Ac 4411(1) Walthamston wal 35 BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1952 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. MEDICAL OFFICER OF HEALTH BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1952 INDEX page Section A.—Statistics and Social Conditions of the Area 10 Section B.—General Provision of Health Services in the Area 17 Section C.—Sanitary Circumstances of the Area 21 Section D.—Housing 26 Section E.—Inspection and Supervision of Food 33 Section F.—Prevalence and Control over Infectious Diseases 45 Section G.—National Health Service Act, 1946—Part III Services 63 Health Centres 65 Care of Mothers and Young Children 67 Midwifery 81 Health Visiting 83 Home Nursing 86 Vaccination and Immunisation 88 Ambulance Facilities 92 Prevention of Illness, Care and After-Care 92 Domestic Help 95 page Acreage 10 Adulteration 39 Ambulance Facilities 18, 92 Ante-Natal Clinics 67 Assessments 10 Bacteriological Examination 33, 40 B.C.G. Immunisation 59 Birth Notifications 68 Birth Registrations 17 Births, Illegitimate 71 Birth Rate 11, 13 Cancer 14 Cancer Education 62 Caravans 24 Care and After-Care 92 Care of Illegitimate Children 71 Child Guidance 75 Child Welfare Clinics 72 Chiropody 94 Clean Food Campaign 40 Cleansing (Personal) 18, 81 Committees 4, 63 Comparability Factor 12 Confinements 67 Convalescence for Adults 94 Convalescence for Pre-School Children 77 Conveniences, Public 61 Cremation 61 page Daily Guardian Scheme 80 Day Nurseries 78 Deaths 11, 13, 14 Deaths, Infants 11, 15, 70 Deaths, Infectious Diseases 13 Death Rate 11, 12, 13 Deaths, Causes of 14 Dental Laboratory 66 Dental Treatment 74 Diphtheria 47 Diphtheria Immunisation 88 Diseases of Animals Acts 42 Disinfestation 25 District Midwifery 81 Domestic Help 95 Dysentery 52 Employment 11 Emergency Unit 83 Encephalitis, Acute 52 Enteric Fever 52 Erysipelas 54 Essex County Council Act 21 Fog 62 Food & Drugs Act, 1938 39 Factories Acts, 1937/48 44 Food, Clean 40, 41 Food Inspection 33 Food Poisoning 42, 53 Foot Clinic 94 Funeral Arrangements 60 Gas and Air Analgesia 83 General Dental Service 65 page Health Centres 65 Health Education 61 Health Visiting 83 Home Help 95 Home Nursing 86 Home Visits 84 Hospitals 18 Housing, Closure and Demolition 30 Housing, General 31 Housing, Statistics 26 Housing Act, 1936 29 Housing Inspections 27 Ice Cream 34 Illegitimacy 71 Immunisation 88, 90 Infant Mortality 11, 15, 16, 69 Infectious Disease 45 Infestation 81 Inquests 60 Invalid Children's Aid Association 77 Laboratory Facilities 17 Malaria 50 Maternal Mortality 13, 15, 16 Maternity Homes 21 Maternity Nursing 83 Maternity Outfits 83 Meals on Wheels Service 58, 59 Measles 11, 47 Meat Inspection 37 Medical Aid 82 Medical Examinations 61 Medicaments 78 Meningococcal Infection 50 Midwifery 81 Milk Inspection 33 Milk Special Designations Order 33 Milk Supply 33 Miscellaneous 59 Moral Welfare 71 Mortuary 60 National Assistance Act, 1946, Sec. 47 20 Neo-Natal Mortality 15, 16, 68 Notices, Sanitary 21 Notification of Births 68 Nursery Nursing Certificate 79 Nurseries & Child Minders (Reg.) Acts, 1948 79 Nursing Homes 21 Nutrients 78 Occupational Therapy 94 Old People's Welfare 59 Ophthalmia Neonatorum 52 Ophthalmic Treatment 75 Orthopaedic Treatment 74 Outworkers 45 page Pediatric Clinic 76 Pet Animals Act, 1951 42 Pneumonia 49 Poliomyelitis 50 Poliomyelitis Follow-up 94 Population 10 Post-Mortems 60 Post-Natal Clinics 67 Premature Infants 69 Prevention of Damage by Pests Act, 1949 43 Prevention of Tuberculosis 58 Prevention of Illness 92 Puerperal Pyrexia 52 Pupil Midwives 83 Queens Institute of District Nursing—Training 86 Rainfall 61 Rateable Value 10 Reconstruction 62 Rehabilitation 94 Rehousing on Medical Grounds 32, 58 Rent and Mortgage Restriction Acts 30 Rodent Control 43 Sanitary Inspection 21 Scabies Clinic 18 Scarlet Fever 46 Sickroom Equipment 94 Smallpox 52 Smoke Abatement 25 Social Conditions 10 Staff 8, 17 Statistics 10 Sterilised Maternity Outfits 83 Still births 11, 13, 15, 16 Sunlight Treatment 74 Swimming Baths 25 Total Infant Mortality 16 Tonsils and Adenoids 75 Training of Nursery Nurses 79 Training of Pupil Midwives 83 Tuberculosis 11, 54, 92 Vaccination 91 Virus Infections During Pregnancy 67 Vital Statistics 11, 68 Vitamins 78 Walthamstow Association of Tuberculosis Care Helpers 93 Walthamstow Child Welfare Society 73 Water 21 Welfare Services 96 Whooping Cough 11, 47 Whooping Cough Immunisation 90 Women's Clinic 81 HEALTH COMMITTEE 1952-53 Chairman: Alderman Lady McEntee. J.P. Vice-Chairman: Councillor Mrs. S. Candy. Ex-o fficio: The Worshipful The Mayor—Councillor W. F. Savill, J.P The Deputy Mayor Alderman Lord McEntee, C.B.E. Chairman of Finance Committee—Alderman Ross Wyld, O.B.E., J.P. Alderman Mrs. L. P. Bailey, J.P. „ W. Gillett. „ A. E. Manning. „ W. H. Shaw. Councillor F. A. Burton. Councillor E. G. Richards. A. W. Ellis. „ M. Sharland. A. G. Green. „ A. F. Whicher. Mrs. M. E. Marchant. „ J. M. Wight. Town Clerk: G. A. Blakeley, Esq. TO THE CHAIRMAN AND MEMBERS OF THE HEALTH COMMITTEE Lady McEntee, Ladies and Gentlemen, I beg to present in the following pages a report on the Health Services in the Borough during 1952. 1 am required by the Minister of Health to deal generally with matters regarding public health and preventive medicine. The report therefore includes reference to the personal health services, which, in July, 1948, were transferred to the County Council as the Local Health Authority. These matters are referred to in my capacity as Acting Area Medical Officer and by courtesy of the County Medical Officer. The population remained fairly static at 120,400, a decrease of 500 on the previous year, and on this basis vital statistics were again good, and once more compared very favourably with the rates for England and Wales, London and Greater London. The crude birth and death rates were 12.6 and 10.8 respectively. The infant mortality rate was 24.5 as compared with 27.6 for England and Wales and 23.8 for the London Administrative County. Of 66 illegitimate live births none died under one year of age. The still-birth rate fell and the neo-natal death rate rose slightly, the number of deaths being the same. The tuberculosis death rate was only 0.18 per thousand population, as compared with 0.24 for England and Wales, and 0.31 for London Administrative County. The rate for Walthamstow for 1951 was 0.31. The total of notifications of infectious disease was less than in 1951, especially in regard to whooping cough, measles, meningitis and dysentery, but there were more notifications of scarlet fever, pneumonia, puerperal pyrexia (due largely to the new regulations), and food poisoning. Again there was no confirmed case of diphtheria. Although the notifications of tuberculosis remained fairly static, the continued fall in deaths from this disease is striking, and stresses the need to render as many as possible non-infectious, otherwise the infecting pool of cases will increase. Approximately half of new cases investigated were infectious on notification or soon after. Reference is made in the report to the disquiet at the revocation of the old tuberculosis regulations. Preventive measures against tuberculosis are fully referred to in the text. An increasing amount of time became necessary in dealing with the aged and chronic sick, especially in investigating cases for possible compulsory removal to hospital and in assisting the requests made by family doctors for admission to hospital, and with particular reference to social grounds. The need for special laundry facilities for the incontinent became apparent, and a scheme is now under consideration. More time was also devoted in investigating and advising on the medical aspects of re-housing applications. At the end of the year Chingford Hospital, formerly the "Sanatorium," became a "General" Hospital, thus ending over fifty years' fine service to the Borough as a hospital for infectious diseases. The work of the sanitary inspectorate again continued on the high level of previous years. Turning to the Part III Services administered by the Walthamstow Health Area Sub-Committee, two capital building projects were considered and approved—a Health Services Clinic at Priory Court and an extension to the District Nurses' Training Home. The General and the Priority Dental Services were well maintained and included the recruitment of an additional dental surgeon and a part-time dental hygienist. The dental workshop was employed about equally on work for the Priority and the General Dental Services, and these facilities were made available to the Hospital Service and to the Leyton Committee for Education. The arrangements for pre-school child guidance continued with success. In spite of pronouncements in various quarters suggesting the demise of the child welfare centres 88% of infants under one year attended the centres, and each infant made over 17 attendances during the year. District midwifery and maternity cases fell from 440 in 1951 to 348 in 1952, but "district" or home nursing rose from 1,621 new cases and 51,798 attendances in 1951 to 1,671 new cases and 59,166 visits in 1952. The average number of visits per equivalent whole-time nurse was 3,698. The percentage of mothers given gas and air analgesia on the district was nearly 70. The services were improved by the opening of the Branch Nurses' Home at " Hillcrest," Highams Park, in April. A scheme for the extension of the main Nurses' Home at Carisbrooke Road was approved at an estimated cost of approximately £3,500. Health Visiting Staffing was reasonably adequate, but the establishment was not fully maintained. Particular difficulty continued in regard to the recruitment of tuberculosis health visitors. An increasing amount of time of the health visitors was needed for the care of the aged and chronic sick, and in regard to the multiplicity of investigations now required. The various protective measures, i.e., vaccination against smallpox and immunisation against diphtheria and whooping cough were well maintained, and with the ready assistance of family doctors. The percentages represented by completed cases in children under one year of age were: Vaccination—34.0%, Immunisation against Diphtheria—47.8%, Immunisation against Whooping Cough—21.6%. The Minister's target of 75% completed immunisations against diphtheria by one year has not been reached in most parts of the country, and was 47.8 for Walthamstow. Although the percentage for the age group 0/15 years was nearly 80, complacency continues in the absence of diphtheria, but there have been several sharp reminders elsewhere, not only as to the need for primary immunisation, but also for the "boosting" immunisation, preferably at entry to school, and ideally again before transfer to the primary school. It must never be forgotten that "DIPHTHERIA STILL KILLS." The services in regard to the prevention of illness, care and after-care and the domestic help service were well maintained, especially in regard to the tuberculous. The lack of extended chiropody facilities is still to be deplored, especially as foot defect is a major cause of rendering old people non-ambulant. Dr. Sheppard and Miss Keenan (Superintendent Health Visitor) retired during the year, after long and faithful service. Once again I have to record the good work of the departmental staff, the help and consideration of the members of the Committees concerned, and particularly of the Chairman, Alderman Lady McEntee. I would also record the help of the other chief officers concerned and last, but not least, of the family doctors practising in the Borough. 1 have the honour to be. Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. 8 STAFF OF THE HEALTH SERVICES Appointments and Resignations during 1952 WALTHAMSTOW BOROUGH COUNCIL Appointments. Mrs. A. D. Sharp Clerical Staff 7. 1.52 L. Joyce Sanitary Inspector 28. 7.52 B. G. Goode Clerk/Pupil Sanitary Inspector 1.12.52 Resignations. Nil ESSEX COUNTY COUNCIL Appointments. Miss C. Berry Student Nursery Nurse 1. 1.52 Mrs. E. Levis, S.R.N., S.C.M., H.V. Health Visitor/School Nurse (part-time) 1. 1.52 Mrs. M. Robinson Domestic Assistant 9. 1.52 Miss J. Bushby. S.R.N., S.C.M., Q.N. District Nurse/Midwife 14. 1.52 Miss W. Hails, S.R.N., S.C.M., Q.N. District Nurse/Midwife 14. 1.52 Dr. J. L. Collmann. M.B., B.S. Assistant County Medical Officer 21. 1.52 Miss D. Hooper Clerical Staff 21. 1.52 Miss M. Fitzpatrick, S.R.N., S.C.M. District Nurse/Midwife 7. 2.52 Mrs. E. Rudei.hoff Domestic Assistant 7. 2.52 Miss M. Cronshey, S.R.N.. S.C.M., Q.N. Assistant Superintendent 1. 3.52 Miss B. Yelland Day Nursery Warden 10. 3.52 Mrs. F. Hart Domestic Assistant 18. 3.52 Mrs. E. Richardson Whole Time Domestic Help 18.3.52 Miss E. Sullivan Whole Time Domestic Help 18. 3.52 Miss A. Mooney Domestic Assistant 24. 3.52 Miss D. Anklesaria, L.D.S., R.C.S. Dental Officer 3. 4.52 Mrs. H. Everitt Clerical Staff 21. 4.52 Mrs. R. Riopedre, S.R.N. District Nurse (part-time) 27. 4.52 Miss I. Moore Nursery Nurse 26. 5.52 Miss J. Hall Student Nursery Nurse 16. 6.52 Mrs. D. Hughes Domestic Assistant 18. 6.52 Miss I. Moore Deputy Matron 30. 6.52 W. Setford Temporary Caretaker/Cleaner 7. 7.52 Miss E. Long worth, S.R.N., S.C.M. District Nurse/Midwife 1. 8.52 Miss M. McDonnell, S.R.N., S.C.M. District Nurse /Midwife 1. 8.52 Miss M. Wroe, S.R.N. C.M.B.(I) District Nurse 1. 8.52 Miss H. Harris Student Nursery Nurse 5. 8.52 Mrs. H. Taylor Temporary Domestic Assistant (part- time) 11. 8.52 Miss K. Mitchell, S.R.N., S.C.M.. R.F.N. H.V. Tuberculosis Visitor 18. 8.52 Miss B. Allingham Student Nursery Nurse 1. 9.52 Miss E. Carter Student Nursery Nurse 1. 9.52 9 Miss R. Hyland Student Nursery Nurse 1. 9.52 Mrs. M. Marriott Domestic Assistant 8. 9.52 G. Allen Dental Technician 15. 9.52 Dr. J. Beat-tie, M.B., B.S.. L.R.C.P.. M.R.C.S., D.P.H. Temporary Asst. Medical Officer 22. 9.52 W. Taylor Stoker/Gardener 13.10.52 Miss D. Orr, S.R.N., S.C.M. District Nurse/Midwife 1.11.52 Mrs. A. Dunford, S.R.N. School Nurse 10.11.52 Miss M. Crowley, S.R.N., S.C.M. District Nurse/Midwife 1.12.52 Miss A. Stacey, S.R.N., S.C.M. District Nurse/Midwife 1.12.52 Miss A. Stewart, S.R.N. S.C.M. District Nurse/Midwife 1.12.52 Mrs. L. Wood Domestic Assistant 14.12.52 Mrs. A. Daniels, B.D.S. Dental Officer 15.12.52 Mrs. 1. Montague Domestic Assistant 17.12.52 Mrs. E. Cooper, S.R.N. Part-time Relief District Nurse 19.12.52 D. Warder Clerical Staff 22.12.52 Mrs. J. Foulkes, S.R.N., S.C.M., H.V. Superintendent Health Visitor 29.12.52 Resignations. Dr. M. Sheppard, M.A., M.B.. B.Ch.. B.A.O., D.P.H., Barrister-at-Law Assistant County Medical Officer 18. 1.52 Mrs. D. McLennan, R.S.C.N. Deputy Matron, Day Nursery 23. 1.52 Mrs. E. Simmons Whole-time Domestic Help 23. 1.52 Mrs. E. Bassett Domestic Assistant 30. 1.52 Miss D. Izod Student Nursery Nurse 31. 1.52 Mrs. N. Newson Domestic Assistant 7. 2.52 Miss K. Burton Warden, Day Nursery 15. 2.52 Mrs. F. Hart Whole-time Domestic Help 18. 3.52 Miss E. Rawlincs Clerical Staff 31. 3.52 Miss S. Oliver Student Nursery Nurse 9. 4.52 Mrs. 1. Stern, S.R.N., S.C.M., H.V. Health Visitor/School Nurse 15. 4.52 Mrs. M. Matthews. S.R.N. School Nurse 25. 4.52 Miss R. Taylor Student Nursery Nurse 30. 4.52 Mrs. I. Montague Domestic Assistant 7. 5.52 Miss I. Moore Nursery Nurse 29. 6.52 Miss G. Martin Student Nursery Nurse 30. 6.52 Miss M. Self Nursery Nurse 30. 6.52 Dr. T. Currie, M.B.. B.S. Assistant County Medical Officer 4. 7.52 Mrs. D. Hughes Domestic Assistant 9. 7.52 W. Setford Temporary Caretaker/Cleaner 19. 7.52 H. Edmonds Dental Technician 31. 7.52 Miss J. Phillips Student Nursery Nurse 31. 7.52 Mrs. I. Smith, S.R.N. District Nurse 31. 7.52 Mrs. M. Owen Whole-time Domestic Help 17. 8.52 Miss J. Clark Student Nursery Nurse 15. 8.52 Mrs. M. Christmas, S.R.N. District Nurse 30. 8.52 Mrs. E. Cawston Domestic Assistant 2. 9.52 10 Miss K. Munday, S.R.N., S.C.M., H.V. Health Visitor/School Nurse 13. 9.52 Mrs. D. Purves, S.R.N. Tuberculosis Visitor 15. 9.52 Miss J. Bushby, S.R.N. S.C.M., Q.N. District Nurse/Midwife 17.10.52 Miss W. Hails, S.R.N., S.C.M., Q.N. District Nurse/Midwife 17.10.52 Mrs. J. Haynes, S.R.N., S.C.M. School Nurse 3.10.52 Miss D. Lucas Student Nursery Nurse 12.10.52 Miss M. Wroe, S.R.N. District Nurse 18.10.52 Miss G. Gibbons Student Nursery Nurse 26.10.52 B. Goode Clerical Staff 30.11.52 Mrs. I. Ball, S.R.N. District Nurse 10.12.52 Miss P. Dunnage Student Nursery Nurse 10.12.52 Dr. J. Beathe. M B.. B.S., L.R.C.P., M.R.C.S., Temporary Assistant County D.P.H. Medical Officer 21.12.52 Miss S. Stothart Student Nursery Nurse 21.12.52 Mrs. E. Cooper, S.R.N. Part-time Relief District Nurse 22.12.52 Miss A. C. Keenan, S.R.N., S.C.M., H.V. Superintendent Health Visitor 24.12.52 Mrs. H. Everitt Clerical Staff 28.12.52 STAFF—GENERAL 1. Miss A. C. Keenan, S.R.N., S.C.M., retired in December, 1952, after serving the Borough Council (and later the County Council) as Superintendent Health Visitor since 1926. The Council recorded its appreciation of Miss Keenan's long and faithful service. 2. Mr. L. Joyce, a former member of the clerical staff, and later a pupil Sanitary Inspector, obtained his certificate in July, and was appointed a District Inspector. Another member of the clerical staff was then appointed to succeed him as pupil Inspector. At the end of the year four former members of the clerical staff were employed in the Sanitary Inspectorate. 3. Difficulty has been experienced in recruiting nursing stall'. One contributory cause is the application of the limit of £50 to the Superannuation liability. This seems to affect many married nurses who wish either to join or return to the service of a Local Authority after a break in service. A.—STATISTICS & SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year, 1952) 120,400 Number of Assessments (31st December, 1952) 36,839 Rateable Value (31st December, 1952) £909,942 Sum represented by penny rate £3,690 11 Population.—The Registrar-General's Estimate of the home population at mid-year, 1952, is 120,400, a decrease of 500 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 350 women were placed in employment every month during the year 1952 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, and Wanstead and Woodford, was approximately 82,000. Of this number, it is estimated that about 40,000 were employed in Walthamstow. During 1952, the average number of persons unemployed in the whole area was 900 men and 450 women; these included approximately 90 disabled men and 30 disabled women. Extracts from Vital Statistics.—The Registrar-General's midyear, 1952, estimate of the home population (viz., 120,400) has been used for the calculation of all vital statistics. Total Males Females Live Birth Legitimate 1,446 739 707 Birth rate per Illegitimate 66 36 30 1,000 of the Total 1,512 775 737 estimated home Population 12.6 Stillbirths 29 Rate per 1,000 total (live and still) births 18.8 Deaths 1,304 Death rate per 1,000 of the estimated home population 10.8 Deaths from puerperal causes:— Puerperal Sepsis Deaths Nil Other Puerperal Causes 3 Death rate of infants under one year of age:— All infants per 1,000 live births 24.5 Legitimate infants per 1,000 legitimate live births 25.6 Illegitimate infants per 1,000 illegitimate live births Nil Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under two years of age) 1 Pulmonary Tuberculosis death rate 0.18 Non-Pulmonary Tuberculosis death rate Nil The natural increase of population, i.e., excess of births over deaths was 208. 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. 12 The total number of deaths in 1952 (1,304), compares with 1,309 in 1951, the death rates for each year being 10.8 per 1,000 population. Comparability Factor.—The comparability factors for Walthamstow are given by the Registrar-General as follows:— Comparability factor for births 0.96 Comparability factor for deaths 1.04 The above factors, when applied to the crude rates, produce the following adjusted rates:— Live births 12.1 Deaths 11.3 13 Birth-Rates, Death-Rates, Analysis of Mortality, Maternal Mortality, and Case Rates for certain Infectious Diseases in the year 1952. Provisional figures based on Quarterly Returns. England and Wales 160 County Borough and Great Towns (including London); 160 Smaller Towns (Resident Population 25,000-50,000 at 1951 Census) London Administrative County Walthamstow Rates per 1,000 Home Population Births:- Live Births 15.3 16.9 15.5 17.6 12.6 Still Births 0.35 0.43 0.36 0.34 0.24 22.6* 24.6* 23.0* 19.2* 18.8* Deaths:— All Causes 11.3 12.1 11.2 12.6 10.8 Typhoid and Paratyphoid 0.00 0.00 0.00 — — Whooping Cough 0.00 0.00 0.00 0.00 0.00 Diphtheria 0.00 0.00 0.00 0.00 — Tuberculosis 0.24 0.28 0.22 0.31 0.18 Influenza 0.04 0.04 0.04 0.05 0.02 Smallpox 0.00 — — — — Acute Poliomyelitis (including Polioencephalitis) 0.01 0.01 0.00 0.01 - Pneumonia 0.47 0.52 0.43 0.58 0.77 Notifications (Corrected):— Typhoid Fever 0.00 0.00 0.00 0.00 0.00 Paratyphoid Fever 0.02 0.02 0.03 0.01 0.02 Meningococcal Infection 0.03 0.03 0.03 0.02 0.02 Scarlet Fever 1.53 1.75 1.58 1.56 3.47 Whooping Cough 2.61 2.74 2.57 1.66 1.57 Diphtheria 0.01 0.01 0.03 0.01 — Erysipelas 0.14 0.15 0.12 0.14 0.27 Smallpox 0.00 0.00 0.00 — — Measles 8.86 10.11 8.49 9.23 13.06 Pneumonia 0.72 0.80 0.62 0.57 0.83 Acute Poliomyelitis (including Polioencephalitis):— Paralytic 0.06 0.06 0.06 0.06 0.07 Non-paralytic 0.03 0.03 0.02 0.03 0.02 Food Poisoning 0.13 0.16 0.11 0.18 0.18 Puerperal Pyrexia 17.87* 23.94* 10.22* 30.77* 47.37* Rates per 1,000 Live Births Deaths :— All causes under 1 year of age 27.6† 31.2 25.8 23.8 24.5 Enteritis and Diarrhoea under 2 years of age 1.1 1.3 0.5 0.7 0.7 Maternal Mortality : A.115 Sepsis of Pregnancy, Childbirth and the Puerperium 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.l 19 Abortion with Sepsis A. 120 Other Complications of Pregnancy, Childbirth and the Puerperium A.116 Number of Deaths: Walthamstow - - - - - - 3 England and Wales 61 13 147 59 31 47 138 Rates per 1,000 Total (Live and Still) Births: Walthamstow - - - - - - 1.95 England and Wales 0.09 0.02 0.21 0.09 0.04 0.07 0.20 * Per 1,000 Total (Live and Still) Births. † Per 1,000 Related Live Births. 14 Causes of Death as given by the Registrar-General for the year 1952 Whole District Causes of Death Males Females Total 1951 1. Tuberculosis, Respiratory 16 6 22 33 2. Tuberculosis, Other - - - 4 3. Syphilitic Disease 3 4 7 7 4. Diphtheria — — — — 5. Whooping Cough — 1 1 — 6. Meningococcal Infections 1 — 1 — 7. Acute Poliomyelitis — - — — 8. Measles — — — 1 9. Other Infective and Parasitic Diseases 1 1 1 8 10. Malignant Neoplasm, Stomach 19 19 38 32 11. Malignant Neoplasm, Lung, Bronchus 33 5 38 39 12. Malignant Neoplasm, Breast - 27 27 18 13. Malignant Neoplasm, Uterus - 7 7 6 14. Other Malignant and Lymphatic Neoplasms 61 62 123 106 15. Leukaemia, Aleukæmia 3 5 8 5 16. Diabetes 3 4 7 10 17. Vascular Lesions of Nervous System 58 82 140 127 18. Coronary Disease, Angina 132 69 201 157 19. Hypertension with Heart Disease 18 17 35 47 20. Other Heart Disease 78 128 206 221 21. Other Circulatory Disease 17 28 45 22 22. Influenza 2 1 3 21 23. Pneumonia 43 50 93 100 24. Bronchitis 73 30 103 126 25. Other Diseases of Respiratory System 10 6 16 13 26. Ulcer of Stomach and Duodenum 5 2 7 19 27. Gastritis, Enteritis and Diarrhoea — 4 4 5 28. Nephritis and Nephrosis 7 4 11 10 29. Hyperplasia of Prostate 20 - 20 13 30. Pregnancy, Childbirth, Abortion - 3 3 2 31. Congenital Malformations 8 3 11 8 32. Other defined and ill-defined diseases 43 54 97 119 33. Motor vehicle accidents 9 1 10 7 34. All other accidents 7 5 12 13 35. Suicide 5 - 5 10 36. Homicide and operations of war 1 — 1 - Totals, 1952 676 628 1,304 - Totals, 1951 668 641 — 1,309 The age distribution of Cancer deaths was as follows Under 1 yr. 1-2 yrs. 2-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 yrs. and over — — — - - 7 90 136 15 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 1952 1,512 12.6 29 19.2 0.24 23 15.2 37 24 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 The death rate from Diarrhoea and Enteritis in children under one year of age per 1,000 live births was 0.7. 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 1952 there were three deaths classified as being due to pregnancy, childbearing or associated therewith. The details are included in the following table:— Case No. Date of Death Certified Cause of Death Age Ward 1 5.2.52 Sub-acute Obstruction and Partial Volvulus 36 Hi 2 7.5.52 Anremia—Prolonged Labour (recent delivery) 27 H.H. 3 9.8.52 Pulmonary Embolism. Thrombosis of Uterine Veins (recent full-term delivery) 30 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 1952 1,541 - 3 3 - 1.95 1.95 1951 1,675 2 2 1.19 - 1.19 1950 1,635 - - - - - - 1949 1,863 — 2 2 — 1.07 1.07 1948 2,114 - - - - - - 16 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 MATERNAL MORTALITY, STILLBIRTHS & NEO-NATAL DEATHS The following table shows the maternal mortality, stillbirth and neo-natal death rates for the past five years: — Rate (per 1,000 live births) 1952 1951 1950 1949 1948 Maternal Mortality 1.98 1.22 — 1.09 — Stillbirths 19.2 23.2 23.1 14.7 22.2 Neo-Natal Mortality 15.2 14.0 20.6 16.9 11.1 17 REGISTRATION OF BIRTHS The Registrar-General's returns show the following registrations during the calendar year:— (a) Live Births. Males Females Totals Legitimate 739 707 1,446 Illegitimate 36 30 66 775 737 1,512 The stillbirth rate per 1,000 population was 0.24. Of the 1,553 local registrations, 397 belonging to other areas are excluded, leaving a net total of 1,156. There were no nonnotified births during 1952. St. James Street High Street Hoe Street Wood Street Hale End Higham Hill Total Totals m. 71 f. 83 m. 64 f. 60 m. 94 f. 95 m. 86 f. 91 m. 137 f. 126 m. 129 f. 120 m. 581 f. 575 Grand Totals 154 124 189 177 263 249 1,156 B-—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA 1. Public Health Officers of the Authority The names and qualifications of the officers employed by the Authority were given at the beginning of the 1951 Report. The changes during 1952 are specified at the beginning of this Report and all are whole-time officers unless otherwise stated. 2. Laboratory Facilities Laboratory investigations are done at the Public Health Laboratory, at St. Margaret's Hospital, Epping. There is a morning collection Mondays to Fridays, with a special collection on Saturdays on request. Specimens are taken by van to the Laboratory at Epping. There is a collecting box at the Town Hall for specimens from familv doctors. Dr. Frank Marsh, Pathologist in charge of the Laboratory at Epping, has kindly supplied the following information in regard to work done for Walthamstow:—  Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec Total Faeces and rectal swabs 13 4 8 3 5 - 3 1 5 9 1 2 54 Agglutinations 6 6 8 4 7 5 10 2 1 13 4 4 70 Rhesus, Group and Kahn 19 9 17 3 7 14 15 14 12 8 9 11 138 Urine 6 2 1 2 1 3 4 2 3 7 2 5 38 Nose & Throat Swabs 4 19 15 16 4 12 2 2 11 11 6 7 109 Ear Swabs — — — — — — - 2 — — — — 2 Food — — — — — — — — — — — 1 1 Haemoglobin estimation 15 6 11 3 5 10 10 11 14 7 8 6 106 Hairs — — 2 — - — — — - — — 2 Wash Water — — — — 2 — — — — - — — 2 Patches — — — — 2 — — — - - - 2 TOTAL 63 46 62 31 33 44 44 34 46 55 30 36 524 18 In December, 1952, a new and well-equipped laboratory was provided by the Regional Hospital Board in the former school premises adjoining Connaught Hospital. 3. Ambulance Facilities These are available from a local depot in Walthamstow which is administered centrally from Chelmsford, via the Control Centre at Ilford. 4. Scabies Clinic The arrangements at the Special Treatment Centre detailed in previous reports were continued. One session per week is held at the Clinic premises which are situated at the back of the Public Baths in High Street. Treatment is by appointment only, i.e., through the family doctor or the Health Department. The number of cases treated during 1952 was 44, involving 69 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 42 such treatments in 1952 out of the total specified above. 5. Hospital Accommodation (a) Acute Cases.—There were no major changes in 1952 in regard to the hospital accommodation available for the inhabitants of the Borough. 19 (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, and only two outstanding cases remained at the end of the year. The following table shows the position in regard to hospital admissions considered and supported on " social " grounds. No. of cases at end of 1951 awaiting Hospital admission 1 No. of new cases considered during 1952 for Hospital admission 15 No. of admissions to Hospital 13 No. of cases who died before admission 1 No. of cases outstanding at end of 1952 2 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. During the year under review Walthamstow admissions rose to approximately 75%. (d) Infectious Diseases.—The Regional Hospital Board decided that after the 31st December, 1952, cases of infectious diseases would not be admitted to Chingford Hospital and that patients from Walthamstow would be admitted to St. Ann's Hospital, Tottenham. It is eventually intended that Chingford Hospital will become a General Hospital, but the immediate policy will be to transfer post-operative and certain medical cases from the other hospitals in the Group and to continue the admission of light medical cases from the surrounding area. There will be 64 beds available at the beginning of 1953, and it is hoped, a further 20 beds will be available in 1954. 20 This decision closes a memorable chapter in the history of this Hospital which was provided by the then Urban District Council of Walthamstow at the beginning of the century. The change of user is a reflection of the progress which has been made in the control of these diseases. 6. Aged and chronic Sick. National Assistance Act, 1948 (Section 47). Application was made to the Stratford Court for the compulsory removal to hospital of an aged male living by himself under grossly insanitary conditions. The hearing was adjourned, the Bench declining an invitation to visit the premises to see the actual conditions. Subsequent to the second adjournment the man was found dead in his "home." In a second case authority was given by the Council to make application to the Court for an order. The person concerned was a woman of some 85 years of age, the owner-occupier of a house, who was blind and cardiac and who sub-let to two other elderly and infirm tenants. Part-time domestic help and "Meals on Wheels" had been provided since May 1949, following a refusal of her family doctor's advice to accept institutional treatment which had been arranged. At a visit paid in November 1949 the general conditions were bad, and there was considerable danger through the use of oil lamps for heating and cooking. It was felt, however, that from previous experience in regard to Section 47 procedure that an order might not be granted by the Court. The position remained static until May 1951, when the domestic help reported Mrs. "C" to be unwell, and that she would not call the family doctor through fear of removal to hospital. Later there was some improvement, but in August 1950, the family doctor reported Mrs. "C" to be "falling about" increasingly and that she had again refused hospital treatment. Later there was again improvement, but in January 1952, domestic help was again increased together with home nursing, and the family doctor was in daily attendance. The patient still refused hospital treatment. By February 1952, the patient was obviously permanently bedridden and the family doctor urged compulsory removal to hospital. Following the Council's resolution to make application to the Court, the only known relative, a niece in Wales, was asked to come to Walthamstow to persuade her aunt to go to hospital, a bed at Langthorne having been made available by the transfer of a patient to Part III accommodation by the Welfare Officer. Fortunately, when the ambulance called, the niece was able to persuade the old lady to go to hospital and without recourse being made to the Court. 21 National Assistance (Amendment) Act, 1951. The Medical Officer of Health is authorised by the Council 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. Four inspections of each home were made by the medical staff. No difficulties in regard to supervision arose. Routine enquiries are made with regard to unregistered homes. 8. Essex County Council Act, 1933 (Establishments for massage and special treatment). One new licence was granted under the Act. 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 1952. All dwelling houses in the area are supplied direct with running water. The information included in the report for 1951 in respect of Ministry of Health Circular 42/51, also applied to 1952. Sanitary Inspection of the Area Mr. F. W. Kemp, Chief Sanitary Inspector reports as follows:— No. of Inspections Made No. of Nuisances Detected No. of Complaints Received No. of Intimation Notices No. of Statutory Notices Total Visits Served Complied With Served Complied With 15,857 5,203 2,402 1,434 1,619* 234 297* 22,114 * Includes Notices outstanding from previous year. 22 Of the 1,434 intimation notices served, 295 were in respect of business premises and the remainder (1,139) related to defects in private houses. Of the latter figure, 906 were complied with without resort to statutory procedure. Owing to the failure of Owners to comply with Abatement Notices served under Section 93 of the Public Health Act, 1936, it was necessary to institute legal proceedings in nine cases. Orders were made by the Justices in two instances, Costs of £1 1s. Od. and £5 5s. Od. respectively being awarded. Owing to further default on the part of one Owner, the Council subsequently carried out the work at a cost of £30 17s. 11d. In seven cases the Summonses were withdrawn on payment of Costs ranging from £1 1s. Od. to £2 2s. Od., the required work having been undertaken before the date of Hearing. The following table shows the nature of work executed and improvements effected during the year:— Drains tested, 294; Drains reconstructed or repaired, 409; Drains, obstructions removed, 121; Drains, means of access provided, 44; Drains, ventilation provided or improved, 70; Drains, ventilation repaired, 76; Soil pipes repaired or renewed, 106; Rain-water pipes repaired or renewed, 134; Rain-water pipes disconnected from drains, 8; Roofs repaired or renewed, 582; Gutterings repaired or renewed, 319; W.C. pans or traps provided, 257; Gully traps provided, 94; W.C. flushing cisterns repaired or renewed, 214; W.C. floors concreted, 76; W.C.s repaired and cleansed, 234; W.C.s light and ventilation improved, 44; Waste pipes repaired, renewed or trapped, 197; New sinks provided, 78; Stoves and firegrates repaired or renewed, 257; Water supply reinstated, 16; Water supply taken off main, 6; Cisterns cleansed and covered, 25; Sculleries paved, 34; Yards and forecourts paved or repaired, 76; Dirty houses cleansed, 31; Dirty rooms cleansed, 418; Floors repaired, 396; Ventilations under floors provided or improved, 131; New damp proof courses provided, 35; Sites concreted, 1; Offensive accumulations removed, 20; Animals improperly kept, removed, 4; Stables repaired and cleansed, 20; Manholes repaired or re-sealed, 142; Other causes of dampness remedied, 527; Miscellaneous repairs, 2.044. Infectious Diseases. Visits to premises, 671; Re-visits to premises, 14. Disinfections. Rooms disinfected, 169; Articles disinfected, 479; Articles destroyed. 54. 23 Special, Premises. Visits Number paid Factories (a) Non-power 89 157 (b) Power 463 842 (c) Other premises 45 133 Outworkers 572 826 Butchers—80: Horseflesh only—3 83 450 Bakehouses 36 189 Fishmongers, Fish Fryers and Curers, etc. 41 193 Cafes and Caterers 115 509 Grocers, etc. 268 770 Ice Cream Manufacturers and Vendors 276 360 Dairies and Milksellers 133 149 Laundries 3 14 Hairdressers 74 84 Rag and Bone Dealers 4 20 Piggeries 2 4 Street Stalls Numerous 294 Greengrocers 94 160 Stables 21 128 Schools — 120 Conveniences — 77 As a result of the regular periodical visiting of the Special Premises the following works were carried out:— Butchers. Special cleansings, 53; Pavings repaired, 8; Accumulations removed, 7; New galvanised bins provided, 18; Drains repaired, 1; W.C.s repaired and cleansed, 10; Floors repaired and ventilated, 5; Light and ventilation improved, 1; Other improvements, 41; Bakehouses. Special cleansings, 48; New ceilings fixed, 2; Floors repaired, 6; Light and ventilation improved, 4; Roofs repaired. 1; Other improvements, 17. Fishmongers. Special cleansings, 24; Yards repaved, 5; Accumulations removed, 8; Drains cleared, 5; Other improvements. 16. Grocers. Store rooms cleansed, 101; Washing accommodation improved. 27: Other improvements, 54. 24 Cafes and Caterers. Special cleansings, 94; Light and ventilation improved, 6; Floors repaired, 5; Other improvements, 52. Ice Cream Manufacturers and Vendors. Special cleansings, 4; Other improvements, 2. Dairies and Milkshops. Special cleansings, 24; New fittings and other improvements, 9; Pavings relaid, 1. Hairdressers. Special cleansings, 29; Other improvements, 8. Stable Premises. Cleansings, 14; Accumulations removed, 10; Pavings repaired, 3; Other improvements, 3. Laundries. Special cleansings, 4. Rag and Bone Dealers. Cleansings, 4; Accumulations removed, 1. Piggeries. Cleansing, 1. Street Traders. Stalls improved, 14; Storerooms improved, 6. Public Houses. Special cleansings, 12; Hot water supply improved, 3. Caravans. There are no authorised sites in the borough. During the year considerable trouble was experienced from unauthorised campers on the verge in Folly Lane, but with the co-operation of the police authorities and the Borough Architect, Engineer and Surveyor's Department they were removed, only to return later and again to be removed. 25 Smoke Abatement. Complaints of smoke nuisance were received and investigations carried out in respect of eleven premises, seven of which were factories. Ten smoke observations were carried out. Five written intimations were sent. A cyclone grit-arrestor was fitted to one factory boiler plant and one bakehouse changed from solid fuel to gas. Eradication of Bed Bugs, etc. The number of houses reported to be verminous still remains comparatively small. Seventy-six rooms were fumigated with DDT smoke or sprayed with DDT solution. Insecticides were issued free of charge to tenants of seventy-one premises. Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1938:— No notifications were received during the year. 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, 1952, the Baths were open on 294 days. Number of Swimming Bath Bathers during this period was 111,670. "Maximum load was on July 1st, when we had 1,137. "During this period we also had 125,155 Slipper Bath Bathers." Sampling was carried out on seven occasions, with generally 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. 26 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. 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 19,500 people passed through during the season. "The new chlorination plant was very satisfactory, and except when the pool was very heavily loaded and a boost of liquid chlorine used, produced an average of .5 ppm in the shallow end and .3 ppm in the deep end. "Several times it was necessary to run the plant all night due to a heavy load the previous day. This was partly due to night swimming which the inception of floodlighting produced." Bacteriological and chemical analyses were carried out on five occasions with satisfactory results. D.—HOUSING Statistics The Borough Architect, Engineer and Surveyor, 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 1952:— Hoe Stree Ward 18 Flats 12 Houses St. James Street Ward 2 Houses Higham Hill Ward 93 Flats 12 Houses High Street Ward Nil Hale End Ward 34 Flats 3 Houses Wood Street Ward 20 Flats 21 Houses TOTAL 165 Flats 50 Houses 27 Houses erected by Private Enterprise during 1952:— Hoe Street Ward Nil St. James Street Ward 2 Houses Higham Hill Ward Nil High Street Ward 6 Houses Hale End Ward 10 Houses Wood Street Ward 6 Houses TOTAL 24 Houses Note: All were permanent houses or flats. Houses Erected During 1952 During the calendar year 1952. 50 new houses and 165 flats have been erected. Twenty-four houses were erected by private enterprise. The principal schemes completed by the Council during the year include 24 flats at Gordon Avenue, 5 houses and 20 flats at Wyatts Lane, 12 flats and 8 maisonettes at Chingford Road/ Evesham Avenue, 68 flats and 5 houses. Bulls Farm, Billet Road, and 5 shops with maisonettes over have also been completed at this Estate. Fifty-one houses and 4 flats are at present under construction at Bulls Farm, and the completed scheme will provide a total of 133 houses and flats and 5 shops. Development is proceeding on a number of smaller sites throughout the Borough and 31 houses for the higher income group are in course of erection at Gordon Avenue. 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) 2,799 (b) Number of inspections made for the purpose 7,763 (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 256 (b) Number of inspections made for the purpose 309 28 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 8 (N.B.—These comprise individual unfit houses) (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,131 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 906 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 (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 233 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners *295 (b) By Local Authority in default of owners 1 C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— *Includes those outstanding from previous year. 29 (1) Number of dwelling houses in respect of which Demolition Orders were made 1 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 4 D. Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 4 (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 Housing Act, 1936 Unfit Houses The following premises were dealt with as follows:— Demolition Orders: 258, Hale End Road Closing Orders: 23, Church Hill (Basement) 172, Wood Street 174, Wood Street 3, Eldon Road (Basement) Houses Demolished: 36, Elm Grove 38, Elm Grove 1, Eden Road 110, Upper Walthamstow Road Unfit Houses: The Ministry of Housing and Local Government (Form P.13 (HSG)/53)—Return for the period 1st April, 1952, to 31st December, 1952. 10 Part B.—Houses not included in Clearance Areas. Demolition and Closing Orders No. of houses No. of persons displaced (1) Housing Act, 1936 (a) Houses demolished as a result of formal or informal procedure under Section 11 3 9 (b) Houses closed in pursuance of an undertaking given by the owners under Section 11, and still in force 1 2 (c) Parts of buildings closed (Section 12) 1 2 (2) Housing Act, 1949 (a) Closing Orders made under Section 3(1) — — (b) Demolition Orders determined and Closing Orders substituted under Section 3 (2) — — (3) Repairs Number of unfit or defective houses rendered fit during the period as a result of informal action by the local authority under the Public Health or Housing Acts 1,263 (4) Public Health Acts Number of houses in which defects were remedied after service of formal notices— (a) By owners 220* (b) By local authority in default of owners 1 (5) Housing Act, 1936 Number of houses made fit after service of formal notices— (a) By owners — (b) By local authority in default of owners — *Includes those brought forward from preceding year. Marlowe Road Redevelopment Area In February, the Council decided to investigate the possibility of declaring a redevelopment area in the Wood Street Ward. This involved the detailed inspection of some 300 houses, 256 of which were completed by the end of the year. Rent and Mortgage Restriction Acts During the year thirteen certificates were granted to tenants. No applications were received for clearance certificates. Housing Act, 1936, Section 62 Applications for "permitted number" were received from landlords and certificates issued during the year respecting 85 lettings. Thirty special enquiries from the Housing Manager were also dealt with. 11 Local Land Charges Particulars relating to outstanding sanitary notices were supplied in reference to 1,527 enquiries. General Mr. C. W. Rayner, the Council's Housing Manager, kindly gives the following details of rehousing carried out by his Department in 1952:— No. of new properties made available for letting 197 Normal vacancies 40 TOTAL 237 Families rehoused:— 1-bedroom group 47 2-bedroom group 104 3-bedroom group 74 4-bedroom group 12 TOTAL 237 Of the total number of families rehoused, in 18 instances there was a medical recommendation made in respect of tuberculosis. The following extract is taken from a Report made to the Sub-Committee on housing policy held in January, 1952, and showing the housing situation in Walthamstow, at the 31st December, 1951. "Categories "To make an intelligent assessment of the housing needs of the Borough the Housing Department has analysed the applications with the following results:— (a) Families living in dwellings where there is overcrowding in excess of 1½ persons per room 700 (b) Families in dwellings considered to be fully occupied. viz., 1½ persons per room 474 (c) Families in dwellings where there is ½ unit of under- occupation 824 (d) Families in dwellings where there is 1 unit of under- occupation 709 (e) Families in dwellings where there is 1½ units of under- occupation but more than one person per room 1,210 (0 Cases of one person per room or less 2,473 6,390 "As indicated in the above statement a dwelling is regarded as 'overcrowded' if there are more than 1½ persons per living or 32 bedroom. Kitchens and bathrooms are ignored, and children count as ½ persons. The Ministry's official overcrowding figure is two persons per room. "The 'hard core' of the housing register is probably to be found in the following categories:— 1½ persons or more per room 1,174 Three families per dwelling 330 Families with 2 or more children living with in-laws 556 Priority I 2,060 "There will also be some exceptional cases (not covered above) requiring special treatment. "To these ought to be added if possible:— Over 1 person per room 2,743 Priority II 2,743 "The remainder are chiefly those who already have as many rooms as we would allot them or those who want a change of landlord or a house with present-day comforts and improvements. While such desires are natural, the Council cannot hope to be able to cater fully for these last groups. "The basic need, therefore, is 2,060 dwellings, to which should be added (if possible) a further 2,743." Rehousing of Medical Cases During 1952, 91 cases claiming priority of rehousing for tuberculosis were investigated and reported upon. Of these, 16 cases were added to the list of cases and classified in order of urgency. The position at the end of 1952 was as follows:— Class 1 Class 2 Class 3 Class 4 Total On List, at end of 1951 12 17 9 37 75 Added to List during 1952 7 3 5 1 16 19 20 14 38 91 Rehoused or removed from List during 1952 17 6 1 13 37 On List at end of 1952 2 14 13 25 54 In addition to the tuberculosis cases, 48 cases were recorded as needing special investigation on medical grounds, and 57 on general housing grounds. 33 A grand total of 263 investigations were made during the year. In order to assess medical and rehousing claims, the necessary enquiries were made from the Chest Clinic and the Housing Department, from which the closest co-operation has been received. Duplication of enquiries was thus prevented. E.—INSPECTION AND SUPERVISION OF FOOD (a) Milk Supply. The following is contributed by the Chief Sanitary Inspector:— Designated Milk. During the year 144 samples of milk were submitted to the Counties Laboratories for bacteriological examination, including Phosphatase, 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 tables gives details of samples taken:— Grade No. of Samples Results Satisfactory Unsatisfactory (Methylene Blue Test) Pasteurised 115 114 1 Tuberculin Tested Pasteurised 22 22 - Sterilised 7 7 — Totals 144 143 1 Biological Test. Four samples of Pasteurised milk were examined, all of which were satisfactory. 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. Supplementary Licences. Pasteurised 45 Pasteurised 9 Sterilised 114 Sterilised 11 Tuberculin Tested 26 Tuberculin Tested 9 34 Licences (Plant). Pasteurisers 2 Tuberculin Tested (Dealers) 2 There are no Cow-keepers in the district. The number of Retail Milk Distributors is 133. One hundred and forty-nine visits were paid to registered premises and a satisfactory standard of cleanliness was maintained. The Milk (Special Designations) (Specified Areas) Order, 1951. The above Order came into operation on the 1st October, 1951. All milk retailed within the Borough must be either Pasteurised or Sterilised. (b) Ice Cream. Fifty-one applications for Registration were received. New licences were granted as follows:— Vendors, New 27 Vendors, Transfers 20 Refused 4 Number on Register at end of year 276 Number of premises used for manufacturing 9 Ice Cream (Heat Treatment, Etc.) Regulations, 1947-51. The trade has continued to co-operate and a good standard has been maintained. Food Standards (Ice Cream) Order, 1951. Four samples were taken and submitted to the Public Analysts who reported the following satisfactory results:— Fat content 12.3% 10.9% 8.7% 5.5% 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 sixth year. 35 A session is held one afternoon a week and forty-nine 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 twenty-six samples were submitted for bacteriological examination and for grading in accordance with the provisional test of the Ministry of Health. The following summary gives the comparative results as between the old standard test and the new (provisional) test. Grades I and II of the latter are considered satisfactory. Plate Count Coliform Reaction (in 1/10 ml.) Bacterium Coli (in 1/10 ml.) Very Satisfactory Passable Not Passable Methylene Blue Reduction Time Test Grade 400 — — X Not in 4 hrs. I 4,000 — — X 4 „ I 500 — — X „ 4 „ I 5,000 — — X „ 4 „ I 1,000 — — X „ 4 „ I 9,000 — — X „ 4 „ I 2,000 — — X „ 4 „ I 4,500 — — X „ 4 „ I 1,400 — — X „ 4 „ I 1,200 — — X „ 4 „ I 3,800 — — X „ 4 „ I 7,000 x1 tube — X „ 4 „ I 900 — — X „ 4 „ I 2,800 — — X „ 4 ,, I 4,600 — — X „ 4 „ I 2,500 — — X „ 4 „ I 800 — — X „ 4 „ I 2,000 xl tube — X „ 4 „ I 6,000 — — X „ 4 „ I 200 — — X „ 4 „ I 400 — — X „ 4 „ I 2,800 — — X „ 4 „ I 1,800 — — X „ 4 „ I 3,200 — - X „ 4 „ I 9,000 — — X „ 4 „ I 400 — — X „ 4 „ I 100 — — X „ 4 „ I 1,00 xl tube — X „ 4 „ I 500 — - X „ 4 „ I 100 — — X „ 4 „ I 3,500 - - X „ 4 „ I 6,500 — - X „ 4 „ I 4,400 x2 tubes - X „ 4 „ I 1,600 - X „ 4„ I 8,000 — - X „ 4 ,, I 3,800 xl tube - X „ 4 „ I 300 — - X „ 4 „ I 1,800 - - X „ 4 „ I 1,600 - - X „ 4 „ I 300 - - X „ 4 „ I 2,500 — - X „ 4 „ I 36 Plate Count Coliform Reaction (in 1/10 ml.) Bacterium Coli (in 1/10 ml.) Very Satisfactory Passable Not Passable Methylene Blue Reduction Time Test Grade 1,200 xl tube — X Not in 4 hrs. I 300 — — X „ 4 „ I 6,000 xl tube — X „ 4 „ I 200 — — X „ 4 „ I 1,200 — — X „ 4 „ I 1,900 — — X „ 4 „ I 600 — — X „ 4 „ I 1,600 — — X „ 4 „ I 1,800 xl tube — X „ 4 „ I 1,200 — — X „ 4 „ I 2,700 xl tube — X „4 „ I 5,500 xl tube — X „ 4 „ I 3,000 — — X „ 4 „ I 900 — — X „ 4 „ I 1,500 — — X „ 4 „ I 4,500 xl tube — X „ 4 „ I 400 xl tube — X „ 4 „ I 100 — — X „ 4 „ I 300 — — X „ 4 „ I 200 xl tube — X „ 4 „ I 800 — — X „ 4 „ I 100 — — X „ 4 „ I 6,000 xl tube — X „ 4 „ I 3,000 — — X „ 4 „ I 15,000 — — X „ 4 „ I 1,400 — — X „ 4 „ I 9,000 xl tube — X „ 4 „ I 1,700 — — X „ 4 „ I 1,700 — — X „ 4 „ I 700 — — X „ 4 „ I 200 — — X „ 4 „ I 100 — — X „ 4 „ I 200 xl tube — X „ 4 „ I 300 — — X „ 4 „ I 100 — — X „ 4 „ I 3,600 — — X „ 4 „ I 2,200 — — X „ 4 „ I 2,800 — — X „ 4 „ I 1,000 — — X „ 4 „ I 800 — — X „ 4 „ I 2,200 — — X „ 4 „ I 4,400 - — X „ 4 „ I 400 - — X „ 4 „ I 500 - — X „ 4 „ I 1.800 - — X „ 4 „ I 1,200 - — X „ 4 „ I 4,800 - — X „ 4 „ I 4,000 - — X „ 4 ,, I 2,800 - — X „ 4 „ I 2,700 xl tube — X „ 4 „ I 800 xl tube — X „ 4 „ I 8,000 xl tube — X In 4 „ II 3,600 xl tube — X „ 4 „ II 3,200 xl tube — X „ 4 „ II 13,000 xl tube — X „ 4 „ II 250 xl tube — X „ 4 „ II 8,800 xl tube — X „ 4 „ II 18,000 — — X „ 4 „ II 7,000 xl tube — X „ 3½ „ II 37 Plate Count Coliform Reaction (in 1/10 ml.) Bacterium Coli (in 1/10 ml.) Very Satisfactory Passable Not Passable Methylene Blue Reduction Time Test Grade 18,000 x2 tubes — X In 3½ „ II 1,500 - — X „ 3½ „ II 100 xl tube — X „ 3½ „ II 3,200 x1 tube — X „ 3½ „ II 6,400 xl tube — X „ 3½ „ II 9,500 - — X „ 3½ „ II 700 - — X „ 3½ „ II 9,000 - — X „ 3½ „ II 23,000 xl tube — X „ 3½ „ II 9,000 - — X „ 3½ „ II 4,000 x2 tubes — X „ 3½ „ II 13,200 x3 tubes — X „ 3 „ II 1,500 x3 tubes — X „ 3 „ II 28,000 x2 tubes — X „ 2½ „ II 24,000 x2 tubes x2 tubes X „ 2½ „ II 300 x2 tubes — X „ 2½ „ II 56,000 x3 tubes — X „ 2½ „ II 2,600 x3 tubes — X „ 2½ „ II 22,000 x2 tubes — X „ 2½ „ II 28,000 - — X „ 2½ „ II 70,000 x3 tubes xl tube X „ 2½ „ II 3,400 x3 tubes x3 tubes X „ 2 „ III 18,000 x2 tubes — X „ 2 „ III 14,000 x3 tubes — X „ 1½ „ III 12,000 x3 tubes — X „ 0 „ IV 110,000 x3 tubes — X „ 0 „ IV By the old test, of a total of 126, 109 were in the categories "Very Satisfactory" or "Satisfactory" and 13 "Passable." In the latter group the bacteriologists invariably amplified their classification with a special note. By the new (provisional) test, 92 were in Grade I, 28 Grade II, 4 Grade III and 2 Grade IV. When an unsatisfactory sample is obtained the supplies are 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. Four samples were submitted to the Public Analysts, who reported all free from prohibited dyes and metallic poisoning. Nine samples were examined for bacterial purity, all of which were of a satisfactory standard. (c) Meat and Other Foods. The Live Stock (Restriction of Slaughtering) Order, 1940, continued in force and no slaughtering was carried out. 38 The following is a summary of food surrendered and con- demned as being unfit for human consumption. Where possible, the food was salvaged for animal feeding-stuffs, etc. 881 tins Evaporated Milk 28 tins Spaghetti 265 „ Full Cream Milk 14 drums Mustard 65 „ Machine Skimmed 22 bots. Salad Cream „ Milk 5 jars Pickles 1 tin Cream 1 bot. Sauce 1 „ Malt Beverage 78 tins Soup 119 tins Strained Foods 6 pkts. Soup Squares 503 „ Peas 28 lbs. Split Peas 391 „ Beans 4 „ Sugar 113 „ Tomatoes 3¾ „ Tea 55 „ Vegetable salad 1729 „ Prunes 16 „ Carrots 60 „ Currants 14 „ Rhubarb 4½ „ Figs 1 tin Celery Hearts 4320 „ Tomatoes 1626 tins Cherries 448 lbs. Sweephat 735 „ Plums 12 pkts. Bun Flour 230 „ Apples 8 „ Pudding Mixture 180 „ Strawberries 50 lbs. Flour 146 „ Raspberries 1¼ „ Shredded Coconut 103 „ Oranges 2 pkts. Blanc Mange 101 „ Peaches 3 Jellies 71 „ Pineapple 53 lbs. Cheese 67 „ Greengages 18 „ Macaroon Biscuits 55 „ Apricots 5 „ Cake 35 „ Blackcurrants 144 bars Peppermint Rock 33 „ Damsons 122 boxes Chocolate 32 „ Gooseberries 90 lbs. Confectionery 28 „ Prunes 7 pkts. Chewing Gum 12 „ Grapes 27 jars Lemonade Crystals 11 „ Grapefruit 5 doz. Mineral Waters 6 „ Pears 62 tins Sardines 7 „ Loganberries 23 „ Fish Paste 5 „ Blackberries 22 „ Roe 4 „ Youngberries 11 „ Herrings 2 „ Bananas 8 „ Salmon 1 „ Mango Slices 7 „ Pilchards 77 „ Jam 5 „ Lobster 22 „ Marmalade 2 „ Crab 2 „ Mincemeat 38 stone Skate 2 „ Lemon Curd 7 „ Dogfish 2 „ Syrup 6 „ Whiting 9 „ Pease Pudding 3 „ Kippers 48 Christmas Puddings 1 „ Bream 6 tins Milk Pudding 10 lbs. Cod 1 tin Plum & Apple 12 cwt. Mussels Pudding 690 tins Luncheon Meat 39 87 tins Stewed Steak 161 lbs. Geese 38 „ Beef Loaf 4062 „ Lambs' Livers 37 „ Sausages 3091 „ Beef 31 „ Tongue 924 „ Lambs' Kidneys 24 „ Veal & Ham Loaf 412 „ Mutton 19 „ Braised Steak 810 „ Ox Cheeks 13 „ Brawn 294 „ Lambs' Hearts 1 tin Braised Kidneys 54 „ Pigs' Livers 1 „ Rabbit 20½ „ Pork 2 jars Meat Paste 14 „ Lamb 1504 lbs. Ham (tinned) 10 „ Ox Kidney 262 „ Pork (tinned) 6 „ Bacon 248 „ Jellied Veal (tinned) 28 „ Fat (beef) 186 „ Chicken (tinned) (d) Adulteration, etc.—Food and Drugs Act, 1938. During the year, ninety-seven samples of food and drugs were submitted to the Public Analysts. Three were reported as being unsatisfactory, details respecting same are given below:— Description of Article Pork Sausages Result of Analysis Deficient in Meat by 15% Action Taken Through Ministry of Food. Fined £10 and £5 5s. Od. Costs. Cough Syrup (2) Unfit—contained mould growth Old stock—1 bottle surrendered. The following summary gives details of food sampled and result of analyses:- Formal No. Examined No. Formal Unsatisfactory Informal Total Informal Total Milk 17 — 17 — — — Cheese Spread — 3 3 — — — Doughnut 1 1 2 — — — Lobster Paste - I 1 — - - Macaroni 1 - 1 - - - Meat, potted — 1 1 — — — Pepper 1 4 5 — — — Sausages, Liver 2 - 2 - - - Sausages, Pork 1 — 1 1 — 1 Self-raising Flour 1 — 1 - — — Sweet Pearls for Cake Decorations - 1 1 - - - Tapioca Wafer Flake 1 - 1 - - - Vinegar 3 - 3 - - - Epsom Salts - 1 1 - - - Eye Ointment - 1 1 - - - Mercurial Ointment - 1 1 - - - Soothing Syrup - 1 1 - - - Aspirin Tablets - 1 1 - - - Saccharin Tablets - 2 2 - - - Olive Oil — 1 1 — — — 40  Formal No. Examined No. Formal Unsatisfactory Informal Total Informal Total Cough Syrup 1 1 2 1 1 2 Syrup of Figs — 1 1 - — — Baking Powder — 1 1 - — — Cake Mixture — 2 2 - — — Batter Flour 1 — 1 - — — Sponge Mixture — 1 1 - — — Cream Bun — 1 1 - — — Swiss Roll — 1 1 - — — Prepared Milk Food 1 — 1 - — — Ice Cream — 4 4 - — — Ice Lollies — 4 4 - — — Ice Cream Cones — 3 3 - — — Jelly 2 1 3 - — — Mincemeat — 1 1 - — — Pork Brawn — 1 1 - — — Beef, Pressed 1 — 1 - — — Linseed, Meal — 1 1 - — — Cherries in Syrup — 1 1 - — — Salad Cream — 1 1 - — — Gravy Powder 1 — 1 - — — Horseradish Relish — 1 1 - — — Pickled Onions — 1 1 - — — Spice, Mixed — 1 1 - — — Welsh Rarebit — 1 1 - — — Coffee 1 — 1 - — — Custard Powder 1 — 1 - — — Sherbet Sucker — 1 1 - — — Sweets — 2 2 - — — Kosher and Vegetarian Cooking Fat - 1 1 - - - Procea Bread — 1 1 - — — Pudding, Christmas 1 — 1 - — — Whisky 4 — 4 - — — Gin 1 — 1 - — — Rum I — 1 - — — 44 53 97 2 1 3 (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. (f) Clean Food Campaign. The majority of "Progressive" food-traders now fully realise that "Clean Food" is more than a slogan, and they seriously endeavour to attain a standard suitable to their calling. For several years their efforts were met with frustration. Fortunately, conditions are now easing; materials for raising the 41 cleanliness-standard of premises are in more plentiful supply, wrapping papers are available although still comparatively expensive, and suitable washable coats and aprons are readily obtainable. In fact, the conditions laid down in the Council's Byelaws for securing the observance of sanitary and cleanly conditions and practices in connection with the Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air, can now be attained without great hardship. The "careless" food-trader should note that the Byelaws contain a Penalty clause for offences, and fines up to £5, and for a continuing offence a further fine not exceeding 40/- per day, may be inflicted on summary conviction of the offender. Clean Food Guild. A conference took place during the year with representatives of the Walthamstow Trades Council and of the Walthamstow Chamber of Commerce to consider the possible issue of Certificates of Hygiene to traders, etc., if the conditions of their premises satisfied standards to be laid down by the Borough Council and to consider the issue of a booklet on clean food. Later, representations were received from the Chamber of Commerce, stating that after consulting with other bodies through the National Chamber of Commerce, it was considered that a Clean Food Guild would not meet with success, and that reliance should be placed on the enforcement of the model Byelaws which had been adopted by the Council. Lectures. During the autumn a course of lectures was arranged by the Superintendent of No. 11 Nursing Division of the St. John Ambulance Brigade on Hygienic Food Handling. The lectures were given by Dr. M. Watkins, Deputy Medical Officer of Health, assisted by the Sanitary Inspectorate, and of sixteen who subsequently sat for the Hygiene Food Handling Certificate, fifteen were successful. Lectures in connection with the campaign continue to be given, as and when required. Food Hygiene. In the House of Commons attention was called recently to the need for further action to encourage cleanliness in the handling of food. It was stated that nowadays this problem was primarily one of germ infection. The old fears of metallic contamination and the iike had largely disappeared. It was also largely a problem of meat and milk products—mainly meat. The danger lay in dishes 42 that were not eaten as soon as they were cooked, if indeed they were cooked, but were left exposed to flies. The public should realise that it was not necessarily the food that smelt that was dangerous; the greater danger lay in foods that were not obviously contaminated. It was wrong in the home or in a food establishment for a person suffering from diarrhoea, or from a superficial infection of the skin, however apparently trivial, to handle food. It was essential for people to wash their hands before handling food and also after using a lavatory. The free use of the Borough Public Conveniences with washing facilities has been continued. (g) Food Poisoning Outbreaks. Twenty-two notifications were received and investigated. Further particulars are to be found on page 53. DISEASES OF ANIMALS ACTS Swine Fever Order, 1938.—No action necessary. Regulation of Movement of Swine Order, 1950.—No action necessary. Parasitic Mange Order, 1938.—No action necessary. Foot and Mouth Disease (Controlled Areas) Special Orders No. 11/51 and No. 1/52.—One movement licence countersigned regarding two pigs. Foot and Mouth Disease (Infected Areas) Special Order No. 102.—Two licences issued respecting fifteen pigs. The following Orders were dealt with, as necessary:— Live Poultry (Restrictions) Order, 1952 (One warning to street trader on a Saturday afternoon for selling dayold chicks). Foot and Mouth Disease (Infected Areas) Special Order No. 30. Foot and Mouth Disease (Controlled Areas) Special Orders Nos. 4, 5, 9, 11 and 13. PET ANIMALS ACT, 1951 This Act became operative in April, 1952, and the Chief and Deputy Chief Sanitary Inspectors were authorised by the Council to inspect premises to be licenced under the Act. Conditions were adopted for insertion in the Licences to be issued. All known dealers were informed of their responsibilities under the Act and twenty licences were granted. 43 PREVENTION OF DAMAGE BY PESTS ACT, 1949 The agreed scheme of work has continued, and the two trained Operatives have been fully engaged under the general supervision of the Sanitary Inspectors. The following summary of work carried out is in the revised form as suggested by the Infestation Control Division of the Ministry of Agriculture and Fisheries:- Type of Property Local Authority Dwelling Houses Agricultural All Other (including Business Premises) Total I. Total No. of Properties in Local Authority's District 12 33,175 5 2,770 35,962 II. No. of Properties inspected by the Local Authority during 1952 as result of: (a) Notification 3 465 — 64 532 (b) Survey or otherwise 9 480 - 131 620 III. No. of Properties inspected (see Section II) which were found to be infested by rats: (a) Major 1 13 — 6 20 (b) Minor 3 483 — 26 512 IV. No. of Properties inspected (see Section II) which were found to be seriously infested by mice 81 _ 33 114 V. No. of Infested Properties (see Sections III & IV) treated by the Local Authority 4 571 - 65 640 VI. No. of Notices served under Section IV: (1) Treatment — 1 — 1 2 (2) Structural Works (i.e. Proofing) .. 1 78 — 1 80 VII. No. of cases in which default action was taken by the Local Authority following the issue of a Notice under Section IV - - - - Nil VIII. Legal Proceedings — — — — Nil IX. No. of "Block" Control Schemes carried out 11 44 PETROLEUM (REGULATION) ACTS An unauthorised store of approximately 1,000 gallons of Petroleum Mixture was brought to light. Legal proceedings were taken and the defendant fined £10 and £6 6s. Od. costs. 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 89 157 17 - Factories not included above in which Section 7 is enforced by the Local Authority 463 842 39 - Other premises in which Section 7 is enforced by the Local Authority 45 133 4 - Totals 597 1,132 60 - 2.—DEFECTS FOUND IN FACTORIES, ETC. Particulars Number of Defects Number of Cases in which Prosecutions were Instituted Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness 79 75 — — — Overcrowding 2 2 — — - Unreasonable temperature I 1 — — - Inadequate ventilation 9 1 - - — Ineffective drainage of floors.. 6 5 - - - Sanitary Conveniences Insufficient 4 1 — - - Unsuitable or defective 109 100 — 23 — Not separate for sexes — - — — — Other offences 49 45 3 2 — Totals 259 236 3 25 — 45 NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1952 Wearing apparel, making of 442 Carding, etc., of Buttons 14 Paper Bags 41 Artificial Flowers 5 Brush-making 6 Boxes 31 Lampshades 6 Stuffed Toys 19 Brass and Brass articles 8 Total 572 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. It will be seen from the first table that there was considerablv less notifiable disease in 1952 than in 1951. Although there was an increase in notifications of scarlet fever, pneumonia, puerperal pyrexia and food poisoning, this was more than counterbalanced by fewer notifications of measles, whooping cough and dysentery. All Ages Under l yr. 1-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over 1952 1951 Scarlet Fever 418 118 - 79 327 7 5 - - Whooping Cough 189 742 18 88 81 1 — — 1 Measles 1,572 2,295 41 654 868 7 2 - - Diphtheria — — — — — — — — - Pneumonia 100 84 3 5 15 1 24 28 24 Meningococcal Infection 2 5 1 - 1 - - - - Acute Poliomyelitis: Paralytic 8 8 - 4 2 - 2 - — Non-Paralytic 2 1 - 1 1 — — — — Acute Infective Encephalitis - - - - - - - - - Post Infective Encephalitis - - - - - - - - - Dysentery 9 159 2 1 2 - 3 1 - Ophthalmia Neonatorum 2 2 2 - - - - - - Puerperal Pyrexia 73 43 - - - 29 44 - - Smallpox - - - - - - - - - Paratyphoid Fever 2 1 - 2 - - - - - Typhoid Fever 1 1 - - - - 1 - - Food Poisoning 22 14 - 5 5 2 6 4 - Erysipelas 32 33 - - - 1 9 13 9 Malaria - 2 - - - - - - - Tuberculosis 115 123 2 5 8 28 46 21 5 Totals 1952 2,547 - 69 844 1,310 76 142 67 39 Totals 1951 — 3,631 110 1,691 1,496 81 132 85 36 46  St. James Street High Street Hoe Street Wood Street Hale End Higham Hill Totals Scarlet Fever 34 28 50 27 147 132 418 Whooping Cough 26 26 29 27 33 48 189 Measles 189 168 198 208 483 326 1,572 Diphtheria — — — — — — — Pneumonia 24 11 10 15 25 15 100 Meningococcal Infection — 1 1 — — — 2 Acute Poliomyelitis: Paralytic 3 1 1 1 1 1 8 Non-Paralytic 1 1 — — — — 2 Acute Infective Encephalitis - - - - - - Post Infective Encephalitis - - - - - - - Dysentery — — — — 8 1 9 Ophthalmia Neonatorum - 1 — — — 1 2 Puerperal Pyrexia 6 4 5 32 16 10 73 Smallpox — — — — — — — Paratyphoid Fever 1 1 — - - — 2 Typhoid Fever - - - - - 1 1 Food Poisoning 2 1 1 1 6 11 22 Erysipelas 2 3 5 2 6 14 32 Malaria — — — — — — — Tuberculosis 11 14 19 12 30 29 115 Totals 1952 299 260 319 325 755 589 2,547 Totals 1951 549 376 531 429 861 885 3,631 The Registrar-General gives the statistics for the 52 weeks ended 31st December, 1952, 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 418 — 3 100 73 32 Case rate:— England and Wales 1.53 0.01 0.02 0.72 Not available 0.14 Walthamstow 3.47 — 0.02 0.83 0.61 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 47.37 England and Wales 17.87 SCARLET FEVER A total of 418 cases of Scarlet Fever was notified during 1952, as compared with 118 in 1951. 47 The incidence by months and wards is given below:— January 27 July 33 February 31 August 11 March 37 September 13 April 35 October ... 46 May 32 November 64 June 29 December 60 St. James Street 34 Wood Street 27 High Street 28 Hale End 147 Hoe Street 50 Higham Hill 132 The last fatal case of scarlet fever occurred in 1936 and since then up to the end of 1952 there have been 4,237 notified cases without fatality. DIPHTHERIA During 1952, 10 cases were notified, but none was confirmed following observation in hospital. There has been no death from diphtheria in the Borough for six years. Diphtheria remains a deadly disease, but unfortunately, in its absence, complacency continues. Every baby should be immunised before reaching the age of one year. Diphtheria immunisation is referred to more fully in Section G of the Report in regard to Part III Health Services. MEASLES AND WHOOPING COUGH All cases of these diseases are now notifiable, but in many cases notifications are received too late to be of any real value, since the health visitors are then unable to visit patients in unsatisfactory homes where their advice would be of value. The health visitors are given complete discretion as to the cases which might merit a visit. Measles. January 21 July 257 February 9 August 127 March 11 September 42 April 8 October 218 May 7 November 193 June 109 December 570 St. James Street 189 Wood Street 208 High Street 168 Hale End 483 Hoe Street 198 Higham Hill 326 48 Whooping Cough. January 21 July 15 February 23 August 10 March 12 September 19 April 13 October 2 May 21 November 5 June 41 December 7 St. James Street 26 Wood Street 27 High Street 26 Hale End 33 Hoe Street 29 Higham Hill 48 The age incidence compared with previous years was as follows:— Under l 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 1952 18 15 32 22 19 83 189 One death occurred in a female child of two years, who died in hospital and who was not immunised against whooping cough. A follow-up of notified cases of whooping cough, started late in 1951, shows that the classification of severity during the years 1951/2 was as follows:— (Some visits were ineffective.) Year Classification Information not available Total 0 1 2 3 4 5 6 1951 — — 1 35 13 7 3 - 59 1952 2 1 4 100 40 7 — 3 157 The classification is in accordance with the scheme suggested by the Medical Research Council in their Whooping Cough Trials, and the assessment of severity is as follows:— 0—No clinically recognisable Stage A or Stage B (or history thereof). 1—Recognisable (clinical, bacteriological or cytological) Stage A, but no Stage B. 49 2—Stage A followed by a typical or abortive Stage B. 3—Stage B MILD = less than 10 paroxysms in 24 hours. 4—Stage B MODERATE = 10-20 paroxysms in 24 hours. 5—Stage B SEVERE = 20-40 paroxysms in 24 hours. 6—Stage B VERY SEVERE = Attacks complicated by convulsion and/or bronchopneumonia. Four cases notified as whooping cough during 1952 had previously been immunised, and details are as follows :— Sex Age Date Immunised Date of Attack M.R.C. Classification F. 1 year 4mths. Oct. 1951 Feb. 1952 3 F. 1 year 8 mths. April 1951 Feb. 1952 3 M. 3 years June 1950 Aug. 1952 3 F. 1 year 3 mths. March 1952 Aug. 1952 3 The total number of children immunised against whooping cough up to the end of 1952 was 3,030. PNEUMONIA January 15 August 3 February 12 September 1 March 10 October 9 April 10 November 8 May 3 December 20 June 9 St. James Street 24 Wood Street 15 High Street 11 Hale End 25 Hoe Street 10 Higham Hill 15 INFLUENZA There were two deaths from influenza during the year. "GASTRIC" INFLUENZA In January, 1953, attention was drawn to vomiting which had affected teachers and staff during the autumn term at one of the High Schools for Girls. Three members of the staff and 19 pupils were involved. The condition resembled that noted in the 1951 Report and continued after the re-opening of the school in 1953. Up to the end of January six more staff and 20 additional pupils had suffered from vomiting. The 1953 cases were accompanied by a few cases of catarrhal jaundice. 50 MENINGOCOCCAL INFECTION Two cases were notified, the particulars being as follows Sex Age Ward Hospital Remarks 1. F. 7 yrs. High Street Yes Recovered 2. M. 6 mths. Hoe Street No Died at home, P.M. MALARIA There were no cases notified during the year. ACUTE ANTERIOR POLIOMYELITIS AND POLIOENCEPHALITIS Sixteen cases were notified in 1952, but only 10 were confirmed. Out of the 10 confirmed cases, seven occurred in children below the age of six years. Eight cases were paralytic, but fortunately none was severe. There was residual paralysis in four cases. The majority of cases occurred in the more densely populated portion of the Borough, i.e., the South-Western half. This portion is contiguous with the Borough of Ley ton, but separated from the London County Council area by the River Lea. Four cases occurred during July, three in August, two in September and one in October. In only two cases could direct contact be established. Close questioning of intimate contacts regarding history of illness before and after contact revealed practically no positive evidence. Except for two cases in one family, evidence of association of contacts with other definite cases of poliomyelitis was completely negative. Such evidence is very difficult to obtain in a dormitory town like Walthamstow, where there is so much travelling to and from Central London. The particulars in regard to these cases are : 51 No. Sex Age Ward Date of Onset Date Notified Date of Removal to Hospital Site of Paralysis Final Follow-up Report (January, 1953) 1 M. 12 Hi. 9.7.52 21.7.52 17.7.52 ? Respiratory N.P. 25.7.52* 2 M. 4¾ Ho. 15.7.52 21.7.52 21.7.52 Right leg Right leg ½-in. shortening—attending hospital for massage and exercises three times a week. 3 F. 26 W. 15.7.52 23.7.52 21.7.52 Right leg and right arm, Encephalitis— Pregnancy 6/12. No residual paralysis. 4 M. 4½ Hi. 23.7.52 30.7.52 31.7.52 Bulbar Slight paresis right leg. Slight ptosis of eyelid. No treatment. 5 F. 6 St. J. 23.8.52 3.9.52 27.8.52 Shoulder—Respiratory. Having treatment for both arms three times weekly at hospital. Not fit foi school. 3.9.52* 6 M. 1¾ St. J. 27.8.52 3.9.52 29.8.52 Shoulder Having treatment for right leg twice a week at hospital. 3.9.52* 7 M. 5 St. J. 23.8.52 3.9.52 25.8.52 Non-paralytic Non-paralytic. 3.9.52* 8 M. 4 H.E. 6.9.52 9.9.52 9.9.52 ? Back Weakness right leg. Attending hospital. 9 M. 3½ H.H. 14.9.52 16.9.52 16.9.52 ? Left leg No trace of paralysis. 10 M. 27 St. J. 22.10.52 29.10.52 29.10.52 Left leg No residual paralysis. * Date transferred to an Infectious Diseases Hospital. 5 2 ACUTE ENCEPHALITIS No notifications were received. BACILLARY DYSENTERY The low total of notifications in 1952 is in contrast with the 159 notifications of the previous year. The nine notifications are analysed below in months and wards:— February 5 October 3 May 1 Hale End 8 Higham Hill 1 OPHTHALMIA NEONATORUM Two cases were reported and in neither case was vision impaired. PUERPERAL PYREXIA The total of notifications rose from 43 in 1951 to 73 in 1952, but chiefly because of the operation of the new regulations in August, 1951. The new regulations, which make more cases notifiable, were therefore in operation for the whole of 1952, as compared with seven months in 1951. SMALLPOX No notifications were received. ENTERIC FEVER Three cases of enteric fever were notified, one of typhoid and two of para-typhoid "B" The latter were both in young children and within a month of each other, but one was phage type " 1 " whilst the other was "untypable." No. Sex Age Ward Date Notified Type Remarks 1 F. 41 H.H. 10.1.52 from hospital. Untypable. Recovered. Onset before Christmas. No food away from home. 2 F. 4i Hi. 26.7.52 Paratyphoid 'B' Type 1. Recovered. Had been on holiday on south coast. 3 M. 4 St. J. 28.8.52 from hospital. Paratyphoid 'B' Untypable. Recovered. Had taken food at a forest kiosk. 53 Public Health (Infectious Diseases) Regulations, 1927. (a) In view of the continued carrier condition of a cafe proprietress, her suspension was renewed in June, 1952. In August, information was received that in spite of this suspension the carrier was serving in the cafe, and confirmation was obtained on making an inspection. The seriousness of the position was pointed out, and the carrier left the premises the same day. Consideration was given by the Council to the advisability of legal proceedings, but these were held up pending proof of the sale of the business, which was eventually obtained. (b) Part-compensation continued to be paid in conjunction with an adjoining authority to a chronic carrier, in order to prevent her from following her occupation as a cook. The carrier is now 72 years old and for some years was employed by the other authority as a convenience attendant. After retirement, she claimed that she was still physically fit and able to work as a cook. For this reason, part-time compensation continued to be paid. 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 1952. 2. Food Poisoning Notifications (Corrected) Returned to R.G. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 4 6 12 Nil 22 3. Outbreaks Due to Identified Agents. Total Outbreaks Nil Total Cases Nil Outbreaks due to :— (a) Chemical Poisons (d) CI. Botulinum (b) Salmonella Organisms (c) Staphylococci (in- (e) Other bacteria eluding toxin) Nil. 4. Outbreaks of Undiscovered Cause. Total Outbreaks 4 Total Cases 13 5. Single Cases. Agent Identified Unknown Causes Total Salmonella Typhi — 3 Murium I 6 6 9 54 There were 13 cases in four families. In the first, shell fish had been bought from a street trader and two adults and a child were affected. In the second family, the mother and four children alleged that the illness followed consumption of tinned stewed steak. The third family produced cases in three children, the suspected cause being cold meat from a Sunday joint. The standard of hygiene in this house was reported to be very low. In the fourth family there were two children and an adult, the suspected cause being tinned foods. In none of these cases was it possible to identify accurately either the agent or the cause. The incidence by months and wards was as follows February 3 May 1 March 1 August 4 April 5 September 8 St. James Street 2 Wood Street 1 High Street 1 Hale End 6 Hoe Street 1 Higham Hill. 11 ERYSIPELAS The incidence by months and wards is given below :— February 3 August 3 March 5 September . 3 April 4 October 3 May 1 November 3 July 2 December 5 St. James Street 2 Wood Street 2 High Street 3 Hale End 6 Hoe Street 5 Higham Hill 14 TUBERCULOSIS Ihe following table shows particulars of new cases ot tuberculosis and of all deaths from the disease in the Borough during 1952 :— Age Periods New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. Under 1 year 1 1 — — — — — — 1-5 years 2 2 — 1 — — — — 5-10 — 4 — 2 — — — — 10-15 1 —. 1 — 15-20 6 10 1 1 - — — — 20-25 4 5 — 1 1 — — — 25-35 15 12 2 2 1 — — — 35-15 8 6 — 1 — 1 — - 45-55 5 5 — — 1 3 — — 55-65 8 2 — I 6 1 — — 65 and over 3 — 2 — 7 1 — — Totals 53 47 5 10 16 6 — — 100 15 22 115 22 55 As each new case of pulmonary tuberculosis has been notified, enquiry has been made as to the infectivity of the patient. Of 98 cases investigated, 43 were sputum positive on notification or soon after, 41 were negative and 14 were inconclusive for the following reasons:— No sputum 12 Tests incomplete 1 Notified after death 1 There was a history of tuberculosis in near relatives in 14 cases. The 22 deaths represent a death rate of 0.18 per 1,000 population (England and Wales, 0.24). New cases in 1951 were 123 with 37 deaths—a rate of 0.31. The returns for the past two years are compared below Year New Cases Deaths Pulmonary NonPulmonary Total Pulmonary NonPulmonary Total M. F. M. F. M. F. M. F. 1952 53 47 5 10 115 16 6 22 1951 64 44 11 4 123 25 8 3 1 37 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 Pill. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. 3 — 1 — 2 — — 12 3 1 — The ratio of deaths in non-notified cases (i.e., columns to the right of the double line) to total deaths from tuberculosis was 1 to 5.5. Fall in Tuberculosis Mortality. The reduction in deaths from 37 in 1951 to 22 in 1952 is in keeping with general experience, and the following extract from The Lancet" of May 9th, 1953, is of interest:— "Figures published by the World Health Organisation demonstrate the remarkable fall in tuberculosis mortality that 56 has taken place in many parts of the world since 1939. Combined statistics from 21 countries (including the United Kingdom) with a total population of 404 million in 1950, show that the death rate has been roughly halved in the past fifteen years. The chief causes are thought to be the energetic mass action directed towards the early detection of the disease by radiography and its prevention by B.C.G. vaccination and the control of milk; improved medical facilities and progress in treatment have also contributed to the success. The decline in mortality has been greatest in children and adolescents. The male mortality-rate has always been higher than the female, and the difference between the two is becoming greater because, it is suggested, recent social progress and improvements in hygiene have had more effect on women's living conditions." Non-Notification. Analysis of the position in Walthamstow in regard to nonnotification since 1945 reveals the following position:— Year Total T.B. Deaths Non-notified Deaths Total Percentage of Non-notified to Total T.B. Deaths Pulmonary NonPulmonary 1945 67 14 3 17 25.3 1946 58 9 2 11 18.9 1947 58 11 1 12 20.6 1948 64 7 — 7 10.9 1949 52 5 5 10 19.2 1950 33 5 — 5 15.1 1951 37 3 2 5 13.5 1952 22 3 - 3 13.6 Three deaths registered in 1952 from tuberculosis had not previously been notified. Details are given below:— Case(l)—Male aged 71 years, admitted to a hospital in another area 12.1.52 with a provisional diagnosis of pneumonia. Died 21.1.52, and final diagnosis only possible at Post Mortem. Case (2)—Female aged 44 years, admitted to hospital with pleural effusion 15.11.52. Sudden collapse and death 17.11.52. Had suffered from "influenza" in July, 1952. This was followed by pain in the chest and shortness of breath since October, 1952. There was no cough or bleeding, but gradual loss of weight and progressive worsening. Diagnosis not possible without Post Mortem. 57 Case (3)—Male aged 61 years, admitted to mental institution in 1938, admitted to hospital September, 1952, for loss of weight. Diagnosis not possible without Post Mortem. The reasons given for non-notification of the three pulmonary cases in 1951 were as follows:— Case(l)—Male aged 60. Died from Coma, Emaciation and Phthisis. Family Doctor stated that this man only moved into the Borough 14 days before death, that he was previously under the care of his own doctor for tuberculosis and was therefore presumably notified in a London Borough but the notification was not transferred. Case (2)—Male aged 25. Died prior to 11th July at a mental institution from pulmonary tuberculosis and amentia. Apparently at an institution for 15 years and not notified in Walthamstow. Case (3)—Male aged 68. First seen by family doctor 6.9.51 and still working. Diabetes diagnosed 21.9.51 and admitted to hospital 30.9.51. Rapidly deteriorated. Cause of death found to be miliary tuberculosis with chronic pulmonary tuberculosis at Post Mortem. Unfortunately, the transfer of notifications between sanitary districts on change of domicile leaves much to be desired. Notification. The issue of Circular 6/52 in April, 1952, has caused considerable disquiet amongst Health Workers in the tuberculosis field. It is understood that the Public Health (Tuberculosis) Regulations 1930, were revoked in spite of strong representations from the Joint Tuberculosis Council. The new (1952) regulations no longer require a Medical Officer of Health to keep a Register of Tuberculosis notifications, although the Ministry urges that he should do so. The " essential Tuberculosis Registers" are to be those maintained at chest clinics. The requirement contained in the 1930 regulations for providing information in regard to a tuberculosis patient entering or leaving a sanatorium or hospital is also omitted from the new regulations. Heat-Treated Milk and Non-Pulmonary Tuberculosis. The table gives particulars of fifteen non-pulmonary cases notified in 1952 and the observations of Dr. Ramsay, Chest Physician, who found no evidence that the infection was due to raw or untreated milk. 58 In at least five cases there was evidence of contact with another case of tuberculosis. Five of the cases had not been seen at the local Chest Clinic. No. Sex Age Date Notified Location of Tuberculosis 1 M. 70 30.1.52 Cervical Glands 2 M. 27 13.2.52 Knee 3 F. 61 21.2.52 Cervical Adenitis 4 F. 14 27.2.52 Cervical Adenitis 5 F. 39 17.4.52 Iridocyclitis 6 F. 2 6.5.52 Spine, Glands and Lungs 7 M. 17 12.6.52 Spine 8 F. 33 17.6.52 Lumbar Spine 9 F. 15 18.7.52 Sacro-iliac Joint 10 F. 29 31.7.52 Lymph Glands 11 F. 22 24.9.52 Endometrium 12 F. 6 30.9.52 Cervical Glands 13 M. 31 25.11.52 Bladder 14 M. 67 25.11.52 Spine 15 F. 5½ 24.12.52 Meninges Prevention of Tuberculosis. The various preventive measures detailed in the Report for 1950 continued in subsequent years and were shared between the Borough Council as the Sanitary Authority, and as the Excepted District for Education, and by the Health Area Sub-Committee administering the Part III Services under the National Health Service Act. Those services provided by the Borough Council included the following:— 1. Rehousing on Medical Grounds.—Pulmonary Tuberculosis continued to constitute the only ground for top priority, the criterion being the infectivity of the patient, overcrowding on the standards of the Housing Act, 1936, and the presence in the same dwelling of young children or adolescents. At the end of the year and with the help and co-operation of the Chest Physician and of the Housing Manager, all outstanding, urgent and infectious cases had been dealt with by rehousing. During 1952 the number of families rehoused was 237, which included 18 families where there was a medical recommendation in respect of tuberculosis, i.e., say eight per cent. 2. "Mobile Meals"—Mobile Meals, where necessary, were provided by the " Meals on Wheels " service, organised by the Old People's Welfare Committee. 3. Sanitary Inspection.—Each case of tuberculosis is, on notification, visited by the Sanitary Inspector as well as by the 59 Tuberculosis Health Visitor. Full enquiries are made as to the source of infection and into any infection possibly caused by the sputum positive patient. Close watch is maintained in regard to inter-connected cases, e.g., multiple cases from the same place of employment. As far as possible, each case is investigated on the same lines as a case of major infectious disease. 4. Other Action.—This includes the chest X-ray examination on appointment of those employed in contact with groups of children, e.g., school and nursing staff; B.C.G. vaccination of school leavers under the Medical Research Council's Field Trials, and of child contacts at the clinics. These are referred to fully in the Report of the Borough School Medical Officer. At the Chest Clinic, 90 direct contacts were vaccinated with B.C.G. during 1952. The Mass Radiography Unit of the Regional Hospital Board did not visit the Borough during 1952, but is to be here in the Spring of 1953. The services provided by the Health Area Sub-Committee include Health Education, Home Visiting and Home Nursing, the provision of Home Helps, extra nourishment and care and after-care. These services are more fully referred to in the later section of the Report. Care and After-Care.—This matter is dealt with under Section "G" of the Report. MISCELLANEOUS 1. Old People's Welfare.—The Town Clerk, as Honorary Secretary of the Old People's Welfare Committee, states that 12,506 meals were provided during 1952. The monthly totals varied between a minimum of 851 in February to a maximum of 1,300 in October. An additional round was begun in October, making five rounds in all on Monday, Wednesday and Friday. There were 40 voluntary helpers at the end of the year, but more were required. The Committee organised outings, a Christmas dinner to the recipients of Meals on Wheels and a concert to some 500 old people. At the end of the year there were seven Old People's Clubs. According to the Registrar General's Estimates of the sex and age distribution of civilian population (England and Wales) at the 31st December, 1947, the number of Walthamstow residents aged 65 years and over compared with the total population in Walthamstow was the second highest of the six Boroughs in Metropolitan Essex, the figures being as follows:— 60 Population No. of Persons Percentage 65 + 122,000 12,578 10.3 The following table shows the breakdown of the age groups: — Ages Male Female Total % Total Population 65-74 3,762 4,998 8,760 7.18 75-84 1,282 2,078 3,360 2.75 85 and over 157 301 458 0.37 Totals 5,201 7,377 12,578 10.30 An increasing amount of time of the medical, home nursing and domestic help services and of the sanitary inspectorate is required in regard to old people's welfare. The need appears to be for increased services in the following directions, especially those which help in assisting with domiciliary treatment. (1) "Meals on Wheels" daily. (2) Laundry facilities for the incontinent. (3) Ample home nursing and domestic help facilities, including weekends. (4) Increased chiropody facilities. (5) Companionship, sitters-in and occupational therapy. (6) Increased Part III accommodation and long and short stay annexes. The Glasspool Trust has again been ready to help in cases of hardship, particularly with the supply of bedding. The Area Officer of the National Assistance Board has again been most co-operative and has been helpful in making money grants for bedding, clothing and laundry, this is supplemented by the Health Department by the retention of mattresses removed at the request of the owners for destruction after infectious disease Where some use remains, the mattresses are steam disinfected and given to persons in need. 2. Funeral Arrangements.—Arrangements were made in regard to the burial of one person. 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. By the end of the year the construction of a six unit refrigeration plant at a total cost of £588 was well under way. Mortuary and post-mortem facilities are now fully adequate. The Borough Architect, Engineer and Surveyor reports that the numbers of inquests and post mortems were as follows:— 61 Inquests only 69; Post Mortems only 311; Post Mortems and Inquests 45. 4. Conveniences, Public. — During 1952 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. 5. Erection of Additional Public Conveniences.—The Borough Architect, Engineer and Surveyor, Mr. F. G. Southgate, A.R.I.B.A., A.M.T.P.I., summarises the position as follows :— Oak Hill/Woodford New Road (opposite Napier Arms) and Chingford Road (immediately north of the Crooked Billet). The public conveniences on these two sites were completed and opened for use during the year. 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 Architect, Engineer and Surveyor reports that the annual rainfall at Ferry Lane Station was 22.06 inches. 8. Medical Examinations.—During the year the medical staff carried out 143 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 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." " Breast Feeding." " Care of Toddler." " Hygiene in the Home." " Wise Parentcraft." 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. 62 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.—The leaflet of advice printed in the 1951 Report is available for distribution. 11. Deaths possibly associated with Fog, December 5th/8th, 1952.—At the request of the Ministry of Health enquiries have been made into this matter. Seventeen deaths occurring between the 5th and 15th December last were reported to Her Majesty's Coroner and the exact cause of death became known by PostMortem Examination. Of these 17 deaths, two were Chingford Residents dying in Walthamstow, and were therefore excluded. Enquiries were made into the other 15 cases, but since one lived alone and had no known relatives no information was available. Of the remaining 14, fog was considered by the relatives to have been contributory to death in only four cases. These were females aged 61, 77 and 80 years, and a male aged 68 years. The cause in all 17 cases was either Cardiac or Respiratory or a combination of both and it appears possible that the extra handicap of the fog may have upset the compensation which normally operated. The youngest person to die in this group was aged 51 years. The findings have been sent to the Ministry of Health and will be submitted to a special Committee, which it is understood will consider all the evidence available from Greater London. A full analysis cannot be carried out until the final Return is received from the Registrar General later on in regard to those Walthamstow residents who died outside the district during the quarter ended 31st December last. 12. Reconstruction.—Gradual elimination of the scars of war proceeded by the clearance and fencing of bombed sites and by the provision of small gardens and seats. The disintegration of dwarf forecourt walls following the war-time removal of iron railings continues, but individual improvements by re-building increase and with a variety of styles and materials. 63 SECTION G PART III SERVICES WALTHAMSTOW HEALTH AREA SUB-COMMITTEE (1952/53) Chairman: Aid. Lady McEntee, J.P. (Executive Council for Essex). Vice-Chairman: Councillor Mrs. S. Candy (Walthamstow Borough Council). Membership: Nominated by— Essex County Council Alderman Mrs. M. Ball (Chairman, Health Committee, E.C.C.). Councillor Dr. C. Skinner (ViceChairman, Health Committee, E.C.C.). Councillor Mrs. L. P. Bailey, J.P. Councillor Mrs. A. M. Burrell. Councillor Mrs. F. E. Cochrane. Councillor Mrs. E. F. M. Hollis. Councillor H. J. E. Palethorpe. Walthamstow Borough Council Alderman Lord McEntee, C.B.E. Alderman W. B. Fitt. Alderman W. Gillett. Alderman A. E. Manning. Alderman W. H. Shaw. Alderman Ross Wyld, O.B.E., J.P. „ Councillor F. A. Burton. Councillor Mrs. S. Candy. „ „ Councillor A. W. Ellis. Councillor A. G. Green. ,, „ „ Councillor Mrs. M. E. Marchant. Councillor E. G. Richards. Councillor M. Sharland. Councillor A. F. Whicher. „ Councillor J. M. Wight. HospitalManagementCommittee Dr. D. R. Blunn. Executive Council for Essex Alderman Lady McEntee, J.P. 64 Local Medical Committee for Essex Dr. J. L. McK. Brown, O.B.E. Voluntary Organisations Dr. M. Cohen (Walthamstow District Nursing Charitable Association). E. P. Marr, Esq. (Walthamstow Child Welfare Society). Mrs. M. Osora (Invalid Children's Aid Association). Mrs. A. Cordell (Walthamstow and Chingford Association of Tuberculosis Care Helpers). 65 HEALTH CENTRES (Section 21) HEALTH CENTRE SITES The general position remains as detailed in the previous report, i.e., six sites have been defined in the Borough on the basis of one centre per 20,000 population and to serve an area with a radius of one mile. One of these sites is on the Borough Council's Priory Court Housing Estate with some 400 flats. During the year a proposal was approved in principle to include in the lists of Capital Building Projects for 1953/4 a Health Services Clinic at Priory Court, to be combined in the first instance with a central hall for community centre purposes, and later with a health centre for the use of family doctors. The proposal is still under consideration, and the estimated cost will be £16,000. HEALTH AREA PREMISES During 1951, arrangements were made to make available the part-time use of a room at the West Avenue Health Services Clinic for the local representatives of the Children's Department. In 1952 similar arrangements were made to make available the parttime use of other rooms to the local representatives of the Welfare Department and the psychiatric social worker in the Mental Health Service. In addition, the whole-time use of a further room was made available to the Mental Health Service so that the sub-office to serve Leyton, Walthamstow and Forest areas could be accommodated at West Avenue. In each case a reservation has been made to secure the use of the rooms for any extension of the Area Health Services which at present include welfare sessions and a dental clinic. GENERAL DENTAL SERVICE The Senior Dental Officer reports as follows:— "It has been possible to work rather more sessions this year than last, as the dental surgeon appointed to a full-time post early in the year has been able to provide two extra evening sessions weekly. This has been very fortunate, as in spite of the imposition of charges to patients over 21, the demand has, somewhat unexpectedly, greatly increased. For example, over double the number of patients were treated than was the case in 1951. With the exception of dentures, all other items of treatment show substantial increases." 66 Herewith is a summary of the work done during the years 1951 and 1952 1951 ] Number of patients treated 290 731 Appointments made 3684 4872 Appointments kept 3335 4431 Fillings 1129 1591 Scalings 232 317 Dressings 516 685 Extractions 730 929 General Anaesthetics 279 285 Local Anaesthetics 163 280 Impressions 539 527 Bites 166 179 Try-ins 170 175 Dentures supplied 311 220 Dental Laboratory Below is appended a list of the appliances completed in the Dental Laboratory for the General Dental Service during 1952:— New Dentures 226 Repairs 166 Orthodontic Appliances 2 Inlays 2 Crowns 6 During the year the following appliances were completed for the Walthamstow and Lcyton Committees for Education : Walthamstow Leylon Orthodontic Appliances 170 47 Dentures 80 - Crowns 27 - Inlays 3 - Repairs 39 7 In addition to the above, the following appliances were completed for the Regional Hospital Board:— Bite splint appliances for correction of temporo-mandibular disorders 4 Adjustments to same 8 Dentures 3 The following appliances were completed for Maternity and Child Welfare Patients: — Dentures 16 Orthodontic Appliances 1 Crowns 2 The copper depositing outfit installed during 1951 has proved most effective in producing perfect replicas for the production of jacket and post crowns. 67 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 . 1107 994 Low Hall Lane Clinic 252 55 Silverdale Road Clinic 30 6 Totals 1389 1055 Total Attendances:— Ante-Natal Post-Natal Thorpe Coombe Maternity Hospital . 9122 1249 Low Hall Lane Clinic 873 59 Silverdale Road Clinic 106 7 Totals 10101 1315 Of the 1558 cases confined in the Borough, 89% received Ante-Natal Care either at the Thorpe Coombe Maternity Hospital or the County Council's Clinics. Blood grouping/Haemoglobin estimation and Rhesus and Kahn tests were taken at all clinics for all patients. 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 pregnancy and congenital defects in the child. CONFINEMENTS The following table shows the location of confinements during 1952 68 Thorpe Coombe Maternity Hospital 1161 Other Hospitals and Maternity Homes. 384 Total in Hospital, etc. 1545 At home 376 Total Confinements 1921 A total of 128 Walthamstow patients were unable to book accommodation at Thorpe Coombe. If they were unable to make their own alternative arrangements, bookings at other Maternity Hospitals were made for them through Thorpe Coombe. The grounds for admission to Thorpe Coombe were:— (1) First Confinements. (2) Medical and Obstetrical. (3) Unsuitable home/social conditions. VITAL STATISTICS Walthamstow England & Wales Live birth-rate per 1,000 population 12.6 15.3 Stillbirth rate per 1,000 population 0.24 0.35 Infant mortality rate per 1,000 live- births 24.5 27.6 Extracts from vital statistics are given more fully in Section "A" of this Report. NOTIFICATION OF BIRTHS 1,942 births (366 of which belonged to other areas) were notified during the year under the Public Health Act, 1936. Notifications were received as follows:— Doctors, 311; Midwives, 1,603; others, 28. Included in the above are 366 births which were notified as having occurred outside the Borough. Also included are 40 stillbirths, four of which belonged to other areas. Of the total, nine occurred outside the Borough. NEO-NATAL MORTALITY The neo-natal mortality is the number of infants dying under one month per 1,000 live births. During 1952, 23 infants died in the first four weeks of life, a rate of 15.2. 69 INFANT MORTALITY The deaths of infants under one year were :— Males Females Totals Legitimate 20 17 37 Illegitimate — — — Totals 20 17 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, 24.5; Illegitimate, Nil. Total, 24.5 The Infant Mortality Rates for other areas during 1952 were as follows :— England and Wales 27.6 160 County Boroughs and Great Towns (including London) 31.2 160 Smaller Towns (25,000-50,000 population) 25.8 London Administrative County 23.8 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 1952, 67 live premature infants were born to residents of the Borough, 14 at home and 53 in hospitals and nursing homes. Of the 14 born at home, three were transferred to hospital. The remaining 11 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. 70 CAUSES OF DEATH OF CHILDREN UNDER 1 YEAR OF AGE—1952 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 Street High Street Hoe Street Wood Street Hale End Higham Hill Total Influenza - - - - - - - 1 - 1 - - 1 - - - 1 Measles - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - Diphtheria - - - - - -- - - - - - - - - - - - Phthisis - - - - - - - - - - - - - - - - - Other forms of T.B. - - - - - - - - - - - - - - - - - T.B. Meningitis - - - - - - - - - - - - - - - - - Meningitis (Non-T.B. - - - - - - - 1 - - - - 1 - - - 1 Convulsions - - - - - - - - - - - - - - - - - Bronchitis - - - - - 1 - - - 1 - - 1 - - - 1 Pneumonia 3 — — — 3 2 1 1 - 7 - 1 2 3 1 - 7 Diarrhoea - — — - - 1 - - - 1 - - 1 - - - 1 Syphilis - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - Inattention at birth, wilful neglect - - - - - - - - - - - - - - - - - Suffocation (Overlaying) 1 — — — 1 - 1 — — 2 - - - 1 - - 2 Injury at Birth - - - - - - - - - - - - - - - - - Atelectasis 3 — — - 3 - - - - 3 - - 1 - 1 1 3 Congenital Malformation 2 1 — - 3 1 2 — 2 8 - 1 1 3 7 I 8 Premature Birth . . 12 — — - 12 - - - - 12 7. 1 7 2 3 2 12 Atrophy, Debility, Marasmus - - - - - - - - - - - - - - - - - Inanition - - - - - - -- - - - - - - -- - - - Heart Failure - - - - - - - - - - - - - - - - Other Causes 1 — - — 1 — — — — 1 1 — — — — — 1 Totals 22 1 — — 23 5 4 3 2 37 3 3 10 9 7 5 37 71 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 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 1952 1,446 66 37 — 25.6 Nil Totals 1948 to 1952 (5 yrs.) 8,314 337 202 11 24.3 32.6 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 high record of care and service. Mothers of all religious denominations are cared for and the work done during 1952 is summarised below by Miss Williams, the Superintendent:— Admitted Adults Babies Total From Walthamstow 18 13 31 From rest of County 28 24 52 From outside the County 32 21 53 Totals 78 58 136 Outdoor Work : Walthamstow Cases (Mother and Baby placed) 48 8 56 Other Essex Cases 10 - 10 72 Miss Williams states that fewer cases were admitted to the Home because many of the mothers were young, and needed a longer stay in the Home on account of rehabilitation difficulties. 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, Highams Park. Tuesday „ The Welfare Centre, West Avenue, E.17. Wednesday „ Low Hall Lane, Markhouse Road, E.17. Wednesday „ Silverdale Road, Highams Park. Thursday 10 to 12 noon The Memorial Hall, Winchester Road, Highams Park. Thursday 2 to 4 p.m. Low Hall Lane, Markhouse Road, E.17. Thursday „ St. John's Church Hall, Penrhyn Avenue, E.17. Thursday „ " Brookscroft," Forest Road, E.17. Thursday „ The Welfare Centre, West Avenue, 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 342 58 400 5,831 5,347 11,178 11,578 Penrhyn Avenue 248 30 278 4,313 4,321 8,634 8,912 West Avenue 170 43 213 2,638 2,217 4,855 5,068 Winchester Road 144 23 167 2,560 3,107 5,667 5,834 Silverdale Road. 85 33 118 1,412 1,877 3,289 3,407 Total 1952 989 187 1,176 16,754 16,869 33,623 34,799 Repeated instances of burglaries and hooliganism have occurred at Welfare Centres, especially at Silverdale Road. 73 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. of age 1-5 yrs. of age Total Under 1 yr. of age 1-5 yrs. of age Total 1952 347 33 380 6,051 2,470 8,521 8,901 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 438 64 552 8,855 2,622 11,477 12,029 1948 596 70 666 10,028 2,923 12,951 13,617 1947 687 64 761 11,074 3,353 14,427 15,188 Fifty-nine children were immunised during the year at "Brookscroft." Summary of Attendances at all Welfare Clinics First Attendances 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 Local Authority Scheme 989 187 1,176 16,754 16,869 33,623 34,799 " Brookscroft " 347 33 380 6,051 2,470 8,521 8,901 Total 1952 1,336 220 1,556 22,805 19,339 42,144 43,700 74 TREATMENT (a) Orthopaedic.—The facilities provided by the Education Authority's Orthopaedic Scheme are available for all children attending the Welfare Centres. Miss Garratt, 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 4 Talipes— Scoliosis, Lordosis, Kyphosis 2 (a) Equino Varus 2 Rickets—(a) Genu Varum 22 (b) Calcaneo Valgus 9 (b) Genu Valgum 22 (c) Mid Tarsal Varus 1 Pes Piano Valgus 24 Torticollis 5 Spastic Paralysis 3 Erbs Paralysis1 Progressive Muscular Congenital Defects 3 Atrophy 1 Miscellaneous 2 Total 101 No. of treatments given—1,139. (b) Sunlight.—376 ultra-violet light treatments were given during the year. (c) Dental.—Mr. L. W. Elmer, L.D.S., Senior Dental Officer, reports as follows:— "As far as possible every expectant and nursing mother and pre-school child referred to us from the welfare centres has been examined. "The infants have increased in numbers and it is pleasing to find that a larger proportion have 'stayed the course' and have been made dentally fit. "Almost double the number of mothers have been referred and examined but only 120 have been made really dentally fit. This is a slightly better proportion than last year, but nothing has occurred to alter my opinion that a concentration upon the dental education and treatment of the adolescent female would be far more fruitful of results than the present concentration upon the expectant and nursing mother." The following gives details of the work done during the year by the Dental Staff:— 75 The services of the Dental Hygienist appointed initially in Leyton were made available to Walthamstow on two days per week. Apart from chairside work for the priority groups, talks were given both at the Child Welfare Clinics and at Thorpe Coombe Maternity Hospital. In September, following the issue of a joint circular by the Ministries of Health and Education with regard to "priority" Dental Services, it was agreed by the Walthamstow Committee for Education and the Health Area Sub-Committee to recommend the appointment of an additional dental surgeon, and the appointment was made later in the year. (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.—The special session for children under school age which began at the West Avenue Welfare Centre in 1951 was continued with success. The following report is contributed by Dr. Helen Gillespie, Senior Psychiatrist at the Walthamstow Child Guidance Clinic:— "This clinic has now been running for a year, and is held on alternate Tuesday mornings. Most of the cases are referred by the Medical Officers in attendance at the Maternity and Child Welfare Clinics in the Borough. Numbers provided with dental care: Expectant & nursing mothers Children under 5 Number examined 489 519 Number needing treatment 444 478 Number treated 420 494 Number made dentally fit 154 290 Forms of dental treatment provided: Extractions 385 343 Anaesthetics—Local 17 General 153 264 Fillings 196 151 Scalings or scaling and gum treatment 138 264 Silver Nitrate treatment 20 272 Dressings 68 67 Radiographs 7 — Dentures provided—Complete 9 — Partial 7 — 76 "During this first year, 19 children have been diagnosed and treated, and 14 of these have already been discharged after satisfactory results were obtained. A further 5 are still under observation or treatment. These figures confirm the wisdom of the Authority in setting up this clinic, and the good results that can be obtained by this form of early treatment at a pre-school stage as 1 predicted in my last annual report. I found this group of mothers particularly receptive and co-operative, and this has contributed largely to the good therapeutic results obtained with the children. "I would like to see an expansion of this side of the work, and would welcome yet more cases. I hope that all the Maternity and Child Welfare services in the Borough will make use of the facilities provided. Such a clinic may offer some solution to certain of the problems in the non-physical sphere which are so often presented to the paediatrician, as pointed out by Dr. Hinden in his report for 1951." The following is an analysis of the cases treated: — Habit disorders 6 Sleep disturbances 1 Fears 5 Behaviour disorders 7 19 (g) Pædiatric Clinic.—The fortnightly clinic, under the charge of Dr. Elchon Hinden, Paediatrician to Whipps Cross Hospital, continued during 1952, and 17 children under five years of age were seen. Dr. Hinden reports as follows:— "Work in the clinic has proceeded on the same lines as in 1951. The bulk of the children seen have presented minor deviations from the normal, or else have been suffering from behaviour disorders. Acute medicine has, rightly, been absent; a pleasing feature has been the very small number suffering from chronic rheumatic heart disease. I have the impression that in height and weight the children compare favourably with those born before the war, and I think that the standard of parental care is rising also. Poor housing still seems the major detrimental environmental factor. "The radiological and pathological departments at Whipps Cross Hospital have continued their welcome service to the clinic, so greatly enhancing its value. A number of children have also been admitted to hospital there for 77 gation and treatment. I am grateful to my colleagues, the Assistant School Medical Officers, for referring the children to me." Under 5 years New cases 17 Total attendances 25 Physical Defects: (a) Asthma (b) Heart disease (c) Other 7 Referred to Hospital 1 Discharged 1 Psychological Disorders: (a) Enuresis 4 (b) Other Referred to Hospital 2 Discharged (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:— Children referred by:- Hospitals 4 School Health Services 2 General Practitioners 3 9 Classification of cases: — Anaemia and debility 1 After-effects of illness 3 Bronchitis or pneumonia 1 Nervous conditions 1 Diseases of the ear, nose and throat 1 Diseases of the skin 1 Various 1 9 (i) Convalescence.—During 1952, ten children were sent away on medical recommendation to convalescent homes. As in previous years, the arrangements were normally made through the local branch of the Invalid Children's Aid Association. 78 PROVISION OF NUTRIENTS AND MEDICAMENTS Details of nutrients and medicaments sold and issued free during 1952 are as folows:— Sales Free Issue lbs. ozs. lbs. ozs. Adexolin — — 22 11¾ Bemax 224 7 — — Colact 245 — — — Cow and Gate 3,182 — — — Cod Liver Oil Emulsion — — 23 8 Cod Liver Oil and Malt 277 — — — Diphenan Tablets — — 500 tablets Farex 859 4 — - Fersolate Tablets - - 15,120 tablets Glucodin 225 4 — — Lactogol 75 7¼ — — Lactogen 375 - — — Magnesia — - 22 8 Maltoline with Iron — - 399 — Marmite Mist Ferri et Ammon Cit Pro 1,072 8 — — Infantibus — — 4 8 Ostermilk 905 — — — Osto-Calcium Tablets — — 7,160 tablets Robinson's Groats 451 — — — Scott's "Twin Pack" 402 8 - - Sodium Citrate Tablets - - 10,000 tablets Trufood 79 — — — Virol 1,440 — — — Value of Cash Sales £1,434 13s. Id. VITAMINS The facilities for the distribution of vitamins were continued at all Welfare Centres. Every effort is made to increase the demand. DAY NURSERIES The following table shows the average attendances at the Day Nurseries during 1952 (Mondays to Fridays only). 79 Month Nurseries Under 2 years Over 2 years Total January HighamHill 6.8 48.1 54.9 Handsworth Avenue 7.8 39.1 46.9 February Higham Hill 7.8 44.9 52.7 Handsworth Avenue 13.0 39.9 52.9 March Higham Hill 9.9 46.3 56.2 Handsworth Avenue 11.3 35.7 47.0 April Higham Hill 8.6 43.5 52.2 Handsworth Avenue 7.9 37.0 44.9 May Higham Hill 9.8 47.5 57.3 Handsworth Avenue 9.3 45.9 55.2 June Higham Hill 14.6 38.4 53.0 Handsworth Avenue 9.4 42.5 51.9 July Higham Hill 13.2 32.7 45.9 Handsworth Avenue 8.9 41.9 50.8 August Higham Hill 11.9 35.0 46.9 Handsworth Avenue 9.1 37.9 47.0 September HighamHill 11.8 44.2 56.0 Handsworth Avenue 7.4 41.1 48.5 October Higham Hill 9.4 45.9 55.3 Handsworth Avenue 8.6 42.9 51.5 November Higham Hill 11.1 42.7 53.8 Handsworth Avenue 9.3 37.3 46.6 December Higham Hill 9.9 36.7 46.6 Handsworth Avenue 3.2 26.4 29.6 Average for Whole Year Higham Hill 10.3 42.2 52.5 Handsworth Avenue 8.8 39.0 47.8 Both Day Nurseries are approved for training in the care of children aged 0-5 years. Both have 60 places. Training.—Seven pupils sat for the Nursery Nurses' Certificate in 1952 and six passed. Three proceeded to take up general hospital training and three became Nursery School Assistants. Two gave up training because of financial circumstances and domestic circumstances respectively. Towards the end of the year, electric washing machines and drying cabinets were installed at both Day Nurseries. The installation has been a success, but a final assessment of the saving has not yet been made. NURSERIES AND CHILD MINDERS (REGULATION) ACT, 1948 Registration in one case was requested for the care of up to 16 children aged 3/5 years, and granted. 80 DAILY GUARDIAN SCHEME This Scheme was begun in May, 1951, and Guardians are paid a retaining fee of 1/- per day (6d. per half day), by the County Council, whilst they are caring for a child. Guardians are approved subject to a satisfactory Health Visitors report. The experience since the commencement has been as follows:— 1951 No. of Daily Guardians on Register at 31.12.51 8 No. of applications for services of Daily Guardian 25 Referred to Day Nurseries 10 Referred to Daily Guardian but nothing further heard 6 Placed with Daily Guardian 9 These nine children were in the care of a Daily Guardian for periods as follows:— Duration of Care (in weeks) 1 2 3 12 16 No. of Children 1 4 1 2 1 Two of these children continued to be cared for in 1952. 1952 No. of Daily Guardians on Register at 31.12.52 19 No. of applications for services of Daily Guardian 23 Referred to Daily Guardian but nothing further heard Placed with Daily Guardian 12 Placed with Daily Guardian during 1951, and continued in care of Daily Guardian into 1952 These 14 children were in the care of a Daily Guardian for periods as follows:— Duration of Care (in weeks) 1 2 5 7 9 11 13 14 15 32 37 47 49 No. of Children 1 1 1 1 1 1 1 1 2 1 1 1 1 Eight of these children continued to be cared for in 1953. 81 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 This Clinic continued on the same lines as in previous years at Thorpe Coombe Maternity Hospital, under the clinical charge of Miss Helen Rodway, F.R.C.O.G., who states that the number of patients attending has been as follows:— New Cases Attendances 1949 31 528 1950 34 475 1951 19 444 1952 24 411 MIDWIFERY (Section 23) There were 37 practising midwives in the Borough at the end of 1952, including those at Thorpe Coombe Maternity Hospital. Medical supervision was carried out by the Medical Staff and non-medical supervision by the Superintendent of the Nurses' Training Home. The following table shows the work done by Midwives during 1952:— No. of confinements attended as a Midwife 1,295 „ confinements attended as a Maternity Nurse 256 Medical Aid Notices sent 622 Twin Births notified Stillbirths notified 10 3 Notifications of Artificial Feeding 14 „ Discharging Eyes 1 82 The previous table includes the following numbers in regard to work done at Thorpe Coombe Maternity Hospital:- Midwifery cases 1,040 Maternity cases 121 Medical Aid Notices 558 The percentage of Medical Aid Notices were: All cases 40.1 Maternity Hospital Midwives 48.0 Other Midwives 18.3 The conditions for which Medical Aid was summoned by Midwives in domiciliary practice and private practice and private nursing homes have been summarised and are as follows:— For complications during pregnancy:— Miscarriage 1 Ante-partum Hæmorrhage 5 Abortion 1 Other Conditions 4 Total 11 For complications during labour:— Prolonged first and second stage 4 Ruptured perineum 17 Premature labour 1 Rise in temperature 2 Post-partum haemorrhage 3 Uterine inertia 1 Retained placenta 1 Abnormal presentation 4 Other conditions 7 Total 40 For complications in regard to the infant:— Asphyxia ... ... ... ... ... 1 Jaundice 1 Inflamed eyes ... ... ... ... 2 Prematurity and feebleness ... ... 1 Cyanosis ... ... ... ... ... 1 Other conditions ... ... ... ... 7 Total 13 83 The table below shows the number of visits carried out by the District and Home Nurse Midwives:— Ante-Natal Examinations Deliveries Lying- in Visits Total Visits Patients Homes Midwife's House Clinic Mid. Mat. District Midwives Home Nurse 1,252 651 297 185 46 3,418 5,849 Midwives 113 351 8 57 60 1,027 1,616 Totals 1,365 1,002 305 242 106 4,445 7,465 Two midwives in private practice undertook 13 cases as midwives, and 29 cases as maternity nurses. Gas and Air Analgesia.—The Ambulance Service provided transport facilities for gas and air apparatus. A total of 243 patients on the District received gas and air analgesia, representing a percentage of 69.8 of District confinements. 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) decreased to 106, or 30.4 percent. of the total. Previously, this percentage has increased 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 one Walthamstow case during 1952. Maternity Outfits.—348 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 26 pupils successfully underwent Part II training during 1952. HEALTH VISITING (Section 24) Health Visiting Staff.—The equivalent of whole-time Health Visitors at the end of the year was 8.1, and one Superintendent. 84 This was equal to one whole-time district Health Visitor to 195 notified births, and one whole-time district Health Visitor per 190 registered births during 1952. 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 1952 1,445 4,331 5,776 10,227 16,003 1951 1,637 5,015 6,652 11,321 17,973 The following table shows the number and nature of visits paid in 1952:— Ward Visits to Children under 1 year Visits to Children 1-5 yrs. Grand Total Unsuccessful Visits Ante-Natal Visits Other Visits Total Visits First Visits Subsequent Visits Total Visits First Visits Subsequent Visits Total Visits 1 2 3 4 5 6 _ 7 8 Cols. 5-8 St. James Street 193 326 519 1,262 1,781 491 96 43 139 452 2,863 High Street 173 390 563 1,175 1,738 221 62 23 85 239 2,283 Hoe Street 225 491 716 1,198 1,914 524 94 16 110 420 2,968 Wood Street 229 441 670 849 1,519 548 38 13 51 283 2,401 Hale End 312 1,701 2,013 2,603 4,616 392 109 42 151 723 5,882 Higham Hill 313 982 1,295 3,140 4,435 418 81 18 99 444 5,396 Totals, 1952 1,445 4,331 5,776 10,227 16,003 2,594 480 155 635 2,561 21,793 Totals, 1951 1,637 5,015 6,652 11,321 17,973 2,249 318 140 458 3,325 24,005 85 86 Health Visiting—Investigation.—An increasing amount of the time of the health visiting staff has been given to "follow up" in connection with investigations. These have included the Medical Research Council's B.C.G. Trials, Prematurity, Virus Diseases during Pregnancy, the Population Investigation of the Royal College of Obstetricians and Gynaecologists and Institute of Child Health (University of London), and lastly, Breast Feeding. Liaison with Hospital Services.—During the autumn of 1951, the appropriate Committees agreed that the Health Visitors and School Nurses should in turn attend the ward rounds of Dr. Hinden, Paediatrician, Whipps Cross Hospital, who holds a fortnightly session at the Town Hall Clinic. At the end of a trial period of six months, 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 from hospital, the Health Visitor ensured that his advice was followed in the home. For the Health Visitor, her knowledge is kept up to date and she learns of new advances in the treatment of children's diseases. During 1952, the arrangement was extended to the medical staff, who in turn accompany the Paediatrician on his ward rounds and with benefits similar to those outlined above. HOME NURSING (Section 25) Branch Nurses' Training Home.—The Branch Nurses' Training Home at "Hillcrest," Handsworth Avenue, Highams Park, was opened in May, and this has been a very great advantage in regard to the Home Nursing/Midwifery services of this portion of the Borough. The premises comprise a double-fronted detached house with garage and garden. There are four rooms on the ground floor, including a treatment room, and four bedrooms and a boxroom on the first floor. Three Home Nurse/Midwives are accommodated. Queen's Training.—An inspection of the Carisbrooke Road Home was carried out in October, 1951, by the Queen's Institute of District Nursing, but the report was not received until 1952. As a result of the comments made in the report, the Health Area Sub-Committee instructed the Area Surveyor for Building Maintenance to prepare a scheme for the improvement of the Home, with a view to inclusion in the County Council's list of Capital Projects, which has now been done. The estimated cost of improvement will be £3,500. In May, it was reported that three candidates who had taken their Queen's training were successful. 87 This participation in the training scheme completes the picture in regard to the recruitment of staff for home nursing. Pupil Midwives in the second part of their training at Thorpe Coombe Maternity Hospital undergo District Midwifery training at "Carisbrooke," working alongside the Home Nurses. Many decide to stay on as temporary Home Nurses, and some to take their Queen's training in Home Nursing and to remain on the permanent staff. General.—The Superintendent of the District Nurses' Home, Miss E. G. Welbrock, S.R.N., S.C.M., M.T.D., reports as follows:— "Several changes occurred during 1952. Owing to increase of work, it was found necessary to appoint an Assistant Superintendent. Miss M. H. Cronshey, S.R.N., S.C.M., Q.N., was appointed to this post in February, 1952. "Our work steadily increases, and at the moment the District Nurses are doing an average of 20 cases in a morning, apart from return visits in the evening. "The District Midwives continue to work happily with us. "Another alteration has been the holding of the clinics by District Midwives at ' Carisbrooke.' "Staff on the 31st December, 1952, was as follows:— 1 Superintendent; Queen's S.R.N., S.C.M., M.T.D. 1 Assistant Superintendent; Queen's S.R.N., S.C.M. 3 Full-time Queen's S.R.N., S.C.M. 1 „ „ S.R.N., S.C.M., H.V. Certificate. 11 „ „ S.R.N., S.C.M. 3 „ „ S.R.N. 1 „ „ Male Queen's S.R.N. 1 Part-time Queen's S.R.N., S.C.M. 4„ „ S.E.A.N. "During the year 39 pupils entered for District Midwifery Training. "Midwifery and Maternity Nursing undertaken during the year was as follows:— Cases Visits Midwifery 242 3,007 Maternity 106 1,308 Ante-Natal — 2,672 Post-Natal — 130 Total 348 7,117 Maternity Outfits supplied 348 88 "Gas and Air Analgesia was administered on 243 occasions—a percentage of 69.8. "The following gives details of Home Visits during the year New Cases Total Visits Medical 1,162 45,300 Surgical 247 10,144 Tuberculosis 62 3,105 Out-Patients 3 7 Operations 7 37 Miscarriages 5 51 Specials 46 321 Casuals 139 201 Totals 1,671 59,166 "The average number of visits per nurse per annum was 3,698." VACCINATION AND IMMUNISATION (Section 26) DIPHTHERIA IMMUNISATION Immunisation was carried out at the weekly clinic held at the Town Hall, at Schools and all Welfare Centres, on the lines detailed in previous reports. The following summarises the work done:— Total number of immunisations completed during 1952:— (a) School age 284 (b) Pre-school age1,177 Total 1,461 (c) Number already immunised having a reinforcing dose 1,702 Details of the immunisations included in the above total are set out below:— No. completed at Schools 216 No. completed at Welfare Centres 311 No. completed at Town Hall Clinic 448 No. completed at "Brookscroft" 59 No. completed by General Practitioners 427 No. of Clinics held for immunisation at Town Hall 52 No. of attendances made for diphtheria immunisation 906 Average attendance per session for diphtheria immunisation 17.4 The percentage of children immunised under the age of one year was 47.8 DIPHTHERIA IMMUNISATION Year Regd. Births Age at Immunisation Percentage Immunised to Population in Age Groups Notified Cases 0-1 yr. 1-2 yrs. 2-3 yrs. 3-4 yrs. 4-5 yrs. Total 0-5 yrs. School Age Over School Age Grand Total % 0-1 to Total Births % 0-5 yrs. %/ 5-15 yrs. % 0-15 yrs. Admitted to Hospital Diagnosis Confirmed Deaths 1947 2,670 719 869 Ill 68 77 1,844 810 4 2,658 26.9 52.4 86.0 72.2 38 0 — 1948 2,068 1,076 780 105 41 47 2,049 662 1 2,712 52.0 61.5 91.5 79.2 34 1 — 1949 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 — 1951 1,637 670 442 59 22 19 1,212 265 — 1,477 40.9 58.1 99.3 83.0 11 — — 1952 1,512 723 361 48 24 18 1,174 412 — 1,586 47.8 49.4 98.3 79.6 10 — — 115 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 total on the previous page. There have only been two confirmed cases of diphtheria in the last six years, and no deaths. 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. The Ministry of Health, in Circular 8/53 in regard to the Publicity Campaign for Diphtheria Prophylaxis, considers that co-operation on this matter is essential between local councils and the County Councils as local health authorities. During the past five years the percentages immunised in the various age groups were as follows :— 89 90 The Circular continues:— "An intensive effort must, therefore, be made to achieve the level of immunisation necessary to secure the full benefit of the campaign; if parents leave their children unprotected there may be a return of diphtheria outbreaks, and there have been several sharp reminders of this possibility during the last twelve months. The fear of diphtheria has declined among parents in a direct relation to the decline of the disease itself; the majority of parents of young children nowadays have never seen or heard of a case of diphtheria among their neighbours' children and are more afraid of illnesses they know than of the dangers of diphtheria. It cannot be said too often by Medical Officers of Health in their Annual Reports and public utterances that ' diphtheria still kills' and that elimination of this disease is conditional upon the maintenance of an adequate level of immunisation. But for these timely reminders the general public will often be under the impression that all is well, and that they themselves, as parents of young children, have no part to play in protecting their children and so help to maintain a proper level of immunisation. Sustained publicity by local authorities is therefore essential if parents are to be helped to realise that diphtheria is still a deadly threat, and to be persuaded to have their children immunised. An organised system of personal persuasion in which doctors, health visitors, district nurses, staffs of welfare centres, and voluntary workers play their part is still the most powerful element in any local campaign. Authorities are also reminded of the assistance which is available in many areas, on request, from the St. John Ambulance Brigade, the British Red Cross Society and the Women's Voluntary Services, who have many opportunities of speaking to the parents of young children in the ordinary course of their work." 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 on the following page. Immunisation is restricted to infants under 18 months old. 91 Age at Date of Final Injection Under 1 yr. 1-2 yrs. 2-3 yrs. 3-4 yrs. 4-5 yrs. 5-14 yrs. Total Clinics and Nurseries 258 132 7 5 3 — 405 General Practitioners 70 33 5 1 3 3 115 Total 328 165 12 6 6 3 520 No. of clinics held for immunisation at Town Hall 52 No. of attendances made for whooping cough immunisation 1,133 Average attendance per session for whooping cough immunisation 21.8 The percentage of children immunised under the age of one year was 21.6 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 1952 was 3,030. VACCINATION The ages of persons vaccinated is shown below:— Age at Date of Vaccination Under 1 yr 1-2 yrs. 2-4 yrs. 5-14 yrs. 15 and over Total Primary 514 21 19 23 74 651 Secondary — — 10 8 187 205 Total 514 21 29 31 261 856 Vaccinated by General Practitioners or at Hospital 580 Vaccinated at Town Hall Clinic 276 The vaccinations under one year during 1952 represented approximately 35% of babies surviving to the age of one year. For the purpose of comparison similar figures have been calculated for the past three years as follows:— Year Percentage 1949 18 1950 23 1951 37 92 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 24 were done during 1952. AMBULANCE FACILITIES (Section 27) The Ambulance Service is administered centrally from Chelmsford via the Control Centre at Ilford, 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, Consultant Physician at the Walthamstow Chest Clinic, has contributed the following, and has also expressed his appreciation of the good work carried out by the Tuberculosis Visitors "There have been two major developments in the work of the Clinic in 1952. B.C.G. vaccination has been greatly increased and a total of 90 cases has been dealt with. The policy with B.C.G. so far is to vaccinate only contact groups who are found by a special test not to have had a previous infection. These groups are at greater risk than the ordinary population. The question of extending the scheme is being widely discussed and decisions on this point will depend on further study and experience of the method. "The second development is the addition of an Odelca Camera X-ray Unit. This Unit takes miniature films of 70 x 70 mm., and the routine X-ray of large numbers of patients is much simplified, and much less costly in film. Where abnormalities are detected, large films of the usual kind are taken, as in the larger Mass Radiography scheme. "In February, Dr. Alan Pote was appointed as an additional assistant Chest Physician and the total medical staff is now three. The Health Visitor staff remains unaltered. There has been no increase for many years past in spite of the ever-increasing work of the Clinic. The time has now come for a review of nursing staff, if adequate attention is to be given to all aspects of the work." 93 Miss Woolgar, Secretary of the Walthamstow and Chingford Association of Tuberculosis Care Helpers, reports as follows:— " The work of the Association has continued on much the same lines as in previous years. Vouchers for milk and grocery have been issued where necessary, fares to visit patients have been paid, materials for occupational therapy have been provided and many small grants made to assist patients with personal difficulties. "A new departure during the year was the granting of financial help to enable a patient to take advantage of the Ministry's scheme to send suitable cases to Switzerland. This help was necessary as although cost of treatment and travel is met by the Ministry of Health, a great deal of incidental expense falls on the patient unless assistance is available from some charitable source. "For the first time also, the Association was able to send its Secretary as delegate to the Commonwealth and Empire Health and Tuberculosis Conference and to receive a firsthand report on the proceedings. "Towards the end of the year our financial position became very difficult, owing to the non-arrival of the Sunday Cinema Fund grant, normally received in July, and for the first time in many years, it was necessary to suspend almost all the assistance being given to patients or their families. Local efforts to raise funds, and donations from charitable sources restored the position sufficiently for grants to be resumed on a restricted scale in December and before the end of the year, the payment of the Sunday Cinema Fund Grant, together with the most successful Christmas Seal Sale ever recorded in the district, put our finances into a very healthy state to face the New Year. "Material assistance was given as follows:— Milk Vouchers to 54 cases Grocery Vouchers to 28 Fuel 7 „ Fares 8 Clothing 8 „ Holidays 2 Occupational Therapy 25 Minor Grants 18 „ "Many other patients or their relatives were helped with advice or by reference to organisations more suited to their particular needs. A close liaison is now firmly established with all such bodies, to our mutual advantage and that of the patients." 94 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 51. REHABILITATION OF TUBERCULOSIS PATIENTS During the year the Area Sub-Committee accepted financial responsibility for two patients undergoing rehabilitation at Papworth Village Settlement. No charge is made to patients. OCCUPATIONAL THERAPY The County Health Committee decided to employ three wholelime Occupational Therapists for domiciliary occupational therapy in the six extra Metropolitan Boroughs, and Leyton and Walthamstow are to share one. Up to the present, no appointment has been made in these Boroughs, and experience is being awaited of the appointment made elsewhere. In addition, there has been some difficulty in finding sufficient cases in Walthamstow to employ a Therapist on a half-time basis. CONVALESCENCE FOR ADULTS The total of cases sent away for recuperative convalescence was 73. The length of convalescence was one week in 2 cases, two weeks in 69 cases and three weeks in 2 cases. Recovery of cost or part-cost was made. The demand for recuperative convalescence was naturally high between April and October. A tendency was noted on the part of some patients to try and abuse the scheme as a means of obtaining an annual holiday. SICK-ROOM EQUIPMENT There are two main depots for sick-room equipment, 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. Special items of equipment are provided when necessary. 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 1952 were 15,410, including 1,743 new patients. 95 DOMESTIC HELP SERVICE (Section 29) Mrs. C. M. Hall, Domestic Help Organiser, reports as follows:— "1952 is so far the peak year with regard to domestic help and the demand continues unabated. The service continues to be administered along lines similar to those adopted in previous years and during the year 1,990 visits were made to patients and helps—776 more than in 1951. "One more full-time and many more part-time workers were enrolled to cope with the ever-increasing requests for help, the number employed at the end of the year being eight full-time and up to 189 part-time helps. The need for more full-time helps is still urgent and the number of cases carried forward at the end ot 1952 was 97 more than brought forward from 1951. "Below is a summary of the year's work:— DOMESTIC HELP Brought forward from 1951 339 New cases during 1952 325 Cases completed in 1952 228 No. of cases carried forward to 1953 436 Analysis: Acule Chronic Old People T.B. Others Total 70 501 59 22 12 664 (not sick) HOME HELP (for Confinements) No. of cases completed in 1952 88 "The last quarter of the year is normally the worst and the severe weather in November and December, particularly the bad fog on December 5th-8th put a great strain on the service: apart from adding more patients to the waiting list the number of helps was reduced owing to sickness amongst themselves or their families, thereby adding to the difficulties. "It will be seen from the foregoing analysis that the number of aged chronic sick has increased even further during the year and continues to require the services of the majority of part-time helps. Hospitals cannot cope with the everpressing need, and at the earliest opportunity patients are discharged home to be cared for by the Home Nursing and Domestic Help services. Fortunately the number of tuberculous patients requiring help remained low and all requests for assistance were met. 96 "During November six full-time helps took a week's course and examination arranged by the National Institute of Houseworkers, and four of the six were successful in obtaining the Institute's diploma and badge. The total now certificated is six. "Domestic Help plays a great part in the Health Services—the helps take pride in their work and contribute much to the welfare and comfort of the sick." COUNTY COUNCIL OF ESSEX—WELFARE COMMITTEE WELFARE SERVICES Mr. G. E. Pegram, County Welfare Officer, kindly contributes the following:— "The following statistics show the extent to which the main services provided by the County Welfare Committee under the National Assistance Act, 1948, have been afforded to persons residing within the Borough of Walthamstow during the year 1952:— (1) Residential and Temporary Accommodation. (a) Admitted to hostels and other residential establishments : Men, 8; Women, 14. (b) Admitted to temporary accommodation : Men, 1; Women, 5; Children, 11. (2) Blind Persons. The numbers of registered blind, partially sighted and defective sighted persons resident in the Borough during the twelve months ended 31st December, 1952, were as as follows:— (i) Registered as blind 213 (ii) Partially sighted 38 (iii) Defective sighted 11 all of whom were under the supervision of Home Teachers and seven participated in the Home Workers' Scheme operated through the agency of the London Society for Teaching and Training the Blind. In addition, two blind persons were employed in the Workshops for the Blind and during the year two were placed in employment (open industry), the total number of Walthamstow residents so employed being nineteen. "At some future date welfare services for deaf or dumb and other handicapped persons will be introduced in accordance with the terms of Ministry of Health Circular 32/51.