WAL 37 AC 4411(1) WALTHAMS70 BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1953 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. MEDICAL OFFICER OF HEALTH E. G. Ellis & Sons, Willow Street, E.4 BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1953 INDEX PAGE Section A.—Statistics and Social Conditions of the Area 8 Section B.—General Provision of Health Services in the Area 24 Section C.-—Sanitary Circumstances of the Area 30 Section D.—Housing 35 Section E.—Inspection and Supervision of Food 46 Section F.—Prevalence and Control over Infectious Diseases 58 Section G.—Miscellaneous 73 Section H.—National Health Service Act, 1946—Part III Services 79 Health Centres 80 Care of Mothers and Young Children 82 Midwifery 101 Health Visiting 104 Home Nursing 106 Vaccination and Immunisation 108 Ambulance Facilities 112 Prevention of Illness, Care and After-Care 113 Domestic Help 118 page Acreage 8 Adulteration 51 Ambulance Facilities 26,112 Ante-Natal Clinics 82, 91 Antibiotics, Administration of 107 Assessments 8 Bacteriological Examination 46, 48, 53 B.C.G. Immunisation 69 Birth Notifications 84 Birth Registrations 15 Births, Illegitimate 90 Birth Rate 8, 10 Cancer 11 Cancer Education 77 Caravans 33 Care and After-Care 113 Care of Illegitimate Children 90 Census, 1951 16, 23 Child Guidance 95 Child Welfare Clinics 91, 92 Chiropody 116 Clean Food Campaign 53 Cleansing (Personal) 26, 101 Clearance Areas 39 Committees 4, 79 Comparability Factor 9 Confinements 84 Contact Examinations 116 Convalescence for Adults 116 Convalescence for Pre-School Children 98 Conveniences, Public 78 Cremation 78 Daily Guardian Scheme 100 Day Nurseries 99 Deaths 8,10,11 Deaths, Infants 9, 12, 87 Deaths, Infectious Diseases 10 PAGE Death Rate 8,9, 10 Deaths, Causes of 11 Dental Laboratory 81 Dental Treatment 93 Diphtheria 60 Diphtheria Immunisation 77, 109 Diseases of Animals Acts 55 Disinfestation 33 District Midwifery 101 Domestic Help 118 Dysentery 63 Employment 8 Emergency Unit 103 Encephalitis 63 Enteric Fever 63 Essex County Council Act 29 Flood Disaster, Canvey Island 106 Food 6? Drugs Act, 1938 51 Factories Acts, 1937/48 57 Food, Clean 53 Food Inspection 46 Food Poisoning 54, 64 Foot Clinic 116 Funeral Arrangements 76 Gas and Air Analgesia 103 Gastric Influenza 60 General Dental Service 81 Health Centres 80 Health Education 76 Health Visiting 104 Home Nursing 106 Home Visits 104 Hospitals 27 Housing Act, 1936 38 Housing, Closure and Demolition 39 Housing, General 45 Housing Inspection 36 Housing Statistics 35 page Hydrogen Cyanide Regs.1958 34 Ice Cream 47 Illegitimacy 90 Immunisation 77, 109, 112 Infant Mortality 9, 12, 14, 85 Infectious Disease 58 Infestation 101 Inquests 78 Integration of Health Services 24 Invalid Children's Aid Association 97 Laboratory Facilities 25 Malaria 61 Maternal Mortality 10, 12, 13, 15 Maternity Homes 29 Maternity Medical Services 103 Maternity Outfits 104 Meals on Wheels Service 73 Measles 9 Meat Inspection 49 Medical Aid 102 Medical Examinations 76 Medicaments 98 Meningococcal Infection 61 Midwifery 101 Milk Inspection 46 Milk Special Designations Order 47 Milk Supply 46 Misuse of Milk Bottles 54 Moral Welfare 90 Morbidity 72 Mortuary 78 National Assistance Act, 1948, Sec. 47 28 Neo-Natal Mortality 12, 15, 85, 89 Notices, Sanitary 30 Notification of Births 84 Nursery Nursing Certificate 99 Nurseries &? Child Minders (Reg.) Acts, 1948 100 Nursing Homes 29 Nutrients 98 Occupational Therapy 116 Old People's Welfare 73 Ophthalmia Neonatorum 63 Ophthalmic Treatment 95 Orthopedic Treatment 93 Outworkers 58 Pediatric Clinic 96 Poliomyelitis 61 Poliomyelitis Follow-up 116 Population 8 page Post-Mortems 78 Post-Natal Clinics 82, 91 Premature Infants 88, 89 Prevention of Damage by Pests Act, 1949 55 Prevention of Illness 113 Prevention of Tuberculosis 69 Public Health (Infectious Diseases) Reg. 1953 70 Pupil Midwives 104 Queens Institute of District Nursing—Training 106 Rainfall 77 Rateable Value 8 Redevelopment and Clearance Areas 39 Rehabilitation 116 Rehousing on Medical Grounds 45 Rent and Mortgage Restriction Acts 46 Review of Housing Position in Borough 41 Rodent Control 55 Sanitary Inspection 30 Scabies Clinic 26 Sickroom Equipment 116 Smallpox 63 Smoke Abatement 33 Social Conditions 8 Staff 24,80 Statistics 8 Still births 8, 12, 15, 89 Sunlight Treatment 93 Swimming Baths 34 Total Infant Mortality 14 Tonsils and Adenoids 95 Training of Nursery Nurses 99 Training of Pupil Midwives 104 Tuberculosis 65,113 Vaccination 108 Virus Infections During Pregnancy 84 Vital Statistics 8, 84 Vitamins 98 Walthamstow Association of Tuberculosis Care Helpers 14 Walthamstow Child Welfare Society 92 Water 30 Welfare Services 119 Whooping Cough Immunisation 112 Women's Clinic 101 HEALTH COMMITTEE 1953-54 Chairman : Alderman The Lady McEntee, J.P. Vice-Chairman : Councillor Mrs. S. Candy. Ex'officio : The Worshipful The Mayor—Alderman T. W. Smith, J.P. The Deputy Mayor—Councillor W. F. Savill. Chairman of Finance Committee—Alderman Ross Wyld, O.B.E., J.P. Alderman Mrs. L. P. Bailey, J.P. „ W. Gillett. G. R. Lowton, J.P. „ A. E. Manning. „ W. H. Shaw. Councillor A. W. Ellis, M.B.E. Councillor E. G. Richards L. Jones. „ G. E. Usher. „ Mrs. M. E. Marchant. „ A. F. Whicher Mrs. W. M. Palethorpe. „ J. M. Wight. J. W. Pringle. Town Cler\ : G. A. Blakeley, Esq. Medical Officer of Health, Borough School Medical Officer and Area Medical Officer: A. T. W. Powell, M.C., M.B., B.S., D.P.H. Deputy Medical Officer of Health and Deputy Borough School Medical Officer: M. Watkins, M.R.C.S., L.R.C.P., D.P.H. Chief Sanitary Inspector, Petroleum Officer and Chief Inspector, Diseases of Animals Acts : W. R. Richards, M.R.S.I., M.S.I.A. TO THE CHAIRMAN AND MEMBERS OF THE HEALTH COMMITTEE Lady McEntee, Ladies and Gentlemen, I present herewith a report on the Health Services in the Borough during the calendar year 1953. Since I am required to deal generally with all matters of public health interest, the report includes those personal health services which were transferred to the County Council as the Local Health Authority on the appointed day of the National Health Service Act. These services are referred to in my capacity as Area Medical Officer and by courtesy of the County Medical Officer. The Essex Report on the Census of 1951 became available in March, 1954, and the more important tables affecting Walthamstow are included in detail. During the intercensal period since 1931, the population decreased by 11,837, or 8.9% of the 1931 population. There was an increase in population in Hale End Ward, but a decrease in all others. Private households (or families) increased from 34,973 to 38,847, and structurally separate dwellings from 28,639 to 33,213. Both dwellings and families were smaller, since rooms per dwelling occupied fell from 5.11 in 1931 to 4.83 in 1951, and private households (or families) per occupied dwelling fell from 1.22 to 1.17. Rooms per household fell from 4.18 to 4.13, persons per room from 0.9 to 0.75, and persons per household from 3.76 to 3.10. Table 13 gives a valuable analysis of various household arrangements, i.e. piped water, cooking, sink, water closet and fixed bath. Staff changes included the retirement of Mr. L. W. Kemp, Chief Sanitary Inspector, who retired in March, 1953, after nearly 46 years' service with the Borough Council. He was succeeded by Mr. W. R. Richards, who was previously Deputy Chief Sanitary Inspector. Hospital accommodation was reasonably satisfactory, except for the continued lack of accommodation for the elderly and chronic sick. A considerable amount of time was again required in dealing with persons who needed institutional accommodation but who refused to accept it. Details of these cases are given and fortunately application for power of compulsory removal under Section 47 of the National Health Service Act 1948, did not become necessary. Notable progress in housing was made, and extracts are given from a report presented to the Council by the Town Clerk, Borough Architect, Engineer and Surveyor and Housing Manager. Towards the end of the year it was decided to proceed with the clearance of unfit houses, and details are given of four small clearance areas. Infectious diseases continued at an average incidence, and again there was no case of confirmed diphtheria. Deaths from infectious diseases given by the Registrar General included the following: Tuberculosis 22, Syphilitic disease 4, Meningococcal infections 1, Poliomyelitis 1. The incidence of dysentery served once more to stress the need for strict personal hygiene. Graphs are given showing the notification and death rates of tuberculosis. With the continuing rate of notification and the smaller death rate, there must be an increase in the number of infective persons in the community, in spite of new methods of treatment. For some years it has been the local practice to treat each new case of tuberculosis as a case of major infectious disease, and to attempt to trace the infecting source. During the year a public conference was convened by the Council in regard to old people's welfare. Many thousands of booklets were issued to old people, setting out the services available and including a reply card if a visit was desired. The results of the visits paid by the health visitors is recorded. The personal health services are now dealt with by the Walthamstow Health Area Sub'Committee of the County Health Committee. Staffing continued to be satisfactory except for some difficulty in recruiting health visitors, especially for tuberculosis duties. In spite of the increased charges at day nurseries, the average attendance after an initial fall recovered to 92 out of 120 places. Training at day nurseries continued with good results and of 14 who gained their certificates in 1952 and 1953, no fewer than 6 proceeded to general nursing training. Good work was again done by the health visiting, home nursing and midwifery staff. Although Thorpe Coombe Maternity Hospital now deals with patients from the whole of the Hospital Group, a large part of the work done is for Walthamstow mothers and it is a pleasure to record once again the good work carried out at Thorpe Coombe, and the co-operation received from Miss Helen Rodway, F.R.C.O.G., Consultant Obstetrician. The arrangements for vaccination and immunisation against diphtheria and whooping cough were continued, and with the extension of whooping cough immunisation, to all ages and by general practitioners. Unfortunately, during the summer months there was some curtailment of immunisation, and this in turn, tends to undermine public confidence. Diphtheria remains a deadly disease and outbreaks have occurred in other parts of the country, showing that in the absence of a sufficient degree of immunity in young children and the administration of reinforcing doses, fatal cases can still occur. Co-operation between the Chest Clinic and the Health Department continued and Dr. Ramsay refers to the increasing use of the Odelca X-ray unit by general practitioners. The Domestic Help and Chiropody Services were again extended to the limit and experience continued to show how vital these are to the welfare of old people. In conclusion, I have again to record the help and the good work of the staff of the Department, the consideration of the Committees concerned, and in particular of their Chairman, Alderman The Lady McEntee, J.P. Full co-operation has also been experienced from other departments and from the family doctors in the town. I have the honour to be, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. 8 A.—STATISTICS 8C SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1953) 119,400 Number of Assessments (31st December, 1953) 37,186 Rateable Value (31st December, 1953) £916,517 Sum represented by penny rate £3,690 Population.—The Registrar-General's Estimate of the home population at mid-year, 1953, is 119,400, a decrease of 1,000 on the previous year. Employment.—According to information kindly supplied by Miss G. Cordell, Manager of the Local Employment Exchange, approximately 650 men and 340 women were placed in employment every month during the year 1953, through the placing machinery of the Employment Exchange. The number of persons insured under the National Insurance Acts employed in the whole area covered by the exchange, comprising the Boroughs of Walthamstow, Leyton, Chingford, Wanstead and Woodford was approximately 82,000. Of this number, it is estimated that about 40,000 were employed in Walthamstow. During 1953, the average number of persons unemployed in the whole Area was 970 men and 390 women, these included 90 disabled men and 25 disabled women. Extracts from Vital Statistics.—The Registrar-General's midyear 1953 estimate of the home population (viz., 119,400) has been used for the calculation of all vital statistics. Total Males Females Legitimate 1,404 709 695 Birth rate per Live Illegitimate 50 26 24 1,000 of the Births Total 1,454 735 719 estimated home population 12.2 Stillbirths 38 Rate per 1,000 total (live and still) births 25.5 Deaths 1,183 Death rate per 1,000 of the estimated home population 9.9 Deaths from puerperal causes:— Puerperal Sepsis Deaths - Other Puerperal Causes 2 9 Death rate of infants under one year of age:— All infants per 1,000 live births 28.2 Legitimate infants per 1,000 legitimate live births 28.5 Illegitimate infants per 1,000 illegitimate live births 20.0 Deaths from measles (all ages) - Deaths from whooping cough (all ages) - Deaths from diarrhoea (under two years of age) 1 Pulmonary tuberculosis death rate 0.18 Non-pulmonary tuberculosis death rate - The natural increase of population, i.e., excess of births over deaths was 271. The usual comparison of rates with those for the whole country is shown in the table on the following page. Deaths.—The Registrar-General's classification of causes of death by sex totals is given. The total number of deaths in 1953 (1,183), compares with 1,304 in 1952, the respective death rates being 9.9 and 10.8 per 1,000 population. Comparability Factor.—To make an approximate allowance for the way in which the sex and age distribution of the local population differs from that for England and Wales as a whole, the crude birth and death rates for the areas should be multiplied by the appropriate area comparability factor. When local crude birth and death rates have been so adjusted, they are comparable with the crude rate For England and Wales or with the corresponding adjusted rate for any other area. The comparability factors for Walthamstow are given by the Registrar-General as follows:— Comparability factor for births 0.98 Comparability factor for deaths 1.02 The above factors, when applied to the crude rates, produce the following adjusted rates:— Live births 11.9 Deaths 10.1 10 Birth-Rates, Death-Rates, Analysis of Mortality, Maternal Mortality, and Case Rates for certain Infectious Diseases in the year 1953. Provisional figures based on Quarterly Returns. England and Wales. 160 County Boroughs and Great Towns (including London) 160 Smaller Towns (Resident Population 25,000'50,000 at 1951 Census) London Adminis trative County. Walthamstow. Rates per 1,000 Home Population Births:- Live Births 15.5 17.0 15.7 17.5 12.2 Still Births 0.35 0.43 0.34 0.38 0.32 *22.4 *24.8 *21.4 *21.0 *25.5 Deaths: - All Causes 11.4 12.2 11.3 12.5 9.9 Typhoid and Paratyphoid 0.00 0.00 - - - Whooping Cough 0.01 0.01 0.00 0.00 - Diphtheria 0.00 0.00 0.00 - - Tuberculosis 0.20 0.24 0.19 0.24 0.18 Influenza 0.16 0.15 0.17 0.15 0 18 Smallpox 0.00 0.00 0.00 - - Acute Poliomyelitis (including Polioencephalitis) 0.01 0.01 0.01 0.01 0.00 Pneumonia 0.55 0.59 0.52 0.64 0.68 Notifications (Corrected):- Typhoid Fever 0.00 0.00 0.00 0.01 - Paratyphoid Fever 0.01 0.01 0.01 0.01 0.00 Meningococcal Infection 0.03 0.04 0.03 0.03 0.02 Scarlet Fever 1.39 1.50 1.44 1.02 2.42 Whooping Cough 3.58 3.72 3.38 3.30 5.8 Diphtheria Erysipelas 0.01 0.14 0.01 0.14 0.01 0.13 0.00 0.12 0.23 Smallpox 0.00 0.00 0.00 - - Measles 12.36 11.27 12.32 8.09 8.16 Pneumonia 0.84 0.92 0.76 0.73 1.01 Acute Poliomyelitis (including Polioencephalitis) Paralytic 0.07 0.06 0.06 0.07 0.05 Non-Paralytic 0.04 0.03 0.04 0.03 0.02 Food Poisoning 0.24 0.25 0.24 0.38 0.18 Puerperal pyrexia *18.23 *24.33 *12.46 *28.61 *54.96 Deaths:- Rates per 1.000 Live Births All causes under 1 year of age Enteritis and Diarrhoea under 2 years of age f26.8 30.8 24.3 24.8 28.2 1.1 1.3 0.9 1.1 0.7 Maternal Mortality: - A.115 Sepsis of pregnancy, childbirth and the puerperium Abortion with toxaemia Uther toxaemias of pregnancy and the puerperium A.117 Haemorrhage of pregnancy and childbirth A.118 Abortion without mention of sepsis or toxaemia A. 119 Abortion with sepsis A.120 Other complications of | pregnancy, childbirth and the puerperium A.116 Number of Deaths :- Walthamstow - - - 1 - - 1 England and Wales 68 7 166 90 30 39 123 Rates per 1,000 Total (Live and stil) Births:- Walthamstow - - - 0.67 - - 0.67 England and Wales 0.10 0.01 024 0.13 0.04 0.06 0.18 * Per 1,000 Total (Live and Still) Births, †Per 1,000 related live births. 11 Causes of Death as given by the Registrar-General for the year 1953 Whole District Causes of Death Males Females Total 1952 1. Tuberculosis, Respiratory 19 3 22 22 2. Tuberculosis, other - - - - 3. Syphilitic Disease 1 3 4 7 4. Diphtheria - - - - 5. Whooping Cough - - - 1 6. Meningococcal Infections - 1 1 1 7. Acute Poliomyelitis 1 - 1 - 8. Measles - - - - 9. Other Infective and Parasitic Diseases 1 1 2 10. Malignant neoplasm, stomach 19 19 38 38 11. Malignant neoplasm, Lung, bronchus 40 9 49 38 12. Malignant neoplasm, breast - 14 14 27 13. Malignant neoplasm, uterus - 10 10 7 14. Other malignant and lymphatic neoplasms 53 43 96 123 15. Leukaemia, aleukaemia 2 2 4 8 16. Diabetes 3 2 5 7 17. Vascular lesions of nervous system 54 72 126 140 18. Coronary disease, angina 120 54 174 201 19. Hypertension with heart disease 5 5 10 35 20. Other heart disease 73 96 169 206 21. Other circulatory disease 19 29 48 45 22. Influenza 11 10 21 3 23. Pneumonia 38 43 81 93 24. Brondhitis 74 40 114 103 25. Other diseases of respiratory system 12 7 19 16 26. Ulcer of stomach and duodenum 12 2 14 7 27. Gastritis, enteritis and diarrœha 1 3 4 4 28. Nephritis and nephrosis 8 3 11 11 29. Hyperplasia of prostate 8 - 8 20 30. Pregnancy, childbirth, abortion - 2 2 3 31. Congenital malformations 11 5 16 11 32. Other defined and ill-defined diseases 50 45 95 97 33. Motor vehicle accidents 3 1 4 10 34. All other accidents 4 7 11 12 35. Suicide 7 4 11 5 36. Homicide and 'operations of war - - - 1 Totals, 1953 649 534 1,183 - Totals, 1952 676 628 - 1,304 The age distribution of Cancer deaths was as follows :- Under lyr. 1-2 yrs. 2-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 yrs. & over - - - 2 - 12 69 128 12 INFANT DEATHS, NEO NATAL MORTALITY AND STILLBIRTHS Year. Live Births. Live Birth Rate per 1,000 Population. Stillbirths. Neo-Natal Deaths. Infant Deaths. No. Per 1,000 total (live and still) births. Per 1,000 population. No. Per 1,000 live births. No. Per 1,000 live births. 1953 1,454 12.2 38 25.5 0.32 27 18.6 41 28.2 1952 1,512 12.6 29 18.8 0.24 23 15.2 37 24.5 1951 1,637 13.5 38 22.7 0.31 23 14.0 37 22.6 1950 1,598 13.0 37 22.6 0.30 33 20.6 42 26.2 1949 1,836 14.9 27 14.5 0.22 31 16.9 1.4 29.4 The average mean annual mortality rate for the quinquennium 1931/35 was 49, and for the quinquennium 1946/50 it was 27. During the three years 1951/53 it fell to 24.5, i.e., exactly half the rate for 1931/35. 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 1953 there were two 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 1 11.5.1953 Meconium embolism during Childbirth. 34 2 29.9.1953 Ante and postpartum haemorrhage due to adherent placenta previa. 41 13 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. 1953 1,492 - 2 2 - 1.34 1.34 1952 1,541 - 3 3 - 1.95 1.95 1951 1,075 - - 2 1.19 - 1.19 1950 1,0 5 - - - - - - 1949 1,803 - 2 2 - 1.07 1.07 14 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:— 15 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). 1953. 1952. 1951. 1950. 1949. Maternal Mortality 1.37 1.98 1.22 - 1.09 Stillbirths 26.1 19.2 23.2 23.1 14.7 Neo-Natal Mortality 18.6 15.2 14.0 20.6 16.9 REGISTRATION OF BIRTHS The Registrar-General's returns show the following registra tions during the calendar year :— (a) Live Births. Males. Females. Totals. Legitimate 709 695 1,404 Illegitimate 26 24 50 735 719 1,454 The stillbirth rate per 1,000 population was 0.32. Of the 1,539 local registrations, 421 belonging to other areas are excluded, leaving a net total of 1,118. There were no nonnotified births during 1953. St. James High Hoe Wood Hale Higham Street. Street. Street. Street. End. Hill. Total. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Totals. 76 58 43 60 94 91 90 71 129 131 j 136 139 568 j 550 -Grand Totals 134 103 185 161 I 260 1 275 1,118 16 CENSUS, 1951 The detailed results of this Census with regard to Walthamstow Municipal Borough are shown in the 18 tables in the County Report for Essex issued in March, 1954, by the General Register Office, through Her Majesty's Stationery Office. Nine of the tables, viz., numbers 2, 3, 7, 10, 11, 16, 17, 21 and 23, are very similar to the tables published after the 1931 Census. The remaining nine tables, viz., L, Q, 12, 13, 15, 18, 24, 25 and 27, are new tables. Those tables considered of sufficient interest to print, appear in the following pages. The titles of all the various tables relating to Walthamstow are given below:— Table 2—POPULATION 1921-1951 and Intercensal Variations. Table 3—ACREAGE, POPULATION, PRIVATE HOUSEHOLDS and DWELLINGS. Table 7 PARLIAMENTARY CONSTITUENCIES showing ACREAGE, POPULATION and ELECTORS. Table L—Housing of Private Households. Table 10—DWELLINGS, ROOMS and HOUSEHOLDS. Table 11—-PRIVATE HOUSEHOLDS by SIZE, ROOMS OCCUPIED and DENSITY OF OCCUPATION in (a) All dwellings ; (b) Shared dwellings. Table 12—PRIVATE HOUSEHOLDS by DENSITY of OCCUPATION (Persons per Room). Table 13—PRIVATE HOUSEHOLDS according to possession of certain HOUSEHOLD ARRANGEMENTS. Table 15—PRIVATE HOUSEHOLDS by MARITAL CONDITION, AGE and SEX of HEAD. Table Q—Distribution by Marital Condition and Age and Sex Ratios. Table 16—Population in NON-PRIVATE HOUSEHOLDS by HABITATIONS. Table 17- INSTITUTIONS and SPECIAL PREMISES : Number, Total Population and Inmates. Table 18- HOTELS and BOARDING HOUSES with 10 or more rooms, by Rooms and Population Content. Table 19—BIRTHPLACES and NATIONALITIES of all population. Table 21—AGES (quinary) by MARITAL CONDITION. Table 23—AGES single years under 21. Table 24—PERSONS IN FULL-TIME ATTENDANCE AT AN EDUCATIONAL ESTABLISHMENT. Table 25—OCCUPIED POPULATION in 3 Age Sections by 5 TERMINAL EDUCATION AGES. Table 27—SOCIAL CLASS distribution of Occupied and Retired MALES aged 15 and over. 17 Census Population. The 1951 Census statistics are in respect of the living population enumerated as at midnight, 8th/9th April, 1951. Definitions, etc. Dwelling means a structurally separate dwelling and generally comprises any room or suite of rooms intended or used for habitation, having separate access to the street or to a common landing or staircase to which the public has access. Households.—The term " household " now replaces the term " family " used in the previous census. Private households can broadly be regarded as comprising single persons living alone or groups of individuals voluntarily living together under a single menage in the sense of sharing the same living room or eating at the same table. Rooms.—For the purpose of the census, the rooms counted are the usual living rooms, including bedrooms and kitchens, but excluding sculleries, kitchenettes, landings, lobbies, closets, bathrooms or any warehouse, office or shop rooms. Household arrangements.—The 1951 census schedule contained the following instructions :— Piped water supply within the house ' means water laid on either from the mains or from a storage tank, if the tap can be reached without leaving the shelter of the building or an attached covered structure. It does no': include a tap in the open yard or a public standpipe. Cooking Stove or Range means any cooking stove, kitchen range, or other fixed grate using gas, electricity or any other fuel, provided there is an oven. One or more gas-rings, hot-plates or portable electric ovens are not by themselves enough to be called a cooking stove or range. Kitchen Sink' means a sink inside the building, whether in a kitchen or not, with a drain pipe leading outside the building, and normally used for washing up, etc. It need not have water piped to it. It does not include a wash basin designed for personal toilet. Watercloset' here means a watercloset flushed by water, either from a cistern or by hand, and emptying into a main sewer, septic tank or cesspool. It does not include a chemical closet or earth closet. ' Fixed Bath ' means a bath permanently installed and connected with a waste pipe leading outside the building. It does not matter for this purpose whether there is water piped to at, or whether the room where it is installed is used only as bathroom or not. 18 The following notes refer to the tables indicated Table 3 shows the intercensal population variations by wards, the marked increase in Hale End Ward and the decrease in all others. The Higham Hill Ward showed the highest density of persons per room, and Wood Street Ward the highest percentage of persons at more than two persons per room. Table 10.—Dwellings occupied by two families fell from 5,464 in 1931 to 4,992 in 1951, and those occupied by three families from 412 to 282 . Table ' L.—This table shows a 15.7 per cent, increase in structurally separate dwellings since 1931. Over the same period rooms per dwelling increased from 4.83 to 5.11. There was an 11.1 per cent. increase in households (or families), and 28.3 per cent. of households were sharing dwellings. Persons living alone amounted to 10.2 per cent., and 10.5 per cent. were occupying one or two rooms only. Table 12 shows the number of persons living at a density of more than two per room and the very marked reduction from 5.62 to 1.01 per cent. This reduction is in line with a similar reduction in the other five Essex Boroughs in the London outer ring. Table 13.—This table is the first of its kind in any Census of England and Wales, but the Report states that allowance must be made for inconsistency amongst heads of households as to what constitutes " sharing " of a household arrangement, but the broad picture is considered by the Registrar General to be reasonably accurate. To summarize, the following are the percentages of households without the exclusive use of the arrangements specified Piped Water 22 Cooking Stove 7 Kitchen Sink 11 Water Closet 23 Fixed Bath 56 The following are the percentages of households having the exclusive use of the items stated:- All five arrangements 41 All except Bath 28 Stove and Sink 88 19 TABLE 2.—POPULATION 1921-1951 AND INTERCENSAL VARIATIONS Population: 1921 Persons 129,395 1931 Persons 132,972 Males 63,468 Females 69,504 1951 Persons 121,135 Males 57,068 Females 64,067 Increase or Decrease (-) 1921-31 2.8% 1931-51 -11, 837 persons .8.9% TABLE L.—HOUSING OF PRIVATE HOUSEHOLE Structurally Separate Dwellings Occupied and Vacant: Number 33,566 % Increase or Decrease (-) 1931-1951 15.7 % Vacant unfurnished 0.50 Occupied: Rooms per dwelling, 1951 4.83 do. 1931 5.11 % with 1 or 2 rooms only 2.01 Households Number 38,847 % Increase or Decrease (-) 1931-1951 11.1 % sharing a dwelling 28.3 Rooms per household 4.13 % occupying 1 or 2 rooms only 10.5 Persons per household, 1951 3.10 do. 1931 3.76 % of 1 person households 10.2 Heads of household, % non-married 22.0 Density of Population (Persons per Room) Persons per room 0.75 % of population at density: Over 2 1.0 Over 1½ 6.2 % of households at density: Over 2 0.7 Over 1½ 3.8 20 TABLE 3. ACREAGE, POPULATION, PRIVATE HOUSEHOLDS AND DWELLINGS Administrative Area Acreage (Land Inland Water) POPULATION PRIVATE HOUSEHOLDS & DWELLINGS, 1951 1931 195 1 Private Households Population in Private Households Structurally Separate Dwellings Occupied Rooms occupied Density of Occupation Persons Persons Males Females Persons per Acre Persons per Room Percentage of persons at more than 2 per Room (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (1) (m) Walthamstow M.B. and C.P. 4,342 132,972 121,135 57,068 64,067 27.9 38,847 120,442 33,213 160,473 0.75 1.0 Wards: Hale End 1,326 23,467 28,840 13,548 15,292 21.7 9,287 28,797 8,257 40,519 0.71 0.6 Higham Hill 977 29,113 28,455 13,683 14,772 29.1 8,488 28,448 7,930 35,802 0.79 1.1 High Street 688 18,258 13,194 6,171 7,023 19.2 4,374 13,183 3,807 17,639 0.75 0.9 Hoe Street 355 22,328 18,655 8,616 10,039 52.6 6,381 18,407 4,617 24,893 0.74 0.9 St. James Street 486 22,568 16,524 7,868 8,656 34.0 5,365 16,524 4,655 21,415 0.77 1.2 Wood Street 510 17,238 15,467 7,182 8,285 30.3 4,952 15,083 3,947 20,205 0.75 1.5 21 TABLE 10. DWELLINGS, ROOMS AND HOUSEHOLDS STRUCTURALLY SEPARATE DWELLINGS NUMBER OF ROOMS 1 Room 2 Rooms 3 Rooms 4 Rooms 5 Rooms 6 Rooms 7 Rooms 8 or 9 Rooms 10 or more Rooms All sizes Occupied Vacant Total Furnished Others (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (1) (m) (n) (o) Dwellings occupied by 1 Private Household(s) 99 567 3,283 6,298 13,586 3,446 471 153 36 27,939 129,457 245 135 129,837 by 2 - 1 9 336 1,230 2,718 448 234 16 4,992 29,016 18 18 29,052 by 3 „ „ or more - — — 6 34 108 52 52 30 282 2,000 3 — 2,003 Total dwellings occupied 99 568 3,292 6,640 14,850 6,272 971 439 82 33,213 160,473 266 153 160,892 Dwellings wholly vacant furnished 2 5 25 40 74 34 4 1 - 185 858 858 others - 2 23 38 66 30 5 4 - 168 803 803 Total Dwellings occupied and vacant 101 575 3,340 6,718 14,990 6,336 980 444 82 33,566 160,473 1,124 956 162,553 Number of Private Households therein 99 569 3,301 6,989 16,149 9,216 1,536 786 202 38,847 Miscellaneous habitations and institutions housing non-private households 17 N.B. The above includes (a) 2 houseboats comprising 2 rooms occupied by 2 households. (b) 8 caravans comprising 8 rooms occupied by 8 households. 22 TABLE 11.—PRIVATE HOUSEHOLDS BY SIZE, ROOMS OCCUPIED AND DENSITY OF OCCUPATION IN: (a) All dwellings. (b) Shared dwellings. Number of Persons in Household Number of HOUSEHOLDS occupying the following number of ROOMS Total Households Total Persons in Household Total Rooms Occupied Average Number of Persons per 1 Room 2 Rooms 3 Rooms 4 Rooms 5 Rooms 6 Rooms 7 Rooms 8 or 9 Rooms 10 or more Rooms (a) (b) (c) (d) (e) (f) (g) (h) (i) (i) (k) (1) (m) (n) (a) Households in All Dwellings 1 463 1,006 1,238 570 557 120 11 4 — 3,969 3,969 12,085 0.33 2 169 1,313 3,391 2,030 3,239 716 79 22 5 10,964 21,928 42,366 0.52 3 112 685 2,603 2,216 3,848 897 102 33 5 10,501 31,503 43,814 0.72 4 31 239 1,328 1,780 3,303 834 111 32 10 7,668 30,672 34,275 0.89 5 8 40 392 755 1,730 484 90 22 4 3,525 17,625 16,696 1.06 6 2 7 103 236 725 222 33 19 6 1,353 8,118 6,691 1.21 7 1 — 35 77 284 104 18 12 4 535 3,745 2,729 1.37 8 1 1 6 26 104 39 10 4 1 192 1,536 994 1.55 9 — 2 4 4 47 24 8 1 — 90 810 475 1.71 10 or more — — — 1 27 12 5 3 2 50 536 291 1.84 Total Households 787 3,293 9,100 7,695 13,864 3,452 467 152 37 38,847 Total Persons 1,328 6,911 24,048 24,382 48,318 12,718 1,899 656 182 120,442 0.75 Rooms Occupied 787 6,586 27,300 30,780 69,320 20,712 3,269 1,253 409 160,416 Distribution per 1,000 households by rooms occupied 1951 20 85 234 198 357 89 12 4 1 1,000 (b) Households in Shared Dwellings 1 397 831 824 118 24 2 — — — 2,196 2,196 5,135 0.43 2 155 1,065 2,261 408 58 15 1 — — 3,963 7,926 11,087 0.71 3 106 591 1,593 471 85 14 2 1 1 2,864 8,592 8,492 1.01 4 26 196 801 268 70 16 1 2 — 1,380 5,520 4,363 1.27 5 4 35 248 109 37 4 2 1 — 440 2,200 1,485 1.48 6 6 67 34 22 10 2 141 846 533 1.59 7 or more — 2 24 13 20 7 1 — 1 68 519 288 1.80 Total Households 688 2,726 5,818 1,421 316 68 9 4 2 11,052 Total Persons 1,149 5,746 15,148 4,265 1,142 278 45 16 10 27,799 0.89 Rooms Occupied 688 5,452 17,454 5,684 1,580 408 63 33 21 31,383 Distribution per 1,000 households by rooms occupied 1951 62 247 526 129 29 6 1 0 0 1,000 23 TABLE 12.—PRIVATE HOUSEHOLDS BY DENSITY OF OCCUPATION (Persons per Room) Households in all Dwellings at Successive Densities Total 38,847 Numbers : Over 3 46 3 and over 2 222 2 and over 1½ 1,186 l½ and over 1 4,205 1 or less 33,188 Percentages: Over 3 0.1 3 and over 2 0.6 2 and over 1 3.1 1½ and over 1 10.8 1 or less 85.4 Numbers of Households in Shared Dwellings at Successive Densities Total 11,052 Over 3 32 3 and over 2 172 2 and over 1½ 687 1-½and over 1 1,576 1 or less 8,585 Population in all Households at Successive Densities Total 120,442 Over 3 217 3 and over 2 1,105 2 and over 1½ 6,171 1½ and over 1 20,379 1 or less 92,570 Percentage of Persons Living at more than 2 per room 1951 1.01 1931 5.62 24 B.—GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. 1. Public Health Officers of the Authority The names and qualifications of the Senior Public Health officers employed by the Authority are given at the beginning of the Report. Mr. F. W. Kemp retired as from the 31st March, 1953, and the Council have placed on record their appreciation of the long and faithful service given by Mr. Kemp and presented him with a testimonial under the seal of the Council. Following the retirement of Mr. Kemp, Mr. W. R. Richards, Deputy Chief Sanitary Inspector since September, 1945, was appointed as Chief Sanitary Inspector. Following again from the promotion of Mr. Richards, Mr. H. L. Hughes from another Borough was appointed as Deputy Chief Sanitary Inspector. On the transfer of a District Sanitary Inspector to the Town Clerk's Department as an articled pupil, the resultant vacancy was filled by a transfer of a temporary Sanitary Inspector to the permanent staff. At the end of the year one of the District Sanitary Inspectors resigned his appointment and transferred to a Metropolitan Borough, and a replacement was appointed in January, 1954. There was no other change in the officers employed by your authority. 2. Integration of Health Services. The circular issued by the Ministry of Health in regard to the preparation of Annual Reports suggests the inclusion of informa' tion into progress made during the year towards closer integration of the Health Services with the general practitioner medical services and the hospital and specialist services. The following is the position in Walthamstow .— (a) Regular clinical meetings are held under the aegis of the local division of the British Medical Association and the Medical Societies of the local Hospitals, i.e., Connaught and Whipps Cross. (b) The medical and nursing staff of the Local Health Authority attend clinical rounds at Whipps Cross and Thorpe Coombe Hospitals. TABLE 13. PRIVATE HOUSEHOLDS ACCORDING TO POSSESSION OF CERTAIN HOUSEHOLD ARRANEGMENTS Total Number of Households Households with Household Arrangements as follows:— (E = having exclusive use; S = sharing with another household; N = entirely without) Piped Water Cooking Stove Kitchen Sink Water Closet Fixed Bath All five arrangements E Stove E, Sink E Bath S or N, other four arrangements E Sink S or Water Closet S or N Households Per Cent S or N Households Per Cent S or N Households Per Cent S or N Households Per Cent S or N Households Per Cent S or N Households per cent Households Per Cent Households Per Cent Households Per Cent S N S N S N S N S N (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (1) (m) (n) (o) (P) (q) (r) (s) (t) (u) (v) (w) (x) (y) All Households 38,845 8,627 36 22 2,657 216 7 3,455 896 11 8,772 78 23 4,722 17,176 56 15,747 41 34,357 88 10,770 28 3,944 10 Households Comprising:— 1 person (s) 3,969 1,687 13 43 645 153 20 901 249 29 1,841 18 47 886 2,250 79 696 18 2,769 70 955 24 1,066 27 2 „ 10,964 2,990 7 27 891 34 8 1,157 359 14 3,101 15 28 1,863 5,036 63 3,687 34 9,408 86 2,965 27 1,338 12 3 10,499 2,153 6 21 646 16 6 818 213 10 2,227 20 21 1,212 4,614 55 4,360 42 9,448 90 3,004 29 926 9 4 or 5 11,193 1,540 7 14 416 9 4 507 68 5 1,427 19 13 666 4,450 46 5,780 52 10,598 95 3,199 29 537 5 6 or more persons 2,220 257 3 12 59 4 3 72 7 4 176 6 8 95 826 41 1,224 55 2,134 96 647 29 77 3 Households in single Household Dwellings occupying 1 room(s) 97 63 10 75 36 18 56 47 23 72 62 12 76 34 53 90 5 5 27 28 12 12 66 68 2 „ 567 267 3 48 116 7 22 156 42 35 293 4 52 183 223 72 130 23 366 65 83 15 184 32 3 „ 3,282 667 2 20 114 7 4 162 54 7 901 9 28 269 1,890 66 1,008 31 3,062 93 1,010 31 176 5 4 or 5 „ 19,822 1,525 6 8 144 12 1 185 9 1 309 19 2 169 7,980 41 11,265 57 19,609 99 6,902 35 185 1 6 or more room(s) 4,025 278 1 7 38 5 1 45 2 1 85 1 2 57 1,237 32 2,632 65 3,972 99 1,072 27 43 1 Total room(s) 27,793 2,800 22 10 448 49 2 595 130 3 1,650 45 6 712 11,383 44 15,040 54 27,036 97 9,079 33 654 2 Households sharing Dwellings and occupying 1 room(s) 688 577 5 85 389 88 69 462 80 79 595 6 87 314 342 95 15 2 130 19 31 5 533 77 2„ 2,726 1,850 4 68 909 52 35 1,177 309 55 2,168 7 80 1,271 1,277 93 86 3 1,216 45 187 7 1,386 51 3 „ 5,818 2,582 4 44 658 22 12 895 342 21 3,517 18 61 1,723 3,452 89 339 6 4,541 78 1,073 18 1,051 18 4 or 5 „ 1,737 784 1 45 239 4 14 310 35 20 813 2 47 673 701 79 241 14 1,369 79 384 22 306 18 6 or more room(s) 83 34 — 41 14 1 18 16 — 19 29 — 35 29 21 60 26 31 65 78 16 19 14 17 Total room(s) 11,052 5,827 14 53 2,209 167 21 2,860 766 33 7,122 33 65 4,010 5,793 89 707 6 7,321 66 1,691 15 3,290 30 25 (c) Circular letters are issued by the Medical Officer of Health to general practitioners and hospital medical staffs as and when necessary. Eleven such circular letters were issued in 1953, referring to 24 items, the subject matters being as follows:— Prevention of Tuberculosis (Mass Radiography); Immu nisation against Whooping Cough (Extension of facilities to general practitioners); Treatment of Anthrax, Botulism, Snake-bite and Mushroom Poisoning, etc.; Home Nursing (Availability of Service); Smallpox (Information as to North Country Outbreak); The Public Health (Infectious Diseases) Regulations 1953; Medical Aid Fees; Health Visiting (Availability of health visitors to assist general practitioners); Bacillary Dysentery (Evidence of increase. Care required in case of food handlers); Poliomyelitis (Incidence in Walthamstow—names and addresses of consultants available); Treatment of Scabies (Suspension of Walthamstow arrangements. Treatment at Hackney Scabies Clinic); Weil's Disease (Reminder as to possibility of cases); Co-operation of Public Health Services; Tuberculin Testing of School Entrants; School Medical Records (Availability of); Maternity Medical Services (Limited circulation to general practitioners on obstetric list and accepting medical aid notices—clarification of doctors' wishes in regard to booked patients). (d) Patients are referred from the Local Health Authority Clinics to consultants for a further opinion by means of triplicate forms. When the opinion has been received, a copy is passed to the family doctor. The Children's Department of one hospital is particularly good in supplying copies of discharge reports. (e) The Medical Officer of Health is a member of the Group Medical Advisory Committee and one of its representatives on the Group Hospital Management Committee. The Deputy Medical Officer of Health is the Honorary Secretary of the Group Medical Advisory Committee and also parttime Medical Superintendent of Chingford Hospital. 3. 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 26 Epping. There is a collecting box at the Town Hall for specimens from family doctors. Dr. Frank Marsh, Pathologist in charge of the Laboratory a 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 — 3 4 144 110 11 3 3 3 41 20 345 Widal agglu tinations 5 3 10 6 1 7 9 7 11 5 4 68 Rhesus, Group and Kahn 17 2 18 14 7 21 38 20 22 28 17 11 215 Urine 5 8 2 — 1 5 4 2 2 1 2 1 33 Nose and throat swabs 4 6 7 7 3 3 9 4 5 3 3 3 57 Food — — — — — — — — — 1 — 1 Haemoglobin estimation 4 — 2 1 - 2 3 2 1 1 3 11 30 Hairs — — 1 — — — — — — — — 1 White cell count — 2 2 — — — — — — — — — 4 Blood sugar 1 — — — — — — — — — — — 1 Totals 36 21 44 33 156 141 72 40 43 47 72 50 755 4. Ambulance Facilities. These are available from a local depot in Walthamstow which is administered centrally from Chelmsford, via the Control Centre at Ilford. 5. Treatment of Scabies and Verminous Conditions. In April, it was decided that in view of the comparatively few cases under treatment, the Skin Clinic be closed and placed on a care and maintenance basis and that arrangements be made with the Hackney Borough Council for the treatment of Walthamstow patients at a payment of 7/6d. per attendance. The Clinic was eventually closed on 1st August, 1953. 27 6. Hospital Accommodation. (a) Acute Cases.—There were no major changes in 1953 in regard to the hospital accommodation available for the inhabitants of the Borough. (b) Chronic Cases.—Regional Hospital Boards have asked that Medical Officers of Health shall support when necessary on "social grounds," the recommendations of medical practitioners for the admission of the chronic sick to hospital. All possible help was given when requested, and only six 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 1952 awaiting Hospital admission 2 No. of new cases considered during 1953 for Hospital Admission 26 No. of admissions to Hospital 17 No. of cases who died before admission 1 No. of cases cancelled or deferred 4 No. of cases outstanding at end of 1953 6 It is a pleasure again to record the unfailing help and considera' tion 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, in 1951 to 64.1 and in 1952 it rose to 75. During 1953, Walthamstow admissions were 72%. (d) Infectious Diseases.—Since the 1st January, 1953, cases of infectious diseases have not been admitted to Chingford Hospital. Patients from Walthamstow are mainly admitted to St. Ann's Hospital, Tottenham. No difficulties have been noted. 28 It is eventually intended that Chingford Hospital will become a General Hospital, but the immediate practice is to transfer postoperative and certain medical cases from other hospitals in the Group and to continue the admission of light medical cases from the surrounding area. 7. Aged and Chronic Sick. National Assistance Act, 1948 (Section 47). Five patients were investigated as to the possibility of compulsory removal through their not being in receipt of adequate care in their homes. Case (1).—Female reported by Housing Department, 13th January. On disharge from hospital after rehabilitation, domestic help was provided, but the patient's doctor did not consider it safe for the patient to live by herself, owing to loss of memory. She at first declined admission to Part III accommodation, but accepted it in April. Case (2).—Female, aged 87 years. Patient reported by Sanitary Inspector 27th February. Several other members of family residing in same house, but daughter who primarily cared for her mother was admitted to hospital, and granddaughter expecting baby almost at once. Bed arranged at Langthorne Hospital, but removal refused by patient when ambulance called. Visited and told of possibility of compulsory removal, and then agreed to enter hospital voluntarily. Admitted 2nd March. Case (3).—Female, aged 80 years. Circumstances reported by District Sanitary Inspector, 1st May. Ill in bed, had been given no solid food for some time, no coal or fire and accommodation dirty. Patient reported to be a chronic drunkard, separated from husband and children not interested. Family doctor had requested hospital admission and the patient's name was on the waiting list. On visiting the patient, she was found to be very confused and when the Domestic Help Organiser called, one of the married daughters from the West Country was visiting her mother and had been able to make arrangements for another daughter to look after her mother, pending hospital admission. Home nursing was also arranged and admission to hospital was effected on the 29th May. Case (4).—Female, aged 83 years, reported by family doctor 11th May, who requested compulsory removal and loan of a dry mattress. Acute incontinence and bedsores. On visiting, patient found to be cared for by other tenant, and daughter called daily. 29 Hospital removal declined, and family doctor agreed to trial of home nursing and payment of other tenant as a domestic help. A second-hand mattress was supplied. In July, the domestic help arrangement ceased since the help was not well enough and her child had contracted scarlet fever. By then the patient had improved, but there was still some urinary incontinence. A new domestic help was arranged. Case (5).—Male, aged 82 years, reported 20th November. Had been in receipt of domestic help since 1951, but difficulty in arranging continuing help because of patient's habits. Patient reported to be falling about and on visiting, the position was explained and voluntary entry to hospital suggested, rather than the possibility of compulsory removal. Patient admitted to Langthorne Hospital on 30th November and discharged by agreement on the 18th December. Patient worsened at the end of January, 1954, and reconsideration given to need for compulsory removal, since patient obstinately refused to enter hospital voluntarily. 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. 8. 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. Three 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. 9. Essex County Council, Act, 1933 (Establishments for massage and special treatment). No new licences were granted under the Act during the year. 30 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 1953. All dwelling houses in the area are supplied direct with piped water. The information included in the report for 1951 in respect of Ministry of Health Circular 42/51 also applied to 1953. Sanitary Inspection of the Area Mr. W. Richards, Chief Sanitary Inspector, reports as follows: No. of No. of No. of No. of in- No. of com- Intimation Notices Statutory Notices. Total spections nuisances plaints Visits. made. detected. received. Complied Complied Served. with Served. with 15,042 4,923 2,411 1,496 1,383 180 181* 21,579 * Includes notices outstanding from previous year. Of the 1,496 intimation notices served, 252 were in rcspect of business premises and the remainder (1,244) related to defects in private houses. Of the latter figure, 1,041 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 16 cases. An order was made by the Justices in one instance, a cost of £1 1s. Od. being awarded. In 15 cases the Summonses were withdrawn on payment of costs of £1 Is. 0d., 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, 291; Drains reconstructed or repaired, 293; Drains, obstructions removed, 121; Drains, means of access provided, 18; Drains, ventilation provided or improved, 43; Drains, ventilation repaired, 72; Soil pipes repaired or renewed, 99; Rain water pipes repaired or renewed, 117; Rain water pipes disconnected from drains, 5 ; Roofs repaired or renewed, 474; Gutterings repaired or renewed, 280; W.C. pans or traps 31 provided, 246; Gully traps provided, 53; W.C. flushing cis terns repaired or renewed, 184; W.C. floors concreted, 41; W.C.'s repaired and cleansed, 184; W.C.'s light and ventilation improved, 47; Waste pipes repaired, renewed or trapped, 127; New sinks provided, 63; Stoves and firegrates repaired or renewed, 177; Water supply reinstated, 7; Water supply taken off main, 2; Cisterns cleansed and covered, 24; Sculleries paved, 20; Yards and forecourts paved or repaired, 49; Dirty houses cleansed, 4; Dirty rooms cleansed, 212; Floors repaired, 329; Ventilation under floors provided or improved, 109; New damp courses provided, 25; Offensive accumulations removed, 19; Animals improperly kept, removed, 5; Stables repaired and cleansed, 11; Manholes repaired or repealed, 101; Other causes of dampness remedied 416 ; Miscellaneous repairs, 1599. Infectious Diseases. Visits to premises, 656; Re-visits to premises, 15. Disinfections. Rooms disinfected, 52; Articles disinfected, 326; Articles destroyed, 86. Special Premises. Visits Number paid Factories (a) Non-power 81 140 (b) Power 482 711 (c) Other premises 36 69 Outworkers 491 724 Butchers—81; Horseflesh only—3 84 389 Bakehouses 36 133 Fishmongers, Fish Fryers and Curers 42 190 Cafes and Caterers 121 438 Grocers, etc. 269 711 Ice Cream Manufacturers and Vendors 297 344 Dairies and Milksellers 143 138 Laundries 3 10 Hairdressers 74 44 Rag and Bone Dealers 4 19 Piggeries 2 4 Street Stalls Numerous 312 Greengrocers 94 103 Stables 21 96 Schools 139 Conveniences 39 As a result of the regular periodical visiting of the Special Premises the following works were carried out:— 32 Butchers. Special cleansings, 49; Pavings repaired, 5; Accumulations removed, 4; New galvanised bins provided, 13; Drains repaired, 1; W.C.'s repaired and cleansed, 9; Floors repaired and ventilated, 3; Light and ventilation improved, 2; Other improvements, 25. Bakehouses. Special cleansings, 38; New ceilings fixed, 1; Floors repaired, 1; Light and ventilation improved, 1; Roofs repaired, 1 ; Other improvements, 17. Fishmongers. Special cleansings, 18; Yards repaved, 1; Accumulations removed, 6 ; Drains cleared, 1; Other improvements, 31. Grocers. Store rooms cleansed, 66; Washing accommodation improved, 10; Other improvements, 45. Cafes and Caterers. Special cleansings, 60; Light and ventilation improved, 6; Floors repaired, 8; Other improvements, 43. Ice Cream Manufacturers and Vendors. Special cleansings, 7; Other improvements, 7. Dairies and Milkshops. Special cleansings, 18; New fittings and other improvements, 8. Hairdressers Special cleansings, 14; Other improvements, 7. Stable Premises. Cleansings, 7; Accumulations removed, 5; Pavings repaired, 2; Other improvements, 5. Laundries. Special cleansings, 5; Other improvements, 4. Rag and Bone Dealers. Cleansings, 5; Accumulations removed, 2; Pavings repaired, 2. 33 Piggeries. Cleansings, 1. Street Traders. Stalls improved, 12; Storerooms improved, 4. Public Houses. Special cleansings, 7; Hot water supply improved, 4. 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 willing 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. Smoke Abatement. At the end of the year, a resolution submitted from the National Smoke Abatement Society following its Annual Confer' ence in Glasgow, stated that it viewed with alarm the menace of fumes caused by the extension of the use of diesel oil engines and their faulty maintenance, and that all Local Authorities and Police be requested to enforce, and if necessary, to increase their powers to ensure minimising or suppression of these fumes in the interests of public health. The Council decided that the Metropolitan Police and the Essex County Council be asked to enforce their powers relating to the emission of fumes by motor vehicles, and that representations be made to the Ministry of Fuel and Power for a larger allocation of smokeless fuel to the Borough. Complaints of smoke nuisance were received and investigations carried out in respect of 28 premises, 24 of which were factories. Forty-eight smoke observations were carried out. By the end of the year, 23 of the above complaints had been remedied. Eradication of Bed Bugs, etc. During the year an electric spray was purchased for the disin festation of premises and has proved a very great advantage. 34 The number of houses reported to be verminous still remains comparatively small. Eighty-five rooms were fumigated with DDT smoke or sprayed with DDT solution. Insecticides were issued free of charge to tenants of 59 premises. Hydrogen Cyanide (Fumigation of Buildings) Regulations. 1938:— One notification was 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, 1953, the Baths were open on 288 days. Number of Swimming Bath bathers during this period was 115,707. "Maximum load was on September 7th, when we had 1,052 bathers. "During this period we also had 126,617 Slipper Bath bathers." Sampling was carried out on nine occasions, with satisfactory results. (b) Whipps Cross Bathing Pool.—This is a large open-air pool situated in Epping Forest, in the area of the Borough of Leyton and a few hundred yards from the Walthamstow boundary. It is administered by a joint Committee representing the two Boroughs. The pool is supervised by the Medical Officer of Health for Leyton, who kindly sends a copy of the analytical findings when samples are taken. (c) South-West Essex Technical College.—Sampling was carried out on nine occasions. One sample was unsatisfactory ; the bath was emptied and chlorination was increased on refilling. Subsequent samples were all satisfactory. 35 (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 Secretary kindly gives the follow ing particular :— "The attendance between the 1st May and the 30th September, 1953, was in the neighbourhood of 17,500 people. The turnover of the pool was from 7—9 hours. Due to the inclement weather, it was only necessary to run the plant all night on three occasions. Chlorination tests, on average, showed .3 parts per million at the deep end and .5 at the shallow end." Bacteriological and chemical analyses were carried out on three occasions with satisfactory results. D.—HOUSING Statistics The Borough Architect, Engineer and Surveyor, F. G. Southgate, Esq., A.R.I.B.A., A.M.TP.I., has kindly contributed the following:— Houses erected by the Local Authority during 1953 :— Hoe Street Ward 22 Flats 8 Houses St. James Street Ward 12 Flats 3 Houses Higham Hill Ward 2 Flats 60 Houses High Street Ward 8 Houses Hale End Ward 8 Flats 22 Houses Wood Street Ward 45 Flats 2 Houses TOTAL 89 Flats 103 Houses Houses erected by Private Enterprise during 1953:— Hoe Street Ward Nil St. James Street Ward 8 Flats — Higham Hill Ward 3 Houses High Street Ward Nil Hale End Ward 9 Houses Wood Street Ward 2 Houses TOTAL 8 Flats 14 Houses Note:—All were permanent houses or flats. 36 Houses Erected During 1953 During the calendar year 1953, 103 new houses and 89 flats have been erected. 22 new houses were erected by private enterprise. Schemes completed by the Council during the year include :- 10 Flats St. Barnabas Road. 11 „ Wood Street/Chestnut Avenue. 18 „ Brookfield Avenue. 12 „ Fernhill Court, Hempstead Road. 12 „ Hoe Street/Grosvenor Park Road (completion of scheme). 6 „ Chaucer Road, Milton Road, Ickworth Park Road. 4 „ Western Road/Shernhall Street. 6 „ Chingford Lane. 8 „ Wingfield Road. 2 „ Priory Court. In addition, 103 houses have been completed on various sites throughout the Borough. The main scheme completed is that at Bulls Farm, Billet Road, which provides accommodation for 129 families. A number of houses for the higher income group have been completed at Gordon Avenue site and the whole scheme will be completed in the early part of 1954. Forty two flats are under construction at the Manor House site in Vincent Road, and a number of smaller sites are at present being developed for housing. 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) 2,612 (b) Number of inspections made for the purpose 6,929 (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 96 (b) Number of inspections made for the purpose 138 37 (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 1,124 II.—Remedy of Defects During the Year Without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 1,084 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 180 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 181 (b) By Local Authority in default of owners Nil 38 C. Proceedings under Sections 11 and 13 of the Housing Act, 1936: — (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 (3) Number of dwelling houses where Demolition Orders withdrawn (houses made fit) 1 D. Proceedings under Section 12 of the Housing Act, 1936:— (1) Number ot separate tenements or underground rooms in respect of which Closing Orders were made 3 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit I * Including those outstanding from previous year. Housing Act, 1936 Unfit Houses The following premises were dealt with as follows:— Closing Orders: 60 Downsfield Road 199 Markhouse Road (Basement) 211 Markhouse Road (Basement) 84 St. Mary Road Houses Demolished: 800-814 Forest Road (Pre-war closures) 258 Hale End Road Unfit Houses: The Ministry of Housing and Local Government (Form P. 13 (HSG)/53)—Return for the year 1953. 39 Part B.—Houses not included in Clearance Areas. Demolition and Closing Orders. (1) Housing Act, 1936 Number Number of persons of houses displaced (a) Houses demolished as a result of formal or informal procedure under Section 11 1 13 (b) Houses closed in pursuance of an undertaking given by the owners under Section 11, and still in force — (c) Parts of buildings closed (Section 12) 3 7 (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) Local Government (Miscellaneous Provisions) Act, 1953 Closing Orders made under Section 10(1) 1 5 (4) 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 1,041 (5) Public Health Acts Number of houses in which defects were remedied after service of formal notices— (a) By owners 181 (b) By Local Authority in default of owners — (6) Housing Act, 1936 Number of houses made fit after service of formal notices— (a) By owners 1 (b) By Local Authority in default of owners — * Includes brought forward from preceding year. Redevelopment and Clearance Areas In July, a report was presented to the Health Committee in regard to the redevelopment and clearance of sub-standard property. The report included the results of a provisional survey of the Marlowe Road area. It was decided that a detailed survey of the Marlowe Road area he taken with a view to possible clearance and that afterwards a detailed survey be made of the Grange Road and Frederick Street areas. 40 Subsequently in November, the Council considered official representations in regard to four areas situated in the Wood Street Ward and the following areas were agreed by the Council:— Walthamstow (Short Road) Clearance Area, 1953 (comprising 15 dwellings). Walthamstow (Vallentin Road and Back Road No. 1) Clearance Area, 1953 (comprising 10 dwellings). Walthamstow (Vallentin Road and Back Road No. 2) Clearance Area, 1953 (comprising 10 dwellings). Walthamstow (Vallentin Road and Back Road No. 3) Clearance Area, 1953 (comprising 6 dwellings). The total number of dwellings concerned was 41. The Census of the dwellings carried out immediately prior to the consideration of the representations by the Health Committee showed that there were (under the standard of the Housing Act, 1936) 122 equivalent adult units occupying accommodation with a permitted number of 289 units. In other words, there was under occupation to the extent of 167 units, or 55%. It would appear from this finding, and from general experience, that there is a large amount of under-occupation of dwellings in the Borough generally. A considerable alleviation of the present housing shortage would result from the appropriate conversion of the larger under-occupied houses into flats with modern amenities. During the year, the Council decided to consider the possibility of making a clearance area in respect of 119 houses in Grange Road, Frederick Street and Lynmouth Road. By the end of the year, a detailed inspection of 96 houses in this area had been completed. During the course of detailed house-to-house inspections in connection with these clearance areas, it became obvious that there had been a very great improvement in the standard of living and of maintenance in these older houses in the Borough. Good furnishings and house-pride were in much greater evidence than before the war, and in the large majority of cases, the tenants had themselves undertaken interior maintenance, to the extent of installing fixtures, such as new fireplaces, and in some cases, baths with hot and cold water. In some cases the interior of these older houses, in spite of very defective structure, was quite exceptional. 41 Review of Housing Position in the Borough Towards the end of 1953, the Council reviewed the housing position in the Borough and a joint report was presented by the Town Clerk, the Borough Architect, Engineer and Surveyor, and the Housing Manager. The report contained interesting factual information which it is thought should be recorded:— EXISTING COUNCIL DWELLINGS Dwellings now under the control of the Council are:— Pre-war houses and flats (including 53 rebuilt) 1,613 Post-war houses and flats 1,229 Temporary Bungalows 522* Requisitioned properties 383† Miscellaneous properties 66 3,813 * Originally 535 temporary bungalows were erected. 13 have been demolished in Blackhorse Road and Cornwallis Road for permanent development by Warner Estate Ltd. † This figure is continually being reduced following releases from requisitioning in accordance with the Council's general policy. PRESENT HOUSING PROGRAMME Houses Flats Totals Under construction 31 87 118 Tenders not yet approved by the Ministry of Housing § Local Government — — — Tenders so approved but erection not commenced — 72 72 Tenders to be obtained in 1954 — — 317 31 159 507 42 REHOUSING SINCE 1945 (a) Council Activities: Families rehoused Families rehoused indirectly Families rehoused in New Towns 1945 215 Nil Nil 1946 277 54 Nil 1947 518 133 Nil 1948 220 58 Nil 1949 309 70 2 1950 365 90 6 1951 167 57 48 1952 237 21 153 1953 281 33 165 2,589 516 374 (b) Private Development: Dwellings completed 204 Dwellings under construction 57 Dwellings licensed but not commenced 8 Dwellings approved but not licensed 58 327 War-destroyed houses rebuilt 246 573 Additional dwellings by this means in future will be much more restricted, because of the shortage of housing sites suitable for private development. HOUSING REGISTER The housing register statistics as compiled at the 30th September, 1953 revealed:— 43 Within Outside hardcore of Register hardcore of Register Accommodation No. of Per No. of Per required applications cent. applications cent. 1-bedroom 912 29 1,508 38 2-bedroom 1,289 42 1,732 43 3-bedroom 772 25 732 18 4-bedroom 130 4 53 1 3,103 100% 4,025 100% Summary No. of Per applications cent. 1-bedroom 2,420 34 2-bedroom 3,021 42 3-bedroom 1,504 21 4-bedroom 183 3 Total number of applications 7,128 100% TYPES OF DWELLINGS AND DENSITY On examining the statistics the Committee reached the con' clusion that the basic need was in the region of 3,000 dwellings, the remaining applicants to be dealt with as and when they come within the higher range of the points scheme. Moreover, the Committee felt that new dwellings should, unless and until otherwise decided, be of the one bedroom and two-bedroom type, which gives the maximum flexibility in rehousing, including transfers from under occupied property. It was also agreed that a density figure of 100 persons per acre should be accepted as a general standard. Temporary Housing Sites. The following proposals were made to the Committee on the redevelopment of temporary housing sites:— 44 No. of Site temporary No. of new Net No. of bungalows dwellings dwellings Brookfield Avenue 5 18 13 Prospect Hill, Church Hill 23 82 59 Higham Hill, Oatland Rise 24 71 47 Grosvenor Park Road 18 50 32 Westbury Road 12 42 30 Gaywood Road 8 28 20 Higham Hill 4 12 8 Carlton Road 10 30 20 Farnan Avenue 7 18 11 York Road 5 15 10 Elmfield Road 3 9 6 Hale End Road 15 45 30 134 420 286 After full consideration of the matter extending into 1954, the Council resolved:— "That for five years or unless otherwise decided earlier by the Council, new dwellings to be erected in the Borough or obtained by the conversion of existing properties be of the one-bedroom and two bedroom type not exceeding three storeys in height and that a density figure of a maximum of 100 persons per acre be accepted as a general standard for such property." "That the proposals made to the Committee for the redevelopment of temporary housing sites be approved. "That the proposals made to the Committee for the redevelopment of areas to be cleared of large or obsolescent properties, such areas being lettered A to R in the list now submitted and signed by the Chairman, be approved subject to examination in detail by a Sub'Committee to be appointed 45 General Mr. C. W. Rayner, the Council's Housing Manager, kindly gives the following details of rehousing carried out by his Department in 1953:— No. of new properties made available for letting 190 Normal vacancies 76 Nominations to private landlords 40 Total 306 Families rehoused :— 1-bedroom group 54 2-bedroom group 116 3-bedroom group 114 4-bedroom group 22 Total 306 Of the total number of families rehoused, in 14 instances there was a medical recommendation made in respect of tuberculosis. Rehousing of Medical Cases During 1953, 77 cases claiming priority of rehousing for tuberculosis were investigated and reported upon. Of these, 13 cases were added to the list of cases and classified in order of urgency. The position at the end of 1953 was as follows:— Class 1 Class 2 Class 3 Total On List at end of 1952 2 14 13 29 Added to List during 1953 9 6 — 15 11 20 13 44 Rehoused or removed from List during 1953 7 10 7 24 On List at end of 1953 4 10 6 20 In addition to the tuberculosis cases, 49 cases were recorded as needing special investigation on medical grounds, and 102 on general housing grounds. A total of 269 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, 46 from which the closest co-operation has been received. Duplication of enquiries was thus prevented. Grateful acknowledgement must be made of the co-operation from the Housing Manager in regard to all recommendations made on medical grounds. The Health Department in turn advises on all claims involving a medical aspect. Rent and Mortgage Restriction Acts During the year four 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 582 lettings. Two special enquiries from the Housing Manager were also dealt with, involving 110 lettings. Local Land Charges Enquiries relating to outstanding sanitary notices were dealt with in 1,653 cases. 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 mainly 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. 47 The following table gives details of samples taken:— Grade No. of Samples Results Satisfactory Unsatisfactory (Methylene Blue Test) Pasteurised 114 113 1 Tuberculin Tested (Pasteurised) 25 25 - Sterilised 5 5 - Totals 144 143 1 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 50 Pasteurised 9 Sterilised 119 Sterilised 11 Tuberculin Tested 30 Tuberculin Tested 9 Licences (Plant). Pasteurisers 2 Tuberculin Tested (Dealers) 2 There are no Cow-keepers in the district. The number of Retail Milk Distributors is 143. One hundred and thirty-eight 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. Forty-four applications for Registration were received, and were dealt with as follows:— 48 Vendors, New 24 Vendors, Transfers 20 Refused Number on Register at end of year 297 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 9.3% 7.6% 3.5% 3.0% 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 seventh year. Thirty-five persons had blood specimens taken. No "Carriers" were found during the period under review. Bacteriological Examination of Ice Cream. One hundred and fifteen samples were submitted for examination and for grading in accordance with the provisional test of the Ministry of Health, with the following results:— Grade I = 89 „ II = 23 „ III = 2 „ IV = 1 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. 49 Lollies (Various). Nine samples were submitted to the Public Analysts who reported all free from prohibited dyes and excessive metallic contamination. Sixteen samples were examined for bacterial purity, two of which were unsatisfactory. (c) Meat and Other Foods The Live Stock (Restriction of Slaughtering) Order, 1940, continued in force and no slaughtering was carried out. The following is a summary of food surrendered and condemned as being unfit for human consumption. Where possible, the food was salvaged for animal feeding-stuffs, etc. 1592 tins Evaporated Milk 2 tins Goldenberries 218 „ Full Cream Milk 1 tin Fruit Pie Filling 60 „ Skimmed Milk 1946 tins Marmalade J5 „ Cream 49 „ Jam 3 „ Baby Food 7 „ Mincemeat 102 lbs. Milk Powder 1 jar Peanut Butter 421 tins Peas 1 tin Apple Puree 138 „ Beans 1 jar Sandwich Spread 43 „ Tomatoes 1½ lbs. Cheese Spread 5 „ Rhubarb 6 tins Syrup 3 „ Carrots 11 „ Prune 6? Apple Pudding 2 „ Vegetable Salad 2 „ Pease Pudding 1 tin Beetroot 4 „ Spaghetti 1 „ Celery 4 jars Pickles 7322 tins Greengages 1 bott. Ketchup 1349 „ Plums 1 „ Salad Cream 403 „ Peaches 75 tins Soup 263 „ Fruit Salad 22 „ Irish Stew 171 „ Prunes 1 pkt. Shredded Wheat 168 „ Cherries 1 „ Corn Flakes 88 „ Oranges 1½ lbs. Oats 67 „ Damsons 4 „ Sugar 66 „ Gooseberries 1 lb. Raisins 32 „ Apples 142 Eggs 27 „ Pineapple 9 lbs. Margarine 27 „ Apricots 17 ,, Flour 19 „ Raspberries 128 „ Cheese 18 „ Pears 180 „ Bread 17 „ Strawberries 5f „ Sandwich Cake 15 „ Blackcurrants 2 ctns. Sponge Cakes 12 „ Grapefruit 320 Tea Cakes 9 „ Blackberries 135 Swiss Rolls 5 „ Grapes 2 Meat Pies 50 42 lbs. Confectionery 1 tin Meat Pudding 47 „ Chocolate 1 „ Pork 3 pkts. Chocolate Dessert 1 „ Rabbit 1 bott. Lime Juice 470 lbs. Ham (tinned) 105 tins Sardines 230 „ Jellied Veal (tinned) 60 „ Brislings 55 „ Chopped Pork (tinned) 10 „ Pilchards 82 ,, Corned Beef 10 „ Salmon 1 tin Meat Paste 4 „ Herrings 1 jar Tongue Paste 49 „ Fish Paste 1 ,, Veal & Ham Paste 2 ,, Anchovy Paste 3026 lbs. Beef 43 stone Whiting 604 „ Lamb 16½ „ Skate 500 ,, Ox Cheeks 13 „ Catfish 280 „ Pork 8 „ Roker 141 „ Ox Liver 5 „ Cod 118 „ Sausages 4½ „ Haddock 117 „ Sheep's Heads 3 „ Conger Eel 103 ,, Rabbits 3 „ Dogfish 95 ,, Pigs' Heads 2 „ Roe 79 „ Mutton 1 ,, Cutlets 48 „ Pigs' Heads 2½ ,, Melts 24 „ Ox Tails 240 tins Luncheon Meat 16 ,, Brisket 147 „ Stewed Steak 13½ „ Beef Fat 70 ,, Beef Loaf 12 „ Saveloys 14 ,, Pork & Beef Loaf 9½ „ Ham (cooked) 13 ,, Minced Meat Loaf 7½ ,, Bacon 3 ,, Veal & Ham Loaf 3½ „ Sheep's Pluck 35 „ Sausages 2½ „ Brawn 6 „ Tongue 105 „ Sausage Meat 4 ,, Steak Pudding 52 „ Sausage Rusk 3 ,, Steak & Kidney 15 „ Seasoning 2 „ Braised Liver In addition to the above, a large stock of varied foodstuffs was certified damaged by fire and/or water at a grocer's shop. During the summer months, the Council drew the attention of the Ministry of Food to the large quantity of meat which had been condemned during July and August. In reply, it was stated that the Ministry was concerned about the condemnations of meat and that stringent precautions were taken to ensure that deterioration was kept to a minimum. It was reported that the amount condemned by the Council during these months represented approximately 0.1% of the total meat issued during the period. Following from the attendance of the Vice-Chairman of the Committee and the Chief Sanitary Inspector at the 60th Annual Conference of the Sanitary Inspectors' Association, it was agreed that the Ministry of Food be informed that the Council strongly 51 support the Resolution passed at the Conference regretting the change in the arrangements for the disposal of condemned meat recently introduced by the Ministry. Later, the Town Clerk submitted a letter from the Ministry of Food and giving a general statement as to the views of the Ministry and claiming that all meat condemned for human consumption was stained green by the Ministry before delivery to the Borough. The Ministry claimed that it notified sanitary authorities in whose districts slaughter-houses are situated, and also the names and addresses of the buyers of condemned meat. In view however, of the representations which had been made, it had been decided to amend the Conditions of Sale to require the sterilization of condemned meat. On further consideration, the Council remained of the opinion that the revised Conditions of Sale would not prevent the sale of condemned meat for human consumption and recommended that all such meat should be disposed of to contractors for conversion into technical products. (d) Adulteration, etc.—Food and Drugs Act, 1938. During the year, one hundred and fourteen samples of food and drugs were submitted to the Public Analysts. Ten were reported as being unsatisfactory, details respecting same are given below:— Description of Article Result of Analysis Action Taken Ice Cream Cones (2) Prohibited boric acid used to extent of 0.05% and 0.06% Verbal warning. Pork Luncheon Meat Not palatable Withdrawn from sale. Milk, hot 2.6% fat (minimum 3%) Warning letter sent. Almond and Butter Cracknels (2) 2% butter fat Warning letter sent. Vinegar Contained 3% acetic acid (minimum 4%) Warning letter sent. Vinegar Contained 3.8% acetic acid (minimum 4%) Warning letter sent. Ice Cream (2) Contained 3% and 3.5% fat (minimum 5'%) Summons issued but deferred. The following summary gives details of food sampled and results of analyses:— 52  No. examined No. unsatisfactory Formal Informal Total Formal Informal Total Milk 19 1 20 1 - 1 Almonds, Ground — 2 2 — - — Apple Vinegar 1 — 1 - - — Cake Mixture 1 — 1 - - — Coconut, desiccated 1 — 1 — - — Cream buns — 2 2 - - — Cream, synthetic — 1 1 - - — Ice cream cones — 2 2 - 2 2 Meat Pie 1 — 1 — — — Meat Pudding — 1 1 - — — Milk Chocolate Turkish Delight 1 - 1 - - - Peel, Candied 1 1 - — — Pork Luncheon Meat — 1 1 - 1 1 Sandwich Spread, cream filled 1 - 1 - - - Sausages, Liver — 1 1 — — — Soup, Beef and Liver — 1 1 — — — Suet, Shredded 1 - 1 — — — Castor Oil — 1 1 — — — Cough Balsam — 1 1 — — — Liver and Stomach Herbs — 1 1 - — — Almond and Butter Cracknels 1 1 1 1 2 Cheese Spread — 1 1 — — — Chocolate Coconut Square 1 — 1 — — — Chocolate Wafer — 1 1 - — — Clear Gums — 1 1 — — — Coconut Meringue — 1 1 — — — Coffee and Chicory 1 — 1 — — Cream Powder — 1 1 - — Dripping — 1 1 — — — Pepper — 1 1 — — — Steak and Kidney Pie — 1 1 - — — Stewed Steak 1 — 1 - — — Tapioca Flakes 1 1 - — — Tea Cake Mixture 1 — 1 — — — Vinegar 5 — 5 2 — 2 Gin 3 — 3 — — — Whisky 11 — 11 — — — Catarrh Syrup — 1 1 — — — Sulphur Tablets — 1 1 — — Cake Flour — — — — Cream Soda — 1 1 — — — Fish Paste — 1 1 — — - Jam, Blackcurrant — 1 1 — — — Mate Tea 1 — 1 — - Orange Squash — 1 1 — - — Sauce — 1 1 — - - 53  No. examined No. unsatisfactory Formal Informal Total Formal Informal Total Sausage Meat, Unclassified 1 - 1 - - - Beer 1 - 1 - - - Sherry 1 — 1 — — — Wine - 1 1 — — - Fuller's Earth Cream - 1 1 — — - Saccharin Tablets - 1 1 - - - Almond Flavouring - 1 1 - - - Condiment, non-brewed - 1 1 — - — Ice Cream 1 2 3 1 1 2 Ice Cream Mix - 1 1 - — — Water Ice - 1 1 - — — Lollies Various - 9 9 - - — Peaches in Syrup - 2 2 - - — Pineapple Fruit - 1 1 - - — Raisin-flavoured Wine — 1 1 - - — 57 57 114 5 5 10 (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.I. (f) Clean Food Campaign. Most of the food traders in the area have now attained a reasonable standard in respect of their premises. It was necessary to serve statutory notices under the Food and Drugs Act in one or two cases, requiring extensive works to be carried out. In one case the works required to be carried out were so extensive that the proprietor decided to give up his business, and the premises are no longer used for food preparation. In another case the proprietor decided to rebuild his premises entirely. This has now been carried out. The conditions laid down in the Council's Clean Food ByeLaws are now being maintained throughout the district. Lectures in respect of clean food continue to be given to various local organisations. The following numbers of food premises are now established in the Borough:— Butchers, 84; Bakehouses, 36; Fishmongers, 42; Cafes and Caterers, 121; Grocers, 269; Dairies and Milksellers, 143; Ice Cream Manufacturers and Vendors, 297. 54 The following premises were registered under Section 14 of the Food and Drugs Act, 1938:— 58 Forest Road 149 Hoe Street 13 Wingfield Road. There are two dairy premises in the area registered under the Milk and Dairies Regulations, 1949. The following inspections were carried out in respect of food premises:— Butchers, 389; Bakehouses, 133; Fishmongers, 190; Cafes and Caterers, 438; Grocers, 711; Ice Cream turers and Vendors, 344; Dairies and Milksellers, 138. Condemned food is destroyed at the Council's Depot at Low Hall Farm. The only exception to this is where sufficient meat is condemned and is worth salvaging, it is disposed of through reliable sources, being used mainly for soap manufacture. In certain cases condemned meat was returned, on request, to the Ministry of Food. The new wall sheet provided by the Ministry of Health was issued to eight large factory canteens and to ten school kitchens. In February, on the instruction of the Council, a letter was sent by the Chief Sanitary Inspector to all general stores and grocers suggesting that wrapped loaves only be sold. Misuse of Milk Bottles Arising out of a complaint received by a member of the Council from a shopkeeper to the effect that he had been asked by his customers to sell paraffin in milk bottles, the Health Committee considered the whole question and were informed that such misuse constituted an offence in connection with which a commercial firm which represented the trade were always willing to co-operate in any prosecution instituted by the Ministry of Food. Authority was given for offences to be reported to the Ministry of Food and for the Chairman to make a public statement at the next ordinary meeting of the Council. (g) Food Poisoning Outbreaks. Twenty-two notifications were received and investigated. Further particulars are to be found on page 64. 55 DISEASES OF ANIMALS ACTS Swine Fever (Infected Areas) Order, 1953.—Eleven movement licences dealt with involving 59 pigs. Fowl Pest Order, 1936. (a) Notification received of an "Infected Place" in a garden of a house. Nine pullets killed, and poultry batteries and pens disinfected by an Inspector of the Ministry of Agriculture and Fisheries. Pullet carcases disposed of by incineration at the Refuse Destructor. (b) Order issued by the Ministry of Agriculture and Fisheries restricting movement of chickens brought to a house from an infected area. The Order was observed until the expiry date of that Order. The following Orders were dealt with as necessary:— Parrots and Miscellaneous Birds (Prohibition of Importation) Order, 1953. Live Poultry (Restrictions) Order, 1952 (reminder to dealers). 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:— 56  Type of Property Local Authority Dwelling Houses Agri' cultural All other (including Business Premises) TOTAL 1. Total No. of Properties in Local Authority's District 16 33,371 5 3,405 36,797 II. No of Properties inspected by the Local Authority during 1953 as result of: (a) Notification 2 350 - 76 428 (b) Survey 12 117 - 3 132 (c) A visit primarily for some other purpose - 50 - - 50 III. No. of Properties inspected (see Section II) which were found to be infested by rats : (a) Major 2 5 - 5 12 (b) Minor 1 438 - 34 473 IV. No. of Properties inspected (see Section II) which were found to be seriously infested by mice - 74 - 38 62 V. No. of Infested Properties (see Sections III and IV) treated by the Local Authority 3 467 - 77 547 VI. No. of Notices served under Section IV: (1) Treatment (2) Structural Works (i.e., Proofing) - 30 (Verbal) — 1 (Verbal) 31 (Verbal) 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 15 57 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. (1) Number of No. on Register (2) Inspections. (3) Written Notices. (4) Occupiers Prosecuted. (5) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 81 140 1 - Factories not included above in which Section 7 is enforced by the Local Authority 482 711 43 - Other premises in which Section 7 is enforced by the Local Authority 36 69 2 - Totals 599 920 46 - 2.—DEFECTS FOUND IN FACTORIES, ETC. Particulars. Number of Defects. Number of cases in which prosecutions were instituted Found. Remedied. Referred to H.M. Inspector. Referred By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness 74 78 — — — Overcrowding — — — — — Unreasonable temperature 1 1 — — — Inadequate ventilation 10 12 1 — — Ineffective drainage of floors 6 3 — — — Sanitary Conveniences insufficient 6 4 — 2 — unsuitable or defective 122 122 — 11 — not separate for sexes 3 2 — 1 — Other offences 52 47 — — — Totals 274 269 1 14 — 58 NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1953 Wearing apparel, making of 402 Curtains and furniture hangings 2 Furniture and upholstery 3 Brass and brass articles 6 Iron and steel cables and chains 1 Artificial flowers 4 Total Paper bags 35 Boxes 17 Brush making 8 Stuffed toys 7 Cosaques, Christmas crackers, Christmas stockings, etc 5 Lampshades 1 491 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. The total of notified cases was only slightly less in 1953 than in 1952. Once again there was no confirmed case of diphtheria; scarlet fever and measles were fewer, but cases of pneumonia, puerperal pyrexia, whooping cough and dysentery were higher. 59 Notifications of tuberculosis, poliomyelitis, food poisoning and erysipelas werevery similar to those in 1952. All ages. Under 1 yr. 1-5 yrs. 5-15 yrs. 5-25 yrs. 25-45 yrs. 45-65 yrs. 65 & over. 1953 1952 Scarlet Fever 289 418 1 64 217 2 5 - - Whooping Cough 692 189 43 286 352 1 7 3 — Measles 974 1572 28 517 413 9 6 1 — Diphtheria — — — — — — — — — Pneumonia 121 100 — 12 15 11 24 30 29 Meningococcal Infection 3 2 1 1 1 — — — — Acute Poliomyelitis: Paralytic 6 8 — 3 1 1 1 — — Non-Paralytic 2 2 — — 1 — 1 — — Acute Infect. Encephalitis - - - - - - - - - Post Infect. Encephalitis 1 — — — 1 — — — — Dysentery 84 9 5 25 37 4 10 3 — Ophthalmia Neonatorum 1 2 1 — — — — — — Puerperal Pyrexia 82 73 — — — 34 47 1 — Smallpox — — — — — — — — — Paratyphoid Fevers 1 2 — — 1 — — — — Typhoid Fever — 1 — — — — — — — Food Poisoning 22 22 2 2 5 3 5 5 — Erysipelas 27 32 — — 1 3 7 8 8 Malaria 2 — — — - 1 1 — — Tuberculosis 117 115 — 6 8 27 49 22 5 Totals, 1953 2424 — 81 916 1053 96 163 73 42 Totals, 1952 — 2547 69 844 1310 76 142 67 39 St. James Street. High treet. Hoe Street. Wood Street. Hale End. Higham Hill. Totals. Scarlet Fever 52 35 59 23 62 58 289 Whooping Cough 125 28 83 80 186 190 692 Measles 81 88 114 148 210 333 974 Diphtheria - — — — — — - Pneumonia 27 9 16 21 22 26 121 Meningococcal Infection 1 - - - 2 — 3 Acute Poliomyelitis: Paralytic 1 - 1 1 2 1 6 Non-Paralytic - - - 1 1 — 2 Acute Infect. Encephalitis - — — — — — — Post Infect, Encephalitis - - 1 - - - 1 Dysentery 20 12 5 3 13 31 84 Ophthalmia Neonatorum - - - - 1 - 1 Puerperal Pyrexia 4 7 9 35 11 16 82 Smallpox - - - - - - - Paratyphoid Fevers - - - 1 - - 1 Typhoid Fever - - - - - - - Food Poisoning — 4 2 3 5 8 22 Erysipelas 7 — 6 1 6 7 27 Malaria - - - - - 2 2 Tuberculosis 16 14 18 18 25 26 117 Totals, 1953 334 197 314 335 546 698 2,424 Totals, 1952 299 260 319 325 755 589 2,547 60 The Registrar-General gives the statistics for the 52 weeks ended 31st December, 1953, 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 289 — 1 121 82 27 Case rate:— England and Wales 1.39 0.01 0.01 0.84 Not available 0.14 Walthamstow 2.42 —- 0.00 1.01 0.69 0.23 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 54.96 England and Wales 18.23 DIPHTHERIA Thirteen cases were removed to hospital for observation, but none was confirmed as diphtheria. Most of the cases were considered to be "tonsillitis" but two were cases of glandular fever and one each of Vincent's angina and malaria. There has been no death from diphtheria in the Borough for seven 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. "GASTRIC" INFLUENZA OR EPIDEMIC NAUSEA AND VOMITING During 1953, one "outbreak" was reported in January at a Girls’ High School. It was found to have extended back into 1952 and approximately four staff and nineteen children had been affected in 1952. During January approxiamtely six other staff and twenty other children were affected, but few, if any of these, had obtained medical advice. Later two members of the staff and three pupils were reported to be suffering from jaundice. In mid-November, 18 children were reported to be away from 61 a Junior Mixed School, most of them suffering from sickness. All the affected children had partaken of a school meal and the usual samples were submitted for examination. Three of the adult helpers had taken the first course only and were unaffected, and another had both courses and was sick during the night. Investigations were carried out at the central kitchen with completely negative results. All the children were soon back at school and during the subsequent week there were four further cases and during the next week another three cases. All the pathological specimens taken were negative and the "outbreak" was regarded more in the nature of winter vomiting than of food infection. MENINGOCOCCAL INFECTION Three cases were notified, the particulars being as follows:— Sex Age Ward Hospital Remarks 1. M. 1.2/12 yrs. Hale End Yes Recovered 2. F. 9 yrs. Hale End No Died, P.M. 3. F. 5/12 yrs. St. James St. Yes Recovered MALARIA Two cases were notified during the year. Both were ex'Servicemen who had suffered from previous attacks. ACUTE ANTERIOR POLIOMYELITIS AND POLIOENCEPHALITIS Nineteen cases were notified during 1953, but of these only eight were confirmed. Three were young adults aged 24, 26 and 27 years, and five were children, three being under 5 years of age and two being aged 5 and 7 years. The first five cases were of bulbar paralysis, one aged 27 years being fatal. Two were paralytic and one non-paralytic. All Wards except High Street Ward were affected and a few of the cases occurred in the Wood Street and Hale End Wards. There was no apparent contact infection. The first case occurred in February, then three bulbar cases followed at the end of July and two more at the beginning of August, i.e., a total of five bulbar cases in nineteen days. 62 Particulars are shown in the following table. No. Age Sex Ward Date of onset Date notified Date of removal to hospital Site of Paralysis Final Follw-up Report 1 M. 24 yrs. Hoe Street 31.1.53 6.2.53 3.2.53 *18.2.53 Bulbar Restricted movement, right arm and shoulder. 2 M. 5 yrs. Higham Hill 16.7.53 20.7.53 20.7.53 Bulbar Very slight paralysis left side of face. 3 M. 4½ yrs. Wood Street 22.7.53 26.7.53 26.7.53 Bulbar Very slight paresis. ? Double Vision. 4 F. 3 yrs. St. James Street 23.7.53 25.7.53 25.7.53 Bulbar Appears normal. 5 M. 27 yrs. Hale End 3.8.53 6.8.53 6.8.53 Bulbar Died 8.8.53. 6 F. 26 yrs. Wood Street 4.8.53 8.8.53 8.8.53 Non-paralytic Non-paralytic. 7 M. 7 yrs. Hale End 18.8.53 24.8.53 24.8.53 Legs and thighs Non-paralytic. 8 M. 4½ yrs. Hale End 18.9.53 21.9.53 21.9.53 ? Legs Still in hospital. Awaiting calipers and will then be taught to walk. *Date transferred to an Infectious Diseases Hospital. Final assessments of aftereffects are as follows:— Adults.—One died, one has restricted movement and one no paralysis. Children.—One severe paralysis, two slight paralysis and two no paralysis. 63 POST INFECTIVE ENCEPHALITIS One male aged five years was notified following whooping cough. BACILLARY DYSENTERY (SONNE) A total of 84 cases of bacillary dysentery were notified, as compared with 9 in the previous year. Seventeen were over school age, 34 of school age and 33 under school age. Of the cases at school, there were five in one department, three in each of three departments, two in each of four departments and one in each of twelve departments, i.e., a total of twenty ments. In view of the infectivity of bacillary dysentery, the very limited spread is a matter for congratulation. Of the thirty-three under school age, twenty-seven occurred at Higham Hill Day Nursery, where the usual routine measures were taken on suspicion of the first case and where the chemo-therapy found successful in previous years was reintroduced. OPHTHALMIA NEONATORUM One case was notified and vision was unimpaired. SMALLPOX No notification was received. Six suspect cases were seen— one as a contact from a ship from which a member of the crew had died of smallpox at an African port. The other five were consultations in regard to severe or doubtful cases of chickenpox. ENTERIC FEVER (a) Typhoid Fever. One male, aged 42 years, was removed to hospital for observation, but diagnosis was not confirmed. (b) Para-typhoid. One female, aged 11 years, was admitted to hospital and confirmed as paratyphoid 'B' type B.A.O.R. Public Health (Infectious Diseases) Regulations, 1927 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 73 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 continues to be paid. 64 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 1953 2. Food Poisoning Notifications (Corrected) Returned to R.G. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 5 7 4 6 22 3. Outbreaks Due to Identified Agents. Total Outbreaks: — Total Cases: — 4. Outbreaks of Undiscovered Cause. Total Outbreaks:— Total Cases:— 5. Single Cases. Agent Identified Unknown Causes Total Salmonella TyphiMurium 7 13 22 Salmonella 2 An outbreak of 17 cases of suspected food poisoning due to staphylococcal infection was reported from a hospital, but as no notifications were received, the numbers were not included in the figures sent to the Registrar General. 65 TUBERCULOSIS The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1953:— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year — — — - — - — — 1-5 years 2 2 2 - - - - - 5-10 „ 1 - 3 3 — - — — 10-15 „ — 1 - - - - - - 15-20 „ 6 8 - - - - - - 20-25 „ 7 5 — 1 — - — — 25-35 „ 16 11 2 1 2 1 — — 35-45 „ 9 10 — — 3 - — — 45-55 „ 10 1 — 2 5 1 — — 55-65 „ 6 3 — - 5 1 — - 65 and over 4 1 — — 4 - — — Totals 61 42 7 7 19 3 — — 103 14 22 - 117 22 As each new case of pulmonary tuberculosis has been notified, enquiry has been made as to the infectivity of the patient. Of 103 cases investigated, 47 were sputum positive on notification or soon after. 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. 1953 61 42 7 7 117 19 3 — - 22 1952 53 47 5 10 115 16 6 - - 22 The period elapsing between notification and death and the number of cases not notified were as follows:— Under 3 months. 3 to 6 months. 6 to 9 months. 9 to 12 months. Over 12 months. Not notified. Notified after death. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. 2 - 1 — 1 — — — 14 — 3 - 1 — 66 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. 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 Percentage of nonnotified to total T.B. s Pulmonary NonPulmonary Total 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 1953 22 4 — 4 18.2 Four deaths registered in 1953 from tuberculosis had not previously been notified and details are given below Case (1)—Male aged 38 years, admitted to hospital June, 1952, when tuberculosis was diagnosed and the patient transferred to another hospital, where he died on the 14th April, 1953 from pulmonary tuberculosis and carcinoma of the stomach. Case (2)—Male aged 51 years, admitted to hospital on 15th April, 1953, died 26th April. Had suffered from chronic bronchitis for 10 years and had been off work and bedridden for 5 months before death. Cause of the death was considered to be primarily carcinoma of the Bronchus, and tuberculous broncho pneumonia was only found at post mortem 67 Case (3)—Male aged 30 years, admitted to hospital 13th September, 1953, died 23rd September, 1953. Apparently notified in another district, but notification not transferred on change of residence. Case (4)—Male aged 73 years, admitted to hospital on 8th December, 1953, and died on 15th December, 1953, from advanced lung disease. At post mortem, carcinoma of the bronchus was found to be the immediate cause of death. Unfortunately, the transfer of notifications between sanitary districts on change of domicile leaves much to be desired. 68 TUBERCULOSIS—NOTIFICATION AND DEATH RATES The following graph shows the trend of notifications of tuberculosis since 1930, and of deaths from tuberculosis. The fall in the latter results in the survival (and increased longevity due to new methods of treatment) of many infective patients, i.e., an increase in the infecting pool. Notifications of tuberculosis (all forms) in persons of all ages are shown in black, and deaths from tuberculosis (all forms) in persons of all ages are shown in red. 69 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 Sanitary Authority, and as the Excepted District for Education, and by the Health Area Subcommittee 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 priority, the criterion being the infectivity of the patient, overcrowding on the standard of the Housing Act, 1936, and the presence in the same dwelling of young children or adolescents. During 1953 the number of families rehoused was 306, which included 14 families where there was a medical recommendation in respect of tuberculosis, i.e., say 5 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 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. Towards the end of the year, the Committee for Education approved a scheme of 'jelly' testing school entrants as a method of case finding. At the Chest Clinic, 48 direct contacts were vaccinated with B.C.G. during 1953. 70 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 aftercare. These services are more fully referred to in the later section of the Report. 5. Mass Radiography. The Mass Radiography Unit re-visited Walthamstow in 1952 and 1953. In 1952, the premises of one industrial firm were visited and a total of 426 persons were examined, one active post'primary case being discovered, together with two inactive primaries and six inactive post-primary cases. One case of lung cancer and one heart condition were also discovered. The 1953 examinations covered visits to the Old Monoux School Yard, where the main hall of the Youth Employment Centre became available through the co-operation of the Walthamstow Committee for Education. Organised groups of school staff and children were seen over a period of several weeks, and certain public sessions were also held. The findings in the school group are more fully referred to in the Report of the Borough School Medical Officer. In addition, examination centres were set up at the South-West Essex Technical College, and at seven industrial premises. The total of examinations was 15,383 as compared with 11,153 at the previous visit in 1950. Included in these totals are 3,743 in the school group, as compared with 4,414 in the same group in 1950. The detailed findings in regard to adult examinations were not available at the time of writing. Care and After-Care. This matter is dealt with under Section "G" of the Report. THE PUBLIC HEALTH (INFECTIOUS DISEASES) REGULATIONS, 1953. These Regulations became effective on the 1st April, 1953, and supersede the Regulations for 1927. Ministry of Health Circular 6/53 explains the purpose of the new Regulations in the following terms:— "In their general substance and form the new regulations are similar to the old; that is to say, they require notification of malaria, dysentery, acute primary pneumonia and acute influenzal pneumonia, and provide for preventive steps to be taken against the spread of certain diseases specified in the Fourth Schedule to the regulations. This schedule has now 71 been framed, however, as compared with the First Schedule of the 1927 regulations, to accord with the present shape and working of the health services; and, in Part III, it differs from the corresponding part of the earlier regulations in some important respects concerning prevention of food poisoning. In making these changes referred to below, the Minister has taken into consideration the Report of the Catering Trade Working Party on Hygiene in Catering Establishments, as well as suggestions made by Medical Officers of Health. "The provisions about action to be taken by local authorities and Medical Officers of Health against the risk of food poisoning applied under the old regulations to" enteric fever and dysentery." They now apply to "typhoid fever, paratyphoid fever or other salmonella infections, dysentery, and staphylococcal infection likely to cause food poisoning." (The phrase "typhoid fever, paratyphoid fever or other salmonella infections" comprises the diseases previously described as "enteric fever"). Under the 1927 regulations the steps prescribed could only be taken in relation to a person suffereing from the disease in question, and for the purpose of preventing such a person from continuing to work in an occupation connected with the preparation and handling of food or drink. The new regulations go further. They provide for action to be taker not only as regards a person suffering from the disease in question, but also a person shown to be a carrier of the disease; and a person in either class may now be prevented not only from continuing to work in an occupation connected with food or drink but also from entering such an occupation. Under the 1927 regulations, again, the prescribed steps concerned could not be taken until the Medical Officer of Health had reported the case concerned to the local authority. In the new regulations, while the same general prinicple is maintained (because action may involve the local authority in paying compensation under Section 278(1) of the Public Health Act, 1936), there is provision to enable a local authority to give its Medical Officer of Health such authorisation as will permit him to take the prescribed action in a particular case without waiting to report it—though he is required to report it at the earliest opportunity -if in his judgment this action needs to be taken as a matter of immediate urgency to prevent the spread of infection. "Regulation 4 requires the local authority to send a copy of the regulations to all medical practitioners practising in their district." After consideration by the Council, the Medical Officer of Health was authorised to issue any notice on behalf of the Council 72 under Parts II and III of the Fourth Schedule to the Public Health (Infectious Diseases) Regulations 1953, in relation to any particular case if in his judgment it is immediately and urgently necessary for him to do so for the purpose of preventing the spread of infection. MORBIDITY The arrangement under which a statement of new claims to Sickness Benefit is received weekly from the Ministry of National Insurance has provided an interesting measure of morbidity. During 1952 and 1953, the weekly averages of new claims were as follows : 1952 1953 January 464 747 February 433 832 March 390 401 April 350 300 May 270 232 June 214 236 July 200 197 August 205 201 September 262 257 October 369 370 November 311 360 December 426 291 The closeness of the averages for the period June to October will be noted. The "Smog" which involved the Borough, in common with London generally, between December 5th and 8th, 1952, did not produce an increase in claims until the week ending 16th December, when 682 claims were received, as compared with 401 on each of the two weeks preceding. During the next two weeks, claims fell to 374 and 271 respectively. In 1953, new claims were exceptionally heavy in January and February, the weekly number being 681, 573, 728, 1,005, 1,202, 880, 684 and 561 over the eight-week period. For the rest of the year the pattern was very similar to that of 1952. No deaths were reported from Influenza in Walthamstow in November and December, 1952, but there was one in January and five during the first 3 weeks in February, 1953, i.e., during the period of increased sickness. 73 The Home Nursing and Domestic Help Service of the County Council were only maintained with difficulty because of sickness amongst Home Nurses and Domestic Helps. Considerable and welcome help has been available from the Local Organisation of the St. John Ambulance Brigade. G.—MISCELLANEOUS 1. Old People's Welfare. (a) General. The Town Clerk, as Honorary Secretary of the Old People's Welfare Committee, states that 15,227 meals were provided during 1953. The monthly totals varied between a mini' mum of 1,090 in February to a maximum of 1,423 in July. Five rounds are in operation on Monday, Wednesday and Friday. There were 45 voluntary helpers at the end of the year, but more were required. An increasing amount of time of the medical, health visiting, home nursing and domestic help services and of the sanitary inspectorate was 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 week-end help. (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 and other items 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. The following items were supplied : Mattresses 12; Pillow cases 6; Blankets 3; Bedsteads 3; Shoes 2 pairs; Chair 1 and Dressing Gown 1. Towards the end of the year it was agreed to commence a pilot scheme for laundering bed linen and nightwear of patients suffering from incontinence. This was commenced during 1954. (b) Public Conference. In March, the Walthamstow Old People s Welfare Committee convened a public conference on 74 "Problems and Progress of Old People's Welfare" at the Town Hall. The Town Clerk, as Honorary Secretary to the Committee, included the following in the notice issued before the Conference: "The Committee is a voluntary one, constituted in 1947 of representatives of organisations and statutory bodies and has thus been able to review all aspects of welfare work for old people in the past few years. It is anxious to make known the services the Committee provide, such as meals on wheels and old people's clubs and to discuss with organisations and persons interested, the problems which still confront the Committee and other agencies concerned with old people's welfarenow a matter of major national importance." A leaflet prepared by the Town Clerk was issued at the Conference, stating the problem for consideration (vide the table included on page 60 of the Report of the Medical Officer of Health, 1952) and describing the various agencies, official and voluntary, their duties and their services in regard to old people's welfare. The services provided by the Borough Council were referred to in the following terms:— "Responsible as the housing authority for providing housing accommodation for all classes of the community (including old people). "In the Council's pre-war housing estates are 40 one-bedroom flats specifically designed for letting to elderly couples. The post-war housing programme has so far included 14 onebedroom flats at the Priory Court and 20 flats at McEntee Avenue. Of the other 58 one-bedroom flats erected, the majority have been let to old people, particularly if they could give the Council vacant possession of a three or four bedroom house in exchange. "In addition the Council have provided accommodation for 44 old people in 5 hostels owned or controlled by them. "As the sanitary authority for the cleansing of persons and premises and for the removal to hospital or other suitable premises (after court proceedings) of old people in need of care and attention because of age, infirmity, physical incapacity or insanitary conditions. "This is a useful but distasteful power which has been used in 3 cases only in the past 3 years. "As the library authority for providing a mobile library service for old people. "As a local authority for exercising the permissive power given by the National Assistance Act, 1948, to make 75 tions to the funds of any voluntary organisation whose activi' ties consist in or include the provision of recreation of meals for old people. "The average contribution by the Walthamstow Borough Council to the funds of the Walthamstow Old People's Welfare Committee in the past six years in cash and kind (cars for meals on wheels, staff, premises, etc.) has been £1,200 per annum. In addition one car has been provided free of charge by a public spirited person on each day meals have been delivered." (c) Publicity. In August, the Old People's Welfare Committee circulated to old people in the Borough, many thousands of a booklet entitled "Questions and Answers on Old People's Welfare." Full information was given in regard to retirement pensions, non-contributory old age pensions, assistance grants, medical attention, sudden illness, home nursing, the supply of medical and surgical appliances, spectacles and dentures, domestic help, institutional care, old people's clubs (of which there are seven in Walthamstow), meals on wheels and a library service for the infirm. Enclosed in the booklet was a prepaid postcard requesting the name and address of the sender, and reading as follows:— Do you want anyone to call ? (Yes or No.) What help can the Committee give you ? Towards the end of the year, it was agreed to assist in the resulting enquiries which were required, by enlisting the aid of the County Council's Health Visitors, and a total of 53 persons were visited. The main requests were for the following services:— Social Visits 18; Meals on Wheels 2; Domestic Help 5; Financial Assistance 8; Legal Advice 2. Appropriate action was taken in each case. (d) Co-operation by Health Visitors. The role of the Health Visitor in regard to old people's welfare is set out below:— (i) Old People in Council Hostels.—Visits are paid on the first Wednesday morning of each month to old people in Council Hostels by the Superintendent Health Visitor and a senior representative of the Housing Department. Any urgent case is dealt with as soon as possible. 76 (ii) Old people occupying Council Flats.—These old people are also visited regularly by the same "team." The particulars are then handed over to the district Health Visitors who pay such visits as are necessary in regard to the provision of home nursing, domestic help, meals on wheels, etc. (iii) Patients ready for discharge from Langthorne Hospital.—An arrangement has been made with the Almoner at Langthorne Hospital that the homes of patients shall be visited by the Health Visitor to ascertain the suitability and readiness of the home for their return and to make any necessary arrangements in addition, e.g., home nursing, domestic help, meals on wheels, etc. Whenever information is received in the Health Department that an old person appears to be in need of help, then one or all of the following, in accordance with the circumstances obtaining, may be asked to visit:— Health Visitor; Sanitary Inspector; Domestic Help Organiser. Instructions have been given that Health Visitors are as far as possible, to get to know of all elderly people on their districts, especially those who apparently need and wish help in any way. 2. Funeral Arrangements. Arrangements were made in regard to the burial of 3 persons. In view of the expiry of the contract for burials under the National Assistance Act 1948, temporary arrangements were continued with the usual firm at a slightly increased fee. A new contract was negotiated on the basis of this fee. 3. Medical Examinations. During the year the medical staff carried out 195 examinations of Borough Council employees in respect of the Superannuation and Sick Pay Schemes. 4. Health Education. Miss H. Rodway, F.R.C.O.G., Obstetrician Superintendent at Thorpe Coombe Maternity Hospital, arranged the usual course of mothercraft lectures. In each case the speaker was a medical or nursing specialist. The programme was as follows:— "Mothercraft Demonstrations" (including Baby bathing, ante-natal treatment of breast, babys layette, gas and air analgesia)." 77 "The Importance of Ante'Natal Care." "Preparation for Childbirth" (demonstrations of exercises and gas and air analgesia). "The Growth of Your Baby from Conception to Birth." "How Your Baby is Born" (demonstration of gas and air analgesia). "Breast Feeding" (demonstration of gas and air analgesia). "Care of Toddler" "After Baby is Born" (demonstration of gas and air analgesia). "Diet in Pregnancy." A lecture on "Wise Parentcraft" was given in September by Dr. Leslie Housden, a well-known speaker on parentcraft. At each lecture there was an attendance of about 50 expectant mothers. 5. Cancer Education. The leaflet of advice printed in the 1951 Report is available for distribution. 6. Diphtheria Immunisation—Publicity Campaign. Following from the receipt of Ministry of Health Circular 8/53 on the subject of local diphtheria immunisation publicity campaigns during 1953, the Council decided that a copy of the Circular be sent to each member of the Council, to the local Press and to the local branches of the British Red Cross Society, St. John Ambulance Brigade and Women's Voluntary Services and that all necessary steps be taken to implement the suggestions of the Ministry of Health. 7. General. The Borough Architect, Engineer and Surveyor contributes the following information:— (a) Rainfall. The annual rainfall at Ferry Lane Station was 17.68 inches. 78 (b) Public Conveniences. There were no new public conveniences erected during 1953, but tenders have been invited for the erection of a convenience in Larks Hall Road and certain existing conveniences have been modernised. During 1953 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. In January, following from a survey of the public conveniences in the Borough, it was reported that four were now reaching a stage where complete or major reconstruction was essential. It was suggested that the position would require the provision of six new conveniences, involving capital expenditure in the region of £25,000. The Council agreed to the proposals on a three year programme, two new conveniences to be constructed in each year, commencing in 1953/54, with new conveniences at St. James Street Car Park and Highams Park Broadway. Authority was also given for plastic plates to be exhibited at public conveniences in regard to free washing facilities. Authority was given in March for the Town Clerk to enter into agreement with the owners of four public houses for the taking over by the Council of the urinals at those premises so that they could remain open during closing hours. (c) Cremation. Facilities for cremation are available at the Crematorium provided by the City of London at Manor Park, Little Ilford. Negotiation continued with adjoining Local Authorities. (d) Mortuary Provision, Inquests, 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. Mortuary and post mortem facilities are now fully adequate. During the year, the number of inquests and post mortems were:— Walthamstow Others Total Inquests only 8 38 46 Post Mortems only 122 245 367 Post Mortems and Inquests 17 30 47 79 SECTION H NATIONAL HEALTH SERVICE ACT, 1946 PART III SERVICES WALTHAMSTOW HEALTH AREA SUB-COMMITTEE (1953/54) Chairman: Alderman The Lady McEntee, J.P. (Executive Council for Essex). Vice-Chairman: Councillor Mrs. S. Candy (Walthamstow Borough Council). Members: Nominated by— Essex County Council Alderman Mrs. M. Ball (Chairman, Health Committee, E.C.C.). „ „ „ Alderman Mrs. B. K. Lowton. „ „ „ Councillor Dr. C. Skinner Chairman, Health Committee, E.C.C.). „ „ „ Councillor Mrs. L. P. Bailey, J.P. „ „ „ Councillor Mrs. A. M. Burrell. „ „ „ Councillor C. W. Clayden. „ „ „ Councillor H. J. E. Palethorpe. Walthamstow Borough Council Alderman W. Gillett. „ „ „ Alderman G. R. Lowton, J.P. „ „ „ Alderman A. E. Manning. „ „ „ Alderman W. H. Shaw. „ „ „ Councillor W. E. Barnes. „ „ „ Councillor Mrs. S. Candy. „ „ „ Councillor A. W. Ellis, M.B.E. „ „ „ Councillor L. Jones. „ „ „ Councillor Mrs. M. E. Marchant. „ „ „ Councillor Mrs. W. M. thorpe. „ „ „ Councillor J. W. Pringle. „ „ „ Councillor E. G. Richards. „ „ „ Councillor G. E. Usher. „ „ „ Councillor A. F. Whicher. „ „ „ Councillor J. M. Wight. 80 Hospital Management Committee Dr. J. Spencer. Executive Council for Essex Alderman The Lady McEntee, J.P. Local Medical Committee for Dr. J. L. McK. Brown, O.B.E. Essex Voluntary Organisations Dr. M. Cohen (Walthamstow District Nursing Charitable Association). „ „ E. P. Marr, Esq. (Walthamstow Child Welfare Society). „ „ Mrs. M. Osora (Invalid dren's Aid Association). „ ,, Mrs. A. Cordell (Walthamstow and Chingford Association of Tuberculosis Care Helpers). STAFF During the year, 34 whole-time members of the Health Area Staff resigned their appointments and 42 new appointments were made. It was found necessary to engage three additional whole-time Domestic Helps and the Establishment of the District Nursing Service was increased by one Senior Nurse at the Branch Home, Handsworth Avenue. The apparent inconsistency between the numbers of resignations and appointments is accounted for by the difference between the number of vacancies at the beginning and end of the year. HEALTH CENTRES (Section 21) HEALTH CENTRE SITES The general position remains as detailed in the previous reports, 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. HEALTH AREA PREMISES Repeated burglaries and acts of vandalism have occurred at welfare centres and day nurseries. 81 GENERAL DENTAL SERVICE The Senior Dental Officer reports as follows:— "This year there has been a proportionate increase in the number of young patients who need rather a long period of treatment time, mainly for conservative work, and older patients needing replacements of dentures. "The staff was slightly increased by an extra session a week undertaken by a School Dental Surgeon appointed at the end of 1952, and despite the continued enforcement of payment for dental treatment, I am glad to note that it has been possible to complete a larger number of operations, especially fillings (2,066 as against 1,591 in 1952). Also the number of dentures has risen from 220 to 280, i.e. an increase of 21%." Herewith is a summary of the work done during the years 1952 and 1953:- 1952 1953 Number of patients treated 731 680 Appointments made 4,872 4,531 kept 4,431 4,150 Plastic fillings 1,591 465 2,066 total Amalgam 1,601 Inlays 10 4 Crowns 33 36 Scalings and gum treatments 317 411 Dressings 685 628 No. of teeth extracted 929 959 General anaesthetics 285 207 Local „ 280 345 X-rays 252 270 Impressions 527 623 Bites 179 163 Try-ins 175 227 Full upper dentures 91 280 total dentures „ lower „ 220 79 Partial upper dentures 72 „ lower ,, 38 DENTAL LABORATORY Herewith is a list of the appliances completed for the General Dental Service: New Dentures 291 Orthodontic Appliances — Crowns 8 Repairs 182 Inlays — 82 During the year the following appliances were completed for the Education Committee:— Orthodontic Appliances 219 Dentures 89 Crowns 20 Inlays 4 Repairs 52 The following appliances were completed for the Regional Hospital Board. This work is now done for patients in the Connaught, Harts and King George Hospitals: Bite splints for correction of temporo-mandibular disorders 15 Gunning splints 2 Dentures 2 The following appliances were completed for the Maternity and Child Welfare Patients:— New Dentures 73 Crowns 1 Inlays 1 Repairs 1 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 1,142 837 Low Hall Lane Clinic 201 80 Silverdale Road Clinic 41 32 District Nurses' Training Home and Midwives' Homes 311 — Totals 1,695 949 83 Total Attendances— Ante-Natal Post-Natal Thorpe Coombe Maternity Hospital 8,968 1,038 Low Hall Lane Clinic 726 85 Silverdale Road Clinic 152 33 District Nurses' Training Home and Midwives' Homes 1,964 25 Totals 11,810 1,181 Blood grouping/Haemoglobin estimation and Rhesus and Kahn tests were carried out for all patients attending Ante-Natal Clinics. All Rhesus negative results were verified at a second laboratory and repeated at the 20th and 34th weeks of pregnancy. Facilities were also available at Thorpe Coombe on Sunday mornings (by courtesy of Miss Rodway, Consultant Obstetrician) for Rhesus tests to be carried out on the husbands of Rhesus negative women, and when they were unable to attend at the ordinary weekday clinic. All Rhesus negative expectant mothers attending ante-natal clinics were and are advised to have their confinements in hospital. Blood pressure estimations were done at every examination, in order to obtain warning of possible toxaemia. Midwives in domiciliary practice were advised that in accordance with the ruling of the Ministry of Health, they could in extreme urgency, and when unable to obtain immediate medical aid, summon the Obstetric Flying Squad direct. Finally, they were reminded that (except in doctors' booked cases) patients with any serious abnormality should be referred to the Consultant Obstetrician at Thorpe Coombe Maternity Hospital. An analysis of haemoglobin estimations done in the first eight months of the year showed that out of 131 patients, no fewer than 14, i.e., over 10% were 65% or less, and obviously required treatment for their anaemia. Instructions were given to midwives that all patients with this degree of anaemia should be referred to their family doctors with a request that they should be sent back for a re-estimation of hæmoglobin after 4/6 weeks. Family doctors undertaking Maternity Medical Services were advised that blood specimens could be taken from their patients either at an ante-natal clinic or a weekly clinic at the Town Hall. 84 VIRUS INFECTIONS DURING PREGNANCY Ministry of Health Enquiry This enquiry extended to all the Ante-Natal Clinics including those at Thorpe Coombe Maternity Hospital. The purpose of the enquiry is to collect information as to a possible relationiship between virus diseases (especially German measles) during pregnancy and congenital defects in the child. CONFINEMENTS The following table shows the location of confinements during 1953:— Thorpe Coombe Maternity Hospital 1,133 Other Hospitals and Maternity Homes 393 Total in Hospital, etc. 1,526 At Home 412 Total Confinements 1,938 A total of 10 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 12.2 15.5 Stillbirth rate per 1,000 population 0.32 0.35 Infant mortality rate per 1,000 live- births 28.2 26.8 Extracts from vital statistics are given more fully in Section "A" of this Report. NOTIFICATION OF BIRTHS 1,966 births (385 of which belonged to other areas) were notified during the year under the Public Health Act, 1936. Notifications were received as follows: Doctors, 307; midwives, 1,637; others, 22. 85 Included in the above are 364 births which were notified as having occurred outside the Borough. Also included are 48 stillbirths, 9 of which belonged to other areas. Of the total, 9 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 1953, 27 infants died in the first four weeks of life, a rate of 18.6. INFANT MORTALITY The deaths of infants under one year were:— Males. Females. Totals. Legitimate 25 15 40 Illegitimate — 1 1 Totals 25 16 41 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, 27.5; Illegitimate, 0.7; Total 28.2. The Infant Mortality Rates for other areas during 1953 were as follows: England and Wales 26.8 160 County Boroughs and Great Towns (including London) 30.8 160 Smaller Towns (25,000—50,000 population) 24.3 London Administrative County 24.8 Of the 41 deaths of children under one year of age, 5 took place at home. In three of these, broncho-pneumonia was the primary cause of death, the children varying in age from 3 to 10 months. Home care was adequate in two cases, but in the third, the 86 mother had not attended the welfare centre and had previously received the attention of the N.S.P.C.C. Inspector. The other two cases were aged one and ten months respectively : the younger died as a result of a very precipitate labour in rather unusual surroundings ; the elder weighing 4 lbs. 8 ozs., died of prematurity and atelectasis. The deaths of all infants dying under one year of age are classified in the accompanying table, according to cause and age. Of the forty-one, 29 are regarded as unavoidable, and 12 preventable—the cause of death being pneumonia in 9 and one each from meningitis, diarrhoea and injury at birth. In the last two months of the year, there was some evidence of a virus pneumonia which did not respond to antibiotic treatment. 87 CAUSES OF DEATH OF CHILDREN UNDER 1 YEAR OF AGE—1953 Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total deaths under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under 1 year. St. James St. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Total. Influenza - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - Phthisis - - - - - - - - - - - - - - - - - Other forms of T.B. - - - - - - - - - - - - - - - - - T.B. Meningitis - - - - - - - - - - - - - - - - - Meningitis (Non-T.B.) — - — — — - — 1 — 1 — - — — 1 — 1 Convulsions - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - - - - - Pneumonia - - — 1 2 - 3 3 1 9 4 - — 2 1 2 9 Diarrhoea, - - — — - - — 1 — 1 1 - - - - - 1 Syphilis - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - Inattention at birth, wilful neglect - - - - - - - - - - - - - - - - - Suffocation (overlaying) - - - - - - - - - - - - - - - - - Injury at birth 1 -- - - 1 - - - - 1 - - 1 - - - 1 Atelectasis 8 1 — — 9 - — — — 9 2 - 3 1 2 1 9 Congenital malformation 1 1 1 1 4 1 — — 4 9 — - 1 3 2 3 9 Premature birth 6 - 1 — 7 - — — — 7 1 - 2 — — 4 7 Atrophy, debility, marasmus - - - - - - - - - - - - - - - - - Inanition - - - - - - - - - - - - - - - - - Heart failure - - - - - - - - - - - - - - - - - Other causes 3 1 - - 4 - - - - 4 - - 1 — 2 1 4 Totals 20 3 2 2 27 1 3 5 5 41 8 — 8 6 8 11 41 88 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 1953, 89 live premature infants were born to residents of the Borough, 17 at home and 72 in hospitals and nursing homes. Of the 17 born at home, five were transferred to hospital. The remaining 12 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. 89 STILLBIRTHS, PREMATURE BIRTHS 6? NEO-NATAL DEATHS (England and Wales and Walthamstow) The table shows a comparison of the rates for England and Wales, and Walthamstow, back to 1945. Year STILLBIRTHS (per 1,000 total births) PREMATURE BIRTHS (i.e., birthweight 5½ lbs. or under). NEO-NATAL DEATHS (per 1,000 live births) Per 100 live births Percentage of Premature Confinements occurring at:— Institutions Home Institutions Home Eng. & W. Wal'stow. Eng. & W. Wal'stow. Eng. & W. Eng. & W. Wal'stow. Wal'stow. Eng. & W. Wal'stow. 1945 28.0 31.6 4.5 5.9 63.2 36.8 87.1 12.9 24.8 21.0 1946 27.2 26.7 5.14 3.7 62.0 38.0 71.3 28.7 24.5 19.2 1947 24.1 21.6 5.0 3.9 62.0 38.0 76.6 23.4 22.7 13.1 1948 23.2 21.7 N.A. 3.4 N.A. N.A. 74.6 25.4 19.7 11.1 1949 22.7 14.5 5.6 4.3 65.0 35.0 79.7 20.3 19.3 16.9 1950 22.6 22.6 6.2 4.2 70 30 71.4 28.6 18.5 20.6 1951 23.0 22.7 6.0 5.2 71 29 69.4 30.6 18.8 14.0 1952 22.7 18.8 6.2 4.4 72 28 79.1 20.9 1.8.3 15.2 1953 22.4 25.5 N.A 6.1 N.A. N.A. 80.9 19.1 N.A. 18.6 N.A. = Not Available. NOTE :—The national figures for the proportion of births in the earlier years should be treated with reserve, since notification of birth weights of premature infants did not approach completeness for some years after it was introduced in 1944. 90 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 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 Nil 25.6 Nil 1953 1,404 50 40 1 28.5 20.0 Totals 1949 to 1953 (5 yrs.) 7,743 294 203 8 26.2 27.2 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. Miss E. Williams, the Superintendent, reports as follows - "Mothers of all religious denominations are cared for and the work done during 1953 is summarised below Admitted Adults Babies Total From Walthamstow 12 7 19 From rest of County 37 27 64 From outside the County 19 16 35 Totals 68 50 118 Outdoor work— Walthamstow Cases (Mother and baby placed) 50 18 68 Other Essex Cases 9 9 "Apart from a small outbreak of influenza, the health of the mothers and babies has been good. "Because so many of the mothers were young, the average stay in the Home was longer. "We do not have so many Shelter cases now, hence our number of residents is lower." Summary of Attendances at Welfare Clinics Clinic. First Attendances of New Cases. Re-attendances. Grand T otal. Under 1 yr. of age. 1-5 yrs. of age. Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Markhouse Road 361 64 425 5,740 4,678 10,418 10,843 Penrhyn Avenue 307 19 326 4,064 3,535 7,599 7,925 West Avenue 171 35 206 2,223 1,413 3,636 3,842 Winchester Road 142 31 173 2,749 2,533 5,282 5,455 Silverdale Road 88 23 111 1,159 1,450 2,609 2,720 Totals 1953.. 1,069 172 1,241 15,935 13,609 29,544 30,785 Repeated instances of burglaries and hooliganism have occurred at Welfare Centres, especially at Silverdale Road. 91 MATERNITY AND CHILD WELFARE CLINICS (a) Ante and Post Natal: Monday (once monthly) 1 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, clinics are held at the District Nurses' Homes, and a large proportion of the antenatal work of the Borough 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, iHighams Park. Tuesday „ The Welfare Centre, West Avenue, E.17. Wednesday „ Low Hall Lane, Markhouse Road, E.17. Wednesday „ Silverdale Road, Highams Park, E.4. 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. 92 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:— Year First Attendances of New Ca&es. Re-attendances. Grand Total. Under 1 yr. 1-5 yrs. Total. Under 1 yr. 1-5 yrs. Total. 1953 347 35 382 5,737 2,181 7,918 8,300 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 488 64 552 8,855 2,622 11,477 12,029 1948 596 70 666 10,028 2,923 12,951 13,617 Thirty-eight children were immunised during the year at "Brookscroft." Summary of Attendances at all Welfare Clinics First Attendances. Re-attendances. Grand Total. Under 1 year of age. 1-5 years of age. Total. Under 1 year of age. 1-5 years of age. Total. Local Authority Scheme 1,069 172 1,241 15,935 13,609 29,544 30,785 "Brookscroft" 347 35 382 5,737 2,181 7,918 8,300 Total 1953 1,416 207 1,823 21,672 15,790 37,462 | 39,085 93 TREATMENT The facilities provided at the Education Authority's Clinics are available for all children attending the Welfare Centres. (a) Orthopa?dic.—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- Surgical Tuberculosis 1 (a) Equino Varus 2 Scoliosis, Lordosis, Kyphosis 2 (b) Calcaneo Valgus 5 Genu Valgum 21 (c) Mid Tarsal Varus 1 Genu Varum 18 Digitus Varus 1 Genu Varum 18 Overlapping Toes 3 Pes Valgus 35 Other Congenital Defor- Spastic Paralysis 4 mities 2 Torticollis 3 Miscellaneous (including Perthes Disease 1 chest conditions) 8 Total 111 No. of treatments given—1,200. (b) Sunlight.—Sunlight treatment was given at the Hale End Clinic to 36 children under 5 years of age for 144 treatments. (c) Dental.—Mr. L. W. Elmer, L.D.S., Senior Dental Officer, reports as follows:— "As in past years every expectant and nursing mother and pre-school child referred from the welfare centres has been examined. The numbers have been about the same as in 1952, which suggests that 'saturation point' may have been reached. "I am pleased to report that during 1953 a larger proportion of both mothers and children have completed treatment, and have been made dentally fit. "In 1952, 444 mothers were found to require treatment and only 154 were made dentally fit. In 1953, the corresponding figures were 439 and 207, a definite improvement. This is possibly due at least in part, to the provision of free dentures, 71 being supplied in 1953, as against only 16 in 1952. "Of the children, 356 completed treatment out of 483 requiring it. Last year the corresponding figures were 290 out of 478." 94 The following gives details of the work done during the year by the dental staff:— Patients inspected and treated during the year : Expectant Mothers ; Nursing Mothers Children under School age Patients examined 304 153 507 Patients found to require treatment 296 143 483 Patients who have commenced treatment 265 137 446 Patients who have completed treatment 116 91 356 Patients awaiting treatment 23 29 28 Attendances for treatment 572 382 676 Types of treatment given: Expectant Mothers Nursing Mothers Children under School age 1. Extractions : (a) permanent teeth 251 150 — (b) temporary „ — — 413 2. Fillings: (a) permanent teeth 219 137 — (b) temporary „ — — 227 3. Inlays provided — 1 — 4. Crowns „ 2 — — 5. Anaesthetics administered: (a) local 26 18 8 (b) general:— (i) by medical officers on County Staff — — — (ii) by others 82 56 247 6. (a) Scaling 71 21 1 (b) Prolonged Scaling and gum ment 17 5 - 7. Silver Nitrate Treatment 13 17 314 8. Dressings 74 56 77 9. X-ray examinations 8 10 — 10. Dentures provided: (a) full 4 22 — (b) partial 15 30 — 11. Dentures repaired — — — 12. Dentures remade: (a) full — — — (b) partial — 2 — 13. Orthodontic appliances: (a) fixed — — — (b) moveable — — — 95 14. Prophylactic treatment and other operations: Impressions 22 56 — Bites 5 20 — Try-ins 11 24 — Easing 1 12 — Polishing 51 11 — Gum Treatments 23 2 — Syringing 10 — — 15. Number of treatments included above in 6 or 14, carried out by Oral Hygienist 111 21 — The services of the Dental Hygienist were available on two days per week. Apart from chairside work for the priority groups, talks were given at Thorpe Coombe Maternity Hospital. (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: — "There has been a falling off in the number of children under school age referred to the special clinic held at West Avenue Welfare Centre. During the year ten only were referred, as against nineteen in 1952, and only eight attended for diagnostic interview. "The following is an analysis of cases treated : Habit disorders 1 Fears 2 Behaviour disorders 5 8 96 "Of these, three cases are still under treatment, presenting problems of unusual severity. Five have been discharged as being no longer in need of help. "The falling off in numbers seems regrettable, in view of the encouraging results obtained during the last two years. Similar good results have been obtained in clinics of this type in other areas, and it is considered that valuable prophylactic work can be achieved in the sphere of mental health by treating children who show symptoms of faulty adjustment at this early age. It is to be hoped that the doctors working with this age group in the Borough will avail themselves more freely of the facilities provided." (g) Paediatric Clinic.—The fortnightly clinic, under the charge of Dr. Elchon Hmden, Pediatrician to Whipps Cross Hospital, continued during 1953, and 27 children under five years of age were seen. Dr. Hinden reports as follows:— "There have been no major changes in the work of the clinic during the past year. The bulk of the patients are suffering from abnormalities of growth or development, or from behaviour disorders; ordinary organic disease is not commonly seen at the clinic. "One of the most serious diseases interfering with normal growth and development is Cerebral Palsy. This has many causes—birth injury, infantile infections, and the like—but the end picture is the same ; a child who has difficulty in making his muscles do what he wants them to do, and with varying degrees of mental defect as well. The disease can have any degree of severity, from the bed'ridden idiot to the seemingly normal child with a clumsy right hand. This makes diagnosis very hard, particularly in the important early months of growth. "Is my child 'spastic' ?" is a thought in the mind of many a parent, when babyhood seems prolonged more than usual; and although often a true answer can be given, occasionally only time can tell. "The treatment of these unfortunates is a long and tedious business, and must last as long as life itself. Many disciplines are needed to enable the child to make the best possible use of his damaged motor apparatus, and these must be combined with schooling, so that the development of his brain does not lag behind that of his body. I doubt whether it is possible to set up sufficient 'cerebral palsy units' to cope with all the children needing special treatment—for one thing, they are excessively expensive. But a Special School for the 97 physically handicapped, such as exists in the Borough at Hale End, is able to make a very real contribution to the problem. In such a school, physiotherapy, remedial exercises and speech therapy are available actually in the school building, so that the pupils may use them with the minimum disturbance to their learning. The Consultative Clinic is already being used as a diagnostic centre for suspected spastic children ; it would not take much to equip Hale End as a completely adequate treatment centre." Under 5 years New cases 27 Total attendances 39 Physical Defects: Cases seen 24 Referred to Hospital 6 Discharged 4 Psychological Disorders: (a) Enuresis 3 (b) Other Referred to Hospital Discharged 3 (h) Invalid Children's Aid Association.-Mrs. Osora, Secre tary 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 1 School Health Services 3 General Practitioners 3 7 Classification of Cases:— Anaemia, debility 1 After effects of acute or infectious illness or operation 3 Bronchitis or pneumonia 2 Rheumatism, Chorea, Heart 1 7 98 (i) Convalescence.—During 1953, eight 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. In addition, a nursing mother and her baby were sent away for a period of convalescence. PROVISION OF NUTRIENTS AND MEDICAMENTS Details of nutrients and medicaments sold and issued free during 1953 are as follows Sales Free Issue lbs. ozs. lbs. ozs. Adexoline 21 4¾ Bemax 174 9 Colact 99 — Cow and Gate 2,312 — 38 — Cod Liver Oil Emulsion 20 8 Cod Liver Oil and Malt — — 135 — Farex 670 — Fersolate Tablets — — 6,993 Tablets Gentian Violet Tablets — — 1,440 Tablets Glucodin 189 4 Lactogol 37 4¾ — — Magnesia — — 24 — Maltoline with Iron — — 250 — Marmite 851 — — — Mist Ferri et Ammon Cit Pro Infantibus — — 15 14 Ostermilk 819 — 24 — Ostocalcium Tablets — — 2,840 Tablets Robinson's Groats 271 — — — Scott's "Twin Pack" 393 — — — Sodium Citrate Tablets — — 20,000 Tablets Trufood 45 — — — Virol 1,203 8 — — Value of Cash Sales £1,208 4s. 5d. VITAMINS The facilities for the distribution of vitamins were continued at all Welfare Centres. Every effort is made to increase the demand. 99 DAY NURSERIES The following table shows the average attendances at the Day Nurseries during 1953 (Mondays to Fridays only). Month Nurseries Under 2 yrs. Over 2 yrs. Total January Higham Hill 8.7 30.9 39.6 Hands-worth Ave. 7.5 29.4 36.9 February Higham Hill 8.6 33.5 42.1 Handsworth Ave. 7.5 29.5 37.0 March Higham Hill 11.1 45.0 56.1 Handsworth Ave. 6.5 26.5 33.0 April Higham Hill 12.0 41.4 53.4 Handsworth Ave. 8.0 30.45 38.45 May Hignam Hill 11.7 37.3 49.0 Handsworth Ave. 8.45 36.8 45.25 June Higham Hill 12.0 31.7 43.7 Handsworth Ave. 9.19 37.24 46.43 July Higham Hill 12.4 42.5 54.9 Handsworth Ave. 9.39 38.78 48.17 August Higham Hill 12.1 36.15 48.25 Handsworth Ave. 6.55 46.65 53.2 September Higham Hill 11.09 30.32 41.41 Handsworth Ave. 6.5 46.0 52.5 October Higham Hill 13.8 30.7 44.5 Handsworth Ave. 4.8 43.9 48.7 November Higham Hill 15.3 35.5 50.8 Handsworth Ave. 4.8 46.6 51.4 December Higham Hill 14.0 32.4 46.4 Handsworth Ave. 4.9 44.0 48.9 Average Whole Year Higham Hill 11.9 35.6 47.5 Handsworth Ave. 7.0 38.0 45.0 Both Day Nurseries are approved for training in the care of children aged 0—5 years. Both have 60 places. Training.—During 1952, seven students entered for the Nur sery Nurses' Certificate, of whom six passed, and during 1953, eight entered and passed, the one failure during 1952 being the first in the 10 years in which the Day Nurseries have been training students. The subsequent careers of the 14 who gained their certificates during 1952 and 1953 have been as follows : General Nursing Training 6 Other Day Nurseries 4 Private Nurseries 2 Promotion in Walthamstow Nursery 1 Teaching1 Illegal Entry.—Repeated entries took place at one of the Day Nurseries. 100 Effect of New Increased Charges.—The County Council's new scale of assessment became operative as from January, 1953, and later the Area Financial Officer reported to the Health Area SubCommittee that following from the introduction of the increased charges, 23 out of 62 children were withdrawn within the next few days at Handsworth Avenue Day Nursery, and 19 out of 64 at Higham Hill Day Nursery. Of the total of 42 children withdrawn, 3 were due to nonfinancial reasons. For the two months prior to the increased charges, the daily average attendances at Higham Hill were 43.1 and at Handsworth Avenue, 33.4. These had increased respectively to 49.5 and 34.9 during February and March. At the end of the year, the averages were 47.6 and 47.7. NURSERIES AND CHILD MINDERS (REGULATION) ACT, 1948 Registration was continued in one case for the care of up to 16 children aged 3/5 years. 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 Visitor's report. The experience since the commencement has been as follows:— 1951 1952 1953 No. of Daily Guardians on Register at 31.12.51 8 19 19 No. of applications for services of Daily Guardian 25 23 26 Referred to Day Nurseries 10 — 20 Referred to Daily Guardian but nothing further heard 6 11 Placed with Daily Guardian 9 12 1 Continued in care of Daily Guardian from previous year - 2 8 These 9 children were in the care of a Daily Guardian for periods as follows:— (Two of the children continued to be cared for in 1954). 101 Duration of Care (in weeks) : 1 2 3 5 7 9 11 12 13 14 15 16 17 20 32 37 38 47 49 No. of Children : 1953 211 1 1— 1 1 — 1952 .1 1—1 1 1 1—1 1 21 1—1 1 1951 1 4 121 INFESTATION The steps taken to combat infestation include cleanliness inspections and treatment at Clinics (which includes the supply of Lethane and of steel combs at cost price). OPHTHALMIA NEONATORUM This is 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 yeai at Thorpe Coombe Maternity Hospital, under the clinical charg of Miss Helen Rodway, F.R.C.O.G., who states that the numbt of patients attending has been as follows:— New Cases. Attendances. 1949 31 528 1950 34 475 1951 19 444 1952 24 411 1953 28 337 MIDWIFERY (Section 23) There were 37 practising midwives in the Borough at the end of 1953, 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. 102 The following table shows the work done by Midwives during 1953:— No. of confinements attended as a Midwife 1,215 ,, confinements attended as a Maternity Nurse 301 „ Medical Aid Notices sent 629 „ Twin Births notified 26 „ Stillbirths Notified 4 ,, Notifications of Artificial Feeding 18 ,, Discharging Eyes 1 The previous table includes the following numbers in regard to work done at Thorpe Coombe Maternity Hospital:— Midwifery cases 995 Maternity cases 138 Medical Aid Notices 568 The percentage of Medical Aid Notices were:— All cases 41.4 Maternity Hospital Midwives50.1 Other Midwives 15.9 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 Antepartum haemorrhage 1 Other conditions 2 Total 4 For complications during labour: — Prolonged first and second stage 2 Ruptured perineum 27 Premature labour 1 Rise in temperature 2 Post-partum haemorrhage 3 Uterine inertia 1 Abnormal presentation 4 Other conditions 6 Total 46 103 For complications in regard to the infant: — Asphyxia 1 Jaundice 2 Inflamed eyes 2 Prematurity and feebleness 1 Cyanosis 2 Other conditions 3 Total 11 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 1,033 423 849 174 138 3,864 6,481 Home Nurse Midwives 72 33 710 46 25 553 1,439 Totals 1,105 456 1,559 220 163 4,417 7.920 Two midwives in private practice undertook 14 cases as midwives, and 25 cases as maternity nurses. Gas and Air Analgesia.—The Ambulance Service provided transport facilities for gas and air apparatus. A total of 537 patients on the District received gas and air analgesia, representing a percentage of 87.98 of District confinements. Maternity Medical Services.—In November, a meeting was convened of all doctors undertaking Maternity Medical Services, in order to improve co-operation with and from the district midwives, and to ensure that the exact role of the doctor and the midwife in acting as maternity nurse should be understood, and not least by the patient. Emergency Unit.—This Unit, stationed at Thorpe Coombe Maternity Hospital, was called out to 5 Walthamstow cases during 1953. 104 Maternity Outfits.—391 outfits were issued. Training of Pupil Midwives.—Thorpe Coomhe 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 37 pupils successfully underwent Part II training during 1953. HEALTH VISITING (Section 24) Health Visiting Staff.—The equivalent of whole-time Health Visitors at the end of the year was 9.6, and one Superintendent. This was equal to one whole-time district Health Visitor to 165 notified births, and one whole-time district Health Vistor per 160 registered births during 1953. 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. 1953 1,447 3,719 5,166 9,445 14,811 1952 1,445 4,331 5,776 10,227 16,003 The following table shows the number and nature of visits paid in 1953:— 105 Ward Visits to Children under 1 year Visits to Children under 1 year of age Visits to Children 2—5 years Grand Total Unsuc' cessful Visits Ante-Natal Visits Other Visits Total Visits _ First Visits Subsc quent Visits Total Visits First Visits Subsequent Visits Total Visits (1) (2) (3) (4) (5) (6) (7) — — (8) (9) Cols. 6-9 St. James Street 222 374 596 256 890 1,742 401 92 34 126 387 2,656 High Street 174 395 569 322 936 1,827 193 42 9 51 251 2,322 Hoe Street 202 392 594 382 894 1,870 606 130 16 146 460 3,082 Wood Street 179 296 475 187 493 1,155 434 33 8 41 140 1,770 Hale End 345 1,367 1,712 1,048 1,309 4,069 310 68 45 113 422 4,914 Higham Hill 325 895 1,220 1,043 1,685 3,948 530 52 14 66 467 5,011 Totals 1953 1,447 3,719 5,166 3,238 6,207 14,611 2,474 417 126 543 2,127 19,755 Totals 1952 1,445 4,331 5,776 10,227 16,003 2,594 480 155 635 2,561 21,793 106 Health Visiting—Investigation.—An increasing amount of the time of 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.—Health visitors and school nurses, as well as medical staff, continued to attend ward rounds of Dr. Hinden, Paediatrician, Whipps Cross Hospital, who holds a fortnightly session at the Town Hall Clinic. Canvey Island Flood Disaster—February, 1953.—Two health visitors were loaned, one for 13 days and one for 8 days, to assist generally, and the following report received from the health visitors is of interest :— "We were required to take charge of a day nursery converted by an R.A.F. medical unit into a residential nursery for semi-sick children who would normally have been nursed in their own homes but who could not be cared for in a school room with 20 other persons. "The other staff were day nursery staff and voluntary workers of every possible kind who worked magnificently. A general practitioner acted as medical officer. "The children came from the rest centres and from the hospitals to convalesce before being picked up by their parents, some of whom took a long time to locate. We were told we saved the hospital bed situation from complete breakdown during the crisis. "It was a most interesting experience to work so closely with day nursery personnel and the general practitioner service." Old People's Welfare.—Reference is made in Section "G" of the report to the help given by health visitors in visiting old people on requests received following the issue of the Borough Council s booklet. HOME NURSING (Section 25) Queen's Training.—Four nurses completed their Queen s training and passed their examination. Three more have started t^e'^ training. Theoretical work was carried out at the Lady Rayleigh Home, Leytonstone, and practical work at " Carisbrooke . 107 This participation in the Queen's 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. Administration of Antibiotics—Skin reactions.—During 1953, an enquiry was made into the occurrence of skin reactions amongst home nursing staff administering antibiotics. During 1952, over 14,000 such injections were given and fortunately without ill effect to the nursing staff. None has been reported during 1953 in the 13,461 injections given. The advice given in Ministry of Health Circular 16/53 was brought to the notice of all home nursing 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:— "During the year a second male Queen's nurse was appointed. "Staff on the 31st December, 1953, 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. 7 Full'time Queen's S.R.N., S.C.M. 1 „ „ S.R.N., S.C.M., H.V. Certificate. 8 „ „ S.R.N., S.C.M. 4 „ „ S.R.N. 2 „ „ Male Queen's S.R.N. 1 Part-time S.R.N. 4 „ „ S.E.A.N. "Assistance was given by members of the St. John Ambulance Brigade during the influenza epidemic in the early part of the year and this was a considerable help to us. "The following gives details of Home Visits during the year New Total cases visits Medical 812 35,153 Surgical 217 9,542 Tuberculosis 56 2,672 Out-patients 24 150 Operations 12 40 Miscarriages 3 18 Specials 41 609 Casuals 108 229 Hypodermic Injections 556 13,461 Totals 1,829 61,874 108 VACCINATION AND IMMUNISATION (Section 26) During 1953, immunisation against diphtheria and whooping cough continued to be available at all welfare centres and at the special clinic held weekly at the Town Hall, where vaccination was also done. On April 1st, whooping cough immunisation was extended to all ages and in addition, general practitioners were brought into the scheme on the same basis as that previously obtaining in regard to vaccination and diphtheria immunisation. Owing to the prevalence of poliomyelitis, the immunisation of new cases was suspended between the 27th July and 3rd October, 1953. The ideal programme is vaccination before the end of the third month, whooping cough immunisation during months 4, 5 and 6, and diphtheria immunisation during months 7 and 8, with a 'booster' dose immediately before school entry and preferably another before transfer from the infants to the junior department, i.e., say about 10 years. A ' booster 1 dose should also be given against whooping cough before school entry and re-vaccination performed. The following were the attendances during the weekly Town Hall Clinic :— Diphtheria Immunisation 614 Whooping Cough Immunisation 679 Vaccination 628 Total 1,921 This represented an average of 36.9 attendances per session. There are two attendances for each vaccination and diphtheria immunisation, and three for each whooping cough immunisation. VACCINATION The ages of persons vaccinated is shown below:— Age at date of Vaccination Under 6 months 6-12 months l year 2—4 years 5—14 years 15 years and over Total Primary 376 139 17 17 30 49 628 Secondary — — 1 4 20 147 172 Total 376 139 18 21 50 196 800 109 Vaccinated by General Practitioners 486 Vaccinated by County Staff 314 The vaccinations under one year during 1953 represented approximately 36.4% of babies surviving to the age of one year. For the purpose of comparison, similar figures have been calculated for the past four years as follows:— Year Percentage 1952 35 1951 37 1950 23 1949 18 VACCINATION AND RE-VACCINATION OF DEPARTMENTAL STAFF The staff of the department and ambulance drivers, especially those who would be expected to deal with smallpox in the event of cases occurring, were again offered facilities for vaccination and revaccination. The number vaccinated was 44. DIPHTHERIA IMMUNISATION The following is a summary of the work carried out during the year:— Total number of immunisations completed: (a) School age 191 (b) Pre-school age 1,005 Total 1,196 (c) Number already immunised having reinforcing dose 1,749 Details of the immunisations included in the above total are set out below:— No. completed at schools 193 No. completed at welfare centres 239 No. completed at Town Hall Clinic 281 No. completed at "Brookscroft" 38 No. completed by general practitioners 445 110 182 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 totals given above. There have only been two confirmed cases of diphtheria in the last seven 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 before reaching the age of one year. 111 DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION During the past five years the percentages immunised in the various age groups were as follows :— Age at Immunisation Total % Immunised to Population in Age Groups Notified Cases Year Regd. Births 0—1 year 1—2 years 2—3 years 3—4 years 4—5 years Total 0—5 years School Age Over School Age Grand Total % 0—1 to Total Births % 0—5 years % 5—15 years % 0—15 years Admitted to Hospital Diagnosis Confirmed Deaths 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 — — 1953 1,454 610 324 36 16 19 1,005 191 — 1,196 41.9 44.4 92.5 73.8 13 — — Number of children at 31st December, 1953, who had completed a course of immunisation at any time before that date (i.e., at any time since 1st January, 1939):— Under 1 (born 1953) 144 1— 4 (born 1952-1949) 4,277 5— 9 (born 1948-1944) 8,390 10—14 (born 1943-1939) 6,191 Total immunised under 15 years 19,002 112 IMMUNISATION AGAINST WHOOPING COUGH The numbers and age groups of children immunised during the year are shown in the following table:— Age at date of Final Injection Under 6 mths. 6—12 months 1 year 2 years 5 years 5-14 years Total Clinics, Nurseries and Welfare Centres 23 301 119 51 - 8 502 General Practitioners 15 136 79 16 — 6 252 Total 38 437 198 67 - 14 754 The percentage of children under the age of one year immunised was 32.7. 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 1953 was 3,784. Twenty'two cases of whooping cough notified during the year gave a history of previous immunisation. All these cases were followed up, and an assessment of severity at the conclusion of each case on the criteria laid down by the Medical Research Council showed twelve to have had no clinically recognizable stage A or B, eight to have suffered from a mild attack, with less than ten paroxysms in twentyfour hours, and two to have had severe attacks. On the whole, this is considered a reasonably satisfactory assurance of the value of whooping cough immunisation. 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 " suspended vaccine was continued. 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. 113 PREVENTION OF ILLNESS — CARE AND AFTER-CARE (Section 28) TUBERCULOSIS In the Annual Report for 1952, Dr. Ramsay referred to the extension of B.C.G. vaccination in contacts, and the advantage of an Odelca camera X-ray unit which had been added to the equipment of the Chest Clinic. During the course of the year, Dr. Ramsay addressed a letter to all general practitioners in the Chest Clinic area (which includes the whole of Walthamstow), drawing attention to this new diagnostic aid, especially for the examination of persons with respiratory symptoms. It was suggested that every case where there was the slightest doubt as to a chest condition, especially the "chronic bronchitic "should be referred for examination. Patients could be referred by the general practitioner on Mondays, Tuesdays and Thursdays at 9.15 a.m. Dr. Ramsay, in commenting on the work of the Chest Clinic during 1953, writes as follows:— "I do not think there is much one can say about the Clinic activities for 1953. The routine has been the same as last year. "Some further information on the Odelca Camera Unit and on B.C.G. might be interesting. 1. The work of the Odelca Camera Unit has shown a steady increase since it was started in July, 1952. A special request form has been devised which is sent to the general practitioners in the area. It is of simple design and is intended to make things easy for patients to be referred to the Clinic for miniature film. The response on the part of the local doctors has been excellent and the numbers of new cases referred for this examination are now of the order of 80 to 100 each week. "2. B.C.G. routine has been continued and the total number vaccinated is 48. Apparently the interest of the public is maintained and it is very rare for anyone to refuse the offer of vaccination. "During the year Miss Ames, the Senior Tuberculosis Visitor retired. She has given many years devoted service to the Clinic and to the local population and I would like to place on record my personal appreciation of her excellent work." Tuberculosis Case Conferences.—Starting in June, periodic case conferences have been held at the Chest Clinic, the participants 114 being the Chest Physician, his medical colleagues, the Tuberculosis Health Visitors, the Welfare Clerk, the Medical Officer of Health or his Deputy, the Superintendent Health Visitor and the Chief Administrative Assistant. Nine of these conferences were held during 1953, the matters considered including all new notifications since the last case conference, together with hospital admissions and discharges, entrants to the contacts register, action taken to ensure attendance of contacts for examination and re-examination, non-notification of tuberculosis, medical priority in re-housing and any other matter of interest. Other action in regard to Ascertainment and Follow-up— (i) A chest X-ray examination on appointment is required in regard to those persons in contact with groups of children. (ii) When a new case of pulmonary tuberculosis is notified, enquiry is made as to infectivity, and if sputum positive, all the records are marked accordingly, and action is taken as if it were a case of major infectious disease. (iii) Towards the end of 1953, approval was given in principle to a pilot scheme of case finding by the patch testing of school entrants, and this has already commenced in 1954. Miss A. Woolgar, Honorary Secretary of the Walthamstow and Chingford Association of Tuberculosis Care Helpers, contributes the following report:— "During 1953 there has been a considerable change in the work of the Association, the main emphasis being no longer on the provision of extra nourishment. Few milk vouchers have been issued since the County Council's own scheme of such vouchers became established and although more grocery allowances are being made, expenditure on extra nourishment generally is considerably less than has been usual. "Funds previously spent on these items were thus available for use in other directions, making it possible for us to provide, in two instances, equipment for patients who were unable to return to their previous employment, to undertake light work at home, another patient being placed in employment following a refresher driving course arranged by the Association. "It has also been possible, where a family has incurred weekly payments before the onset of illness, to pay off their accounts, so making it practicable for them to manage 115 ably well on the available income and retain some feeling of independence. Considerable sums have been spent on this type of assistance. "The provision of clothing and bedding has continued where the National Assistance Board was not liable and many small grants have been made to meet individual need, particularly in regard to fares for relatives to visit patients in hospital. "Mr. McGiverin has continued to teach hand-weaving to patients confined to bed at home and has done very useful work, but it has become increasingly apparent that only a trained therapist, with time to devote to visiting and teaching the various crafts, will really meet the need. "Our financial position throughout the year has been satisfactory so that we have not at any time had to curtail our activities for lack of funds, and have been able to give help more generously than in some earlier years. "During the period covered by this report, the following help has been given:— "Cases assisted with— Milk 14 Grocery 30 Fuel 4 Fares and Car Hire 14 Clothing, Furniture and Bedding 31 Holidays 5 Occupational Therapy 24 Debts, Hire Purchase and Miscellaneous Grants 30 Christmas Grants 65 Rehabilitation Grants 4 Removal Expenses 2 "These figures may give some indication of the material help given, but letters from patients and their families indicate that it is not only the material help but also the moral support received which is of value in helping them overcome their difficulties during the time of their illness, and in what is often even more trying, the period of rehabilitation and resettlement in employment." 116 CONTACT EXAMINATIONS First examinations of contacts in 1953 were 181 to 117 total notifications. In 1952 there were 268 to 115 notifications. POLIOMYELITIS FOLLOW-UP During the course of their routine duties the Health Visitors visited all cases of poliomyelitis notified during the year. 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 wholetime occupational thereapists 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 two Boroughs because of the lack of suitable applicants. CONVALESCENCE FOR ADULTS The total of cases sent away for recuperative convalescence was 78. The length of convalescence was one week in 2 cases, two weeks in 74 cases, three weeks in 1 case and four weeks in 1 case. Recovery of cost or part-cost was made. The demand for recuperative convalescence was naturally high between April and September. 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 epuipment, one at the District Nurses' Home in Carisbrooke Road and the other at the British Red Cross Society Headquarters in Forest Road. During the year routine issues were made of items of equipment such as bed-pans, thermometers and feeding cups, etc. Special items of equipment are provided when necessary. CHIROPODY SERVICES Mr. R. J. King, Chief Chiropodist, contributes the following : "The Chiropody Clinic has continued as in previous years, with four whole-time chiropodists, and the attendances have increased by 1,537 over 1952, with a total of 16,947 treatments. 117 Daily morning sessions are held, with afternoon sessions on Monday, Wednesday, Thursday and Friday, and evening sessions on Monday, Thursday and Friday. " During the year the ladies' dressing cubicle has been moved from the Clinic to the waiting room, and this has made access to the Clinic much less congested. This alteration however, has not solved the problem of limited accommodation and little or no privacy is afforded to the patient or chiropodist. "Elderly people make an ever-increasing demand on the service, and during the year 141 patients were conveyed to the Clinic by ambulance. This is a great asset to those who are in need of treatment but cannot manage the journey, and in some cases it literally keeps them on their feet. Patients are provided with transport on the request of their doctor or health visitor, but the majority of ' the not so young ' manage to make their own way to the Clinic. "One of the greatest problems apart from accommodation, is the size of the waiting list, which had increased to 2,864 by December 26th. A large number of chronic cases require frequent treatment and it is necessary that the period between appointments should be as short as possible, but with the present staff of four this is out of the question. In order to deal adequately with the present volume of patients, a staff of six is needed. "The Tuesday morning clinic, the only ' special ' children's clinic I believe in the London area, gave 2,127 treatments, an increase of 83 over 1952. As in previous years, the majority came to this Clinic with plantar warts. Patients are sent for treatment via the School Health Service." The table below gives details of patients treated during 1953:— Adults Children Collective Total New Old Total New Old Total 1,344 13,476 14,820 466 1,661 2,127 16,947 The following is an extract of a special report made to the Health Area Sub-Committee in November, 1953, with particular reference to attendances at the Foot Clinic:— "Approximately 340 appointments are made weekly, but school children attend without appointment. About 10% of the appointments made are not kept by the patients, but where 118 advance notice is given by a patient of their inability to attend, the vacancy is given to another patient on the waiting list. "Of the patients attending for treatment, over 39% are elderly (i.e., aged 65 years or more). Information regarding the proportionate attendances according to age groups is given in the following table:— Age Group % of total attendances % of Men % of Women (according to age group) 65 years and over 39.3 8 92 55 „ to 64 years 19.7 10 90 45 „ „ 54 „ 19.4 7 93 35 „ „ 44 „ 12.2 7 93 25 „ „ 34 „ 6.3 9 91 24 ,, and under (excluding children) 3.0 5 95 "It will be observed that the number of women attending is roughly 90% of the whole as against 10% for men. "The average waiting period for a patient seeking an appointment for the first time or an old patient re-booking is 8 weeks." DOMESTIC HELP SERVICE (Section 29) Mrs. C. M. Hall, Domestic Help Organiser, reports as follows:— 1953 was a year of yet further expansion in the Domestic Help Service. This Service continues to be administered along lines similar to those adopted in previous years and has faced an even greater demand than hitherto with a large measure of success. During the year, 2,178 visits were made— 188 more than in 1952 ; there were 11 full-time and up to 210 part-time helps employed in an endeavour to meet the everincreasing demand for help and it is hoped to enrol more fulltime helps in the near future to cover outstanding cases. The number of cases carried into 1954 is 517, i.e., 88 more than brought forward from the previous year. "It will be seen from figures given below that the chronic sick receiving help continue to grow in number and absorb much of the available labour. 119 "Below is a summary of the year's work:— Brought forward from 1952 436 New cases during 1953 405 Cases completed during 1953 324 Number of cases carried forward to 1954 517 Analysis : Mater- Acute Chronic Sick Aged not nity Sick T.B. Aged : Others Sick Others Total 71 45 17 522 105 76 5 841 "During September one help was accepted for a two weeks training course for domestic helps at Chelmsford and was found to be entirely satisfactory in her work. The possibility of issuing a certificate at a later date is being considered. "It will be seen from comparative figures that it has been an extremely busy year and unfortunately during December there arose a waiting list for help: this need is being dealt with as quickly as possible. "Despite many difficulties, 1953 was a year of great consolation to many sick people and a year of achievement for the Service." 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 1953:— (1) Residential and Temporary Accommodation. (a) Admitted to hostels and other residential establishments : Men, 9; Women, 23. (b) Admitted to temporary accommodation : Men, 3; Women, 4; Children, 9. (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, 1953, were as follows:— 120 (i) Registered as blind 208 (ii) Partially sighted 42 (iii) Defective sighted 9 all of whom were under the supervision of Home Teachers. During the year seven blind persons participated in the Home Workers' Scheme operated through the agency of the Royal London Society for the Blind, and two blind persons were employed in the Workshops for the Blind. In addition, there were twenty-four blind and nine partially sighted persons in open industry. "The Council's Schemes for welfare services for other handicapped persons, including the deaf and dumb and those hard of hearing have, since the last report, been approved by the Minister of Health and such services will be provided (with the co-operation of voluntary agencies) as the Authority may find to be necessary or desirable in the light of experience during the transitional stages of operation, during which a full survey of the needs of the Administrative County in this respect will be carried out.