587,000 131,000 12.3 10.6 14.9 12.9 30 23 29 22 59 45 39.6 34.7 3.78 2.75 1941-45 38,149,000 99,576 12.8 12.6 15.9 16.9 26 22 24 17 50 39 30.5 29.0 2.23 3.4 1946* 40,909,000 118,050 12.0 11.2 19.1 21.5 22 19 21 15 43 34 27.2 26.7 1.43 0.76 1947* 42,006,000 122,470 12.3 10.7 21.1 21.8 23 13 18 16 41 29 24.0 21.6 1.17 1.46 E.W. England and Wales. W. Walthamstow. — Not separately recorded. * All rate for 1946 and 1947 are provisional. 62 Neo-Natal Mortality. The neo-natal mortality is the number of deaths of infants under one month per 1,000 live births. During 1947, 35 infants died in the first four weeks of life, yielding a rate of 13.1. For the last ten years in England and Wales the neo-natal deaths have been approximately half the deaths under one year of age. Infant Deaths, Neo-Natal Mortality and Stillbirths Year. Live Births. Birth Rate. Stillbirths. Neo-Natal Deaths. Infant Deaths. No. Per 1,000 live births. Per 1,000 population. No. Per 1,000 live births. No. Per 1,000 live births. W'stow. England & Wales. 1947 2,670 21.8 59 21.6 0.48 35 13.1 23.0 77 29 1946 2,544 21.5 70 27.5 0.59 49 19.2 24.5 87 34 1945 1,713 16.5 56 32.6 0.54 36 21.0 24.8 66 38 1944 1,915 18.9 52 27.1 0.51 40 20.8 24.3 71 37 1943 1,828 18.2 58 30.7 0.57 48 26.2 25.2 73 40 The neo-natal mortality for England and Wales is shown for comparison and is higher than the Walthamstow rates with the exception of 1943. The death rate from Diarrhoea and Enteritis in children under one year of age per 1,000 live births was 2.2. TOTAL INFANT MORTALITY This is defined as the sum of the deaths that occur during child birth and during the first year of life. The attached graph shows the position since 1930 and that the 1947 total Infant Mortality was the lowest recorded. 63 CARE OF ILLEGITIMATE CHILDREN The action taken under Circular 2866/1944 is fully set out in the report for that year. The Council has an agreement with the Walthamstow Moral Welfare Association, which provides a hostel of 19 beds staffed by three whole-time workers. The chief difficulties in 1947 were again to secure accommodation for confinements and suitable foster mothers. The local Day Nurseries helped very considerably. Every possible step has, as in previous years, been taken to ensure that the care of illegitimate children does not fall below that given to children who are legitimate. The figures quoted below give a comparison between illegitimate and legitimate rates. 64 Illegitimate Births and Mortality Year. Live Births. Infant Deaths. Death Rates. Legitimate. Illegitimate. Legitimate. Illegitimate. Legitimate. Illegitimate. 1938 1,572 45 63 3 40.0 66.0 1939 1,566 40 45 — 29.0 — 1940 1,535 40 56 4 41.0 100.0 1941 1,254 50 50 2 40.0 40.0 1942 1,662 56 67 3 40.0 53.0 1943 1,767 61 71 2 40.0 32.0 1944 1,825 90 68 3 37.0 33.0 1945 1,614 99 61 5 37.0 50.0 1946 2,453 91 81 6 33.0 66.0 1947 2,597 73 76 1 29.0 13.0 Miss Williams, Superintendent of the Home provided by the Walthamstow Branch of the Chelmsford Diocesan Moral Welfare Association, states that the number of cases dealt with were as follows:— Number of cases admitted from other areas 107 Number of Babies 62 Number of Walthamstow cases 26 Total admissions 195 In approximately half the Walthamstow cases the maintenance was paid by the Public Assistance Committee. Improvements have now been effected with regard to the bathroom arrangements, and a refrigerator has been installed. The Home was recently inspected by a Medical Inspector from the Home Office, who seemed to be entirely satisfied with the general tone of the Home and the routine of the Nursery. The closest co-operation exists between Miss Williams and your Council's Health Visitors. CARE OF PREMATURE INFANTS The action suggested in Circular 20/44 has been carried out as far as possible and the steps taken were detailed in the report for 1944. During 1947, 26 premature babies were born at home and 78 in Hospitals and Nursing Homes in the area. Of the 26 premature babies born at home, 13 were entirely nursed at home, one died during the first 24 hours (i.e., 3.8%) and 21 survived at the end of one month (i.e., 80.8%). Of the 78 premature babies born in Hospital, one died during the first 24 hours (i.e., 1.3%) and 73 survived at the end of one month (i.e., 93.6%). The table "Causes of Death" which follows includes seven deaths from premature birth as compared with 22 in 1946. 65 CAUSES OF DEATH OF CHILDREN UNDER 1 YEAR OF AGE Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total deaths under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under 1 year. St. James St. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Total. Influenza — — — — — — — — — — — — — — — — — Measles — — — — — — — 1 — 1 — — 1 — — — 1 Whooping Cough — — — — — — — — — — — — — — — — — Diphtheria — — — — — — — — — — — — — — — — — T.B. Meningitis — — — — — — — — — — — — — — — 1 1 Phthisis — — — — — — — — — — — — — — 1 — 1 Other forms of T.B. — — — — — — — — — — — — — — — — — Meningitis (Non-T.B.) — — — — — — 1 1 — 2 — 1 — — — 1 2 Convulsions — — — — — — — — 1 1 — — — — — 1 1 Bronchitis — — — — — 1 2 — — 3 1 — — — 1 1 3 Pneumonia (all forms) — 1 — 1 2 1 1 1 2 7 — 3 1 2 1 — 7 Diarrhoea, — — — — — 1 1 3 1 6 1 — 1 — 2 2 6 Syphilis — — — — — — — — — — — — — — — — — Rickets — — — — — — — — — — — — — — — — — Inattention at birth, wilful neglect — — — — — — — — — — — — — — — — — Suffocation (overlaying) — — — 1 1 1 1 — — 3 — 1 — — — 2 3 Injury at birth — — — — — — — — — — — — — — — — — Atelectasis 8 — — — 8 1 — — — 9 1 2 1 3 — 2 9 Congenital malformation 6 2 — — 8 1 3 — 1 13 3 1 1 — 3 5 13 Premature birth 5 — 2 — 7 — — — — 7 — 1 1 2 1 2 7 Atrophy, debility, marasmus — — — 1 1 — 1 — — 2 — 1 1 — — — 2 Inanition — — — — — — — — — — — — — — — — — Heart failure 1 — — — 1 — — — — 1 1 — — — — — 1 Other causes 2 5 — — 7 7 5 — 1 20 2 2 3 4 4 5 20 Totals 22 8 2 3 35 14 16 6 6 77 9 12 10 11 13 22 77 66 CHILD WELFARE The equivalent of whole'time Health Visitors at the end of the year was eight, equal to one whole'time Health Visitor per 300 notified births, and one whole-time Health Visitor per 334 registered births during 1947. MATERNITY AND CHILD WELFARE CLINICS Monday 2 p.m. Ante & Post-Natal Markhouse Road, E.17. *Tuesday 9 a.m. „ „ „ „ „ „ Wednesday „ „ „ „ „ „ „ * New cases only. Monday 2 to 4 p.m. Child Welfare St. John's Church Hall, Penrhyn Ave., E.17. Tuesday „ „ „ The Memorial Hall, Winchester Rd., E.4. Wednesday „ „ „ Low Hall Lane, Mark- house Road, E.17. Wednesday „ „ „ "Brookscroft," Forest Road, E.17. Thursday 10 to 12 noon. „ „ The Memorial Hall. Winchester Rd., E.4. Thursday 2 to 4 p.m. „ „ Low Hall Lane, Mark- house Road, E.17. Thursday „ „ „ St. John's Church Hall, Penrhyn Ave., E.17. Thursday „ „ „ " Brookscroft," Forest Road, E.17. Friday „ „ „ Low Hall Lane, Mark house Road, E.17. In addition, the Walthamstow Child Welfare Society holds massage and sunlight sessions. MUNICIPAL SCHEME The detailed findings at first visits paid during 1947 are given in the following table:— 67 From the above table it will be seen that of 2,674 children, 2,131 or 79.7% were breast fed on first being visited, and 15 or How Fed. Sleeping Arrangements. Condition of Baby. Accommodation. Breast Breast & Hand Hand With Mother Cot or Cradle Good Fair Bad Whole house Flat Half house Three rooms Two rooms One room St. James Street 312 53 24 1 388 305 79 5 126 62 89 11 34 67 High Street 255 35 33 — 323 293 28 2 86 179 9 9 28 12 Hoe Street 317 55 53 4 421 380 44 1 114 116 89 16 39 51 Wood Street 260 32 55 3 344 336 11 — 63 107 60 83 18 16 Hale End 469 41 69 2 577 561 18 — 274 138 89 6 34 38 Higham Hill 518 57 36 5 606 573 26 12 403 123 34 2 28 21 Total 1947 2,131 273 270 15 2,659 2,448 206 20 1,066 725 370 127 181 205 1946 1,928 203 183 26 2,288 2,118 180 16 1,029 703 248 149 97 88 PRE-WAR (1938) 1,305 146 169 48 1,572 1,429 183 8 317 293 122 60 17 Percentages 1947 6.8 7.6 1938 3.7 1.0 68 0.56% had no separate sleeping accommodation. 513 infants lived in accommodation of three rooms or less, as compared with 334 in 1946 Ward. Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. Unsuccessful Visits. Visits to Nurse Children. Ante-Natal Visits. Other Visits. Total Visits. The following table shows the number and nature of visits paid during 1947:— First. Subsequent visits. Total. First Visits. Subsequent Visits. Total Visits. 1 2 3 4 5 6 7 — — 8 9 Cols. 5-9 St. James St. 389 542 931 909 1,840 452 18 109 40 149 270 2,729 High Street 323 670 993 826 1,819 293 7 50 11 61 117 2,297 Hoe Street 425 794 1,219 986 2,205 628 32 5 — 5 249 3,119 Wood Street 347 344 691 345 1,036 160 24 36 7 43 103 1,366 Hale End 579 1,679 2,258 1,604 3,862 288 36 71 36 107 285 4,578 Higham Hill 611 1,566 2,177 2,558 4,735 299 27 66 38 104 318 5,483 Totals, 1947 2,674 5,595 8,269 7,228 15,497 2,120 144 337 132 469 1,342 19,572 Totals, 1946 2,314 4,417 6,731 6,466 13,197 2,021 112 436 134 570 1,130 17,030 69 INFESTATION The steps taken to combat infestation include cleanliness inspections by School Nurses once per term, treatment at School Clinics (which includes supply of Lethane and of steel combs) and inspection and treatment for scabies and pediculosis at the Skin Clinic. In addition educational work is carried out at all Walthamstow Schools, Day Nurseries and Welfare Centres. CLINICS Dr. M. Sheppard, reports as follows "The Council's Welfare Clinics are held at three centres in the Borough and all three centres were well attended. "The births in the district during 1947 were 2,670, and the number of new babies seen at the Welfares was 2,032—and as there is a voluntary welfare also functioning I think one may feel happy about the care given to the babies in Walthamstow. "The attendances at the Post-Natal Clinic are still not good enough, being only 26% of the attendances at the Ante-Natal Clinic. "During 1947, 574 children under five years of age were immunised at the Welfare Centres—31% of all under-fives immunised in the district. "Again thanks are due to the voluntary workers at all the Welfare Centres." Ante-Natal and Post-Natal Services The following table summarises the attendances at the Clinics held:— New Patients:— Ante-Natal. Post-Natal. Thorpe Coombe Maternity Hospital 1,275 902 Low Hall Lane Clinic 746 195 Totals 2,021 1,097 The percentage of Ante-Natal cases to notified births was 72.6. Total Attendances:— Ante-Natal. Post-Natal. Thorpe Coombe Maternity Hospital 10,511 1,397 Low Hall Lane Clinic 1,566 292 Totals 12,077 1,689 70 Welfare Clinics Attendances at the Municipal Welfare Clinics are summarised in the following table:— Summary of Attendances at Welfare Clinics Clinic. First Attendances of New Cases. Re-attendances. Grand Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Markhouse Road 939 43 982 14,512 11,070 25,582 26,564 Higham Hill 574 21 595 9,407 5,538 14,945 15,540 Hale End 519 17 536 8,586 6,394 14,980 15,516 Total 1947 2,032 81 2,113 32,505 23,002 55,507 57,620 1946 1,471 236 1,707 22,814 19,004 41,818 43,525 Child Life Protection.—At the end of 1947 there were 27 nurse-children on the register, compared with 30 at the end of 1946. There were no deaths among nurse-children during 1947. Number on Register, 31.12.46 30 New Registrations 11 41 Deduct: Removals from District 9 Number reaching the age of 9 years 2 Number adopted 2 Not now within meaning of the Act 1 14 Number on Register, 31.12.47 27 In addition there were 91 children under nine years in homes and institutions exempted from visiting. The following is the information required by Circular 2790 of the Ministry of Health with regard to the Adoption of Children (Regulation) Act, 1939:— (a) Number of persons who gave notice under Section 7 (3) during the year 16 (b) Total number of children in respect of whom notice was given under Section 7 (3) during the year 16 71 (c) No. of children notified under Section 7 (3): — (i) Under supervision at the end of the year 15 (ii) Who died during the year Nil (in) On whom inquests were held during the year Nil (d) Particulars of any proceedings taken during the year Nil The arrangements in force with regard to Child Life Protection remain as detailed in the 1945 Report. Adoption.—Close co-operation exists with the Education Department's Attendance Officers, and a Health Visitor's report is given in regard to each application. Similar action is taken in cases referred from adoption societies and Public Assistance Officers. Sixteen persons gave notice under Section 7 of the Adoption of Children (Regulation) Act, 1939. All these children except one were under supervision at the end of the year and no legal proceedings were ne'cessary. Massage.—Six sessions per week were held at the Welfare Centres, i.e., Low Hall Lane, Monday, Tuesday, Thursday and Friday; Highams Park, Tuesday; and Higham Hill, Wednesday. 201 cases attended for massage and these made 2,692 attendances. Sale of Milk, etc., at Clinics.—The quantity and value of milk and food sold and issued free during 1947 was as follows:— Sales Free Issue lbs. ozs. lbs. ozs. Cow & Gate 20,934 — 238 — Ostermilk 6,690 — 30 — Ambrosia 1,933 — 3 — Trufood 1,356 — — — Lactogen 7,517 — 133 — Prune and Banana Syrup 112 8 — — Parrishes Food 123 12 — — Cod Liver Oil 10 8 — — Cod Liver Oil and Malt 986 — — — Cod Liver Oil Emulsion 488 — — — Cream of Magnesia 254 — — — Virol 1,071 — — 8 Virolax 95 — — — Roboleine 1,047 — — — Farex 1,687 8 — 8 Ovaltine 2,177 8 — — 72  Sales Free Issue lbs. ozs. lbs. ozs. Marmite 2,270 10 — — Glucose 88 — — — Maltoline 900 10 3 2 Adexolin 21 4 — — Midlothian Oat Food 2,119 — — — Allergilac 42 — — — Bemax 295 — — — Robinson's Groats 60 — — — Halibut Oil Emulsion 14 bottles — — Halibut Oil Tablets 25 packets — — Calfos 34 packets — — Value £5,905 2s. 7d. WALTHAMSTOW CHILD WELFARE SOCIETY The organisation, staffing and accommodation provided by the Society was fully dealt with in the 1935 Report. Clinics are held as follows:— Tuesday Friday, 2 to 4 p.m. Wednesday, 2 to 4 p.m. Thursday, 2 to 4 p.m. Massage and Sunlight Treatment. Weighing Clinic and Dispensary Treatment. Infant Consultations. The work done during the calendar year is shown in the following table compiled from information kindly supplied by Miss D. Carter: — Clinics First Attendances of New Cases. Re-attendances. Grand Total. Under 1 yr. 1-5 yrs. Total. Under 1 yr. 1-5 yrs. Total. 1947 697 64 761 11,074 3,353 14,427 15,188 1946 690 79 769 9,631 2,988 12,619 13,388 1945 545 55 600 7,211 2,348 9,559 10,159 1944 421 39 460 6,140 1,903 8,043 8,503 1943 489 51 540 8,513 2,627 11,140 11,680 73 Home Visits Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. First. Subsequent. Total. 1947 . 291 507 798 505 1,303 1946 314 54 368 1,413 1,781 1945 319 632 951 686 1,637 1944 .. 271 578 849 719 1,568 1943 443 824 1,267 909 2,176 A total of 152 children were immunised against Diphtheria during the year at " Brookscroft." Your Council, under the Scheme approved by the Ministry of Health, makes an annual grant of £700 to the Society. SUMMARY OF MUNICIPAL AND VOLUNTARY SCHEMES The following tables give the total number of attendances at clinics and home visits : — Attendances at Clinics First Attendances. Re-attendances. Grand Total. Under 1 year of age. 1-5 years of age. Total. Under 1 year of age. 1-5 years of age. Total. Municipal Scheme Brookscroft 2,032 81 2,113 32,505 23,002 55,507 57,620 697 64 761 11,074 3,353 14,427 15,188 Total 1947 2,729 145 2,874 43,579 26,355 69,934 72,808 1946 2,161 315 2,476 32,445 21,992 54,437 56,913 The total of 72,808 represents the highest total ever recorded. The percentage of first attendances of children under 1 year of age at Child Welfare Centres to the number of notified live births was 100.3. Home Visits To Children under 1 year of age. To Children 1-5 years of age. Total. First. Subsequent. Total. Municipal Scheme 2,674 5,595 8,269 7,228 15,497 Brookscroft 291 507 798 505 1,303 Total 1947 2,965 6,102 9,067 7,733 16,800 1946 2,628 4,471 7,099 7,879 14,978 74 TREATMENT (a) Orthopaedic.—The facilities provided by the Education Authority's Orthopaedic Scheme are available for all children attending the Welfare Centres. Miss Garratt has kindly furnished the following information with respect to children under five years of age :— Defects Seen at Orthopaedic Clinic in Children Under Five Years of Age Anterior Poliomyelitis 4 Scoliosis—LordosisKyphosis 1 Arthritis — 1 Rickets—(a) Genu Varum 32 (b) Genu Valgum 62 Pes Piano Valgus 43 Spastic Paralysis 7 Progressive muscular atrophy 1 Talipes—(a) Equino Varus 16 (b) Calcaneo Valgus 19 Torticollis 9 Achondroplasia 1 Congenital defects 17 Miscellaneous 11 Total 224 (b) Dental.—-The following work has been done by the Education Authority's Dental Surgeons in respect of Maternity and Child Welfare patients :— Mothers. Children under 5. Cases treated 129 188 Attendances 332 302 Fillings 87 141 Extractions 259 91 General Anaesthetics 98 66 Scalings 29 — Dressings 145 145 Dentures 11 — Mr. Charles Shamash, L.D.S., contributes the following report in regard to the treatment of mothers and children under five years of age :— " During the year the improvement in attendances of children under five continued, and it is pleasant to note the increased interest of parents in the conservation of deciduous teeth and the control of habits which would otherwise cause deformity of the teeth and jaws. " The Ante-Natal and Post-Natal treatment of mothers showed, however, disappointing results. This can be attributed to the fact that only cases of gross neglect are referred for treatment—and that conservative work is only sought by the younger mothers who have probably received treatment previously in the School Clinics." (c) Tonsils and Adenoids.—Children are treated under the arrangements made by the Education Authority with the Connaught Hospital. 75 (d) Ophthalmic Defects and Minor Ailments.—Children are given treatment either at the School Clinics or by special appointment. (e) Sunlight.—64 infants were referred for sunlight treatment during 1947. (/) Child Guidance.—Arrangements exist for children under five years of age to be referred to the Education Authority's Child Guidance Clinic. (g) Invalid Children's Aid Association.—Miss O. M. Barnard, Secretary to the local branch of the Invalid Children's Aid Association, kindly reports that the following cases of children under five years of age were dealt with by her association :— Referred by :— Voluntary Hospitals and Medical Men 27 Public Authority General Hospitals 2 School Medical Services 10 Welfare Centres, Local Authority Services 16 Voluntary Agencies 6 Parents 6 67 Classification of cases :— Anasmia, debility and malnutrition 4 After effects of acute or infectious illness or operation 15 Bronchitis and pneumonia 12 Asthma 1 Heart 2 Other crippling defects (non-T.B.) 22 Nervous conditions 3 Diseases of : (a) Ear, Nose and Throat 3 (b) Eyes 1 (c) Skin 1 Accidents Various 2 67 Help given to old and new cases :— Sent to Convalescent homes and Nurseries 28 Provided with surgical appliances 16 Transferred to other agencies 2 Referred for visiting and advice 10 56 76 ASSISTED MILK SCHEME Number of applications during 1947 37 Number of families assisted 30 The National Milk Scheme operated from July, 1940, and the above represents applications for special brands of dried milk not supplied under that scheme. HOME HELPS Applications for the provision of Home Helps, if approved, are granted financial assistance for a period of two weeks. In addition to the 50 Home Helps approved during 1947 many mothers attending the Clinics have made their own arrangements to obtain the help of suitable women whose names were supplied by the Health Visitors. 99 applications were above scale for financial assistance. The total demand for Home Helps has been as follows :— 1947 Granted at part cost ...., 50 Rejected as over scale 99 149 1946 Granted free of cost 2 Granted at part cost 116 Rejected as over scale 73 191 PRIORITY SHEET DOCKETS In March the Board of Trade withdrew Priority Sheet Dockets as such and issued certificates equivalent to four or six coupons (for single or double bed sheets respectively). Except for the wording of the certificates, however, the scheme remains precisely the same as in previous years. During 1947, one mother was supplied with three 4-coupon certificates and 506 mothers with 1,482 6-coupon certificates. STERILISED MATERNITY OUTFITS A total of 744 sets were supplied and 57 outfits were issued below cosit price. INSTITUTIONAL TREATMENT No children were sent to Institutions under your Committee's arrangements. 77 CONFINEMENTS The following table shows the location of confinements for 1947 and the previous eight years. CONFINEMENTS 1939 1940 1941 1942 1943 1944 1945 1946 1947 Thorpe Coombe Maternity Hospital 595 720 645 695 891 907 995 1,247 1,253 Other Hospitals and Maternity Homes 322 203 104 242 236 257 226 442 551 Total in Hospital 917 923 749 937 1,127 1,164 1,221 1,689 1,804 District r Municipal 299 364 155 284 293 266 157 350 399 W.D.N.A 162 164 142 222 205 203 178 336 291 W.D.N.A. (Private) 56 80 20 49 30 43 12 31 140 W.D.N.A. Total 218 244 162 271 235 246 190 367 431 Total on District 517 608 317 555 528 512 347 717 830 Grand Totals 1,434 1,531 1,066 1,492 1,655 1,676 1,568 2,406 2,634 Births Registered 1,606 1,575 1,304 1,718 1,828 1,915 1,730 2,544 2,670 78 HOSPITAL ACCOMMODATION FOR CONFINEMENTS The following numbers of confinements occurred at the Institutions specified (Walthamstow residents only) :— 1947 1946 Thorpe Coombe Maternity Hospital 1,253 1,247 Maternity Homes in Walthamstow 259 160 Mothers' Hospital Clapton 100 108 Forest Gate Hospital 9 30 Other Maternity Hospital and Homes 183 144 Totals 1,804 1,689 EVACUATION OF EXPECTANT MOTHERS Since August, 1945, cases have been charged to the Council at 15s. Od. per day, the total cost per case amounting to over £26. Patients have been required to meet this charge subject to reduction in accordance with the Council's scale of assessment. There was only one case in 1947. WALTHAMSTOW DISTRICT NURSING ASSOCIATION (In affiliation with the Queen's Institute of District Nursing) The Superintendent, Miss C. A. Lee, S.R.N., S.C.M., reports as follows :— " As requested, I have pleasure in submitting a short account of the work of the Walthamstow District Nursing Association. " This has been a very busy year all round. The increase of work reflected in all phases of the general and midwifery cases. " Owing to the heavy calls the winter was particularly trying. It was found necessary to hire cars for some of the out-lying districts as the nurses could not use their bicycles owing to the snow. This has naturally increased our expenditure (already very heavy owing to increased salaries of nurses and domestics, cost of living and equipment). In spite of that the Committee decided to acquire a car. This has proved a great success. " The following report of the inspection undertaken by the Inspector of the Queen's Institute of District Nursing during several days in November, 1946, was as follows :— ' Patients were visited on the district will all members of the permanent staff and one pupil-midwife. They all worked very well and were efficient and thorough in their nursing methods and most of the technique was in keeping with the " Queen's " accepted procedure. ' The Home was very comfortable and happy, and running smoothly. 79 ' The books, records and equipment were in order and the opening of another room for use as a general district room and minor ailment centre is a great improvement.' " Despite every effort to replace vacancies on the staff with ' Queens ' nurses the Committee have been unsuccessful, and it can only be hoped that before long this state of affairs will have improved. " As will have been seen from the following figures the Municipal midwifery service was heavily taxed. " In view of this fact the Council provided a third midwife whom we were fortunate enough to be able to supply. " The following cases were attended during the year 1947 : Municipal. Voluntary. Total. Without Doctor 261 112 373 With Doctor 30 28 58 291 140 431 MIDWIVES ACTS, 1902-1936 No. of Notices of Intention to Practise, January, 1947 32 during 1947 15 Total 47 No. of Midwives ceasing to practise during 1947 13 „ „ practising at the end of 1947 — 34 There was no change in the arrangements for the employment or subsidy of midwives by the Council. Non-medical supervision of Municipal Midwives has been carried out by the Matron at the Maternity Hospital. The following table shows the work done by Midwives (including those employed at Thorpe Coombe Maternity Hospital) during 1947 :— No. of confinements attended as a Midwife 2,091 „ „ „ „ „ Maternity Nurse 329 „ Medical Aid Notices sent 793 „ Notifications of Death — „ Twin Births notified 33 „ Stillbirths notified 5 ,, Notifications of Liability to be a Source of Infection 2 „ Notifications of Laying out a Dead Body — „ Notifications of Artificial Feeding 7 „ Notifications of Disinfection 5 80 The table above includes the following numbers with regard to work done at Thorpe Coombe :— Midwifery cases 1,125 Maternity cases 128 Medical Aid Notices 554 The percentage of Medical Aid Notices were :— All cases 37.9 Maternity Hospital Midwives 49.2 Domiciliary Midwives 21.5 The conditions for which Medical Aid was summoned by Midwives in domiciliary practice have been summarised and are as follows: — For complications during pregnancy :— Miscarriage 4 Antepartum haemorrhage 7 Other conditions 5 Total 16 For complications during labour : — Prolonged 1st and 2nd Post-partum hasmor- stage 30 rhage 6 Ruptured perineum 49 Retained placenta 8 Premature labour Abnormal presentation 6 Rise of temperature 8 Other conditions 25 Total 132 For complications in regard to the infant: — Stillbirth 2 Prematurity and Feeble Jaundice 3 ness 5 Convulsions 1 Asphyxia 3 Inflamed eyes 9 Cyanosis 2 Other conditions 6 Total 31 Medical Aid Fees.—Your Committee recommended—that, as from beginning of the financial year, no recovery was to be obtained from the patient in regard to medical aid fees. Compensation for Loss of Cases.—Compensation is made to Midwives by payment of 10s. Od. per confinement lost by reason of the reference of the patient from the Council's Ante-Natal Clinic to hospital on account of any abnormality. No claim for compensation was made during 1947. Gas and Air Analgesia.—The Municipal Ambulance Service provided transport facilities for gas and air apparatus. 81 MUNICIPAL MIDWIFERY AND MATERNITY SERVICE The table below shows the number of visits done :— Ante-Natal Visits. Deliveries. Lying-in Visits. Total Visits. Patients' Homes. Midwife's House. Clinic. Mid. Mat. Municipal 876 1,671 27 355 44 5,216 7,189 W.D.N.A. 1,094 1,841 — 261 30 5,788 9,014 Total 1,970 3,512 27 616 74 11,004 16,203 FACILITIES FOR CONFINEMENT The table below gives details of " future bookings" at the end of the month stated. 1 The peak months for bookings were October and November, 1946, and it will be noted that bookings have steadily declined throughout the current year. Jan. Feb. Mar. Apr. May June July Aug. Sep. Oct. Nov. Dec. (a) Thorpe Coombe 562 571 547 529 515 511 503 499 543 562 566 556 (b) District Municipal 230 210 221 188 185 161 122 95 91 90 86 86 (c) District, W.D.N.A. 253 247 251 198 181 178 163 134 132 130 122 126 (d) Total (6) and (c) 483 457 472 386 366 339 285 229 223 220 208 212 Grand Total (a) and (d) 1,045 1,028 1,019 915 881 850 788 728 766 782 774 768 Public Health Act, 1936 (Nursing Homes).—See Public Health Section of the Report. PUERPERAL PYREXIA Thirty cases of Puerperal Pyrexia were notified during 1947. The notifications were received from the following sources :— Maternity Hospital 20 Hospitals outside the area 5 General Practitioners 5* * All were in Hospital or admitted except one. The Puerperal Pyrexia rate for 1947 was 10.99 per 1,000 births as compared with 12.62 in 1946, and the mortality due to puerperal sepsis was nil. 82 The Registrar-General has issued the following rates with regard to the notification of Puerperal Pyrexia. The Walthamstow rates are set out in comparison. Area. Per 1,000 live and still births. Puerperal Fever. Puerperal Pyrexia. England and Wales 126 County Boroughs and Great 7.16 Towns, including London 8.99 148 Smaller Towns (25,000 to 50,000 population 6.27 London Administrative County 1.21 6.94* Walthamstow 10.99 * Including Puerperal Fever. The notifications and rates for Walthamstow for the past five years have been as follows : — Per 1,000 Total Births (live and still) Puerperal Pyrexia Year. No. Rate. 1947 30 10.99 1946 33 12.62 1945 32 18.08 1944 28 14.23 1943 44 23.33 The rates have been high because of the strictness of notification at the Maternity Hospital, i.e., cases are notified which in other areas would not be notified, especially in domiciliary practice. ABORTION Circular 1661.—The number of cases in which medical aid notices were issued during 1947 by Midwives in accordance with Rule E of the Central Midwives Board was :— Threatened abortion and miscarriage Nil Abortion and miscarriage Nil OPHTHALMIA NEONATORUM The number of cases notified during the last two years were:— Year. Totals. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. 1947 .. 5 1 1 1 1 1 1946 .. 4 1 1 1 1 Year. Treated Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 1947 . . 4 1 5 — — 1946 .. 3 1 4 — — — 83 MATERNAL MORTALITY During 1947 there were four deaths due to other puerperal causes. DEATHS DUE TO PREGNANCY AND CHILD BEARING AND/OR ASSOCIATED THEREWITH DURING 1947 Case No. Date of Death. Certified Cause of Death and Classification. Age. Ward. 1 9.3.47 Acute eclampsia. (Live birth) 33 Ho. 2 11.6.47 Pulmonary embolism due to femoral phlebothrombosis accompanying pregnancy— not delivered. 34 J. 3 10.9.47 Pulmonary infarction. Morbidly adherent placenta. Premature labour. (Live birth) 22 W. 4 26.12,47 Shock following lacerations of the vagina from efforts to deliver foetus in occipitoposterior position. 26 H.H. The following table shows the maternal mortality rates for 1947 :— Births. Registered. Deaths of Women due to Pregnancy and Child-Bearing. WALTHAMSTOW. England and Wales. Puerperal Sepsis. (Heading 29 R.G.) Other Puerperal Causes. (Heading 30 R.G.) Total Rates per 1,000 Births registered. Rates per 1,000 Births registered. Puerperal Sepsis. Other Puerperal Causes. Total. Puerperal Sepsis. Other Puerperal Causes. Total. Live, 2,670 — 4 4 — 1.49 1.49 No t availa ble Live and Stillbirths. 2.729 . . 4 4 1.46 1.46 >> »» " The following table sets out the maternal mortality, stillbirth and neo-natal death rates for the past five years: — Rate (per 1,000 live births). 1947. 1946. 1945. 1944. 1943. Maternal Mortality 1.49 0.78 1.74 5.21 4.92 Stillbirths 21.6 27.5 32.6 27.1 30.7 Neo-Natal Deaths 13.1 19.2 21.0 20.8 26.2 84 The maternal mortality rates (per 1,000 total births) for the past five years have been as follows: — Year. Total Births Registered. Deaths. Rates per 1,000 Births. (Live and Still) Puerperal Sepsis. Other Puerperal Causes. Total. Puerperal Sepsis. Other Puerperal Causes. Total 1947 2,729 — 4 4 — 1.46 1.46 1946 2,614 — 2 2 — 0.70 0.70 1945 1,769 2 1 3 1.13 0.56 1.69 1944 1,967 2 8 10 1.01 4.06 5.07 1943 1,886 6 3 9 3.18 1.59 4.77 I. THORPE COOMBE MATERNITY HOSPITAL. An additional medical officer was appointed during the year. In September the Royal College of Obstetricians recognised the hospital for post graduate experience for the membership of the College. In December, the Council decided to revert to the previous arrangement whereby patients remained in hospital for 14 days after confinement. General.— (a) Form M.C.W. 96A (Ministry of Health). 1. Name and address of Institution—Thorpe Coombe Maternity Hospital, 714, Forest Road, Walthamstow, E.17. 2. Number of maternity beds in the Institution (exclusive of labour and isolation beds)—48. 2a. Number of beds, if any, included under item 2 which have been reserved for expectant mothers in need of hospital treatment.—Variable according to requirements. No special reservation. 3. Number of maternity cases admitted during the year—1,455 plus seven miscarriages (including ante-natal and post-natal admissions). 3a. Number of women treated during the year in the ante-natal beds shown against item 2a. (These women should also be included against item 3)—225. 3b. Average duration of stay of expectant mothers in the antenatal beds shown against item 2a—3.1, 85 4. Average duration of stay in lying-in wards—11.8. 5. Number of cases delivered by— (a) Midwives—1,125 ; (b) Doctors—128 ; Total—1,253. 6. Number of cases in which medical assistance was sought by a midwife in emergency—554. 7. Number of cases admitted after delivery—21. 8. Number of cases notified as— (a) Puerperal Fever—Nil ; (b) Puerperal Pyrexia—20. 9. Number of cases of pemphigus neonatorum—Nil. 10. (a) Number of infants on a supplementary or complementary feed on discharge—250. (b) Number of infants wholly breast fed on leaving the Institution—976. 11. (a) Number of cases notified as ophthalmia neonatorum—1. (b) Result of treatment in each case—Satisfactory. 12. Number of maternal deaths—2. 13. (a) Number of stillbirths—31. (b) Cause of death in each case, and results of post-mortem examination (if obtainable)—See Clinical Report. 14. (a) Number of infant deaths within 10 days of birth—18. (b) Cause of death in each case, and results of post-mortem examination (if obtainable)—See Clinical Report. The stillbirth rate was 24.5 per 1,000 live and still births, and the neo-natal mortality within 10 days of birth was 14.0 per 1,000 live births. (b) Occupation of Beds.—The average daily occupation of beds was as follows : — January 45.2 July 46.9 February 42.5 August 39.8 March 44.7 September 31.6 April 48.1 October 41.7 May 37.5 November 37.2 June 42.1 December 41.0 The average for the whole year was equal to 83 per cent, of beds occupied (based on 50 beds). (c) Emergency Unit.—The services of the emergency unit were required on four occasions in the District during the year. (d) Gas and Air Analgesia.—The Maternity Hospital is approved by the Central Midwives Board for the purpose of giving special instruction in gas and air analgesia. (e) Training of Pupil Midwives.—The Hospital is approved by the Central Midwives Board (jointly with the Middlesex Hospital), for the training of pupil midwives in Part I and Part II of the training. 86 During 1947, 44 pupils from Thorpe Coombe obtained the Part I and 34 the Part II Certificate of the Central Midwives Board. The Council agreed to pay the examination fees. (f) Conditions of Service.—The Council have adopted all the recommendations of the Midwives' Salaries Committee. The following has been compiled by Miss Helen Rodway, F.R.C.O.G., Resident Obstetrician and Medical Superintendent. THORPE COOMBE MATERNITY HOSPITAL CLINICAL REPORT FOR 1947 It is with regret that the Medical Superintendent has to state that this is the last complete annual report of the Hospital to the Council of the Borough of Walthamstow as the hospital authority, as on July 5th, 1948, when the National Health Service Act comes into force, the Hospital will be transferred to the Regional Hospital Board. "Thorpe Coombe" with 35 maternity beds, two labour wards and two nurseries, was opened in May, 1934. Since then there have been added to the Hospital an ante-natal clinic, eight maternity beds with two small nurseries, a post-natal or isolation block, a nurses home and medical officer's quarters. Following the extensions of the hospital buildings which have provided wider scope for our maternity service, the amount of work carried out by the Hospital has, year by year, steadily increased. During the eight months of 1934, there were 229 confinements in the Hospital, and for the year 1947 the number increased to 1,253, bringing the total figure for 13 years and eight months to 10,814. Of the 1,253 confinements for this year, 814 were first births, that is 64.9 per cent, of the total. Other confinements were those of women admitted on account of a medical or obstetric complication or because of unsuitable home conditions. The number of infants born was 1,275 ; this includes 22 cases of twins, a percentage of 1.7 relative to the total number of confinements. The number of admissions to the Hospital during the year was 1,462, including 65 unbooked cases, of which 21 were mothers admitted with 22 infants. There were in addition 14 infant admissions. Attendances at the ante-natal clinic were as usual good; 1,275 expectant mothers making 10,511 attendances for examination. The total number of attendances at the monthly mothercraft classes was 679. 87 At the post-natal clinic 902 mothers, a percentage of 71.9 of the related confinements, attended for examination and advice approximately six weeks from the date of confinement and made 495 subsequent attendances for treatment. A summary of the work of the Hospital follows. A full statistical clinical report has been prepared as usual and is available for reference. SUMMARY OF THE WORK OF THE HOSPITAL Clinic Attendances— (A) Ante-Nata! Clinics : No. of Clinics held. No. of attendances. Average attendance per session. (a) Consultant's Clinic 12 99 8.2 (b) Resident Obstetrician's Clinic 212 *1,275 5.9 do. — +4,180 19.7 (c) Midwives' Clinics 210 4,957 23.6 Totals 434 10,511 * New patients, t Old patients. The average number of attendances made by each patient was 8.2. (B) Post-Nata! Clinics : No. of Clinics held. No. of attendances. Average attendance at each session. (a) First Visits 51 902 17.7 (b) Subsequent Visits 495 9.7 Total 1,397 27.4 Percentage of first visits relative to number of confinements was 71.9. ADMISSIONS TO THE HOSPITAL (a) Ante-Natal (b) For Confinement (c) Post-Natal (d) On account of miscarriage Total 225 1,209 21 7 1,462 (44 patients were confined before discharge.) (e) Infants 36* * Including 22 admitted with the mother 88 Indications for the Admission of Ante-Natal Patients. No. of Cases. Antepartum hemorrhage 14 Threatened miscarriage 7 Hyperpiesis and oedema 10 Hyperemesis gravidarum 2 Albuminuria ; hyperpiesis and oedema 43 Chronic nephritis 1 Heart disease 12 Urinary infection 3 Glycosuria; hematuria 3 Phlebitis 4 Neuritis 2 Prolapsed cervical polypus 1 Abdominal pain ; pyrexia. (Undiagnosed) 2 Breech for version : Successful 22 Unsuccessful 5 Refused anaesthetic 1 Other malpresentations 3 Poor general condition—for rest 6 For induction of labour because apparently due 17 158 This represents 12.6 per cent, relative to 1,253 confinements. For observation and discharged because not in labour 67 225 89 COMPARATIVE FIGURES FOR CONFINEMENTS AND CLINIC ATTENDANCES From May, 1934, until 31st December, 1947 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1. No. of confinements 1,253 1,247 995 907 891 695 645 720 595 691 640 660 646 229 2. Total number of admissions 1,462 1,446 1,135 1,018 1,037 801 717 817 675 775 729 769 747 258 3. Clinic Attendances : Antenatal Clinics— (a) New Patients 1,275 1,253 1,190 1,016 944 764 824 750 733 702 753 691 762 371 (b) Old Patients 9,236 10,702 8,692 7,666 7,775 6,551 5,661 6,679 5,750 6,032 5,501 5,354 4,543 1,745 Total Ante-Natal Attendances 10,511 11,955 9,882 8,682 8,719 7,315 6,485 7,429 6,483 6,734 6,254 6,045 5,306 2,116 Postnatal Clinics— (a) First attendances 902 920 667 617 769 504 315 330 401 479 380 453 256 — (b) Subsequent attendances 495 583 227 219 114 117 149 140 155 151 145 177 210 — Total Post-Natal Attendances 1,397 1,503 894 836 883 621 464 470 556 630 525 630 466 — 5>0 No. of Emergency Admissions: Oases Ante-partum hemorrhage 6 Hyperpiesis 1 Albuminuria ; hyperpiesis and oedema 4 Heart disease 2 Glycosuria ; hematuria 2 Phlebitis 1 Poor general condition 4 Complications of labour 13 Arrangements for confinement failed 9 Threatened miscarriage 2 44 Postnatal Admissions : Postpartum hemorrhage and retained placenta 5 Post-partum eclampsia 1 Mothers admitted with : (a) Premature infants 5 (b) 111 infants 3 Unsatisfactory—(a) Medical condition 2 (b) Mental condition 1 Mastitis 1 Gastro-enteritis 1 Unsatisfactory home conditions 2 21 22 infants were admitted with the mother ; this includes four cases of twins. Infant Admissions without the Mother : Prematurity 7 For treatment of eyes 4 Unsatisfactory condition of child 3 14 Operations Performed : External version 22 Internal version 4 Surgical induction of labour 14 Forceps delivery 85 Manual removal of placenta 24 Cesarean section *3 Exploration of the uterus 5 157 * The operation was performed in all three cases for contracted pelvis and disproportion. Two of these cases were emergency admissions. 91 No. of Medical Aid Requests : Cases Malpresentation 3 Ante-partum hemorrhage 14 Premature labour 2 Premature labour ; patient with pneumonia 1 Hematuria 1 Failed foetal heart 1 Foetal distress 9 Eclamptic fit 1 Abnormal presentation 3 Cardiac patient in labour 6 Breech delivery 23 Delay 2nd stage 56 Delay in birth of second twin 1 For forceps delivery 24 For episiotomy 37 Perineal lacerations 272 Delay in 3rd stage and post-partum hemorrhage 45 Retained placenta 10 Threatened miscarriage and incomplete abortion 2 Obstructed Labour 3 Unsatisfactory condition of patient 3 Prolapse of cord 1 Cesarean section 1 Emergency admission 1 520 Infants : Asphyxia 12 Collapse 10 Unsatisfactory condition 2 Premature infant 5 Jaundice 2 Hare lip and cleft palate 1 Stillbirth 1 Child vomiting blood 1 34 The percentage of medical aid requests relative to the number of confinements was 41.5, and for the infant, 2.7. INFANTS The number of infants born in the Hospital this year was 1,275 ; this figure includes 22 cases of twins and 98 premature infants—a premature birth rate of 7.6 relative to the total number of infants. In addition, 36 infants, of which 16 were premature, were admitted from the district. 92 Premature Infants.—For statistical reports a premature infant is taken as one weighing 5½ lbs. or 'less. This is an international standard. Infants born in Thorpe Coombe. Infants born at home. (a) 5½ lbs. or more than 4½ lbs. 48 7 (b) 4½ lbs. „ „ „ 3½ lbs. 28 — (c) 3½ lbs. „ „ „ 2½ lbs. 13 3 (d) 2½ lbs. or less 4 5 (e) Weight not recorded 5 1 Totals 98 16 Breast Feeding.—On discharge from Thorpe Coombe at 10 to 12 days, 79.6 per cent, of mothers were feeding their infants, 16.25 per cent, partly breast feeding, while 4.15 per cent of infants were fed on dried cows' milk. 1947 1946 1945 1944 1943 1942 1941 1940 (a) Infants completely breast fed 79.6 85.8 88.1 85.6 82.5 83.9 87.6 77.4 (6) Infants partly breast fed 16.3 10.2 9.4 11.5 12.2 12.0 9.9 18.7 (c) Infants not breast fed 4.1 4.0 2.5 2.9 5.3 4.1 2.5 3.9 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 FOETAL AND INFANT MORTALITY (a) Stillbirths. Number of cases 54 lbs or less Over 5 ½ lbs Macerated Recent Macerated Recent Total (i) Developmental defects 3 2 — 1 6 (ii) Maternal conditions : Toxaemia, Hyperpiesis, Antepartum Hemorrhage, Pneumonia, following a fall 7 3 – 2 12 (iii) Foetal conditions : Erythroblastosis foetalis, Cord complications – – 1 1 2 (iv) Complications of labour — 2 — 4 6 (v) Unknown 1 2 1 1 5 Totals 11 9 2 9 31 A postmortem examination was held in five cases. 93 The premature stillbirth rate for the year relative to 98 infants of birth weight 5^ lbs. or less was 20.4 per cent. The stillbirth rate relative to 1,177 infants of birth weight over 5 lbs. was 0.93. The total stillbirth rate was 2.4 per cent. (b) Infant Deaths. Number of cases. 5½ lbs. or less. Over 5½lbs. Total. (i) Developmental defects 1 2 3 (ii) Erythroblastosis : Hydrops foetalis 1 1 2 (iii) Hemorrhagic disease 2 1 3 (iv) Broncho pneumonia 3 2 5 (v) Atelectasis 2 1 3 (vi) Circulatory failure — 1 1 (vii) Sub-arachnoid hemorrhage — 1 1 9 9 18 A postmortem examination was held in 14 cases. The premature infant death rate for the year relative to 78 infants born alive of birth weight 5J lbs. or less was 10.2 per cent. The infant death rate relative to 1,116 infants born alive of birth weight over 5^- lbs. was 0.77. The total infant death rate was 1.4 per cent. There were in addition six deaths of infants admitted after birth from the District — five premature and one which weighed over 54 lbs. Number of cases. 5 ½ lbs. or less. Over 5½ lbs. Total. (i) Atelectasis 2 1 3 (ii) Broncho-pneumonia 2 — 2 (iii) Prematurity 1 — 1 5 1 6 PUERPERAL PYREXIA There were 20 cases of puerperal pyrexia notified during the year ; 17 or 1.4 per cent, occurred in 1,188 booked cases and 3 or 4.6 per cent, in 65 unbooked cases. 94 Apparent Causes of Pyrexia. No. of cases. Percentage of cases relative to total of 20. (i) (a) Local uterine infection 7 35.0 (b) Local uterine infection and pulmonary embolism 1 5.0 (ii) Urinary infection — — (iii) Urinary infection and local infection of uterus or perineum 5 25.0 (iv) Non-suppurative mastitis or flushed breast 4 20.0 (v) Throat infection 1 5.0 (vi) Influenzal cold 1 5.0 (vii) Gastro-enteritis 1 5.0 20 GASTROENTERITIS During the last seven months of the year, a number of cases of diarrhoea occurred among the patients and babies, also among the Hospital staff. The following number of cases were reported : — Number of cases Percentage of cases relative to Mothers 61 Total number of 849 admissions during the seven months period 7.1 Babies 12 Total number of 741 babies born during that period 1.6 Nursing staff 21 Total number of 105 nursing staff employed in the Hospital 20.0 Domestic staff 10 Total number of 67 domestic staff employed during that period 15.0 All patients and babies recovered. N.B.—Mothers and babies remain in the Hospital an average of 10 to 12 days. Nursing and domestic staff included in this list have worked in the Hospital for periods varying from three to seven months. The longer period during which the members of the staff were exposed to this infection resulted in a higher percentage of cases relative to the total number of staff. The matter has been fully investigated in conjunction with the medical staff of the Ministry of Health, the Medical Research Council and the Laboratory services. Maternal Deaths. There were two maternal deaths during the year. One patient admitted with acute suppurative bronchopneumonia died on the day she was admitted, another patient died of shock following complications of labour.