WAL 34 AC 4411 (1) WALT HASTON BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1951 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 1951 INDEX pace Section A.—Statistics and Social Conditions of the Area 12 Section B.—General Provision of Health Services in the Area 19 Section C.—Sanitary Circumstances of the Area 22 Section D.—Housing 27 Section E.—Inspection and Supervision of Food 32 Section F.—Prevalence and Control over Infectious Diseases 45 Section G.—National Health Service Act, 1946—Part III Services 66 Health Centres 68 Care of Mothers and Young Children 69 Midwifery 84 Health Visiting 86 Home Nursing 89 Vaccination and Immunisation 91 Ambulance Facilities 94 Prevention of Illness, Care and After-Care 94 Domestic Help 96 page Acreage 12 Adulteration 39 Ambulance Facilities 19, 94 Ante-Natal Clincs 69 Assessments 12 Bacteriological Examination 32,40 B.C.G. Immunisation 59 Birth Notifications 71 Birth Registrations 18 Births, Illegitimate 75 Birth Rate 12, 14 Breast Feeding 87 Cancer 15 Cancer Education 63 Caravans 25 Care and After-Care 94 Care of Illegitimate Children 75 Child Guidance 79 Child Welfare Clinics 76 Chiropody 96 Clean Food Campaign 40 Cleansing (Personal) 19, 83 Committees 4,66 Comparability Factor 13 Confinements 70 Contact Examinations 59 Convalescence for Adults 96 Convalescence for Pre-School Children 80 Conveniences, Public 61 Cremation 62 PAGE Day Nurseries 82 Deaths 13, 15 Deaths, Infants 13,16,73 Deaths, Infectious Diseases 14 Death Rate 12, 13, 14 Deaths, Causes of 15 Dental Laboratory 69 Dental Treatment 78 Diphtheria 46 Diphtheria Immunisation 91 Diseases of Animals Acts 41 Disinfestation 25 District Midwifery 84 Domestic Help 96 Dysentery 51 Employment 12 Emergency Unit 86 Encephalitis, Acute 51 Enteric Fever 54 Erysipelas 55 Essex County Council Act 21 Food & Drugs Act, 1938 39 Factories Acts, 1937/48 43 Food, Clean 40 Food Inspection 32 Food Poisoning 41, 54 Foot Clinic 96 Funeral Arrangements 61 Gas and Air Analgesia 85 General Dental Service 68 Haemoglobin Survey 97 Health Centres 68 Health Education 62 page Health Visiting 86 Home Help 97 Home Nursing 89 Home Visits 88 Hospitals 19 Housing, Closure and Demolition 30 Housing, General 31 Housing, Statistics 27 Housing Act, 1936 30 Housing Conditions, 87 Housing Inspections 28 Hygiene in Catering Trades 41 Ice Cream 3 3 Illegitimacy 75 Immunisation 91,93 Infant Mortality 13, 16, 17, 71 Infectious Disease 45 Infestation 83 Inquests 61 Invalid Children's Aid Association 80 Laboratory Facilities 60 Malaria 49 Maternal Mortality 14, 16, 18 Maternity Homes 21 Maternity Nursing 86 Maternity Outfits 86 Meals on Wheels Service 61 Measles 13, 48 Meat Inspection 36 Medical Aid 84 Medical Examinations 59, 62 Medicaments 81 Midwifery 84 Milk Inspection 32 Milk Special Designations Order 32 Milk Supply 32 Miscellaneous 61 Moral Welfare 75 Mortuary 61 National Assistance Act, 1946, Sec. 47 20 Neo-Natal Mortality 16, 18, 71 Notices, Sanitary 22 Notification of Births 71 Nursery Nursing Certificate 82 Nurseries & Child Minders (Reg.) Acts, 1948 83 Nursing Homes 21 Nutrients 81 Occupational Therapy 95 Old People's Welfare 61 Ophthalmia Neonatorum 53 Ophthalmic Treatment 79 Orthopaedic Treatment 78 Outworkers 44 PAGE Paediatric Clinic 80 Pneumonia 49 Poliomyelitis 50 Poliomyelitis Follow-up 95 Population 12 Post-Mortems 61 Post-Natal Clinics 69 Premature Infants 72 Prevention of Damage by Pests Act, 1949 41 Prevention of Tuberculosis 58 Prevention of Illness 94 Puerperal Pyrexia 53 Pupil Midwives 86 Rainfall 62 Rateable Value 12 Rehabilitation 96 Rehousing on Medical Grounds 31,60 Rent and Mortgage Restriction Acts 30 Retrolental Fibroplasia 74 Rodent Control 41 Sanitary Inspection 22 Scabics Clinic 19 Scarlet Fever 46 Sickroom Equipment 96 Smallpox 54 Smoke Abatement 25 Social Conditions 12 Staff 7, 19 Statistics 12 Sterilised Maternity Outfits 86 Still births 12, 14, 16, 18, 71 Sunlight Treatment 78 Swimming Baths 26 Total Infant Mortality 17 Tonsils and Adenoids 79 Training of Nursery Nurses 82 Training of Pupil Midwives 86 Tuberculosis 13, 56, 94 Vaccination 93 Virus Infections During Pregnancy 70 Vital Statistics 12, 71 Vitamins 81 Walthamstow Association of Tuberculosis Care Helpers 94 Walthamstow Child Welfare Society 77 Water 22 Welfare Services 98 Whooping Cough 13,48 Whooping Cough Immunisation 93 Women's Clinic 83 HEALTH COMMITTEE 1951-52 Chairman: Alderman Lady McEntee, J.P. Vice-Chairman: Councillor Mrs. S. Candy. Ex-officio: The Worshipful The Mayor—Alderman Lord McEntee, C.B.E., J.P. The Deputy Mayor—Councillor A. E. Simmons, J.P. Chairman of Finance Committee—Alderman Ross Wyld, O.B.E., J.P. Alderman Mrs. L. P. Bailey, J.P. „ W. Gillett. „ A. E. Manning. „ T. Smith. Councillor R. H. Ayres. Councillor A. W. Phillips. ,, F. A. Burton. „ E. G, Richards. ,, A. W. Ellis. „ M. Sharland. ,, Mrs. M. E. Marchant. „ W. H. Shaw. Councillor J. M. Wight. Town Cler: G. A. Blakeley, Esq. TO THE CHAIRMAN AND MEMBERS OF THE HEALTH COMMITTEE Lady McEntee, Ladies and Gentlemen, I submit herewith a report on the health of the Borough for the year 1951 and as in previous years the directive issued by the Ministry of Health requires me to deal generally with matters within my responsibility regarding public health and preventive medicine. The report therefore includes reference to the personal health services of the County Council made in my capacity as Acting Area Medical Officer and by courtesy of the County Medical Officer of Health. The Registrar-General's estimate of the home population at mid 1951 was 120,900, a decrease of 1,800 since mid-1950. On the basis of this population the vital statistics were again generally good and compare favourably both with National rates and those for London Administrative County. As regards the health of the mother and child, there were two maternal deaths from septic abortion. The infant mortality rate was reduced from 26 to 23. Still-births rose but neo-natal deaths showed a reduction. The crude birth-rate of 13.5 and the crude death-rate of 10.8 were both below the National rates. The tuberculosis death-rate at 0.31 was the same as that for England and Wales but less than that for London Administrative County at 0.38. Although the notifications of Whooping Cough were nearly twice the National rate, no death from this disease was recorded. The scheme of immunisation inaugurated by your Council and continued by the County Council has no doubt contributed materially to this position. The following seem worthy of note:— There was no failure to notify birth; the diminution of scabies; the continuing shortage of hospital accommodation for the tuberculous and for the aged and chronic sick; the increasing action which becomes necessary in regard to compulsory removal under Section 47 of the National Assistance Act. The problems of housing, tuberculosis, care of the aged and chronic sick and clean food remain in the forefront. The action taken in regard to each is detailed in the various sections of the Report. The work of the Sanitary Inspectorate has continued on the same high level as in previous years. In the field of infectious disease there was a major epidemic of measles, fortunately with only one death. Poliomyelitis was of decreasing incidence and residual paralysis; bacillary dysentery made a re-appearance especially at day nurseries and reference is made to a prophylactic trial. The incidence and fatality of tuberculosis increased but the effect of the increasing use of heat-treated milk is clearly demonstrated. Again, there was no death from diphtheria for the fifth successive year but there still remains the increasing apathy due to a decreased awareness on the part of the public to the dangers of diphtheria. In the field of health education, the question of cancer publicity was fully explored and a leaflet has been issued in the early part of 1952. The personal health services provided through the Walthamstow Health Area Sub-Committee of the County Health Committee have continued and expanded. Health centre sites were fixed ; the priority dental service was maintained; health visitors attended rounds in the children's wards at Whipps Cross Hospital. An analysis was made of the careers of nursery nurse trainees after qualifying and reference is made to a "pilot" nutritional survey amongst housewives. The staff of the department have again worked loyally and conscientiously and this Report would not have been possible without their help. Miss C. A. Lee, S.R.N., S.C.M., Superintendent of the District Nurses' Home at "Carisbrooke" retired on the 31st March, 1951 after 16 years' faithful service to the former District Nursing Association and since the appointed day to the County Council. I cannot conclude this Report without renewed appreciation of the help and consideration received from the members of the Committees concerned and particularly from the Chairman, Alderman Lady McEntee. I have the honour to be, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. 7 STAFF OF THE HEALTH SERVICES WALTHAMSTOW BOROUGH COUNCIL Medical Officer of Health, Borough School Medical Officer and Acting Area Medical Officer (Essex County Council): A. T. W. Powell, M.C., M.B., B.S., D.P.H. Deputy Medical Officer of Health, Deputy Borough School Medical Officer: M. Watkins, M.R.C.S., L.R.C.P., D.P.H. Chief Sanitary Inspector, Petroleum Officer and Chief Inspector, Diseases of Animals Acts : F. W. Kemp, M.R.S.I., M.S.I.A. (a) (b) (c). Deputy Chief Sanitary Inspector: W. R. Richards, M.R.S.I., M.S.I.A. (b) (d) (e). District Sanitary Inspectors: E. A. Austerberry, M.S.I.A. (b) (d) (e). R. C. Bland, M.R.S.I., M.S.I.A. (b) (d). V. Croft, (b) (d). D. R. King, A.R.S.I. (b) (d). s. E. Muggeridge, M.R.S.I. (b) (d). F. Northcote, A.R.S.I., M.S.I.A. (b) (c). (a) Cert. S.I.E.B. (London). (b) Cert. Inspector Meat and other Foods. (c) S.I. Cert, of R.S.I. (d) S.I. Cert, of R.S.I. and S.I.E.J.B. (e) Cert. of Sanitary Science, R.S.I. In addition, some of the Inspectors hold special certificates. Infectious Disease Nurse: Miss I. H. Jennings, S.R.N., S.C.M. Chief Clerk: R. Rose. Clerical Staff: G. J. Bradley. G. H. Eve. Miss M. J. Game. B. W. Goode. Miss S. A. Horsnell. L. F. Joyce. L. R. W. Kemp. Miss N. Lewis. Miss T. M. Pullen. Disinfecting Staff: H. Thompson. H. Lewiston. Rodent Operatives: H. J. Newbury. W. Hill. 8 ESSEX COUNTY COUNCIL Assistant County Medical Officers: Mrs. Joyce Beattie, M.B., B.S., D.P.H. (Commenced 24.5.51; Ceased duty 21.7.51; Commenced 10.9.51; Ceased duty 30.11.51). Miss Philippa Carter, M.B., B.S. (Commenced 15.2.51; Ceased duty 16.6.51). Trevor T. Currie, M.B., B.S. (Commenced 8.1.51). Miss Roshan A. Irani, M.D., M.S., M.R.C.O.G. James R. Mayer, M.B., B.S., D.P.H. (Commenced 18.6.51; Ceased duty 21.7.51). Miss M. Sheppard, M.A., M.B., B.Ch., B.A.O., D.P.H., Barrister-at-Law. Mrs. Jessie A. Stansfield, M.B., Ch.B., D.P.H. (Ceased duty 13.1.51). Specialist Part-time Medical Officers. (Regional Hospital Board Appointment): Aural Surgeon: F. P. M. Clarke, B.A., B.Sc., L.R.C.S. (Ed.), L.R.C.P., L.R.F.P.S. (Glas.). Ophthalmologist: R. Bulsara, B.Sc., M.B., B.S., D.O., D.O.M.S. Orthopedic Surgeon: B. Whitchurch Howell, M.B., B.S., F.R.C.S. Pædiatrician: E. Hinden, M.D., M.R.C.P. Physician in Charge, Cardiac and Rheumatism Clinic: Miss M. Wilmers, M.D., M.R.C.P. Psychiatrists: Mrs. Helen Gillespie, M.R.C.S., L.R.C.P. C. Haffner, M.B., Ch.B., D.P.M. (Ceased duty 31.10.51). Senior Dental Officer: Mr. L. W. Elmer, L.D.S., R.C.S. (Eng.). Dental Officers: Miss D. Anklesaria, L.D.S., R.C.S. (Part-time). R. E. Hyman, L.D.S., R.C.S. C. Lancer, B.D.S. (Commenced 14.2.51; Ceased duty 19.11.51). R. Tait, B.Sc., L.D.S., R.C.S. (Part'time). G. P. L. Taylor, L.D.S., R.C.S. J. Timmis, L.D.S., R.C.S. Superintendent Health Visitor: Miss A. C. Keenan, S.R.N., S.C.M., H.V. Cert. 9 Health Visitors and Health Visitor/School purses: Miss R. Boyd, S.R.N., S.C.M., H.V. Cert. Miss M. B. Cassidy, S.R.N., S.C.M., H.V. Cert. (Ceased duty 16.3.51). Miss E. L. Cunnington, S.R.N., S.C.M., H.V. Cert. Miss C. R. Douglas, S.R.N., S.C.M., H.V. Cert. Miss E. du Randt, S.R.N., S.C.M., H.V. Cert. Mrs. D. Lambert, S.R.N., S.C.M., H.V. Cert. (Part-time). (Commenced 1.2.51). Miss D. G. Legg, S.R.N., S.C.M., H.V. Cert. Mrs. E. Levis, S.R.N., S.C.M., H.V. Cert. Miss K. Munday, S.R.N., S.C.M., H.V. Cert. Miss O. North, S.R.N., S.C.M., H.V. Cert. Miss J. M. Palmer, S.R.N., S.C.M., H.V. Cert. Mrs. G. H. Salter, S.R.N., S.C.M., H.V. Cert. Mrs. I. C. Stern, S.R.N., S.C.M., H.V. Cert. (Commenced 1.9.51). Miss A. Stuart, S.R.N., S.C.M., H.V. Cert., T.B. Cert. (Deceased 17.4.51). Miss A. Wright, S.R.N., S.C.M., H.V. Cert. Tuberculosis Visitors: Miss A. Ames, S.R.N., S.C.M., T.A. Cert. Mrs. G. E. Carey, S.R.N. Mrs. D. Purves, S.R.N. Superintendent of District Nurses' Home: Miss C. A. Lee, S.R.N., S.C.M., Q.N. (Retired 31.3.51). Miss E. G. Welbrock, S.R.N., S.C.M., M.T.D., Q.N. (Commenced 21.3.51). District Nuurse/Midwives and District Nurses: Mrs. I. Ball, S.R.N. (Commenced 16.4.51). Miss D. L. Chandler, S.R.N., S.C.M., Q.N. Mrs. M. Christmas, S.R.N. Miss M. H. Cronshey, S.R.N., S.C.M., Q.N. (Assistant Superintendent from 1.3.52). Miss A. E. Edmonds, S.R.N., S.C.M. (Ceased duty 26.12.51). Mrs. K. Jackson, S.R.N., S.C.M. (Ceased duty 7.1.51). Miss R. Kenny, S.R.N., S.C.M. (Ceased duty 13.7.51). Mrs. E. Law, S.E.A.N. (part'time). Mrs. E. Lucas, S.E.A.N. (part-time). (Commenced 22.1.51). J. H. Moore, S.R.N., Q.N. Mrs. A. Norman, S.R.N. Miss M. Owen, S.R.N., S.C.M. (Commenced 23.2.51). Miss F. Ralph, S.R.N. (Ceased duty 6.12.51). Mrs. J. M. Shepherd, S.E.A.N. (part-time). (Commenced 1.11.51). Mrs. I. Smith, S.R.N 10 District J^urse/Midwives and District Nurses—(continued): Miss W. Stevens, S.R.N., S.C.M., Q.N. Miss P. Tharp, S.R.N., S.C.M., H.V. (Commenced 6.7.51). Mrs. L. Wale, S.R.N. Miss R. M. Walker, S.R.N., S.C.M., Q.N. (Commenced 9.2.51). Mrs. E. B. Wilkinson, S.R.N., S.C.M., Q.N. District Midwives: Miss M. Gahan, S.R.N., S.C.M. (Ceased duty 13.12.51). Mrs. A. Gilbert, S.R.N., S.C.M. Miss N. Hodges, S.R.N., S.C.M. Miss A. Krolfifer, S.C.M. Mrs. P. Rayner, S.R.N., S.C.M. Miss O. Roberts, S.R.N., S.C.M. Mrs. M. Washbourne, S.R.N., S.C.M. Matrons of Day Nurseries: Mrs. D. Androvenda, S.R.N. Mrs. G. Moore, S.R.N., S.C.M., S.R.F.N. Dental Attendants: Miss D. Sanford (Senior). Miss J. Bradley. (Ceased duty 4.9.51). Mrs. M. A. Dumper, S.R.N. (Part-time). (Commenced 26.9.51). Miss G. M. Hutchins. Miss N. E. Hutchinson. (Commenced 10.9.51). Miss S. Snowdon. Mrs. M. E. Wright. Dental Technicians: Mr. G. H. Higgins (Senior). Mr. H. J. Edmunds. Mr. P. Barnett (Apprentice). Educational Psychologists: Miss E. M. Smith, M.A. Miss A. M. Marshall, B A. Psychiatric Social Workers: Miss A. M. Lacquer. Miss M. Russell. Play Therapist: Mrs. K. Barker (Part-time). Orthoptists (Part-time): Miss L. M. Box, S.R.N., S.C.M., D.B.O. (Ceased duty 25.1.51). Miss J. F. Dearlove, D.B.O. (Commenced 25.1.51 ; Ceased duty 25.9.51). Mrs. E. Silvester, D.B.O. (Commenced 31.8.51). 11 Physiotherapist: Miss H. Garratt, C.S.P. Speech Therapists: Miss C. M. Gregory, L.C.S.T. Miss A. Hemmings, L.C.S.T. Chiropodists: R. J. King, M. Ch. S. G. McCart, M. Ch. S. L. N. C. Martin, M. Ch. S. L. R. Skinner, M. Ch. S. Clinic Nurse and Auxiliary: Mrs. P. Crisp, S.R.N. Mrs. E. Lynch. Domestic Help Organiser: Mrs. C. M. Hall. Senior Administrative Assistant: F. J. Aylward. Administrative and Clerical Staff: Miss M. J. Berry. (Commenced 31.12.51). Mrs. M. Crosier. Mrs. E. M. Goody. R. A. C. Green. E. H. Irwin. (Ceased duty 31.12.51). Miss V. N. Jennings. (Commenced 24.9.51). Mrs. J. W. Joyce. (Ceased duty 31.12.51). Miss D. E. Lane. Mrs. M. Manton. G. B. Martin. Miss S. Martyn. (Ceased duty 15.12.51). R. T. Prudden. (Commenced 10.12.51). Mrs. G. M. Roberts (Part-time). Mrs. M. J. Smitten. Mrs. A. S. Speechley. Miss M. R. Stanley. (Ceased duty 31.3.51). A. T. Wade. Miss M. Warren. Miss E. Weatherill. Mrs. M. E. West (Part-time). 12 A.—STATISTICS & SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1951) 120,900 Number of Assessments (31st December, 1951) 36,631 Rateable Value (31st December, 1951) £908,395 Sum represented by penny rate £3,630 Population.—The Registrar-General's Estimate of the home population at mid-year, 1951, is 120,900, a decrease of 1,800 on the previous year. Employment.—According to information kindly supplied by Mr. Percy C. Graham, Manager of the Local Employment Exchange, approximately 550 men and 250 women were placed in employment every month during the year 1951, through the placing machinery of the Employment 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, Wanstead and Woodford, was approximately 82,000. Of this number, it is estimated that about 40,000 were employed in Walthamstow. During 1951 the average number of persons unemployed in the whole area was 571 men and 230 women ; these included approximately 70 disabled men and 15 disabled women. Extracts from Vital Statistics.—The Registrar-General's midyear 1951 estimate of the home population (viz., 120,900) has been used for the calculation of all vital statistics. Total Males Females Live Births Legitimate 1,586 817 769 Birth rate per 1,000 of the estimated home population 13.5 Illegitimate 51 19 32 Total 1,637 836 801 Stillbirths 38 Rate per 1,000 total (live and still) births 22.7 Deaths 1,309 Death rate per 1,000 of the estimated home population 10.8 Deaths from puerperal causes:— Puerperal Sepsis Deaths 2 Other Puerperal Causes —+ 13 Death rate of infants under one year of age:— All infants per 1,000 live births 23 Legitimate infants per 1,000 legitimate live births 21 Illegitimate infants per 1,000 illegitimate live births 59 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under two years of age) — Pulmonary Tuberculosis death rate 0.27 Non-Pulmonary Tuberculosis death rate 0.03 The natural increase of population, i.e., excess of births over deaths was 328. 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 1951 (1,309) compares with 1,305 in 1950, the respective death rates per 1,000 population being 10.8 and 10.6. Comparability Factor.—The comparability factor applicable for 1950 was revised by the Registrar-General in September, 1951. The revised factors were:— Area comparability factor for births 0.96 Area comparability factor for deaths 1.04 The above factors, when applied to the crude rates, produce the following adjusted rates:— Live births 13.0 Deaths 11.3 14 Birth-Rates, Death-Rates, Analysis of Mortality, Maternal Mortality, and Case Rates for certain Infectious Diseases in the year 1951. 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 Adminis' trative County. Walthamstow. Rates per 1,000 Home Population Births:— Live Births 15.5 17.3 16.7 17.8 13.5 Still Births 0.36 0.45 0.38 0.37 0.31 Deaths:— All Causes 12.5 13.4 12.5 13.1 10.8 Typhoid and Paratyphoid 0.00 0.00 0.00 — 0.00 Whooping Cough 0.01 0.01 0.01 0.01 — Diphtheria 0.00 0.00 0.00 0.00 — Tuberculosis 0.31 0.37 0.31 0.38 0.31 Influenza 0.38 0.36 0.38 0.23 0.17 Smallpox 0.00 0.00 0.00 — — Acute Poliomyelitis (including Polioencephalitis) 0.00 0.01 0.01 0.00 – Pneumonia 0.61 0.65 0.63 0.61 0.83 Notifications (Corrected):— Typhoid Fever 0.00 0.00 0.00 0.01 0.00 Paratyphoid Fever 0.02 0.03 0.02 0.01 0.00 Meningococcal Infection 0.03 0.04 0.03 0.03 0.04 Scarlet Fever 1.11 1.20 1.20 1.10 0.98 Whooping Cough 3.87 3.62 4.00 3.11 6.14 Diphtheria 0.02 0.02 0.03 0.01 — Erysipelas 0.14 0.15 0.12 0.15 0.27 Smallpox 0.00 0.00 0.00 — — Measles 14.07 13.93 14.82 14.64 18.98 Pneumonia 0.99 1.04 0.96 0.72 0.69 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.03 0.03 0.03 0.02 0.07 Non-Paralytic 0.02 0.02 0.03 0.02 0.00 Food Poisoning 0.13 0.15 0.08 0.23 0.11 Deaths:— Rates per 1,000 Live Births All causes under 1 year of age 29.6(a) 33.9 27.6 26.4 22.6 Enteritis and Diarrhœa under 2 years of age 1.4 1.6 1.0 0.7 – Notifications (Corrected):— Rates per 1,000 Total (Live 6? Still) Births Puerperal Fever Pyrexia 10.66 13.77 | 8.08 14.90 25.67 Maternal Mortality:— A. 115 Sepsis of pregnancy childbirth and the puerperium A.116 Abortion with toxaemia Other toxaemias of pregnancy and the puerperium A. 117 Haemorrhage of pregnancy and childbirth A.118 Abortion without mention of sepsis or toxaemia A. 119 Abortion with sepsis A.120 lOther complications of 1 pregnancy, childbirth 1 and the puerperium Number of Deaths:— Walthamstow – — — — 2 — England and Wales 70 3 167 91 37 66 125 Rates per 1,000 Total (Live and Still) Births:— Walthamstow — — — — — 1.19 – England and Wales 0.10 0.00 0.24 0.13 0.05 0.09 0.18 (a) Per 1,000 related live-births. 15 Causes of Death as given by the Registrar-General for the year 1951 Whole District Causes of Death Males Females Total 1950 1. Tuberculosis, Respiratory 25 8 33 33 2. Tuberculosis, other 3 1 4 – 3. Syphilitic Disease 5 2 7 7 4. Diphtheria — — — — 5. Whooping Cough — — — — 6. Meningococcal Infections — — — 1 7. Acute Poliomyelitis — — — 2 8. Measles 1 — 1 2 9. Other Infective and Parasitic Diseases 3 5 8 3 10. Malignant neoplasm, stomach 17 15 32 37 11. Malignant neoplasm, Lung, bronchus 38 1 39 50 12. Malignant neoplasm, breast — 18 18 26 13. Malignant neoplasm, uterus — 6 6 12 14. Other malignant and lymphatic neoplasms 50 56 106 123 15. Leukaemia, aleukaemia 3 2 5 5 16. Diabetes 2 8 10 4 17. Vascular lesions of nervous system 47 80 127 147 18. Coronary disease, angina 96 61 157 168 19. Hypertension with heart disease 21 26 47 54 20. Other heart disease 89 132 221 223 21. Other circulatory disease 12 10 22 35 22. Influenza 7 14 21 9 23. Pneumonia 50 50 100 64 24. Bronchitis 83 43 126 80 25. Other disease of respiratory system 10 3 13 10 26. Ulcer of stomach and duodenum 12 7 19 16 27. Gastritis, enteritis and diarrhoea 5 S 2 28. Nephritis and nephrosis 6 4 10 17 29. Hyperplasia of prostate 13 – 13 10 30. Pregnancy, childbirth, abortion – 2 2 – 31. Congenital malformations 2 6 8 13 32. Other defined and ill-defined diseases 53 66 119 110 33. Motor vehicle accidents 5 2 7 13 34. All other accidents 9 4 13 12 55. Suicide 6 4 10 17 36. Homicide and operations of war – – – – Totals, 1951 668 641 1,309 – 685 620 – 1.305 Under l yr. 1-2 yrs. 2-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 yrs. & over – — — – – 13 46 142 16 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. 1951 1,637 13.5 38 23.2 0.31 23 14.0 37 23 1950 1,598 13.0 37 23.1 0.30 33 20.6 42 26 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 There were no deaths during 1951 from Diarrhœa and Enteritis in children under one year of age. 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 During 1951 there were two deaths due to puerperal sepsis. Deaths due to Pregnancy and Child-Bearing and/or associated therewith during 1951 Case No. Duration of Pregnancy Date of Death Certihed Cause of Death and Classification Age Ward 1 8-12 weeks 5.9.51 Renal suppression and failure following septic abortion (self-induced) 31 J 2 12-16 weeks 13.9.51 Gas forming septicemia due to septic instrumental abortion 25 w The maternal mortality rates (per 1,000 total births) for the past five years have been given 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. 1951 1,675 2 – 2 1.19 – 1.19 1950 1,635 — – — — – — 1949 1,863 – 2 2 — 1.07 1.07 1948 2,114 — — — — — — 1947 2.729 — 4 4 — 1.46 1.40 17 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 18 MATERNAL MORTALITY, STILLBIRTHS & NEO-NATAL DEATHS During 1951 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). 1951. 1950. 1949. 1948. 1947. Maternal Mortality 1.22 — 1.09 – 1.49 Stillbirths 23.2 23.1 14.7 22.2 22.1 Neo-Natal Mortality 14.0 20.6 16.9 11.1 13.1 REGISTRATION OF BIRTHS The Registrar-General's returns show the following registrations during the calendar year:— (a) Live Births. Males. Females. Totals. Legitimate 817 769 1,586 Illegitimate 19 32 51 836 801 1,637 The stillbirth rate per 1,000 population was 0.31. Of the 1,701 local registrations, 363 belonging to other areas are excluded, leaving a nett total of 1,338. There were no nonnotified births during 1951. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Total. Totals M. F. M. F. M. F. M. F. M. F. M. F. M. F. 80 85 74 82 116 94 102 100 146 131 164 164 682 656 Grand Totals 165 156 210 202 277 328 1.338 19 B—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. 1. Public Health Officers of the Authority The names and qualifications of officers employed by your Authority are given at the beginning of the Report. All are whole-time officers unless otherwise stated. 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. The Clinic premises are situated at the back of the Public Baths in High Street and treatment is by appointment only, i.e., through the family doctor or the Health Department. Owing to a decrease in the number of cases requiring treatment, sessions were reduced to one per week with effect from the 1st January, 1952. The number of cases treated during 1951 was 42 involving 82 treatments. Facilities remained available to Leyton patients on the same basis as those from Wanstead/Woodford and the Forest Division, i.e., at a fee of 7/6d. per treatment, payable by the Local Sanitary Authority. There were 15 such treatments in 1951 out of the total specified above. 5. Hospital Accommodation (a) Acute Cases.—There were no major changes in 1951 in regard to the hospital accommodation available for the inhabitants of the Borough. (b) Chronic Cases.—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 1951, 17 elderly chronic sick patients still awaited admission to a suitable hospital. 20 The following table shows the position in regard to hospital admissions considered and supported on "social" grounds. 1. No. of cases at end of 1950 awaiting Hospital admission 12 2. No. of new cases during 1951 considered on Social Grounds 16 3. No. of new cases during 1951 supported on Social Grounds 11 4. No. of old and new cases requiring Hospital admission 23 5. No. of admissions to Hospital during 1951 6 6. No. of outstanding cases at end of 1951 17 It is a pleasure to record the unfailing help and consideration experienced from the Senior Medical Officer (Dr. DeLargy) at Langthorne Hospital. (c) Maternity.—The effect of the transfer of Thorpe Coombe Maternity Hospital to the Regional Hospital Board has, somewhat naturally, been to restrict the admission of Walthamstow patients who were expected to have a normal confinement other than the first and in favour of patients from other parts of the Hospital Group, and presumably requiring admission on obstetric and/or "social" grounds. At the same time it must be stated that no patient booking late and requiring hospital accommodation either on obstetric and/or "social" grounds has been refused admission to some other maternity hospital by arrangement made at Thorpe Coombe. The percentage of Walthamstow residents admitted to Thorpe Coombe prior to the appointed day was of the order of 98—99. In 1949 it fell to 88.4, in 1950 to 77 and in 1951 to 64.1. (d) Out-Patient Facilities.—On the 25th June, 1951, the Chairman of the North-East Metropolitan Regional Hospital Board opened the new Out-patient Department at the Connaught Hospital, which met a long-felt want in relieving the gross overcrowding at the Department. The accommodation comprises two main consulting rooms each with an examination room and four dressing cubicles, a treatment room, a new waiting hall with comfortable seating and canteen facilities. 6. Aged and Chronic Sick. National Assistance Act, 1948 (Section 47). Full reference was made in last year's report to the first case dealt with under this Act. The hearing took place on 31st January and an order was made for three months' care in Part III accommodation. Application was made for extension on the 2nd May and the patient, Mrs. M.I., died on the 14th August. 21 The second case was Mrs. M.W., aged 63 years, who was first discovered by the District Sanitary Inspector in December, 1950, to be living alone in unsanitary conditions. An unsuccessful attempt was made to give domestic help and on the 8th February Mrs. W. was found lying on the floor unconscious. The patient's doctor attempted "voluntary" removal to hospital without success and application had to be made to the Court on the 8th March, removal being effected the same day. The patient was admitted to hospital and transferred to Part III accommodation on the 19th May. The third case was Mrs. A.H., aged 83 years, first reported by the family doctor who had been called by the Police. He found the patient suffering from bronchitis, myocardial degeneration and senility. She was found living in unsanitary conditions and refused care and attention both from the home nurses and relatives. The hearing was on the 14th March, removal the same evening and death occurred seven days later. A fourth patient suffering from extensive cancer of the face declined removal to hospital for some days but eventually consented when served with intimation of the projected Court hearing. He died within a few days. National Assistance (Amendment) Act, 1951. The Council has authorised the Medical Officer of Health to make application for the necessary orders in cases to which the Act applies. 7. 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 2 4 18 22 There were no refusals or appeals. Five inspections were made by the medical staff. No difficulties in regard to supervision arose. Routine enquiries are made with regard to unregistered homes. Notice was received from the proprietor that the St. Margaret's Nursing Home, a small home registered for three maternity patients would close as from the 18th June. 8 Essex County Council Act, 1933 (Establishments for massage and special treatment). No new licences were granted under the Act and one lapsed. 22 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 1951. All dwelling houses in the area are supplied direct with water. In accordance with Circular 42/51, 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 two 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 The Inspectorate was, owing to sickness, one below complement for 19 weeks. Mr. F. W. Kemp, Chief Sanitary Inspector, reports as follows:— No. of inspections made. No. of nuisances detected. No. of complaints received. No. of Intimation Notices No. of Statutory Notices. Total Visits. Served. Complied with. Served. Complied with. 14,375 6,989 3,157 1,985 1,976* 266 212* 21,352 * Includes notices outstanding from previous year. Of the 1,985 intimation notices served, 175 were in respect of business premises and the remainder (1,810) related to defects in private houses. Of the latter figure, 1,544 were complied with without resort to statutory procedure. It was found necessary to institute legal proceedings against Owners for non-compliance with 11 Abatement Notices served under Section 93 of the Public Health Act, 1936. Orders were made by the Justices in four cases—costs ranging from £1 0s. 0d. to £1 3s. 0d.—and in six cases the summonses were withdrawn on payment of costs, the work having been completed before the date of Hearing. One case was adjourned sine die. 23 The following table shows the nature of work executed and improvements effected during the year:— Drains tested, 327; Drains reconstructed or repaired, 388; Drains, obstructions removed, 190; Drains, means of access provided, 54; Drains, ventilation provided or improved, 72; Drains, ventilation repaired, 92; Soil pipes repaired or renewed, 117; Rain water pipes repaired or renewed, 203; Rain water pipes disconnected from drains, 19; Roofs repaired or renewed, 797; Gutterings repaired or renewed, 366; W.C. pans or traps provided, 303; Gully traps provided, 138; W.C. flushing cisterns repaired or renewed, 239; W.C. floors concreted, 52; W.C.'s repaired and cleansed, 267; W.C.'s light and ventilation improved, 41; Waste pipes repaired, renewed or trapped, 194; New sinks provided, 94; Stoves and firegrates repaired or renewed, 335; Water supply reinstated, 13; Water supply taken off main, 9; Cisterns cleansed and covered, 24; Sculleries paved, 35; Yards and forecourts paved or repaired, 82; Dirty houses cleansed, 32; Dirty rooms cleansed, 571; Floors repaired, 405; Ventilations under floors provided or improved, 173; New damp-proof courses provided, 54; Sites concreted, 1; Offensive accumulations removed, 23; Animals improperly kept, removed, 7; Stables repaired and cleansed, 22; Manholes repaired or re-sealed, 151; Other causes of dampness remedied, 605; Miscellaneous repairs, 2,624. Infectious Diseases. Visits to premises, 508 ; Re-visits to premises, 16. Disinfections. Rooms disinfected, 159; Articles disinfected, 387; Articles destroyed at Low Hall Lane, 80. Special Premises. Number Visits paid Factories (a) Non-power 67 178 (b) Power 455 627 (c) Other premises 41 129 Outworkers 544 746 Slaughterhouses (re-application) — 1 Butchers 82 434 Bakehouses 36 197 Fishmongers, Fish Fryers and Curers, etc. 44 205 Cafes and Caterers 115 465 Grocers, etc. 268 761 Ice Cream Manufacturers and Vendors 249 325 Dairies and Milksellers 100 127 Laundries 3 13 24 Special Premises (continued). Number Visits paid Hairdressers 74 93 Rag and Bone Dealers 3 20 Piggeries 2 6 Street Stalls Numerous 352 Greengrocers 92 191 Stables 37 106 Schools — 25 Conveniences — 32 As a result of the regular periodical visiting of the Special Premises the following works were carried out:— Butchers. Special cleansings, 49; Pavings repaired, 5; Accumulations removed, 5; New galvanised bins provided, 16; Drains repaired, 4; W.C.'s repaired and cleansed, 15; Floors repaired and ventilated, 7; Light and ventilation improved, 3; Other improvements, 48. Bakehouses. Special cleansings, 57; New ceilings fixed, 3; Floors repaired, 7; Light and ventilation improved, 5; Roofs repaired, 2; Other improvements, 39. Fishmongers. Special cleansings, 37; Yards repaved, 3; Accumulations removed, 5; Drains cleared, 5; Other improvements, 21. Grocers. Store rooms cleansed, 99; Washing accommodation improved, 45; Other improvements, 75. Cafes and Caterers. Special cleansings, 96; Light and ventilation improved, 16 ; Floors repaired, 9 ; Other improvements, 86. Ice Cream Manufacturers and Vendors. Special cleansings, 14; Special cleansings of utensils, 2; Yard pavings repaired, 2 ; Other improvements, 6. Dairies and Milkshops. Special cleansings, 28; New fittings and other improve' ments, 19; Pavings relaid, 2; Light improved, 1. 25 Hairdressers. Special cleansings, 29; Other improvements, 11. Stable Premises. Cleansings, 17; Accumulations removed, 15; Roofs repaired, 2; Pavings repaired, 2; Other improvements, 6; Manure receptacles provided, 1. Laundries. Special cleansings, 3; Other improvements, 6. Rag and Bone Dealers. Cleansings, 5; Pavings repaired, 1. Piggeries. Cleansings, 2. Camping Sites. There are no authorised sites in the area. The caravan dwellers at Higham Hill still remain. Smoke Abatement. Complaints were received and investigations carried out relating to thirteen premises. Of these, ten were in respect of boiler plants burning solid fuel; one oil; one trade refuse (sawdust) incinerator and one Refuse Destructor. Smoke observations were carried out where necessary and warnings or advice given. Five written intimations were sent. One boiler plant was replaced with new, and one completely modernised. Eradication of Bed Bugs, etc. The number of houses reported to be verminous still remains comparatively small. Ninety rooms were fumigated with DDT smoke or sprayed with DDT solution. Insecticides were issued free of charge to tenants of 65 premises. Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1938: — No notifications were received during the year. 26 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, 1951, the Swimming Bath was open on 289 days. Number of bathers during this period was 104,677. "Maximum load was on September 10th when we had 780 bathers." Sampling was carried out on two 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 65,000 gallons. New plant was installed during the year. Sampling was carried out with satisfactory results. (e) Woodford County High School.—Sampling was carried out with satisfactory results. (f) Kingfisher Pool.—The Managing Director kindly gives the following particulars:— "Normal turnover of between 6 and 8 hours. "Approximately 18,000 people passed through during the season. "A new chlorination plant (not break-point) was installed in the latter half of the season, which produced 1 ppm in the shallow end and .4 ppm in the deep end. A more comprehensive study will be made in 1952. "Once only was it necessary to run the plant overnight due to a heavy load the previous day." Bacteriological and chemical analyses were carried out on two occasions with satisfactory results. 27 D.— HOUSING Statistics The Borough Architect, F. G. Southgate, Esq., A.R.I.B.A., A.M.T.P.I., has kindly contributed the following:— Houses erected by the Local Authority during 1951:— Hoe Street Ward 6 Flats (P) 14 Houses (P) St. James Street Ward Nil Higham Hill Ward Nil High Street Ward 18 Flats (P) Hale End Ward 46 Flats (P) 2 Houses (P) Wood Street Ward 9 Flats (P) TOTAL 79 Flats (P) 16 Houses (P) Houses erected by Private Enterprise during 1951:— Hoe Street Ward Nil St. James Street Ward Nil Higham Hill Ward 40 Flats (P) High Street Ward Nil Hale End Ward 1 House (R) 34 Houses (P) Wood Street Ward 13 Houses (R) TOTAL 40 Flats (P) 34 Houses (P) 14 Houses (R) Note: (P) Post-war permanent Houses and Flats. (R) Rebuilding war-destroyed Houses. Houses Erected During 1951 During the calendar year 1951, 16 new houses and 79 new flats have been erected. 14 war destroyed houses were rebuilt by private enterprise and 74 new houses and flats were erected by private enterprise. Most of the Council's schemes are now the development of small sites, infilling between older development on war-damaged or vacant land, in some cases this entails the erection of a pair of houses only. This process takes considerably longer than in dealing with a large estate where a number of buildings can be undertaken at one time. During the early months of the year the weather was extremely bad which delayed the completion of several schemes. Most of the accommodation now under construction is of three-storey flats with two bedrooms or two-storey flats with one bedroom. A few houses for the higher income group have been completed. The larger sites developed during the year include 24 flats Chingford Road, 22 flats Beechwood Drive, 18 flats Stoneydown and 9 flats forest Rise. Four experimental two-bedroom houses costing under 28 £1,000 each were completed in Ickworth Park Road and contracts have been placed for a further 34 of similar design, although the price has increased due to continually rising costs of labour and materials. An award was received from the Council of the Festival of Britain for the scheme at Oak Hill of 36 flats. 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) 3,034 (b) Number of inspections made for the purpose 8,673 (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 5 (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 1,810 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 1,544 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 Nil 29 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil (c) Withdrawn—premises vacated and undertaking not to allow future occupation Nil B. Proceedings under the Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 266 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners— 212 (b) By Local Authority in default of owners Nil C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil D. Proceedings under Section 12 of the Housing Act, 1936:— (1) Number ot separate tenements or underground rooms in respect of which Closing Orders were made 3 (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. 30 Housing Act, 1936 Unfit Houses The following premises were dealt with as follows:— Demolition Orders: 1, Eden Road 110, Upper Walthamstow Road 73, Albert Road (Appeal lodged) Closing Orders: 1, Eldon Road (Basement) 48, Orford Road (Basement) 56, Orford Road (Basement) Houses Demolished: Nil Unfit Houses: The Ministry of Local Government and Planning (Form P.13 (HSG)/52)—Return for the year ended 31st March, 1952. Part B.— Unfit houses not included in Clearance Areas. (1) Housing Act, 1936 Number of houses Number of persons i displaced (a) Houses demolished as a result of formal procedure under Section 11 1 8 (b) Houses demolished as a result of informal notices preliminary to formal procedure under Section 11 – – (c) Houses closed in pursuance of an undertaking given by the owners under Section 11, and still in force – – (d) Parts of buildings closed (Section 12) 3 12 (e) Houses made fit— (l) as a result of formal notices under Sections 9 to 12 – – (ii) as a result of informal notices preliminary to formal procedure under Sections 9 to 12 1,568 568 – (2) Housing Act, 1949 (f) Closing Orders made under Section 3(1) – – (g) Demolition Orders determined and Closing Orders substituted under Section 3 (2) – – (h) Demolition Orders quashed under Section 2 – – Rent and Mortgage Restriction Acts During the year six certificates were granted to tenants. One clearance certificate was issued to an owner. Housing Act, 1936, Section 62 Applications for "permitted number" were received from landlords and certificates issued during the year respecting 165 lettings. Fifty-three enquiries from the Housing Manager were also dealt with. 31 Local Land Charges Particulars relating to outstanding sanitary notices were supplied in reference to 1,791 enquiries. General Mr. C. W. Rayner, your Council's Housing Manager, states that in 1951 the number of families rehoused by the Department was 166, which included 15 families where there was a medical recommendation in respect of tuberculosis. During the year a meeting was arranged with Dr. Hugh Ramsay, Chest Physician in charge of the Walthamstow Chest Clinic, to agree the urgency of various applicants suffering from infectious pulmonary tuberculosis living under overcrowded conditions and in contact with young children, i.e., the Class I cases referred to below. Rehousing of Medical Cases During 1951, 157 cases claiming priority on medical grounds in connection with rehousing and tuberculosis were investigated and reported upon. Of these, 40 cases were added to the list of cases and classified in order of urgency. The position at the end of 1951 was as follows:— Class 1 Class 2 Class 3 Class 4 Total On List, Dec., 1951 14 20 7 29 70 Added to List during 1951 11 4 3 22 40 25 24 10 51 110 Removed from the List during 1951 13 7 1 14 35 Under priority recommendation, Dec., 1951 12 17 9 37 75 The remaining 117 cases investigated were new claims or reviews where medical priority could be given. Apart from tuberculosis, 60 cases were recorded as needing special investigation on medical grounds, and 63 on grounds of overcrowding. A grand total of 326 investigations were made during the year in order to assess medical and rehousing claims and to prevent duplication of enquiries by the Housing Department, from which the closest co-operation has been received. 32 E.— INSPECTION AND SUPERVISION OF FOOD The following is contributed by the Chief Sanitary Inspector:— (a) Milk Supply. Designated Milk. During the year 144 samples of milk were submitted to the Counties Laboratories for bacteriological examination, including Phosphatase, Methylene Blue and Turbidity 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 Pasteuriser's Licences. The following table gives details of samples taken:— Grade No. of Samples Results Satisfactory Unsatisfactory (Methylene Blue Test) Pasteurised 116 111 5 Tuberculin Tested Pasteurised 24 4 – Sterilised 4 24 – Totals 144 139 5 * Maximum Atmospheric Shade Temperature: 62 F.—2; 65 F.—2. Biological Test. No samples were submitted owing to the temporary cancellation of scheme. The Milk (Special Designation) (Pasteurised & Sterilised Milk) Regulations, 1949 & 1950. The Milk (Special Designation) (Raw Milk) Regulation, 1949. Licences for the sale of milk under Special Designations were granted as follows:— Dealers' Licences. Pasteurised 46 Sterilised 87 Tuberculin Tested 24 Licences (Plant). Pasteurisers 2 Supplementary Licences. Pasteurised 9 Sterilised 10 Tuberculin Tested 9 Tuberculin Tested (Dealers) 2 33 There are no Cow-keepers in the district. The number of Retail Milk Distributors is 100. One hundred and twenty seven visits were paid to registered dealers and a satisfactory standard of cleanliness was maintained. The Milk (Special Designations) (Specified Areas) Order, 1951. The above Order, which came into operation on the 1st October, implemented Sub-Section (1) of Section 19 of the Food & Drugs (Milk, Dairies and Artificial Cream) Act, 1950, relating to the compulsory use of special designations for retail sales of milk. This Borough is included in the Specified Areas, therefore, all milk sold must be either Pasteurised or Sterilised. (b) Ice Cream. Sixty-five applications for Registration were received. New licences were granted as follows:— Vendors, New 34 Vendors, Transfers 28 Refused 2 Withdrawn 1 Number on Register at end of year 249 Number of above receiving allocations of fats, sugar, etc., for manufacturing 25* * Twelve of these pass their dockets to other firms who manufacture for them. Ice Cream (Heat Treatment, Etc.)—Regulations, 1947-51. The trade has continued to maintain a very good standard to comply with the above Regulations. Medical Examination—Typhoid, Etc., Carriers. The scheme of voluntary medical examination and blood testing of employees in the ice cream trade has now reached its fifth year. A session is held one afternoon a week and 88 employees presented themselves for the purpose of having blood specimens taken by the Medical Officer of Health. No "Carriers" were found during the period under review. Bacterial Quality and Grading of Ice Cream. One hundred and thirty-eight samples were submitted for bacteriological examination and for grading in accordance with the Provisional Test of the Ministry of Health. 34 The following summary gives the comparative results of the old standard test and the new (provisional) test. Grades I and II of the latter are considered satisfactory. Place Count Coliform Reaction (in 1/10 ml.) Bacterium coli (in 1/10 ml.) Satisfactory *Passable Not Passable Methylene Blue Test Reduction time Grade 100 – – X Not in 4 hours I 180 – – X „ 4 „ I 200 – – X „ 4 „ I 700 – – X „ 4 „ I 200 – – X „ 4 „ I 400 – – X „ 4 „ I 200 – – X „ 4 „ I 3,700 xl tube – X „ 4 „ I 900 – – X „ 4 „ I 1,400 – – X „ 4 „ I 9,200 – – X „ 4 „ I 900 – – X „ 4 „ I 600 x1 tube – X „ 4 „ I 1,100 – – X „ 4 „ I 400 – – X „ 4 „ I 3,000 – – X „ 4 „ I 700 – – X „ 4 „ I 1,500 – – X „ 4 „ I 1,500 – – X „ 4 „ I 300 – – X „ 4 „ I 300 – – X „ 4 „ I 200 – – X „ 4 „ I 800 – – X „ 4 „ I 300 – – X „ 4 „ I 500 – – X „ 4 „ I 600 – – X „ 4 „ I 1,600 – – X „ 4 „ I 900 – – X „ 4 „ I 3,600 – – X „ 4 „ I 600 – – X „ 4 „ I 1,200 – – X „ 4 „ I 2,000 – – X „ 4 „ I 500 – – X „ 4 „ I 3,000 – – X „ 4 „ I 3,500 – – X „ 4 „ I 1,200 – – X „ 4 „ I 1,500 – – X „ 4 „ I 1,200 – – X „ 4 „ I 2,000 – – X „ 4 „ I 1,700 x2 tubes – X „ 4 „ I 500 – – X „ 4 „ I 900 – – X „ 4 „ I 1,200 – – X „ 4 „ I 1,500 – – X „ 4 „ I 600 – – X „ 4 „ I 600 xl tube – X „ 4 „ I 900 – – X „ 4 „ I 2,100 – – X „ 4 „ I 300 – – X „ 4 „ I 800 – – X „ 4 „ I 1,500 x1 tube – X „ 4 „ I 300 – – X „ 4 „ I 700 – – X „ 4 „ I 35 Plate Count Coliform Reaction (in 1/10 ml.) Bacterium coli (in 1/10 ml. Satisfactory •Passable Not Passable Methylene Blue Test Reduction time Grade 1,600 – – X Not in 4 hours I 15,000 – – X „ 4 „ I 4,000 – – X „ 4 „ I 6,000 – – X „ 4 „ I 900 – – X „ 4 „ I 400 – – X „ 4 „ I 2,200 – – X „ 4 „ I 9,000 – – X „ 4 „ I 300 xl tube – X „ 4 „ I 1,200 – – X „ 4 „ I 4,000 – – X „ 4 „ I 4,200 – – X „ 4 „ I 700 – – X „ 4 „ I 2,200 – – X „ 4 „ I 3,000 – – X „ 4 „ I 1,200 xl tube – X „ 4 „ I 1,500 – – X „ 4 „ I 200 – – X „ 4 „ I 900 – – X „ 4 „ I 400 – – X „ 4 „ I 4,200 – – X „ 4 „ I 800 – – X „ 4 „ I 650 – – X „ 4 „ I 3,200 – – X „ 4 „ I 800 – – X „ 4 „ I 180 – – X „ 4 „ I 3,200 – – X „ 4 „ I 1,500 xl tube – X „ 4 „ I 2,800 – – X „ 4 „ I 1,200 – – X „ 4 „ I 3,000 xl tube – X „ 4 „ I 1,200 – – X „ 4 „ I 1,100 – – X „ 4 „ I 1,500 – – X „ 4 „ I 600 – – X „ 4 „ I 2,000 – – X „ 4 „ I 1,800 – – X „ 4 „ I 1,200 – – X „ 4 „ I 1,700 – – X In 4 „ II 1,200 x2 tubes – X „ 4 „ II 400 – – X „ 4 „ II 8,000 – – X „ 4 „ II 6,000 xl tube – X „ 4 „ II 5,500 x2 tubes – X „ 4 „ II 5,500 x2 tubes – X „ 3½ „ II 500 – – x „ 3½ „ II 3,700 – – X „ 3½ „ II 5,200 x2 tubes – X „ 3½ „ II 2,000 xl tube – X „ 3 „ II 800 xl tube – X „ 3 „ II 15,000 x2 tubes – X „ 3 „ II 40,000 x3 tubes – X „ 3 „ II 7,000 – – x „ 3 „ II 30,000 xl tube – x „ 3 „ II 7,000 xl tube – X „ 3 „ II 8,000 x3 tubes x2 tubes X „ 3 „ II 3,300 x3 tubes – X „ 3 „ II 2,400 x2 tubes – x „ 3 „ II 20,000 – – X „ 3 „ II 36 Plate Count Coliform Reaction (in 1/10 ml.) Bacterium coli (in 1/10 ml. Satisfactory *Passable Not Passable Methylene Blue Test Reduction time Grade 2,700 x3 tubes xl tube X In 2½ hours II 4,000 x3 tubes xltube X „ 2½ „ II 15,000 – – X „ 2½ „ II 3,000 x2 tubes – X „ 2½ „ II 4,000 x3 tubes – X „ 2½ „ II 4,300 x2 tubes – X „ 2½ „ II 2,000 x3 tubes x3 tubes X „ 2½ „ II 12,000 x2 tubes – X „ 2½ „ II 20,000 – – X „ 2 „ III 50,000 x3 tubes xl tube X „ 2 „ III 42,000 x3 tubes – X „ 2 „ III 65,000 x3 tubes x3 tubes X „ 2 „ III 52,000 x3 tubes – X „ 2 „ III 78,000 x3 tubes – X „ 1½ „ III 2,800 x2 tubes – X „ 1½ „ III 17,000 xl tube – X „ 1½ „ III 45,000 x3 tubes – X „ 1½ „ III 16,000 x3 tubes – X „ 1 „ III 3,600 x3 tubes – X „ 1 „ III 13,000 x3 tubes xl tube X „ ½ „ III 25,000 x3 tubes – X „ ½ „ III 42,000 x3 tubes – X „ 0 „ IV 12,000 – – X „ 0 „ IV 250,000 x3 tubes x3 tubes X „ 0 „ IV 170, 000 x3 tubes – X „ 0 „ IV 8,000 x2 tubes – X „ 0 „ IV * The Bacteriologists' reports call attention to desired improvement. By the old test, of a total of 138, 107 were in the categories "Very Satisfactory" or "Satisfactory" and 22 "Passable." In the latter group the bacteriologists invariably amplified their classification with a special note. By the new (provisional) test, 91 were in Grade I, 29 Grade II, 13 Grade III and 5 Grade IV. When an unsatisfactory sample is obtained the vendor is re-sampled as soon as possible. In the case of ice cream manufactured other than within the district, copy reports are sent to the appropriate local authority. Ice Lollies. Eight samples were submitted to the Public Analysts who reported all free from metallic poisoning. (c) Meat and Other Foods. The Live Stock (Restriction of Slaughtering) Order, 1940, continued in force and no slaughtering was carried out. 37 The following summary gives details of food condemned as unfit for human consumption. Where possible the food was salvaged for animal feeding purposes, etc. 1245 tins Evaporated Milk 238 „ Full Cream Milk 111 „ Machine Skimmed Milk 1 cwt. Milk Powder 777 tins Strained Foods 7 „ Cocoa-Malt 52 „ Sardines 40 „ Pilchards 33 „ Salmon 7 „ Herrings 5 „ Roe 3 „ Fish Paste 3 „ Crayfish 3 ,, Brisling 3 „ Crab 2 „ Anchovies 1 tin Crab Paste 627 tins Peas 348 „ Beans 327 „ Tomatoes 66 „ Beetroot 64 „ Carrots 36 „ Potatoes 17 „ Rhubarb 7 „ Vegetable Salad 1 tin Celery 1 „ Mushrooms 1 „ T urnips 1594 tins Cherries 825 „ Plums 123 „ Damsons 89 „ Peaches 76 „ Apples 63 „ Raspberries 53 „ Pineapple 37 „ Blackcurrants 32 „ Apricots 32 „ Greengages 26 „ Oranges 24 „ Strawberries 14 „ Fruit Salad '' » Gooseberries 9 „ Pears 9 „ Grapes 6 tins Grapefruit Juice 5 „ Grapefruit 5 „ Prunes 2 „ Guavas 2 „ Coconut in Syrup 1 tin Blackberries 1 „ Mangoes 5 tins Loganberries 20 lbs. Apricot Pulp (tinned) 1 gall. Nectarines (tinned) 123 tins Jam 29 „ Marmalade 6 jars Peanut Butter 8 „ Lemon Spread 6 „ Honey Spread 2 „ Sandwich Spread 12 tins Syrup 10 „ Mincemeat 2 „ Pudding 120 „ Spaghetti 1 tin Pate de Fois Gras 2¼ galls. Pickled Gherkins 8 bots. Sauce 6 jars Pickles 3 „ Salad Cream 1 jar Horse-radish 1 „ Capers 208 tins Soup 168 pkts. Soup 6 „ Gravy Browning 4 „ Seasoning 10 jars Meat Paste 450 tins Luncheon Meat 29 „ Stewed Steak 16 „ Pork 14 „ Sausages 9 „ Kidneys 7 „ Tongue 3 „ Brawn 3 „ Meat and Gravy 3 „ Cooked Pork 2 „ Minced Beef 2 „ Potted Meat 1 tin Steak Pudding 1 „ Meat and Vegetables 38 1 tin Chicken 43 tins Beef Loaf 6 „ Veal and Ham Loaf 6 „ Ham Loaf 5 „ Pork Loaf 2 „ Veal Loaf 3254 lbs. Ham (tinned) 1061 „ Beef 523 „ Corned Beef 96 „ Jellied Veal (tinned) 52 „ Ox Cheeks 30 „ Brawn 21 „ Lamb 10 „ Beef Fat 9 „ Bacon 6 „ Ox Tongue 41 pkts. Macaroni 4 tins Rice 1 tin Semolina 71 tins Coffee (compound) 10 bots. Coffee (extract) 1 lb. Tea 1069 lbs. Sugar 19 „ Salt 5 drums Dried Onions 28 lbs. Sultanas 14 „ Figs 63 „ Margarine (tinned) 39 „ Butter 12 „ Fat Compound 16½ ,, Beef Dripping 423 pkts. Pudding Mixture 9 „ Sponge Mixture 6 „ Baking Powder 9 lbs. Albumen 360 pkts. Barley Flour 210 lbs. Flour 2 „ Cornflour 74 pkts. Jelly 62 „ Custard Powder 6 „ Junket 76 lbs. Cheese 54boxesCheese (portioned) 66 lbs. Vanilla Wafers 4¼ „ Sandwich Cake 205 „ Desiccated Coconut 96 „ Almonds 93 „ Milk Chocolate Couverture 70 „ Vitacream Easichoc 42 „ Marshmallow 14 „ Marzipan 38 „ Chocolate Dates 22 „ Confectionery 12 drums Lemonade Crystals 134 Xmas 6? Wedding Cakes 31 Sponge Sandwiches 19 stone Skate 10 „ Roker 10 „ Roe 7 „ Whiting 3 „ Cod 1 „ Lemon Soles 1 bushel Winkles 3 Hindquarters Beef (557 lbs.) 20 Pigs' Plucks (136 lbs.) 3 Lamb Carcases (143 lbs.) 126 Lambs1 Heads (404 lbs.) 44 Ox Heads (1020 lbs.) 1 Calf Carcase (50 lbs.) 1 Calf's Head 123 Eggs 104 Rabbits 10 Turkeys (97 lbs.) 3 Geese (18 lbs.) Canned Ham. Owing to the large quantities of imported canned ham condemned each month, the Council directed that a communication be sent to the Ministry of Food calling attention to the undesirability of allowing the importation of this grade of food. The Ministry of Food has now placed an embargo on canned ham from several countries. 39 (d) Adulteration, etc.— Food and Drugs Act, 1938. One hundred and fifteen samples of food and drugs were submitted to the Public Analysts. Four were reported as being unsatisfactory, particulars of same are given below:— Description of Article Result of Analysis Action Taken Vinegar Not genuine — nonbrewed. Court proceedings. Case dismissed. 40/- costs. Luncheon Meat Unfit—slight excess of lead and tin. Stock surrendered (5 tins). Ice Cream (2) Deficient in fat Investigation. Deficiency due to use of imported fat-compound. The following summary gives details of food and drugs sampled and the results of analyses:— No. examined No. unsatisfactory Milk Formal 28 Informal – Total 28 Formal Informal Total Milk Powder, Skimmed – 1 1 – – – Cake Flour Mixture 1 – 1 – – – Chocolate, Milk – 1 1 – – – Cinnamon, Ground 1 – 1 – – – Doughnut – 1 1 – – – Cream Cake – 1 1 – – – Fish Paste – 1 1 – – – Flavouring, Vanilla – 1 1 – – – Flavouring, Pineapple – 1 1 – – – Flavour Compound, Lime – 1 1 – – – Malted Milk – 1 1 – – – Meat Pie – 1 1 – – – Luncheon Meat – 2 2 – 1 1 Olive Oil 1 1 2 – – – Onion Relish – 1 1 – – – Sage & Onion Stuffing 1 – 1 – – – Tomato Ketchup – 1 1 – – – Pickling Spice – 1 1 – – – Fruit Chutney – 1 1 – – – Salad Cream – 1 1 – – – Table Cream – 1 1 – – – Vinegar 5 1 6 1 – 1 Potato Crisps – 1 1 – – – Baking Powder – 1 1 – – – Pepper 1 1 2 – – – Beef Cubes – 1 1 – – – Fruit Salad in Syrup 1 – 1 – – – Rhubarb in Syrup – 1 1 – – – Fruit, Mixed Dried with added Sugar 1 – 1 – – – Rice, Flaked 1 – 1 – – – Cream Powder, Synthetic – 1 1 – – – Macaroon 1 – 1 – – – Farinoca 1 – 1 – – – Jelly 1 1 2 – – – Jelly Crystals 1 – 1 – – – Ice Cream 2 19 21 1 1 2 40  No. examined No. unsatisfactory Formal Informal Total Formal Informal Total Iced Lollies – 8 8 – – – Coconut, Shredded 1 – 1 – – – Peanut Butter – 1 1 – – – Tea Time Tablets – 1 1 – – – White Wine 1 – 1 – – – Whisky 4 – 4 – – – Rum 1 – 1 – – – Castor Oil – 1 1 – – – Borax and Honey – 1 1 – – – White Precipitate Ointment – 1 1 – – – Gripe Water – 1 1 – – – Chloro Gums 1 – 1 – – – 55 60 115 2 2 4 (e) Chemical and Bacteriological Examination of Foods. Chemical examinations of food samples are carried out by the Public Analysts, Mr. G. Taylor, F.R.I.C., and Dr. J. H. Hammence, F.R.I.C., of 20, Eastcheap, E.C.3, and bacteriological examinations by the Counties Public Health Laboratories, 66, Victoria Street, S.W.1. (/) Clean Food Campaign. During the last few years traders and the public alike have become more clean-food conscious. This has been brought about by judicious publicity on all phases of food hygiene. No opportunity is missed in reminding all concerned that the clean food campaign has come to stay and it must be a progressive feature in Food Factory, Shop, Canteen and Home. The District Sanitary Inspectors carry out routine visits to all premises where food is prepared. Informal talks with the staffs on the necessity for absolute care and cleanliness in food handling materially help to keep the important subject well to the fore. Lectures in connection with the campaign continue to be given. Reminders were sent to 850 traders during the months of May and August calling attention to the Council's Byelaws re Handling, Wrapping and Delivery of Food, and Sale of Food in the Open Air. Laxity in "food handling" undoubtedly developed during the long war years. We have made some definite steps forward since, but owing to the great increase in cost of wrapping papers, containers, protecting screens and cabinets, overalls, etc., many traders find it difficult to attain or maintain the standard they desire. The free use of Public Conveniences and washing facilities throughout the Borough has been continued. 41 (g) Hygiene in Catering Trades. The report of the working party was brought to the attention of all Council Departments engaged in catering and copies were made available in the Public Libraries. (h) Dogs in Food Shops. The form of notice suggested by the Ministry of Health for exhibition by food traders was adopted and copies of the notice have been distributed to all food traders during the current year. (i) Food Poisoning Outbreaks. No "Outbreaks" occurred but ten sporadic single cases and two family cases (two members each) were investigated. DISEASES OF ANIMALS ACTS Swine Fever Order, 1938.—No action necessary. Regulation of Movement of Swine Order, 1950.—One licence received respecting eighteen pigs and two issued regarding four pigs. Foot and Mouth Disease (Controlled Areas) Special Orders Nos. 3 & 4, 1951.—Two licences countersigned regarding nine pigs. Parasitic Mange Order, 1938.—No action necessary. The following Orders were dealt with as necessary:— Live Poultry (England 6? Wales) (Restrictions) Order, 1950 and (Amendment) Order, 1951. Live Poultry (East Anglia) (Restrictions) Order, 1950. Live Poultry (Restrictions) Order, 1951. Poultry Carcases (Importation) (Amendment) Order, 1951. Isles of Scilly (Prohibition of Importation of Live Poultry and Hatching Eggs) Order, 1951. Foot and Mouth Disease (Controlled Areas) Order No. 11, 1951. PREVENTION OF DAMAGE BY PESTS ACT, 1949 Our rodent repression scheme has continued on the lines required by the Ministry of Agriculture and Fisheries Infestation Control Division. Two whole-time trained Operatives are engaged on work in connection with private dwellings and business premises. 42 The following summary of work carried out during the year is in the revised form as suggested by the Infestation Control Division :— Type of Property Local Authority Dwelling Houses Agricultural All other (including Business & Industrial) TOTAL I. Total No. of properties in Local Authority's District 15 32,505 5 2,542 35,067 II. No. of properties inspected by the Local Authority during 1951 as a result (a) of notification (a) 15 433 1 72 521 or (b) otherwise (b)– 82 – 144 226 III. No. of properties (under II) found to be infested by rats Major – 11 1 9 21 Minor 3 398 – 20 421 IV. No. of properties (under II) found to be seriously infested by mice 1 106 43 150 V. No. of infested properties (under III &? IV) treated by the Local Authority 4 456 1 65 526 VI. No. of Notices served under Section 4 :— (1) Treatment – 5 – 1 6 (2) Structural Works (i.e., Proofing) – 51 – 1 52 Total – 56 – 2 58 VII. No. of cases in which default action was taken by Local Authority following issue of notice under Section 4 – – – – Nil VIII. Legal Proceedings – – – – Nil IX. No. of "block" control schemes carried out – – – – 9 43 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 67 178 11 Nil Factories not included above in which Section 7 is enforced by the Local Authority 455 627 39 Nil Other premises in which Section 7 is enforced by the Local Authority 41 129 4 Nil Totals 563 934 54 Nil 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) (6) (6) Want of cleanliness 73 68 – 2 – Overcrowding 1 1 – – – Unreasonable temperature 1 1 – – – Inadequate ventilation 11 7 – – – Ineffective drainage of floors 5 5 – – – Sanitary Conveniences insufficient 12 11 – 1 – unsuitable or defective 114 97 – 9 – not separate for sexes 1 1 – – – Other offences 59 57 – – – Totals 277 248 – 12 –– 44 NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1951 Wearing apparel, making of 433 Artificial Flowers 3 Boxes 32 Stuffed toys 17 Curtains and furniture hangings 1 Paper bags 45 Brush-making 5 Basket-making 1 Brass and brass articles 7 Total 544 45 F.— PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES General.— The following tables show the age and ward incidence of the various infectious diseases which are referred to in later pages of the report. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. 1951 1950 Scarlet Fever 118 181 1 29 85 3 – – – Whooping Cough 742 502 47 421 262 2 9 1 – Measles 2295 308 59 1137 1085 10 4 – – Diphtheria – 1 – – – – – – – Pneumonia 84 43 1 4 12 3 18 27 19 Meningococcal Infection 5 5 – 3 – – 2 – – Acute Poliomyelitis : Paralytic 8 13 – 2 4 2 – – – Non-Paralytic 1 – – – – 1 – – – Acute Infect. Encephalitis – – – – – – – – – Post Infect. Encephalitis – – – – – – – – – Dysentery 159 6 85 34 9 16 13 2 Ophthalmia Neonatorum 2 1 2 – – – – – – Puerperal Pyrexia 43 14 – – – 16 27 – – Smallpox – – – – – – – – – Paratyphoid Fevers 1 1 – – – 1 – – – Typhoid Fever 1 – – – – 1 – – – Food Poisoning 14 28 – 1 1 2 4 5 1 Erysipelas 33 29 – – – – 9 13 11 Malaria 2 – – – – – 2 – – Tuberculosis 123 105 – 9 13 31 41 26 3 Totals, 1951 3631 – 110 1691 1496 81 132 85 36 Totals, 1950 – 1237 45 506 468 61 79 57 21 St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Totals. Scarlet Fever 14 8 19 16 34 27 118 Whooping Cough 101 92 86 88 202 173 742 Measles 333 231 372 259 550 550 2,295 Diphtheria – – – – – – – Pneumonia 21 8 13 15 15 12 84 Meningococcal Infection 2 – – – – 3 5 Acute Poliomyelitis : Paralytic 2 1 2 1 1 1 8 Non-Paralytic – – – – – 1 1 Acute Infect. Encephalitis – – – – – – – Post Infect. Encephalitis – – – – – – – Dysentery 41 13 13 15 21 56 159 Ophthalmia Neonatorum – – – 1 1 – 2 Puerperal Pyrexia 1 8 4 15 4 11 43 Smallpox – – – – – – – Paratyphoid Fevers 1 – – – – – 1 Typhoid Fever – 1 – – – – 1 Food Poisoning 5 1 2 – 4 2 14 Erysipelas 6 1 4 2 90 11 33 Malaria – 1 – –_ – 1 2 Tuberculosis 22 11 16 17 20 37 123 Totals, 1951 549 376 531 429 861 885 3,631 Totals, 1950 220 136 199 114 306 262 1,237 46 The Registrar-General gives the statistics for the 52 weeks ended 31st December, 1951, 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 118 – 2 84 43 33 Case rate — England and Wales 1.11 0.02 0.02 0.99 Not available 0.14 Walthamstow 0.98 – 0.01 0.69 0.35 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 25.67 England and Wales 10.66 The rate for Walthamstow has been high because of the strict ness of notification at the Maternity Hospital, i.e., cases are notified which in other areas would probably not be notified. SCARLET FEVER A total of 118 cases of Scarlet Fever was notified during 1951 as compared with 181 in 1950. The incidence by months and wards is given below :— January 13 February 8 March 11 April 10 May 9 June 9 St. James Street 14 High Street 8 Hoe Street 19 July 2 August 5 September 8 October 16 November 10 December 17 Wood Street 16 Hale End 34 Higham Hill 27 The last fatal case of scarlet fever occurred in 1936 and since then up to the end of 1951 there have been 3,819 notified cases without fatality. DIPHTHERIA During 1951, 11 cases were notified but none was confirmed following observation in hospital. There has been no death from Diphtheria in the Borough for five years. 47 The suggestions as to publicity made by the Ministry of Health were carried out. Diphtheria immunisation is referred to more fully in Section G of the Report in regard to Part III Health Services. The report included below was made to the Committee in April, 1952:— "The following is extracted from the March issue of the Monthly Bulletin of the Ministry of Health:— "The situation is now being reached—a situation scarcely dreamed of in 1940 when the immunisation campaign started —where the eradication of diphtheria as a disease in this country can be foreseen as a very real possibility within the next few years, providing there is no slackening in the immunisation efforts that have been so dramatically successful in the past 10 years. Complacency resulting from what has already been achieved, or loss of interest or of confidence in immunisation, may mean that diphtheria will go on occurring in this country indefinitely, with the ever-present risk of a return to high mortality; but a vigorously continued immunisation programme, combined with existing methods of epidemic control, may free us entirely from the disease except for the occasionally imported case.' "In Walthamstow during the last five years (1947/51) 114 patients were admitted to hospital for observation for possible diphtheria. This is the only reasonable course to be taken in a formidable disease like diphtheria. Of these 114 patients, only two were confirmed as diphtheria and there were no deaths. "By contrast, during the previous five years, i.e., 1942/46, there were 306 admissions, 80 being confirmed as diphtheria, with 10 fatal cases. Going back even further, there were 238 admissions to hospital and 15 deaths during the five years 1937/41, and 1,155 admissions and 26 deaths during the five years 1932/36. "It is now estimated that if a non-immunised child catches diphtheria, the chances of dying from the disease are seven times greater than those of an immunised child. "The need still remains to concentrate on the immunisation of as many babies as possible on reaching the age of nine months. At present, about 40% of the babies born annually are immunised before reaching the age of one year, but the target still remains at 75%." 48 MEASLES AND WHOOPING COUGH During the post-war years, the general position in regard to these childhood infections has been as follows:— Year Measles Whooping Cough 1947 1,081 223 1948 639 565 1949 1,550 226 1950 308 502 1951 2,295 742 The details of incidence during 1951 by months and wards are as follows:— Measles. January 343 February 760 March 629 April 301 May 68 June 51 St. James Street 333 High Street 231 Hoe Street 372 July 12 August 7 September 22 October 62 November 19 December 21 Wood Street 259 Hale End 550 Higham Hill 550 Whooping Cough. January 216 February 162 March 102 April 67 May 48 June 45 St. James Street 101 High Street 92 Hoe Street 86 July 35 August 7 September 7 October 10 November 21 December 22 Wood Street 88 Hale End 202 Higham Hill 173 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 1950 27 40 68 82 58 227 502 1951 47 70 110 101 140 274 742 Many fewer cases under two years of age (and especially under one year) occurred in 1951 than in 1948 when there were six deaths. 49 ACUTE PNEUMONIA January 18 February 16 March 8 April 7 May 10 June 1 St. James Street 21 High Street 8 Hoe Street 13 July 3 August 1 September 2 October 5 November 6 December 7 Wood Street 15 Hale End 15 Higham Hill 12 INFLUENZA During the first quarter of 1951 there were seven deaths from influenza in January, five in February, and one in March, compared with none for the same quarter in 1948 which was a low year "GASTRIC" INFLUENZA In September some 49 cases of sickness were reported at a Girls' School. Absences were mainly only for one day. Twelve of the children did not take school meals. Detailed visits, inspections, and examinations were carried out by the Medical, Nursing and Sanitary staffs. Food and milk samples were examined but no definite conclusion was reached as to the nature of the infection nor of the cause. Probably it was a virus infection usually referred to either as gastric influenza or winter vomiting. In November attention was drawn to an epidemic of vomiting with occasional sickness, which had affected an infants' school since September. The total number of cases was 52, roughly half of which had occurred in the previous fortnight. The usual enquiries and inspections, both at the school and at children's homes, were carried out and the position was discussed with the Consultant in Pathology for the area, who suggested that in view of the negative pathological findings, the condition was probably one of " winter vomiting." Some 72 children were visited by the School Nurse, and the total number of cases was 84 before the outbreak ended naturally at the beginning of December. MENINGOCOCCAL INFECTION Five cases were notified, the particulars being as follows:— Sex Age Ward Hospital Remarks 1. M. 21 yrs. James Street Yes Recovered. 2. M. 26 yrs. Higham Hill Yes Recovered. 3. M. 2½ yrs. Higham Hill Yes Recovered. 4. F. 1½ yrs. Higham Hill Yes Recovered. 5. F. 43 yrs. James Street Yes Recovered. By contrast, in 1950 of 50 cases, 2 were fatal. MALARIA Two cases were notified but both were recurrent cases of malaria contracted abroad. 50 ACUTE ANTERIOR POLIOMYELITIS AND POLIOENCEPHALITIS Nine cases were notified in 1951, including one non-paralytic case. No. Sex Age Ward Date of onset Date notified Date of removal to hospital Site of Paralysis Final Follow-up Report The particulars in regard to these cases are :— 1. M. 5 St. James St 4.1.51 6.1.51 6.1.51 Bulbo-Spinal Slight paralysis face; under treatment. 2. F. 8 St. James St. 3.1.51 10.1.51 10.1.51 Spine Recovered. 3. F. 3½ Wood Street 27.11.50 3.2.51* 27.1.51 Quadriceps Recovered. 4. F. 15 Hale End 24.12.50 19.2.51* 24.12.50 Palatal Recovered. 5. M. 6 Hoe Street 4.5.51 25.5.51* Not removed Left leg Slight wasting left leg. 6. F. 3 High Street 8.8.51 12.8.51 12.8.51 Left arm Out Area case— left for own home. 7. F. 23 Higham Hill 18.8.51 20.8.51 20.8.51 Legs and arms Able to walk but cannot do housework. 8. M. 23 Higham Hill 28.8.51 26.9.51* 3.9.51 Non-paralytic (polioencephalitis) Recovered. 9. F. 13 Hoe Street 18.9.51 27.9.51 26.9.51 Bulbar poliomyelitis Recovered. * Cases 3, 4 and 8 were discovered on return home. Delay in notification was due to admission to hospital. Case No. 5 attended hospital as an out-patient. 51 Individual case reports were sent to the Medical Research Council in connection with their research. The usual follow-up of notified cases was carried out after recovery and a note made of the degree of the remaining disability, ability to work and nature of work, to use public transport and the general domestic circumstances. Where applicable, advisability was stressed as to registration as a Disabled Person and attention was drawn to the activities of the local branch of the Infantile Paralysis Fellowship. ACUTE ENCEPHALITIS No notifications were received. BACILLARY DYSENTERY Unlike its predecessor, 1951 produced a considerable amount of dysentery. The 159 notifications are analysed below :— January 33 July 3 February 75 August 1 March 41 September — April 2 October 1 May 1 November — June 2 December — St. James Street 41 Wood Street 15 High Street 13 Hale End 21 Hoe Street 13 Higham Hill 56 Notifications of dysentery in previous years have been as follows :— Year No. of notifications Year No. of notifications 1932 9 1941 0 1933 0 1942 3 1934 0 1943 71 1935 1 1944 83 1936 5 1945 84 1937 84 1946 25 1938 23 1947 0 1939 3 1948 2 1940 1 1949 3 1950 6 1937 figures include 49 notified cases at the Nursery school, the true incidence being nearer 90. The school was closed temporarily to limit the epidemic. 52 The 1944 figures include outbreaks at two of the Day Nurseries, 31 at Wyatts Lane and 13 at Higham Hill. The Day Nurseries were not closed, the infection lasting about six weeks at Wyatts Lane and about four weeks at Higham Hill. The 1945 figures include nine at Higham Hill Day Nursery and six at Handsworth Avenue Day Nursery and 26 at various schools. During 1951 both Day Nurseries were again affected, the details being as follows :— Nursery. Date of commencement. Date last case cleared No. of cases. Handsworth Avenue 19.1.51 7.3.51 16 Higham Hill 23.1.51 6.3.51 22 Nursery School 13.2.51 12.4.51 42 Dr. Watkins, Deputy Medical Officer of Health, suggested the prophylactic use of a Sulpha drug and the following is an abridged statement:— "After consultation with the Ministry of Health and the County Medical Officer, and with the authority of your chairman, it was decided to administer succinylsulphathiazole prophylactically to all members of the staff and to all children remaining in the Nursery. "Treatment was commenced on Monday, 29th January, at the two nurseries and continued over the next two weeks Before prophylaxis was commenced all parents were warned of the existence of dysentery at the Nurseries and were informed that if they wished, they should keep their children at home, and that the admission of children on and after the 29th was to be on the understanding that a prophylactic drug would be given. "Children aged 1-3 years were given 1 gramme per day, children aged 3-5 years 2 grammes per day and adults 3 grammes per day. "On Monday, 5th February, all staff and children were swabbed at the Handsworth Avenue Day Nursery and similarly at the Higham Hill Day Nursery on the 6th February. Different dates had to be arranged owing to pressure on the Pathological Laboratory in view of the incidence of dysentery generally and particularly at a residential institution in another area. The total number of swabs taken was 84, and all were negative. 53 "On the Monday and Wednesday following the 10-day course of prophylactic treatment, i.e., spread over a fortnight, swabs were again taken from staff and children remaining in the Nurseries, and again all were negative. "Higham Hill Day Nursery was back to its pre-epidemic attendance by the 12th February, i.e., in three weeks, and Handsworth Avenue by the 14th February. "Concurrent with dysentery in the Nursery, measles and whooping cough were also epidemic in the Borough, and to some extent affected day nursery attendances. " It is felt that the use of this prophylactic was justified. "Some 3,500 tables were required at a total cost of £28 9s. 4d." Washing Facilities at Schools. In February a question was raised as to the supply of paper towels in schools other than infants' schools which were already being supplied. The cost of supplying all schools was found to be prohibitive, and it was finally decided to supply paper towels to those schools in which dysentery had occurred and until cases had ceased for two weeks. Bacillary Dysentery at Nursery School. The first case of Sonne Dysentery was notified in mid-February, the school being cleared by mid-April with a total of 42 cases. The routine which had been worked out for the control at Day Nurseries was applied, including the prophylactic use of a sulphonamide (Thalazole). OPHTHALMIA NEONATORUM Two cases were reported and in neither case was vision impaired. PUERPERAL PYREXIA The total of notifications rose to 43 as against 14 in 1950 and 17 in 1949 and an average of 27 each year during the period The new regulations came into force on August 1st, notifications during the previous seven months being 15 and during the subsequent five months 28—wholly due to the new definition of notifiable pyrexia. Forty of the notifications were from hospitals. 54 SMALLPOX Eight cases were seen during the year as contacts of smallpox or for diagnosis. Six were from ships which had carried cases of smallpox ; the other two were cases of chicken pox in which the family doctor wished confirmation of diagnosis. The services of the Central Public Health Laboratory at Colindale were again used for the examination of specimens. ENTERIC FEVER Two cases were notified, one of typhoid and one of paratyphoid. Both were males in the 15/25year group and both were food workers. The patient with typhoid was a baker's vanboy and in spite of the fullest enquiries, the source of infection was not traced. On discharge from hospital and with the co-operation of the patient, his parents and the Youth Employment Officer, he was placed in other employment not involving food handling. The paratyphoid patient was a learner-waiter in another area. Again, no source of infection could be discovered and on discharge from hospital and the satisfaction of the usual clearance tests, he was permitted by the Area concerned to resume his employment. The phage types were "untypable" and "Jersey" respectively. Public Health (Infectious Diseases) Regulations, 1947. 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 person referred to in the Report for 1949 remained suspended from her work at a cafe. FOOD POISONING The annual return of food poisoning notifications made to the Ministry of Health was as follows :— 1. Local Authority—Borough of Walthamstow. Year 1951. 2. Food Poisoning Notifications (Corrected) Returned to R.G. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 1 3 4 6 14 55 3. Outbreaks Due to Identified Agents. Total Outbreaks Nil Total Cases Nil Outbreaks due to :— (a) Chemical Poisons. (d) Cl. botulinum. (b) Salmonella Or ganisms (c) Staphylococci (in- (e) Other bacteria. cluding toxin) Nil. 4. Outbreaks of Undiscovered Cause. Total Outbreaks Nil Total Cases Nil 5. Single Cases. Agent Identified Unknown Cause Total 1 duck egg ? Salmonella. 12 14 1 Salmonella Typhi murium. All were single cases except four. The articles suspected included meat pudding, duck eggs, eel pies, ham, shell fish and cream puffs, i.e., those articles of food long associated with food poisoning. In only three instances was the suspected food consumed away from home. The danger from insufficiently cooked duck eggs cannot be overstressed—boiling should be for at least ten minutes and they should not be used in lightly cooked foods. No particular food was suspect in the typhi murium case who was an excreter on hospital discharge in November, 1951, but was negative in February, 1952. ERYSIPELAS The incidence by months and Wards is given below:— January 2 July 3 February 3 August 1 March 3 September — April 7 October 2 May 5 November 5 June 2 December — St. James Street 6 Wood Street 2 High Street 1 Hale End 9 Hoe Street 4 Higham Hill 11 56 TUBERCULOSIS The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1951 :— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year - — - — — - — — 1- 5 years 3 2 2 2 — - — 1 5-10 „ 3 2 1 1 — — — — 10-15 „ — 3 2 1 — — — — 15-20 „ 4 10 3 — — 1 — — 20-25 „ 8 6 — — 1 1 — — 25-35 „ 15 7 2 — 2 - — — 35-45 „ 8 9 — — 6 3 2 — 45-55 „ 16 2 1 — 8 2 — — 55-65 „ 5 2 — — 7 — 1 — 65 and over 2 1 — — 1 1 — — Totals 64 44 11 4 25 8 3 1 108 15 33 4 123 37 The 37 deaths represent a death rate of 0.31 per 1,000 population (England and Wales, 0.31). New cases in 1950 were 105 with 33 deaths—a rate of 0.26. The returns for the past two years are compared below :— Year. New Cases. Deaths. Pulmonary. NonPulmonary. Total. Pulmonary. NonPulmonary. Total. 1951 M. F. M. F. M. F. M. F. 37 64 44 11 4 123 29 8 3 1 1950 66 32 4 3 105 19 14 — — 33 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. — 2 4 — 1 — 1 — 24 — 3 2 — 57 The ratio of deaths in non-notified cases (i.e., columns to the right of the double line) to total deaths from tuberculosis was 5 to 37 or 1 to 7.4. The table given below shows the number of cases on the register at the beginning and end of 1951 :— Pulmonary. Total. NonPulmonary. Total. Grand Total. No. on Register 1st January M. F. M. F. 882 2,829 1,066 881 1,947 484 398 Notified during 1951 64 44 108 11 4 15 123 Totals 1,130 925 2,055 495 402 897 2,952 Removed from Register, 1951 38 42 80 3 6 9 89 No. on Register 31st December 1,092 883 1,975 492 396 888 2,863 Deaths from Tuberculosis in 1950. The following rates were received from the Registrar-General's Office after publication of the 1950 report :— 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 Deaths : Tuberculosis 0.36 0.42 0.33 0.39 0.26 Removals from the Register are made up as follows :— Deaths. Removals. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 25 8 3 1 13 34 - 5 33 4 47 6 V 37 52 89 58 Heat-treated milk and non-pulmonary tuberculosis. Reference is made elsewhere to the compulsory heat treatment of all milk retailed in Walthamstow since October, 1951. Virtually all milk has in fact been so treated since 1949 and it is of interest to note the decrease in notifications of non-pulmonary tuberculosis— which is mainly due to the consumption of milk infected with tubercle—with increasing heat-treatment of milk :— Year Heat Treated Milk (Estimated percentage) Notifications Deaths Before 1923 10 38 26 1923 50 57 27 1924 75 56 21 1931 80 40 13 1944 90 27 14 1946 98 25 12 1949 99.9 19 8 1950 99.9 7 — 1951 100 14 4 (N.B. The deaths mainly related to cases notified in previous years). The rise in 1951 may be due to a "time-lag" from evacuation and the consumption of non-treated milk or possibly to contact with human infections. Dr. Ramsay has very kindly assessed the probable sources of infection in these patients, and the classification would appear to be as follows :— Infection from human sources 8 Indefinite 5 Inward transfer 1 14 Milk and Dairies Regulations, 1949. Notice was served on a milk roundsman who was found to be suffering from infectious pulmonary tuberculosis. Prevention of Tuberculosis. 1. The various preventative measures detailed in the 1950 reports were in operation during 1951, except that in November the chest x-ray examination of teachers on appointment had to be stopped since the County Council would not approve of payment to the Regional Hospital Board and the Consultant. An appropriate amount had been allowed by the Walthamstow Committee for Education in the Estimates for the year 1952/53, but this was disallowed by the Local Education Authority early in 1952. 59 In April 1952, Circulars 248/9 were received from the Ministry of Education, and briefly they may be summarised as follows :— (a) Local Education Authorities are to do whatever is practicable to implement the recommendations of the Joint Tuberculosis Council, especially in regard to teachers and attendants in nursery schools. X-ray examinations will depend on local resources. (b) Teachers and intending teachers will be required to undergo chest x-ray examinations as from the 1st April, 1953. The examination of other employees will be a matter for Local Education Authorities. (c) Annual chest x-ray examinations to be done as far as practicable. The circulars also refer to the existing grounds for suspension from employment, to the follow-up of cases of high incidence amongst children, and to the fees payable for individual examination. (d) Non-maintained schools are being recommended to follow the same suggestions. 2. The mass radiography facilities available in the area of the North East Metropolitan Regional Hospital Board do not permit of an annual visit to the various sanitary districts. It is therefore a pleasure to record that an "Odelca" fitting will be provided shortly. This fitting can be attached to the x-ray plant in use at the Chest Clinic and will permit a modified system of mass radiography as a static unit. It is hoped that this additional facility will help towards the discovery of the many undiagnosed and infective cases of tuberculosis still at large. 3. In April a conference was convened in Walthamstow by the Trades' Council and various interested persons attended. B.C.G. Immunisation.—This matter is referred to more fully in the report on the School Health Services. In short, there is participation in the Medical Research Council's trials of antituberculosis vaccine amongst school-leavers. Medical Examination of Staff.—During 1951, 125 members of the staff of the County and Borough Councils, especially those working amongst children, were referred for chest X-ray as part of the normal medical examination on appointment or as an annual check-up. Contact Examinations.—In co-operation with the Chest Physician, the aim now is for the maximum possible examination of contacts by treating each notified case on the same lines as a notified case of one of the major infectious diseases. To this end, 60 both the Tuberculosis Health Visitor and the District Sanitary Inspector visit the house, and the latter in particular, concentrates on enquiry as to places of employment with a view to further confidential enquiries. No disclosure can of course be made without the patient's consent, and this adds very materially to the difficulties of such contact examinations. Rehousing on Medical Grounds.—For many years tuberculosis has been the only ground for medical priority in rehousing. In making recommendations the infectivity of the patient, over' crowding on Housing Act, 1936 standards, and the presence of young children or adolescents in the house, are taken into consideration. During 1951, the number of families rehoused was 166, which included 15 families where there was a medical recommendation in respect of tuberculosis, i.e., say 9 per cent. Care and After-Care.—This matter is dealt with under Section ' G ' of the Report. 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 Faeces 196 430 287 24 14 3 1 6 28 8 5 2 1004 Agglutinations 5 14 13 6 25 12 16 12 14 18 3 3 141 Rhesus & Group 21 20 15 7 14 24 13 7 11 18 6 8 164 Urines 3 6 10 2 3 5 2 2 8 7 5 4 57 P.N. Plates 65 37 14 13 4 5 - - - - - - 138 Nose & Throat Swabs t 8 2 2 14 19 5 - 5 6 10 6 3 80 Ear Swabs - - 1 - - - - 1 - - - 1 3 C.S. Fluid - - - - - - - - - - 1 — 1 Food 1 - - - - - - - 4 - - - 5 W.R. & Kahn — 1 1 - - - - - - - - - 3 Haemoglobin — 1 - - - - - - - - - — 1 Hairs - - - - - - - - - 1 — — 1 Total 299 511 343 66 79 54 32 33 72 62 26 21 1598 The large number of faecal examinations was due to the outbreak of Bacillary Dysentery in the first quarter of the year. 61 MISCELLANEOUS 1. Old Peoples Welfare.—The Town Clerk, as Honorary Secretary of the Old People's Welfare Committee, kindly provides the following :— "The Walthamstow Old People's Welfare Committee continues to provide, in conjunction with the statutory and other agencies, for the welfare of old people and was assisted by a financial grant made by the Council under Section 31 of the National Assistance Act 1948. "Old People's Clubs are provided by the Committee at St. Luke's Church Room, Greenleaf Road ("Welcome In" Club), St. Stephen's Church Room, Copeland Road ("Evergreen Club"), Methodist Church Hall, Gloucester Road ("Valentine Club"), Winchester Road Methodist Church Hall ("Darby and Joan" Club). The Committee are actively considering opening other Clubs particularly in the St. James' Street and Wood Street Areas. " The Meals-on-Wheels service, started on the 1st April, 1947, continues to give a much needed service to old people unable to provide for themselves, midday meals being delivered by the voluntary workers of the Committee on Monday, Wednesday and Friday each week. The Council provide two cars and drivers for the use of the Committee on these days. An average of 65 meals was delivered on each delivery day, the total for the year being 8,882." The meals are cooked and packed by the Council's Catering Department. 2. Funeral Arrangements.—Arrangements were made in regard to the burials of three persons. 3. Mortuary Provision, etc.—A Coroner's Court, mortuary (with special provision for infectious disease cases) and a post mortem room is provided by your Council at Queen's Road Cemetery. The Borough Engineer and Surveyor reports that the numbers of inquests and post mortems were as follows :— Inquests only 58 ; Post Mortems only 286 ; Post Mortems and Inquests 46. 4. Conveniences, Public.—During 1951 free washing facilities continued to be available by the supply of soap and paper towels at Public Conveniences. A charge of 2d. continues for the issue of cloth towels. No charges are made for the use of public conveniences. 62 5. Erection of Additional Public Conveniences. The Borough Architect, Mr. F. G. Southgate, A.R.I.B.A., A.M.T.P.I, summarises the position as follows :— Tamworth Avenue/Stanford Road (Adjoining Highams park Lake). The erection of the conveniences on this site was completed in November last. Oak Hill/Woodford New Road (opposite Napier Arms) and Chingford Road (immediately north of the Crooked Billet). The public conveniences now in course of erection on these two sites will be completed and opened for use early in the Spring. Application has been made to the Ministry of Transport for approval to erect a convenience in a central reservation of The Broadway, Highams Park. 6. 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. 7. Rainfall.—The Borough Engineer and Surveyor reports that the annual rainfall at Ferry Lane Station was 30.92 inches. 8. Medical Examinations.—During the year the medical staff carried out 146 examinations of Borough Council employees in respect of the Superannuation and Sick Pay Schemes. 9. Health Education.—Miss H. Rodway, F.R.C.O.G., Obstetrician Superintendent at Thorpe Coombe Maternity Hospital, arranged the usual course of 9 mothercraft lectures. The subjects covered were :— " Introducing your Maternity Service." " The Importance of Ante-natal Care." " Preparation for Childbirth." " The growth of your baby from Conception to Birth.' " How your Baby is born." " Demonstration of Gas 'and Air." " Care of Toddler." " Hygiene in the Home." " Wise Parentcraft." 63 and in each case the speaker was a medical or a nursing specialist, the last lecture being given by Dr. Leslie Housden, a well-known speaker on parentcraft. Although the lectures were primarily intended for mothers booking at Thorpe Coombe, by arrangement with Miss Rodway it was possible for mothers having their babies at home to attend the lectures. 10. Cancer Education.—In the autumn, Miss H. Rodway, F.R.C.O.G. arranged a meeting at Thorpe Coombe with Mr. Malcolm Donaldson, F.R.C.S., F.R.C.O.G. to explore this matter. The meeting was attended by the Mayor, the Chairman of the Health Committee, the Secretary of the Local Division of the British Medical Association and your Medical Officer of Health. Later a report was made to the Health Committee which instructed that a written report be submitted. This was done setting out the arguments for and against cancer publicity and copies of all available literature were circulated to members of the Council. It was decided to prepare a leaflet, and, after discussion with the medical profession in the Borough, to make the leaflets available for distribution at all clinics and libraries. These leaflets became available early in 1952, and a copy is set out on the following pages. 64 BOROUGH OF WALTHAMSTOW If it is taken in time it has been shewn that:— CANCER IS CURABLE If you have any of the symptoms or signs stated on the other side of this leaflet :— DON'T DELAY GOING TO YOUR DOCTOR Their presence does not necessarily mean that you have Cancer, but you should see your Doctor. He may be able to put your mind at rest. If there is any doubt he can seek further advice and no time will have been lost. 65 Go To Your Own Doctor If You Have . . * A sore which will not heal with " home " treatment, especially in your mouth or on your tongue, lip or face. * A lump in your breast or a discharge from your nipple (except in a mother who is breast feeding). * A lump (especially a new one) in any other part of the body. * Unusual or sudden and continued bleeding from any natural body opening. * Any marked change in your normal bowel habits. * Continuing hoarseness, difficulty in swallowing, or persistent indigestion. Remember.. These symptoms and signs don't mean that you have Cancer. Only a Doctor can tell you that and they do occur in other diseases. Don't go to your Doctor if you have no Symptoms 66 SECTION G PART III SERVICES WALTHAMSTOW HEALTH AREA SUB-COMMITTEE (1951/52) Chairman : And. Lady McEntee, J.P. (Executive Council for Essex). Vice-Chairman : Councillor Mrs. S. Candy (Walthamstow Borough Council). Membership : Nominated by— Essex County Council Councillor K. E. B. Glenny (Chairman, Health Committee, E.C.C.). „ „ „ Councillor P. Porter (Vice- Chairman, Health Committee, E.C.C.). „ „ „ Councillor Mrs. L. P. Bailey, J.P. „ „ „ Councillor Mrs. A. M. Burrell. „ „ „ Councillor Mrs. E. F. M. Hollis. „ „ „ Councillor A. R. Kiggins. Walthamstow Borough Council Alderman W. B. Fitt. „ „ „ Alderman W. Gillett. „ „ „ Alderman A. E. Manning. „ „ „ Alderman T. W. Smith. „ „ „ Alderman Ross Wyld, O.B E.. J.P. „ „ „ Councillor R. H. Ayres. „ „ „ Councillor F. A. Burton. „ „ „ Councillor Mrs. S. Candy. , „ „ „ Councillor A. W. Ellis. „ „ „ Councillor Mrs. M. E. Marchant. „ „ „ Councillor A. W. Phillips. „ „ „ Councillor E. G. Richards. „ „ „ Councillor W. H. Shaw. „ „ „ Councillor M. Sharland. „ „ „ Councillor J. M. Wight. Hospital Management Committee Councillor W. E. Barnes. Executive Council for Essex Alderman Lady McEntee, J.P. Local Medical Committee for Essex Dr. J. L. McK. Brown, O.B.E. 67 Walthamstow District Nursing Association Dr. M. Cohen. Walthamstow Child Welfare Society E. P. Marr, Esq. Invalid Children's Aid Association Mrs. M. Osora. Walthamstow and Chingford Association of Tuberculosis Care Helpers Mrs. E. Cordell. 68 HEALTH CENTRES (Section 21) HEALTH CENTRE SITES In May a report was made to the Health Area Sub-Committee that the appropriate members of the County Council had agreed that six centres should be defined in the Borough for Health Service purposes in the draft town maps. The selected sites are :— 1. Brookscroft (adjoining) 1.25 acres 2. Queen's Road/Longfellow Road 1.0 acres 3. Vincent Road 1.0 acres 4. Stoneydown (Pretoria Avenue) 0.97 acres 5. Priory Court 0.9 acres 6. Wood Street (Clearance Area) Not yet defined The decision regarding the number of sites was reached on the basis of one centre per 20,000 population and to serve a radius of one mile. GENERAL DENTAL SERVICE The Senior Dental Officer reports as follows :— This service has continued as in previous years but once again I have to report a further decline in the number of sessions worked. This is mainly due to the circumstance that one of the part-time staff, Mr. Clarke, has been studying for a higher qualification and has been compelled to reduce his number of sessions. The diminution has this time been comparatively slight and the amount of treatment given has naturally been slightly less than last year. The exception has been in extractions and dentures, which remain about the same. In a preventive service this is not an advantage, and more conservative work could be completed for the younger patients if more evening sessions could have been worked. These patients are usually unable to attend during the day. The number of new patients shows a considerable reduction on last year's figures as it was felt to be fairer, in difficult circumstances, to give regular patients a certain priority. Herewith is a summary of the work done during the years 1950 and 1951 1950 1951 Number of patients treated 451 290 Appointments made 4058 3684 Appointments kept 3755 3335 Fillings 1453 1129 Scalings 304 232 Dressings 473 516 Extractions 739 730 General Anaesthetics 269 279 Local Anaesthetics 284 163 Impressions 605 539 Bites 176 166 Try-ins 210 170 Dentures supplied 285 311 69 Dental Laboratory Below is appended a list of the appliances completed in the Dental Laboratory for the General Dental Service during 1951:— New Dentures 290 Repairs 150 Orthodontic Appliances 1 Inlays 5 Surgical Appliances Crowns 10 (obturators) 2 During 1951 the following additional appliances were completed for the Walthamstow and Leyton Committees for Education :— Walthamstow Leyton Orthodontic Appliances 184 62 Dentures 70 — Crowns 27 — Inlays 2 — Repairs 47 5 In addition to the above, the following work was completed for the Regional Hospital Board :— Bite splint appliances for correction of temporo-mandibular disorders 15 Repairs to same 4 The volume of work undertaken remains much the same as in previous years but the balance has shifted in favour of orthodontic and surgical appliances against the more usual prosthetic appliances. This work requires considerably more skill and experience. Tests have been carried out during the year in the use of the new denture material, chrome-cobalt steel. A copper depositing outfit has been installed and it is hoped to use other appliances as they are proved desirable. 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 1224 838 Low Hall Lane Clinic 211 52 Silverdale Road Clinic 22 8 Totals 1457 898 70 Total Attendances— Ante-Natal Post-Natal Thorpe Coombe Maternity Hospital 10612 1227 Low Hall Lane Clinic 840 56 Silverdale Road Clinic 94 8 Totals 11546 1291 Of the 1795 cases confined in the Borough, 81% received Ante-Natal Care at either the Thorpe Coombe Maternity Hospital or the County Council's Clinics. Rhesus and Kahn tests were taken at all clinics. VIRUS INFECTIONS DURING PREGNANCY Ministry of Health Enquiry This enquiry extended to all the Ante-Natal Clinics including those at Thorpe Coombe Maternity Hospital. Notices were displayed at all, reminding expectant mothers of the need to report the occurrence of any infectious disease at the next visit to the Clinic. The purpose of the enquiry is to collect information as to a possible relationship between virus diseases (especially German measles) during early pregnancy and congenital defects in the child. CONFINEMENTS The following table shows the location of confinements during 1951 :— Thorpe Coombe Maternity Hospital 1227 Other Hospitals and Maternity Homes 336 Total in Hospital, etc. 1563 At home 486 Total Confinements 2049 A total of 134 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. 71 The grounds for admission are :— (1) First Confinements. (2) Medical and Obstetrical. (3) Unsuitable home/social conditions. VITAL STATISTICS Walthamstow England & Wales Live birth-rate per 1,000 population 13.5 15.5 Stillbirth rate per 1,000 population 0.31 0.36 Infant mortality rate per 1,000 live- births 22.6 29.6 Extracts from vital statistics are given more fully in Section "A" of this Report. NOTIFICATION OF BIRTHS 2,108 births (352 of which belonged to other areas) were notified during the year under the Public Health Act, 1936. Notifications were received as follows: Doctors, 226; Midwives, 1,825 ; others 57. Included in the above are 313 births which were notified as having occurred outside the Borough. Also included are 50 stillbirths, ten of which belonged to other areas. Of the total, seven occurred outside the Borough. STILLBIRTHS Forty local stillbirths were notified, yielding a rate per 1,000 population of 0.33. NEO-NATAL MORTALITY The neo-natal mortality is the number of infants dying under one month per 1,000 live births. During 1951, 23 infants died in the first four weeks of life, yielding a rate of 14. INFANT MORTALITY The deaths of infants under one year were: — Males. Females. Totals. Legitimate 20 14 34 Illegitimate 2 1 3 Totals 22 15 37 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, 20.77 ; Illegitimate, 1.83. Total, 22.6. 72 The Infant Mortality Rates for other areas during 1951 were as follows : England and Wales 29.6 126 County Boroughs and Great Towns (including London) 33.9 148 Smaller Towns (25,000—50,000 population) 27.6 London Administrative County 26.4 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 1951, 85 live premature infants were born to residents of the Borough, 26 at home and 59 in hospitals and nursing homes. Of the 26 born at home, ten were transferred to hospital. The remaining 16 who were nursed entirely at home, survived at the end of one month. The routine supervision consists of the following :— (1) After the 14th day infants are visited weekly by the Health Visitor if remaining at home, or on discharge from hospital and until they attain average weight. (2) Weekly Welfare attendances are made, if the condition of the infant allows. (3) The report on premature infants, i.e., as to nursing and survival within 28 days is completed at the end of the first month. During the course of the year, with the help and co-operation of Miss Rodway, F.R.C.O.G., and Matron at Thorpe Coombe, a lecture was given by Dr. Elchon Hinden, Paediatrician at Whipps Cross and Thorpe Coombe Hospitals, to Health Workers in the Borough and the adjoining areas. A total of about 90 doctors, health visitors and midwives attended. 73 CAUSES OF DEATH OF CHILDREN UNDER 1 YEAR OF AGE—1951 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 - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - Phthisis - - - - - - - - - - - - - - - - - Other forms of T.B. - - - - - - - - - - - - - - - - T.B. Meningitis - - - - - - - - - - - - - - - - - Meningitis (Non-T.B.) - - - - - - - - - 1 - - - - 1 - 1 Convulsions - - - - - - - - - - - - - - - - - Bronchitis - - - - - 2 - - - 2 - - 1 1 - - 2 Pneumonia 2 - - 1 3 1 - 1 - 5 2 - 1 1 1 - 5 Diarrhoea - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - Inattention at birth, wilful neglect - - - - - - - - - - - - - - - - - Suffocation (overlaying) - - - - - - 1 - - 1 - 1 - - - - 1 Injury at birth 2 1 - - 3 - - - - 3 1 1 - 1 - - 3 Atelectasis 2 - - - 2 1 - - - 3 - - 1 2 - - 3 Congenital malformation — 1 - - 1 4 2 1 - 8 - - 1 3 2 2 8 Premature birth 12 - - - 12 - - - - 12 2 6 3 - - 1 12 Atrophy, debility, marasmus - - - - - - - - - - - - - - - - - Inanition - - - - - - - - - - - - - - - - - Heart failure - - - - - - - - - - - - - - - - - Other causes 2 - - - 2 — — - - 2 1 — — — — 1 2 Totals 20 2 — 1 23 9 3 2 — 37 6 8 7 8 4 4 37 74 ANALYSIS OF INFANT DEATHS, 1951 Dr. Melville Watkins reports as follows on the classification of the 37 infant deaths that occurred in 1951 :— Inevitable Unavoidable Preventable Total Number 6 22 9 37 Percentage 16.2 59.5 24.3 100 I he general trend remains the same as in the previous two years, the unavoidable deaths accounting for over half the numbers whilst the percentage of preventable deaths remains approximately the same as last year. The main cause of inevitable deaths was congenital abnormalities, and that of unavoidable deaths atelectasis and prematurity. This was the case during the previous two years. All but two of the preventable deaths were due to respiratory infection, and it is gratifying to note that not one was caused by the common infectious diseases. One death under this heading was unfortunatelv caused bv suffocation. The following table gives deaths by age groups :— 0—1/52 1/52—1/12 1/12—3/12 3/12—6/12 6/12—12/12 Total 20 3 9 3 2 37 There has been no significant decline in the death rate during the first month of life and the causes for these neo-natal deaths remain much the same. Most of these are classified as inevitable and unavoidable. The factors which induced a general reduction in the over-all infant mortality during recent years have obviously not influenced the neo-natal death rate to any appreciable degree. RETROLENTAL FIBROPLASIA This rather curious condition was first observed about 1936 in America and is now found in premature infants in this country. It is an opacity situated behind the lens of the eye which may develop rapidly after birth and often leads to complete and permanent blindness in both eyes. The condition is limited almost entirely to premature babies with a birth weight of two to three lbs. Two such cases were reported in 1952. The first was J.C., a female, born at home on the 12th May, 1951, with a birth weight of 3 lbs. 6 ozs. ; she was admitted to Thorpe Coombe a few hours later and blindness was diagnosed in September. The baby was retained in Thorpe Coombe until the 2nd January when she weighed 16 lbs. 6 ozs. After very considerable difficulty a foster-mother was found to look after the baby pending further examination at the age of 3 years for admission to a Sunshine Home. The second case was a female born in Thorpe Coombe on the 17th September, 1951, with a birth weight of 2 lbs. 123/4 ozs. The mother had been admitted some three weeks before the baby 75 was born on account of hypertension and albuminuria. At the thirty-second week of pregnancy the mother had an eclamptic fit and two days later labour was induced. The baby was transferred to hospital on the 4th December with fibroplasia and was discharged on the 12th January after Cortisone treatment to return regularly for observation. It was not then possible to assess the interference with visual acuity. CARE OF ILLEGITIMATE CHILDREN The action taken under Circular 2866/1944 is fully set out in the Report for that year. 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. Illegitimate Births and Mortality Year Live Births Infant Deaths Death Rates per 1,000 Live Births Legitimate Illegitimate Legitimate Illegitimate Legitimate Illegitimate 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 1950 1,536 62 41 1 25.0 16.0 1951 1,586 51 34 3 21.0 58.8 Totals 1947 to 1951 (5 vrs.) 9,465 344 241 12 25.0 34.0 MORAL WELFARE The "Carville" Home at 38 The Drive, E.17, is administered by the Walthamstow Deanery Branch of the Chelmsford Diocesan Moral Welfare Association. The Home provides accommodation for a total of 16 mothers and their babies and has a hich record of care and service. Mothers of all religious denominations are cared for and the work done during 1951 is summarised below by Miss Williams, the Superintendent :— Admitted Adults Babies Total From Walthamstow 11 10 21 From rest of County 35 18 53 From outside the County 37 21 58 Totals 83 49 132 Outdoor work— Walthamstow Cases (Mother and baby placed) 41 10 51 Other Essex Cases 10 - 10 76 The total of Walthamstow cases helped was 72 plus 48 general interviews. All mothers from Walthamstow were placed in homes in Essex. The grand total of Essex cases dealt with was 135. Miss Williams states that fewer cases were admitted to the Home because of the difficulty in the placing of the babies, thus necessitating a longer stay in the Home. During the financial year ended the 31st March, 1951, out of a total of payments amounting to £2,172, the largest single contribution was the maintenance payments received from the mothers and which totalled nearly £1,172. The next largest was from the Diocesan Association totalling £460, and the third donations totalling £230. 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). (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.l 7. 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. Summary of Attendances at Welfare Clinics Clinic. First Attendances of New Cases. Re-attendances. Grand Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Markhouse Road 382 57 439 6,186 6,063 12,249 12,688 Penrhyn Avenue 285 46 331 4,244 5,244 9,488 9,819 West Avenue 165 64 229 2,863 2,254 5,117 5,346 Winchester Road 200 30 230 3,124 3,451 6,575 6,805 Silverdale Road 98 25 123 1,573 1,768 3,341 3,464 Total 1951 1,130 222 1,352 17,990 18,780 36,770 38,122 77 Walthamstow Child Welfare Society Clinics are held as follows at “Brookscroft," Forest Road, E.17 :— 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. 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 l yr. 1-5 yrs. Total. 1951 389 28 417 6,819 2,528 9,347 9,764 1950 413 49 462 7,165 2,378 9,543 10,005 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 Fifty-three children were immunised during the year at “ Brookscroft." On February 1st, 1951. the 20,000th new case was booked 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 1,130 222 1,352 17,990 18,780 36,770 38,122 Brookscroft 389 28 417 6,819 2,528 9,347 9,764 Total 1951 1,519 250 1,769 24,809 21,308 46,117 47,886 78 TREATMENT (a) Orthopaedic.—The facilities provided by the Education Authority's Orthopaedic Scheme are available for all children attending the Welfare Centres. Miss Garratt, C.S.P., has kindly furnished the following information with respect to children under five years of age :— Defects Seen at Orthopaedic Clinic in Children Under Five Years of Age Anterior Poliomyelitis 5 Scoliosis, Lordosis, Kyphosis 2 Rickets—(a) Genu Varum 22 (b) Genu Valgum 33 Pes Piano Valgus 38 Spastic Paralysis 4 Progressive Muscular Atrophy 1 Talipes— (a) Equino Varus 5 (b) Calcaneo Valgus 12 (c) Mid Tarsal Varus 1 Torticollis 8 Spina Bifida 1 Digitus Varu 1 Congenital Defects 5 Miscellaneous 2 Total 140 (b) Sunlight.—325 ultra-violet light treatments were given during the year. (c) Dental.—Mr. L. W. Elmer, L.D.S., Senior Dental Officer, reports as follows :— “An effort was made this year to treat the “ priority group of expectant and nursing mothers and the dental staff examined more than double those seen last year. “With the present limited staff this meant that fewer children under five were treated. “I am even more strongly of the opinion that the true order of priority should be :— (a) pre-school children. (b) school children. (c) adolescents. “ If circumstances permitted these categories to be treated systematically, I am convinced that the expectant mother, much to her benefit and, incidentally, her relief, would need little or no dental attention." 79 The following gives details of the work done during the year by the Dental Officers :— Numbers provided with dental care : Expectant and nursing mothers Children under 5  Number examined 218 476 Number needing treatment 212 522 Number treated 210 443 Number made dentally fit 48 224 Forms of dental treatment provided : Extractions 157 242 Anaesthetics—Local 7 5 General 47 132 Fillings 56 155 Scalings or scaling and gum treatment 16 2 Silver Nitrate treatment 2 162 Dressings 27 56 Radiographs 9 1 Dentures provided—Complete 9 — Partial 9 — (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.—Towards the end of the year and at Dr. Gillespie's suggestion, suitable cases under 5 years were seen informally at the West Avenue Welfare Centre. The informality was reassuring to the parents and patients. They were comparatively simple cases which were dealt with in two or three interviews. This innovation was thoroughly justified by the results attained. Brief details are as follows :— Child, aged 4 years, referred for tantrums and disobedience. Found to be of normal intelligence and an only child. Mother suffers from cardiac trouble. Restricted and anxious home atmosphere. Treatment was by play therapy and guidance interviews and there were early signs of improvement. Another child was a case of classical sibling jealousy. Play therapy was commenced and the outlook considered to be good. 80 (g) Pædiatric Clinic.—Fifty-one children under 5 years of age were referred to Dr. Hinden's Paediatric Clinic. This fortnightly clinic has proved a great boon since children requiring hospital treatment or observation can be so readily admitted to Whipps Cross Hospital. During the year a new arrangement was made whereby Health Visitors in turn accompanied Dr. Hinden on his rounds at Whipps Cross Hospital. The matter is also referred to under Health Visiting. (h) 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 19 School Medical Services 4 Welfare Centres — Voluntary Agencies 1 Parents 7 31 Classification of cases :— Anaemia, debility, malnutrition 3 After-effects of illness 12 Bronchitis and pneumonia 1 Nervous conditions 2 Diseases of the ear, nose and throat 3 Diseases of the skin 2 Visits, advice, follow-up after illness — Various 8 31 (i) Convalescence.—During 1951 eleven 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. 81 PROVISION OF NUTRIENTS AND MEDICAMENTS The quantity and value of nutrients and medicaments sold and issued free during 1951 was as follows:— Sales Free Issue  lbs. ozs. lbs. ozs. Adexoline — — 16 15¼ Bemax 147 — — — Calfos Tablets — — 67 pkts. Colact 403 — — — Cow and Gate 3,666 — — — Cod Liver Oil Emulsion — — 56 8 Farex 1,036 — — — Fersolate Tablets — — 192 pkts. Glucodin 141 12 — — Lactogol 79 10¾ — — Lactogen 1,842 — — — Magnesia — — 61 8 Cod Liver Oil 1 — — — Cod Liver Oil and Malt — — 359 — Maltoline with Iron — — 165 8 Marmite 1,036 12 — — Mist Ferri et Ammon Cit — — 3 12 Ostermilk 987 — — — Parrish's Food — — 4 8 Robinson's Groats 528 — — — Roboleine 14 — — — Scott's “ Twin Pack " 527 8 — — Sodium Citrate Tablets — — 4,000 Virol 1,322 8 — — Value of Cash Sales £1,532 6s. 8d. VITAMINS The facilities for the distribution of vitamins were continued at all Welfare Centres. Every effort is made to increase the demand. 82 DAY NURSERIES The following table shows the average attendances at the Day Nurseries during 1951 (Mondays to Fridays only). Month Nurseries Under 2 yrs. Over 2 yrs. Total  January Higham Hill 5.9 33.0 38.9 Handsworth Ave. 6.1 26.8 33.0 February Higham Hill 8.7 31.7 40.4 Handsworth Ave. 3.4 25.5 28.9 March Higham Hill 8.3 33.3 41.6 Handsworth Ave. 8.2 42.7 50.9 April Higham Hill 6.9 40.4 47.3 Handsworth Ave. 9.8 44.2 54.0 May Higham Hill 10.0 43.0 53.0 Handsworth Ave. 7.6 40.2 47.8 June Higham Hill 11.4 47.4 58.8 Handsworth Ave. 8.1 44.3 52.4 July Higham Hill 10.4 49.5 59.9 Handsworth Ave. 10.1 50.8 60.9 August Higham Hill 9.2 37.8 47.0 Handsworth Ave. 7.7 45.0 52.7 September Higham Hill 11.9 44.4 56.3 Handsworth Ave. 9.9 47.9 57.8 October Higham Hill 9.8 45.4 55.2 Handsworth Ave. 10.1 42.6 52.7 November Higham Hill 8.9 44.1 53.0 Handsworth Ave. 10.6 46.0 56.6 December Higham Hill 8.6 46.9 55.5 Handsworth Ave. 9.6 44.4 54.0 Average Whole Year Higham Hill 9.1 41.0 50.1 Handsworth Ave. 8.4 41.7 50.1 Both Day Nurseries are approved for training in the care of children aged 0—5 years. Training.—Nine students obtained the Nursery Nurses Certificate during the year. Since the two day nurseries were approved for training in 1944, all students who completed training secured the Certificate of the National Nursery Examination Board, two only failing at the first attempt, but passing at the second. The total certificates gained during these eight years amounted to 46 and it is of interest to analyse the subsequent careers of the trainees which were as follows :— General Hospital Training 12 Children's Nursing Training 1 Residential Nursery Work 3 Other Day Nursery Work (including 4 Wardens) 10 Teaching 7 Promotion in Walthamstow Nurseries 10 83 NURSERIES AND CHILD MINDERS (REGULATION) ACT, 1948 There were no registrations during 1951. 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. WOMEN'S CLINIC During 1951 the financial responsibility for patients seen at the Women's Clinic was held to be that of the Local Health Authority and appropriate adjustments were made with the Hospital Management Committee back to the appointed day. Fortunately, no change in the general arrangement was necessary. The patients attending the Clinic were reviewed at the end of the year and those who were not strictly eligible to receive treatment on medical grounds were referred elsewhere. As a result, the numbers attending the Clinic became reduced and the sessions were reduced accordingly during 1952. Miss Helen Rodway, F.R.C.O.G., states that the number of patients attending has been as follows :— New Cases. Attendances.  1949 31 528 1950 34 475 1951 19 444 84 MIDWIFERY (Section 23) There were 32 practising midwives in the Borough at the end of 1951. Medical supervision was carried out by the Medical Staff and non-medical supervision by the Matron of the Maternity Hospital until 30th September, 1951, afterwards by the Superintendent of the District Nurses' Home. The following table shows the work done by Midwives (including those employed at Thorpe Coombe Maternity Hospital) during 1951 :— No. of confinements attended as a Midwife 1,421 „ confinements attended as a Maternity Nurse 292 Medical Aid Notices sent 576 ,, Twin Births Notified 15 ,, Triplet Births Notified — Stillbirths Notified 4 „ Notifiications of Liability to be a source of Infection 4 „ Notifications of Laying-out a Dead Body — Notifications of Artificial Feeding 12 „ Notifications of Disinfection 4 The previous table includes the following numbers in regard to work done at Thorpe Coombe Maternity Hospital :— Midwifery cases 1,102 Maternity cases 125 Medical Aid Notices 495 The percentage of Medical Aid Notices were :— All cases 33.1 Maternity Hospital Midwives 40.3 Other Midwives 16.6 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 1 Albuminuria 2 Antepartum haemorrhage 3 Abortion — Other conditions 6 Total 12 85 For complications during labour: — Prolonged first and second stage 6 Ruptured perineum 28 Premature labour 1 Rise of temperature 5 Post partum haemorrhage 4 Uterine inertia 2 Retained placenta 2 Abnormal presentation 3 Other conditions 8 Total 59 For complications in regard to the infant: — Asphyxia — Jaundice 5 Inflamed eyes — Prematurity and feebleness 3 Cyanosis 1 Other conditions 1 Total 10 The table below shows the number of District visits done :— Ante-Natal Examinations. Deliveries. Lying-in Visits. Total Visits. Patients' Homes. Midwife's House. Clinic. Mid. Mat. 2.463 1,088 53 295 145 8,203 12,247 Two midwives in private practice undertook 24 cases as midwives and 22 cases as maternity nurses. Gas and Air Analgesia.—The Ambulance Service provided transport facilities for gas and air apparatus. A total of 213 patients on the District received gas and air analgesia, representing a percentage of 48.4 of District confinements. 86 Midwives acting as Maternity Nurses.—During the year the number of maternity cases (i.e., where responsibility for the case was taken by the doctor) increased to 145 or 32.9 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%, during 1949, 21%, during 1950, 28.8%, and during 1951, 32.9%. Emergency Unit.—This Unit, stationed at Thorpe Coombe Maternity Hospital, was called out to four Walthamstow cases during 1951. Maternity Outfits.—448 outfits were issued. Training of Pupil Midwives.—Thorpe Coombe Maternity Hospital is a training school for both Parts I and II, the latter in association with home confinements on the " district." A total of 27 pupils successfully underwent Part II training during 1951. HEALTH VISITING (Section 24) Health Visiting Staff.—The equivalent of whole-time Health Visitors at the end of the year was 10½, equal to one whole-time Health Visitor per 167 notified births, and one whole-time Health Visitor per 155 registered births during 1951. Most of the Health Visitors also carry out duties as School Nurses. Home Visits To Children under 1 year of age. To Children 1-5 years of age. Total.  First. Subsequent. Total. Total 1951 1,637 5,015 6 652 11,321 17,973 „ 1950 1,586 4,649 6,235 13,021 19,256 The detailed findings at first visits paid by Health Visitors are shown in the table on the following page. 87 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 171 31 24 1 225 169 56 1 43 17 72 16 32 46 High Street 169 6 16 1 190 183 8 — 48 115 6 1 15 6 Hoe Street 168 25 25 — 218 195 23 — 49 53 52 16 29 19 Wood Street 149 27 37 — 213 189 24 — 53 54 28 18 13 47 Hale End 344 28 31 1 402 390 13 — 226 72 25 32 22 26 Higham Hill 292 46 48 2 384 373 12 1 144 88 21 1 83 49 Total 1951 1,293 163 181 5 1,632 1,499 136 2 563 399 204 84 194 193 1950 1,331 135 120 3 1,583 1,469 112 5 574 434 176 84 186 132 From the above table it will be seen that of 1,637 children, 1,293 or Per cent., were breast-fed on first being visited, and only five babies had no separate sleeping accommodation. 471 inants lived in accommodation of three rooms or less, as compared with 402 in 1950. 88 Ward. Visits to Children under 1 year. Visits to Children 1-5 years. Grand Total. Unsuccessful Visits. Ante-Natal Visits. Other Visits. Total Visits.  The following table shows the number and nature of visits paid in 1951 : — First. Subsequent visits. Total. First Visits. Subsequent Visits. Total Visits. 1 2 3 4 5 6 — — 7 8 Cols. 5-8 St. James St 226 467 693 1,491 2,184 456 82 48 130 564 3,334 High Street 191 592 783 1,490 2,273 253 46 13 59 301 2,886 Hoe Street 218 407 625 1,151 1,776 421 20 10 30 513 2,740 Wood Street 213 323 536 810 1,346 493 24 9 33 248 2,120 Hale End 403 2,424 2,827 3,256 6,083 253 91 53 144 1,036 7,516 Higham Hill 386 802 1,188 3,123 4,311 373 55 7 62 663 5,409 Totals, 1951 1,637 5,015 6,652 11,321 17,973 2,249 318 140 458 3,325 24,005 Totals, 1950 1,586 | 4,649 6,235 13,021 19,256 j 2,292 421 221 642 1,333 23,523 89 Health Visiting—Attendance at Paediatric Hospital Rounds.— In September, the Health Area Sub-Committee agreed that an arrangement be made for the Health Visitors in turn to attend the Paediatric Physician's Ward rounds at Whipps Cross Hospital and for a trial period of six months. At the end of this period it was apparent to all concerned that the arrangement was well worth while. Information as to home conditions became more fully and quickly available to the Paediatrician and after the child's discharge, the Health Visitor ensured that his advice was followed in the home. For the Health Visitor, her knowledge of paediatric nursing is kept up-to-date and she learns of new advances in the treatment of children's diseases. HOME NURSING (Section 25) The Superintendent of the District Nurses' Home, Miss E. G. Welbrock, S.R.N., S.C.M., M.T.D., reports as follows :— "The year 1951 has been a very busy year both on the General and on the Midwifery side. " Miss C. A. Lee retired after 16 years of loyal service to the Nursing Association and the staff were very sorry to lose their Superintendent. " Three of the General Nurses commenced their Queen's District Training in the latter part of 1951 and were successful in passing the examination in March, 1952. " On the 1st October, 1951, the Municipal Midwives, who had previously worked under the supervision of the Thorpe Coombe Maternity Hospital, were transferred to ' Carisbrooke,' and we are all working very happily together. " The Branch Home at Highams Park is not yet ready for occupation but it is hoped the work of alteration and adaptation will be commenced early in January, 1952, and that the Home will be opened in the Spring * The Branch Home has become a necessity in view of the increasing population to be cared for in that portion of the Borough. " A further urgent necessity is the provision of a second car for the Male Nurse. In order to relieve the Nurses of heavy and unsuitable male cases, the Male Nurse has to cover most of Walthamstow. * The Branch Home was opened on 5th May, 1952. 90 " Staff on the 31st December, 1951, was as follows 1 Superintendent ; Queen's S.R.N., S.C.M., M.T.D. 1 Full-time Queen's S.R.N., S.C.M. 1 „ „ S.R.N., S.C.M., H.V. Certificate. 8 „ „ S.R.N., S.C.M. 1 „ „ S.C.M. 1 „ „ Queen's Male S.R.N. 4 „ „ S.R.N. 1 Part-time Queen's S.R.N., S.C.M. 1 „ „ S.R.N. 3 „ „ S.E.A.N. " During the year 26 pupils entered for District Midwifery Training from Thorpe Coombe Maternity Hospital. Most were resident at ' Carisbrooke.' " Midwifery and Maternity Nursing undertaken during the year was as follows :— Cases Visits  Midwifery 126 3,009 Maternity 73 1,744 Ante-Natal — 1,690 Post-Natal — 270 Total 199 6,713 Maternity Outfits supplied 205 " The following gives details of Home Visits during the year :— New cases Total visits  Medical 949 38,844 Surgical 310 9,614 Tuberculosis 48 2,536 Out-patients 97 254 Operations 20 33 Miscarriages 3 21 Specials 74 276 Casuals 120 220 Totals 1,621 51,798 91 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 1951 :— (a) School age 265 (b) Pre-school age 1,212 Total 1,477 (c) Number already immunised having a reinforcing dose 2,025 The above total includes 53 children immunised at " Brooks croft " and 470 immunised by General Practitioners. No. of Clinics held for immunisation at Town Hall 51 No. of attendances made for diphtheria immunisation 797 Average attendance per session for diphtheria or whooping cough immunisation 39.1 Immunised at schools (included above) :— No. immunised 196 No. awaiting second dose 32 No. having a booster, i.e., immunised in previous year 1,709 No. Schick tested for first time Nil No. of Schick tests following immunisation 16 (a) Negative 13 (b) Positive 2 (c) Pseudo and Positive 1 92 During the past five years the percentages immunised in the various age groups were as follows :— DIPHTHERIA IMMUNISATION Age at Immunisation Percentage Immunised to Population in Age Groups Notified Cases Year Regd. Births 0—1 year 1—2 years 2—3 years 3—4 years 4—5 years Total 0—5 years School Age Over School Age Grand Total % 0—1 to Total Births % 0—5 years % 5—15 years % 0—15 years Admitted to Hospital Diagnosis Confirmed Deaths  1946 2,544 287 946 212 140 160 1,745 882 11 2,638 11.2 50.3 77.4 67.7 80 22 6 7 2,670 719 869 111 68 77 1,844 810 4 2,658 26.9 52.4 86.0 72.2 38 0 — 8 2,068 1,076 780 105 41 47 2,049 662 1 2,712 52.0 61.5 91.5 79.2 34 1 — 9 1,836 1,112 391 63 60 32 1,648 304 1 1,953 60.5 62.5 96.2 82.1 20 0 — 1950 1,598 707 288 29 31 18 1,073 261 — 1,334 44.2 60.5 96.5 81.9 11 1 — 1 1,637 670 442 59 22 19 1,212 265 — 1,477 40.9 58.1 99.3 83.0 11 — — From the above table it will be seen that there have only been two confirmed cases of diphtheria in the last five years, and no death. On the other hand, the fall in the number of children immunised, especially in the 0—1 age group, gives rise to misgiving, especially since the target of immunisation in this group is 75% of babies born before reaching the age of one year. There are several contributory causes to this decline, e.g., the reduction in the number of births, the publicity given to the alleged association between injections of any kind and poliomyelitis, and the decreased awareness on the part of the public to the dangers of diphtheria. In addition there is some evidence that general practitioners do not send in records in order to claim fees for many of the immunisations done by them. 62 children were given “combined” diphtheria/whooping cough immunisation by general practitioners, but the prophylactic was not supplied by the Local Authority. These are included in the above total. 93 IMMUNISATION AGAINST WHOOPING COUGH The Medical Research Council's trials ended in June, 1951 and the final report in regard to the trials is awaited. The use of ' Glaxo' vaccine continued with good results, the numbers of completed cases being set out below. Immunisation is restricted to infants under 18 months old. Age at date of Final Injection Under 1 year 1-2 years 2-3 years 3-4 years 4-5 years 5-14 years Total  Clinics and Nurseries 288 94 9 16 25 – 432 General Practitioners 37 18 2 2 — 3 62 Total 325 112 11 18 25 3 494 Immunisations done by General Practitioners were with combined Diphtheria/Whooping Cough prophylactic. The total number of children immunised against Whooping Cough up to the end of 1951 was 2,510. VACCINATION The ages of persons vaccinated is shown below :— Age at date of Vaccination Under 1-2 2-4 5-14 15 and Total  1 year years years years over Primary 596 30 30 74 118 848 Secondary — 1 5 27 256 289 Total 596 31 35 101 374 1,137 Vaccinated by General Practitioners or at Hospital 827 Vaccinated at Town Hall Clinic 310 The weekly Vaccination Clinic was started at the Town Hall at the beginning of April. VACCINATION AND RE-VACCINATION OF DEPARTMENTAL STAFF The staff of the Department, especially those who would be expected to deal with smallpox in the event of cases occurring, were again offered facilities for vaccination and re-vaccination and 11 were done during 1951. 94 AMBULANCE FACILITIES (Section 27) The Ambulance Service is administered centrally from Chelmsford and (as far as information is available) it appears to be adequate for the needs of the Borough. 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 Dr. H. Ramsay, Physician in charge of the Walthamstow Chest Clinic, has contributed the following :— “The work of the Clinic has continued on very similar lines to previous years. There has been the usual increase in numbers of patients seen and X-rays taken ; these figures are, of course, returned to the Hospital Management Committee and Regional Hospital Board in detail. " With regard to general care, there were many persons interviewed on welfare matters and we continued to hold “Work clinics " at intervals in association with the local Labour Office to place patients in work suitable for them, or to arrange rehabilitation." Miss Woolgar, Secretary of the Walthamstow and Chingford Association of Tuberculosis Care Helpers, reports as follows :— “Applications for assistance through the Association have increased during the year. In spite of the wide application of the County Council's extra nourishment vouchers, the number of persons needing additional vouchers for milk or grocery has grown steadily. The high cost of clothing has also led to an increase in the number of applications for help in obtaining pyjamas and warm underwear, and there have been many requests for help in the provision of bedding and bed-linen. Although some of these cases could be referred to other agencies, the cost to the Association of those cases dealt with direct, has proved considerable. 95 " Our small stock of sick-room equipment has been in constant use and on occasions when additional equipment has been lent by an organisation charging a fee, the cost of loan has been met by the Association. " The experimental scheme of occupational therapy has shown itself to be of value, and additional looms have been bought as required. Disposal of work produced has not been easy, but where sold, it has shown a good return for the patients' efforts. " On three occasions during the year the Secretary addressed local organisations on the work of the Association and the services available to the tuberculous. In each case the talk, given at the request of the organisation concerned, stimulated their interest in the work and increased their understanding of the needs and problems of the patients. " The following is a summary of the direct assistance given to patients or their families during the year, many others having been helped with advice or put in touch with other organisations more suited to their particular needs. Patients assisted with— Milk 60 Grocery 25 Fares to visit patients 6 Clothing 15 Bedding 14 Sickroom equipment 20 Debts 5 Occupational therapy 18 Removal expenses 3 Domestic help 4 Cost of tuition 1 ” POLIOMYELITIS FOLLOW-UP During the course of their routine duties the Health Visitors visited all cases of poliomyelitis notified during the year. The result of the follow-up is shown on page 50. 96 REHABILITATION OF TUBERCULOSIS PATIENTS During the year the Area Sub-Committee accepted financial responsibility for three patients undergoing rehabilitation at Papworth Village Settlement. No charge is made to patients. CONVALESCENCE FOR ADULTS The total of cases sent away for recuperative convalescence was 62. The length of convalescence was two weeks in 43 cases, three weeks in 17 cases, and four weeks in two cases. Recovery of cost or part-cost is made. SICK-ROOM EQUIPMENT There are two main depots for sick-room epuipment, one at the District Nurses' Home in Carisbrooke Road and the other at the British Red Cross Society Headquarters in Forest Road. During the year routine issues were made of items of equipment such as bed-pans, thermometers and feeding cups, etc. One chair-commode was provided for a special case. 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 Mondays, Wednesdays and Fridays, and evening sessions on Mondays, Thursdays and Fridays. Treatment was by appointment and unfortunately, there has always been a long waiting list. Total attendances in 1951 were 15,201, including 1,848 new patients. DOMESTIC HELP SERVICE (Section 29) Mrs. C. M. Hall, Domestic Help Organiser, reports as follows :— "The year 1951 showed no sign of any slackening in the demand for domestic help. On the contrary the service has met more requests than ever, and continues to be administered along lines similar to those adopted during 1950. During the year 1,214 visits were paid to patients and helps. To meet the increased demand in the service, it became necessary to engage more helps, the number at the end of the year being 7 full-time and 192 part-time workers. Cases carried forward at end of 1951 were 71 more than brought forward from 1950. A greater number of full-time helps and less part-time is desirable but the response to advertisements for full-time helps has been poor. 97 " Below is a summary of the year's work :— DOMESTIC HELP Brought forward from 1950 268 New cases during 1951 296 Cases completed in 1951 225 No. of cases carried forward to 1952 339 Analysis : Acute Chronic Old People (not sick) T.B. Total  53 416 79 16 564 HOME HELP (for Confinements) No. of cases completed in 1951 116 " The new scale of assessment has been responsible in some cases for refusal or cancellation of help but any cases of special hardship were dealt with by the appropriate Committee. " The aged chronic sick are still the greatest problem of the service as their numbers increase and hospital accommodation becomes more limited. This necessitates continuous help, in some cases over a period of years, and absorbs large numbers of part-time helps. Another difficulty encountered is the reluctance on the part of helps to assist in homes where there is a tuberculous patient, but so far all these applications for help have been met. “ There is no doubt that the domestic help service is more than ever an essential part of the health service and that this worth-while effort brings much relief and comfort to the sick." HÆMOGLOBIN SURVEY In July, Medical Officers of the Ministry of Health carried out a survey of a random representative sample of housewives in Walthamstow. The method of approach was more or less on trial, but with the co-operation of the Health Visitors, it was considered to be quite successful. The survey extended over five days. 98 The results of the investigation have been published in the Medical Press (B.M.J. 23.2.52) and broadly speaking, the mean haemoglobin level showed no difference from the 1943 mean hæmoglobin level. In each case where the haemoglobin was unduly low, the housewife was referred to the family doctor so that treatment, where necessary, could be instituted. COUNTY COUNCIL OF ESSEX—WELFARE COMMITTEE WELFARE SERVICES Mr. G. E. Pegram, County Welfare Officer, kindly contributes the following :— " The County Welfare Committee is responsible to the County Council for the duties imposed by Part III of the National Assistance Act, 1948, the main aspects being : (a) the provision of residential and temporary accommodation and (b) welfare arrangements for blind and other handicapped persons. " Schemes operate in respect of the provision of residential and temporary accommodation, as defined in Section 21 of the National Assistance Act, 1948, and in respect of the general welfare of blind persons coming within the provisions of Section 29 of the Act. As regards " other handicapped persons," a detailed scheme is now in course of preparation with a view to ultimate submission to the Ministry of Health. " Statistics are appended showing the extent to which the present services have been applied to residents within the Borough of Walthamstow during the year 1951 :— (1) Residential and Temporary Accommodation. (a) Admitted to hostels and other residential establishments : Men, 19 ; Women, 21 (including one blind person). (b) Admitted to temporary accommodation : Men, 14 ; Women, 10 ; Children, 16. (2) Blind Persons. Number of blind persons in the Borough :— (i) Registered as blind 215 (ii) Partially sighted 31 (iii) Defective sighted 21 all of whom are under the supervision of Home Teachers and six participate in the Home Workers' Scheme operated through the agency of the London Society for Teaching and Training the Blind. 99 " In addition, two blind persons are employed in the Workshops for the Blind and during the year two were placed in employment (open industry), the total number of Waltham stow residents so employed now being 17. " On three occasions during the year it became necessary for the Borough Council to make application under Section 47 of the National Assistance Act, 1948, for the removal of aged persons to suitable accommodation. The persons concerned would not voluntarily undertake to go into a residential home, and the necessity to take Court action was for the reason only of securing for the person the care and attention needed."