AC 4411(1) NAHAMSTOW BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1949 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 1949 INDEX page Section A.—Statistics and Social Conditions of the Area 7 Section B.—General Provision of Health Services in the Area 14 Section C.—Sanitary Circumstances of the Area 15 Section D.—Housing 21 Section E.—Inspection and Supervision of Food 27 Section F.—Prevalence and Control over Infectious Diseases 41 Section G.—National Health Service Act, 1946—Part III Services 56 Health Centres 58 Care of Mothers and Young Children 61 Midwifery 74 Health Visiting 77 Home Nursing 80 Vaccination and Immunisation 81 Ambulance Facilities 84 Prevention of Illness, Care and After-Care 84 Domestic Help 87 page Acreage 7 Adulteration 3 3 Ambulance Facilities 84 Ante-Natal Clinics 61, 67 Assessments 7 Bacteriological Analyses 29, 34 Births 13,62 Birth Rate 7 Breast Feeding 78 Cancer10 Caravans 19 Care of Illegitimate Children 66 Cerebro-Spinal Meningitis 48 Child Guidance 71 Child Welfare Clinics 67 Clean Food Campaign 35 Committees 4, 56 Confinements 61 Convalescence 72, 86 Cremation 54 Day Nurseries 73 Deaths 9, 10 „ Infants 11,64 „ Infectious Diseases 42 Death Rate 7 Dental Treatment 59,70 Diphtheria 44 „ Immunisation 81 Diseases of Animals Acts 38 Disinfestation 74 District Midwifery 74 Domestic Help 87 Dysentery 46 page Emergency Unit 77 Encephalitis Lethargica 41 Enteric Fever 44 Erysipelas 48 Essex County Council Act 15 Factories Acts, 1937/48 39 Food & Drugs Act, 1938 33 Food Inspection 31 Food Poisoning 36 Foot Clinic 87 Funeral Arrangements 54 Gas and Air Analgesia 76 Health Centres 58 Health Visiting 77 Home Nursing 80 Home Visits 77 Hospital Accommodation Housing 21 Act, 1936 24, 25 „ Conditions 25 „ Inspections 23 Ice Cream 28 Immunisation 81 Infant Mortality 62 Infestation 19,74 Inquests 54 Invalid Children's Aid Assn. Laboratory Services 77 Landlord & Tenant (War Damage) Acts, 1939-41 page Malaria 49 Maternal Mortality 11,13 Maternity Homes 15 Meals on Wheels Service 87 Measles 49 Meat Inspection 31 Medical Aid 75 ,, Examinations 55 Midwifery 74 Milk, Special Designations Order 28 „ Supply 27 Miscellaneous 53 Mortuary 54 Neo-Natal Mortality 11, 13,62 Notices, Sanitary 16 Notification of Births 62 Nursing Homes 15 Nurseries & Child Minders (Reg.) Act, 1948 74 Old People's Welfare 53 Ophthalmia Neonatorum 43 Ophthalmic Treatment 71 Orthopaedic Treatment 69 Outworkers 40 Pneumonia 48 Poliomyelitis 46 Populations 7 Post-Mortems 54 Post-Natal Clinics 61 Premature Infants 63 Prevention of Blindness 43 Propaganda 60 Puerperal Pyrexia 42 page Rainfall 54 Rateable Value 7 Rats and Mice Destruction Act 39 Rehabilitation 86 Rent and Mortgage Restriction Acts 25 Sanitary Inspection 16 Scabies Clinic 14 Scarlet Fever 44 Sickroom Equipment 86 Smallpox 43 Staff 14, 58 Statistics 7 Sterilised Maternity Outfits 77 Stillbirths 11, 13,62 Sunlight Treatment 70 Swimming Batths 20 Total Infant Mortality 12 Tonsils and Adenoids 71 Tuberculosis 50, 84 Training of Nursery Nurses 74 ,, ,, Pupil Midwives 77 Unemployment 7 Vaccination 82 Vital Statistics 7 Vitamins 73 Walthamstow Assn. of Tuberculosis Care Helpers 85 Walthamstow Child Welfare Society 68 Water 15 Whooping Cough 49 „ „ Protection 83 HEALTH COMMITTEE 1949-50 Chairman: Alderman Mrs. C. McEntee, J.P 'Vice-Chairman : Councillor Mrs. Candy. Ex'officio : The Worshipful The Mayor—Alderman E. C. Redhead, JP. The Deputy Mayor—Councillor Miss D. Wrigley, B.A., J.P. Chairman of Finance Committee—Alderman Ross Wyld, O.B.E., J.P. Alderman Mrs. L. P. Bailey. „ W. B. Fitt. W. Gillett. Councillor F. A. Burton. Councillor Mrs. Marchant. „ Mrs. Flint. „ E. G. Richards. H. F. Fulton. „ W. H. Shaw. A. J. D. Llewellyn. „ A. E. Simmons. Councillor Mrs. Tillyer. Town Clerk: G. A. Blakeley, Esq. TO THE CHAIRMAN AND MEMBERS OF THE HEALTH COMMITTEE Ladies and Gentlemen, I beg to present in the following pages a report on the health of your Borough during 1949. The appropriate directive issued by the Ministry of Health requires me to deal specifically with certain matters and also generally with matters within my responsibility regarding public health and preventive medicine. I have therefore included references to those health services which were transferred to the responsibility of the County Council as a result of the operation of the National Health Service Act, 1946. Such references are made in my capacity as Acting Area Medical Officer and by courtesy of the County Medical Officer. The population at mid-year 1949 was 123,400, an increase of 700 on the corresponding population of 1948. Vital statistics were again good and although the new low record infant mortality rate of 1948 could not be maintained, the Walthamstow rate for 1949 was still below that for England and Wales. The stillbirth rate, which may be regarded as an index of good maternity services, constituted a new low record at 0.22 per thousand population as compared with 0.39 for England and Wales. In regard to Hospital Services, reference is made to the admittedly unsatisfactory provision for the chronic sick. The year 1949 saw good progress in regard to housing, with the virtual completion of the notable scheme of 414 flats at Priory Court. The Chief Sanitary Inspector, in his section of the report, refers to the steps taken in regard to clean food. Your Council was again to the forefront in providing free washing facilities to food handlers, and indeed to the public generally. In the field of infectious diseases, 1949 was again an unfortunate year in regard to poliomyelitis, with three fatal cases. Measles was also epidemic but fortunately with no fatality. With regard to those services coming within Part III of the National Health Service Act, 1946, progress has been made in the reservation of sites for health centres. Mr. L. W. Elmer, Senior Dental Surgeon, reports on the Dental Services, both priority and general. In regard to the care of mothers and young children, the Rhesus Test has become a routine at ante-natal clinics. A table is given showing the death rate of illegitimate infants over the last 12 years, and it is gratifying to note that this rate was only 45 as compared with a death rate of 33 for legitimate infants. A new welfare centre was opened at West Avenue and an additional session was started at Penrhyn Avenue. The good work done at " Brookscroft " has continued. The Day Nurseries were inspected by officers of the central Ministries and a satisfactory report was given. The staff of Health Visitors, although not quite up to establishment, has been reasonably well maintained. This also applies to Home Nurses, in spite of the delay in the revision of their salaries which has resulted in considerable difficulties of recruitment. In spite of staffing difficulties, the good work of previous years has been maintained. Immunisation against Diphtheria was well maintained, but with the lapse of compulsory vaccination this practice has fallen to what may well prove to be a dangerously low level. Commencement was made with the Medical Research Council trials in regard to whooping cough vaccine, and the results will be assessed over the next two years. Measures for the prevention of illness, care and after-care, received full consideration and use. The Domestic Help Service continued to expand, and the only real difficulty is to keep it within the limits of the financial provision allowed. The administrative difficulties inseparable from the delegation of the transferred Part III Services have continued, and it can only be hoped that the discussions taking place at the time of writing, i.e., at the end of the two-year trial period, will do something to ease the position. The only really satisfactory solution for a Borough such as Walthamstow appears to be the achievement of County Borough status, either alone or in combination. Once again it is my pleasure to acknowledge the help and co-operation of the Committees concerned, and the good work of the staff in general. I am, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. 7 A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1949)—- Civilian 123,400 Total 123,500 Number of Assessments (1st April, 1949) 35,908 Rateable Value £887,366 Sum represented by penny rate £3,600 Population.—The Registrar - General's Estimate of the civilian population at mid-year 1949 is 123,400, an increase of 700 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 500 women were placed in employment during the year 1949 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 approximately 82,000 in 1949. Of this number, it is estimated that about 40,000 were employed in Walthamstow. During 1949 the average number of persons unemployed in the whole area was 790 men and 200 women : these included approximately 140 disabled men and 25 disabled women. Extracts from Vital Statistics.—The Registrar-General's midyear 1949 estimate of the civilian population (viz., 123,400) has been used for the calculation of all vital statistics. Total Males Females Legitimate 1,771 944 827 Birth rate per Live Illegitimate 65 32 33 1,000 of the Births Total 1,836 976 860 estimated civilian population 14.9 Stillbirths 27 Rate per 1,000 total (live and still) births 14.5 deaths 1,299 Death rate per 1,000 of the estimated civilian population 10.5 8 Deaths from puerperal causes:- Puerperal Sepsis Deaths - Other Puerperal Causes 2 Death rate of infants under one year of age:- All infants per 1,000 live births 29 Legitimate infants per 1,000 legitimate live births 28 Illegitimate infants per 1,000 illegitimate live births 46 Deaths from Measles (all ages) - Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under two years of age) 2 Pulmonary Tuberculosis death rate - 0.35 Non'Pulmonary Tuberculosis death rate 0.06 The natural increase of population, i.e., excess of births over deaths was 537. The usual comparison of rates with those for the whole country is shown in the table on the following page. Deaths.—The Registrar-General's classification of causes of death by sex totals is given. The total number of deaths in 1949 (1,299) compares with 1,243 in 1948, the respective death rates per 1,000 population being 10.5 and 10.1. Comparability Factor.—The comparability factor for Walthamstow is given by the Registrar-General as 1.05, which, when applied to the crude death rate of 10.5, gives an adjusted rate of 11.0. 9 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and case Rates for certain Infectious Diseases in the year 1949. 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 1,0 00 Civilia n Population. Births:- Live 16.7(a) 18.7 18.0 18.5 14.9 Still 0.39(a) 0.47 0.40 0.37 0.22 Deaths:- All Causes 11.7(a) 12.5 11.6 12.2 10.5 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 - Whooping Cough 0.01 0.02 0.01 0.01 0.01 Diphtheria 0.00 0.00 0.00 0.00 - Tuberculosis 0.45 0.52 0.42 0.52 0.42 Influenza 0.15 0.15 0.14 0.11 0.13 Smallpox 0.00 0.00 - - - Acute Poliomyelitis and Polioencephalitis 0.01 0.02 0.02 0.01 0.03 Pneumonia 0.51 0.56 0.49 0.59 0.54 Notifications:- Typhoid Fever 0.01 0.01 0.01 0.01 0.01 Paratyphoid Fever 0.01 0.02 0.01 0.01 0.03 Cerebro-spinal Fever 0.02 0.03 0.02 0.02 0.02 Scarlet Fever 1.63 1.72 1.83 1.46 1.47 Whooping Cough 2.39 2.44 2.39 1.70 1.83 Diphtheria 0.04 0.05 0.04 0.07 - Erysipelas 0.19 0.20 0.19 0.17 0.27 Smallpox 0.00 0.00 0.00 0.00 - Measles 8.95 8.91 9.18 8.54 12.56 Pneumonia 0.80 0.91 0.65 0.55 0.81 Acute Poliomyelitis 0.13 0.13 0.12 0.18 0.14 Acute Polioencephalitis 0.01 0.01 0.02 0.01 0.01 Food Poisoning 0.14 0.16 0.14 0.19 0.12 Deaths:- Rates per 1,000 Live Births. All causes under 1 year of age 32(b) 37 30 29 29 Enteritis and Diarrhoea under 2 years 3.0 3.8 2.4 1.7 1.1 Rates per 1,000 Total Births (Live & Still) Notifications:- Puerperal Fever and Pyrexia 6.31 8.14 5.30 6.82 9.12 Maternal Mortality:- No. 140. Abortion with No. 141. Abortion without Sepsis. No. 147 Puerpera Infection Nos. 142-6. 1 148-50. s. Other. Wal larnstow - - - 1. 07 England and Wales. 0.11 0.05 0.11 0.71 (a) Rates per 1,000 Total Population. (b) Per 1,000 related births. 10 Causes of Death as given by the Registrar-General for the year 1949 Whole District Causes of Death. Males. Females. Total. 1. Typhoid and Paratyphoid Fevers - - - 2. Cerebro-spinal Fever - - - 3. Scarlet Fever - - - 4. Whooping Cough 1 - 1 5. Diphtheria - - - 6. T.B. of Respiratory System 27 17 44 7. Other Forms of Tuberculosis 4 4 8 8. Syphilitic Diseases 7 - 7 9. Influenza 9 7 16 10. Measles - - - 11. Acute Poliomyelitis and Polioencephalitis 2 2 4 12. Acute Infectious Encephalitis - - - Cancer of buccal cavity and oeso13.phagus (Males) 5 - 5 [Cancer of uterus (Females) - 10 10 14. Cancer of stomach and duodenum 21 13 34 15. Cancer of breast 1 21 22 16. Cancer all other sites 76 62 138 17. Diabetes 1 7 8 18. Intra-cranial vascular lesions 45 88 133 19. Heart Disease 168 202 370 20. Other Diseases of the Circulatory System 20 29 49 21. Bronchitis 73 42 115 22. Pneumonia 29 38 67 23. Other Respiratory Diseases. . 20 4 24 24. Ulceration of the Stomach or Duodenum 12 6 18 25. Diarrhoea (under 2 years) 1 1 2 26. Appendicitis 2 3 5 27. Other Digestive Diseases 11 10 21 28. Nephritis 11 13 24 29. Puerperal and Post-abortive Sepsis - - - 30. Other Maternal Causes - 2 2 31. Premature Birth 4 1 5 32. Congenital Malformation, Birth Injury, Infantile Disease 18 19 37 33. Suicide 2 5 7 34. Road Traffic Accidents 5 1 6 35. Other Violent Causes 11 12 23 36. All Other Causes 53 41 94 Totals, 1949 639 660 1,299 Totals, 1948 619 624 1,243 The age distribution of Cancer deaths was as follows:- Under 1 yr. 1-2 yrs. 2-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 yrs. & over - - - - - 9 63 137 11 INFANT DEATHS, NEO-NATAL MORTALITY AND STILLBIRTHS Year. Live Births. Birth Rate. Stillbirths. Neo-Natal Deaths. Infant Deaths. No. Per 1,000 live births. Per 1,000 population. No. Per 1,000 live births. No. Per 1,000 live births. 1949 1,836 14.9 27 14.7 0.22 31 16.9 54 29 1948 2,068 16.8 46 22.2 0.37 24 11.1 43 20 1947 2,670 21.8 59 22.1 0.48 35 13.1 77 29 1946 2,M4 21.5 70 27.5 0.59 49 19.2 87 34 1945 1,713 16.5 56 32.6 0.54 36 21.0 66 38 The death rate from Diarrhœa and Enteritis in children under one year of age per 1,000 live births was 1.1. The table showing the classification of infant deaths is given in the section of the report dealing with the care of mothers and young children (Section 22). MATERNAL MORTALITY The maternal mortality rates (per 1,000 total births) for the past five years have been as follows:- Year. Total Births Registered. Deaths. Rates per 1,000 Births. (Live and Still) Puerperal Sepsis. Other Puerperal Causes. Total. Puerperal Sepsis. Other Puerperal Causes. Total. 1949 1,863 — 2 2 — 1.07 1.07 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 12 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 :— Rate per 1,000 live births 13 MATERNAL MORTALITY, STILLBIRTHS & NEO NATAL DEATHS During 1949 there were two deaths 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). 1949. 1948. 1947. 1946. 1945. Maternal Mortality 1.09 — 1.49 0.78 1.74 Stillbirths 14.7 22.2 22.1 27.5 32.6 Neo-Natal Mortality 16.9 11.1 13.1 19.2 21.0 REGISTRATION OF BIRTHS The Registrar-General's returns show the following registra tions during the calendar year:- (a) Live Births. Males. Females. Totals. Legitimate 944 827 1,771 Illegitimate 32 33 65 976 860 1,836 (b) Stillbirths. Males. Females. Totals. Legitimate 15 11 26 Illegitimate 1 — 1 16 11 27 The stillbirth rate per 1,000 population was 0.22. Of the 1,765 birth registrations received in the Department during the year eight were not notified. Appropriate action was taken when necessary. Of the 1,765 local registrations, 220 belonging to other areas are excluded, leaving a nett total of 1,545. 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. toatals 114 93 101 90 127 118 108 117 172 140 191 174 813 732 207 191 245 225 312 365 1,545 14 B.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. 1.—Public Health Officers of the Authority.—There were no changes in the officers employed by your Authority. 2.—Laboratory Facilities.— (See I.D. Section). 3.—Ambulance Facilities.—These are available from a local depot in Walthamstow which is administered centrally from Chelmsford. 4.—Scabies Clinic.—The arrangements at the special treatment centre detailed in previous reports were continued. Three sessions per week are held at the 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). 83 cases were treated during the year, receiving 262 treatments. The treatment of school children from the Forest Division was agreed at a fee of 7/6d. per treatment. 5.—Hospitals.—There were no changes during 1949 in the hospital services used by the inhabitants of the Borough. It is understood that a new hospital with 500 beds may be commenced at Wanstead during next year. Unfortunately, however, the travelling facilities to and from Wanstead are not at all convenient for Walthamstow residents. The second Annual Report of the Forest Group Hospital Management Committee records the following :— " It is regretted that the Board has not been able to include the proposed extensions at the Connaught Hospital in their three-year Capital Building programme. There is room for an additional 180 beds on the present site with the acquisition of the Old Town Hall and the Church School. More beds are urgently needed as Walthamstow and Chingford are highly industrialised areas with a combined population of 174,000." The Report refers to the concern of the Committee with regard to the lack of accommodation for the chronic sick, and to arrangements made with three private nursing homes. Regional Hospital Boards have asked that Medical Officers of Health shall support when necessary on "social grounds," the recommendations of medical practitioners for the admission of the chronic sick to hospital. All possible help was given when requested but even so, at the end of 1949, nineteen elderly chronic sick patients still awaited admission to a suitable hospital. 15 The urgent need in connection with the chronic sick appears to be the provision of convalescent annexes to hospitals admitting such patients so that after rehabilitation they can be sent there so as to lessen the need for skilled nursing attention. Somewhat similar provision might be made by local authorities, particularly to deal with those distressing cases where the home has, for various reasons, become unavailable, so rendering an otherwise fairly fit elderly person tied to an institution with a consequent wastage of valuable beds and staff. A small "reservoir" of suitable accommodation in the hands of local authorities would permit the "circulation" of these patients in and out of hospital when necessary without permanent sterilisation of beds. Until some such solution is found, it only remains possible to do the best with home nursing, domestic help and meals on wheels services. These services are unquestionably bringing very great assistance and relief to the chronic elderly sick. 6.—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. 15 inspections were made by the medical staff. No difficulties in regard to supervision arose. Routine enquiries are made with regard to unregistered homes. 7.—Essex County Council Act.—Two new licences to practise chiropody were 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 actual or suspected cases of enteric fever. The Board then arranged special tests at the addresses concerned. All were negative in 1949. All dwelling houses in the area are supplied direct with water. 16 In accordance with Circular 2/50, the following information is also given :— (i) The water supply of the area and its several parts has been satisfactory (a) in quality, (b) in quantity. (ii) A total of seven bacteriological examinations was carried out with satisfactory results. (iii) As far as is known, there is no plumbo-solvent action in the water supplied to the Borough. (iv) No action was necessary in respect of contamination. (v) There are no houses supplied by stand-pipes. Sanitary Inspection of the Area 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. 16,161 10,844 3,137 2,390 2,262* 332 318* 24,029 * Includes notices outstanding from previous year. Of the 2,390 informal notices served, 146 were in respect of business premises and the remainder (2,244) related to defects in private houses. Of the latter figure, 1,916 were complied with without resort to statutory procedure. Owing to the failure of Owners to comply with certain statutory notices served under Section 9 of the Housing Act, 1936, the Council undertook the necessary work to two houses at a cost of £29 9s. lid. It was found expedient to institute legal proceedings against Owners for non-compliance with 29 Abatement Notices served under Section 93 of the Public Health Act, 1936. Orders were made by the Justices in 23 cases; fines with costs inflicted in four; costs ranging from £1 Is. Od. to £5 5s. Od. in 15; and six were withdrawn. 17 The following table shows the nature of work executed and improvements effected during the year :— Drains tested, 443; Drains reconstructed or repaired, 516; Drains, obstructions removed, 195; Drains, means of access provided, 68; Drains, ventilation provided or improved, 87; Drains, ventilation repaired, 93; Soil pipes repaired or renewed, 131; Rain-water pipes renewed, 233; Rain-water pipes disconnected from drains, 8; Roofs repaired or renewed, 953; Gutterings repaired or renewed, 334; W.C. pans or traps provided, 345; Gully traps provided, 105; W.C. flushing cisterns repaired or renewed, 276; W.C. floors concreted, 55; W.C.'s repaired and cleansed, 29; W.C.'s light and ventilation improved, 38; Waste pipes repaired, renewed or trapped, 230; New sinks provided, 120; Stoves and firegrates repaired or renewed, 430; Water supply reinstated, 19; Water supply taken off main, 28; Cisterns cleansed and covered, 27; Sculleries paved, 48; Yards and forecourts paved or repaired, 111; Dirty houses cleansed, 80; Dirty rooms cleansed, 588; Floors repaired, 495; Ventilations under floors provided or improved, 156; New damp-proof courses provided, 53; Sites concreted, 2; Offensive accumulations removed, 29; Animals improperly kept, removed, 8; Stables repaired and cleansed, 28; Manholes repaired or re-sealed, 163; Other causes of dampness remedied, 569 ; Miscellaneous repairs, 2,905. Infectious Diseases. Visits to premises, 339 ; Re-visits to premises, 12. Disinfections. Rooms disinfected, 151; Articles disinfected at Low Hall Lane, 303 ; Articles destroyed at Low Hall Lane, 104. Special Premises. Number Visits paid Factories (a) Power 449 645 (b) Non-power 124 214 (c) Other premises 58 107 Outworkers 472 502 Slaughter-houses - - Butchers 81 396 Bakehouses 37 160 Fishmongers, Fish Fryers and Curers, etc. 44 207 Cafes and Caterers 113 429 Grocers, etc. 286 607 Ice Cream Manufacturers and Vendors 183 364 18 Special Premises—Continued Number Visits paid Cowsheds 1 2 Dairies and Milksellers 65 170 Laundries 3 14 Hairdressers 81 87 Rag and Bone Dealers 3 21 Piggeries 2 11 Street Stalls Numerous 637 Greengrocers 67 164 Stables 36 144 Schools - 15 Conveniences - 75 As a result of the regular periodical visiting of the Special Premises the following works were carried out:— Butchers. Special cleansings, 55; Paving repaired, 8; Accumulations removed, 7; New galvanised bins provided, 19; Drains repaired, 6; W.C.'s repaired and cleansed, 22; Floors repaired and ventilated, 5; Light and ventilation improved, 4; Other improvements, 20. Bakehouses. Special cleansings, 74; New ceilings fixed, 7; Floors repaired, 6; Light and ventilation improved, 3; Roofs repaired, 6 ; Other improvements, 10. Fishmongers. Special cleansings, 35; Yards repaved, 5; Accumulations removed, 5 ; Drains cleared, 2 ; Other improvements, 11. Grocers. Store-rooms cleansed, 64; Washing accommodation improved, 44 ; Other improvements, 59. Cafes and Caterers. Special cleansings, 86; Light and ventilation improved, 20 ; Floors repaired, 18 ; Other improvements, 128. Ice Cream Manufacturers and Vendors. Special cleansings, 23; Special cleansings of utensils, 12; Yard pavings repaired, 2 ; Other improvements, 10. Cowsheds and Milkshops. Special cleansings, 12; New fittings and other improvements, 7 ; Pavings relaid, 1. 19 Hairdressers. Special cleansings, 13;Other improvements, 23. Stable Premises. Cleansings, 25;Accumulations removed, 14;Roofs repaired, 3;Pavings repaired, 2;Other improvements, 7. Laundries. Special cleansings, 3;Other improvements, 8. Rag and Bone Dealers. Cleansings, 5. Piggeries. Cleansings, 2. Camping Sites. There are no authorised sites in the area. The caravan dwellers at Higham Hill still remain. Smoke Abatement. A slight improvement has taken place in the type of boiler fuel supplied during the year. Smoke observations were carried out on four occasions relative to complaints made in respect of two factory chimneys. From time to time inferior coal is delivered and excessive smoke is temporarily produced until the necessary adjustments in firing, etc., are made. Eradication of Bed Bugs, etc. The number of houses reported to be bug'infested is still comparative low. Fumigations or special sprayings with DDT solutions were carried out at 72 rooms and free insecticides were issued to tenants of 94 premises. Remedial measures were taken regarding a somewhat serious house-fly infestation. Hydrogen Cyanide (Fumigation of Buildings) Regulations 1938:- No notices were received during the year. 20 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, 1949, the swimming bath was open on 293 days. The number of bathers during this time was 113,748. "The maximum load was on July 4th, when we had 991 bathers." Sampling was carried out on four occasions, 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. "The approximate number of swimmers in 1949 was 27,000. "Bacteriological and chemical analyses were carried out on three occasions with satisfactory results." 21 D.—HOUSING (a) Statistics The Borough Architect, F. G. Southgate, Esq., A.R.I.B.A., M.I.M. Cy.E., has kindly contributed the following:— Houses erected by the Local Authority during 1949:— Hoe Street Ward Nil St. James Street Ward Nil Higham Hill Ward 220 Flats (P) 12 Houses (P) 19 Houses (R) High Street Ward Nil Hale End Ward 5 Houses (R) 29 Houses (P) Wood Street Ward Nil TOTAL 220 Flats (P) 24 Houses (R) 41 Houses (P) Houses erected by Private Enterprise during 1949:— Hoe Street Ward 6 Houses (P) 1 House (R) St. James Street Ward 4 Houses (R) Higham Hill Ward 4 Houses (P) 1 House (R) High Street Ward 8 Houses (P) Hale End Ward 2 Houses (R) 15 Houses (P) Wood Street Ward 8 Houses (R) TOTAL 33 Houses (P) 16 Houses (R) Note: (P) Post-war permanent Houses and Flats. (R) Rebuilding war-destroyed Houses. "During the calendar year 1949, 24 war-destroyed Council houses have been rebuilt, and 41 new houses and 220 new flats erected. "Sixteen war-destroyed houses were rebuilt by private enter' prise and 33 new houses were erected by private enterprise. "The new houses erected by the Corporation are of traditional construction with a living and dining-room and a kitchen on the ground floor, and three or four bedrooms on the first floor with a bathroom and separate W.C. "With regard to the Countess Road Scheme, of the total of 414 flats comprised in the complete scheme, 180 three-bedroom type flats and 40 two-bedroom type flats were completed during the year. "The flats consist of living-room, kitchen, two/three bedrooms as the case may be, with bathroom and separate W.C., and a private balcony is accessible from the living-room and kitchen. Each living-room is heated by a solid fuel open fire, and hot water supplied by electric storage heater in the kitchen. 22 "Every flat is fitted with linen cupboard, a meter and electrical distribution cupboard and coal store and has built-in wardrobes in the bedrooms. The kitchen is equipped with larder, broom cupboard, dry goods cupboard combined serving hatch and dresser fitment, table, aluminium sink unit with double drainer. "Provision is made for the connection of either gas or electric cooker. "The refuse disposal system consists of vertical pipe ducts which run the full height of the building and discharge into mobile containers housed in special chambers at ground level. "In addition to the staircases from the entrance hall, each flat is served by lifts, the ground floors provide storage accommodation for perambulators and bicycles, communal laundry facilities, handicraft rooms and covered playgrounds for children. "The site had been used as a rubbish tip for many years, and was quite unsuitable for normal foundations. Concrete piles cast in situ were used and the buildings are designed with reinforced concrete frames and floors. "Provision has been made for sound and heat insulation. The floors are laid as "floating floors" on an insulation mattress of glass silk. This reduces impact noises very considerably—the liftshafts are built as separate units and insulated from the main structure. External walls are generally cavity, the inner skin being light-weight diatomaceous earth blocks. "One block is a two-storey brick building containing single bedroom flats for elderly tenants and a Common Room with a Sun Shelter for the use of tenants is included in the Scheme. "To ensure that the residential character of the new estate was preserved, the layout was deliberately designed to discourage the use of its roads by all but local traffic. One principal road, connected at each end to existing roads on adjoining estates, and two secondary loop roads form the basis of the layout plan. As a deterrent to through traffic, islands are being erected at the points where the principal road crosses the boundary. These islands are so designed that they can only be negotiated at low speeds. "The twenty six-storey blocks of flats and the one two-storey block are laid out in two well defined groups, one formal and the other informal, and are arranged to give most of the flats an east/west aspect. The buildings are generally approached by service roads, but where the distances involved are small only footpaths are provided. Provision has been made in the scheme, though not in the immediate building programme, for a community centre, shops, estate office, garage accommodation, tennis courts, children's playground and a chapel of rest. The ground, which will require top-soiling, will be grassed and planted with carefully placed trees." 23 (b) Inspection The following information is given in the form required by the Ministry of Health, and is supplied by the Chief Sanitary Inspector:- I.—Inspection of Dwelling-Houses During the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under the Public Health or Housing Acts) 3,476 (b) Number of inspections made for the purpose 9,375 (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 8 (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 2,244 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 1,814 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 29 (2) Number of dwelling-houses which were rendered fit after service of formal notices:- (a) By owners *30 24 (b) By Local Authority in default of owners (at a cost of £29 9s. 11d.) 2 (c) Withdrawn—premises vacated and taking 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 332 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) By owners 282 (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 6 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders *5 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 * Including those outstanding from previous year. (c) Housing Act, 1936 Unfit Houses The following premises were dealt with as follows :— Demolition Orders : 51, Brunner Road 29a Milton Road 9, Higham Street 22, Courtenay Place 29, Milton Road 23, Courtenay Place Closing Orders : 44, Orford Road (Basement) 1, Erskine Road (Basement) 25 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 sixteen certificates were granted to tenants. Three clearance certificates were issued to owners. Housing Act, 1936, Section 62. Applications for "permitted number" were received and certificates issued during the year respecting 271 lettings. Local Land Charges. Particulars relating to outstanding sanitary notices were supplied in reference to 1,617 enquiries. (d) General. The following is supplied by Mr. J. E. West, your Council's Housing Manager :— "In the report for 1948, mention was made of the development of a system of transfer and exchanges of tenants which provided suitable accommodation being made to applicants on the Housing Register. During the year, 220 flats at Priory Court and a number of new houses have become available for letting, and by a development of this system of transfer, it has been possible to alleviate the difficult housing conditions of a large number of families. This process has in fact, had the same effect as would be obtained by the erection of a large number of flats and houses than has otherwise obtained. "By reference to the statistics hereunder it will be seen that the difference between the number of houses erected during the year and families rehoused in that period gives a very marked increase over the numbers for 1948 and would seem to justify the steps taken to encourage transfers and for all property owners and agents, etc., to co-operate in the endeavour to assist in this most vital social problem which is affecting so many of our people ; this includes those who are already assisting at great inconvenience by giving temporary accommodation to our applicants. I refer chiefly to ' in-laws.' 26 "In this connection I must pay real tribute to Messrs. Warner Estates Ltd., who have been particularly helpful and co-operative in every respect. "The building programme, limited in view of the sites available in the Borough, will not solve the housing problem in Walthamstow, but it can be said, with emphasis, that the position has improved. The problem, however, is still very much with us, but without being complacent, the provision of new accommodation has provided the means whereby a good proportion of the most distressing cases have been provided with suitable homes. Concern must, however, be stressed with regard to the small family unit. The building programme in general makes provision for the erection of three and fourbedroom accommodation and therefore, despite the policy of transfer, the assistance given to this particular group is not as effective as that appertaining to the larger family unit. "With an assessment of the new accommodation which will be provided in the forthcoming year, it can be anticipated that by even greater development of the transfer of tenants and co-operation of other landlords, a very good proportion of the small family units living in overcrowded conditions will be offered material assistance. The allocation of property is carried out in strict accordance with the Council's points scheme and it is from the facts shown in the assessment of all cases in accordance with the rules of this scheme, that it is possible to give this optimistic assurance. The progress made in rehousing and the situation at the 31st December, 1949, is as follows :— Building Programme— 1947 1948 1949 Total Prefabricated bungalows 466* 69 — 535 Priory Court flats 14 100 220 334 New houses 22 72 41 135 War-damaged Council houses rebuilt 27 — 24 51 529 241 285 1055 Pre-war Council houses — — — 1,562 Grand Total — — — 2,617 * Includes 232 bungalows erected prior to 1947. Families rehoused 400 323 438 1,161 Housing applications on the "live " register reduced on canvass 1.4.1948 to 6,176 9,553 7,012 7,353 Personal interviews 11,407 9,273 7,723 27 "The minimum amount of accommodation required to meet the minimum housing requirements as analysed from the list of housing applications on the 'live' register is as follows :— 2 rooms 2,282 3 „ 3,495 4 „ 1,368 5 „ 172 6 „ 36 7,353 Total properties requisitioned 1,066 Total properties still held 552 "It should be noted that the foregoing analysis is summarised from the total list of applicants and does not infer that all the applicants are in need, but rather desire improved accommodation in that particular category or group." 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. 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 104 99 5 Tuberculin Tested Pasteurised 24 24 - Sterilised 7 6 1 Heat Treated 9 7 2 Totals 144 136 8 28 The seven unsatisfactory samples of Pasteurised and HeatTreated Milk were taken during the months of July and August when the shade temperature was somewhat abnormal. 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 was one Cowshed in the district and the average number of cows kept was four. Use now discontinued. The number of Retail Purveyors of Milk is 65. All of these sell milk in bottles " as received." One hundred and seventy-two visits were paid to registered dealers and a satisfactory standard of cleanliness was maintained. (b) Ice Cream. Fifty-seven applications for Registration as Vendors were received. New licences were granted as follows :— Vendors 47 Transfers 10 Number on the Register at the end of the year 183 Number of above holding Manufacturers' licences 17 Ice Cream (Heat Treatment, Etc.), Regulations, 1947/8. The trade has adopted a co-operative attitude and due care and attention is paid in order to comply with the requirements of the above Regulations. Medical Examination—Typhoid, Etc., Carriers. This is the third year of the voluntary scheme of medical examinations and blood tests of those engaged in the ice-cream trade. The Medical Officer of Health holds a session weekly and 114 employees presented themselves for examination. 29 No chronic carriers of Typhoid were found but three persons were found to require further examination. Bacterial Quality and Grading of Ice Cream. One hundred and fourteen 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. Grades 1 and 2 of the latter are considered satisfactory. Plate Count Old Standard Test Very satis' factory Passable Not Passable New (Provisional) Test Methylene Blue Test Coliform Reaction (in 1/10 ml.) Bacterium coli (in 1/10 ml.) Reduction time Grade 200 — — X Not in 4½ hours 1 3,000 — — X „ 4½ „ 1 700 — — X „ 4½ „ 1 500 — — X „ 4½ „ 1 100 — — X „ „ 4½ „ 1 4,000 — — X „ 4½ „ 1 1,600 — — X „ 4½ „ 1 300 — — X „ 4½ „ 1 2,100 — — X „ 4½ „ 1 1,300 — — X „ 4½ „ 1 100 — — X „ 4½ „ 1 7,600 — — X „ 4½ „ 1 12,000 — — X „ 4½ „ 1 11,000 — — X „ 4½ „ 1 800 — — X „ 4½ „ 1 18,000 — — X „ 4½ „ 1 1,800 — — X „ 4½ „ 1 2,600 — — X „ 4½ „ 1 2,500 — — X „ 4½ „ 1 2,000 — — X „ 4½ „ 1 18,000 — — X „ 4½ „ 1 3,000 — — X „ 4½ „ 1 1,400 — — X „ 4½ „ 1 12,000 x3 tubes — X „ 4½ „ 1 9,000 — — X „ 4½ „ 1 800 — — X „ 4½ „ 1 500 — — X „ 4½ „ 1 1,500 — — X „ 4½ „ 1 1 6,000 — — x „ 4½ „ 1,500 — — X „ 4½ „ 1 4,000 — — X „ 4½ „ 1 16,000 — — X „ 4½ „ 1 700 — — X „ 4½ „ 1 9,500 — — X „ 4½ „ 1 98 — — X „ 4½ „ 1 9,200 — — X „ 4½ „ 1 200 — — x „ 4½ „ 1 500 — — X „ 4½ „ 1 200 — — X „ 4½ „ 1 200 — — X „ 4½ „ 1 2,500 — — X „ 4½ „ 1 300 — — x „ 4½ „ 1 400 — — X „ 4½ „ 1 30 Plate Count Old Standard Test New (Provisional) Test Methylene Blue Test Coliform Reaction in 1/10 ml.) Bacterium coli (in 1/10 ml.) Very satisfactory Passable Not Pass' able Reduction time Grade 5,600 — — X „ 4½ „ 1 900 — — X „ 4½ „ 1 400 — — X „ 4½ „ 1 300 — — X „ 4½ „ 1 300 — — X „ 4½ „ 1 600 — — X „ 4½ „ 1 500 — — X „ 4½ „ 1 100 — — X „ 4½ „ 1 3,000 — — X „ 4½ „ 1 1,500 — — X „ 4½ „ 1 3,000 xl tube — X „ 4½ „ 1 2,400 — — X „ 4½ „ 1 3,500 — — X In 4 „ 2 9,200 — — X „ 4 „ 2 18,000 — — X „ 4 „ 2 26,000 — — X „ 4 „ 2 80,000 — — X „ 4 „ 2 12,000 — — X „ 4 „ 2 7,000 x3 tubes — X „ 4 „ 2 1,500 xl tube — X „ 4 „ 2 4,000 x2 tubes — X „ 4 „ 2 6,500 x3 tubes — X „ 4 „ 2 9,800 x3 tubes — X „ 4 „ 2 32,000 x3 tubes — X „ 4 „ 2 20,000 x3 tubes — X „ 4 „ 2 130,000 — — X „ 3½ „ 2 9,000 x3 tubes — X „ 3½ „ 2 15,000 — — X „ 3½ „ 2 14,000 — — X „ 3½ „ 2 36,000 x3 tubes — X „ 3½ „ 2 23,000 x3 tubes — X „ 3½ „ 2 50,000 x3 tubes — X „ 3 „ 2 2,000 x3 tubes — X „ 3 „ 2 90,000 x3 tubes — X „ 3 „ 2 1,700 xl tube — X „ 3 „ 2 8,000 x3 tubes — X „ 3 „ 2 38,000 x3 tubes — X „ 3 „ 2 4,500 — — X „ 2½ „ 2 180,000 — — X „ 2½ „ 2 12,000 — — X „ 2½ „ 2 90,000 x3 tubes — X „ 2½ „ 2 36,000 x3 tubes — X „ 2½ „ 2 22.000 x3 tubes — X „ 2½ „ 2 26,000 x3 tubes — X „ 2½ „ 2 80,000 x3 tubes — X „ 2½ „ 2 7,000 x3 tubes — X „ 2½ „ 2 30,000 — — X „ 2½ „ 2 5,000 — — X ' „ 2½ „ 2 25,000 x3 tubes — X „ 2½ „ 2 12,000 xl tube — X „ 2½ „ 2 140,000 x3 tubes — X „ 2 „ 3 40,000 x3 tubes — X „ 1½ „ 3 35,000 x2 tubes — X „ 1½ „ 3 120,000 x3 tubes — X „ 1 „ 3 250,000 x3 tubes — X „ 1 „ 3 90,000 x3 tubes — X „ 1 „ 3 80,000 x3 tubes — X „ ½ „ 3 31 Plate Count Old Standard Test New (Provisional) Test Methylene Blue Test Conform Reaction (in 1/10 ml.) Bacterium coli (in 1/10 ml.) Very satisfactory Passable Not Pass- able Reduction time Grade 60,000 x3 tubes — X „ ½ „ 3 500,000 x3 tubes — X „ 0 „ 4 500,000 x3 tubes — X „ 0 „ 4 120,000 x3 tubes — X „ 0 „ 4 90,000 x3 tubes — X „ o „ 4 120,000 x3 tubes — X „ o „ 4 250,000 x3 tubes — X „ 0 „ 4 72,000 x3 tubes — X „ 0 „ 4 6,000 x3 tubes — X „ 0 „ 4 300,000 x3 tubes — X „ 0 „ 4 150,000 x3 tubes — X „ 0 „ 4 20,000 x3 tubes — X „ 0 „ 4 27,000 x3 tubes — X „ 0 „ 4 9,000 x3 tubes — X „ o „ 4 By the old test, of a total of 114, 108 are in a category not less than " passable," whereas by the new (provisional) test 93 were classified as "satisfactory" (Grades 1 and 2) ; eight in Grade 3 and 13 in Grade 4. The presence of Bacterium Coli was reported in one sample only. Care in manufacture and 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. The following list gives details of meat and other food condemned as unfit for human consumption. Where possible, the food was salvaged for animal feeding purposes. 3091 tins Evaporated Milk 20 „ Sardines 444 „ Full Cream Milk 14 „ Hake 98 „ Machined Skimmed 12 „ Fish Paste Milk 9 „ Herrings 21 „ Malted Milk 8 „ Mackerel 17 lbs. Dried Milk 7 „ Snoek 6 tins Dried Egg 5 „ Crab 38 „ Baby Food 3 „ Iceland Cheeko 146 „ Cod Liver & Roe Paste 2 „ Haddock Liver 110 „ Pilchards 2 „ Brisling 74 „ Crayfish 2 „ Whiting 46 „ Fried Fish 2 „ Anchovy 41 „ Mussels 2 „ Herring Spread 41 „ Salmon 1 tin Kipper Snacks 30 „ Roe 1 „ Shrimps 26 „ Silds 1 ,, Whalemeat Loaf 32 1 tin Cod 65 bots. Sauce 1 „ Fish Fillets 1 tin Mustard Relish 6 jars Smoked Herring 37 bots. Salad Cream 1471 tins Tomato Paste (2½ oz.) 142 pkts. Gravy Powder 125 „ Tomatoes 5 bots. Gravy Browning 24 „ Tomato Juice 120 tins Soup 376 „ Peas 13 „ Stew 264 „ Beans 6 „ Broth 53 „ Carrots 14 pkts. Bisto 13 „ Rhubarb 158 tins Veal Loaf 10 „ Mixed Vegetables 33 „ Ham Loaf 6 „ Beetroot 137 „ Beef Loaf 6 „ Macedoine 123 „ Meat and Vegetables 2 „ Turnips 32 „ Meat and Gravy 3 „ Potatoes 111 „ Luncheon Meat 2 „ Celery 43 „ Pork 2½ lbs. French Salad 20 „ Brawn 580 „ Oranges 20 „ Tongue 6 tins Oranges 15 „ Stewed Steak 6 „ Orange Juice 9 „ Sausages 156 „ Peaches 2 „ Sausage Meat 122 „ Plums 9 „ Rabbit 31 „ Apples 6 „ Bacon 4 „ Apple Puree 5 „ Potted Meat 29 „ Grapes 6 „ Chopped Pork 17 „ Prunes 3 „ Jellied Veal 16 „ Apricots 2 „ Steak and Kidney Pudding 16 „ Grapefruit 8 „ Grapefruit Juice 2 „ Chili Con Carne 13 „ Pears 2 „ Brisket (Beef) 8 „ Pineapple 2 „ Minced Beef 11 „ Pineapple Juice 2 „ Hungarian Meat 5 „ Strawberries 1 tin Boiled Beef 4 „ Cherries 1 „ Hors d'Oeuvres 4 „ Damsons 965 lbs. Corned Beef 6 „ Black Currant and Apple Juice 355 „ Tripe 335½ „ Lamb 2 „ Fruit Salad 191 „ Sausages 1 tin Figs 201 „ Steak 1 bott. Gooseberries 168 „ Pigs' Trotters 58 tins Jam 94 „ Beef 40 „ Marmalade 91 „ Mutton 8 „ Syrup 76 „ Rabbits 4 „ Pudding 30”½ „ Liver 3 „ Pate de Fois Gras 30 „ Ox Tongue 12 „ Spaghetti 4½ „ Bacon 21 lbs. Spaghetti 2 „ Pork Pie 229 jars Pickles 23 „ Jelly Maws (tinned) 33 156 pkts. Cereals 96 lbs. Cheese 11 „ Malt Extract 40 pkts. Biscuits 8 „ Cereoca 6 lbs. Biscuits 7 „ Semolina 27 pkts. Chocolate Biscuits 56 „ Oats 28 tins Chocolate Spread 42 „ Oat Cakes 6 jars Sandwich Spread 191 lbs. Oatmeal 1 tin Lemon Spread 112 „ Pearl Barley 29½ lbs. Confectionery (various) 70 „ Peas 5 bars Chocolate 2 tins Coffee 4 pkts. Edible Cake 29 bots. Coffee Essence Decorations 1334 lbs. Sugar 120 portions Jellied Trifle 30 „ Sultanas 53 „ Chocolate Trifle 4½ „ Prunes 199 stone Skate 10 „ Margarine 29 „ Plaice 6 lbs. Cooking Fat 22 „ Cod 5 „ Butter 20 „ Haddock 336 „ Cake Mixture 15½ „ Bream 61 pkts. Cake Mixture 12 „ Dogfish 84 „ Sponge Mixture 10½ „ Roe 24 lbs. Pudding Mixture 10 „ Whiting 18 pkts. Pudding Mixture 9½ „ Kippers 10 „ Cake Flour 6 „ Catfish 1152 „ Bun Flour 5 „ Roker 98 lbs. Flour 4 „ Witch 34 pkts. Custard Powder 5 bushels Winkles 13 „ Blanc Mange Powder 755 Eggs 9 „ Dessert Powder 22 Ducks 1 pkt. Jelly 2 Chickens 141 pkts. Cheese 12 Beef Cubes (d) Adulteration, etc.—Food and Drugs Act, 1938. One hundred and seventeen samples of food and drugs were submitted to the Public Analysts. Eight samples were found to be unsatisfactory in some respect. Details are given below :— Description of Article Result of Analysis Action Taken Savouries (Vegetable) (2) Mis-described as savour- Manufacturers warned. ies — no significant amount of aromatic spices or herbs Tomato Paste .— Metallic contamination Consignment of 1,471 tins surrendered fore sampling. Fizzy Lemon Barley Powder Not harmful but no Manufacturer warned. significant amount of effervescence. Milk (2) Added water 8% Vendor fined £5 and Milk (2) Added water 21% costs £l 1s. 0d. 34 Below is given a full list of samples taken for analysis :— Formal No. examined Informal Total No. unsatisfactory Formal Informal Total Milk 17 4 21 2 2 4 Beef Cubes — 1 1 — — — Coffee Extract — 1 1 — — — Iced Lollies — 8 8 — — — Sausages 6 1 7 — — — Sausages, Whalemeat — 1 1 — — — Sweephat 1 — 1 — — — Saccharin — 2 2 — — — Bread — 1 1 — — — Brawn — 1 1 — — — Cream Buns — 4 4 — — — Ice Cream — 8 8 — — — Peach Jam — 1 1 — — — Savouries (" Sausages ") — 2 2 — 2 2 Sweets — 2 2 — — — Vinegar 4 4 8 — — — Whisky 8 — 8 — — — Candy Floss — 1 1 — — — Cream Doughnuts — 1 1 — — — Fizzy Effervescing Drink — Powder — 1 1 — — — Fizzy Lemon Barley Powder — 1 1 — 1 1 Frying Oil 3 — 3 — — — Lemonade Powder — 1 1 — — — Meat Pie 1 1 2 — — — Meringue — 1 1 — — — Olive Oil — 1 1 — — — Pepper — 1 1 — — — Tomato Paste — 1 1 — 1 1 Trifle — 1 1 — — — Vita Crunch (Malt preparation) — 1 1 — — — Dyspepsia Tablets — 1 1 — — — Health Herbs — 1 1 — — — Indigestion Tablets — 1 1 — — — Almond Flavouring — 1 1 — — — Frizets — 1 1 — — — Ginger Wine Flavouring — 1 1 — — — Golden Crumbs — 1 1 — — — Jelly Crystals 1 — 1 — — — Pastry Mix — 1 1 — — — Raising Powder — 1 1 — — — Spice, Pickling 1 — 1 — — — Suet, Beef — 1 1 — — — Swiss Roll 1 — 1 — — — Rum 1 — 1 — — — Camphorated Oil — 1 1 — — — Cascara Tablets — 1 1 — — — 109 8 (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. 35 Certain biological examinations are undertaken by Dr. A. L. Sheather of Chorley Wood. (f) Clean Food Campaign. Over two years ago the first of the post-war efforts was directed towards the Ice Cream trade. The sampling of Ice Cream for chemical and bacteriological examination has long been established in this borough, but a special inspection of all premises where this commodity was being manufactured was called for by the Ice Cream (Heat Treatment, etc.) Regulations. In order to be sure that they are making Ice Cream of the required standard, nearly 100% of the manufacturers now have private samples taken at their own expense, and during 1949 they paid for the examination of no less than 1,246 bacteriological samples, and in addition the local Inspectors took 114 for examination by the County Bacteriologists. Generally speaking, Ice Cream manufactured and sold in this district is of a high standard of bacterial purity. In May, 1947, a voluntary scheme was commenced by which members of the Ice Cream trade could submit to a Blood Test or Swabbing to ascertain if they were Typhoid, etc., carriers. This scheme has been well received, and quite a large number of Ice Cream handlers attend for examination, and we congratulate them for this. I think we can justly claim to have been pioneers in the "Wash your hands" campaign, as early in the war we distributed some hundreds of cards to food handlers calling upon them to "Wash their hands before commencing work and on re-commencing work." "Wash your hands, please " is now a national slogan. We still issue appropriate cards to traders free of cost. Caterers— During the early part of the year a special inspection of the 113 Cafes, Restaurants and Eating Houses was carried out. Special note was made of the standard of hygiene in the kitchens and restaurants, and where conditions were in some respect unsatisfactory an intimation was later on sent to the proprietors. The trade generally has been co-operative and many additional sinks and hot-water heaters, crockery racks, refrigerators, etc., have been installed and the standards raised. Many more have works in hand. Dairymen— Quite recently the Dairy trade has been the subject of much new legislation. 36 The Dairymen have again shewn their willingness to co-operate and very soon it is expected that Walthamstow will have a 100% retail delivery of milk, bottled or in sealed churns, sold as received from the dairies holding Pasteurisers and Bottlers' licences. Lectures relative to the Clean Food Campaign have been given by the Medical and Sanitary Inspectors' staffs and much interest has been shewn by numerous members of the public. At some later date the Council will no doubt consider the question of compiling "Codes of Practice" for all food trades and the formulating of "Grading Schemes." The Council have resolved to make byelaws in regard to the Handling, Wrapping and Delivery of Food, and in connection with the Sale or Exposure in the Open Air of Food intended for human consumption. The matter is now in hand. (g) Food Poisoning Outbreaks. During the year eleven outbreaks were brought to light involving 110 children and 30 adults. One death was notified. The outbreaks may be summarised as follows :— Cases Meals served Factory Canteens 2 21 400-500 Schools Meals Service 5 104 3,100 Seaside Vendors 2 13 Numerous Restaurants 1 1 Numerous Private 1 1 No. 1 Factory Canteen.—A specimen meal was available. This was submitted to the Pathologist at Epping, with negative results. No. 2 Factory Canteen.—A death from suspected food poisoning was reported by the Coroner. The deceased man had a midday meal at the Canteen. 300-400 meals were served—no other case of illness reported. With regard to the Schools' Meals Service— Outbreak No. 1.—37 cases, 150 meals served. Pains and Diarrhoea 3-4 hours after mid-day meal. No food available. Swab of faeces proved negative. Outbreak No. 2.—50 cases, 200 meals served. Pains and Diarrhoea 12 hours after mid-day meal. Two specimens Cold Beef submitted. Result (a) Moderate growth of coagulase positive staphylococcus. (b) No pathogenic organisms isolated. Outbreak No. 3.—5 cases, 150 meals served. On various occasions pains in stomach 2-3 hours after mid-day meals. Five rectal swabs taken. Result—No pathogenic organisms isolated. 37 Outbreak No. 4.—8 cases, 544 meals served. Pains and sickness 3-4 hours after mid-day meal. Specimens submitted— (a) Canned Pilchards. (b) Fish-cake. Result (a) All cultures sterile. (b) Very scanty gram positive cocci seen singly and in pairs. Very scanty growth of Staphylococcus albus. Outbreak No. 5.—4 cases, 2,000 meals served. Four sick 10-18 hours after mid-day meal. No food available when reported. One case was reported where 12 or 13 hours after eating at a Restaurant the patient experienced severe pains and sickness. Some hundreds of meals were served but no other case of illness notified. In thirteen cases illness was reported following visits to the seaside and the eating of Cockles, Whelks or Winkles. Note by the Medical Officer of Health. Following reports made to the Health Committee in regard to the need to provide washing facilities for outdoor food handlers, your Council resolved that a scheme on the following lines be put into operation, on trial :— (1) Any person using a public convenience shall be entitled to wash at the existing wash basin (s) in each public convenience in the men's or women's sections, and provided, free of charge, with a paper towel and soap. (2) This facility shall apply to all users of the public conveniences whether food handlers or not. (3) Suitable notices shall be displayed in all public conveniences of the free facilities, the notices to make a particular appeal to handlers of food. In addition, shops and other firms concerned in the sale and handling of food shall be circularised by the Medical Officer of Health urging them to encourage their employees to use the free facilities and giving them publicity. (4) That a sum of £500 be provided in the estimates for 1949/50 to cover any expenditure in connection with the provision of additional washing facilities at the public conveniences which may be found necessary. The Borough Engineer and Surveyor stated at the close of 1949, that a total of 4,930 paper towels had been used between 2nd June, 1949 and the 21st January, 1950—an average of 12 towels per convenience per week. In addition, there was an average of 8 persons per week per convenience paying for washing facilities. 38 Later in the year your Council agreed to the discontinuation of the charges for the use of public conveniences. It can only be hoped that these facilities will become better used as the public becomes educated to the need to "now wash your hands." During the year attention was drawn to the potential dangers from the manufacture and sale of Candy Floss and Ice Lollies. Further powers are needed to control these articles, but all possible action was taken by the Sanitary Inspectorate, even to the extent of unofficial registration. The Model Byelaws issued in October by the Ministry of Food for the handling, wrapping and delivery of food and the sale of food in the open air, were considered and adopted by your Council. The following information is given in the form requested by the Ministry of Health :— A total of 15 cases was notified, two of which were admitted to hospital. Of the 15 cases, twelve were apparently due to the consumption of shellfish, one was apparently due to the consumption of duck eggs, and in two the cause was unidentified. The following are the details which are given to comply with Ministry of Health Circular 2/50 :— (a) Total number of out- (d) There were no definite breaks 11 bacteriological findings in any of the investigations (b) Number of Cases 140 made. (e) Shellfish (A series of 12 (c) Number of Deaths 1 cases). Duck Eggs (1 case). DISEASES OF ANIMALS ACTS, 1894-1938 Swine Fever Order, 1938.—No action necessary. Sheep Scab Order, 1938.—No action necessary. Regulation of Movement of Swine Order, 1922.—One licence 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 1949) and Amendment Orders. Foot and Mouth Disease (Infected Areas) Special Orders (Nos. 9, 10 and 11) 1949 — One licence was dealt with. 39 RATS AND MICE DESTRUCTION ACT, 1919 AND INFESTATION ORDER, 1943 Two trained Rodent Operatives continue to be engaged in the important work of rodent repression in private dwellings and business premises. The methods adopted are those recommended by the Ministry of Agriculture and Fisheries (Infestation Control Division) and the Council are participants in the Ministry's Scheme as outlined in Local Authority Circulars Nos. N.S. 1921. Pre-baiting and poison baiting methods have proved to be a 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 26 421 20 311 281 4 5 84 Complaints received 321 Premises rat-proofed 11 Re-inspections 597 RODENT OPERATIVES No. of Infestations No. of Infestations Estimated Treated Retreated Cleared. Kill. 566 29 562 2,800 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 124 214 23 Nil Factories not included above in which Section 7 is enforced by the Local Authority 449 645 43 Nil Other premises in which Section 7 is enforced by the Local Authority 58 107 4 Nil Totals 631 966 70 Nil 40 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 57 49 3 — Overcrowding 2 2 — — — Unreasonable temperature 1 1 — 1 — Inadequate ventilation 7 7 — 1 — Ineffective drainage of floors 7 7 — — — Sanitary Conveniences insufficient 10 10 — 3 — unsuitable or defective 99 91 — 13 — not separate for sexes 4 2 — 2 — Other offences 44 37 7 — — Totals 231 206 7 23 — NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1949 Wearing apparel, making of 291 Lampshades 1 Fur-pulling 1 Artificial Flowers 13 Paper bags 31 Boxes 47 Brush-making 46 Stuffed toys 42 Total 472 41 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. 15-2 yrs. 5 25-4 yrs. 5 45-65 yrs. 65 & over. 1949 1948 Scarlet Fever 182 188 1 64 113 4 — — — Diphtheria — 1 — — — — — — — Typhoid Fever 2 2 — — 1 1 — — — Paratyphoid Fever 4 — — — 2 — 2 — — Pneumonia 101 85 3 14 7 5 27 31 14 Erysipelas 34 27 — — 1 — 14 12 7 Puerperal Pyrexia 17 22 — — — 6 11 — — Ophthalmia Neonatorum 1 2 1 — — — — — — Encephalitis Lethargica — — — — — — — — — Cerebro-spinalMeningitis 3 1 2 — — 1 — — — Anterior Poliomyelitis 18 3 1 6 10 — 1 — — Polio-encephalitis 1 — — — — — 1 — — Measles 1550 639 46 838 658 4 4 — — Whooping Cough 226 565 21 134 67 1 2 1 — Dysentery 3 2 — 1 1 1 — — — Food Poisoning 15 — — — 4 — 8 3 — Tuberculosis 158 144 — 6 15 58 53 20 6 Totals, 1949 2315 — 75 1063 879 81 123 67 27 Totals, 1948 — 1681 121 724 564 78 114 47 33 St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Totals. Scarlet Fever 31 30 34 13 28 46 182 Diphtheria — — — — — — — Typhoid Fever — 1 — — — 1 2 Paratyphoid Fever — 1 — 2 — 1 4 Pneumonia 11 10 13 14 30 23 101 Erysipelas 3 4 8 1 7 11 34 Puerperal Pyrexia 2 3 2 3 4 3 17 Ophthalmia Neonatorum — — — — 1 — 1 Encephalitis Lethargica . — — — — — — — Cerebro-spinal Meningitis — 1 — 1 — 1 3 Anterior Poliomyelitis . 2 3 2 3 4 4 18 Polio-encephalitis — 1 — — — — 1 Measles 218 214 210 245 321 342 1550 Whooping Cough 44 26 25 18 60 53 226 Dysentery 1 — — 1 1 — 3 Food Poisoning 2 — 1 1 4 7 15 Tuberculosis 19 13 25 21 36 44 158 Totals, 1949 333 307 320 323 496 536 2,315 Totals, 1948 292 244 313 160 304 368 1,681 42 The Registrar-General gives the statistics for the 52 weeks ended 31st December, 1949, 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 182 — 6 101 17 34 Case rate :— England and Wales 1.63 0.04 0.02 0.80 Not available 0.19 Walthamstow 1.47 — 0.04 0.81 0.13 0.27 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 9.12 England and Wales 6.31 Disease. Total notified. Removed to Hospital. Per cent, removed to Hospital. Deaths. Deaths per cent, of cases notified. Scarlet Fever 182 78 42.8 — — Diphtheria — — — — — Diphtheria Observation 20 20 100.0 — — Typhoid Fever 2 2 100.0 — — Paratyphoid Fever 4 4 100.0 — — Pneumonia 101 45 44.5 67 66.3 Erysipelas 34 3 8.8 — — Puerperal Pyrexia 17 1 5.8 — — Ophthalmia Neonatorum 1 1 100.0 — — Encephalitis Lethargica. — — — — — Cerebro-spinalMeningitis 3 3 100.0 — — Anterior Poliomyelitis 18 17 94.4 3 16.6 Polio-encephalitis 1 I 100.0 1 100.0 Measles 1550 31 2.0 — — Whooping Cough 226 18 7.9 1 0.4 Dysentery 3 2 66.6 — — Food Poisoning 15 2 13.3 — — Tuberculosis (all Forms) 158 n/a n/a 52 32.9 PUERPERAL PYREXIA Seventeen cases of Puerperal Pyrexia cases were notified during 1949. The notifications were received from the following sources : Maternity Hospital 12 Hospital outside the area 4 General Practitioners 1 43 The Puerperal Pyrexia rate for 1949 was 9.12 per 1,000 births as compared with 10.40 in 1948. Mortality due to Puerperal Sepsis was nil. The Registrar-General has issued the following rates with regard to the notification of Puerperal Pyrexia. The Walthamstow rates are set out in comparison. England and Wales 6.31 126 County Borough and Great Towns (including London) 8.14 148 Smaller Towns (Population 25,000-50,000) 5.30 London 6.82 Walthamstow 9.12 The notifications and rates for Walthamstow for the past five years have been as follows :— Year Number Rate 1949 17 9.12 1948 22 10.40 1947 30 10.99 1946 33 12.62 1945 32 18.08 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. OPHTHALMIA NEONATORUM One case was notified and removed to Hospital. Vision was unimpaired. 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 ConCacts.—Contacts were reported for surveillance on disembarkation from several transports and were cleared after close observation. Vaccination.—In view of the importance of maintaining the vaccinal condition of members of the staff whose duties might bring them into contact with cases of smallpox, and as stressed in the report of the Chief Medical Officer of the Ministry of Health, enquiries were made and vaccination offered. It is intended to repeat this procedure annually. 44 Vaccination has now become an 'area' service and is referred to separately under that section. SCARLET FEVER A total of 182 cases of Scarlet Fever was notified during 1949 as compared with 188 in 1948. The incidence by months and Wards is given below :— January 9 July 14 February 11 August 7 March 6 September 9 April 6 October 20 May 10 November 41 June 9 December 40 Total 182 St. James Street 31 High Street 30 Hoe Street 34 Wood Street 13 Hale End 28 Higham Hill 46 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 1949, there have been 3,520 non-fatal cases. DIPHTHERIA During 1949, 20 cases were removed to hospital for diphtheria observation. No case was confirmed. ENTERIC FEVER Seven cases were notified during the year but in two, the diagnosis was not confirmed. The following table gives particulars of the confirmed cases :— Initials Sex Age Ward Date Notified Remarks Phage Type J.S. M 14 yrs. W 20.7.49 Paratyphoid B 3a.1 C.S. M 34 yrs. W 29.7.49 Do. 3a.1 H.W. F 13 yrs. HI 20.7.49 Do. 3a/l J.A. F 26 yrs. HH 28.9.49 Do. C.F. M 22 yrs. HI 20.12.49 Typhoid E.l With regard to the first three cases notified in July, all of whom were of phage type 3a. 1, two were father and son, and although the father had experienced mild symptoms some little time previously he was symptomless when his son was notified. Both had stayed at a bungalow at an Estuary in Essex but in spite of the fullest investigations no source of infection was discovered. 45 The third case was notified from a local hospital following the failure of the patient's temperature to resolve after the removal of her appendix. There were no discoverable common factors between the three cases in spite of renewed enquiries, when it was found that all three patients were of the same phage type. The last case (C.F.) was admitted to hospital for Appendicitis, and since his post-operative condition did not clear up he was further investigated and found to be a case of Typhoid. In spite of the most detailed enquiries the source of infection could not be traced. Early in January, 1950, a case was notified in an adjoining area and the Medical Officer of Health stated that his patient had taken meals in a cafe in Walthamstow, at which C.F. had also taken meals. This cafe had already been visited in connection with the enquiries in regard to C.F., but nothing suspicious had been found. Further enquiries were now made including tests on all staff at the cafe and as a result, one was found to be excreting typhoid organisms of the same type as the patient, i.e., phage type E.l. Since the cafe was used by many persons from surrounding areas and by Transport drivers, the Medical Officers of Health of surrounding areas were notified and as a result, 5 further cases were brought to light, one from each of five other areas—4 in Essex and 1 in Middlesex, and all of whom were of the same phage type. Unfortunately, one of these patients died. The patient at the cafe who was found to be excreting typhoid organisms was suspended under the Public Health (Infectious Diseases) Regulations, 1927. 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 agreed at a sum of £501 11s. 6d. for the period April, 1946 to April, 1949 plus costs of £23 12s. 6d. An undertaking was also given for the payment of annual compensation at the rate of £168 until the position was finally resolved. 46 The carrier was most co-operative and was finally cleared in July after removal of the gall bladder sometime previously. DYSENTERY Three cases were notified during 1949, details being as follows : Sex Age Ward Removed to Hospital Remarks M 4 yrs. Wood Street Yes Recovered F 6 yrs. St. James St. Yes Recovered F 19 yrs. Hale End No Recovered ACUTE ANTERIOR POLIOMYELITIS During 1949 a total of 19 confirmed cases was notified as compared with a total of 27 in 1947. The incidence by months and Wards is given below : January July 1 February August 4 March September 4 April October 8 May November June 1 December 1 Total 19 St. James Street 2 High Street 4 Hoe Street 2 Wood Street 3 Hale End 4 Higham Hill 4 In September/October of 1949 there were six definite cases in school children. Five schools were involved, there being two cases in one class but fortunately no further cases were notified. 58 per cent. of the patients were females and 42 per cent. were males. With regard to age incidence, 5.3 per cent. were under one year, 31.6 per cent, between one and five years, 52.6 per cent. between five and fifteen years and 10.5 per cent. were aged twentyfive years and over. Three patients aged 6, 10 and 28 years died, but on the other hand twelve patients either recovered completely or sustained only slight permanent weakness. Arrangements were made through the Clinical Secretary of the South-West Essex Branch of the B.M.A. for the showing of a film sponsored by the Ministry of Health in regard to the diagnosis and management of poliomyelitis, and all medical practitioners in the area were notified of the showing. The table overleaf shows the position since 1912, when poliomyelitis first became compulsorily notifiable :— 47 POLIOMYELITIS INCIDENCE IN WALTHAMSTOW. 1912-1949 Compulsorily Notifiable from 1.9.1912. Year Population No. Notified Notification Rate Age Group Deaths Death Rate Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 1912 128,480 4 0.03 — 2 — — 2 1 0.007 1913 131,636 9 0.06 — 9 — — — Nil — 1914 131,980 1 0.007 — — 1 — — Nil — 1915 131,718 — — — — — — — Nil — 1916 * 128,146 27 0.21 1 19 6 1 — 2 0.01 * 131,718 0.20 0.01 1917 132.994 1 0.007 — — 1 — — 1 0.007 1918 127.701 2 0.01 — 1 1 — — 2 0.01 1919 133,008 3 0.02 — 2 1 — — 1 0.007 1920 132,771 Nil — — — — — — Nil — 1921 127,441 2 0.01 — 1 1 — — 2 0.01 1922 129,700 1 0.007 — — — — 1 Nil — 1923 130,000 1 0.007 — — — 1 — 1 0.007 1924 131,100 6 0.04 1 5 — — — Nil — 1925 130,800 1 0.007 — — 1 — — Nil — 1926 125,500 2 0.01 — 1 1 — — Nil — 1927 124,330 3 0.02 — 1 2 — — Nil — 1928 122,400 2 0.01 — — 2 — — Nil — 1929 124,800 Nil — — — — — — Nil — 1930 124,800 Nil — — — — — — Nil — 1931 134,420 1 0.007 — 1 — — — Nil — 1932 135,010 7 0.05 — 3 4 — — Nil — 1933 135,600 3 0.02 — — 3 — — Nil — 1934 135,090 Nil — — — — — — Nil — 1935 134,490 5 0.03 — 4 1 — — Nil — 1936 133,600 5 0.03 — 1 4 — — 1 0.007 1937 131,900 9 0.06 1 2 6 — — 2 0.01 1938 130,800 Nil — — — — — — Nil — 1939 130,000 Nil — — — — — — Nil — 1940 109,400 1 0.009 — 1 — — — 1 0.01 1941 94,170 1 0.01 — — — 1 — 1 0.01 1942 98,750 2 0.02 1 1 — — — Nil — 1943 100,500 1 0.009 — — 1 — — Nil — 1944 101,140 Nil — — — — — — Nil — 1945 103,320 1 0.009 — — 1 — — Nil — 1946 118,050 Nil — — — — — — Nil — 1947 122,470 24 0.19 1 7 8 5 3 Nil — 1948 122,700 3 0.02 — 2 — — 1 Nil — 1949 123,400 19 0.15 1 6 7 5-10 yrs. 3 10-15 yrs. 2 4 0.03 * 128,146 estimated figure by Registrar-General for Death Rate. 48 PNEUMONIA The incidence by months and Wards is given below :— January 11 July 1 February 22 August 3 March 21 September 4 April 13 October 2 May 5 November 7 June 2 December 10 Total 101 St. James Street 11 High Street 10 Hoe Street 13 Wood Street 14 Hale End 30 Higham Hill 23 ERYSIPELAS The incidence by months and Wards is given below :— January 4 July — February 2 August 1 March 5 September 3 April 3 October 3 May 3 November 3 June 1 December 6 Total 34 St. James Street 3 High Street 4 Hoe Street 8 Wood Street 1 Hale End 7 Higham Hill 11 CEREBROSPINAL MENINGITIS Three cases were notified during the year, details being as follows :— Removed to Sex Age Ward Hospital Remarks M 5 months Wood St. Yes Recovered F 10 months High St. Yes Recovered M 24 years Higham Hill Yes Recovered 49 MALARIA There were no cases notified during the year. MEASLES The incidence by months and Wards is given below:— January 104 July 38 February 397 August 19 March 348 September 4 April 314 October 13 May 212 November 1 June 97 December 3 Total 1550 St. James Street 218 High Street 214 Hoe Street 210 Wood Street 245 Hale End 321 Higham Hill 342 WHOOPING COUGH The incidence by months and Wards is given below:— January 15 July 32 February 13 August 16 March 50 September 4 April 21 October 3 May 29 November 1 June 38 December 4 Total 226 St. James Street 44 High Street 26 Hoe Street 25 Wood Street 18 Hale End 60 Higham Hill 53 The age incidence was as follows:— Under 1 yr. 1-2 yrs. 2-3 yrs. 3-4 yrs. 4-5 yrs. Over 5 yrs. Total 1948 70 102 74 84 76 159 565 1949 21 29 42 30 33 71 226 In 1948 there were six fatal cases, five being under one year of age, and one between 1 and 2 years. In 1949 there was one fatal case under one year of age. 50 TUBERCULOSIS The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1949:— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year — — — - — - - — 1- 5 years 2 2 1 1 — - - 1 5-10 „ 2 5 - 1 — - - — 10-15 „ 2 1 2 2 — - 1 — 15-20 „ 15 8 — 1 1 1 1 — 20-25 „ 9 20 3 2 1 1 - 1 25-35 „ 19 12 3 3 3 5 1 — 35-45 „ 8 8 — — 4 4 - 1 45-55 „ 9 3 — — 6 3 1 — 55-65 „ 8 — — — 6 1 - 1 65 and over 4 2 — — 6 2 - — Totals 78 61 9 10 27 17 4 4 139 19 44 8 J 158 52 The 52 deaths represent a death rate of 0.42 per 1,000 population (England and Wales, 0.45). New cases in 1948 were 144 with 64 deaths—a rate of 0.52. 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. 1949 78 61 9 10 158 27 17 4 4 52 1948 72 58 7 7 144 33 27 1 3 64 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. — 1 5 2 4 — 5 2 25 — 5 5 - - 51 The ratio of deaths in non-notified cases (i.e., columns to the right of the double line) to total deaths from tuberculosis was 10 to 42 or 1 to 4.2. The table given below shows the number of cases on the register at the beginning and end of 1949:— Pulmonary. Total. NonPulmonary. Total. Grand Total. M. F. M. F. No. on Register 1st January 1,052 884 1,936 486 399 885 2,821 Notified during 1949 78 61 139 9 10 19 158 Totals 1,130 945 2,075 495 409 904 2,979 Removed from Register, 1949 71 51 122 6 6 12 134 No. on Register 31st December 1,059 894 1,953 489 403 892 2,845 Removals from the Register are made up as follows:— Deaths. Removals. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. #] 27 17 4 4 44 34 2 2 44 8 78 4 52 82 134 52 The following table shows the position in regard to Tuberculosis notifications and deaths in the last 20 years:— NOTIFICATIONS Notification rates per 1,000 population Pulmonary Non-Pulmonary Grand Total Pul. NonPul. Total M F Total M F Total 1930 72 53 125 18 16 34 159 1.00 0.27 1.27 1931 97 53 150 23 17 40 190 1.12 0.29 1.41 1932 82 70 152 21 13 34 186 1.13 0.25 1.38 1933 56 55 111 27 18 45 156 0.82 0.33 1.15 1934 104 58 162 20 14 34 196 1.20 0.25 1.45 1935 64 58 122 25 16 41 163 0.91 0.30 1.21 1936 58 56 114 15 12 27 141 0.85 0.20 1.05 1937 59 70 129 13 12 25 154 0.97 0.19 1.16 1938 75 60 135 14 15 29 164 1.03 0.22 1.25 1939 71 56 127 10 4 14 141 0.97 0.11 1.08 1940 68 67 135 11 9 20 155 1.23 0.18 1.41 1941 56 35 91 13 12 25 116 0.97 0.26 1.23 1942 67 52 119 17 12 29 148 1.21 0.29 1.50 1943 70 71 141 8 10 18 159 1.40 0.18 1.58 1944 74 57 131 14 13 27 158 1.29 0.26 1.55 1945 75 54 129 17 14 31 160 1.25 0.20 1.45 1946 82 60 142 14 11 25 167 1.20 0.21 1.41 1947 80 49 129 9 13 22 151 1.05 0.18 1.23 1948 72 58 130 7 7 14 144 1.06 0.11 1.17 1949 78 61 139 9 10 19 158 1.13 0.15 1.28 DEATHS Pulmonary Non-Pulmonary Total deaths Total death rate lation/ M F Total Rate M F Total Rate 1930 57 23 80 0.64 6 3 9 0.07 89 0.71 124,800 1931 63 32 95 0.70 5 8 13 0.09 108 0.79 134,420 1932 54 33 87 0.64 9 5 14 0.10 101 0.74 135,010 1933 47 42 49 0.65 5 6 11 0.08 100 0.73 135,600 1934 55 28 83 0.61 6 9 15 0.11 98 0.72 135,090 1935 39 30 69 0.51 3 3 6 0.04 75 0.55 134,490 1936 43 30 73 0.54 12 2 14 0.10 87 0.64 133,600 1937 40 40 80 0.60 6 6 12 0.09 92 0.69 131,900 1938 45 27 72 0.55 7 6 13 0.09 85 0.64 130,800 1939 46 30 76 0.61 3 3 6 0.04 82 0.65 130,000 1940 34 24 58 0.53 7 7 14 0.12 72 0.65 109,400 1941 32 19 51 0.55 9 3 12 0.09 63 0.64 94,170 1942 20 23 43 0.43 5 5 10 0.11 53 0.54 98,750 1943 37 22 59 0.58 1 3 4 0.04 63 0.62 100,500 1944 44 16 60 0.59 8 6 14 0.13 74 0.73 101,140 1945 36 25 61 0.59 5 1 6 0.05 67 0.64 103,320 1946 30 16 46 0.39 10 2 12 0.10 58 0.49 118,050 1947 28 25 53 0.43 1 4 5 0.04 58 0.47 122,470 1948 33 27 60 0.48 1 3 4 0.03 64 0.51 122,700 1949 27 17 44 0.35 4 4 8 0.06 52 0.42 123,400 53 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. 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, 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 objection- able. LABORATORY FACILITIES Dr. F. Marsh, Pathologist in charge of the Laboratory at Epping, has kindly supplied the following information in regard to work done in Walthamstow:- Jan. Feb. Mar. Apr. May June July Aug. Sep. Oct. Nov. Dec. Total Fæces 7 3 4 1 10 8 6 4 13 11 11 2 80 Agglutinations 8 1 6 7 34 21 27 24 20 9 5 2 164 Rhesus, etc. 27 31 29 20 19 13 15 14 20 8 22 18 236 Urine 13 2 7 1 7 6 2 2 2 7 10 1 60 Plates - - - - - - - 11 6 7 19 15 58 Eye Swabs 3 - - - - - - - - - - 1 4 Nose & Throat Swabs 22 16 10 1 10 25 19 18 15 18 6 7 167 Ear Swabs — 1 - 1 — — 1 - — — — — 3 Fluid - - 1 - - - - - - - - - 1 Food — - 3 - - — — - 2 1 1 2 9 Sputum — — — 1 2 2 - - - - - - 5 Totals 80 54 60 32 82 75 70 73 78 61 74 48 787 MISCELLANEOUS 1. Old People's Welfare.—The Council (under the provision of Section 31 of the National Assistance Act, 1948) made the following contributions to the Old People's Welfare Committee: Meals on Wheels, £300; Old People's Clubs, £450; Miscellaneous, £50; a total of £800. In addition, 4 Council cars and drivers were made available for distributing meals on Mondays, Wednesdays and Fridays. Free office accommodation and the services of a shorthandtypist were also made available. 54 2. National Assistance Act, 1948 (Section 47).—No action became necessary to secure the removal of persons in need of care and attention to suitable premises, although such action had to be suggested in several cases. Such suggestions were not implemented because of the inadequate accommodation for the elderly chronic sick, who are unable to secure accommodation even although willing to accept it even without any question of compulsion. 3. Funeral Arrangements.—Up to the end of the year, arrangements were made in regard to the burials of four persons. The arrangements previously used by the Essex County Council were continued. 4. Mortuary Provisions, etc.—A Coroner's Court, mortuary (with special provision for infectious disease cases) and a postmortem room is provided by your Council at Queen's Road Cemetery. The Borough Engineer and Surveyor reports that the number of inquests and post-mortems were as follows:— Inquests only 68 Post-mortems only 202 Post-mortems and Inquests 55 325 5. Cremation.—Facilities for cremation are available at the Crematorium provided by the City of London at Manor Park, Little Ilford. Negotiations continued with adjoining local authorities. 6. Rainfall.—The monthly rainfall at the Ferry Lane Recording Station of the Metropolitan Water Board was noted in pre-war annual reports and the following summary is given:— Average per annum 1900—1909 23.21 inches „ „ „1910—1919 24.82 „ „ „ „1920—1929 28.83 „ „ „ „ 1930—1939 23.58 „ „ „ „1940—1949 21.58 „ In order to complete the picture the following annual rainfall is quoted from Ferry Lane Station through the courtesy of the Borough Engineer and Surveyor:— 1939 30.55 1945 19.62 1940 23.82 1946 27.56 1941 24.17 1947 19.02 1942 20.54 1948 23.27 1943 19.50 1949 18.47 1944 19.89 55 In view of the nature of the sub-soil over a considerable portion of Walthamstow, deficient rainfall is of considerable importance in regard to structural defects resulting from subsidence. 7. Medical Examinations.—During the year examinations were carried out by the Medical staff in respect of the Superannuation and Sick Pay Schemes. 56 SECTION G PART III SERVICES WALTHAMSTOW HEALTH AREA SUB-COMMITTEE (1949/50) Chairman: Cty. Ald. Mrs. C. McEntee, J.P. (Executive Council for Essex). Vice-Chairman : Councillor Mrs. S. Candy (Walthamstow Borough Council). Membership: Nominated by— Walthamstow Borough Council Alderman W. B. Fitt. „ „ „ Alderman W. Gillett. „ „ „ Alderman Ross Wyld, O.B.E., J.P. „ „ „ Councillor F. A. Burton. „ „ „ Councillor Mrs. S. Candy. „ „ „ Councillor Mrs. E. M. Flint. „ „ „ Councillor H. F. Fulton. „ „ „ Councillor A. J. D. Llewellyn. „ „ „ Councillor Mrs. M. E. Marchant . „ „ „ Councillor E. G. Richards. „ „ „ Councillor W. H. Shaw. „ „ „ Councillor A. E. Simmons. „ „ „ Councillor Mrs. A. E. Tillyer. „ „ „ Councillor J. M. Wight. „ „ „ Councillor J. H. Williams. Hospital Management Committee Cty. Councillor W. E. Barnes. Executive Council for Essex Cty. Ald. Mrs. C. McEntee, J.P. Local Medical Committee for Essex Dr. J. L. McK. Brown, O.B.E. Essex County Council Councillor Mrs. L. P. Bailey, J.P. „ „ „ Councillor Mrs. A. M. Burrell. „ „ „ Councillor K. E. B. Glenny (Chairman, Health Committee, E.C.C.). 57 Essex County Council Councillor Mrs. E. F. M. Hollis. „ „ „ Councillor A. R. klggins. „ „ „ Councillor P. Porter (Vice- Chairman, Health Committee, E.C.C.). Walthamstow District Nursing Association Dr. M. Cohen. Walthamstow Child Welfare Society E. P. Marr, Esq. Invalid Children's Aid tion Mrs. M. Osora. Walthamstow and Chingford Association of Tuberculosis Care Helpers Mrs. E. Cordell. 58 STAFF The following were the changes in the whole-time members of the Health Area Staff:— Appointments— Mrs. E. Law (Home Nurse) 1.1.49 Miss E. L. Rawding (Home Nurse Midwife) 26.1.49 Dr. J. A. R. Cripps (Assistant Medical Officer) 7.2.49 Miss D. Dubois (Home Nurse Midwife) 18.2.49 Miss M. R. Stanley (Whooping Cough Immunisation Clerk) 10.3.49 Mrs. H. M. Johnson (Whooping Cough Immunisation Nurse) 21.3.49 Mrs. M. Smitten (Clerical Staff) 27.5.49 R. H. Irwin (Clerical Staff) 27.6.49 Mrs. M. M. Bowtle (Home Nurse) 25.7.49 Miss F. Sayle (Home Nurse) 2.8.49 P. Barnett (Dental Technician Trainee) 15.8.49 Miss Y. N. E. Graham (Home Nurse Midwife) 15.8.49 Miss G. E. Williams (Health Visitor/School Nurse) 15.8.49 Mrs. L. Wale (Home Nurse) 1.9.49 Miss S. H. Argent (Home Nurse Midwife) 5.12.49 Resignations— Miss M. A. Young (Health Visitor/School Nurse) 31.3.49 Miss I. N. MacPherson (Health Visitor/School Nurse) 30.4.49 Miss E. L. Rawding (Home Nurse Midwife) 7.9.49 Miss F. Sayle (Home Nurse) 18.9.49 Mrs. E. L. Tee (Dental Attendant) 21.10.49 Mrs. M. M. Bowtle (Home Nurse) 31.10.49 Miss Y. N. E. Graham (Home Nurse Midwife) 26.12.49 HEALTH CENTRES (Section 21) HEALTH CENTRE SITES The earmarking of sufficient and satisfactory Health Centre Sites has proved to be a difficult problem in a built-up area like Walthamstow, where conveniently situated sites of sufficient size are at a premium, having regard to the need for housing sites. Originally some 14 sites were considered in conjunction with the representatives of the various professions which are to use them. At the time of writing, 9 remaining sites are being considered, which have been inspected and reported upon. At the moment they await the final approval of the Borough Council before submission to the Health Area Sub-Committee. 59 GENERAL DENTAL SERVICE This was continued on the same lines as in previous years, but difficulties arose in regard to dental staffing. Arrangements exist under which X-ray facilities are made available to local dental practitioners. Additional equipment for the Dental Workshop was approved up to a total of £200. The appointment of a trainee dental mechanic was authorised. Mr. L. W. Elmer, L.D.S., Senior Dental Surgeon in charge of all Dental Services reports as follows:— The Municipal Dental Service was initiated by the Walthamstow Borough Council in the spring of 1944, with a staff of three part-time dental surgeons. Each succeeding year has shown a steady increase in public demand for its services, this demand being met by an increase of staff. By July 5th, 1948, the yearly attendance was at the rate of over 6,000 (as compared with 558 in 1944). 1949 was the first complete year of the operation of this service since, under the Health Act, responsibility was transferred to the Executive and County Councils for Essex. The year started with a staff of two full-time and three parttime dental surgeons but, owing to the difficulties common to all forms of salaried dental service it was reduced during the year to four part-time officers. Mr. Clarke, although continuing part-time attendance, resigned in order to take a higher qualification and Mr. Timmis transferred to the School Dental Service. With this shortage of staff it has become increasingly difficult, indeed impossible, to cope with the enormous demand, but every effort has been made to attend to the needs of regular past patients and of expectant and nursing mothers. In spite of the difficulties enumerated above, the number of individual patients treated, and the items of conservative work completed has been equal to that of the previous year. Herewith is a summary of the work done during the years 1944-1949 inclusive:— 1944 1945 1946 1947 1948 1949 Before After July 5 July 5 Number of patients treated 143 379 585 805 419 365 783 Appointments made 633 2234 3719 5614 3422 4099 6256 Appointments kept 558 2143 3315 5181 3025 3833 5850 Fillings 135 1005 786 1065 776 1053 1854 Scalings 67 147 206 314 172 247 331 Dressings 71 228 207 451 228 302 812 Extractions 266 1068 1570 2075 1117 1111 1479 General Anaesthetics 58 238 446 530 269 317 617 Local Anaesthetics 54 112 182 278 186 268 413 Impressions 33 223 371 863 547 553 866 Bites 24 97 162 326 180 200 291 Try-ins 2.3 106 193 392 215 259 438 Dentures supplied 26 134 238 469 241 365 471 60 In addition to the above, 1,010 other items of treatment were given. These comprise easings of dentures, the taking of X-rays, fitting repairs, etc. Dental Laboratory Below is appended a list of the appliances completed in the dental laboratory during 1948 and 1949:— Municipal Dental Service General Dental Service 1.1.48 5.7.48 1949 4.7.48 31.12.48 New Dentures 275 380 486 Orthodontic Appliances — 2 1 Crowns 9 7 12 Repairs 75 104 205 Inlays — 2 3 During the past year considerable structural alterations and the installation of equipment has transformed what was hitherto a workshop into a modern dental laboratory capable of satisfying the requirements of modern prosthetic and orthodontic technique. The laboratory continues to serve both the priority, school and general service and the present trend is to an increased service to the priority and school services at the expense of the general service. In addition to the work for the above services in Walthamstow, special orthodontic appliances are now being supplied to the Leyton School Dental Service. The technical staff remains as in the previous year in spite of the attraction of greatly enhanced salaries offered elsewhere. It, however, seems certain that the continued retention of staff will be dependent upon a satisfactory implementation of the Whitley Council agreement. Propaganda The Central Council for Health Education early in 1949 issued new editions of several booklets to help parents in answering first questions about reproduction. Copies were obtained for trial distribution. An exhibition stand entitled "Sleep" was obtained on loan. Diphtheria and Whooping Cough immunisation and vaccination propaganda was carried out as a routine throughout the year. The parents of every new-born child were sent a birthday letter enclosing suitable pamphlets, and reminders were sent at the appropriate ages. The results obtained are referred to in Section 26. In December, 1949, arrangements were made with the Central Office of Information with regard to the showing of the film: "Another Case of Food Poisoning at all local cinemas. 61 CARE OF MOTHERS AND YOUNG CHILDREN (Section 22) 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 1285* 886 Low Hall Lane Clinic 317 53 Silverdale Road Clinic 23 2 Totals 1625 941 Total Attendances— Thorpe Coombe Maternity Hospital 10813 1284 Low Hall Lane Clinic 854 70 Silverdale Road Clinic 60 2 Totals 11727 1356 * Includes 145 patients from other areas. The percentage of Ante-Natal cases to notified births was 78.3. Rhesus tests were taken at all clinics. CONFINEMENTS The following table shows the location of confinements during 1949:— Thorpe Coombe Maternity Hospital 1240 Other Hospitals and Maternity Homes 366 Total in Hospital 1606 District 446 Total confinements 2052 62 A total of 255 Walthamstow patients were unable to book accommodation at Thorpe Coombe. If they were unable to make their own alternative arrangements, bookings at other Maternity Hospitals were made for them through Thorpe Coombe. The grounds for admission are:— (1) First confinements. (2) Medical and obstetrical. (3) Unsuitable home/social conditions. VITAL STATISTICS These are given in Section A of this Report. The birth rate was below that for England and Wales. The infant mortality rate was 29 against 32 for England and Wales, and the stillbirth rate only 0.22 per 1,000 populations as against 0.39. This is a new low record. The neo-natal mortality rate was 16.9 per 1,000 live births. NOTIFICATION OF BIRTHS 2,074 births (180 of which belonged to other areas) were notified during the year under the Public Health Act, 1936. Notifications were received as follows:—Doctors, 272; Midwives, 1,802. Included in the above are 293 births which were notified as having occurred outside the area. Also included are 31 stillbirths, four of which belonged to other areas. Of the total, three occurred outside the area. STILLBIRTHS Stillbirths were reduced to 27, yielding a rate per 1,000 population of 0.22. NEO NATAL MORTALITY The neo-natal mortality is the number of infants dying under one month per 1,000 live births. During 1949, 31 infants died in the first four weeks of life, yielding a rate of 16.9. INFANT MORTALITY The deaths of infants under one year were:— Males. Females. Totals. Legitimate 31 20 51 Illegitimate 2 1 3 Totals 33 21 54 63 The death rate of infants under one year of age per 1,000 live births when calculated on the totals given by the Registrar- General are therefore:— Legitimate, 28; Illegitimate, 46; Total, 29. The Infant Mortality Rate for other areas during 1949 was as follows:— England and Wales 32 126 County Boroughs and Great Towns (including London) 37 148 Smaller Towns (25,000—50,000 population) 30 London 29 CARE OF PREMATURE INFANTS The action suggested in Circular 20/44 (as amended by Circular LHAL 1/49) has been carried out as far as possible and the steps taken were detailed in the Report for 1944. During 1949, 79 premature infants were born to residents of the area, 16 at home and 63 in Hospitals or Nursing Homes. One premature infant was born in a private nursing home in the area, and was transferred to Hospital. Of the 16 born at home, 9 were transferred to Hospital. The remaining seven, who were nursed entirely at home, survived at the end of one month. The table "Causes of Death of Infants" which follows, Includes 12 deaths from premature birth as compared with four in 1948. 64 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 - - - - - - - - - - - - - - - - - Whooping Cough - - - - - 1 - - - 1 1 - - - - - 1 Diphtheria - - - - - - - - - - - - - - - - - Phthisis - - - - - - - - - - - - - - - - - Other forms of T.B. - - - - - - - - - - - - - - - - - T.B. Meningitis - - - - - - - - - - - - - - - - - Meningitis (Non-T.B.) - - - - - 1 - - - 1 1 - — - — — 1 Convulsions - - - - - - - - - - - - - - - - - Bronchitis - - — 1 1 — 3 - 1 5 — 1 1 - 1 2 5 Pneumonia - - 1 - 1 3 1 1 2 8 1 2 1 1 1 2 8 Diarrhoea, - - — - — 1 — - 1 2 1 — - - — 1 2 Syphilis - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - Inattention at birth, wilful neglect - - - - - - - - - - - - - - - - - Suffocation (overlaying) - - - - - - 1 - - 1 - - - 1 - - 1 Injury at birth 2 - — - 2 — — - — 2 — — — - 2 — 2 Atelectasis 7 1 — - 8 — — - — 8 1 1 2 1 1 2 8 Congenital malformation 5 - 1 - 6 4 — 1 — 11 1 2 1 2 4 1 11 Premature birth 12 - — - 12 — — - — 12 — — — 4 5 3 12 Atrophy, debility, marasmus - - - - - 1 - - - 1 - - - - - - 1 Inanition - - - - - - - - - - - - - - - - - Heart failure - - - - - - - - - - - - - - - - - Other causes - - — 1 1 — 1 - — 2 — — 1 — — 1 2 Totals 26 1 2 2 31 11 6 2 4 54 6 6 6 9 14 13 54 65 EVALUATION OF CHILD HEALTH SERVICES In his report as Chief Medical Officer to the Ministry of Health for the year 1947, Sir Wilson Jameson referred to a survey undertaken in Barnsley in 1945 and based on the investigation and assessment of individual infant deaths, to determine how often a deficiency in certain services or other specified factors had contributed to an infant death. This method was applied to infant deaths occurring in Walthamstow during 1948 and 1949, and arrangements were put in hand in September, 1949, to try and assess the factors resulting in infant deaths. 1950 will therefore be the first year affording the fuller information. Dr. Melville Watkins has undertaken the analysis for 1948/49 and makes the following observations:— "It is suggested that infant deaths under one year should be classified as inevitable, unavoidable, preventable and unclassified. " The following is the classification of infant deaths for the past two years:— 19 4 8 Inevitable Unavoidable Preventable Not Classifiable Total No 6 16 19 2 43 Percentage 14 37 44 5 100 "Of the apparently 'preventable' deaths, 7 were due to infectious disease, 6 to respiratory disease, and 3 to enteritis. " Twenty-four deaths took place in the first month of life, and 19 in the remainder of the first year. 19 4 9 Inevitable Unavoidable Preventable Not Classifiable Total No. 10 25 19 — 54 Percentage 18.5 46.3 35.2 — 100 Infant Mortality by Ages Neo-natal 31 3 months—6 months 6 4 weeks—3 months 11 6 months—12 months 6 "It will be seen that more than half the deaths occur during the first month of life and the greatest risk to infant life occurs within the first three months. 66 "The causes of death were as follows:— Prematurity 14 Birth Injury 2 Congenital Malforma- Haemolytic Disease 2 Congenital Malforma Whooping Cough 1 tion 10 Meningitis 1 Asphyxia, Atelectasis 6 Others 4 Enteritis 2 "In the light of present knowledge it is unlikely that a decline in the rate of inevitable deaths will occur. Of the unavoidable deaths, most were due to Prematurity, Asphyxia and Atelectasis. There is an increasing awareness of the problem of prematurity and it is hoped that with increasing facilities for the care of the premature infant we shall see a decline in their mortality figures. This group accounts for the greatest number of neo-natal deaths. "Respiratory disease is the most frequent cause of deaths classified as inevitable. "Infectious diseases, except in two cases, did not play an important part in causation in this series, but Whooping Cough and Measles, on account of their respiratory complications, may be expected to be a far more important factor in an epidemic year. Clearly the causation under 'Inevitable' is infection, and they account for most of the deaths later in the baby's first year of life. Increased vigilance and care over environmental conditions and better education of the mother in the care and management of the infant may well produce satisfactory results." CARE OF ILLEGITIMATE CHILDREN The action taken under Circular 2866/1944 is fully set out in the Report for that year. The Walthamstow Moral Welfare Association provides a hostel of 19 beds staffed by three whole-time workers. The chief difficulties in 1949 were again to secure accommodation for confinements and suitable foster mothers. 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. 67 Illegitimate Births and Mortality Year. Live Births. Infant Deaths. Death Rates per 1,000 live births Legitimate. Illegitimate. Legitimate. Illegitimate. Legitimate. Illegitimate. 1938 1,572 42 63 3 40.0 69.0 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 1949 1,771 65 51 3 28.0 46.0 Totals 1938 to 1949 (12ys) 21,591 800 728 36 33.0 45.0 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 that they would be higher if more foster mothers and vacancies at Day Nurseries could have been obtained. As a result the stay of the mothers was longer and cases had to be refused. The larger number of cases helped from other areas is equalised by Walthamstow cases requesting help but naturally anxious to be cared for away from their homes. Cases admitted during 1949— Adults—Walthamstow cases 20 From other areas 81 101 Babies—Walthamstow cases 20 From other areas 48 68 Total admissions 169 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. (In addition, a large proportion of the ante-natal work is done at Thorpe Coombe Maternity Hospital). 68 (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. Tuesday „ The Welfare Centre, West Avenue, E.17. 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. Friday „ St. John's Church Hall, Penrhyn Avenue, E.17. In addition, the Walthamstow Child Welfare Society holds massage and sunlight sessions. A new child welfare clinic was opened on the 14th September, 1949, at the former Relief Offices at West Avenue. The premises, consisting of a large hall with small rooms opening from it, provide good facilities and very soon became well attended. An additional welfare session was begun on the 1st April, 1949, at the Penrhyn Avenue Clinic. Summary of Attendances at Welfare Clinics Clinic. First Attendances of New Cases. Re-attendances. Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Markhouse Road 486 81 567 8,036 8,580 16,616 17,183 Penrhyn Avenue 382 61 443 6,139 5,826 11,965 12,408 West Avenue 77 47 124 391 184 575 699 Winchester Road 242 33 275 4,205 4,459 8,664 8,939 Silverdale Road 89 71 160 1,444 1,806 3,250 3,410 Total 1949 1,276 293 1,569 20,215 20,855 41,070 42,639 Walthamstow Child Welfare Society Clinics are held as follows at "Brookscroft," Forest Road:— 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. Alternate Fridays Diphtheria Immunisation. 69 The work done during the calendar year is shown in the following table compiled from information kindly supplied by Miss D. Carter:— First Attendances of New Cases. Re-attendances. Grand Total. Under 1 yr 1-5 yrs. Total. Under 1 yr. 1-5 yrs. Total. 1949 488 64 552 8,855 2,622 11,477 12,029 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 A total of 108 children were immunised during the year at "Brookscroft." Summary of Attendances at all Welfare 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 1,276 293 1,569 20,215 20,855 41,070 42,639 Brookscroft 488 64 552 8,855 2,622 11,477 12,029 Total 1949 1,764 357 2,121 29,070 23,477 52,547 54,668 TREATMENT (a) Orthopædic.—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 6 Torticollis 17 Scoliosis, Lordosis, Kyphosis 7 Cerebellar Ataxia 1 Rickets—(a) Genu Varum 24 Spina Bifida 1 (b) Genu Valgum 55 Achondroplasia 1 Pes Piano Valgus 65 Digitus Varus 2 Spastic Paralysis 4 Congenital Defects 13 Progressive Muscular Miscellaneous 6 Atrophy 1 Talipes— (a) Equino Varus 7 (b) Calcaneo Valgus 24 Total 235 (c) Pes Cavus 1 70 (b) Sunlight.—482 ultra-violet light treatments were given during the year. (c) Dental.—Mr. L. W. Elmer, L.D.S., Senior Dental Surgeon, reports as follows:— "The scheme for the dental treatment of expectant and nursing mothers suffers from the same disadvantage as in the past. This, as ever, is the difficulty of persuading these patients to receive a prolonged and trying course of treatment made necessary by years of neglect. "The problem has indeed been aggravated by the increased difficulty of obtaining regular dental treatment by those who desire it. "It has always seemed to me somewhat absurd to provide regular dental treatment for females up to school-leaving age, to give them no encouragement to continue this until they become expectant mothers, and then expect them to have, at a difficult period, the concentrated treatment which should have been unnecessary. "The disadvantages are so obvious. Either many visits for conservative work are required or, worse still, multiple extractions. Either course involves mental and physical disturbance, the second involving an edentulous period at the very time when it is essential to avoid digestive disturbances. "Regular treatment for the adolescent and young woman appears to me to be the most sensible approach. "In the case of Walthamstow this problem has been met to a limited extent by the provision of treatment through the General Dental Service at the Dental Health Centre. It is satisfactory to examine the mouths of expectant mothers who have been regularly treated since childhood and to find little or nothing needing to be done. "Where the pre-school children are concerned, the position is far more satisfactory. The number attending has increased and a proportion are brought regularly to the clinic for examinations. "It was found that an average of less than one tooth per child needed an extraction whilst an average of two teeth per child was restored by filling or other method. "Treated kindly and tactfully, these little children make very good patients, and the dental surgeon who has been responsible for this important section of the scheme is to be congratulated." 71 The following gives details of the work done during the year by the Dental Surgeons:— Expectant mothers Children under 5 Number examined 111 254 Number needing treatment 111 234 Number treated 111 234 Extractions 74 221 Anaesthetics—Local — — General 34 135 Fillings 139 261 Scalings and Gum Treatment 24 3 Silver Nitrate Treatment — 189 Dressings 32 59 Dentures provided—Complete 18 — Partial — — Number made dentally fit 18 161 (d) Tonsils and Adenoids.—Children are treated at various hospitals. (e) Ophthalmic Defects and Minor Ailments.—Children are given treatment either at the School Clinics or by special appointment. (f) Child Guidance.—Arrangements exist for children under five years of age to be referred to the Education Authority's Child Guidance Centre. (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 32 School Medical Services 7 Welfare Centres 3 Voluntary agencies 2 Parents 4 48 72 Classification of cases:— Anaemia, debility, malnutrition 5 After-effects of illness 12 Bronchitis and pneumonia 9 Heart 1 Diseases of the ear, nose and throat 5 Various 7 Visits, advice, follow-up after illness 9 48 Help given to old and new cases:— Sent to convalescent homes and nurseries 20 Transferred to other agencies 6 Visits, advice, follow-up after illness 41 67 During 1949 a total of 13 children were sent away on medical recommendation to convalescent homes. The arrangements were, as in previous years, made through the local branch of the Invalid Children's Aid Association. PROVISION OF NUTRIENTS AND MEDICAMENTS The quantity and value of nutrients and medicaments sold and issued free during 1949 was as follows:— Sales Free Issue lbs. ozs. lbs. ozs. Cow and Gate 4,310 — 50 — Ostermilk 1,570 — 136 — Ambrosia 724 — — — Trufood 640 — — — Lactogen 2,459 — 10 — Prune and Banana Syrup — — 162 6 Parrish's Food — — 280 8 Cod Liver Oil and Malt 527 — — — Cod Liver Oil Emulsion 168 — — — Magnesia — — 536 8 Virol 1,350 — — — H.O.E. Drops 2 4½ — ½ Virolax — - 100 12 Roboleine 489 - 1 — Farex 1,016 14 — — Ovaltine 991 8 — — Marmite 1,370 8 2 — Glucose 91 8 — — Maltoline 455 4 — 8 Adexoline 19 6¼ — — Midlothian Oat Food 601 - — — Bemax 133 2 — — Robinson's Groats 684 — — — Calfos Tablets — — 167 pkts. Cod Liver Oil 1 8 — — Value of Cash Sales £2,283 14s. Od. 73 VITAMINS The facilities for the distribution of vitamins were continued at all Welfare Centres. Every effort is made to increase the demand. DAY NURSERIES The following table shows the average attendances at the Nurseries during 1949 (Mondays to Fridays only). Month. Nurseries. Under 2 yrs. Over 2 yrs. Total. January Higham Hill 10.5 41.9 52.4 Handsworth Ave. 10.1 47.1 57.2 February Higham Hill 11.0 43.5 54.5 Handsworth Ave. 8.7 41.7 50.4 March Higham Hill 8.8 46.5 55.3 Handsworth Ave. 7.8 25.3 33.1 April Higham Hill 8.4 50.3 58.7 Handsworth Ave. 8.1 35.9 44.0 May Higham Hill 4.5 43.2 47.7 Handsworth Ave. 12.3 41.6 53.9 June Higham Hill 8.5 38.0 46.5 Handsworth Ave. 11.3 44.5 55.8 July Higham Hill 8.3 40.6 48.9 Handsworth Ave. 10.2 43.5 53.7 August Higham Hill 6.9 44.0 50.9 Handsworth Ave. 9.2 39.7 48.9 September Higham Hill 10.0 38.8 48.8 Handsworth Ave. 8.8 40.6 49.4 October Higham Hill 11.2 36.7 47.9 Handsworth Ave. 7.9 35.0 42.9 November Higham Hill 10.3 37.2 47.5 Handsworth Ave. 8.3 40.6 48.9 December Higham Hill 9.7 36.5 46.2 Handsworth Ave. 10.0 39.0 49.0 Average Whole Year Higham Hill 9.0 41.4 50.4 Handsworth Ave. 9.4 39.5 48.9 At present a further Day Nursery is projected at the Hurst Road Site. An inspection of both Day Nurseries was carried out by officers of the Ministry of Health and Education for the purpose of examining the arrangements for the training of nursery students for the certificate of the National Nursery Examination Board. As a result, both Nurseries were approved for the continuation of training in the care of children aged 0-5 years. 74 Recommendations were made that additional toys and play material should be provided to satisfy a new list of basic play material which had not previously been received. It was also suggested that more blankets should be provided to enable children to sleep out of doors throughout the year. Finally, that since the usual 20 per cent. additional names on the Register produced an average attendance in excess of the permitted number, this percentage should be reduced so as to bring the number in each group within the capacity of the nursery. All these suggestions were given effect to as soon as possible. Training.—Ten students obtained the Nursery Nurses' Certificate during the year. NURSERIES AND CHILD MINDERS (REGULATION) ACT, 1948 There were no registrations during 1949. INFESTATION The steps taken to combat infestation include cleanliness inspections, treatment at Clinics (which includes the supply of Lethane and of steel combs at cost price) and inspection and treatment for pediculosis at the Skin Clinic. OPHTHALMIA NEONATORUM AND PUERPERAL PYREXIA These are referred to in Section F of the Report. MATERNAL MORTALITY This matter is referred to in Section A of the Report. MIDWIFERY (Section 23) No. of Notifications of Intention to Practice, January, 1949 35 No. of Notifications of Intention to Practice during 1949 9 Total 44 No. of Midwives ceasing to practise during 1949 10 ,, „ practising at the end of 1949 34 75 Medical supervision has been carried out by Dr. M. Sheppard and non medical supervisions 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 1949:— No. of confinements attended as a Midwife1,507 „ „ „ „ „ Maternity Nurse 259 „ Medical Aid Notices sent 621 „ Notifications of Death - „ Twin-births notified 21 „ Stillbirths notified 4 „ Notifications of Liability to be a source of infection 2 „ Notifications of Laying-out a Dead Body — „ Notifications of Artificial Feeding 3 „ Notifications of Disinfection 2 The previous table includes the following numbers in regard to work done at Thorpe Coombe Maternity Hospital:— Midwifery cases 1,121 Maternity cases119 Medical Aid Notices 498 The percentage of Medical Aid Notices were:— All cases 35.1 Maternity Hospital Midwives40.1 Other midwives 23.4 The conditions for which Medical Aid was summoned by Midwives in domiciliary practice and private nursing homes have been summarised and are as follows:— For complications during pregnancy:— Miscarriage 2 Albuminuria 1 Antepartum haemorrhage 8 Abortion 1 Other conditions 6 Total 18 76 For complications during labour: — Prolonged first and second stage 18 Ruptured perineum 41 Premature labour 1 Rise of temperature 2 Postpartum hæmorrhage 5 Uterine inertia 5 Retained placenta 5 Abnormal presentation 3 Other conditions 7 Total 87 For complications in regard to the infant: — Asphyxia 1 Jaundice 4 Inflamed eyes 2 Prematurity and feebleness 4 Cyanosis 1 Other conditions 6 Total 18 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. 1,718 2,209 18 323 87 7,868 12,223 Three midwives in private practice undertook 63 cases as midwives and 15 cases as maternity nurses. Gas and Air Analgesia.—The Ambulance Service provided transport facilities for gas and air apparatus. A total of 197 patients on the District received gas and air analgesia, representing a percentage of 48. 77 Post-Graduate Lectures to Midwives.—A lecture was given by Miss Helen Rodway, F.R.C.O.G., at Thorpe Coombe Maternity Hospital on " The Use of Drugs in Midwifery Practice." Midwives acting as Maternity Nurses.—During the year the number of maternity cases (i.e., where responsibility for the case is taken by the doctor) increased to 87 or 21 per cent. of the total. This percentage has been increasing steadily since the "appointed day." In 1947 it was 11%, in the period 1st January 1948 to the appointed day, 11%, from the appointed day to the end of 1948, 18%, and during 1949, 21%. Emergency Unit.—This Unit, stationed at Thorpe Coombe Maternity Hospital, was not called out to any Walthamstow case during 1949. Maternity Outfits.—A total of 278 outfits was issued. Training of Pupil Midwives.—Thorpe Coombe Maternity Hospital is a training school for both Parts I and II, the latter in association with the "district." A total of 37 pupils received Part II training during 1949. HEALTH VISITING (Section 24) Health Visiting Staff.—The equivalent of whole-time Health Visitors at the end of the year was 9½, equal to one whole-time Health Visitor per 199 notified births, and one whole-time Health Visitor per 196 registered births during 1949. Most of the Health Visitors also carry out duties as School Nurses. The Walthamstow Child Welfare Society (which normally employed one whole-time Health Visitor) experienced considerable difficulty in filling a vacancy. Home Visits To Children under 1 year of age. To Children 1-5 years of age. Total. First. Subsequent. Total. Local Authority Walthamstow Child 1,854 4,580 6,434 8,208 14,642 Welfare Society 372 339 711 245 956 Total 1949 2,226 4,919 7,145 8,453 15,598 1948 2,361 5,712 8,073 9,287 17,360 The detailed findings at first visits paid by Local Authority Health Visitors are shown in the table on the following page.  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 202 47 15 — 264 195 69 — 66 28 73 50 35 12 High Street 174 30 14 — 218 205 13 — 64 120 — 10 22 2 Hoe Street 236 25 31 — 292 262 30 — 57 77 62 47 41 8 Wood Street 219 14 32 — 265 254 11 — 75 65 32 11 19 63 Hale End 319 20 31 1 369 359 10 1 223 61 45 24 15 2 Higham Hill 398 33 14 — 445 424 19 2 217 104 23 38 55 8 Total 1949 1948 1,548 169 137 1 1,853 1,699 152 3 702 455 235 180 187 95 1,647 213 199 10 2,049 1,877 168 14 810 504 308 171 174 92 78 From the above table it will be seen that of 1,854 children, 1,548, or 83.5 per cent., were breast-fed on first being visited, and only one baby had no separate sleeping accommodation. 462 infants lived in accommodation of three rooms or less, as compared with 437 in 1948. The following table shows the number and nature of visits paid in 1949:— Ward. Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. | Unsuccessful Visits. Visits to Nurse Children. Ante-Natal Visits. Total Visits. First. Subsequent visits. Total. First Visits. Subsequent Visits. Total Visits. Other Visits. 1 2 3 4 5 6 7 — — 8 9 Cols. 5-9. St. James St 264 572 836 1,339 2,175 544 — 92 51 143 380 3,242 High Street 218 656 874 1,077 1,951 271 — 31 27 58 180 2,460 Hoe Street 292 743 1,035 1,204 2,239 415 — 22 7 29 347 3,030 Wood Street 265 283 548 431 979 157 — 49 4 53 257 1,446 Hale End 370 1,397 1,767 1,976 3,743 383 — 111 36 147 387 4,660 Higham Hill 445 929 1,374 2,181 3,55.5 209 — 63 46 109 255 4,128 Totals, 1949 1,854 4,580 6,434 8,208 14,642 1,979 — 368 171 539 1,806 18,966 Totals, 1948 2,059 5,025 7,084 8,477 15,561 2,176 120 331 136 467 1,179 19,503 79 80 HOME NURSING (Section 25) The Superintendent of the District Nurses' Home, Miss C. A. Lee, S.R.N., S.C.M., reports as follows:— "The year 1949 has been a busy but uneventful one. Work on the general side has been kept up to standard both in quality and quantity. Midwifery work has declined considerably. "The Home is in urgent need of re-decoration. This would have been undertaken by the Voluntary Committee if a permit to do so could have been obtained in time before the appointed day. "There is also urgent need for further accommodation, preferably by providing a Home at Highams Park. A second car is also greatly needed. "From the 3rd December, 1948 to the 8th December, 1949, twenty-one pupils entered for their District Midwifery Training. "Staff at the 31st December, 1949, was as follows:— 2 Midwives. 1 Queen's Nurse/Midwife. 2 Full-time S.R.N., S.C.M. 2 Full-time S.R.N. 1 Part-time Male Nurse. 1 Part-time S.R.N., S.C.M. 1 Part-time S.R.N. 1 Part-time S.E.A.N. 4 Pupil Midwives. "Midwifery and Maternity Nursing undertaken during the year was as follows:— Doctors' cases 64 Midwives' cases 123 Total 187 Gas and Air administered 39 Maternity Outfits supplied 202 81 "The following gives details of Home Visits during the year. New Total cases visits Medical 791 29268 Surgical 377 8052 Tuberculosis 20 807 Out-patients—(a) Medical 49 165 (b) Surgical 191 646 Operations 35 71 Specials 55 101 Casuals 43 88 Totals 1,561 39198 VACCINATION AND IMMUNISATION (Section 26) DIPHTHERIA IMMUNISATION Immunisation was carried out at the weekly clinic held at the Town Hall, at Schools and at all Welfare Centres, on the lines detailed in previous reports. The following summarises the work done:— Total number of immunisations completed during 1949 :— (a) School age 304 (b) Pre-school age 1,648 (c) Over school age 1 Total 1,953 (d) Number already immunised having a reinforcing dose 1,628 The above total includes 108 children immunised at "Brookscroft "and 432 by private practitioners. No. of posterior Schick tests (a) Negative 13 (b) Positive — No. of Clinics held for immunisation at Town Hall 51 No. of attendances made for diphtheria immunisation 1,758 Average attendance per session 34.4 Immunisation at Schools (included above):— No. completely immunised 213 No. partly immunised 50 No. having a booster dose, i.e., immunised in previous years 1,459 81 During the past five years the percentages immunised in the various age groups were as follows:— Under 5 years Percentage Immunised 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 1949 62.5 96.2 82.1 During 1949, out of 20 patients admitted to hospital for suspected Diphtheria, none were confirmed as such. This very favourable result was largely due to immunisation and to the fact that over 60 per cent. of children under the age of five years, and over 95 per cent. of children between five 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. This has recently been emphasised by Report No. 272 issued by the Medical Research Council, which states:— "It is of the utmost importance for parents to realise that active immunisation in the first year of life, and reinforcing doses of prophylactic in later years, are just as necessary in the absence of diphtheria epidemics as in their presence. Unless the proportion of the immunised population is kept up to the 75 per cent, level, protection against epidemic diphtheria cannot be reasonably assured. VACCINATION The number of persons vaccinated during 1949 was as follows:— Age at list Dec., 1949 Under 1 1 to 4 5 to 14 15 or over i.e. born in years 1945 to 1935 to Before 1949 1948 1944 1935 Total Number vaccinated 317 18 14 20 369 Number re-vaccinated 5 4 7 84 100 The number of persons vaccinated during recent periods was as follows:— 1948 to July 4th, 1948 433 From July 5th, 1948 145 Total, 1948 578 1949 369 83 This table clearly shows a decrease in vaccination following the repeal of compulsory vaccination by the National Health Service Act of 1946. Vaccination and Re-vaccination of Public Health Staffs The Chief Medical Officer of the Ministry of Health in his Report for 1948, stated that there was a salutary lesson to be learned from the fact that in the two outbreaks of 1947, 6 persons belonging to Public Health staffs, etc., contracted Smallpox because none were protected by recent vaccination and in some instances there was delay in re-vaccination after exposure. The Report went on to state that it is the responsibility of Medical Officers of Health to provide the facilities and the opportunity to Public Health staffs to maintain their immunity at the highest possible level, that the vaccinal state of such staff should be reviewed annually, and that such staff should be re-vaccinated at yearly intervals. The staff of the Department who would be expected to deal with cases of Smallpox, were invited to state their vaccinal condition and facilities were offered for vaccination or re-vaccination. The position will be reviewed each year and in the current year, facilities for vaccination or re-vaccination are being offered to the whole of the staff of the Health Department. WHOOPING COUGH IMMUNISATION Immunisation was first begun in Walthamstow on a trial basis in the autumn of 1942 and at the first of the war-time day nurseries. The trials were made in conjunction with Dr. Maclean of St. Mary's Hospital, who supplied the vaccine. During 1942, 56 children were immunised. There was a limited amount of "follow up" and as far as is known, none of the children contracted whooping cough. Later, immunisation was extended to other war-time day nurseries as they were opened, but ceased as supplies of vaccine became difficult to obtain. In October, 1947, immunisation was re-commenced with a commercial vaccine, and has continued since—again with no recorded case of whooping cough in an immunised child. During 1947, 58 children were immunised, and 99 during 1948. In March, 1949, trials were commenced in conjunction with the Medical Research Council, and parallel with the publicity given through this scheme, the acceptances for immunisation in older children, i.e., above the age of 18 months, became very much increased. 84 The return of immunisation done during the year 1949 is as follows:— Age at date of Final Injection Under 1 year 1—4 years 5—14 years Total M.R.C. Scheme 453 285 — 738 Local Authority Scheme 86 422 18 526 TOTALS 539 707 18 1,264 The grand total of children immunised against whooping cough to date is 1,421. AMBULANCE FACILITIES (Section 27) The Ambulance Service is administered centrally from Chelmsford and (as far as information is available) it appears to be adequate. The Local Service has continued from the Ambulance Depot, which is situated at the Borough Council's Fulbourne Road Depot. PREVENTION OF ILLNESS —CARE AND AFTER-CARE (Section 28) TUBERCULOSIS The prevention of tuberculosis must be regarded as one of the most urgent problems of preventive medicine. The principal preventive measures available have recently been stated as follows : (a) The close supervision of notifications with contact and follow-up examinations. (b) Mass Radiography Surveys. (c) B.C.G. Vaccination. (d) Assisted Housing Schemes and provision of special hostels. (e) Employment schemes and liaison between Chest Physician and Local Office of the Ministry of Labour and the Employer. 85 (f) Health education and propaganda. In Walthamstow it can be claimed that the closest co-operation exists in regard to all these measures and has continued with the Chest Dispensary. All possible help has been received from the Chest Physician, Dr. Ramsay, and his assistant colleague, Dr. Fearn. Reference was made in the 1948 report to the priority given to the rehousing of the tuberculous and to Dr. Ramsay's "work clinics" in co-operation with the Resettlement Officer. Dr. Ramsay has kindly contributed the following observations:— "The work of the Chest Clinic has continued on much the same lines, though there have, of course, been changes in administration under the Health Act. The Regional Hospital Board and local Hospital Management Committee are now in control of the clinical side of the work, while the Local Health Authority has to deal with prevention, care and after-care. This means that the staff team is now divided between the three authorities. It is still necessary, however, for the work to be centred on the clinic, and this is achieved by a close liaison with the Borough Health Department and the maintenance of the status quo as regards all members of the staff continuing to work at the clinic. If any separation had been attempted, many difficulties would have arisen and the agreed arrangement can be regarded as satisfactory. "One of the most important fields for co-operation with the Health Department is in rehousing. There are certain criteria, agreed with the Housing Department, on which priority may be given on health grounds. In practice there is of course the usual limitation on what can be done, as the result of the continuing shortage of accommodation. Nevertheless, a useful contribution has been made by the rehousing of cases in particularly bad home conditions. "The full implications of recent legislation as regards the tuberculosis service are not yet clear. There is a danger that it might break up into two separate compartments and suffer thereby. This can be avoided if, as in this area, there is a mutual understanding and full co-operation between the clinic and the local Health Department." Miss A. Woolgar, Secretary of the Walthamstow Association of Tuberculosis Care Helpers, contributes the following report on the work of the Association :— "The work of the Association has continued smoothly throughout the year. Contrary to general expectations, there has been no decrease in the number of applications, for assistance in spite of the help now available through the Social Insurance schemes. 86 "The supply of clothing to patients in sanatoria, which for a time became quite a problem, should in the future be considerably easier. Since the ruling by the Minister of Health that the supply of clothing to in-patients should be the responsibility of the hospital authorities, arrangements have been made with the Secretaries of the hospitals concerned for cases to be referred to them by the Secretary of the Association. "Other forms of assistance have been continued as previously and in view of the demand for such items, two bedrests and three air-cushions were purchased and are retained at the clinic for the use of patients confined to bed at home. "The following details give some indication of the number of Walthamstow cases dealt with in 1949, but many others requiring help were put in touch with organisations more suited to their particular needs. No. of cases assisted with milk 56 „ assisted with grocery 14 „ assisted with fares to visit patients in hospital 3 „ assisted with convalescent holidays 2 „ provided with bedding 6 „ provided with clothing 4 „ loaned sick-room equipment 8 REHABILITATION OF TUBERCULOSIS PATIENTS During the year the Area Sub-Committee accepted financial responsibility in approved cases for patients undergoing rehabilitation at Papworth and Preston Hall Settlements. There were three cases at Papworth and one at Preston Hall. No charge is made to the patient. CONVALESCENCE FOR ADULTS The total of cases sent away for recuperative convalescence was 32. The length of convalescence was 2 weeks in 16 cases, 3 weeks in 12, and 4 weeks in 4 cases. Recovery of cost or partcost is made. SICK-ROOM EQUIPMENT Apart from stores of equipment which are only available to certain sections of the community, there are two main depots for sick-room equipment, one at the District Nurses' Home in Cansbrooke Road, and the other at the British Red Cross Society Headquarters in Forest Road. No shortage of equipment became apparent during 1949. 87 CHIROPODY SERVICES The Foot Clinic, originally established by the Borough Council, continued as in previous years with four whole-time chiropodists. Daily morning sessions were held, with afternoon sessions on Monday and Wednesdays and evening sessions on Mondays, Wednesdays and Thursdays. Treatment was by appointment and unfortunately, there is always a long waiting list. Total attendances in 1949 were 13,868, including 1,730 by new patients. MEALS-ON-WHEELS SERVICE This Service is administered and subsidised by the Borough Council, and Mr. T. A. O'Connor, Catering Manager, states that 8,112 meals were served during 1949. DOMESTIC HELP SERVICE (Section 29) This continues to be administered on the lines adopted in previous years, but with a considerable expansion. During the year the Clerk in charge was designated as Domestic Help Organiser and an assistant was appointed. The aim has been to staff the Service by a nucleus of wholetime helpers assisted by the required number of part-time helpers. At the end of the year 4 whole-time helpers and 125 part-time helpers were employed. The precautions adopted in the case of helpers employed in tuberculous households included X-ray examination and advice as to the precautions to be followed. The practice was continued of requiring a medical certificate in support of all applications and of renewals after three months. The Local Medical Practitioners were particularly helpful in providing such certificates without fees and there is no question that the practice helps to minimise abuse. The Domestic Help Organiser, Mrs. C. M. Hall, has contributed the following report :— Review of Service for the year 1949 "Since 1948 the Domestic Help Service has become a well-established section of the Health Service and during 1949 met a very serious need in the Borough. 88 "It is now widely known that domestic help can be obtained by sick or infirm persons, provided a medical certificate is supplied by the applicant and that the need is genuine. The same help is extended to mothers confined at home, or where the mother has to be removed to hospital and there are young children to be cared for. The service has brought great relief to many physically incapable people, and eased the mental strain which so often arises when sickness disorganises household affairs. "Below is a summary of the year's work:— DOMESTIC HELP Brought forward from 1948 38 New cases during 1949 268 Cases completed in 1949 136 No. of cases carried forward to 1950 170 No. of cases extending over three months 187 Analysis : Acute Chronic Old People T.B. Others Total (not sick) 66 173 24 24 19 306 HOME HELP No. of cases completed in 1949 109 "Needless to say, this Service has its own peculiar problems. It is not always possible to provide all the help that is desirable immediately it is required. Consideration must be given to a number of factors, including availability of Helps, urgent cases taking priority. Where there are relatives in a position to help they are expected to do so, as the total amount of help provided during the year must be kept within the financial limit. Nevertheless, despite some drawbacks, the Service is now well and truly flourishing. Many lonely people welcome the Domestic Help, not only because she brings order to chaos, but because of the cheerful atmosphere she creates as she hurries from task to task, departing with a cheery : "See you on so-and-so day." Almost without exception the Help holds a definite place in the household's affection, and many grateful patients write to express their appreciation when the help is no longer necessary. "In September, 1949, three full-time and two part-time Helps took a week's course and examination arranged by the National Institute of Houseworkers. All five candidates were successful in obtaining the Institute's diploma and badge. 89 "The Helps themselves are gratified to know they bring a great measure of comfort to the sick, and are happy in a worthwhile job. Their standard of work is high and during the last few years their status has soared in public and professional opinion. "From the organiser's point of view there are, of course, snags, but certainly none which cannot be overcome in time. It has been pointed out on more than one occasion how disappointing it is to both patient and Help that the Organiser does not visit more frequently to admire the decided progress achieved by the Help, but pressure of work does not permit of more than essential visits being paid. There are still improvements to be made, but apart from minor up and downs this Service has run surprisingly smoothly over the past twelve months, despite gathering momentum every day. "Undoubtedly through public demand this Service has come to stay and develop even further"