CWFL(1) WALTHAMS(C) WAL 31 BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1948 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 BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1948 INDEX page Section A.—Statistics and Social Conditions of the Area 16 Section B.—General Provision of Health Services in the Area 20 Section C.—Sanitary Circumstances of the Area 26 Section D.—Housing 31 Section E.—Inspection and Supervision of Food 36 Section F.—Prevalence and Control over Infectious Diseases 47 Section G.—Infectious Diseases Hospital 63 Section H.—Maternity and Child Welfare 66 Section I.—Thorpe Coombe Maternity Hospital 93 page Abortion 92 Adoption 80 Acreage 16 Adulteration 42 Ambulance Facilities 20 Ante-Natal Clinics 78, 94, 99 Assessments 16 Bacteriological Analyses 38,44 Births 16, 18 „ Notification of 68 „ Registration of 68 Birth Rate 16 Breast Feeding 76, 96, 98 Cancer 19 Caravans 29 Care of Illegitimate Children 72 Cerebro-Spinal Meningitis 55 Child Guidance 83 Child Life Protection 80 Child Welfare 75 „ „ Clinics 75, 79 Clinics 20 Committees 4, 66 Compensation (Midwives) 90 Confinements 86 Connaught Hospital 25 Cremation 65 Day Nurseries 69 Deaths 16, 17, 18, 19 „ Infants 70,74 „ Infectious Diseases 49, 64 Death Rate 16 Dental Treatment 22, 83 Diphtheria 53 ,, Immunisation 49 Diseases of Animals Acts 44 Disinfestation 29 District Midwifery 90 Domestic Help 65 Dysentery 54 page Emergency Unit 93 Encephalitis Lethargica 47 Enteric Fever 53 Erysipelas 55 Essex County Council Act 26 Factories Acts, 1937/48 45 Food 6? Drugs Act, 1938 42 Food Inspection 36 Foot Clinic 20 Funeral Arrangements 47 Gas and Air Analgesia 93 Grants 64 Health Visiting 76 Home Helps 85 „ Visits 76,77 Hospital Accommodation 87 „ Infectious Disease 63 Housing 31 Act, 1936 34 „ Conditions 34 „ Inspections 32 Ice Cream 37 Immunisation 49 Infant Mortality 70 Infectious Diseases Clinic 49 ,, ,, Hospital 63 Infestation 78 Institutional Treatment 24, 85 Inquests 65 Invalid Children's Aid Assn. 84 Insulin 65 Laboratory Services 52 Landlord 6? Tenant (War Damage) Acts, 1939-41 34 Malaria 55 Massage 80 Maternal Mortality 92 Maternity and Child Welfare 66 „ Homes 87 page Measles 56 Meat Inspection 40 Medical Aid 88 „ Examinations 65 Midwifery 88 Milk, Assisted Scheme 84 „ Special Designations Order 37 „ Supply 36 Miscellaneous 64 Mortuary 65 Municipal Dental Service 22 „ Laboratory 52 „ Ambulance Servicc 20 „ Midwifery and Maternity Service 90 Neo-Natal Mortality70 Notices, Sanitary 26 Notification of Births 68 Nursing 20 „ Homes 26 Ophthalmia Neonatorum 54 Ophthalmic Treatment 92 Orthopaedic Treatment 83 Outworkers 46 Pneumonia 54 Poliomyelitis 54 Population 16 Post-Mortems 65 Post-Natal Clinics 78,99 Premature Infants 73 Prevention of Blindness 52 Prevention of Illness, Care and After-Care 61 Priority Sheet Dockets 85 Public Assistance 25 Puerperal Pyrexia 91 page Rateable Value 16 Rats and Mice Destruction Act 45 Rent and Mortgage Restriction Acts 34 Sanitary Inspection 26 Scabies Clinic 23 Scarlet Fever 53 Schick Tests 49 Smallpox 52 Social Conditions 25 St. John Ambulance Brigade 20 Staff 7 Statistics 16 Sterilised Maternity Outfits 85 Stillbirths 16, 71 Sunlight Treatment 83 Swimming Baths 30 Thorpe Coombe Maternity Hospital 93 Total Infant Mortality 71 Tonsils and Adenoids 83 Tuberculosis 59 Training of Nursery Nurses 70 „ „ Pupil Midwives 93 Unemployment 16 Vaccination 52 Venereal Disease 25 Vital Statistics 16 Vitamins 69 Walthamstow Assn. of Tuberculosis Care Helpers 62 Walthamstow Child Welfare Society 81 Walthamstow District Nursing Association 87 Water 26 Whooping Cough 56 Women's Clinic 21 HEALTH COMMITTEE Chairman: Alderman Mrs. C. Mc Entee, J.P Vice-Chairman: Councillor E. G. Baily. Ex-officio: The Worshipful the Mayor—Councillor Miss D. Wrigley, B.A., J.P. The Deputy Mayor—Alderman S. N. Chaplin, J.P. Chairman of Finance Committee—Alderman Ross Wyld, O.B.E., J.P Alderman W. B. Fitt. „ T. Fitzpatrick. „ W. Gillett. „ A. E. Manning. „ Mrs. E. M. Miller. Councillor W. E. Barnes. Councillor Mrs. Marchant. „ Mrs. Candy. „ J. W. Pringle. H. C. Fisher. „ W. H. Shaw. G. H. Gardner. „ Mrs. E. A. Smith. (deceased). Sanatorium (Hospital Management) Sub-Committee. (To July 5th, 1948) Chairman Councillor E. G. Baily. Alderman W. B. Fitt. Councillor Mrs. Candy. „ T. Fitzpatrick. „ Mrs. Marchant. Mrs. C. McEntee, J.P. „ J. W. Pringle. Mrs. E. A. Smith. (deceased). Town Clerk 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 1948. On July 5th, 1948, responsibility for all the services included under Part III of the National Health Service Act, 1946, became transferred to the Essex County Council as the Local Health Authority. These included the responsibility for the provision of health centres; the care of mothers and young children; midwifery; health visiting; home nursing; vaccination and immunisation; ambulance services; prevention of illness—care and after-care, and domestic help. Under the scheme of decentralisation of administration submitted by the County Council and approved by the Ministry of Health, the Borough of Walthamstow was constituted as a separate health area with its own Health Area Sub-Committee, the arrangement being subject to review at the expiration of two years. In order to give a complete picture of the year 1948, I am able, through the courtesy of the County Medical Officer, and in my capacity as Acting Area Medical Officer, to include some reference to and statistics of the work carried out in regard to the services transferred to the County Council on July 5th. On the same date your hospitals—i.e., Chingford Sanatorium (opened in 1901) and Thorpe Coombe Maternity Hospital (opened in 1934) were transferred to the North-East Metropolitan Regional Hospital Board. Your Council has every right to be proud of the services provided at these two hospitals. Liaison still remains by the fact that some of your members are, as private individuals, members of the respective House Committees. Again on the same date your Municipal Dental Service (one of the very few in the country) became the responsibility of the Executive Council for Essex. Arrangements have been made for continuity in administration, at least for the time being. The relief afforded to the Department by the transfer of hospital services was comparatively slight since both hospitals had long been "decentralised" as far as possible except for administration at the Committee level. On the other hand, the work involved in connection with the development of health centres, maternal and child health, home nursing (a new duty for Local uthorities), the prevention of illness—care and after-care and the great exPansion of Domestic Help Service resulted in a considerable increase in work and responsibility, especially in view of the difficulties and frustrations inseparable from delegation. Turning to the various sections of the report, vital statistics have again achieved new low records, especially the infant mortality rate of 20. The social conditions and the general provision of health services in the area—although some were under "new managemen "—require no further comment. With regard to sanitary circumstances, the Inspectorate again worked well under many difficulties, especially concerning the repair of dwelling houses. Excellent work was also done in the inspection and supervision of food and all the 144 milk samples were found to be satisfactory. Good work was also done in regard to the supervision of the manufacture and sale of ice cream. In regard to housing, in spite of all the good progress which has been made locally, the position, in common with that in other comparable areas, is most depressing. Not only is there the general shortage of housing accommodation, but the need of more small dwellings for the ageing (with the consequent release of existing under-occupied property) and the housing of the infectious tuberculous or those families in contact with them, remain as health problems of the first magnitude. Linked with the latter is the very difficult problem of the control of Tuberculosis, especially of the infectious case in the early stages awaiting sanatorium treatment and the infectious late case requiring segregation. There is little to note in the control of infectious and communicable diseases except the virtual elimination of Diphtheria (provided the required proportion of young babies can be kept protected). Protection against whooping cough continues to be given at the Day Nurseries and, during the current year, has been extended to the age group 6-18 months (in conjunction with the Medical Research Council). I would wish to acknowledge with thanks the good work of the whole of the staff of the Department, the help of Mr. Alen Wade in the preparation of these annual reports, and the help and consideration of your Chairman and Members. I am, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. 7 STAFF Medical Officer of Health, Borough School Medical Officer, and Acting Area Medical Officer (Essex County Council): A. T. W. Powell, M.C., M.B., B.S., D.P.H. Deputy Medical Officer of Health, Deputy Borough School Medical Officer Melville Watkins, M.R.C.S., L.R.C.P., D.P.H. Assistant Medical Officers * Miss M. Sheppard, M.A., M.B., B.Ch., B.A.O., D.P.H., Barrister-at-Law. * Miss D. B. Hudson, M.B., Ch.B., D.P.H. Resident Medical Officer, Chingford Hospital & Sanatorium ‡ Miss Mary Hamilton, M.B., B.Ch., B.A.O. ‡ Matron Miss V. M. Wilson, S.R.N. Medical Superintendent and Obstetrician, Thorpe Coombe Maternity Hospital: ‡ Miss Helen Rodway, F.R.C.O.G., M.R.C.S., L.R.C.P. ‡ Matron: Miss L. Randall, S.R.N., S.C.M. Specialist (Part-time) Medical Officers (Local Education Authority Appointments) Aural Surgeon F. P. M. Clarke, B.A., B.Sc., L.R.C.S. (Ed.), L.R.C.P., L.R.F.P.S. (Glas.). Orthopaedic Surgeon B. Whitchurch Howell, M.B., B.S., F.R.C.S. Physician-in-Charge, Rheumatism Clinic Miss M. Wilmers, M.D., M.R.C.P. Psychiatrists Mrs. Helen Gillespie, M.R.C.S., L.R.C.P. Miss E. Whatley, B.Sc., M.B., B.S. Dental Surgeons * Mr. L. W. Elmer, L.D.S., R.C.S. (Eng.) (Senior). * Mr. G. P. L. Taylor, L.D.S., R.C.S. * Mr. C. Shamash, L.D.S., R.C.S., B.Ch.D. * Mr. R. E. Hyman, L.D.S., R.C.S. * Mr. R. Tait, B.Sc., L.D.S., R.C.S. (Part-time). † Mr. J. Timmis, L.D.S., R.C.S. † Mr. D. Clarke, L.D.S., R.C.S. General Dental Service. School purses and Health Visitors (Part-time to School Medical Service) * Miss A. C. Keenan, S.R.N., S.C.M., H.V.Cert. (Superintendent) * Miss R. Boyd, S.R.N., S.C.M., H.V.Cert. 8 Staff—continued. * Miss M. B. Cassidy, S.R.N., S.C.M., H.V.Cert. * Miss E. L. Cunnington, S.R.N., S.C.M., H.V.Cert. * Miss C. R. Douglas, S.R.N., S.C.M., H.V.Cert. * Miss E. DuRandt, S.R.N., S.C.M., H.V.Cert. * Miss D. G. Legg, S.R.N., S.C.M., H.V.Cert. * Miss I. N. MacPherson, S.R.N., S.C.M., H.V.Cert. * Miss O. North, S.R.N., S.C.M., H.V.Cert. * Miss J. M. Palmer, S.R.N., S.C.M., H.V.Cert. * Miss A. Stuart, S.R.N., S.C.M., H.V.Cert., T.B.Cert. * Miss A. Wright, S.R.N., S.C.M., H.V.Cert. * Miss M. A. Young, S.R.N., S.C.M., H.V.Cert. District Midwifery Sisters * Miss M. Gahan,S.R.N., S.C.M.§ *Mrs. A. M. Gilbert, S.R.N., S.C.M. * Miss M. Hamilton, S.R.N., S.C.M. * Miss N. Hodges, S.R.N., S.C.M. * Miss A. Krolfifer, S.R.N., S.C.M.§ * Mrs. P. Rayner, S.R.N., S.C.M. * Miss O. Roberts, S.R.N., S.C.M. § Appointed by Walthamstow District Nursing Association. Day Nursery Matrons * Handsworth Avenue Mrs. D. Androvenda, S.R.N. * Higham Hill Mrs. M. A. Clarke, S.R.N. Dental Attendants * Miss J. Bradley. * Miss S. Snowdon. * Miss G. M. Hutchins. *Mrs. E. L. Tee. * Miss D. Sanford. *Mrs. M. E. Wright. * Receptionist: Miss E. Weatherill. Dental Technicians * G. Higgins. * H. J. Edmunds. Infectious Disease Nurse Miss I. H. Jennings, S.R.N., S.C.M. Skin Clinic Nurse and Auxiliary * Mrs. P. Crisp, S.R.N. * Mrs. E. Lynch. Masseuses * Miss H. E. Garratt, C.S.P. * Miss K. Hill, C.S.P. (Part-time). Orthoptist * Mrs. K. S. Box, S.R.N., S.C.M. (Part-time). Speech Therapists * Miss V. L. Babington, L.C.S.T. * Miss C. M. Gregory, L.C.S.T. 9 Staff—continued. Chiropodists * R. J. King, M.Ch.S. * L. N. C. Marten, M.Ch.S. * G. Mc Cart, M.Ch.S. * L. R. Skinner, M.Ch.S. * Receptionist Miss M. Warren. Chief Sanitary Inspector, Petroleum Officer, and Chief Inspector Diseases of Animals Acts F. W. Kemp, M.R.S.I., M.S.I.A. (a) (b) (c). Deputy Chief Sanitary Inspector W. R. Richards, M.R.S.I., M.S.I.A. (b) (d) (e). District Sanitary Inspectors E. A. Austerberry, M.S.I.A. (b) (d) (e). R C. Bland, M.R.S.I., M.S.I.A. (b) (d). V. Croft, (b) (d). D. R. King, A.R.S.I. (d). From 20/9/48. S. E. Muggeridge, M.R.S.I. (b) (d). F. Northcote, A.R.S.I., M.S.I.A. (b) (c). (a) Cert.S.I.E.B. (London). (b) Cert. Inspector Meat and Other Foods. (c) S.I.Cert. of R.S.I. (d) S.I.Cert. of R.S.I. and S.I.E.J.B. (e) Cert. of Sanitary Science, R.S.I. In addition, some of the Inspectors hold special certificates. Clerical Staff (General Health Services) R. Rose (Chief Clerk). * F. J. Aylward. L. R. W. Kemp. G. J. S. Bradley. Miss N. Lewis. G.H Eve. *Mrs. M. Manton. Miss M. Game. * Miss S. Martyn. B. Goode (To H.M.F. 16/9/48). * R. A. C. Green. * Miss T. Martyn. *Mrs. C. M. Hall. *Mrs. Speechley. Miss S. Horsnell. *A. T. Wade. L. Joyce (Resumed after H.M. Service 4/10/48). Disinfecting Staff Rodent Operatives H. Thompson. W. Hill. H. Lewiston. H. J. Newbury. * Transferred to Essex County Council. ‡Transferred to Regional Hospital Board. † Transferred to Local Executive Council. 10 PUBLIC HEALTH AND ALLIED SERVICES. Historical.—The records in the Health Department give the population of Walthamstow in 1851 as 4,957, living in some 900 houses. By 1881 it was 21,715, doubling itself by 1891 and again by 1901 when it had reached 91,125. The population "peak" was reached in 1933 when it was 135,600. After a large decrease due to the war it is again increasing and had reached 122,700 in mid1948. The earliest available Annual Report is that of a part-time Medical Officer of Health in 1883 which refers to "the requirements of this large and rapidly changing district of some 26,000 population" and the danger of "the direct connection of the drains with the interior of the house"; "the intermittent failure of the water supply" and "the abominable and insanitary condition of some of our roads." In 1887 it was noted that the only hospital admitting cases of infectious disease had refused to admit any more. This was in a year with 52 deaths from Diphtheria, 51 from Diarrhoea, 29 from Whooping Cough and 25 from Measles, i.e., a total of 157. By contrast, in 1948 all these diseases, with a population nearly five times greater, caused the death of only 9 persons. In 1888 there were 65 deaths from Diphtheria but in 1948 there was none—very largely because of better conditions generally and of IMMUNISATION. In view of the transfer of responsibility for the 'personal' health services on July 5th, it is appropriate to record the development of the Health Services since the incorporation of Walthamstow in 1929— 1929—A new Maternity and Child Welfare Centre and School Clinic was built and brought into use at Low Hall Lane. This adjoined a new Nursery School of 150 places provided by the Education Committee. A smallpox hospital of 40 beds in hutments was provided in order to cope with an epidemic. 1930—The infant mortality rate of 39 was the lowest yet recorded and the second lowest in the London " outer ring " towns. 116 unfit houses were scheduled for clearance. School dental and nursing staffs were increased. 1931—A new wing was added to the Nurses' Home at the Infectious Diseases Hospital providing 24 bedrooms at a cost of some £10,000. Chiropody and gynaecological clinics were set up—amongst the first in the Greater London area. 11 The Council undertook the administration of the Nursing Homes Registration Act. The result of the census showed Walthamstow to be the most populous Municipal Borough in England and Wales with a population of 132,965. The Education Committee provided a Rheumatism Supervisory Clinic 1932—A scheme of Diphtheria Immunisation was begun—amongst the first in the London area. A Municipal Ambulance Service was commenced with 2 ambulances. Extra Welfare Clinics were started, additional Health Visitors appointed and a panel of consultant obstetricians was set up to help general practitioners. The local District Nursing Association was subsidised in regard to midwifery services. The health visiting and school nursing services were integrated. 1933—A scheme for the rehousing of tuberculous cases was inaugurated in conjunction with the Housing Department. Six clearance orders were confirmed after enquiry. A second "clearance" programme was approved. Additional welfare sessions were begun and the Health Visiting Staff was further strengthened. The Education Committee provided orthodontic (or regulation) treatment. 1934—A "Health Week" was held in conjunction with the Central Council for Health Education. The clearance of 68 horuses was confirmed by the Ministry of Health. The Municipal Maternity Home of 40 beds was opened and was recognised by the Central Midwives' Board for the training of pupil midwives. The School Medical Service carried out a special nutritional investigation. Nearly 70% of school children received milk at school. 1935—A new low record of infant mortality (37) was recorded. Draft plans were approved for the extension of the Maternity Hospital to 54 beds. A Resident Medical Officer was appointed. The Ministry of Health carried out a survey of the Health Services of the Borough—the following is taken from the report made— 12 "It appears that, so far as can be judged from a general survey, the Council are maintaining a reasonable, and for the most part, a high standard of efficiency and progress in the discharge of their functions, relating to public health. In particular, the Minister is glad to learn that good work is being done under the Council's Maternity and Child Welfare Scheme both through their own officers and in co-operation with voluntary bodies. The provision of a Foot Clinic and the arrangements for immunisation against Diphtheria are also noteworthy features of the Council's health work." The Education Committee appointed a third dental team. Dental inspection and treatment were undertaken at secondary and technical schools for the Essex County Council. 1936—Duties imposed by the Housing Act 1936 were carried out and a survey was begun of all dwelling-houses in the Borough. The maternity hospital was fully booked and the plans for extension were passed by the Ministry of Health. The Education Committee provided a new open-air school, appointed a physical training organiser and a speech therapist. Arrangements were made for child guidance treatment. 1937—The measures required by the Housing and Midwives' Acts 1936 were taken. Eight midwives were appointed. The Maternity Hospital provided training in gas and air Analgesia. Attendances at Welfare Clinics were nearly 50,000. The Education Committee appointed a fourth dental team. Tonics were provided at school clinics. The consultant in charge of the Rheumatism Clinic noted a decline of severe heart disease cases attending the Clinic. Good progress was made in Diphtheria Immunisation, as was the case with milk in schools and school meals. Medical inspection and treatment were provided in secondary and technical schools for the Essex County Council. 1938—Diphtheria incidence was only l/3rd that for England and Wales and the Diphtheria death rate was only l/7th that for England and Wales. Welfare attendances increased to 56,000. The Education Committee provided treatment for squint at a special clinic. A special enquiry was conducted in connection with the Rheumatism Clinic. 13 1939—The Civil Defence Casualty Services—first-aid parties, ambulances, and ten "ad hoc" first-aid posts were organised, built and operated. Every effort was made not to curtail health services and activities. There was a new low record in infant mortality (29). The work done at the Maternity Hospital and Clinics was almost as much as that in previous years in spite of four months of war. An investigation was carried out at the Maternity Hospital into daily diets and the cause of mastitis. 1940—A high standard of health was recorded despite shelter life. 1941—Vital statistics were again favourable. Two voluntary societies opened day nurseries. 1942—Diphtheria incidence was only l/20th of that for England and Wales, and the Diphtheria death rate was only l/6th of that for England and Wales. A special clinic was opened for the treatment of Scabies. A war-time day nursery was opened at St. Mary's Convent and additional ante-natal services were provided. The Education Committee's school meals services provided some 4,000 meals per day from six kitchens. 1943—A second day nursery was opened at Higham Hill. Special nutritional investigations were carried out at schools in conjunction with the Ministry of Health and a special investigation (in conjunction with the Essex County Council) was carried out in regard to tuberculosis incidence at schools. The Education Committee decided that in future all school staff should have an X-ray examination on appointment. A full-time psychologist was appointed and a child guidance service was commenced. 1944—The domestic help and municipal dental schemes were commenced. The infant mortality remained low at 37, while the illegitimate rate was even lower at 33—a result of the special measures for the care of infants and of premature; infants. There was a new high record of confinements at the Maternity Hospital (over 1,000 admissions) in spite of rockets ' and ' flying bombs.' 14 A third day nursery was opened at Handsworth Avenue. 82 per cent. of all live births attended child welfare centres. 80 per cent. of all expectant mothers attended antenatal clinics. Post-graduate lectures for midwives were organised and made available to the midwives of adjoining local authorities. The Municipal Ambulance Service carried 6,362 patients for over 33,000 miles. 1,000 treatments were given at the chiropody clinic and some 2,000 at the gynaecological clinic. 104 patients from other local authority areas were treated at the Council's Infectious Diseases Hospital. 1945—Treatments were nearly 10,000 at the Foot Clinic, over 4,000 at the Skin Clinic and over 2,000 at the Women's Clinic. There were nearly 1,000 confinements at Thorpe Coombe. The Municipal Ambulance Service was staffed by the Council in lieu of Civil Defence and three ambulances (with two in reserve) and one motor-car were provided. Additional sessions were provided at the Child Guidance Clinic. 1946—Health services returned rapidly to pre-war level. Live births totalled 2,544 and 86% of the children born were taken to the various welfare centres. The number of confinements at Thorpe Coombe reached a new high level at 1,247. Infant mortality at 34 per 1,000, remained low. The County Council requested the Walthamstow Committee for Education to expand the Child Guidance Service so as to cope with children from the Borough of Leyton and from the Forest Division. The Education Committee agreed to an increase of 3 dental teams and to the establishment of 3 new treatment centres. 1947—The population increased to over 122,000. Another low record was achieved by an infant mortality rate of 29 per 1,000 live births, and a new high peak of 2,670 live births. There were nearly 73,000 attendances at welfare centres. Ambulance calls increased by 35% and mileage by 44% over 1946. The Municipal Dental Scheme was extended by the provision of a full-time dental team and by the establishment of a dental workshop. 15 Good progress was made in the provision of houses, especially for the aged. 1948—Yet another new low record in infant mortality was reached at the very low rate of 20 infant deaths per thousand live births on a total of 2,068 live births. This rate will probably prove to be amongst the lowest rate in towns with a comparable or greater population. Stillbirths and deaths in the first month of life also gave new low records. By the end of the year nearly 80% of all children under 15 years of age had been protected against Diphtheria. There was only one confirmed case of Diphtheria and no death. General. The twenty years 1929/1948 afford a good opportunity to compare the achievements of the Health Services in Walthamstow over two decades. The first, i.e., 1929/1938, was a decade of peace, whereas the second, 1939/1948, was a decade including seven years of war, which was probably as dangerous for the people remaining in Walthamstow as for many who served on so-called 'active service.' The following table makes some comparisons during this period:— Decade Average annual Av. annual Average annual deaths from: Infant E/W Mortality W'stow Av. Infant Deaths per annum Diphtheria Notifications Diphtheria Whooping Cough Measles Diarrhoea Under 2 1929/38 61.5 47.2 84.4 255.7 7.9 5.9 8.5 10.1 1939/48 47.2 35.2 64.4 15.9 1.9 2.1 1.0 4.3 On July 5th, 1948, the responsibility for most of the personal "services was transferred to the Essex County Council as the new 'Local' Health Authority. The position—to some extent—is eased by the fact that the services are administered by a Health Area SubCommittee for the area comprised by the Borough. Your Medical Officer of Health is the 'acting' Area Medical Officer. 16 A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar-General's, Estimate, mid-year 1948) 122,700 Number of Assessments (1st April, 1948) 35,740 Rateable Value £892,302 Sum represented by penny rate £3,510 Population.— The Registrar-General's Estimate of the population at mid-year, 1948, is 122,700, an increase of 230 on the previous figure. Unemployment.—According to information kindly supplied by Mr. Percy C. Graham, Manager of the Local Employment Exchange, approximately 1,100 men and 550 women were placed in employment every month during the year 1948, through the placing machinery of the Exchange. The number of persons insured under the National Insurance Acts, employed in the whole area covered by the Exchange, comprising the Boroughs of Walthamstow, Leyton, Chingford, Woodford and Wanstead, was 82,000 in July, 1948. Of this number it is estimated that about 40,000 were employed in Walthamstow. During 1948, the average number of persons unemployed in the whole area was 930 men and 230 women; these included approximately 160 disabled men and 25 disabled women. Extracts from Vital Statistics.—The Registrar-General's midyear, 1948, estimate of the population (viz., 122,700) has been used for the calculation of all vital statistics:— Total Males Females Live Births Legitimate 1,975 1,032 943 Birth rate per Illegitimate 93 40 53 1,000 of the Total 2,068 1,072 996 estimated resident population 16.8 Stillbirths 46 Rate per 1,000 total (live and still) births 21.7 Deaths 1,243 Death rate per 1,000 of the estimated resident population 10.1 17 Deaths from puerperal causes:— Puerperal Sepsis Deaths Nil Other Puerperal Causes Nil Death rate of infants under one year of age:— All infants per 1,000 live births 20 Legitimate infants per 1,000 legitimate live births 19 Illegitimate infants per 1,000 illegitimate live births 43 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 6 Deaths from Diarrhoea (under two years of age) 2 Pulmonary Tuberculosis death rate 0.48 Non-pulmonary Tuberculosis death rate 0.03 (All death rates are per 1,000 of the estimated residential population.) The natural increase of population, i.e., excess of births over deaths was 825. The usual comparison of 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 1948 (1,243) compares with 1,315 in 1947, the respective death rates per 1,000 population being 10.1 and 10.7. 18 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and case Rates for certain Infectious Diseases in the year 1948. Provisional figures based on 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 1,000 Civilian Population. Births:— Live 17.9* 20.0 19.2 20.1 16.8 Still 0.42* 0.52 0.43 0.39 0.37 Deaths:— All Causes 10.8* 11.6 10.7 11.6 10.1 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Whooping Cough 0.02 0.02 0.02 0.01 0.04 Diphtheria 0.00 0.00 0.00 0.01 — Tuberculosis 0.51 0.59 0.46 0.63 0.52 Influenza 0.03 0.03 0.04 0.02 0.04 Smallpox — — — — — Acute Poliomyelitis and Polioencephalitis 0.01 0.01 0.01 0.00 — Pneumonia 0.41 0.38 0.36 0.54 0.48 Notifications:— Typhoid Fever 0.01 0.00 0.01 0.00 0.01 Paratyphoid Fever 0.01 0.01 0.01 0.01 — Cerebro-spinal Fever 0.03 0.03 0.02 0.03 0.00 Scarlet Fever 1.73 1.90 1.82 1.37 1.53 Whooping Cough 3.42 3.51 3.31 3.13 4.60 Diphtheria 0.08 0.10 0.09 0.10 0.00 Erysipelas 0.21 0.23 0.21 0.22 0.22 Smallpox — — — — — Measles 9.34 9.75 8.84 9.17 5.20 Pneumonia 0.73 0.84 0.60 0.57 0.69 Acute Poliomyelitis 0.04 0.05 0.04 0.04 0.02 Acute Polioencephalitis 0.00 0.00 0.00 0.00 — Rates per 1,000 Live Births. Deaths under 1 year of age 34f 39 32 31 20 Deaths from Diarrhoea and teritis under 2 years of age 3.3 4.5 2.1 2.4 0.9 Rates per 1,000 Total Births (Live & Still) (a) Notifications:— Puerperal Fever and Pyrexia 6.89 8.90 4.71 ‡7.34 10.4 (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 0.11 0.05 0.13 0.73 Walthamstow — — — — * Rates per 1,000 Total Population. f Per 1,000 related births. | In London Puerperal Fever alone was 0.61 19 Causes of Death as given by the Registrar-General for the year 1948 Whole District Causes of Death. Males. Females. Total. 1. Typhoid and Paratyphoid Fevers — — — 2. Cerebro-spinal Fever — — — 3. Scarlet Fever — — — 4. Whooping Cough 4 2 6 6. Diphtheria — — — 6. T.B. of Respiratory System 34 26 60 7. Other Forms of Tuberculosis — 4 4 8. Syphilitic Diseases 7 2 9 9. Influenza 3 3 6 10. Measles 1 — 1 11. Acute Poliomyelitis and Polioencephalitis — — — 12. Acute Infectious Encephalitis 1 2 3 13. Cancer of buccal cavity and oesophagus (Males) 5 — 5 Cancer of uterus (Females) — 1 1 14. Cancer of stomach and duodenum 20 20 40 15. Cancer of breast — 22 22 16. Cancer all other sites 88 67 155 17. Diabetes 3 6 9 18. Intra-cranial vascular lesions 53 87 140 19. Heart Disease 175 184 359 20. Other Diseases of the Circulatory System 16 28 44 21. Bronchitis 46 22 68 22. Pneumonia 31 29 60 23. Other Respiratory Diseases 11 11 22 24. Ulceration of the Stomach or Duodenum 15 4 19 25. Diarrhoea (under 2 years) 1 1 2 26. Appendicitis 3 — 3 27. Other Digestive Diseases 11 13 24 28. Nephritis 8 9 17 29. Puerperal and Post-abortive Sepsis — — — 30. Other Maternal Causes — — — 31. Premature Birth — 1 4 32. Congenital Malformation, Birth Injury, Infantile Disease 14 11 25 33. Suicide 8 5 13 34. Road Traffic Accidents 6 4 10 35. Other Violent Causes 11 8 19 36. All Other Causes 44 49 93 Totals, 1948 619 624 1,243 Totals, 1947 686 629 1,315 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 1 21 101 99 20 B.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA 1:—(1) Public Health Officers of the Authority:—The names and qualifications of officers employed by your Authority are given at the beginning of the Report. All are whole-time officers unless otherwise stated. (ii) (a) Laboratory Facilities:—(See I. D. Section.) (b) Ambulance Facilities:— Municipal Service. This Service was transferred to the County Council on the 5th July, 1948. The following shows the number of calls and the mileage during the period 1st January to 4th July, 1948. Removals. Accidents. Treatment. Maternity. Others. Total. Mileage. 360 1,223 4,233 462 235 6,513 28,539 For the year ended 4th July, 1948, there were 11,562 calls involving a distance of 52,277 miles. 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:— "Number 29 Division celebrated its Golden Jubilee this year. On January 5th, 1899, it was registered as a division in the St. John Ambulance Brigade. "Things have altered a great deal since then—there is now more call on our services, and during 1948 we carried out somewhere in the region of 5,000 local duties. At our local headquarters we treated 200 cases, in addition to the numerous treatments carried out at Public places, which are not recorded locally. "We are now starting a Cadet Division for boys aged 11 to 16 years." (c) Nursing in the Home. (i) General.—The work done by the Walthamstow District Nursing Association was taken over by the County Council on July 5th. General supervision and control became delegated to the Health Area Sub-Committee and its officers. (ii) Infectious Diseases.—No change. (d) Clinics and Treatment Centres. Foot Clinic.—This Service was transferred to the County 21 Council on July 5th. Total attendances were 13,992 and of these 1,634 were by new patients, 12,358 were re-attendances by old patients. The receipts were £1,175 19s. 9d. 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 Service was transferred to the Regional Hospital Board on July 5th. The clinic is held in Thorpe Coombe Maternity Hospital Ante-Natal Block. It deals mainly with gynaecological conditions. Contraceptive advice is given when indicated on medical grounds. 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 52 491 1,644 2,135 41.05 (b) Saturday Morning 26 114 216 330 12.7 Totals 78 605 1,860 2,465 31.6 (c) Tuesday Morning 24 28* 469† 497 20.7 * These patients were transferred from the Post-natal or Gynaecological Clinics. † A number of gynaecological patients' attendances are included in this figure. Summary of New Cases:— Tuesday afternoon. Saturday morning. Total For diagnosis or complications of pregnancy 130 53 183 Sterility 56 6 62 Gynecological 216 47 263 Post-natal 2 1 3 Medical 25 3 28 Surgical 14 — 14 Contraceptive 40 4 44 Not classified 8 — 8 Totals 491 114 605 22 The number of patients transferred to Hospital was 55. This figure does not include those transferred to Hospital for confinement. Comparison of attendances with previous years:— 1948. 1947. 1946. 1945. 1944. 1943. 1942. 1941. 1940. 1939. 1938. New Cases 605 546 610 616 444 524 424 299 260 329 319 Old Cases 1860 1563 1745 1665 1630 1618 1303 1023 1183 1234 1179 Totals 2465 2109 2355 2281 2074 2142 1727 1322 1443 1563 1498 Municipal Dental Service. The responsibility for this Service was transferred to the Executive Council for Essex on July 5th but local control and administration remain unaltered. 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:— "On July 5th this Service was absorbed into the National Health Services and the Clinic was designated a 'Health Centre.' "Shortly before that date it was found necessary to appoint a second full-time dental officer, and Mr. Timmis, L.D.S., was appointed on May 5th, with the necessary chairside assistant. "An X-Ray machine has been installed during the year, and has been found very useful for both the general dental service and the priority dental service, i.e., for school children and Maternity and Child Welfare patients. "With the advent of the National Health Service the expectant and nursing mothers have been given priority over the general public. "The record of work done under the Maternity and Child Welfare service is recorded in that section of the Report. "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:— 23 1944 1945 1946 1947 1948 Before July 5 After July 5 Number of patients treated 143 379 585 805 419 365 Appointments made 633 2234 3719 5614 3422 4099 Appointments kept 558 2143 3315 5181 3025 3833 Fillings 135 1005 786 1065 776 1053 Scalings 67 147 206 314 172 247 Dressings 71 228 207 451 228 302 Extractions 266 1068 1570 2075 1117 1111 General anæsthetics 58 238 446 530 269 317 Local anaesthetics 54 112 182 278 186 268 Impressions 33 223 371 863 547 553 Bites 24 97 162 326 180 200 Try-ins 23 106 193 392 215 259 Dentures supplied 26 134 238 469 241 365 "In addition to the above, 1,277 other items of treatment were given. These comprise easings of dentures, the taking of X-Rays, fitting repairs, etc. "Below is appended a list of the appliances completed in the dental laboratory during 1948:— Municipal Dental Service School Dental Service 1.1.48 5.7.48 1.1.48 5.7.48 4.7.48 31.12.48 4.7.48 31.12.48 New dentures 275 380 10 14 Orthodontic appliances — 2 62 82 Crowns 9 7 15 16 Repairs 75 104 11 11 Inlays — 2 — — "Certain types of appliance were supplied by outside technicians, but, with the acquisition of an electric welder during the year it should be possible to dispense with the services of other laboratories provided an adequate staff can be maintained." Scabies Clinic. The arrangements at the special treatment Centre detailed in previous reports were continued. Sessions are held 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). 166 cases were treated during the year, receiving 510 treatments. (e) Hospitals.—There were no changes during 1948 in the hospital services used by the inhabitants of the Borough. 24 On July 5th the hospital facilities of the Borough were mainly those provided by the Forest Hospital Management Group of the North-East Metropolitan Regional Hospital Board, to which your Council's two hospitals were transferred. Treatment of the Chronic and Elderly Sick. The inadequacy of hospital beds for the chronic and elderly sick is a difficult problem, and every attempt is made to help such cases at home by the provision of Home Nursing, Domestic Help and meals from the Mobile Service. Prior to July 5th, Public Assistance was provided by the South Western Area Guardians Committee of the Essex County Council which retained a certain proportion of beds in each of the local institutions provided by the County Boroughs of East Ham and West Ham. Mr. Pegram, County Welfare Officer, has kindly supplied the following particulars of Walthamstow residents admitted to the various institutions during the period 1st January to 5th July:— Institutions Men Women Children Total Central Home 48 29 3* 80 Whipps Cross Hospital 330 472 202 1,004 Forest Gate Hospital — 1 — 1 Harold Wood Hospital — 2 — Forest House 2 1 — 3 Aldersbrooke Children's Homes — — 44 44 * These children were ultimately transferred to Aldersbrooke. One stillborn infant was born to a Walthamstow mother in Forest Gate Hospital during the above-mentioned period. The number of patients from Walthamstow in Mental Hospitals was 366 on the 4th July, 1948. Mr. Pegram has also kindly supplied the following information in regard to admissions to accommodation under Part III of the National Health Service Act from 5th July to 31st December, 1948:— Establishment Men Women Total Brookfield Hospital, Woodford Green — 3 3 Langthorne Hospital, Leytonstone 7 7 14 Forest House, Leytonstone 2 — 2 In addition it has also been necessary to provide temporary accommodation for evicted or homeless families:— Establishment No. of Cases Men Women Children Total No. of Persons Langthorne Hospital 6 5 6 8 19 St. George's Hospital, Hornchurch 1 1 1 1 3 25 The Connaught Hospital. The Secretary has kindly supplied the following summary of the work done in 1948 In-Patients— Number of patients admitted during 1948 2,804 Average length of stay 14.6 days Daily average number 111.89 Number of patients X-rayed 1,010 Out'Patients— Number of new cases treated 22,310 Number of attendances 110,612 Number of patients X-rayed 10,840 Physiotherapy Department— Number of massage treatments 23,825 Number of electrical treatments 38,513 Number of sunlight treatments 2,526 Operations— Major operations 2,137 Minor operations 2,804 Number of beds 118 Number of new patients 22,310 Venereal Disease Treatment. Treatment was the responsibility of the Essex County Council and all the facilities of the London County Council were 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.—Prior to July 5th out-relief and institutional treatment was provided by the Essex County Council. Mr. Pegram, County Welfare Officer, kindly states that the amount of relief provided in Walthamstow during the period 1st January to 4th July, 1948, was as follows:— Total amount of outdoor relief granted to Walthamstow residents during the period 1st January to 4th July, £24,125 16 5. Average weekly number of Walthamstow residents in receipt of relief:— Men 220 Women 513 Children 309 Total 1,042 26 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. Twelve inspections were made by the medical staff. No difficulties in regard to supervision arose. Routine enquiries are made with regard to unregistered homes. 5. Essex County Council Act.— One 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 1948. All dwelling houses in the area are supplied direct with water. Sanitary Inspection of the Area The Inspectorate was one below complement during the greater part of the year. 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. 13,913 8,525 3,218 2,501 2,783* 324 317* 23,248 * Includes notices outstanding from previous year. 27 Of the 2,501 informal notices served, 220 were in respect of business premises and the remainder (2,281) related to defects in private houses. Of the latter figure, 1,963 were complied with without resort to statutory procedure. In four cases the Owners failed to carry out notices served under Section 9 of the Housing Act, 1936, and the Council executed the work in default at a cost of £60 8s. 5d. In 21 instances it was found necessary to institute proceedings consequent upon owners' default in complying with the requirements of notices served under Section 93 of the Public Health Act, 1936. Orders were made by the Justices in eleven cases and in the ten remaining the summonses were withdrawn on payment of costs, the work being in progress or completed before the hearing. The following table shows the different types of work carried out in the district during the year :— Drains tested, 469; Drains reconstructed or repaired, 639; Drains, obstructions removed, 268; Drains, means of access provided, 69; Drains, ventilation provided or improved, 90; Drains, ventilation repaired, 97; Soil pipes repaired or renewed, 113; Rainwater pipes renewed, 324; Rainwater pipes disconnected from drains, 5; Roofs repaired or renewed, 1,090; Gutterings repaired or renewed, 450; W.C. pans or traps provided, 527; Gully traps provided, 127; W.C. flushing cisterns repaired or renewed, 296; W.C. floors concreted, 78; W.C.s repaired and cleansed, 246; W.C.'s light and ventilation improved, 20; Waste pipes repaired, renewed or trapped, 223; New sinks provided, 101; Stoves and firegrates repaired or renewed, 424; Water supply reinstated, 11; Water supply taken off main, 24; Cisterns cleansed and covered, 15; Sculleries paved, 55; Yards and forecourts paved or repaired, 91; Dirty houses cleansed, 42; Dirty rooms cleansed, 506; Floors repaired, 595; Ventilations under floors provided or improved, 248; New damp-proof courses provided, 63; Sites concreted, 10; Offensive accumulations removed, 23; Animals improperly kept, removed, 7; Stables repaired and cleansed, 21; Manholes repaired or re-sealed, 114; Other causes of dampness remedied, 515 ; Miscellaneous repairs, 2,450. Infectious Diseases. Visits to premises, 336; Re-visits to premises, 9. Disinfections. Rooms disinfected, 137; Articles disinfected at Low Hall Lane, 329 ; Articles destroyed at Low Hall Lane, 98. 28 Special Premises. Visits Number paid Factories (a) Power 453 517 (b) Non-power 100 163 (c) Other premises 38 68 Outworkers 397 470 Slaughterhouses — Butchers 75 408 Bakehouses 31 180 Fishmongers, Fish Fryers and Curers, etc. 39 222 Cafes and Caterers 107 342 Grocers, etc. 286 518 Ice Cream Manufacturers and Vendors 138 153 Cowsheds 1 3 Dairies and Milksellers 65 70 Laundries 3 11 Hairdressers 81 59 Rag and Bone Dealers 3 15 Piggeries 2 7 Street Stalls Numerous 154 Greengrocers 67 153 Stables 45 91 Schools 7 Conveniences 44 As a result of the regular periodical visiting of the Special Premises the following works were carried out: — Butchers. Special cleansings, 44; Paving repaired, 9; Accumulations removed, 3; New galvanised bins provided, 14; Drains repaired, 3; W.C.s repaired and cleansed, 13; Floors repaired and ventilated, 5; Light and ventilation improved, 3; Other improvements, 17. Bakehouses. Special cleansings, 55; New ceilings fixed, 4; Floors repaired, 9; Light and ventilation improved, 1; Roofs repaired, 2; Other improvements, 17. Fishmongers. Special cleansings, 26; Yards repaved, 6; Accumulations removed, 6 ; Drains cleared, 13 ; Other improvements, 20. Grocers. Store rooms cleansed, 31; Washing accommodation improved, 9 ; Other improvements, 34. 29 Cafes and Caterers. Special cleansings, 68; Light and ventilation improved, 10; Floors renewed, 12 ; Other improvements, 27. Ice Cream Manufacturers and Vendors. Special cleansings, 13; Yard pavings repaired, 1; Other improvements, 3. Cowsheds and Milkshops. Special cleansings, 17; New fittings and other improvements, 4; Light improved, 2. Hairdressers. Special cleansings, 28. Stable Premises. Cleansings, 18; Accumulations removed, 10; Roofs repaired, 2; Pavings repaired, 1; Manure receptacles provided, 4 ; Other improvements, 1. Laundries. Special cleansings, 3; Other improvements, 3. Rag and Bone Dealers. Cleansings, 4; Accumulations removed, 2. Piggeries. Cleansings, 2. Camping Sites. There are no authorised sites in the area. The caravan dwellers at Higham Hill still remain. Smoke Abatement. The difficulty of getting suitable boiler fuel still persists although some factory chimneys have been less troublesome during the period under review. On investigation of two complaints it was found that the burning of factory waste was the cause of excessive smoke— this practice was discontinued. Eradication of Bed Bugs, etc. There was a slight increase in the number of houses reported to be bug infested, due no doubt to the exceptionally good summer, but the figure is still comparatively low. Fumigations or special sprayings with DDT were carried out at 90 rooms and free insecticides were issued to tenants of 88 premises. 30 Hydrogen Cyanide (Fumigation of Buildings) Regulations 1938 :— One notice of fumigation was received. This related to a series of Office-Records Rooms, the contents of which were infested with Psocids. 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, 1948, the Swimming Bath was open on 294 days. The number of bathers during this time was 112,199. "The maximum load was on June 12th, when there were 822 bathers." Sampling was carried out 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, 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, with satisfactory results. (e) 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. 31 "The approximate number of swimmers in 1948 was 27,000. "Bacteriological and chemical analyses were carried out on four occasions with satisfactory results. "The following Essex championships were held at the Pool during the year: — Essex County Boys' Springboard Diving. Essex County Girls' Springboard Diving. Essex County Ladies' Springboard Diving." D.—HOUSING (a) Statistics Reference was last made in the report for 1941 to the number of houses erected. No houses were erected during the years 1942/45. The Borough Engineer and Surveyor and the Borough Architect have kindly supplied the following information for the years 1946/8. 1946 Houses Erected by:— (a) Local Authority. (b) Private Enterprise Hoe Street Ward 49 (T) St. James Street Ward 38 (T) Higham Hill Ward 61 (T) 8 (R) 1 (P) High Street Ward 41 (T) Wood Street Ward 26 (T) Hale End Ward 34 (T) 4 (P) 2 (R) TOTALS 249 (T) 8 (R) 5 (P) 2 (R) 1947 Higham Hill Ward 45 (T) 6 (R) 22 (P) 14 (Flats) (P) 33 (R) Wood Street Ward 45 (T) 20 (R) Hale End Ward 15 (R) 3 (P) 30 (R) TOTALS 90 (T) 21 (R) 3 (P) 83 (R) 22 (P) 14 (Flats) (P) 1948 St. James Street Ward 4 (R) Higham Hill Ward 64 (P) 108 (Flats) (P) 21 (R) Wood Street Ward 18 (R) Hale End Ward 196 (T) 1 (P) 45 (R) TOTALS 196 (T) 108 (Flats) (P) 64 (P) 1 (P) 88 (R) Note : (T) Temporary Houses. (R) Rebuilding war-destroyed Houses. (P) Post-war permanent Houses and Flats. 32 The Borough Architect summarises the general position as follows:— "During the calendar years 1946, 1947 and 1948 the Council have erected a total of 535 temporary houses, rebuilt 29 war-destroyed Council houses and have erected 86 new houses and 122 flats; 173 war-destroyed houses were rebuilt by private enterprise and nine new houses erected, giving a grand total of 934 dwellings." The official records show that there were 32,000 houses in the Borough in 1939, 30,000 of which were damaged, including 288 totally destroyed. (b) Inspection The following information is supplied 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) 3,554 (b) Number of inspections made for the purpose 8,494 (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 10 (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 2,271 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 1,963 33 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 37 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 29 (b) By Local Authority in default of owners (at a cost of £60 8s. 5d.) 4 (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 291 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 289 (b) By Local Authority in default of owners Nil 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 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 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 2 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 34 (c) Housing Act, 1936 Unfit Houses The following premises were dealt with as follows:— Demolition Orders 7, West Avenue Road. 41, Brunner Road. 21, Courtenay Place. Closing Orders 136, Wood Street. 14, Church Lane. Landlord and Tenant (War Damage) Acts, 1939-41. No applications were received from owners of houses for certificates. Rent and Mortgage Restriction Acts. During the year eleven certificates were granted to tenants. Five clearance certificates were issued to owners and five refused. Housing Act, 1936, Section 62. Applications for "permitted number" were received and certificates issued during the year respecting 257 lettings. General The following is supplied by Mr. J. E. West, your Council's Housing Manager :— "As additional properties were made available for letting during the year by the supply of temporary bungalows, erection of new houses and flats, it could be stated that some progress has been made. "With equal truth it has to be admitted that the housing situation still remains desperate for many families. Couples who have married during and since the war are anxious to settle down and rear families in tolerable living conditions. As a consequence, pressure is being brought to bear for a higher standard of accommodation, and the young people with their families are not content to remain indefinitely with relatives or continue to live in overcrowded conditions. Such families naturally look to the Local Authority to assist them and it will be seen that applications are received in greater number than houses become available. "Our present building programme, which, admirable in view of the limited building sites available in the Borough, 35 seems to be minute in comparison with the needs of the munity. In an endeavour to relieve the situation everything possible is being done to ensure that such accommodation as becomes available is used to its fullest capacity. It has, on occasion, been found possible to arrange for two, three or more tenants to transfer from present accommodation in order that, on completion of this 'switch-round,' an additional family can be re-housed, i.e., by putting a small family occupying accommodation greater than is needed into accommodation adequate for their requirements, and releasing the larger accommodation for a big family. "Progress in the building programme consists of the balance of the prefabricated bungalows allocated to the Borough being completed, together with a number of permanent houses on the Millfield Estate, and the completion of some of the multistorey flats on the Priory Court Estate. "It had been hoped in the early part of the year to close down the Rest Centre accommodation. Unfortunately, quite the reverse was found to be the case, as additional rest centre accommodation had to be acquired due to the large number of eviction orders effected through the Courts. "Experience in operating the original Points Scheme indicated that some revision was necessary. In the early part of the year, this revision was put into operation but the Scheme was under constant review by a special sub-committee, in order that the most urgent cases could be brought to light and early investigations be made. A further revised scheme was, therefore, decided upon in the latter part of the year. There is no doubt in my mind that as a result of the considerable time and thought spent by the sub-committee in keeping the Points Scheme under constant review, it has fully justified the results. "The progress made in rehousing and the housing situation up to 31st December, 1948, is as follows:— 1947 1948 Prefabricated bungalows occupied 466 535 Priory Court flats occupied 14 114 New houses occupied — 72 War damaged Council houses rebuilt and occupied - 17 Families rehoused 400 323 *Housing applications on the 'live register' 9,553 7.012 Personal interviews 11,407 9,273 * Reduced on a canvass to 6,176 on 1st April, 1948. 36 "The minimum amount of accommodation required to meet the housing needs as analysed from the list of Housing applications, is as follows:— Applications Per cent. No. Pensioners— 1 room 2.05 144 2 rooms 1.02 112 Others— 1 room (single persons) 0.75 53 2 rooms (young married couples) 27.35 1,904 3 rooms (families with one or two children) 54.30 3,786 4 rooms (families with three to four children or two of opposite sex) 12.38 861 5 rooms (families with five to six children) 1.95 137 6 rooms (families with more than six children) 0.20 15 100.00 7,012 1947 1948 No. of properties requisitioned 1,062 1,063 No. of properties still held 616 572." At the end of 1948 there were 5 hostels used solely for the purpose of housing elderly people, with total accommodation for 48 persons. In addition, there was one halfway house with accommodation for 14 persons, and another projected. In the pre-war housing estates, provision had been made for 40 one-bedroomed type flats for the elderly and on the post-war Priory Court estate, provision has been made for 14 one-bedroom type flats together with a common room and sun shelter. These self-contained flats, are let at an inclusive rental of 10/- per week. E.— INSPECTION AND SUPERVISION OF FOOD (a) Milk Supply. The following is contributed by the Chief Sanitary Inspector:— Designated Milk. During the year 144 samples of milk were submitted to the Counties Laboratories for bacteriological examination, including Phosphatase and Methylene Blue tests. 37 These samples of milk were taken from roundsmen during the course of delivery or on arrival at Schools. They include the bi-monthly sampling of the two dairymen holding Producers' Licences. The following table gives details of samples taken:— Grade. No. of Samples. Results Satisfactory. Unsatisfactory in Methylene Blue test only. Pasteurised 101 ALL NIL Tuberculin Tested Pasteurised 29 Tuberculin Tested 1 Sterilised 9 Heat Treated 4 Totals 144 144 - Biological Test. Four samples of pasteurised milk were examined, all of which were satisfactory. The Milk (Special Designations) Order, 1936. Licences for the sale of milk under Special Designations were granted as follows:— Dealers' Licences. Supplementary Licences. Pasteurised Milk 15 Pasteurised Milk 3 Tuberculin Tested Milk 10 Tuberculin Tested Milk 3 Bottling Licences. Pasteurised Milk 2 Tuberculin Tested Milk (Pasteurised) 2 There is one Cowshed in the district and the average number of cows kept is four. The number of Retail Purveyors of Milk is 65. All of these sell milk in bottles "as received." Seventy visits were paid to registered dealers and a satisfactory standard of cleanliness was maintained. (b) Ice Cream. Thirty-eight applications for Registration as Vendors were received. 38 Licences were granted as follows :— Vendors 22 Transfers 11 Refused 2 Withdrawn 3 Ice Cream (Heat Treatment, Etc.), Regulations, 1947/8. The trade was again circularised regarding the provisions of the above regulations. Five traders found it impossible satisfactorily to comply with the new regulations and now have their ice-cream manufactured at approved factories. Medical Examination—Typhoid, Etc., Carriers. The voluntary scheme of attending for Blood Tests or Rectal Swabs is still operative and 67 persons presented themselves for tests during the year. No carrier was found. Bacterial Quality and Grading of Ice Cream. Sixty-one samples were submitted for bacteriological examination and for grading in accordance with the Provisional Test of the Ministry of Health. The following summary shows the comparative results of the old standard test and the new (provisional) test. Grade 1 and Grade 2 of the latter are considered satisfactory. Plate Count Old Standard Test Not Passable New (Provisional) Test Methylene Blue Test Coliform Reaction (in 1/10 ml.) Bacterium coli (in 1/10 ml.) Very satisfactory Passable Reduction time Grade 20,000 — — X Not in 4½ hours 1 10,000 — — X „ 4½ „ 1 3,000 * 3 tubes - X „ 4½ „ 1 2,000 — - X „ 4½ „ 1 400 — — X „ 4½ „ 1 5,000 — - X „ 4½ „ 1 7,000 — - X „ 4½ „ 1 9,000 — — X „ 4½ „ 1 800 — - X „ 4½ „ 1 6,000 *3 tubes - X „ 4½ „ 1 300 — — X „ 4½ „ 1 3,700 — - X „ 4½ „ 1 3,000 — - X „ 4½ „ 1 400 — - X „ 4½ „ 1 700 — - X „ 4½ „ 1 11,000 — - X „ 4½ „ 1 700 — — X „ 4½ „ 1 11,000 — - X In 4 „ 2 2,100 *2 tubes — X „ 4 „ 2 2,200 — — X „ 4 „ 2 30,000 — - X „ 4 „ 2 39 Plate Count Old Standard Test Not able New (Provisional) Test Methylene Blue Test Coliform Reaction (in 1/10 ml.) Bacterium coli (in 1/10 ml.) Very satisfactory Passable Reduction time Grade 15,000 - - X In 3½ hours 2 3,000 - - X „ 3½ „ 2 2,000 - - „ 3½ „ 2 1,000 - - X „ 3 „ 2 6,000 - - X „ 3 „ 2 40,000 *3 tubes - X ,, 3 ,, 2 8,600 *2 tubes - X „ 3 „ 2 120,000 — - X „ 3 „ 2 60,000 *3 tubes - X „ 3 „ 2 20,000 *3 tubes - X „ 2½ „ 2 40,000 — — X „ 2½ „ 2 9,800 — - X „ 2½ „ 2 8,000 *3 tubes - X „ 2½ „ 2 20,000 * 3 tubes - X „ 2½ „ 2 7,600 *1 tube - X „ 2½ „ 2 5,800 *2 tubes - X „ 2½ „ 2 50,000 * 3 tubes - X „ 2½ „ 2 15,000 *3 tubes - X „ 2½ „ 2 8,000 *1 tube — X „ 2½ „ 2 15,000 *3 tubes - X „ 2 „ 3 100,000 *3 tubes - X „ 2 „ 3 5,000 *2 tubes - X „ 2 „ 3 7,500 *3 tubes - X „ 14 „ 3 6,000 * 3 tubes — X „ 1½ „ 3 26,000 *3 tubes - X ,, 1½„ 3 18,000 — - X „1½„ 3 13,000 *2 tubes — X ,, 1½ „ 3 20,000 *3 tubes — X „ 1 „ 3 18,000 *2 tubes — X „ 1 „ 3 45,000 *3 tubes - X ,, ½ „ 3 250,000 — — X „ ½ ,, 3 59,000 *3 tubes - X „ 0 „ 4 240,000 *3 tubes - X ,, 0 „ 4 2,500,000 *3 tubes - X ,, 0 „ 4 48,000 *2 tubes — X „ 0 „ 4 180,000 *3 tubes *3 tubes X „ 2½ „ 2 400,000 *3 tubes * 3 tubes X ,, 0 „ 4 15,000 *3 tubes *3 tubes X „ 0 „ 4 4,000 *3 tubes *2 tubes X „ 0 „ 4 By the old test, of a total of 61, 54 are in a category not less than 'passable," whereas by the new (Provisional) test only 41 were classified in Grades 1 and 2. 40 The presence of Bacterium Coli in only four samples indicates that care in manufacture and cleanliness in handling still predominates. (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. It will be realised that much time has to be devoted to food inspection and the following list of meat and other food condemned as unfit for human consumption is indicative of this. Where possible food was salvaged for processing or animal food. 2971 tins Evaporated Milk 48 tins Oranges 546 „ Full Cream Milk 28 „ Peaches 96 „ Machine Skimmed Milk 16 ,, Apricots 16 „ Dried Egg 16 ,, Pineapple 1810 „ Herring Tit-Bits 6 ,, Pears 294 „ Shellfish (various) 6 „ Prunes 115 „ Salmon 5 „ Damsons 100 „ Whiting 5 „ Cherries 81 „ Herring Spread 3 „ Grapes 79 ,, Pilchards 2 „ Gooseberries 75 „ Sardines 3 „ Rhubarb 56 „ Fish Paste (various) 2 ,, Apples 17 „ Roe 2 ,, Blackcurrants 9 „ Silver Hake 1 tin Apple Jelly 7 ,, Fish Cake 1 „ Blackberries 6 „ Snoek 1 „ Golden Berries 4 „ Anchovy 54 bott. Damsons 3 „ Haddock Liver 8 „ Plums 2 „ Fish Balls 1 „ Cherries 2 „ Fried Minced Fish 1 „ Sliced Apples 1 tin Brisling 1 „ Rhubarb 1 „ Kipper Snacks 2 „ Apples 496 tins Peas 1 gall. Apple Pulp 253 „ Beans 190 tins Jam 60 „ Mixed Vegetables 54 „ Orange Marmalade 55 „ Tomatoes 25 „ Grapefruit Marmalade 49 „ Carrots 8 „ Pudding 17 „ Beetroot 36 „ Spaghetti 15 „ Spinach 1 tin Macaroni Cream Sauce 9 ,, Potatoes 10 tins Pate de Fois Gras 5 ,, Turnips 20 jars Gherkins 3 „ Macedoine 20 „ Pickles 149 ,, Plums 17 bott. Tomato Ketchup 112 ,, Fruit Salad 10 jars Pickled Cabbage 79 „ Grapefruit 2 bott. Onions 41 148 bott. Fruit Sauce 12½ lbs. Tinned Peaches 23 „ Mint Sauce 6½„ „ Plums 9 jars Salad Cream 2210¾ „ Tomatoes 1 cwt. Salt 12 ,, Tinned Peas 25 gall. Vinegar 248 „ Prunes 114 pkts. Soup 124 „ Figs 86 tins Soup 94 „ Butterbeans 4 „ Broth 28 „ Ground Almonds 143 ,, Stewed Steak 25 „ Dried Peaches 6 „ Irish Steak 1 box Dates 2 „ Ulster Steak 35 lbs. Jam 14 „ Steak 6? Kidney Pudding 88 „ Grapefruit Marmalade 2 „ Hors d'Oeuvres 25½ „ Orange Marmalade 193 „ Luncheon Meat 12 „ Grapefruit Orange 145 „ Veal Loaf Marmalade 100 „ Beef Loaf 3 „ Syrup 32 „ Pork Loaf 42 ,, Piping Jelly 16 „ Ham Loaf 18 „ Porridge Oats 91 „ Bacon 145 pkts. Scotch Oat Cakes 82 „ Sausages 66 „ Cereals 66 „ Meat & Veg. Ration 47½ lbs. Barley 18 „ Turkey 170 „ Hazel Kernels 13 „ Galantine 32 „ Butter 7 „ Chilli Con Came 35 pkts. Sweephat 4 „ Potted Meat 423 lbs. Flour 4 „ Beef and Carrots 140 „ Flour Improver 1 tin Minced Beef 6? Cereals 112 „ Rhye Cones 1 „ Meat Hash 9 bott. Coffee 1 „ Meat Roll 14½ lbs. Sugar 1 „ Chicken 63 ¼ „ Cheese 1 „ Rabbit 78 boxes Cheese (Camembert) 24 tins Brawn 1 jar Paste 5 ,, Brisket 88 lbs. Confectionery (various) 902J lbs. Corned Beef 27 bars Mars 519j „ Beef 104 stone Dogfish 245J „ Mutton 59 „ Skate 149 „ Bacon 42¾ „ Cod 42 „ Brawn (Danish) 21 „ Whiting 39 „ Chilli Con Carne 19 ¾ ,, Flaps 30 „ Tongue 19 „ Herrings 24 „ Sweetbreads 17 „ Haddock 16-½ „ Corned Beef Hash 15 „ Roker 8 „ Sausages 15 „ Dabs 8 „ Brisket 13 „ Roe 7 „ Luncheon Meat 8 „ Kippers 2½ „ Kidney 3¾ „ Lemon Soles 2 „ Pork (Danish) 13 lbs. Cod Fillets (cooked) 20 „ Tinned Grape Fruit 2 doz. Fish Cakes 42 2 boxes Kippers 211 Chickens 62 jars Herring Fillets 100 Rabbits 1 jar Bismark Fillets 12 Ducks 2 jars Salmon Chovy 551 Eggs 1 pkt. Stuffing (d) Adulteration, etc.—Food and Drugs Act, 1938. One hundred and three samples of food and drugs were submitted to the Public Analysts. Nine samples were found to be unsatisfactory. Details are given below:— Description of Article Result of Analysis Action Taken Rum (Formal) added water. Letter of warning. Blackcurrant Cordial formal) Slight fermentation. No other stock—warning sent. Vinegar (Informal) Bacterial growth. Consignment returned to Min. of Food. Frying Oil (Informal) Mainly mineral. No further supplies obtainable — warning sent. Vinegar (Formal) Acetic Acid only. Warning sent. Whisky (Formal) 4% added water. Court proceedings. Licensee and Barman fined £5 and costs each. Sausages (Informal) Meat 6% deficiency. Warning sent. Malted Milk (Informal) Out of condition. Stock surrendered. Sausages (Formal) Preservative present and Warning sent. not declared. Below is given a full list of samples taken for analysis:— No. examined No. unsatisfactory Formal Informal Total Formal Informal Total Beef Cup — 1 1 — — — Beef Vegetable Extract — 1 1 — — — Ham. chopped 1 — 1 — — — Cordial, Blackcurrant — 1 1 — 1 1 Curry Powder — 2 2 — — — Fish Roll — 1 1 — — — Gelatine 1 — 1 — — — Ice Cream —. 8 8 — — — Icing Sugar 1 — 1 — — — Peel, mixed 1 — 1 — — — Pepper — 1 1 — — — Spice, mixed — 1 1 — — — Vinegar 7 4 11 1 1 2 Gin 2 — 2 — — — Rum 1 — 1 1 — 1 Whisky 7 — 7 1 — 1 Amara Tonic —- 1 1 — — — Nursery Powder — 1 1 — — — Revitone Tonic — 1 1 — — - Milk 15 — 15 — — - Baking Powder — 2 2 — — — Black Pudding — 1 1 — — - 43  No. examined No. unsatisfactory Formal Informal Total Formal Informal Total Coffee Chicory Essence — 1 1 — — — Corned Beef — 2 2 — — — Lemonade Tablets 1 — 1 — — — Mustard 1 — 1 — — — Potatoes — 2 2 — — — Sausages 3 2 5 1 1 2 Sausages, vegetable 1 — 1 — — — Biscuits, chocolate — 1 1 — — . — Caramel Cream 1 — 1 — — — Butter 2 — 2 — - — Coffee — 1 1 — — — Corned Mutton — 3 3 - - — Frying Oil — 1 1 - 1 1 Lemonade Crystals 1 — 1 — — — Lingo Fizz (Flavoured Effervescent Drink) - 1 1 - - - Meat Paste, beef - 1 1 — — — Oats, breakfast 1 — 1 — — — Pie — 1 1 — — — Sausages, luncheon 1 — 1 — — — Saccharin tablets — 1 1 — — — Cocoa — 1 1 - — — Jam — 1 1 - - — Malted Milk — 1 1 — 1 1 Olive Oil 1 — 1 — — — Onion Powder — 1 1 — — — Pickle — 1 1 — — — Sauce — 1 1 — - — Sausage Meat 1 — 1 — — — Sausage Rolls 1 — 1 — — — Veal Pie 1 — 1 — — — Bicarbonate of Soda — 1 1 — - — Liquid Paraffin — 1 1 — — — 103 9 Meat Products. The Public Analysts were called upon to examine four different samples of Canned Meat Products. These consisted of samples of Corned Mutton and one sample of Corned Beef. Extracts from their report are as follows :— "The reason for submitting these samples for examination was that in some cases when the tins were opened the contents were found to show black discoloured spots or areas. Bacteriological examination showed that the meat was sterile and a special examination was made for the presence of harmful metallic contamination. The results of these special examinations was to show that in the surface layers of some of these meat products traces of lead were found varying between seven and twenty parts per million, whereas analysis of the inner portions of the meat showed the presence of lead amounting to only between five and six parts per million. 44 "Having regard to the semi-official limit of five parts per million for lead in sardines and that, for a short time, as much as twenty parts per million was tolerated in sardines, we expressed the opinion that the inner meat with five parts per million of lead could be used for edible purposes, but nevertheless we hold the view that even five parts per million of lead is rather a generous limit for this type of product and that it should be possible to prepare canned meat with less than five parts per million of lead. "Unfortunately, knowledge of the effect of these minute quantities of lead in foodstuffs is still very limited and some official pronouncement as to the maximum permissible quantity of lead which may be allowed is undoubtedly urgently required." (e) Chemical and Bacteriological Examination of Foods. Chemical examination is carried out by the Public Analysts, Mr. G. Taylor, F.R.I.C., and Dr. J. H. Hammence, F.R.I.C., at 20 Eastcheap, E.C.3, and bacteriological examinations by the Counties Public Health Laboratories, 66 Victoria Street, S.W.I. Certain biological examinations are undertaken by Dr. A. L. Sheather of Chorley Wood. All Manufacturers and Vendors of Ice Cream were circularised regarding the requirements of the Ice Cream (Heat Treatment, etc.) Regulations and also informing them of the facilities offered to the trade re Blood Tests, etc. The hoped-for revised model bye-laws in connection with the sale or exposure for sale in the open air of food intended for human consumption, are not yet available, but may be expected in the near future. DISEASES OF ANIMALS ACTS, 1894-1938 Sheep Scab Order, 1938.—No action necessary. Swine Fever Order, 1938.—No action necessary. Regulation of Movement of Swine Order, 1922.—One case was dealt with. Parasitic Mange Order, 1938.—No action necessary. The following Orders were dealt with as necessary :— The Live Poultry (Regulation of Sales, Exhibitions and Movements) Order of 1948. The Live Poultry (Regulation of Sales, Exhibitions and Movements) (No. 2) Order of 1948. The Live Poultry (Regulation of Sales, Exhibitions and Movements) (No. 3) Order of 1948. The Sheep Scab (Amendment) Order of 1948. 45 RATS AND MICE DESTRUCTION ACT, 1919 AND INFESTATION ORDER, 1943 (a) Rat repression is actively pursued by the Council's trained Rat Catchers ; the Sanitary Inspectors act in a technical and advisory capacity. (b) Local Authority Circular N.S.19.—The Scheme of the Ministry of Agriculture and Fisheries (Infestation Control Division) was accepted by the Council and work is carried on to comply with the Ministry's requirements for effective rodent control of the area. Pre-baiting and poison baiting has been carried out with continued success. The following is a summary of the work undertaken during the year:— SANITARY INSPECTORS Types and No. of Premises found Premises Inspected to be infested Methods used at infested premises Food Other Food Other Baiting Trapping Gassing Other 35 417 30 3 13 295 2 3 55 Complaints received 297 Premises rat-proofed 5 Re-inspections 451 RODENT OPERATIVES No. of Infestations No. of Infestations Estimated Treated Re-treated Cleared. Kill. 351 166 335 3,500 FACTORIES ACTS, 1937 & 1948 The following tables show the work carried out under these Acts:— 1.- INSPECTION OF FACTORIES, ETC. Including Inspections Made by Sanitary Inspectors. Premises. No. on Register Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) (5) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 100 163 14 Nil Factories not included above in which Section 7 is enforced by the Local Authority 453 517 50 Nil Other premises in which Section 7 is enforced by the Local Authority 38 68 1 Nil Totals 591 748 65 Nil 46 2.—DEFECTS FOUND IN FACTORIES, ETC. Particulars. Number of Defects. Number of cases in which prosecutions were instituted Found. Remedied. Referred to H.M. Inspector. Referred By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness 59 56 - 4 - Overcrowding 1 1 — — — Unreasonable temperature 2 2 — — — Inadequate ventilation 18 17 — 1 — Ineffective drainage of floors 5 5 — — — Sanitary Conveniences insufficient 12 10 — 5 — unsuitable or defective 70 64 — 31 — not separate for sexes 3 3 — - — Other offences 33 31 1 1 — Totals 203 189 1 42 — NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1948 Wearing apparel, making Lampshades 2 of 320 Furniture & Upholstery 1 Artificial Flowers 3 Paper bags 30 Boxes 16 Brush making 10 Stuffed toys 14 Christmas crackers 1 Total 397 Hand-washing at Public Lavatories. This matter received consideration by your Council, with particular reference to persons handling foodstuffs. It was agreed in principle, that free facilities be given not only to food handlers but to all members of the public, in an endeavour to focus attention on this very important matter. The facilities provided at public lavatories, include the use of liquid soap and paper towels. 47 Installation of Coo\ing Apparatus in Rooms Containing Water Closets. Instances of this very undesirable practice came to light especially where the Landlord or principal tenant has had such work carried out, usually by a private contractor. The co-operation of the Electricity and Gas Authorities was sought in the matter and a promise was obtained that no fresh installations would be carried out and that every effort would be made to remove those existing. Such installations in private dwelling-houses contravene the local Building Bye-laws and where possible, action is taken to secure removal. . National Assistance Act, 1948—Section 50 FUNERAL ARRANGEMENTS Up to the end of the year, arrangements were made in regard to the burial of three persons, one a newly-born male infant found in Coppermill Lane and two elderly persons, one male and one female. The arrangements previously used by the Essex County Council, were continued. 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 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. 1948 1947 Scarlet Fever 188 232 - 45 124 14 3 2 - Diphtheria 1 - - - 1 - - - - Typhoid Fever 2 - - - 2 - - - - Paratyphoid Fever - - - - — — — — — Pneumonia 85 151 4 8 9 5 28 18 13 Puerperal Pyrexia 22 30 - — — 7 15 — — Ophthalmia Neonatorum 2 5 2 - - - - - - Erysipelas 27 48 - - 1 - 7 9 10 Encephalitis Lethargica - - - - - - - - - Polio-encephalitis - - - - - - - - - Cerebro-spinal Meningitis 1 9 — — 1 — — — — Anterior Poliomyelitis 3 24 — 2 — — 1 — — Measles 639 1081 43 326 263 2 5 - — Whooping Cough 565 223 71 335 153 1 3 2 — Dysentery 2 - - 2 - - - - - Malaria - - - - - - - - - Tuberculosis 144 151 1 6 10 49 52 16 10 Totals, 1948 1,681 - 121 724 564 78 114 47 33 Totals, 1947 — 1,954 83 841 670 106 132 80 42 48 St. James High Hoe Wood Hale Higham Totals. Street. Street. Street. Street. End. Hill. Scarlet Fever 30 23 31 27 38 39 188 Diphtheria — — — — 1 — 1 Typhoid Fever — — — — 1 1 2 Paratyphoid Fever — — — — — — — Pneumonia 10 14 13 10 19 19 85 Puerperal Pyrexia 3 — 4 6 4 5 22 Ophthalmia Neonatorum — — 1 1 — — 2 Erysipelas2 4 3 1 9 8 27 Encephalitis Lethargica — — — — — — — Polio-encephalitis — — — — — — — Cerebro-spinal Meningitis — — — — 1 — 1 Anterior Poliomyelitis 1 — — — — 2 3 Measles 97 87 145 55 123 132 639 Whooping Cough 123 101 95 | 40 73 133 565 Dysentery— 1 — — 1 — 2 Malaria — — — — — — — Tuberculosis 26 14 21 20 34 29 144 Totals, 1948 292 244 313 160 304 368 1,681 Totals, 1947 330 259 275 235 385 470 1,954 The statistics given in the foregoing tables are those for the calendar year 1948. The Registrar-General gives the statistics for the 52 weeks ended 31st December, 1948, 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 188 1 2 85 22 27 Case rate:— Walthamstow 1.53 0.00 0.01 0.69 0.17 0.22 England and Wales 1.73 0.08 0.02 0.73 Not available 0.21 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 10.4 England and Wales 6.89 49 Per cent. Deaths Total Removed removed per cent. Disease. notified. to to Deaths of cases Hospital. Hospital. notified. Scarlet Fever 188 101 53.7 — — Diphtheria 1 1 100.0 — — Diphtheria Observation 3 > 33 100.0 — — Typhoid Fever 2 2 100.0 — — Paratyphoid Fever — — — — — Pneumonia 85 52 61.1 60 70.6 Puerperal Pyrexia 22 1 4.5 — — Ophthalmia Neonatorum 2 1 50.0 — — Erysipelas 27 3 11.1 — — Encephalitis Lethargica — — — — — Polio-encephalitis — — — — — Cerebro-spinal Meningitis 1 1 100.0 — — Anterior Poliomyelitis 3 3 100.0 — — Measles 639 18 2.8 1 0.1 Whooping Cough 565 32 5.6 6 1.0 Dysentery 2 2 100.0 — — Malaria — — — — — Tuberculosis (all Forms) 144 116* — 64 55.1 * This figure also includes cases notified during previous years. Infectious Diseases Control.— 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 51 Number of attendances made 278 Average attendance per session 5.4 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 2 Negative (including pseudo and negative) 1 Positive (including pseudo and positive) 1 50 Total number of immunisations completed during 1948 (a) School age 662 (b) Pre-school age 2,049 (c) Over school age 1 Total 2,712 (d) Number already immunised having a ing dose 2,139 The above total includes 155 children immunised at Brookscroft and 504 by Private Practitioners. Number of Schick tests following immunisation 47 Number positive 3 Number negative 41 Number not seen 3 Number of special clinics held for immunisation at Town Hall 51 Number of attendances made for diphtheria immunisation 1,920 Average attendance per session 37.6 Number of attendances for whooping cough immunisation 323 Average attendance per session 13.5 Immunisation at Schools (included above):— Number completely immunised 454 Number partly immunised 78 Number having a booster dose, i.e., immunised in- previous years 1,940 With the transfer of responsibility for Diphtheria Immunisation from the Borough Council to the County Council on July 5th, it is appropriate to review the results since the commencement of immunisation in the year 1932, and the following table shows the progress:— Year commenced Additional Facilities for Immunisation No. of injections during 1948 at respective centres 1932 Clinics 1,883 1935 Schools 3,004 1938 General Practitioners 1,008 1942 Welfares 1,484 1945 Brookscroft 310 51 During the three years 1936/7/8 an average of some 300 cases per annum were immunised in the age group 0—5 years and some 1,300 cases per annum in the age group 5—15 years. Owing to the outbreak of war and of the incidence of bombing and evacuation, these numbers dropped badly during 1939/40, to pick up again with the commencement of the Ministry of Health Publicity campaign. Coincident with this, the need for early immunisation, i.e., preferably during the first year of life and in any case before school entry, was stressed and immunisation facilities were made available at Welfare Centres in 1942. As a result, the average of completed cases during the last four years, 1945/8 has been: — Under five years of age 1,733 Between five and fifteen years 729 or an average of 2,462 completed cases per annum under fifteen years of age. During these years the percentages immunised in the various age groups were as follows :— Percentage Immunised Year Under 5 years 5—15 years 0—15 years 1945 40.7 80.4 65.7 1946 50.3 77.4 67.7 1947 52.4 86.0 72.2 1948 61.5 91.5 79.2 Excluding 1932, i.e., the first year of immunisation, there were : during the eight years 1933/40 a total of 31 deaths from Diphtheria, and during the eight years 1941/48 a total of 15 deaths from Diphtheria. During the last two years, i.e., 1947 and 1948, there was no death, but the year 1946 was a bad year, when there were six deaths from Diphtheria in unprotected children in the reception areas. During 1948, out of 34 patients admitted to hospital for suspected Diphtheria, only one was confirmed as such. This very favourable result was largely due to immunisation and to the fact that over 60 per cent. of children under five years of age and over 90 per cent. of children between five and and fifteen years of age have so far been protected in Walthamstow. This virtual elimination of Diphtheria can only continue if the percentage of young children protected can be kept up, or better, increased, especially in regard to the under fives. 52 LABORATORY SERVICES The following number of swabs were sent to Epping Laboratory during the year :— School Medical Service 249 Health Department 245 VACCINATION Mr. E. Meddings, Vaccination Officer for the area until 5th July, 1948, has furnished the following return up to that date Births Successfully Percentage Deaths Deathsbefore Post' Registered Vaccinated Vaccinated ceptible tions Vaccination poned 1,005 433 43 — 351 15 12 The figures for the latter half of the year from July 5th onwards, i.e., following the repeal of compulsory vaccination, are given below :— Births Registered Successfully Vaccinated Percentage Vaccinated 840 145 17 During 1948, 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 24.6 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. Smallpox Contacts.— Contacts were reported for surveillance on disembarkation from several transports and were cleared after close observation. In view of the more recent experience (in 1949) following from the "Mooltan" incident, it appears highly desirable to insist that all persons entering this country after passing through areas where smallpox is endemic should have been recently vaccinated or revaccinated. 53 SCARLET FEVER A total of 188 cases of Scarlet Fever was notified during 1948 as compared with 232 in 1947. The incidence by months and Wards is given below:— January 27 July 20 February 16 August 12 March 13 September 5 April 13 October 15 May 18 November 14 June 20 December 15 Total 188 St. James Street 30 High Street 23 Hoe Street 31 Wood Street 27 Hale End 38 Higham Hill 39 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 1948, there have been 3,338 non-fatal cases. DIPHTHERIA During the year there were 34 cases notified for admission to Hospital as cases of Diphtheria observation. Only one of these cases was confirmed as Diphtheria. 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 and at all times at the Infectious Diseases Hospital, and the Fire Station, Forest Road. ENTERIC FEVER There were 2 cases notified during the year, only one of which was confirmed. Sex Age Ward Removed to Hospital Remarks F 36 H. E. Yes Carrier only. Case not confirmed. M 8 H. E. Yes Recovered. 54 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. Another chronic carrier has remained under supervision since 1946. Compensation for prohibition in regard to the manufacture and sale of Ice Cream later became the subject of arbitration. DYSENTERY Two cases were notified during 1948, details being as follows:— Sex Age Ward Removed to Hospital Remarks M 2 H.E. No Recovered M 14 Hi. No Recovered ACUTE ANTERIOR POLIOMYELITIS The total notifications during the year was 3, details being as follows:— Sex Age Ward Removed to Hospital Remarks F 29 St. James St. Yes Recovered F 3 Higham Hill Yes Still under Treatment M 4 Higham Hill Yes Recovered OPHTHALMIA NEONATORUM Two cases were notified during the year, details being as follows:— Sex Age Ward Removed to Hospital Remarks M 3 weeks Wood Street Yes Vision unimpaired M 3 weeks do. No Vision unimpaired PUERPERAL PYREXIA See Maternity and Child Welfare Section. PNEUMONIA The incidence by months and Wards is given below:— January 21 July 5 February 7 August 2 March 7 September 2 April 8 October 9 May 6 November 7 June 1 December 10 Total 85 55 St. James Street 10 High Street 14 Hoe Street 13 Wood Street 10 Hale End 19 Higham Hill 19 Up to July 5th your Council decided to continue the grant to the Walthamstow District Nursing Association, in return for which the Association was, amongst other services, required to provide home nursing facilities for cases of pneumonia. ERYSIPELAS The incidence by months and Wards is given below:— January 3 July 6 February 1 August 1 March 2 September 3 April — October — May — November 2 June 2 December 7 Total 27 St. James Street . 2 High Street 4 Hoe Street 3 Wood Street 1 Hale End 9 Higham Hill 8 CEREBRO SPINAL MENINGITIS One case was notified during the year, details being as follows:— Sex Age Ward Removed to Hospital Remarks M 5 Hale End Yes Recovered MALARIA There were no cases notified during the year. 56 MEASLES The incidence by months and Wards is given below:— January 10 July 66 February 16 August 55 March 11 September 17 April 98 October 22 May 149 November 58 June 78 December 59 Total 639 St. fames Street 97 High Street 87 Hoe Street 145 Wood Street 55 Hale End 123 Higham Hill 132 WHOOPING COUGH The incidence by months and Wards is as follows:— January 101 July 17 February 131 August 7 March 128 September 19 April 95 October 5 May 30 November 9 June 15 December 8 Total 565 St. James Street 123 High Street 101 Hoe Street 95 Wood Street 40 Hale End 73 Higham Hill 133 Whooping Cough became notifiable in 1940, and Table A gives the age incidence since that year. Table B gives death rates. At least 12 of the 18 deaths from Whooping Cough occurred in infants under 1 year of age. By contrast, during the same 10 years, deaths from Diphtheria totalled 19, i.e., there was only one more death from Diphtheria than from Whooping Cough. During 1948, which was an epidemic year, there were no less than 6 deaths from Whooping Cough—5 of them in infants under 1 year of age. This led your Council to consider the commencement of a scheme of protection against Whooping Cough, and it was decided to participate in the field trials conducted by the Medical Research Council. Considerable administrative delay resulted, particularly in view of the transfer of services on July 5th, 57 TABLE "A" WHOOPING COUGH NOTIFICATIONS Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs 45-65 yrs. Over 65 yrs. Total No. Per cent. No. Per cent. No. Per cent. No. Per cent. No. Per cent. No. Per cent. No. Per cent. 1940 2 14.3 7 50.0 4 28.6 — — 1 7.1 — — — 14 (Part year) 1941 39 8.6 237 52.5 171 38.0 1 0.2 2 0.5 1 0.2 - - 451 1942 9 6.0 92 61.0 46 30.4 1 0.65 2 1.3 1 0.65 — — 151 1943 8 8.6 57 61.3 27 29.0 — — 1 1.1 — — — - 93 1944 25 12.8 112 57.4 56 28.7 2 1.0 — — — — — 195 1945 15 11.4 74 56.5 41 31.3 — — — 1 0.8 — — 131 1946 17 8.6 132 67.0 46 23.4 1 0.5 1 0.5 — — - — 197 1947 22 9.8 133 59.6 62 27.8 4 1.7 1 0.4 - - 1 0.4 223 1948 71 12.5 335 59.2 153 27.0 1 0.1 3 0.5 2 0.3 — — 565 58 TABLE "B" WHOOPING COUGH NOTIFICATIONS AND DEATHS Year Number Notified Number of Deaths Ages Death Rate per 1,000 population 1940 14 - - - 1941 451 1 3 weeks 0.01 1942 151 4 2 years 0.04 1 year 2 months 2 months 4 years 1943 93 1 12 days 0.01 1944 195 3 5 weeks 0.02 3 months 1 month 1945 131 — — — 1946 197 3 1 year 0.02 4 months 1 year 1947 223 — — — 1948 565 6 5 weeks 0.04 3 months 3 months 1 year 10 months 9 months 4 months 59 1948, but eventually, protection against Whooping Cough under the M.R.C. scheme was begun in March, 1949, and at the time of writing, over 800 acceptances have been received in the age group 6-18 months, to which ages the trials are restricted. Prior to July 5th, 1948, Whooping Cough protection had been given since October, 1947 at the Council's Day Nurseries. Every child was given protection as soon as possible after admission. Although a considerable number of cases of Whooping Cough occurred during 1948 in the area in which the day nursery children live, there has been no case of Whooping Cough amongst children attending the day nurseries. Apart from the fatality of Whooping Cough in the early years of life, there may result considerable damage to the lung tissue. In addition, the disease is one of the most distressing in infancy and early childhood, and there is considerable keenness amongst the parents of young children to take advantage of the arrangements to give protection. The ultimate aim is the employment of a reliable prophylactic which will protect against both Diphtheria and Whooping Cough with the least possible number of injections. TUBERCULOSIS The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1948:— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year — — 1 — — — — — 1-5 years 2 1 1 2 — — — — 5-10 „ 1 3 1 2 — — — 1 10-15 „ — 2 — 1 — — — — 15-20 „ 10 8 2 1 — 1 1 2 20-25 „ 12 15 1 - 1 2 - - 25-35 „ 17 8 1 1 2 10 - - 35-45 „ 14 11 - - 12 8 - - 45-55 „ 5 4 - - 6 4 - - 55-65 „ 7 - - - 10 - - - 65 and over 4 6 — — 2 2 — — Totals 72 58 7 7 33 27 1 3 130 14 60 4 144 64 60 The 64 deaths represent a death rate of 0.52 per 1,000 population. New cases in 1947 were 151 with 58 deaths—a rate of 0.47. The returns for the past two years are compared below:— Year. New Cases. Deaths. Pulmonary. NonPulmonary. Total. Pulmonary. NonPulmonary. Total. m. f. m. f. m. f. m. f. 1948 72 58 7 7 144 33 27 1 3 64 1947 80 49 9 13 151 28 25 1 4 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 1 1 1 2 — 2 1 43 — 7 — 1 — The ratio of deaths in non-notified cases (i.e., columns to the right of the double line) to total deaths from tuberculosis was 8 to 56 or 1 to 7. The table given below shows the number of cases on the register at the beginning and end of 1948:— Pulmonary. Total. NonPulmonary. Total. Grand Total. m. f. m. f. No. on Register 1st January 1,039 886 1,925 491 402 893 2,818 Notified during 1948 72 58 130 7 7 14 144 Totals 1,111 944 2,055 498 409 907 2,962 Removed from Register, 1948 59 60 119 12 10 22 141 No. on Register 31st December 1,052 884 1,936 486 399 885 2,821 61 Removals from the Register are made up as follows:- Deaths. Removals. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. f. m. f. m. f. m. f. 33 27 1 3 26 33 11 7 60 4 59 18 64 77 141 Notifications of Tuberculosis since 1930 have been as follows:- Pulmonary Non-Pulmonary Males Females Total Males Females Total 1930 72 53 125 18 16 34 1931 97 53 150 23 17 40 1932 82 70 152 21 13 34 1933 56 55 111 27 18 45 1934 104 58 162 20 14 34 1935 64 58 122 25 16 41 1936 58 56 114 15 12 27 1937 59 70 129 13 12 25 1938 75 60 135 14 15 29 1939 71 56 127 10 4 14 1940 68 67 135 11 9 20 1941 56 35 91 13 12 25 <1942 67 52 119 17 12 29 1943 70 71 141 8 10 18 1944 74 57 131 14 13 27 1945 75 54 129 17 14 31 1946 83 67 150 16 12 28 1947 80 49 129 9 13 22 1948 72 58 130 7 7 14 Average 73 58 131 15 13 28 Prevention of Illness, Care and After-Care.—Close co-operation has continued with the Chest Physicians and the Chest Dispensary, and this has been particularly so with regard to cases of Tuber' culosis seeking rehousing on medical grounds. Broadly, first priority is given to sputum positive cases living in overcrowded conditions (particularly having regard to the standards of the Housing Act, 1936) and who are members of families in which there are young children exposed to the risk of infection, or alternatively, young children in another family sharing the same house. Another important work carried out at the Chest Dispensary concerns assistance in obtaining suitable employment. Dr. Ramsay states that the Chest Physicians are in constant contact with the Dispensary Resettlement Officer, and periodic "Work Clinics" 62 are held for consultation between the Dispensary Resettlement Officer and the Chest Physicians, with the patients present at the Clinic. Questions concerning return to work or training for suitable employment can then be discussed fully from all aspects. The continued inadequacy of hospital beds for cases of Pulmonary Tuberculosis gives rise to concern. Tuberculosis is pre-eminently a "community" disease and "a continuing" infection, especially in the case of the elderly infectious and incurable patient who is so often in intimate contact with children and under conditions of overcrowding. Every attempt is made to ease such cases by granting priority in regard to rehousing. Equally essential are beds for the early case in its curable stage. Bye-Law as to Spitting During the year your Council decided to take all possible action to try to prevent the very objectionable habit of spitting in public places. Finally, during the current year, a bye-law was approved, making it an offence to spit on the floor, side, or wall of any public carriage or of any public hall, public waiting room or place of public entertainment. Unfortunately this bye-law does not extend to public and private highways where the offence is most common and objectionable. Walthamstow Association of Tuberculosis Care Helpers.— Miss A. Woolgar, Secretary of the Association, has contributed a very full report on the work and activities. These include propaganda, the loan of sick-room equipment, provision of clothing prior to admission to sanatorium and replacements in long-term cases. Assistance in regard to clothing is also obtained through the Assistance Board, the British Red Cross Society and the S.S.A.F.A. Financial assistance with extra nourishment is provided by means of vouchers for milk and/or grocery, the grocery vouchers being mainly used where there is a family of children or in the case of old age pensioners. The Association also arranges for convalescence for "contact" children at West Mersea, and help is given in some cases with regard to fares for relatives visiting patients in sanatoria. A considerable amount of general welfare work is undertaken and the Area Officer of the Assistance Board has, on several occasions, used the Association as a supervising agency for the spending of special grants made for clothing and furniture. 63 Miss Woolgar gives the following particulars of cases dealt with during 1948, since July 5th:— No. of cases loaned sick-room equipment 3 „ „ provided with clothing 3 „ „ assisted with milk or grocery 55 „ „ assisted with fares 5 „ „ provided with bedding 1 „ children sent for convalescence 8 During the period January 1st to July 4th, the following were also dealt with:— No. of cases provided with milk or grocery 49 „ assisted with fares 5 „ „ provided with sick-room equipment 3 „ children sent for convalescence 10 Treatment of Tuberculosis.—The admissions to Hospital during 1948 were as follows:— Pulmonary. Non-Pulmonary. Total, 1948. Total, 1947. m. f. m. f. Adults 34 63 8 1 106 131 Children 1 2 3 4 10 17 G.—INFECTIOUS DISEASES HOSPITAL The Hospital passed to the control of the North-East Metropolitan Hospital Board on July 5th. This would appear to be a fitting occasion to refer to the splendid work carried out at the Hospital and the completely altered "picture" of the role of the ad hoc Infectious Diseases Hospital with practically no Diphtheria to treat and little Scarlet Fever—now a trivial illness with few complications. At all times the Hospital has been a happy one and children have repeatedly expressed their regret when the time has come for discharge. DAILY AVERAGE NUMBER OF PATIENTS IN HOSPITAL (including Tuberculosis cases) January 45.1 July 36.0 February 48.4 August 32.8 March 40.9 September 28.7 April 40.5 October 34.0 May 39.3 November 36.6 June 38.5 December 43.8 Average for whole year 38.7 64 The question of staffing, both nursing and domestic, continued to give rise to anxiety during the year, especially in regard to the recruitment of probationers. CLINICAL REPORT Dr. M. Hamilton, Resident Medical Officer, reports as follows on the work of the Hospital for the period 1st January, 1948, to 5th July, 1948. AGE AND SEX OF PATIENTS ADMITTED DURING THE PERIOD 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 28 24 17 27 6 2 — 3 51 56 107 Measles 9 14 — — — — - — 9 14 23 Whooping Cough 21 14 — 3 — — — — 21 17 38 Other Diseases 16 14 7 6 3 8 2 11 28 39 67 Totals 74 66 24 36 9 10 2 14 109 126 235 SEX AND AGE AT DEATH Twelve deaths occurred during the period, details being as follows:— 6 Broncho-pneumonia complicating whooping cough Males aged 2, 3, 16 and 22 months. Females aged 3 and 10 months. 2 Cerebral haemorrhage complicating whooping cough Females aged 3 and 18 months. 2 Pulmonary Tuberculosis Females aged 24 and 38 years. 1 Acute Anterior Poliomyelitis Female aged 18 years. 1 Bronchitis and Chickenpox Male aged 16 months. MISCELLANEOUS 1. Grants.—Your Council made the usual grants during the year to the Invalid Children's Aid Association and to the Waltham stow Association of Tuberculosis Care Helpers. 65 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 79 Post-Mortems only 158 Post-mortems and Inquests 49 Total 286 3. Cremation.—Facilities for cremation are available at the Crematorium provided by the City of London at Manor Park, Little Ilford. 4. Medical Examinations.—During the year, 126 examinations were carried out by the Medical Staff in respect of the Superannuation and Sick Pay Schemes. 5. Domestic Help.—Responsibility for this scheme was transferred to the County Council on July 5th. The total number of families assisted under this scheme during 1948 was 66; 13 were assisted between January 1st and July 4th, and 53 between July 5th and December 31st. Separate particulars are given in regard to Home Helps in cases of confinement. 6. Supply of Insulin.—Fourteen patients were supplied with Insulin in accordance with Circular 2734/1943, at a total cost to the Council of £20 10s. 8d. 66 SECTION H MATERNITY AND CHILD WELFARE COMMITTEE Chairman: Alderman Mrs. C. McEntee, J.P. Ex'officio: The Worshipful the Mayor—Councillor Miss D. Wrigley, B.A., J.P. Chairman of Finance Committee—Alderman Ross Wyld, O.B.E., J.P. Alderman W. B. Frtt. Alderman Mrs. E. M. Miller. Councillor W. E. Barnes. „ Mrs. L. P. Bailey. „ Mrs. Bottomley. „ Mrs. Candy. H. J. Cole. „ Mrs. Frewin. Councillor Mrs. Flint A. J. D. Llewellyn E. G. Richards. Mrs. Marchant. „ Mrs. Tillyer. Mrs. E. A. Smith, (deceased). Co-opted. Members: Miss A. Bowers. Mrs. Cooper. Dr. M. Ercolani. Mrs. Holsworth. Mrs. H. A. Christy. Mrs. G. E. Nicholls. Mrs. Riley. Mrs. Williams. 67 TO THE CHAIRMAN AND MEMBERS OF THE MATERNITY AND CHILD WELFARE COMMITTEE Ladies and Gentlemen, I beg to present a report on the work done in regard to Maternity and Child Welfare during the year 1948. The control of these services was transferred from your Council on July 5th and further reference to this question is made at the beginning of this report. The year has been noteworthy for further low records, i.e., one of 20 in regard to infant mortality, 11.1 in regard to deaths of infants within one month of birth, and of 0.37 in regard to stillbirths. These new records have been achieved on a total of 2,068 births. In regard to the care of illegitimate children, it is of interest to note that in four out of the last ten years the illegitimate death rate has actually been lower than the corresponding death rate of legitimate children. In regard to premature infants, only 4 children died from this cause in 1948. The high birth rate of recent years is reflected in the fact that 1,776 new patients attended ante-natal clinics and over 63,000 attended at welfare centres. It is gratifying to report that there was no death classified as being due to pregnancy, childbearing, or associated therewith. All the District Midwifery Sisters engaged in the Borough are qualified to give Gas and Air Analgesia and a total of 124 patients were given gas and air during the year. There still appears to be considerable reluctance amongst patients of the older generation to seek gas and air analgesia. Pressure on the day nurseries continued and the total on the waiting list at the end of the year at both nurseries was 344. In spite of changes, the number of health visiting staff compared with that available in other comparable areas, remains reasonably satisfactory. The report concludes with a summary compiled by Miss Helen Rodway, F.R.C.O.G., on the work done at Thorpe Coombe since its opening in 1934. I would like to take this opportunity of emphasising the great part which Thorpe Coombe has played in securing such consistently low infant mortality rates for the Borough in the past. I would also draw attention to Miss Rodway's out' standing work at Thorpe Coombe. Ail these achievements again reflect the highest credit on the staff concerned in the Borough with maternal and child health, and to them and to your Committee I would wish to express my most grateful thanks. I am, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. 68 NOTIFICATION OF BIRTHS 2,224 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, 291; Midwives, 1,933. Included in the above are 287 births which were notified as having occurred outside the Borough. Also included are 47 stillbirths, 40 of which were notified by Midwives. Of the total, seven occurred outside the area. REGISTRATION OF BIRTHS The Registrar-General's returns show the following registrations during the calendar year:— (a) Live Births. Males. Females. Totals. Legitimate 1,032 943 1,975 Illegitimate 40 53 93 1,072 996 2,068 (b) Stillbirths. Males. Females. Totals. Legitimate 28 17 45 Illegitimate 1 — 1 29 17 46 The stillbirth rate per 1,000 population was 0.37. Of the 1,947 birth registrations received in the Department during the year ten were not notified. Appropriate action was taken when necessary. Of the 1,947 local registrations, 136 belonging to other areas are excluded, leaving a nett total of 1,811. 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 142 106 115 107 168 165 144 129 189 170 195 181 953 858 Grand Totals 248 222 333 273 359 376 1,811 69 VITAMINS The facilities for the distribution of vitamins outlined in the 1942 Report were continued at all Welfare Centres. Every effort is being made to increase the demand. DAY NURSERIES The following table shows the average attendances at the Nurseries during 1948 (Mondays to Fridays only). Month. Nurseries. Over 2 yrs. Under 2 yrs. Total. January Higham Hill 37.7 14.3 52.0 Handsworth Ave. 34.9 11.3 46.2 February Higham Hill 39.9 12.0 51.9 Handsworth Ave. 39.2 12.8 52.0 March Higham Hill 45.3 12.1 57.4 Handsworth Ave. 39.8 11.6 51.4 April Higham Hill 39.9 11.0 50.9 Handsworth Ave. 40.2 12.7 52.9 May Higham Hill 46.4 10.2 56.6 Handsworth Ave. 42.8 10.2 53.0 June Higham Hill 49.6 10.0 59.6 Handsworth Ave. 39.0 10.6 49.6 July Higham Hill 45.3 9.0 54.3 Handsworth Ave. 35.0 8.5 43.5 August Higham Hill 44.1 9.4 53.5 Handsworth Ave. 35.0 9.1 44.1 September Higham Hill 49.9 9.0 58.9 Handsworth Ave. 44.3 10.2 54.5 October Higham Hill 49.2 9.4 58.6 Handsworth Ave. 48.4 10.0 58.4 November Higham Hill 46.7 9.1 55.8 Handsworth Ave. 45.6 9.6 55.2 December . . Higham Hill 41.4 8.8 50.2 Handsworth Ave. 45.8 10.4 56.2 Whole Year Higham Hill 44.6 10.3 54.9 Handsworth Ave. 40.8 10.6 51.4 During the current year it has become necessary to reduce the number of names on the Register at each Nursery from 60 to 55 so as not to exceed the capacity of the Nursery (i.e., 50 places). Pressure on the Day Nurseries remains high even in the priority classes, i.e., the children of unmarried mothers, of widows, or of wives separated from their husbands; the children of mothers whose husbands are frequently ill and cannot work full-time or are unemployed, or who are themselves ill; the children of mothers whose husbands are in the Forces; and of mothers who are working full-time on essential work. 70 Training.—Seven probationers obtained the Nursery Nurses Certificate during the year. 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. Control of the Day Nursery Service passed to the County Council on July 5th. INFANT MORTALITY The deaths of infants under one year were:— Males. Females. Totals. Legitimate 18 21 39 Illegitimate 2 2 4 Totals 20 23 43 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, 19; Illegitimate, 43; Total, 20. The rate constitutes a new low record. The Infant Mortality Rate for other areas during 1948 was as follows:— England and Wales 34 126 County Boroughs and Great Towns (including London) 39 148 Smaller Towns (25,000—50,000) 32 London 31 There were 43 deaths of infants under one year of age out of 2,068 live births, i.e., at the rate of only 20 per 1,000, which constitutes a new low record for the second year in succession. In 1947 the rate was 29. In 1915, when the Maternity and Child Welfare Act was passed, the rate was 93. If this rate had persisted in 1948, with 2,068 babies born, no less than 192 babies would have been lost instead of 43, i.e., there was a saving of 149 infant lives. The very low Infant Mortality rate would appear to be amongst the lowest rate of all areas in England and Wales with a similar or larger population. Neo-Natal Mortality. The neo-natal mortality is the number of deaths of infants under one month per 1,000 live births. During 1948, 24 infants died in the first four weeks of life, yielding a rate of 11.1. 71 For the last ten years in England and Wales the neo-natal deaths have been approximately half the deaths under one year of age. Stillbirths. Stillbirths were reduced to 46, yielding the lowest rate ever recorded per 1,000 population, i.e., 0.37. Infant Deaths, NeoNatal 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. 1948 .. 2,068 16.8 46 22.2 0.37 24 11.1 n/a 43 20 1947 .. 2,670 21.8 59 22.1 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 The neo-natal mortality for England and Wales is shown for comparison for the years 1944—1948 and is consistently higher than the Walthamstow rates. The death rate from Diarrhœa and Enteritis in children under one year of age per 1,000 live births was 0.9. 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 the steady fall since 1945 in the Infant Mortality and the Stillbirth rates. For the third time since 1930 the Infant Mortality rate has fallen below the Stillbirth rate. 72 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 1948 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. 73 Illegitimate Births and Mortality Year. Live Births. Infant Deaths. Death Rates. Legitimate. Illegitimate. Legitimate. Illegitimate. Legitimate. Illegitimate. 1938 1,572 42 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 1948 1,975 93 39 4 19.0 43.0 Miss Williams, Superintendent of the Home provided by the Walthamstow Branch of the Chelmsford Moral Welfare Association contributes the figures set out below and adds as explanation as to the larger number of cases helped from other areas that this is equalised by Walthamstow cases requesting help but naturally anxious to be cared for away from their homes. The total number of cases assisted from other areas, including advice and adoptions, amounts to 163. At the end of the year the electrical wiring was in process of being overhauled at a cost of £100. Cases admitted to the Home during 1948:— Adults—Walthamstow cases 17 From other areas 85 102 Babies—Walthamstow cases 16 From other areas 49 65 Total admissions 167 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 1948, 18 premature babies were born at home and 53 in Hospitals and Nursing Homes in the area. Of the 18 premature babies born at home, 10 were entirely nursed at home, 2 died during the first 24 hours (i.e., 11.1 per cent.) and 15 survived at the end of one month (i.e., 83.3 per cent.). Of the 53 premature babies born in Hospital, 4 died during the first 24 hours (i.e., 7.5 per cent.) and 49 survived at the end of one month (i.e., 92.5 per cent.). The table "Causes of Death" which follows includes four deaths from premature birth as compared with seven in 1947. 74 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 — - - - - 1 3 — 1 5 1 - 4 — - - 5 Diphtheria — - - - - - — — — — — - — - - - - Phthisis - - - - - - - - - - - - - - - - - Other forms of T.B. - - - - - - - - 1 1 — - — 1 - - 1 T.B. Meningitis - - - - - - — — — — — - — — - - — Meningitis (Non-T.B.) - - - - - - - - - - - - - - - - - Convulsions - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - - - - - Pneumonia 1 - 1 - 2 2 3 1 — 8 2 1 2 1 - 2 8 Diarrhoea, - - - - - - - 1 1 2 1 - — — - 1 2 Syphilis - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - Inattention at birth, wilful neglect - - - - - - - - - - - - - - - - - Suffocation (overlaying) - - - - - - - - - - - - - - - - - Injury at birth 2 - - - 2 - - - - 2 - - - 2 - - 2 Atelectasis 9 - - - 9 - - - - 9 - - 4 2 2 1 9 Congenital malformation 3 - 1 1 5 1 1 — 2 9 3 1 2 - - 3 9 Premature birth 2 1 1 - 4 — — — — 4 1 1 1- - - 1 4 Atrophy, debility, marasmus 1 - - - 1 — — — — 1 — - 1 - - - 1 Inanition - - - - - - - - - - - - - - - - - Heart failure. . - - - - - - - - - - - - - - - - - Other causes 1 - - - 1 — — — — 1 — 1 — - - ~~ 1 Totals 19 1 3 1 24 5 7 2 5 43 8 4 15 6 2 8 43 75 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 261 notified births, and one whole-time Health Visitor per 258 registered births during 1948. MATERNITY AND CHILD WELFARE CLINICS (a) Ante and Post Natal: Monday (once monthly) 2 p.m. Silverdale Road, Highams Park. Monday 2 p.m. Markhouse Road, E.17. *Tuesday 9 a.m. Markhouse Road, E.17. Wednesday 9 a.m. Markhouse Road, E.17. *New cases only. (b) Child Welfare: Monday 2 to 4 p.m. St. John's Church Hall, Penrhyn Avenue, E.17. Tuesday ,, The Memorial Hall, Winchester Road, E.4. Wednesday „ Low Hall Lane, Markhouse Road, E.17. Wednesday ,, " Brookscroft," Forest Road, E.17. Wednesday „ Silverdale Road, Highams Park, E.4. Thursday 10 to 12 noon The Memorial Hall, Winchester Road, E.4. Thursday 2 to 4 p.m. Low Hall Lane, Markhouse Road, E.17. Thursday „ St. John's Church Hall, Penrhyn Avenue, E.17. Thursday „ "Brookscroft," Forest Road, E.17. Friday „ Low Hall Lane, Markhouse Road, E.17. A new centre was commenced on 22nd May, 1948, at the remodelled Civil Defence premises at Silverdale Road, Highams Park. In addition, the Walthamstow Child Welfare Society holds massage and sunlight sessions. LOCAL AUTHORITY SCHEME This work was transferred to the County Council on July 5th. The detailed findings at first visits paid during 1948 are given in the following tables:— 76 From the above table it will be seen that of 2,059 children, 1,647, or 79.9 per cent. were breast fed on first being visited, and 10 or 0.48 per cent. had no separate sleeping accommodation. 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 224 49 20 5 288 231 57 5 95 43 73 53 22 7 High Street 250 21 24 — 295 270 24 1 93 152 3 8 32 5 Hoe Street 267 38 38 1 342 293 49 1 83 74 67 51 44 24 Wood Street 220 19 48 — 287 279 6 2 68 76 65 15 9 54 Hale End 334 42 37 1 412 399 12 2 233 58 74 19 28 1 Higham Hill 352 44 32 3 425 405 20 3 238 101 24 25 39 1 Total 1948 1,647 213 199 10 2,049 1,877 168 14 810 504 308 171 174 92 1947 2,131 273 270 15 2,659 2,448 206 20 1,066 725 370 127 181 205 77 437 infants lived in accommodation of three rooms or less, as compared with 513 in 1947. The following table shows the number and nature of visits paid in 1948:— 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. 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. 293 525 818 1,203 2,021 605 13 95 55 150 257 3,046 High Street 295 683 978 899 1,877 292 8 28 7 35 76 2,288 Hoe Street 343 713 1,056 995 2,051 494 18 18 4 22 241 2,826 Wood Street 287 342 629 403 1,032 186 20 42 — 42 98 1,378 Hale End 413 1,590 2,003 2,210 4,213 352 40 56 31 87 175 4,867 Higham Hill 428 1,172 1,600 2,767 4,367 247 21 92 39 131 332 5,098 Totals, 1948 2,059 5,025 7,084 8,477 15,561 2,176 120 331 136 467 1,179 19,503 Totals, 1947 2,674 5,595 8,269 7,228 15,497 2,120 144 337 132 469 1,342 19,572 78 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 at cost price) and inspection and treatment for scabies and pediculosis at the Skin Clinc. All these facilities are available to children under 5 years of age. In addition, educational work is carried out at all Walthamstow Schools, Day Nurseries and Welfare Centres. CLINICS Dr. M. Sheppard, reports as follows:— "During the year routine tests were taken at the AnteNatal Clinic for the Rhesus Factor and other investigations. Of 221 cases, 43 were Rhesus negative, a condition which may be dangerous for the newly born baby unless special precautions are taken. "A new Ante-Natal session was commenced at Silverdale Road Welfare Centre in May. Up to the end of the year, 48 mothers made 104 attendances. At the Markhouse Road Ante-Natal Clinic (for the whole year) 469 mothers made 904 attendances. "It is a matter of regret that Post-Natal attendances were less satisfactory than in 1947, the percentage being 15 against 26. This is the more disquieting since maternal morbidity is a serious menace to the health and wellbeing of the mothers. Steps are being taken to impress the importance of Post-Natal examinations on all newly delivered mothers. "A new welfare centre was opened at Silverdale Road, Highams Park, and this constitutes the fourth Local Authority Centre. Live births during 1948 were 2,068 and the total attendances under one year were 1,319, a satisfactory figure in view of the numbers attending the Brookscroft centre and sessions provided by general practitioners. "Total attendances at Council welfares during the year were 49,931, 26,875 under one year of age and 23,056 between one and five years. "Thanks are again due to the voluntary organisers who gave such cheerful and efficient service during 1948." 79 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 1,259 829 Low Hall Lane Clinic 469 76 Silverdale Road 48 5 Totals 1,776 910 Total Attendances:— Ante-Natal. Post-Natal. Thorpe Coombe Maternity Hospital 9,851 1,269 Low Hall Lane Clinic 904 84 Silverdale Road 104 5 Totals 10,859 1,358 The percentage of Ante-Natal cases to notified births was 79.8. Welfare Clinics Attendances at the 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 lyr. of age. 1-5 yrs. of age. Total. Under lyr. of age. 1-5 yrs. of age. Total. Markhouse Road 592 115 707 11,942 9,680 21,622 22,329 Penrhyn Avenue 353 71 424 6,733 6,637 13,370 13,794 Winchester Road 309 55 364 5,927 5,435 11,362 11,726 Silverdale Road 65 46 111 954 1,017 1,971 2,082 Total 1948 1,319 287 1,606 25,556 22,769 48,325 49,931 1947 2,032 81 2,113 32,505 23,002 55,507 57,620 The lower attendances under one year of age reflect the effect of the reduced birth rate. 80 Child Life Protection.—On the 5th July the Children Act came into operation and the Children's Committee of the County Council became responsible for carrying out the functions of the local authority under the Child Life Protection provisions of Part VII of the Public Health Act 1936, and also under the Adoption of Children (Regulation) Act 1939. There were nineteen nurse-children on the register at 5th July. Number on Register, 31.12.47 27 New Registrations 6 Re-registrations 2 35 Deduct: Removals from District 5 Number reaching the age of 9 years 6 Number adopted 5 16 Number on Register 4.7.48 19 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. Massage.—Six sessions per week were held at the Welfare Centres. 163 cases attended for massage and these made 1,794 attendances. Sale of Milk, etc., at Clinics.—The quantity and value of milk and food sold and issued free during 1948 was as follows:— Sales Free Issue lbs. ozs. lbs. ozs. Cow & Gate 13,002 — 21 — Ostermilk 4,000 — 117 — Ambrosia 1,455 — 1 — Trufood 575 — — — Lactogen 4,654 — 22 — Prune & Banana Syrup 103 — 22 14 Parrish's Food 145 8 45 — Cod Liver Oil & Malt 870 — 1 — Emulsion 362 — 1 — Magnesia 255 8 67 14 Virol 1,450 8 — 8 Virolax 128 8 22 8 81 Sales Free Issue lbs. ozs. lbs. ozs. Roboleine 744 - 4 - Farex 1,891 4 - - Ovaltine 1,522 8 - 8 Marmite 2,212 - - 4 Glucose 67 8 - - Maltoline 903 2 - 10 Adexoline 23 9 - £ Midlothian Oat Food 1,288 - - - Bemax Robinson's Groats 703 - - - Halibut Oil Emulsion 12 14 - - Scott's Baby Cereal 24 - - - Value £4,367 10s. 2d. 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:— Tuesdays and Fridays Massage, Remedial Exercises and Sunlight Treatment. Wednesdays Weighing Clinic and Cookery Lecture. Thursdays Infant Welfare for old and new cases. Two Doctors in attendance. Cookery Lecture. Alternate Fridays Diphtheria Immunisation. 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 l yr. 1-5 yrs. Total. Under 1 yr. 1-5 yrs. Total. 1948 596 70 666 10,028 2,923 12,951 13,617 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 82 Home Visits Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. First. Subsequent. Total. 1948 302 687 989 810 1,799 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 A total of 155 children were immunised against Diphtheria during the year at "Brookscroft." Your Council, under the Scheme approved by the Ministry of Health, made an annual grant of £700 to the Society. SUMMARY OF FOREGOING TABLES 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. Local Authority Scheme 1,319 287 1,606 25,556 22,769 48,325 49,931 Brookscroft 596 70 666 10,028 2,923 12,951 13,617 Total 1948 1,915 357 2,272 35,584 25,692 61,276 63,548 1947 2,729 145 2,874 43,579 26,355 69,934 72,808 The percentage of first attendances of children under 1 year of age at Child Welfare Centres to the number of notified live births was 88. Home Visits To Children under 1 year of age. To Children 1-5 years of age. Total. First. Subsequent. Total. Local Authority Scheme 2,059 5,025 7,084 8,477 15,561 Brookscroft 302 687 989 810 1,799 Total 1948 2,361 5,712 8,073 9,287 17,360 1947 2,965 6,102 9,067 7,733 16,800 83 TREATMENT (a) Orthopaedic.—The facilities provided by the Education Authority's Orthopaedic Scheme are available for all children attending the Welfare Centres. Miss Garratt, C.S.P., 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 7 Talipes—(a) Equino Varus 8 Scoliosis, Lordosis, Kyphosis 1 (b) Calcaneo Rickets—(a) Genu Varum 27 Valgus 24 (b) Genu Valgum 58 Torticollis 6 Pes Piano Valgus 47 Achondroplasia 1 Progressive muscular Digitus Varus 1 atrophy 1 Congenital Defects 13 Osteo Genesis Imperfecta 1 Miscellaneous 15 Spastic Paralysis 6 Congenital dislocation of Total 217 the hip 1 (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 Cases treated 136 205 Attendances 326 507 Fillings 145 200 Extractions 116 101 General Anesthetics 45 73 Scalings 20 42 Dressings 49 72 Silver Nitrate Dressings — 192 Dentures 11 - (c) Tonsils and Adenoids.—Children are treated under the arrangements made by the Education Authority with the Connaught Hospital. (d) Ophthalmic Defects and Minor Ailments.—Children are given treatment either at the School Clinics or by special appointment. (e) Sunlight.—80 infants were referred for sunlight treatment during 1948. (f) Child Guidance.—Arrangements exist for children under five years of age to be referred to the Education Authority's Child Guidance Clinic. 84 (g) Invalid Children's Aid Association. - Mrs. Osora, Secretary to the local branch of the Association, kindly reports that the following cases of children under five years of age were dealt with by her Association:— Referred by:— Hospitals and Medical Men 31 School Medical Services 10 Welfare Centres, Local Authority Services 8 Voluntary agencies 3 Parents 2 54 Classification of cases:— Anaemia, debility, malnutrition 4 After effects of acute or infectious illness or operation 13 Bronchitis and Pneumonia 7 Asthma Heart 1 Other crippling defects (non-T.B.) 11 Nervous conditions 3 Diseases of ear, nose and throat 2 Various 2 Visits, advice 11 54 Help given to old and new cases:— Sent to convalescent homes and nurseries 36 Provided with surgical appliances 10 Transferred to other agencies 5 Visits and advice 10 61 ASSISTED MILK SCHEME Number of applications during 1948 .— 14 Number of families assisted 11 The National Milk Scheme operated from July, 1940, and the above represents applications for special brands of dried milk not supplied under that scheme. 85 HOME HELPS Applications for the provision of Home Helps, if approved, are granted financial assistance for a period of fourteen days. During 1948, 61 applications for Home Help were received— 28 during the period 1st January to 4th July, and 33 during the period 5th July to 31st December. Up to 4th July, 18 were "overscale" and therefore not granted assistance, 9 were granted at part cost, and one free of charge. PRIORITY SHEET DOCKETS During 1948, 67 mothers were supplied with 190 four-coupon certificates and 240 mothers with 595 six'Coupon certificates. The termination of clothes rationing in March, 1949, rendered the scheme obsolete. During 1949 while rationing was still in force, 42 mothers were issued with 131 four-coupon certificates. STERILISED MATERNITY OUTFITS A total of 546 sets were supplied. INSTITUTIONAL TREATMENT No children were sent to Institutions under your Committee's arrangements. 86 CONFINEMENTS The following table shows the location of confinements for 1948 and the previous nine years. CONFINEMENTS 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 Thorpe Coombe Maternity Hospital 595 720 645 695 891 907 995 1,247 1,253 1,183 Other Hospitals and Maternity Homes 322 203 104 242 236 257 226 442 551 427 Total in Hospital 917 923 749 937 1,127 1,164 1,221 1,689 1,804 1,610 Local Authority 299 364 155 284 293 266 157 350 399 252 District W.D.N.A 162 164 142 222 205 203 178 336 291 235 W.D.N.A. (Private) to 5 th July, 1948 only 56 80 20 49 30 43 12 31 140 22 W.D.N A. Total 218 244 162 271 235 246 190 367 431 257 Total on District 517 608 317 555 528 512 347 717 830 509 Grand Totals 1,434 1,531 1 066 1,492 1,655 1,676 1,568 2,406 2,634 2,119 Births Registered 1,606 1,575 1,304 1,718 1,828 1,915 1,730 2,544 2,670 2,068 87 HOSPITAL ACCOMMODATION FOR CONFINEMENTS The following numbers of confinements occurred at the Institutions specified:— 1948 1947 Thorpe Coombe Maternity Hospital 1,183 1,253 Maternity Homes in Walthamstow 151 259 Mothers' Hospital Clapton 158 100 Other Maternity Hospitals and Homes 118 192 Totals 1,610 1,804 WALTHAMSTOW DISTRICT NURSING ASSOCIATION AND HOME NURSING SERVICE (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:— "I have again the pleasure of submitting an account of the work undertaken by the Association, which up to July 5th, 1948, was a voluntary body undertaking for the Council a portion of the Municipal Midwifery Service in addition to the Home Nursing Service. "The year has been an eventful one and an interesting one. "The change-over from a voluntary body to an official one on July 5th was quite smooth,' and did not in any way interfere with the work of the nurses and midwives. They continue to give the same excellent service. "I am fortunate in being able to get and keep a staff of nurses and midwives which up to date has coped fairly successfully with the work. The general work shows signs of increasing quite considerably. "As circumstances permit, I hope to increase the staff to the ratio recommended by the Ministry of Health, vis., 17½ general nurses. "The housing of extra staff will create a difficulty as 17 and 19 Carisbrooke Road are already full to capacity. The re-opening of a Home at Highams Park would relieve the tension and assist the nurses. ''The provision of at least another car (my car is already being used entirely for a nurse to enable the work to be done) would help also, as distances are very great. 88 "From the 1st December, 1947, to the 3rd December, 1948, 26 pupil midwives entered for their District Midwifery training. "Staff at the end of December, 1948, was as follows 3 Midwives. 1 Queens Nurse. 5 full-time S.R.N. 3 part-time S.R.N. 1 part-time Assistant Nurse. 7 Pupil Midwives. "Midwifery and Maternity nursing undertaken for the year was as follows:— Doctors' cases 49 Midwifery cases 208 Gas and Air Analgesia administered 11 MIDWIVES ACTS, 1902-1936 The County Council became the Local Supervising Authority on July 5th, 1948. No. of Notices of Intention to Practise, January, 1948 36 during 1948 12 Total 48 No. of Midwives ceasing to practise during 1948 13 „ „ practising at the end of 1948 35 Non-medical supervision of Midwives has been carried out by the Matron of the Maternity Hospital. The following table shows the work done by Midwives (including those employed at Thorpe Coombe Maternity Hospital) during 1948: — No. of confinements attended as a Midwife 1,656 „ „ „ „ „ Maternity Nurse 217 „ Medical Aid Notices sent 590 „ Notification of Death 1 „ Twin Births notified 18 „ Stillbirths notified 3 „ Notification of Liability to be a Source of Infection „ Notification of Laying out a Dead Body - ,, Notification of Artificial Feeding 5 ,, Notification of Disinfection 7 89 The previous table includes the following numbers in regard to work done at Thorpe Coombe Maternity Hospital:— Midwifery cases 1,084 Maternity cases 99 Medical Aid Notices 421 The percentage of Medical Aid Notices were:— All cases 35.6 Maternity Hospital Mid wives 38.8 Domiciliary Midwives 29.5 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 3 Albuminuria 2 Antepartum Haemorrhage 10 Other conditions 3 Total 18 For complications during labour:- Prolonged first and second stage 19 Ruptured perineum 63 Premature labour 2 Rise of Temperature 4 Postpartum haemorrhage 6 Uterine inertia 4 Retained placenta 2 Abnormal presentation 9 Other conditions 24 Total 133 For complications in regard to the infant:- Stillbirth 1 Jaundice 1 Inflamed eyes 2 Prematurity and feebleness 4 Cyanosis 2 Other conditions 8 Total 18 90 Medical Aid Fees.—As from the 1st April, 1947, no recovery was made 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 was made for compensation during 1948. Gas and Air Analgesia.—The Ambulance Service provided transport facilities for gas and air apparatus. MUNICIPAL MIDWIFERY AND MATERNITY SERVICE The table below shows the number of visits done:- Ante-Natal Examinations. Deliveries. Lying-in Visits. Total Visits. Patients' Homes. Midwife's House. Clinic. Mid. Mat. Local Authority 1,123 1,341 30 224 28 3,337 6,083 W.D.N.A. 1,034 1,521 - 184 51 5,222 8,012 Total 2,157 2,862 30 408 79 8,559 14,095 Post-Graduate Lectures to Midwives. A course of 5 lectures was given by Professor F. J. Browne, M.D., D.Sc., F.R.C.S., F.R.C.O.G., at Thorpe Coombe Maternity Hospital, during March and April. The subjects of the lectures were:- Toxaemias of Pregnancy. Contracted Pelvis and Disproportion. Antepartum Haemorrhage. Puerperal Pyrexia. The average attendance amounted to 57, including 11 medical practitioners. Public Health Act, 1936 (Nursing Homes).—See Public Health Section of the Report. 91 PUERPERAL PYREXIA Twentytwo cases of Puerperal Pyrexia were notified during 1948. The notifications were received from the following sources:— Maternity Hospital 19 Hospitals outside the area 3 The Puerperal Pyrexia rate for 1948 was 10.40 per 1,000 births as compared with 10.99 in 1947. Mortality due to puerperal sepsis was nil. The Registrar-General has issued the following rates with regard co the notification of Puerperal Pyrexia. The Walthamstow rates are set out in comparison. Per 1,000 live and still births. Puerperal Puerperal Area. Fever. Pyrexia. England and Wales 6.89 126 County Boroughs and Great Towns, including London 8.90 148 Smaller Towns (25,000 to 50,000 population) 4.71 London Administrative County 0.61 7.34 Walthamstow 10.4 * 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. 1948 22 10.40 1947 30 10.99 1946 33 12.62 1945 32 18.08 1944 28 14.23 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 probably not be notified, especially in domiciliary practice. 92 ABORTION Circular 1661.—The number of cases in which medical aid notices were issued during 1948 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 was:— Year. Totals. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill 1948 2 - - - 2 - - 1947 5 1 1 1 - 1 1 Year. Treated Vision unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 1948 1 1 2 - - - 1947 4 1 5 - - - MATERNAL MORTALITY, STILLBIRTHS 8c NEO-NATAL DEATHS During 1948 there was no death classified as being due to pregnancy, childbearing or associated therewith. The following table shows the maternal mortality, stillbirth and neo-natal death rates for the past five years:— Rate (per 1,000 live births). 1948. 1947. 1946. 1945. 1944. Maternal Mortality - 1.49 0.78 1.74 5.21 Stillbirths 22.2 22.1 27.5 32.6 27.1 Neo-Natal Deaths 11.1 13.1 19.2 21.0 20.8 The continuing fall in neo-natal deaths is very gratifying. 93 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. (L ive and Still) Puerperal Sepsis. Other Puerperal Causes. Total. Puerperal Sepsis. Other Puerperal Causes. Total. 1948 2,114 - - - - - - 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 I. THORPE COOMBE MATERNITY HOSPITAL. The Hospital was transferred to the North East Metropolitan Regional Hospital Board on July 5th and acknowledgement must be made of the very fine work which has been done there since it was opened in April, 1934. The reputation of the Hospital, kept up by Miss Helen Rodway, F.R.C.O.G., Obstetrician in Charge, the various Matrons and the staff, is second to none both as a Maternity Hospital and as a training school for midwives for Part I and Part II. The Hospital has contributed in no small measure to the progressive decline during the past four years in the stillbirth and the neo-natal infant death rates, and the maternal death rate. Emergency Unit.—The services of an emergency unit are available on the District. has 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. 1 raining of Pupil Midwives.—The Hospital is approved by the ventral Midwives Board (jointly with the Middlesex Hospital) for the training of pupH.midwives in Part I and Part II of the training. During 1948,prior to July 5th 11 pupils from Thorpe Coombe obtained the art I and 26 the Part II Certificate of the Central Midwives Board. (conditions of Service.—Prior to July 5th, the Council had adopti d all the recommendations of the Midwive's Salaries Committee The following statistical report has been compiled by Miss Helen Rodway, F.R.C.O.G., Resident Obstetrician and Medical superintendent. 94  1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 (to July 4) Total 4) Number of Sessions held— (a) Consultant's Clinic 39 21 12 12 12 8 8 12 12 12 12 7 12 12 5 196 (b) Resident trician's Clinic - 125 117 129 155 176 301 154 146 184 191 192 209 213 100 2,392 (c) Mid wives' Clinic 126 225 352 349 294 234 133 283 284 244 227 246 238 223 100 3,558 TOTALS 165 371 481 490 461 418 442 449 442 440 430 445 459 448 205 6,146 No. of attendences at Ante-Natal Clinics (a) Consultant's Clinic - - - - 186 117 85 110 124 144 106 53 98 99 38 1,160 (b) Resident Obste- trician's Clinic - 2,868 2,648 2,382 2,229 2,904 5,547 2,507 2,845 3,287 3,757 4,584 5,664 5,455 2,827 49,504 (c) Midwives' Clinic - 2,437 3,397 3,872 4,319 3,462 1,797 3,868 4,346 5,288 4,819 5,245 6,193 4,957 2,030 56,030 TOTALS ‡116 5,305 6,045 6,254 6,734 6,483 7,429 6,485 7,315 8,719 8,682 9,882 11,955 10,511 4,895 106,694 ‡ 2,116 108,810 Average number of attendances of patients at— (a) Consultant's Clinic - - - - 15.5 14.6 10.6 9.2 10.3 12.0 8.8 7.6 8.1 8.2 7 6 5.9 (b) Resident trician's Clinic 12.8 14.3 12.5 18.4 14.4 16.5 18.4 16.3 19.5 17.9 19 7 23.9 27.1 25.6 28 ?, 16.5 (c) Midwives' Clinic - - - 11.0 14.7 14.8 13.5 13.7 15.3 21.8 21.2 21.3 26.0 22.2 20.3 15.7 Total attendances at Ante-Natal Clinics— (a) New patients 371 762. 691 753 702 733 750 824 764 944 1,016 1,190 1,253 1,275 582 12,610 (b) Old patients 1,745 4,543 5,354 5,501 6,032 5,750 6,679 5,661 6,551 7,775 7,666 8,692 10,702 9,236 4,313 96,200 TOTALS 2,116 5,305 6,045 6,254 6,734 6,483 7,429 6,485 7,315 8,719 8,682 9,882 11,955 10,511 4,895 108,810 Average number of attendances of each patient 5.7 6.9 8.7 8.3 9.5 8.8 9.9 7.8 9.5 9.2 8.5 8.3 9.5 8.2 8.5 7.6 95 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 (to July 4) Total Number of patients admitted— (a) During Ante-natal period 29 95 137 109 96 119 126 101 137 166 141 156 203 225 84 1,924 (b) For confinement 229 646 660 616 675 552 684 615 658 865 868 995 1,222 1,209 606 11,100 (c) On account of mis, carriage 2 1 3 3 3 2 3 4 3 7 31 (d) During post-natal period - 4 1 1 1 4 4 1 4 6 6 7 18 21 6 84 TOTALS 258 747 799 729 775 675 817 717 801 1,037 1,018 1,162 1,446 1,462 696 13,139 Ante-natal patients delivered before discharge - - - 26 16 43 33 30 37 26 39 21 19 47 20 357 No. of confinements 229 646 660 639 691 595 720 645 695 891 907 995 1,247 1,253 624 11,437 No. of patients delivered by— (a) Mid wives 195 564 584 532 570 500 609 572 606 797 795 877 1,084 1,125 566 9,976 (b) Doctors 34 82 76 107 121 95 111 73 89 94 112 118 163 128 58 1,461 TOTALS 229 646 660 639 691 595 720 645 695 891 907 995 1,247 1,253 624 11,437 Percentage of cases delivered by— (a) Mid wives 85.2 87.3 88.5 83.2 82.4 84.0 84.2 88.6 87.2 89.4 87.6 88.1 86.8 89.7 90.7 87.2 (b) Doctors 14.8 12.7 11.5 16.8 17.6 16.0 15.8 11.4 12.8 10.6 12.4 11.8 13.1 10.2 9.3 12.7 Approximately one-fifth of cases delivered by doctors were private cases of general practitioners. The remainder were cases delivered by a medical officer because of abnormal medical or obstetrical condition. 96 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 (to July 4) Total Number of patients for whom medical assistance was required— (a) Antenatal 22 16 3 1 4 4 - 16 ? - - - 10 12 14 ? (b) In labour 22 249 345 262 298 246 362 59 7 329 251 261 259 507 203 ? (c) Puerperium 52 18 - - - 1 - - ? - - - 17 1 - ? (d) For the infant 10 11 17 12 20 13 15 27 ? 10 10 10 13 34 7 ? TOTALS 106 294 365 275 322 264 377 102 365 339 261 271 299 554 224 4,418 Number of infants— (a) Not breast fed at all - - - - 36 31 27 16 28 45 26 24 50 51 32 366 (b) Partly breast fed 3 45 95 73 115 107 130 62 85 104 102 91 126 199 107 1,444 TOTALS 3 45 95 73 151 138 157 78 113 149 128 115 176 250 139 1,810 Number of— (a) Maternal deaths 1 2 1 3 2 2 1 1 1 2 1 - 2 2 - 21 (b) Infant deaths 1 9 8 9 9 12 6 9 11 20 9 13 21 18 4 159 (c) Stillbirths 6 22 22 16 32 19 23 23 22 33 24 38 46 31 14 371 Number of cases of— Puerperal Pyrexia 3 26 25 18 26 26 31 32 21 33 17 26 19 20 8 331 Number of cases of— Ophthalmia Neonatorum 1 - - - - - - - - - - - - 1 - 2 97 HOSPITAL REPORT—1948  Jan. Feb. Mar. Apr. May. June. July. Aug. Sep. Oct. Nov. Dec. Total Percentage Number of patients admitted— Relative to total number of admissions (1348) (a) Antenatal 12 10 16 8 10 7,3 7,3 18 16 17, 75 15 188 13.95 per cent (b) For confinement 92 101 101 87 96 117, 104 97, 99 92 74 83 1,133 84.05 ,, ,, (c) Miscarriage - - - - - - 1 1 - - 7 - 4 0.29 ,, ,, (d) Post-natal 2 1 1 2 - - 3 2 3 6 1 2 23 1.71 ,, ,, TOTALS 106 112 118 97 106 135 131 113 118 110 102 100 1,348 Number of infants admitted 6 2 3 2 3 3 2 4 2 3 30 (Of these infants, 11 were Thorpe Coombe infants re-admitted) Number of patients delivered 1 Relative to total number of confinements (1183) (a) By mid wives 85 97 94 81 86 108 101 92 94 85 78 83 1,084 91.63 per cent , (b) By doctors 9 8 10 5 9 16 8 3 5 11 8 7 99 8.37 „ „ TOTALS 94 105 104 86 95 124 109 95 99 96 86 90 1,183 Number of patients for whom medical assistance was required— Relative to total number of confinements (1183) 1 1 5 1 - 4 5 2 - - - 2 23 1.93 percent (b) In labour 41 36 27, 7.8 37, 41 7,9 31 31 36 7,7 7,1 375 31.69 ,, ,, (c) During puerperium - - - - - - - - - - - - - - ,, ,, (d) For the infant 2 1 — 1 1 2 2 3 1 1 2 3 19 1.56 ,, ,, (Relative to number of infants born plus those admitted from District TOTALS 46 38 27 30 33 47 36 36 32 37 29 26 417 98 HOSPITAL REPORT — 1948  Jan. Feb. Mar. Apr. May June July Aug. Sep. Oct. Nov. Dec. Total Percentage Number of infants— 82.51 percent entirely Breast Fed (Relative to total number of infants discharged) (a) Not breast fed at all 5 3 6 7 5 5 2 4 2 1 — 5 45 3.84 „ „ (b) Partly breast fed 15 25 20 21 9 13 14 11 8 6 7 11 160 13.65 „ „ TOTALS 20 28 26 28 14 18 16 15 10 7 7 16 205 Number of— (a) Maternal deaths - - - - - - - - - - - - - Nil (b) Infant deaths - - - - 2 1 1 2 - 1 2 1 10 0.86 per cent (Relative to total number of births, minus still-births (1165)) (c) Stillbirths 2 1 3 - 4 4 2 2 3 4 3 3 31 2.59 „ „ (Relative to total number of infants born (1196) (d) Deaths of Infants admitted from District - - - - 1 - 1 - - - - 2 (including 13 cases of twins) ) Percentage of Still-births for Booked Cases was 1.88 Number of cases of— Puerperal pyrexia 1 1 1 4 1 - 3 3 2 1 2 — 19 1.60 per cent (Relative to total number of confinements (1183)) Number of cases of— Inflammation of infants' eyes 1 1 1 2 1 2 - 3 2 1 1 2 17 1.46 percent (Relative to total number of living infants (1165)) 99 HOSPITAL REPORT — 1948  Jan. Feb. Mar. Apr. May. June. July. Aug . Sep. Oct. . Nov . Dec. Total Percentage Number of cases of— Ophthalmia Neonatorum - - - - - - - - - 1 - 1 0.08 percent (Relative to total number of living infants (1165)) Ante-natal Clinics— (a) New cases 106 102 71 114 96 82 91 114 148 132 96 107 1.259 Each patient made an (b) Old cases 743 671 660 762 685 702 709 690 744 716 705 805 8,592 average of 7.6 attendances TOTALS 849 773 731 876 781 784 800 804 892 848 801 912 9,851 Post-natal Clinics— (a) New cases 76 71 80 69 54 68 69 95 59 67 69 52 829 70.08 percent (Relative to number of patients confined (1183)) (b) Old cases 35 30 50 38 37 52 26 36 30 35 36 35 440 TOTALS 111 101 130 107 91 120 95 131 89 102 105 87 1,269 100 Miss Helen Rodway, F.R.C.O.G., Obstetrician/Superintendent, contributes the following observations in regard to the period when the Hospital was under the control of the Walthamstow Borough Council. "This report gives a summary of the work of Thorpe Coombe from the opening date, 5th May, 1934, to 4th July, 1948, after which date the Hospital was transferred under the National Health Act from the Borough of Walthamstow to the North'East Metropolitan Regional Board. "From the opening date in May, 1934, until July 4th, 1948, the service of Thorpe Coombe provided facilities for the confinements of 11,437 women. These were chiefly those resident in Walthamstow, although in the early years, some women living outside the Borough were admitted. As increasing demands were made on the Hospital services, it later became necessary to discontinue the practice of admitting women who were resident outside the district. "From a small beginning with 229 confinements during the first eight months from May to December, 1934, the annual number of confinements rose to the peak figure of 1,253 in 1947. During the war period, when many expectant mothers were evacuated to safe areas, the number of confinements which took place in the Hospital fell slightly. In 1939, there were 595 confinements, which was 86 per cent. of the number for 1938, and the lowest figure for any year of the war. On the other hand, in 1944, the number of confinements was 907, which was 31 per cent. more than in 1938. Following the war, the annual number of confinements continued to increase, reaching 1,247 in 1946. Ante-Natal Work. "During their pregnancy, the majority of expectant mothers attended the ante-natal clinic at regular intervals. In the period under review, 12,610 women made an average of 7.6 attendances. "Many mothers showed great interest in the Mothercraft Lectures, which they attended with much enthusiasm; numbers also attended classes for instruction and practice in ante-natal exercise and preparation for childbirth. "Among these 12,610 expectant mothers, there were 1,123 or 8.9 per cent. who were admitted during pregnancy for investigation, rest or treatment. Of these, 413 or 36.8 per cent. required rest or treatment on account of essential hypertension, cardiac nephritis or toxaemia of pregnancy; 113 or 10.0 per cent. had pre-existing cardiac disease; 125 or 11.1 per cent. had ante-partum haemorrhage. "The number of viable infants born from May, 1934, to 4th July, 1948, was 11,601. This includes 292 twin babies and six triplets. The number of multiple births relative to the number of 101 confinements was 98 or 1.37 per cent. for 7,040 first births and 64 or 1.46 per cent. for 4,397 second or later births. The total number of infants recorded as premature, according to the International Standard of lb. or less birth weight, was 809 or 7.1 per cent. relative to 11,437 confinements. Post-Natal Work. "All mothers having their confinements at Thorpe Coombe were invited to return six weeks after their confinement for an examination, and if necessary medical advice and treatment. The highest proportion of women attending the post-natal clinic was in 1943, when 86.3 per cent. attended. The lowest proportion was in 1939, when the figure was 45.8 per cent. of those women who were confined in Thorpe Coombe that year. Infant Welfare Service. "For the supervision and care of the health of the infant, all mothers were visited, as far as possible, within two weeks of confinement in their own homes by a Health Visitor employed by the Borough. The mothers were encouraged to take their babies to one of the Welfare Centres. In this way a follow-up of mothers and babies was continued.