W A L 39 AC 4411(1) WALTHAMSTOW BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1954 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 11/7/55 BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1954 INDEX page Section A.—Statistics and Social Conditions of the Area 7 Section B.—General Provision of Health Services in the Area 14 Section C.—Sanitary Circumstances of the Area 20 Section D.—Housing 25 Section E.—Inspection and Supervision of Food 32 Section F.—Prevalence and Control over Infectious Diseases 43 Section G.—Miscellaneous 52 Section H.—National Health Service Act, 1946—Part III Services 57 Health Centres 58 Care of Mothers and Young Children 60 Midwifery 78 Health Visiting 81 Home Nursing 83 Vaccination and Immunisation 85 Ambulance Facilities 90 Prevention of Illness, Care and After-Care 90 Domestic Help 97 page Acreage 7 Adulteration 37 Ambulance Facilities 16,90 Ante-Natal Clinics 60, 67 Assessments 7 Bacteriological Examination 32, 34, 37 B.C.G. Immunisation 93 Birth Notifications 63 Birth Registrations 13 Births, Illegitimate 66 Birth Rate 7 Cancer 9 Cancer Education 55 Caravans 23 Care and After-Care 90 Care of Illegitimate Children 66 Child Guidance 72 Child Welfare Clinics 67,68 Chiropody 94 Clean Food Campaign 39 Cleansing (Personal) 16, 78 Clearance Areas 29 Committees 4, 57 Comparability Factor 8 Confinements 62 Contact Examinations . 93 Convalescence for Adults 93 Convalescence for Pre-School Children 74 Conveniences, Public 55 Cremation 55 Daily Guardian Scheme . 77 Day Nurseries 76 Deaths 7,8,9 Deaths, Infants 3, 10, 65 page Death Rate 7, 8 Deaths, Causes of 9 Dental Laboratory 59 Dental Treatment 70 Diphtheria 45 Diphtheria Immunisation 87 Diseases of Animals Acts 40 Disinfestation 24 District Midwifery 78 Domestic Help 97 Dysentery 47 Employment 7 Emergency Unit 80 Encephalitis 46 Enteric Fever 47 Essex County Council Act 20 Food & Drugs Act, 1938 37 Factories Acts, 1937/48 42 Food, Clean 39 Food Inspection 32 Food Poisoning 39,47 Foot Clinic 94 Funeral Arrangements 54 Gas and Air Analgesia 80 Gastric Influenza 46 General Dental Service 58 Health Centres 58 Health Education 55,95 Health Visiting 81 Home Nursing 83 Home Visits 81 Hospitals 16 Housing Act, 1936 28 Housing, Closure and Demolition 28 Housing, General 31 PAGE Housing Inspection 26 Housing Statistics 25 Hydrogen Cyanide Regulations, 1938 24 Ice Cream 33 Illegitimacy 66 Immunisation 35, 87 Infant Mortality 8, 10, 12 Infectious Diseases 43 Infestation 78 Inquests 55 Integration of Health Services 14 Invalid Children's Aid Association 73 Laboratory Facilities 15 Laundry Service for the Incontinent 54 Malaria 46 Maternal Mortality 10, 11, 13 Maternity Homes 20 Maternity Outfits 80 Meals on Wheels Service 53 Measles 8 Meat Inspection 35 Medical Aid 79 Medical Examinations 55 Medicaments 75 Meningococcal Infection 46 Midwifery 78 Milk Inspection 32 Milk Special Designations Order 33 Milk Supply 32 Moral Welfare 67 Morbidity 52 National Assistance Act, 1948, Sec. 47 17 Neo Natal Mortality 10,13,63 Notices, Sanitary 21 Notification of Births 63 Nursery Nursing Certificate 77 Nurseries & Child Minders (Reg.) Acts, 1948 77 Nutrients 75 Old People's Welfare 16, 52 Ophthalmia Neonatorum 46 Ophthalmic Treatment 72 Orthopaedic Treatment 69 Outworkers 43 Pediatric Clinic 72 Poliomyelitis 46 page Population 7 Post-Mortems 55 Post-Natal Clinics 60, 67 Premature Infants 66 Prevention of Damage by Pests Act, 1949 40 Prevention of Illness 90 Prevention of Tuberculosis 52 Pupil Midwives 80 Queens Institute of District Nursing—Training 83 Rainfall 55 Rateable Value 7 Redevelopment and Clearance Areas 29 Rehabilitation 93 Rehousing on Medical Grounds 31 Relaxation Classes 62 Rent and Mortgage Restriction Acts 30 Rodent Control 40 Sanitary Inspection 20 Scabies Treatment 16 Sickroom Equipment 94 Smallpox 47 Smoke Abatement 23 Social Conditions 7 Staff 14, 58 Statistics 7 Stillbirths 7,10,13 Sunlight Treatment 70 Swimming Baths 24 Total Infant Mortality 12 Tonsils and Adenoids 71 Training of Nursery Nurses 77 Training of Pupil Midwives 80 Tuberculosis 49,90 Vaccination 85 Virus Infections During Pregnancy 62 Vital Statistics 7, 62 Walthamstow Association of Tuberculosis Care Helpers 91 Walthamstow Child Welfare Society 68 Water 20 Welfare Services 99 Welfare Foods 75 Whooping Cough Immunisation 89 Women's Clinic 78 HEALTH COMMITTEE 1954-55 Chairman : Alderman The Lady McEntf.e, J.F Vice-Chairman : Alderman E. C. Redhead, J.P. Ex-officio : The Worshipful The Mayor—Councillor Mrs. S. Candy, J.P. The Deputy Mayor—Alderman T. W. Smith. Chairman of Finance Committee—Alderman Ross Wyld, O.B.E., J P Alderman Mrs. L. P. Bailey, J.P. „ A. E. Manning. „ W. H. Shaw. Councillors : C. J. Crosbie. L. Jones. Mrs. M. E. Marchant. J. E. Nicholls. Mrs. W. M. Palethorpe. Councillors : J. W. Pringle. W. F. Savill. Mrs. C. E. Stannard. A. F. Whicher. J. M. Wight. 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 My Lady, Ladies and Gentlemen, The following pages contain a report of the work of the Health Services in the Borough during 1954 and include, by courtesy of the County Medical Officer, an account of the personal Health Services administered by the Walthamstow Health Area Sub Committee of the County Council. Vital Statistics are again good and although the birth rate remains steady, the death rate fell as did infant mortality, still birth and the neo natal death rates. Although the death rate fell, the table which gives the causes of death reveals that cancer deaths increased by 45 to 252 in 1954, deaths from heart and circulatory diseases remain steady, but deaths from influenza, pneumonia, bronchitis fell from 235 in 1953 to 132 in 1954. Deaths from peptic ulcer increased from 14 in 1953 to 25 in 1954, and there were 28 deaths in all due to accidents including 7 in the home. The care of the aged and chronic sick required an increasing amount of time and the additional facilities still needed are enumerated. One of the new facilities provided was the laundry service for the incontinent. In regard to housing, further representations were made in regard to 151 dwellings. The Council acquired many dwellings from private ownership and carried out substantial improvements to bring these dwellings up to modern standards. As in previous years the Sanitary Inspectorate worked efficiently and well under the Chief Sanitary Inspector. A great deal of detailed work was necessary in regard to the clearance areas which were represented, and additional work ensued from the Housing Repairs and Rents Act, 1954. An innovation was the sampling of cooked meats. In the field of infectious diseases, there was again no diphtheria, and fortunately, but surprisingly, no poliomyelitis. Notifications of pulmonary tuberculosis showed a dramatic fall, which is clearly shown in the text of the report. The personal Health Services are now the responsibility of the County Council and are administered locally by the Walthamstow Health Area Sub-Committee. The following refer to certain aspects of these services:— The Dental Workshop undertook a considerable amount of work for the General Dental Service, the Leyton and Walthamstow Committees for Education and the Regional Hospital Board. With regard to maternal and child welfare, there were increased attendances for post-natal examinations, and relaxation classes and toddler clinics were started. Neo natal and infant mortality were again reduced ; attendances at the Child Welfare Centres remained steady at over 30,000, and the special clinic for Child Guidance for children of pre-school years continued its preventive work. The distribution of welfare foods was taken over from the Ministry of Food in July. The domiciliary midwifery service attained nearly 90% of gas and air administration. A meeting was arranged between family doctors practising in the Borough and the staff of the Health Department, especially the Health Visitors in order to try and increase co-operation. Progress, however, is slow. The Home Nursing Service attained a total of over 64,000 visits. Extensive additions and alterations were made to the District Nurses' Home, which will now be adequate for many years to come. There is still neglect of primary vaccination and reasons are given stressing the importance of primary vaccination in early infancy. Sufficient time has now elapsed to prove the efficacy of immunisation against whooping cough and parents are now apt to neglect diphtheria immunisation in favour of the former. In the fight against tuberculosis B.C.G. vaccination for school leavers was a notable advance. Arrangements were made to assist in the training of student nurses taking general nursing training, and finally, the Domestic Help and Chiropody Services continued under increasing pressure and strain. Once again I have to record the good work of the staff of the whole of the Department and 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 in the Town Hall, from the Chest Clinic staff 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 7 A.— STATISTICS & SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1954) 119,000 Number of Assessments (31st December, 1954) 37,308 Rateable Value (31st December, 1954) £916,554 Sum represented by penny rate £3,700 Population.— The Registrar-General's Estimate of the home population at mid-year, 1954, is 119,000, a decrease of 400 on the previous year. Employment— According to information kindly supplied by Mr. Percy C. Graham, Manager of the local Employment Exchange, approximately 550 men and 250 women were placed in employment every month during the year 1954 through the placing machinery of the Employment Exchange. The number of persons insured under the National Insurance Acts employed in the whole area covered by the Exchange, comprising the boroughs of Walthamstow, Leyton, Chingford and Wanstead and Woodford, was approximately 82,000. Of this number, it is estimated that about 40,000 were employed in Walthamstow. During 1954, the average number of persons unemployed in the whole area was 690 men and 200 women, including 95 disabled men and 15 disabled women. Extracts from Vital Statistics.—The Registrar-General's mid' year 1954 estimate of the home population (viz., 119,000) has been used for the calculation of all vital statistics. Total Males Females Live Births Legitimate 1,424 733 691 Birth rate per 1,000 of the estimated home population 12.3 Illegitimate 50 25 25 Total 1,474 758 716 Stillbirths 21 Rate per 1,000 total (live and still) births 14.0 Deaths 1,141 Death rate per 1,000 of the estimated home population 9.5 Deaths from puerperal causes :— Puerperal Sepsis Deaths 1 Other Puerperal Causes — 8 Death rate of infants under one year of age :— All infants per 1,000 live births 22.3 Legitimate infants per 1,000 legitimate live births 21.7 Illegitimate infants per 1,000 illegitimate live births 40.0 Deaths from measles (all ages) — Deaths from whooping cough (all ages) — Deaths from diarrhoea (under two years of age) 1 Pulmonary tuberculosis death rate 0.08 Non-pulmonary tuberculosis death rate 0.008 The natural increase of population, i.e., excess of births over deaths was 333. Deaths.— The Registrar-General's classification of causes of death by sex totals is given. The total number of deaths in 1954 (1,141), compares with 1,183 in 1953, the respective death rates being 9.5 and 9.9 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 12.0 Deaths 9.6 9 Causes of Death as given by the Registrar-General for the year 1954 Whole District Causes of Death Males Females Total 1953 1. Tuberculosis, Respiratory 6 4 10 22 2. Tuberculosis, other 1 — 1 — 3. Syphilitic Disease 2 4 6 4 4. Diphtheria — — — — 5. Whooping Cough — — — — 6. Meningococcal Infections — — — 1 7. Acute Poliomyelitis — — — 1 8. Measles — 9. Other Infective and Parasitic Diseases 1 1 2 1 10. Malignant neoplasm, stomach 29 19 48 38 11. Malignant neoplasm, Lung, bronchus 49 9 58 49 12. Malignant neoplasm, breast — 26 26 14 13. Malignant neoplasm, uterus — 5 5 10 14. Other malignant and lym phatic neoplasms 61 54 115 96 15. Leukaemia, aleukaemia 3 6 9 4 16. Diabetes 2 4 6 5 17. Vascular lesions of nervous system 57 80 137 126 18. Coronary disease, angina 100 58 158 174 19. Hypertension with heart disease 5 10 15 10 20. Other heart disease 58 107 165 169 21. Other circulatory disease 20 33 53 48 22. Influenza 2 3 5 21 23. Pneumonia 32 22 54 81 24. Bronchitis 38 22 60 114 25. Other diseases of respiratory system 8 5 13 19 26. Ulcer of stomach and duodenum 21 4 25 14 27. Gastritis, enteritis and diarrhoea 3 4 7 4 28. Nephritis and nephrosis 3 2 5 11 29. Hyperplasia of prostate 15 — 15 8 30. Pregnancy, childbirth, abortion 1 1 2 31. Congenital malformations 5 3 8 16 32. Other defined and ill-defined diseases 40 55 95 95 33. Motor vehicle accidents 4 5 9 4 34. AH other accidents 5 9 14 11 35. Suicide 10 5 15 11 36. Homicide and operations of war — 1 1 — Totals, 1954 580 561 1,141 Totals. 1953 649 534 1.183 The age distribution of Cancer deaths was as follows :— Under 1 yr. 1-2 yrs. 2-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 yrs. & over — — — — 1 13 108 139 10 Deaths from Accidents in the Home Seven deaths took place in 1954 following accidents in the home. Four of the deaths were in hospital and three at home. All were in elderly persons ranging from 75 to 96 years of age, except for one, a baby of seven months who was accidentally suffocated. Of the six elderly adults, five deaths followed from falls and one from burns. 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 iive births. No. Per 1,000 live births. 1954 1,474 12.3 21 14.0 0.17 2 16.9 33 22.3 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 The average mean annual infant mortality rate for the quin quennium 1931/35 was 49, and for the quinquennium 1946/50 it was 27. During the four years 1951/54 it fell to 24.3, i.e., less than half the rate for 1931/35. The death rate for diarrhoea and enteritis in children under one year of age per 1,000 live births was 0.6. 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 1954 one death was classified as being due to pregnancy, childbearing or associated therewith. The details are included in the following table :— Date of Death Certified Cause of Death Age 15.11.1954 Pulmonary embolism due to pelvic phlebothrombosis during labour. 29 11 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. 1954 1,495 1 1 0.66 0.66 1953 1,492 — 2 2 — 1.34 1.34 1952 1,541 — 3 3 — 1.95 1.95 1951 1,675 2 — 2 1.19 — 1.19 1950 1,635 — — — — — — 12 TOTAL INFANT MORTALITY This is defined as the sum of the deaths that occur during child-birth and during the first year of life. The attached graph shows the position since 1930 :— 13 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). 1954. 1953. 1952. 1951. 1950. Maternal Mortality 0.67 1.37 1.98 1.22 — Stillbirths 14.2 26.1 19.2 23.2 23.1 Neo-Natal Mortality 16.9 18.6 15.2 14.0 20.6 REGISTRATION OF BIRTHS The Registrar-General's returns show the following registrations during the calendar year :— (a) Live Births. Males. Females. Totals. Legitimate 733 691 1,424 Illegitimate 25 25 50 758 716 1,474 The stillbirth rate per 1,000 population was 0.17. Of the 1,548 local registrations, 443 belonging to other areas are excluded, leaving a net total of 1,105. There were no nonnotified births during 1954. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Total. Totals m. 69 f. 67 m. f. 64 52 m. 99 f. 84 m. 89 f. 73 m. 125 f. 130 m. 123 f. 130 m. 567 f. 538 Grand Totals 136 116 183 162 255 253 1,105 14 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. The following changes in the officers employed by the Authority took place during the year :— Appointments : R. A. Begley, Sanitary Inspector—1.3.54. F. G. Parker, Clerical Staff (temporary)—26.7.54. E. W. Searle, Driver/Disinfector—30.7.54. A. J. Goffin, Sanitary Inspector—31.8.54. Resignations : H. F. Lewiston, Driver/Disinfector—3.7.54. 2. Integration of Health Services. This matter was referred to in the Report for 1953 and the various arrangements then referred to continued during 1954. Circular letters were addressed to General Practitioners on seven occasions and referred to fifteen items, the subject matter being as follows: — Bacillary Dysentery at Forest Road Junior Mixed School and suggested action ; B.C.G. Vaccination of Schoolchildren and co-operation of family doctors ; Laundry Service for the Incontinent, details of new service ; Annual Reports, availability of copies to family doctors ; Food poisoning, bacteriological diagnosis by faecal and rectal specimens; Health Visitors, liaison with family doctors ; Deputy Medical Officer of Health, private telephone number ; Penicillin Reactions, advice to Home Nurses ; District Nurses' Home, temporary change of address and new telephone number ; The General Practitioner and the Health Visitor, invitation to meeting at the Town Hall ; Rheumatoid Arthritis, availability of handbook issued by the Empire Rheumatism Council ; 15 Notification and Isolation of Scarlet Fever ; details of outbreak at Sidney Burnell Infants' School ; reference to high infectivity and streptococcal carriers, criteria for home nursing and school exclusion ; Night Attendance upon the Sick, new facilities ; Duty arrangements, Medical Officer of Health and Deputy Medical Officer of Health, availability outside office hours ; District Nurses' Home, transfer to Carisbrooke Road and previous telephone number. Three members of the Borough Council served on the Group Hospital Management Committee and in addition the Medical Officer of Health served as a member of the Group Medical Advisory Committee and one of its representatives on the Hospital Management Committee. During the year the Chairman of the Hospital Management Committee arranged for a questionnaire to be sent to all General Practitioners in the area served by the Group Hospitals and later convened a meeting of Consultants, General Practitioners and Medical Officers of Health to discuss liaison between the Hospital and General Practitioner Services. 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 Epping. There is a collecting box at the Town Hall for specimens from family doctors. Dr. Frank Marsh, Pathologist in charge of the Laboratory at Epping, has kindly supplied the following information in regard to work done for Walthamstow :— Jan. Feb. Mar. Apr. May June July Aug. Sept . Oct. Nov. Dec. Total Faeces and rectal swabs 3 92 137 84 86 23 6 5 15 6 11 2 470 Widal agglutinations — — 5 4 1 4 6 4 16 11 6 13 70 Rhesus, Group and Kahn 5 17 8 10 16 17 14 20 13 18 10 7 155 Urine — 6 4 3 2 3 1 3 2 — — 24 Nose and throat swabs 2 4 7 9 7 1 9 2 2 216 54 16 329 Hemoglobin estimation 6 12 4 8 2 7 2 6 5 3 — 2 57 Food — 5 — — — 1 — — — — — 1 7 Totals 16 136 165 118 114 53 40 38 54 256 81 41 1,112 16 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. The arrangement, detailed in last year's report, with the Hackney Borough Council continued, and eight cases were referred there during 1954 receiving fourteen treatments at a total cost of £5 5s. Od. 6. Hospital Accommodation. (a) Acute Cases.—There were no major changes in 1954 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 three 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 1953 awaiting Hospital admission 3 No. of new cases considered during 1954 for Hospital Admission 37 No. of admissions to Hospital 22 No. of cases who died before admission 5 No. of cases cancelled or deferred 10 No. of cases outstanding at end of 1954 3 It is a pleasure again to record the unfailing help and considera' tion experienced from 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. 17 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. In 1952 it rose to 75 ; in 1953 it dropped again to 72%. During 1954 Walthamstow admissions were 60.8%. (d) Infectious Diseases.—Patients from Walthamstow are mainly admitted to St. Ann's Hospital, Tottenham. No difficulties have been noted. 7. Aged and Chronic Sick. National Assistance Act, 1948 (Section 47). Eight cases were under supervision during 1954 in regard to possible action under this section and the first three of those mentioned below were brought forward from 1953, i.e. :— Case 1 (M).—Female, aged 84 years (Case 4/1953). This patient was visited on several occasions by the Medical, Health Visiting and Sanitary Staffs. Conditions remained reasonably tolerable throughout 1954. Case 2 (C).—Male, aged 83 years (Case 5/1953). This patient was persuaded to enter hospital voluntarily in November, 1953 and was discharged after about three weeks' treatment. At the end of January, 1954, the family doctor reported that he was in a shocking condition and that he refused hospital admission. The patient was visited several times in order to try to persuade him to enter hospital voluntarily : this was consistently refused. The family doctor declined to accept part responsibility for a forcible removal in the event of a Compulsory Order being obtained and domestic help was, therefore, continued. Death occurred in hospital in August, admission being ' voluntary \ Case 3 (Q).—Male, aged 77 years and the owner-occupier of a modern house. He was first reported by the Home Nurse in December, 1953. The patient was apt to turn on taps and to pile fuel on the fire. The family doctor had unsuccessfully tried to persuade him to enter an institution through the Social Welfare Officer. Domestic help was arranged and was continued since the Psychiatrist would not certify the patient as suitable to enter a mental hospital. The patient was cared for by a single daughter whose doctor stated she was in danger of a nervous breakdown and she threatened to leave the home, in which case the patient would be living alone. He was visited but refused to enter hospital or an institution. Later the Police were called in to an imaginary burglary. The patient was then seen and certified by the Psychiatrist and removed to a mental hospital. 18 Case 4 (B).—Male, aged 76 years. A letter was received from the son complaining of the father's condition and habits. The family doctor stated that he was suffering from osteo-arthntis and carditis. Hospital admission was advised but refused. On visiting the patient he was found dirty in person and clothing, and had no fire even in mid-winter. He was previously the tenant of the house but had passed the tenancy to the son who provided food only. The daughter-in-law had five young children and was expecting another and was at variance with her father-in-law. Domestic help was refused by the patient. The services of a male Home Nurse were provided, together with bed linen and night clothing through the National Assistance Board. The son later requested a Compulsory Removal Order, and the wishes of the other children were then ascertained. Subsequently a visit was paid together with the Area Welfare Officer and an application for a Compulsory Removal Order was threatened. Arrangements were made for inclusion in the incontinent laundry service, and domestic help was also commenced. At a later visit in April, some improvement was noticed and it was thought better to defer application to the Court for compulsory removal. No further difficulty arose during the remainder of 1954. Home Nursing, Domestic Help and laundry facilities continued. Case 5 (M).—Male, aged 80 years. The husband and wife were living in squalor in a small room behind an unused shop. Both declined hospital admission but the wife's condition worsened so much that she finally agreed to enter hospital and died shortly afterwards. The husband remained at home and was provided with domestic help and home nursing, but refused hospital admission throughout 1954. Case 6 (H).—Female, aged 75 years. Reported by Old People's, Welfare Committee since the voluntary helpers of the ' Meals on Wheels ' service had refused to deliver meals owing to living conditions. Domestic help had continued for some time, but reported the bedding to be very dirty. Patient lived in one room on the first floor of a house where all four rooms were let off to elderly persons. Alternative arrangements were made to provide ' Meals on Wheels ' and visits were paid from time to time by the staff of the Health Department. The patient continued to refuse admission to an institution. She insisted on locking herself in her bedroom and owing to her shuffling gait, there was considerable risk of fire. Authority was obtained in July for application for a Compulsory Removal Order, but application to the Court was deferred pending further persuasion. A visit was paid by the Consultant Geriatrician who considered patient a Part III case and that chiropody was needed. Domiciliary 19 chiropody was provided after a great deal of trouble, together with laundry facilities. Domestic help continued, and at last the patient agreed to enter hospital in December. Case 7 (G).—Male, aged 79 years. This case first came to the attention of the Health Department in 1950 because the son, aged 49 years was both mentally sub-normal and epileptic. The wife and mother had recently died, and the premises generally were reported to be in a dirty condition, but this was not con' firmed on inspection. Supervision continued and by 1952 the Domestic Help had refused to continue. In June, 1954 the Chief Sanitary Inspector suggested the need for compulsory removal. This was confirmed on visiting, but in view of certain local circumstances, it was not considered advisable to apply to the Court until 1955. Case 8 (M).—Female, aged 88 years. Attention was called to this case by the family doctor in September when the doctor was called by the Home Nurse because of the patient falling about and would not let the nurse wash her. The patient was reported to be filthy and unmanageable, and the house was dirty. The patient lived with a brother, aged 84 years, who still went out to work. She refused admission to hospital, but after a visit by the District Sanitary Inspector and the Medical Officer of Health, the patient agreed to enter hospital voluntarily where she died soon after admission. The summaries given above are taken from the appropriate files, but it is hard to convey a measure of the anxiety, time and trouble involved in dealing with these cases by all concerned, i.e., the medical, nursing and sanitary staff of the Health Department, the hospital and welfare authorities and the Old People's Welfare Committee. Not the least distressing is the decision to apply for a Compulsory Removal Order, and so long as these persons are not held to be a danger or nuisance to themselves and other people, it is felt an Order should not be sought. Obviously, there is a considerable risk in postponing a decision indefinitely. Authority for application to the Court was obtained in two cases, but the applications were not in fact exercised and both patients entered hospitals voluntarily. 20 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 1 4 — 4 There were no refusals or appeals. At the end of 1953 there were two registered nursing homes in the Borough. Owing to staffing difficulties it was found necessary to close one of the homes in June 1954. During the year two 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). During the year the medical staff paid 12 visits to the establishments registered for massage and special treatment. One new licence was granted under the Act during 1954. 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 1954. 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 1954. Re-organisation of filing and sanitary records. A new filing system in the Chief Sanitary Inspector's office has been installed, and all records of every property in the Borough have been brought together in separate files relating to each property. 21 Sanitary Inspection of the Area Mr. W. Richards, Chief Sanitary Inspector, reports as follows : No. of inspections made. No. of nuisances detected. No. of complaints received. No. of Intimation Notices No. of Statutory Notices. Total Visits. Served. Complied with. Served. Complied with. 11,815 5,785 1,995 1,551 1,3 2* 195 176* 18,522 * Includes notices outstanding from previous year. Of the 1,551 intimation notices served, 456 were in respect of business premises and the remainder (1,095) related to defects in private houses. Of the latter figure, 908 were complied with without resort to statutory procedure. It was found necessary to institute legal proceedings against owners for non-compliance with eleven Abatement Notices served under Section 93 of the Public Health Act, 1936. Orders were made by the Justices in two cases—in one instance costs of £2 2s. Od. being awarded. In three cases the summonses were withdrawn, the work having been undertaken before the date of Hearing, and six cases were adjourned sine die. The following table shows the nature of work executed and improvements effected during the year Drains tested, 316 ; Drains reconstructed or repaired, 312 ; Drains, obstructions removed, 128 ; Drains, means of access provided, 36 ; Drains, ventilation provided or improved, 27 ; Soil pipes repaired or renewed, 73 ; Rain water pipes repaired or renewed, 112 ; Roofs repaired or renewed, 349 ; Gutterings repaired or renewed, 220 ; W.C. pans and traps provided, 270 ; Gully traps provided, 59 ; W.C's. repaired or cleansed, 240 ; W.C's. light and ventilation improved, 38 ; Waste pipes repaired or renewed, 115 ; New sinks provided, 57 ; Stoves and firegrates repaired or renewed, 166; Water supply reinstated, 9; Yard and forecourt pavings repaired, 62 ; Dirty houses cleansed, 10 ; Dirty rooms cleansed, 193 ; Floors repaired, 229 ; Ventilation under floors provided or improved, 58 ; Dampness remedied, 395 ; Offensive accumulations removed, 9 ; Animals improperly kept, removed, 1 ; Manholes repaired or re-sealed, 82 ; Miscellaneous repairs, 1,267. Infectious Diseases. Visits to premises, 564. 22 Disinfections. Rooms disinfected, 54 ; Articles disinfected, 694 ; Articles destroyed, 72 ; Wasps nests destroyed, 22. Special Premises. Number Visits paid Factories (a) Non-power 61 124 (b) Power 474 675 (c) Other premises 38 48 Outworkers 379 550 Butchers 84 357 Bakehouses 43 167 Fishmongers, Fryers and Curers 44 125 Cafes and Caterers 112 519 Grocers and Greengrocers 365 695 Ice Cream Manufacturers and Vendors 321 375 Dairies and Milksellers 152 222 Laundries 3 9 Hairdressers 74 57 Rag and Bone Dealers 4 25 Piggeries 1 3 Street Stalls Numerous 436 Stables 21 35 Schools — 72 Conveniences 33 As a result of the regular periodical visiting of the above premises the following works were carried out :— Butchers. Cleansings, 46 ; Pavings repaired, 12 ; Accumulations removed, 6 ; New bins supplied, 19 ; W.C's. repaired and cleansed, 10 ; Light and ventilation improved, 3 ; Other improvements, 52. Bakehouses. Cleansings, 39 ; New ceilings fixed, 2 ; Floors repaired, 5 ; Light and ventilation improved, 1 ; Other improvements, 19. Fishmongers. Cleansings, 20 ; Drains cleared, 3 ; Yards repaved, 1 ; Accumulations removed, 3 ; Other improvements, 14. 23 Cafes and Caterers. Cleansings, 61 ; Light and ventilation improved, 7 ; Floors repaired, 10 ; Other improvements, 83. Grocers and Greengrocers. Stores cleansed, 45 ; Washing accommodation improved, 20 ; Other improvements, 34. Ice Cream Manufacturers and Vendors. Cleansings, 16 ; Paving repaired, 1 ; Other improvements, 10. Dairies and Milkshops. Cleansings, 10 ; Other improvements, 10. Laundries. Cleansings, 1. Hairdressers. Cleansings, 6 ; Other improvements, 7. Rag and Bone Dealers. Cleansings, 5 ; Paving repaired, 3 ; Accumulations removed, 1. Street Traders. Stalls improved, 19 ; Store-rooms improved, 2. Stable Premises. Cleansings, 13 ; Accumulations removed, 7 ; Roofs repaired, 2 ; Manure receptacles provided, 1 ; Other improvements, 8. Public Houses. Cleansings, 5 ; Hot water supply improved, 1. Caravans. There are no authorised sites in the Borough. Very little trouble was experienced during the year with unauthorised campers in Folly Lane. They were removed almost immediately. Smoke Abatement. The final report of the Beaver Committee on Air pollution was issued in November. This report is under consideration by 24 ment and it is anticipated that new legislation will be made next year, giving additional powers to local authorities. Complaints of smoke nuisance were received and investigations carried out in respect of 57 business premises. Verminous Premises. The number of houses reported to be verminous still remains comparatively small. One hundred and thirty-four rooms were disinfested and insecticides were issued free of charge to tenants of 83 premises. No notifications were received during the year under the Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1938. 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, the Baths were open on 294 days. Number of Swimming Bath bathers during this period was 124,257. " Maximum load was on September 7th, when we had 819 bathers. During this period we also had 123,285 Slipper Bath bathers." Sampling was carried out on three 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 three occasions with satisfactory results. (d) Forest School.—This is a small swimming bath with a capacity of approximately 65,000 gallons. Sampling was carried out with satisfactory results. 25 (e) Woodford County High School.—Sampling was carried out with satisfactory results. (f) Kingfisher Pool.—The Secretary kindly gives the follow' ing particulars:— "A most disappointing season with very low attendances particularly at week-ends, due to very bad weather. At no time was the pool full to capacity and it was unnecessary to run the plant all night at any time in the season. Total attendances were down in the neighbourhood of 12,000 the corollary of which meant no ' headaches ' in keeping the pool in perfect condition throughout the summer." Bacteriological and chemical analyses were carried out on one occasion with satisfactory results. One sample of river water from the Lea was taken for examination and found to be satisfactory. D.—HOUSING Statistics The Borough Architect, Engineer and Surveyor, F. G. Southgate, Esq., A.R.I.B.A., A.M.T.P.I., has kindly contributed the following :— Houses erected by the Local Authority. 1954. Hoe Street Ward 6 Flats St. James Street Ward — Higham Hill Ward 13 Flats High Street Ward 12 Flats 2 Houses Hale End Ward 14 Flats 22 Houses Wood Street Ward 6 Flats 4 Houses TOTAL 51 Flats 28 Houses Houses erected by Private Enterprise. 1954. Hoe Street Ward — 8 Houses St. James Street Ward — — Higham Hill Ward — 1 House High Street Ward 43 Flats — Hale End Ward — 13 Houses Wood Street Ward 4 Flats 10 Houses TOTAL 47 Flats 32 Houses Note:—All were permanent houses and flats. 26 Houses erected during 1954 During the calendar year, 28 houses and 51 flats, were erected. 32 houses and 47 flats were erected by private enterprise. Schemes completed by the Council during the year include:— 21 Houses Falmouth Avenue/Gordon Avenue. 12 Flats Northcott House, Palmerston Road. 2 Houses 4 Flats Billet Road. 4 Flats Hoe Street. 1 Bungalow Chingford Lane. 8 Flats 2 Houses Maynard Road. 9 Flats Millfield Avenue. 2 Houses Vallentin Road. 6 Flats First Avenue. A number of properties are under construction on various sites throughout the Borough, including schemes of 60 flats and 36 flats in the First and Second Stages of The Drive and Prospect Hill redevelopment area. In addition to the main building programme, the Council have been carrying out improvements and conversions to existing properties. Schemes included are as follows:— Brookscroft Road 10 flats—improvement. Beaconsfield Road 4 houses—improvement. Byron Road 6 houses—improvement. Wimera Lodge, Salisbury Road Conversion into four self-contained flats. Howard Road Conversion of house into flats. Eldon Road 2 houses—repairs and improvements Shakespeare Road 1 house—improvements. 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) 1,900 (b) Number of inspections made for the purpose 5,143 27 (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 94 (b) Number of inspections made for the purpose 76 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 11 (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 1,095 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 908 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 2 (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 185 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners *161 (b) By Local Authority in default of owners *8 28 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 8 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil (3) Number of dwelling houses where Demolition Orders withdrawn (houses made fit) Nil D. Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 1 * Including those outstanding from previous year. Housing Act, 1936 Unfit Houses The following premises were dealt with as follows:— Demolition Orders: 29-30 Back Road. 39-45 Cambridge Road 2-4 Wraggs Cottages, Handsworth Avenue. The Ministry of Housing and Local Government (Form P.13 (HSG)/53)—Return for the year 1954. Part B.—Houses not included in Clearance Areas. Demolition and Closing Orders. (1) Housing Act, 1936 Number of houses Number of persons displaced (a) Houses demolished as a result of formal or informal procedure under Section 11 — — (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) — — 29 (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) — — (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 908 (5) Public Health Acts Number of houses in which defects were remedied after service of formal notices— (a) By owners *161 (b) By Local Authority in default of owners *8 (6) Housing Act, 1936 Number of houses made fit after service of formal notices— (a) By owners — (b) By Local Authority in default of owners — * Includes brought forward from preceding year. Clearance Areas The survey of dwelling houses in Frederick Street, Grange Road and Lynmouth Road was completed in January. As a result of this survey, the Council considered an official representation in respect of this area in February involving a total of 119 houses. The Council decided to make a Clearance Area in respect of these houses and details of the Order were forwarded to the Ministry of Housing and Local Government for confirmation. As objections were lodged by some of the owners of the properties, the Ministry decided to hold a Public Inquiry into the scheme. This Inquiry had not been held by the end of the year. 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) 466 equivalent adult units occupying accommodation with a Permitted Number of 847 units. In other words there was underoccupation to the extent of 381 units or 45%. A further survey involving 32 houses in Chingford Lane, Payzes Cottages, Mill Lane, The Square and Fareys Row was carried out in the early part of the year. An official representation was considered by the Council in April in respect of these dwelling houses. 30 The Council decided to make two Clearance Areas in respect of these properties as follows:— 1. Walthamstow (Chingford Lane and Payzes Cottages) Clearance Area 1954 (comprising 17 dwellings). 2. Walthamstow (Mill Lane, The Square and Fareys Row) Clearance Area 1954 (comprising 15 dwellings). Details of the Orders were forwarded to the Ministry of Housing and Local Government for confirmation. The Census of the dwellings again showed under-occupation as follows:— 1. Walthamstow (Chingford Lane and Payzes Cottages) Clearance Area 1954—42½ units occupying; under-occupation 56%. 2. Walthamstow (Mill Lane, The Square and Fareys Row) Clearance Area 1954—45 units occupying; under occupation 57%. Housing Repairs and Rents Act, 1954 The above Act came into operation in September repealing certain provisions in the Rent and Mortgage Restriction Acts. Up to the end of the year, the following action was taken under this new Act:— Certificates of Disrepair issued 93 „ „ „ refused 2 Certificates of Revocation issued 15 „ „ „ refused — This Act empowered the Landlords of dwelling houses to increase rents, provided the property was in good repair. The above Certificates of Disrepair were issued where a Landlord had proposed a rent increase and the premises were found not to be in good repair. When the Landlord had carried out the works specified on these certificates, a Certificate of Revocation was issued, thus allowing an increase of rent. In order to speed up the procedure under this Act the Council delegated the necessary powers under Section 26 of the Act to the Health Committee, i.e., to grant, revoke, or refuse Certificates of Disrepair. Rent and Mortgage Restriction Acts One certificate was issued under the above Act and was later revoked on completion of the works required. 31 General Mr. C. W. Rayner, the Council's Housing Manager, kindly gives the following details of rehousing carried out by his Department in 1954:— No. of new properties made available for letting 93 Acquired 4 Normal vacancies 71 Nominations to private landlords 23 Total 191 Families rehoused:— 1-bedroom group 32 2-bedroom group 77 3-bedroom group 74 4-bedroom group 8 Total 191 Of the total number of families rehoused, in 8 instances there was a medical recommendation made in respect of tuberculosis. Rehousing of Medical Cases During 1954, 63 cases claiming rehousing priority for tuberculosis were investigated and reported upon. Of these 21 cases were added to the list of cases. The position at the end of 1954 was as follows:— Class 1 Class 2 Class 3 Total On List at end of 1953 4 10 6 20 Added to list during 1954 8 4 9 21 12 14 15 41 Rehoused or removed from List during 1954 4 4 3 11 On List at end of 1954 8 10 12 30 In addition to the tuberculosis cases, 58 other cases were recorded as needing special consideration on medical grounds, and 67 cases on general housing grounds. 32 In order to assess medical and rehousing claims enquiries were made from the Chest Clinic, Housing Department and various hospitals, from all of 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. Housing Act, 1936, Section 62 Applications for "permitted number" were received from landlords and certificates issued during the year respecting 51 lettings. Local Land Charges Enquiries relating to outstanding sanitary notices were dealt with in 1,854 cases. E.—INSPECTION AND SUPERVISION OF FOOD The following is contributed by the Chief Sanitary Inspector:— (a) Milk Supply. Designated Milk. During the year 150 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. The following table gives details of samples taken:— Grade No. of Samples Results Satisfactory Unsatisfactory (Methylene Blue Test) Pasteurised 102 102 — Tuberculin Tested (Pasteurised) 43 38 5 Tuberculin Tested (Farm bottled) 3 3 — Lactachoc 2 2 — Totals 150 145 5 33 Biological Test Thirty-seven samples of raw milk, as delivered to Pasteurisers Depots in the Borough, were submitted to the Counties Laboratories for biological examination, on behalf of the Essex County Council. All were satisfactory except for four samples—two of which gave inconclusive results and two were positive. 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 48 Pasteurised 9 Sterilised 130 Sterilised 11 Tuberculin Tested 17 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 152. Two hundred and twenty-two 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. Thirty-seven applications for Registration were received and were dealt with as follows:— Vendors, New 24 Vendors, Transfers 12 Refused 1 Number on Register at end of year 321 Number of premises used for manufacturing 9 34 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. Three samples were taken and submitted to the Public Analysts who reported the following satisfactory results:— Fat content 8.76% 7.7 % 6.5 % Medical Examination—Typhoid, Etc., Carriers. The scheme of voluntary medical examination and blood testing of employees in the ice cream trade has now reached its eighth year. Thirty-four persons had blood specimens taken. No "Carriers" were found during the period under review. Bacteriological Examination of Ice Cream. Ninety-eight 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 = 76 „ II = 19 „ 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. Lollies (Various). Twenty-eight samples were examined for bacterial purity, four of which were unsatisfactory. 35 (c) Meat and Other Foods There are no slaughterhouses operating in the Borough. 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. 1439 tins Evaporated Milk 623 lbs. Apricot Pulp (tinned) 187 „ Full Cream Milk 60 „ Apples 143 ,, Skimmed Milk 22 „ Grapes 32 „ Cream ½ case Oranges 2 „ Baby Food ½ bag Chestnuts 2 „ Strained Foods 40 tins Sandwich Spread 21 lbs. Dried Milk 21 „ Jam 2 tins Coffee Beverage 4 „ Marmalade 1020 „ Peas 1 tin Syrup 193 „ Beans 1 jar Meat Paste 94 „ Tomatoes 9 tins Pease Pudding 15 „ Carrots 2 lbs. Christmas Pudding 8 „ Rhubarb 6 tins Spaghetti 4 „ Spinach 1 tin Macaroni Cheese 4 „ Vegetable Salad 5 tins Butter Beans 10 lbs. Tomato Puree (tinned) 1¼ ozs. Spice 1 boat Tomatoes 35 botts. Ketchup 560 lbs. Potatoes 1 jar Pickles 180 „ Cabbages 1 „ Salad Cream 345 tins Plums 232 tins Soup 103 „ Peaches 6 „ Irish Stew 102 „ Bilberries 2 „ Broth 101 „ Oranges 1 lb. Meal 98 „ Pineapple 8 lbs. Tapioca 97 „ Damsons 840 „ Prunes 78 „ Pears 25 „ Dried Peaches 71 „ Fruit Salad 12 doz. Eggs 48 „ Apples & Cranberries 48 lbs. Flour 44 „ Apricots 34 „ Icing Sugar 36 „ Cherries 9¾ „ Sponge Mixture 32 „ Strawberries ½ „ Cut Peel 27 „ Blackberries 10 „ Coconut 22 „ Raspberries l½ „ Grapenuts 20 „ Loganberries 1 pkt. Jelly 16 „ Apples 53 lbs. Cheese 15 „ Gooseberries 55 „ Biscuits 14 „ Grapefruit 4 pkts. Wholemeal Biscuits 12 „ Greengages 1 lb. Tea Cakes 11 „ Prunes 1 Blackcurrant Tart 10 „ Blackcurrants 1 Fruit Pie 10 „ Figs 105 lbs. Coconut Ice 7 „ Grapefruit Juice 1 lb. Chocolate 3 „ Pineapple Juice 186 tins Crab 1 tin Orange Juice 28 „ Pilchards 36 6 tins Silds 1 tin Tongue 5 „ Salmon 1 „ Kidneys 4 „ Brisling 1 „ Minced Meat Loaf 2 „ Sardines 1 „ Steak Pudding 1 tin Lobster 1 „ Steak and Kidney 1 „ Crayfish 1 „ Rabbit 1 „ Herrings 693 lbs. Corned Beef 1 „ Tuna Fish 372 „ Ham (tinned) 29 stone Whiting 96 „ Jellied Veal (tinned) 17½ „ Skate 84 ,, Pork (tinned) 4½ „ Plaice 20 „ Lamb's Livers (tinned) 4¼ „ Roe 10 ,, Brisket (tinned) 2 „ Kippers 2362 „ Beef 10 bags Mussels 1278 „ Bacon 226 tins Luncheon Meat 294 „ Ox Cheeks 67 „ Stewed Steak 260 „ Pork 29 „ Beef Loaf 91 „ Pigs' Hearts 15 „ Sausages 15 „ Sausages 13 „ Mutton 8 „ Pigs* Kidneys 6 „ Beef 4½ „ Liver 5 „ Brawn 4½ „ Kidney Fat 4 „ Meat Pudding 4½ „ Beef Suet 3 „ Meat & Gravy 4 Meat Pies 2 „ Pork 11 Chickens 2 „ Steak & Onions 9 Turkeys Shellfish, Jellied Eels and Cooked Meats. The following samples were taken during the year for bacteriological examination:— Mussels 4 Jellied Eels 13 Cooked Meats 12 As a result of this sampling a certain improvement in the standard of these articles of food was obtained. Sampling of Cooked Meats. As the amounts of cooked meats exposed for sale to the public has increased very considerably recently, the Council decided that sampling of these products should be carried out. These samples were to ascertain whether the products are:— (1) suitable for food, (2) manufactured under clean conditions, (3) subject to contamination after manufacture, (4) properly stored before being sold to the public, (5) handled under hygienic conditions. Sampling was commenced on 24th November, 1954, and up to the end of the year a total of 12 samples had been taken. 37 Reports received in respect of these samples were as follows: 2 samples—satisfactory. 8 samples—better results should have been obtained. 2 samples—very unsatisfactory. With respect to the two unsatisfactory samples, these contained very large numbers of bacteria (24 millions and 62 millions). These figures indicated that the meat products were not produced under clean conditions, or had been kept under unsuitable conditions without refrigeration. The bacteria present indicated objectionable contamination after cooking, or reached such a degree of staleness as to be unfit for human consumption. On receipt of these two results, immediate action was taken and instructions given to the manufacturers and retailers with respect to manufacture, handling, and storing of the products. Further samples of the same products indicated very great improvement—the samples being satisfactory. In the case of the eight samples where better results should have been obtained, the contamination was due mainly to dirty handling, insufficient protection of the product when exposed for sale, or unsatisfactory storage. Advice and instructions have been given to the retailers on these lines. It is my intention to continue taking these samples for a considerable period until I am satisfied that all steps are taken to ensure that these products are sold to the public in a satisfactory condition. The samples taken include such foods as Pork Brawn, Calves Tongues, Pork Luncheon Meats, Corned Beef, Cooked Silverside, Liver Sausage, and various other products. So far as I am aware, Walthamstow is the first authority throughout the country to institute sampling of these products, and in view of the results obtained probably other authorities in various parts of the country will be following suit. (d) Adulteration, etc.—Food and Drugs Act, 1938. During the year, ninety-five samples of food and drugs were submitted to the Public Analysts. Six were reported as being unsatisfactory, details respecting same are given below:— Description of Article Result of Analysis Action Taken Sausages, Pork (2) 12% deficient fat Warning given. 6% „ „ Oranges (2) Thiourea present „ „ Whipping Cream No milk fat present „ „ Vinegar Acetic Acid 4.5%. (Non-brewed). „ „ 38 The following summary gives details of food sampled and results of analyses:— No. examined No. unsatisfactory Formal Informal Total Formal Informal Total Milk 7 1 8 — — — Baked Beans — 1 1 — — — Butter Puffs — 1 1 — — — Butter Mints — 1 1 — — — Coffee and Chicory 1 — 1 — — — Coffee 2 — 2 — — — Orange Squash — 1 1 — — — Fresh Orange drink — 1 1 — — — Pepper — 1 1 — — — Pepper Flavoured Compound — 2 2 — — — Sausages, Beef 3 1 4 — — — Sausages, Pork 12 2 14 1 1 2 Sausages, Unclassified 2 — 2 — — — Sausage Rolls — 1 1 — — — Sugared Strands — 1 1 — — — Ale 1 — 1 — — — Whisky 6 — 6 — — — Beer 1 — 1 — — — Gin 1 — 1 — — — Wine — 1 1 — — — Sherry 1 — 1 — — — Cough Remedy — 1 1 — — — Medicinal Glucose — 1 1 — — — Cake Flour — 1 1 — — — Self-raising Flour — 2 2 — — — Pie-filling, Lemon Flavour — 1 1 — — — Soya Flour — 1 1 — — — Cloves, Ground — 1 1 — — — Almonds, Ground 1 2 3 — — — Cinnamon, Ground — 1 1 — — — Cream 1 1 2 — — — Honey — 1 1 — — — Jam — 2 2 — — — Lemon Curd — 1 1 — — — Oranges — 5 5 — 2 2 Whipping Cream — 1 1 — 1 1 Bread and Butter 2 — 2 — — Butter — 4 4 — — — Margarine — 2 2 — — — Custard Powder — 1 1 — — — Ice Cream 3 — 3 — — — Lemonade Powder — 1 1 — — — Vinegar, Malt 4 — 4 1 — 1 Condiment, Non-brewed 1 — 1 — — — Salmon Spread — 1 1 — — 49 46 95 2 4 6 39 (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. A reasonably high standard is now being maintained in the food premises within the Borough. A large number of food stalls were entirely reconditioned and brought up-to-date. It was necessary to serve notices under the Food and Drugs Act in a few cases, most of which had been complied with by the end of the year. 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, 43; Fishmongers, 44; Cafes and Caterers, 112; Grocers and Greengrocers, 365; Dairies and Milksellers, 152; Ice Cream Manufacturers and Vendors, 321. The following premises were registered under Section 14 of the Food and Drugs Act, 1938:— 150 and 152 Wood Street. 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, 357; Bakehouses, 167; Fishmongers, 125; Cafes and Caterers, 519; Grocers and Greengrocers, 695; Ice Cream Manufacturers and Vendors, 375; Dairies and Milksellers, 222. 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. (g) Food Poisoning Outbreaks. Twenty-two notifications were received and investigated. Further particulars will be found on page 47. 40 Epidemiology In November the Council agreed to allow the fees, travelling expenses, and appropriate subsistence allowances for those sanitary inspectors who wished to attend a course at the Public Health Laboratory, Colindale, on the "Bacteriology of Food Poisoning." The names of six district inspectors were submitted. DISEASES OF ANIMALS ACTS Fowl Pest Order, 1936. Two Orders affecting movements of poultry in the borough were issued by the Ministry of Agriculture and Fisheries. These Orders were in respect of poultry brought from infected areas outside the borough. One licence was issued during the year allowing an exhibition of poultry to be held. Swine Fever (Infected Areas) Order, 1953. No licences were issued during the year under the above Order in respect of the movement of swine. 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 is a summary of work carried out during the year 1954:— 41  Type of Property Local Authority Dwelling Houses Agricultural All other (including Business Premises) TOTAL 1. Total No. of Properties in Local Authority's District 18 33,445 4 3,658 37,125 II. No of Properties inspected by the Local Authority during 1954 as a result of : (a) Notification 2 261 — 78 341 (b) Survey 14 76 — 1 91 (c) A visit primarily for some other purpose — 2 — 12 14 III. No. of Properties inspected (see Section II) which were found to be infested by rats : (a) Major 3 — — 2 5 (b) Minor — 290 — 56 346 IV. No. of Properties inspected (see Section II) which were found to be seriously infested by mice — 24 — 32 56 V. No. of Infested Properties (see Sections III and IV) treated by the Local Authority 3 314 — 90 407 VI. No. of Notices served with respect to: (1) Treatment — — — — — (2) Structural Works (i.e., Proofing) — 38 verbal 10 written — — 38 verbal 10 written VII. No. of cases in which de* fault action was taken by the Local Authority following the issue of a Notice — — — — — VIII. Legal Proceedings — — — — — IX. No. of "Block" Control Schemes carried out 1 24 — 1 26 42 FACTORIES ACTS, 1937 & 1948 The following tables show the work carried out under these Acts:— 1.—INSPECTION OF FACTORIES, ETC. Including Inspections Made by Sanitary Inspectors. Premises. No. on Register Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) (5) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 61 124 10 — Factories not included above in which Section 7 is enforced by the Local Authority 474 675 69 — Other premises in which Section 7 is enforced by the Local Authority 38 48 — — Totals 573 847 79 — 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 53 — 4 — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation 12 6 — — — Ineffective drainage of floors 5 4 — — — Sanitary Conveniences insufficient 8 4 — 3 — unsuitable or defective 129 94 — 11 — not separate for sexes 3 4 — 1 — Other offences 24 19 2 — — Totals 255 184 3 19 — 43 NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1954 Wearing apparel, making of 300 Boxes 11 Brush making 7 Curtains and furniture hangings 7 Feather sorting 1 File making 1 Cosaques, Christmas crackers, Christmas stockings, etc. 42 Umbrellas, etc. 1 Artificial flowers 5 Paper bags 3 Lampshades 1 Total 379 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 during 1954 was much smaller than during the previous year. There were more cases of measles than in 1953, and there were two epidemic years in succession. Again there was no case of confirmed diphtheria. Cases of pneumonia were fewer but since there is no apparent usefulness in the notification of this disease, notifications were probably not complete. There was no notified case of poliomyelitis, a most unexpected experience. There was an increase in the incidence of bacillary dysentery. This is a disease which can only be combated by the teaching and practice of strict personal hygiene, i.e., by the washing of hands after using the toilet. Pulmonary tuberculosis notifications after remaining comparatively steady over the previous three years at 104 cases per annum, showed a marked reduction to 60. 44  All ages 0-1 year 1-4 years 5-14 years 15-24 years 25-44 years 45-64 years 65 & over years 1954 1953 Scarlet Fever 187 289 1 46 136 3 — 1 — Whooping Cough 372 692 27 158 180 2 3 1 1 Measles 834 974 19 326 489 — — — — Diphtheria — — — — — — — — — Pneumonia 89 121 1 — 11 10 16 32 19 Meningococcal Infection 3 3 — — 2 1 — — — Acute Poliomyelitis: Paralytic — 6 — — — — — — — Non-Paralytic — 2 — — — — — — — Acute infective encephalitis 2 — — — 1 — — 1 — Post infectious encephalitis — 1 — — — — — — — Dysentery 159 84 1 22 108 6 15 4 3 Ophthalmia Neonatorum 5 1 5 — — — — — — Puerperal Pyrexia 71 82 — — — 30 41 — — Smallpox — — — — — — — — — Paratyphoid Fever — 1 — — — — — — — Typhoid Fever 1 — — — — 1 — — — Food Poisoning 22 22 4 2 3 4 6 3 — Erysipelas 34 27 — — — 1 8 15 10 Malaria 2 2 — — — 1 1 — — Tuberculosis: Respiratory 60 103 — 2 — 22 16 20 — Non-Pulmonary 4 9 — — — 1 2 1 — Central Nervous System 3 5 — 1 — 1 — 1 — Totals, 1954 1848 — 58 557 930 83 108 79 33 T otals, 1953 — 2424 81 916 1053 96 163 73 42 St. James Street High Street Hoe Street Wood Street Hale End Higham Hill Total Scarlet Fever 18 15 24 16 78 36 187 Whooping Cough 46 55 58 30 70 113 372 Measles 139 134 176 105 79 201 834 Diphtheria — — — — — — — Pneumonia 20 9 16 7 12 25 89 Meningococcal Infection — 1 — 1 — 1 3 Acute Poliomyelitis: Paralytic — — — — — — — Non-Paralytic — — — — — — — Acute infective encephalitis — — 2 — — — 2 Post infectious encephalitis — — — — — — — Dysentery 14 9 77 4 11 44 159 Ophthalmia Neonatorum — — 2 1 2 — 5 Puerperal Pyrexia 5 4 4 34 11 13 71 Smallpox — — — — — — — Paratyphoid Fever — — — — — — — Typhoid Fever — — — — — 1 1 Food Poisoning 3 4 2 1 4 8 22 Erysipelas 4 5 4 1 12 8 34 Malaria — — — — — 2 2 Tuberculosis: Respiratory 11 4 11 6 17 11 60 Non-Pulmonary — — — 1 — 3 4 Central Nervous System 1 1 — — — 1 3 Totals, 1954 261 241 376 207 296 467 1848 T otals, 1953 334 197 314 335 546 698 2424 45 The following is a summary of the Quarterly Returns made to the Ministry of Health:— 1st qtr. 2nd qtr. 3rd qtr. 4th qtr. Total Scarlet Fever 46 39 29 73 187 Whooping Cough 207 92 58 15 372 A.P.M.—Paralytic — — — — — Non-Paralytic — — — — — Measles 91 205 230 308 834 Diphtheria — — — — — Pneumonia 25 19 16 29 89 Dysentery 111 40 7 1 159 Smallpox — — — — — Infective encephalitis — — 1 1 2 Post infectious encephalitis — — — — — Typhoid Fever — — 1 — 1 Paratyphoid Fever — — — — — Erysipelas 6 7 4 17 34 Meningococcal Infection — — 1 1 2 Food poisoning 3 4 7 8 22 Puerperal Pyrexia 18 16 19 18 71 Ophthalmia Neonatorum 3 2 — — 5 Malaria 1 — — — 1 Tuberculosis— Respiratory 15 22 12 11 60 Non-Pulmonary 2 1 — 1 4 Central Nervous System 1 — 1 1 3 SCARLET FEVER Although 187 cases of scarlet fever were notified during 1954 as against 289 during 1953, an extremely troublesome outbreak occurred in the Sidney Burnell Infant School which continued to a lessening degree into 1955. The outbreak is fully noted in the Report of the Borough School Medical Officer. DIPHTHERIA Six cases were removed to hospital for observation but none was confirmed. One case was diagnosed as Vincents Angina, four cases as streptococcal tonsillitis and one as non-specific tonsillitis. There has been no death from diphtheria in the Borough for eight years and the last confirmed case of diphtheria was notified in January, 1950. Diphtheria remains a deadly disease, but unfortunately, in its absence, complacency continues. Every baby should be immunised before reaching the age of one year. INFLUENZA Following an enquiry in June from the Medical Staff of the Ministry of Health as to local experience in the "Great Towns" of England and Wales, an enquiry was made as to the incidence of influenza in schools during the winter of 1953/4. 46 During the last thirteen weeks of 1953 and the first thirteen weeks of 1954, there was an average of thirty three cases in each of these quarters, i.e., as reported by the Education Welfare (School Attendance) Officers. At seven school departments there were five cases or more. "GASTRIC" INFLUENZA OR EPIDEMIC NAUSEA AND VOMITING Four schools were involved with three staff and twenty-four children affected. Visits were paid by the Medical and Sanitary Staffs and rectal swabs were taken in some cases to exclude the possibility of food poisoning. In each instance the incidence terminated in a few days. MENINGOCOCCAL INFECTION Three cases were notified, the particulars being as follows:— Sex Age Ward Hospital Remarks 1. F. 15 yrs. Hi Yes Recovered 2. M. 10 yrs.. HH Yes Recovered 3. M. 7 yrs. W Yes Recovered MALARIA Two cases were notified during the year. Both were ex-Ser vice men who had resided abroad and had had previous attacks. ACUTE ANTERIOR POLIOMYELITIS AND POLIOENCEPHALITIS Seven cases were removed to hospital for observation but no case was confirmed. The incidence was singularly light in the South West Essex County Boroughs and Boroughs. Three other Boroughs recorded no notifications. ENCEPHALITIS—INFECTIVE AND POST INFECTIOUS There were two cases of infective encephalitis notified. Sex Age Ward Hospital Remarks 1. M. 45 yrs. Ho Yes Recovered 2. F. 10 yrs. Ho Yes Died. P.M. No case of post infectious encephalitis was notified. OPHTHALMIA NEONATORUM Five cases of ophthalmia neonatorum were notified but in no case was vision impaired. 47 SMALLPOX No notification of this disease was received. ENTERIC FEVER On case of typhoid fever—Vi-phage type A was notified from St. Ann's Hospital in August. The patient had returned from holiday in Italy. The source of infection was not definitely traced, but may have been abroad. Bacillary Dysentry (Sonne) A total of 159 cases of bacillary dysentery was notified. Early in February a Head Teacher reported two or three cases of diarrhoea in a junior department. The school was visited by Medical and Sanitary Staff and special facilities were made available to enable the children to wash during the severe "freeze-up". Paper towels and howls were supplied and the caretaker received special instructions in regard to disinfection of lavatory seats, chains and door handles. Absentees were visited daily by the School Nurses and rectal swabs taken. Local doctors were circularised and asked to co-operate in the taking of rectal swabs and this was willingly done. The outbreak lasted till the end of March when 42 cases had been notified. There were also 11 cases notified from the adjoining Infants Department and from 15 other schools, a total of 54 cases was notified during the period from February to 7th September. 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 74 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. FOOD POISONING The following information is in the form required by the Ministry of Health:— 1. Local Authority—Walthamstow. Year 1954. 2. Food Poisoning Notifications (Corrected) Returned to R.G. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 3 4 7 8 22 48 3. Outbreaks Due to Identified Agents. Total Outbreaks: — Total Cases: — 4. Outbreaks of Undiscovered Cause. Total Outbreaks: 4 Total Cases: 60 (but not all notified.) 5. Single Cases. Agent Identified Unknown Cause Total Salmonella Typhi Murium 4 17 22 Salmonella 1 During September last outbreaks of gastro-enteritis occurred at 4 factory premises in the Borough. Immediate investigation was carried out by the Sanitary Inspectorate at the factory canteens concerned and details of findings are given in the following table. A letter of advice on food hygiene was compiled in conjunction with the Chief Sanitary Inspector and was circulated by him to all factory managements in Walthamstow providing canteen facilities. Date Number affected Number at risk Suspected Food Pathological results Suspected cause Degree of illness Remarks 2 .9.54 28 78 Stewed Steak No specimens available Contamina' tion of plates Slight Canteen standards high. Suggestions made re dish washing. 2 . 9.54 9 30 Stewed Steak All specimens negative ? Slight Left over steak used next day and badly stored. Improvement sug' gested. 8 . 9.54 18 75 Nil. (See "Remarks" Column) All specimens negative Carrier Slight A canteen worker previously had diarrhoea & sick' ness. Declined co'operation. Re' signed. 11.11.54 5 33 Beef No specimens available ? Slight Canteen standards high. 49 TUBERCULOSIS The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1954:— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year — — — — — — — — 1- 5 years 2 — 1 — — — 1 — 5-10 „ — — — — — — — — 10-15 „ — — — — — — — — 15-20 „ 6 6 1 1 — — — — 20-25 „ 4 6 — — — — — — 25-35 „ 5 4 1 — — 1 — — 35-45 „ 4 3 — 1 1 — — — 45-55 „ 9 2 — 2 3 2 — — 55-65 „ 7 2 — — 1 — — — 65 and over — — — — 2 — — — 37 23 3 4 7 3 1 — Totals 60 7 10 1 67 11 As each new case of pulmonary tuberculosis has been notified, enquiry has been made as to the infectivity of the patient. Of 60 cases investigated, 25 were sputum positive on notification or soon after i.e. 42%. 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. 1954 37 23 3 4 67 7 3 1 — 11 1953 .. 61 42 7 7 117 19 3 — — 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. 1 1 1 — — — — — 8 — — — — — 50 Non-Notification. It is gratifying to report that for the first time on record there was no failure to notify any case of tuberculosis before death, although in three cases the interval between notification and death was one day, fourteen days, and four months, respectively. The following table compares notifications, deaths and net survivals for two 12-year periods, i.e. 1931/42 and 1943/54:— 12-year period Notifications Deaths Net Survivals 1931/1942 1,911 1,016 895 1943/1954 1,624 561 1,063 There is, of course, no strict correlation between notification and deaths in any particular year. During the second period there were 287 fewer notifications but 405 fewer deaths, i.e. there was an increase of 168 in net survivors less any who may have been discharged cured in the meantime. Many of these survivors will be sputum positive cases and the net result is an increase in the number of infective persons in the community. It can only be hoped that such persons adhere rigidly to the routine which they have been taught, to minimise the spread of infection. 51 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. 52 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 Sub-Committee administering the Part III Services under the National Health Service Act. The preventive services operated by the Borough Council included the following:—Rehousing on Medical Grounds, "Mobile Meals" where necessary and Sanitary Inspection, both to improve living conditions and to investigate possible sources of infection. MORBIDITY The arrangement under which a statement of new claims for Sickness Benefit is received weekly from the Ministry of National Insurance has provided an interesting measure of morbidity. During the past three years the weekly averages of new claims were as follows. The extraordinary consistency of those for the months of Tune to November will be noted. 1952 1953 1954 January 464 747 500 February 433 832 513 March 390 401 375 April 350 300 267 May 270 232 314 June 214 237 252 July 200 197 220 August 205 201 209 September 262 257 284 October 369 370 348 November 311 360 366 December 426 291 299 (The large number of claims in January and February, 1953, apparently reflected the delayed effects of the severe "smog" experienced in December, 1952.) G.—MISCELLANEOUS 1. Old People's Welfare. (a) General. The Town Clerk, as Honorary Secretary of the Walthamstow Old People's Welfare Committee, states that the Committee's "Meals on Wheels" Service provided 16,074 meals during 1954. Five rounds are now operated on Monday, Wednesday and Friday. The meals are obtained from the Council's Catering 53 ment and distributed by voluntary workers in cars hired by the Committee. This scheme has been in operation in this form since March 1948 and is an essential one for old people who would not otherwise be able to get a cooked meal. The Committee also provided seven old people's clubs in different parts of the Borough and shared the expense of a club at Woodford Green with the Wanstead and Woodford Old People's Welfare Association. The Committee continued to act as the co-ordinating committee for old people's welfare and maintained close liaison with other statutory authorities engaged in-this work. 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) Ample home nursing and domestic help facilities, including weekend help. (3) Increased chiropody facilities. (4) Companionship, sitters-in and occupational therapy. (5) 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: Bedsteads 6; Mattresses 7; Bolster 1; Pillows 2; Blankets 2; Waterproof Sheet 1; Nightdresses 2; Night Commode 1; Chairs 3; and Table 1. (b) Action by Health Visitors. The Health Visitors have been instructed to acquaint themselves as far as possible with all elderly people in their districts and bring to notice any who need help in any way. In addition regular visits are paid to old people in Council Hostels and flats and also both before and after discharge from the Geriatric Wards at Langthorne Hospital, particularly with a view to arranging home nursing, domestic help and/or Meals on Wheels. 54 2. Laundry for the Incontinent. At a Conference convened by the Borough Council in 1953 on the problems and progress of Old People's Welfare reference was made to the need for this service. Subsequently a report was made to the Council that the service could be provided under Section 84 of the Public Health Act, 1936, which gives power "to cleanse at the authority's expense upon a certificate from the Medical Officer of Health or the Sanitary Inspector any article that requires, to be cleansed in order to prevent injury or danger of injury to the health of any person in the premises." Authority was given for a pilot scheme to be put into operation and it was decided that the laundering should be done by the contractor to the hospital service after preliminary cleansing and disinfection at the disinfecting station. The articles dealt with under the scheme comprise mainly bed linen, night clothing or underclothing, and provided the Sanitary Inspector issues a certificate, renewable quarterly, the service is free to the patient. The service can only be given if it is impossible for the washing to be done at home by the relatives or a domestic help. The necessary equipment was installed at the Disinfecting Station and the collection, rinsing and disinfection is done by the Disinfecting Staff. The scheme was put into operation on the 1st March, 1954, and collection is made weekly, the articles being returned completely laundered within twenty-four hours. The following figures show the number of cases dealt with and the actual cost up to the end of the year:— Total No. of Cases 12 Average No. of Cases per week 4 Total No. of articles 1,287 Average No. of Articles per week 29 Total No. of journeys 336 Total Cost of Collection, Delivery, and Laundering (i.e. excluding equipment) £146 approx. The Council authorised the provision of equipment necessary to complete the Laundry installation at Low Hall Farm, i.e. an Electrolux Steam Washing Machine at a cost of £210 and an Electrolux Hydro Extractor at a cost of £155. 3. Funeral Arrangements. Arrangements were made in regard to the burial of 3 persons. A new contract for burials under the National Assistance Act, 1948, was negotiated with the usual firm at a slightly increased fee. 55 4. Medical Examinations. During the year the medical staff carried out 269 examinations of Borough Council employees in respect of the Superannuation and Sick (Pay Schemes. 5. 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. 6. Cancer Education. The leaflet of advice printed in the 1951 Report is available for distribution. 7. General. The Borough Architect, Engineer and Surveyor contributes the following information:— (a) Public Conveniences. Work was commenced on the erection of a new public convenience in Larks Hall Road, and, during the year, certain existing conveniences have been modernised. The construction of a public convenience at St. James Street Car Park will be commenced early in the new year. During 1954 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. (b) Cremation. Facilities for cremation are available at the Crematorium provided by the City of London at Manor Park, Little Ilford. Negotiations continued with adjoining Local Authorities. (c) Rainfall. The annual rainfall at Ferry Lane Station was 24.95 ins. (d) Inquests and Post Mortems. Walthamstow Others Total Post Mortems only 119 228 347 Post Mortems and Inquests 23 55 78 Inquests only 6 30 36 56 GENERAL INFORMATION Duly Authorised Officers: Essex County Council Offices, West Avenue, E.17. (Telephone: COP permill 2418) Office Hours: Mondays to Fridays 9 a.m. to 5.30 p.m. Saturdays 9 a.m. to 12.30 p.m. Social Welfare Department: Essex County Council Offices, 35 Wanstead Place, E.ll. (Telephone: WANstead 0031) Registrar of Births and Deaths: Mr. P. Folkerd, 7 Chingford Road, Walthamstow, E.17. (Telephone: LARkswood 5156) Office Hours : Mondays 9.30 a.m. to 12 noon, 2 p.m. to 5 p.m. 6 p.m. to 8 p.m. Tuesdays and Thursdays 9.30 a.m. to 12 noon, 2 p.m. to 5 p.m. Wednesdays, Fridays and Saturdays 9.30 a.m. to 12 noon. Registrar of Marriages: 663 Lea Bridge Road, Leyton, E.10. (Telephone: COPpermill 2419) Office Hours: Mondays to Fridays 9.30 a.m. to 4.30 p.m. Saturdays 9.30 a.m. to 12.30 p.m. National Assistance Board: 12 Church Hill, Walthamstow, E.17. (Telephone: LARkswood 3347) Office Hours: Mondays to Thursdays 9 a.m. to 1 p.m., 2 p.m. to 4 p.m. Fridays 2 p.m. to 5 p.m. Saturdays 9 a.m. to 12 noon. Ministry of Pensions and National Insurance: 1 Wood Street, Walthamstow, E.17. (Telephone: LARkswood 6821) Office Hours: Mondays to Fridays 10 a.m. to 4 p.m. Saturdays 9 a.m. to 11.30 a.m. 57 SECTION H NATIONAL HEALTH SERVICE ACT, 1946 PART III SERVICES WALTHAMSTOW HEALTH AREA SUB-COMMITTEE (1954/55) Chairman: Alderman The Lady McEntee, J.P. (Essex County Council). Vice-Chairman: Alderman E. C. Redhead, J.P. (Walthamstow Borough Council). Members: Nominated by— Essex County Council Alderman Mrs. M. Ball (Chair' man, Health Committee, E.C.C.). Alderman Mrs. B. K. Lowton. Councillor C. F. H. Green, (ViceChairman, Health Committee, E.C.C.). „ „ „ Councillor Mrs. L. P. Bailey, J.P. „ „ „ Councillor Mrs. A. M. Burrell. „ „ Councillor H. J. E. Palethorpe. Walthamstow Borough Council Alderman G. S. Mace. „ „ „ Alderman A. E. Manning. „ „ „ Alderman W. H. Shaw. ., „ „ Councillor Mrs. E. L. Baldwin. „ Councillor C. J. Crosbie. „ „ „ Councillor L. Jones. „ „ „ Councillor Mrs. M. E. Marchant. „ Councillor J. E. Nicholls. „ „ „ Councillor Mrs. W. M. thorpe. „ „ „ Councillor J. W. Pringle. „ „ „ Councillor W. F. Savill. „ ,, „ Councillor Mrs. C. E. Stannard. „ ,, „ Councillor A. F. Whicher. „ „ „ Councillor J. M. Wight. Hospital Management Committee Mrs. B. E. Bottomley. 58 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, 42 whole-time members of the Health Area Staff resigned their appointments and 52 new appointments were made. 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 each to serve an area with a radius of one mile. GENERAL DENTAL SERVICE The Senior Dental Officer reports as follows:— "Considerably more work could have been carried out during the year had it been possible to devote more sessions to the service but, with the exception of Monday and Friday evenings, the dental suites at the Town Hall have been fully occupied by surgeons throughout the week. The number of dental sessions undertaken during the last three years have been— 691 in 1952, 693 in 1953 and 686 in 1954." 59 Herewith is a summary of the work carried out during the years 1953 and 1954 1953 1954 Number of patients treated 680 725 Appointments made 4,531 4,548 „ kept 4,150 4,054 Plastic fillings 2,066 total 465 437 2,125 total Amalgam 1,601 1,688 Inlays 4 4 Crowns 36 21 Sealings and gum treatments 411 387 Dressings 628 758 No. of teeth extracted 959 755 General anaesthetics 207 222 Local „ 345 418 X-rays 270 440 Impressions 623 627 Bites 163 168 Try-ins 227 213 Full upper dentures 280 total dentures 91 96 262 total dentures lower „ 79 64 Partial upper dentures 72 60 lower 38 42 Repairs 182 195 DENTAL LABORATORY Herewith is a list of the appliances completed for the General Dental Service: 1953 1954 New Dentures 291 253 Orthodontic Appliances – 1 Crowns 8 8 Repairs 182 207 Inlays – 2 During the year the following work was carried out for the Walthamstow and Leyton Committees for Education:— Walthamstow Leyton Orthodontic Appliances 247 25 Dentures 61 – Crowns 18 – Repairs 47 12 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 16 Dentures 36 Repairs 16 60 The following work was undertaken for the Maternity and Child Welfare Patients:— New Dentures 23 Crowns 3 Repairs 6 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 1,132 1,012 Low Hall Lane Clinic 131 63 Silver dale Road Clinic 27 8 West Avenue 3 2 District Nurses' Training Home and Midwives' Homes 304 – Totals 1,597 1,085 Total Attendances— Ante-Natal Post-Natal Thorpe Coombe Maternity Hospital 10,838 1,163 Low Hall Lane Clinic 760 80 Silverdale Road Clinic 120 11 West Avenue Clinic (part year only) 20 1 District Nurses' Training Home and Midwives' Homes 2,072 29 Totals 13,810 1,284 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, when they were unable to attend at the ordinary weekly clinic. 61 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. During 1954 a letter of advice to Rhesus negative expectant mothers was prepared enclosing an explanatory booklet. The latter stressed the need for the examination of the husband's blood and the special steps necessary if a home confinement was insisted upon. There were 18 Rhesus negatives and all Kahn tests were negative. The total of blood tests was 218—first tests 174 mothers and 4 fathers with 18 confirmatory tests and 22 for haemoglobin only. The groupings were 0.98, A.68, B.9 and AB.8. Haemoglobin estimations showed the following results :— 100+ = 1 90—99 = 18 80—89 = 86 70—79 = 65 60—69 = 15 50—59 = 1 40—49 = 1 i.e. 17 or 9.1% were under 70. Instructions were given to midwives that where haemoglobin estimations were found to be 65% or less, patients should be referred to their family doctors with a request that they should be sent back for a re-estimation of haemoglobin 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. Ante-Natal Clinics. An ante-natal clinic was started at West Avenue in order to reduce travelling distances for mothers resident in that area who previously attended the clinic at Markhouse Road. It was considered necessary to commence another ante-natal session at Silverdale Road Health Services Clinic and sessions are now held there on the 1st and 3rd Monday afternoons each month. 62 Relaxation Classes. During the past year relaxation classes have been started at Markhouse Road Welfare Centre on Tuesdays at 2 p.m. and at West Avenue Welfare Centre at 2 p.m. on Wednesdays. These classes prepare the mother for her confinement and considerable benefit can be derived from them. Talks are given at the classes by specially trained Health Visitors and these talks include preparations for confinement and layette, advice on suitable clothing and footwear, personal hygiene and explanation of the mechanism of labour. The classes are held in conjunction with the Ante-Natal Clinics at the respective Welfare Centres. 83 sessions were held during the period under review involving a total of 382 attendances. Toddlers' Clinic. A toddlers' clinic has been started at West Avenue Welfare Centre and sessions are held fortnightly on a Friday afternoon. VIRUS INFECTIONS DURING PREGNANCY Ministry of Health Enquiry New registrations have now ceased but the follow up continues. CONFINEMENTS The following table shows the location of confinements during 1954:— Thorpe Coombe Maternity Hospital 1,157 Other Hospitals and Maternity Homes 398 Total in Hospital, etc 1,555 At Home 358 Total Confinements 1,913 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 12.3 15.2 Still birth-rate per 1,000 total births 14.0 24.0 Infant mortality rate per 1,000 livebirths 22.3 25.5 Extracts from vital statistics are given more fully in section "A" of this Report. 63 NOTIFICATION OF BIRTHS 1,950 births (419 of which belonged to other areas) were notified during the year under the Public Health Act, 1936. Notifications were received as follows: Doctors 345; Midwives 1,583; others 22. Included in the above are 387 births which were notified as having occurred outside the Borough. Also included are 29 stillbirths, 7 of which belonged to other areas. Of the total, 3 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 1954, 25 infants died in the first four weeks of life, a rate of 16.9. INFANT MORTALITY The deaths of infants under one year were:— Males. Females. Totals. Legitimate 14 17 31 Illegitimate 2 – 2 Totals 16 17 33 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, 21.0; Illegitimate, 1.3; Total 22.3. Twenty-five infant deaths out of thirty-three were neo-natal deaths—twenty-three dying within one week of birth. Deaths in age groups were as follows :— wks. 0 — 1 23 wks. mths 1 — 1 2 mths. mths. 1 — 3 3 mths. mths. 3 — 6 1 mths. mths. 6 —12 4 64 Classification of deaths:— Preventable = 7. Unavoidable = 21. Inevitable = 5. Preventable deaths were mostly respiratory infections, one due to enteritis. Unavoidable deaths were mostly due to prematurity and atelectasis. Inevitable deaths were mostly due to congenital malformation. Twenty-eight deaths occurred in hospital and five deaths at home. Most deaths are in the unavoidable category and in the present state of knowledge in regard to prematurity no further improvement can be expected in this category at present. 65 CAUSES OF DEATH OF CHILDREN UNDER 1 YEAR OF AGE—1954 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 – – 1 – 1 – – – – 1 – – – – – 1 1 Measles – – – – – – – – – – – – – – – – – Whooping Cough – – – – – – – – – – – – – – – – – Diphtheria – – – – – – – – – – – – – – – – – Phthisis – – – – – – – – – – – – – – – – – Other forms of T.B. – – – – – – – – – – – – – – – – – T.B Meningitis – – – – – – – – – – – – – – – – – Meningitis (Non-T.B.) – – – – – – – – – – – – – – – – – Convulsions – – – – – – – – – – – – – – – – – Bronchitis – – – – – – – – – – – – – – – – – Pneumonia 1 – – – 1 1 – – – 2 – 1 1 – – – 2 Diarrhoea, – – – – – – – 1 – 1 – – – 1 – – 1 Syphilis – – – – – – – – – – – – – – – – – Rickets – – – – – – – – – – – – – – – – – Inattention at birth, wilful neglect – – – – – – – – – – – – – – – – – Suffocation (overlaying) – – – – – – – – – – – – – – – – – Injury at birth 2 – – – 2 – – – – 2 – – 1 – 1 – 2 Atelectasis 1 – – – 1 – – – – 1 – 1 – – – – 1 Congenital malformation – – – – – 2 1 – 1 4 – – 1 – 3 – 4 Premature birth 15 1 – – 16 – – – – 16 4 – 4 1 5 3 16 Atrophy, debility, marasmus – – – – – – – – – – – – – – – – – Inanition 1 – – – 1 – – – – 1 – – 1 – – – 1 Heart failure – – – – – – – – – – – – – – – – – Other causes 3 – – – 3 – – 2 – 5 1 1 1 2 – – 5 Totals 23 1 1 – 25 3 1 3 1 33 5 3 9 4 9 3 33 66 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 1954, 80 live premature infants were born to residents of the Borough, 18 at home and 62 in hospitals and nursing homes. Of the 18 born at home, 6 were transferred to hospital. Of the remaining 12 who were nursed entirely at home, eleven survived the first twenty-eight days of life, and one died two days after birth. 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. CARE OF ILLEGITIMATE CHILDREN The action taken under Circular 2866/44 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 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 1954 1,424 50 31 2 21.7 40.0 Totals 1950 to 1954 (5 yrs.) 7,396 279 183 7 24.7 25.0 67 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, submits the following statistics relating to the work carried out in 1954:— Admitted Adults Babies Total From Walthamstow 16 11 27 From rest of County 29 19 48 From outside the County 20 16 36 Totals 65 46 111 Outdoor work— Walthamstow Cases (Mother and baby placed) 44 14 58 Other Essex Cases 6 – 6 MATERNITY AND CHILD WELFARE CENTRES Capital Building Programme. During the financial year 1954/55, Silverdale Welfare Centre was completely renovated at an estimated cost of £1,500. Markhouse Road Welfare Centre was redecorated at an estimated cost of £304 and a new composition floor was laid at an estimated cost of £271. The following list gives details of Clinics held at the various Centres situated in the Borough:— (a) Ante and Post Natal Clinics Monday (twice monthly) 2 p.m. Silverdale Road, Highams Park. Monday „ „ 2 p.m. West Avenue, E.17. Monday 2 p.m. Markhouse Road, E.17. Wednesday 9 a.m. Markhouse Road, E.17. (In addition, clinics are held at the District Nurses' Homes, and a large proportion of the ante-natal work of the Borough is done at Thorpe Coombe Maternity Hospital.) (b) Ante-Natal Relaxation Exercises Classes. Tuesday 2 p.m. Markhouse Road, E.17. Wednesday 2 p.m. West Avenue, E.17. 68 (c) Child Welfare Clinics. Monday 2 to 4 p.m. St. John's Church Hall, Penrhyn Avenue, E.17. ^Tuesday „ The Memorial Hall, Winchester Road, Highams Park. Tuesday „ The Welfare Centre, West Avenue, E.17. Wednesday „ Low Hall Lane, Markhouse Road, E.17. Wednesday „ Silverdale Road, Highams Park, 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 „ The Welfare Centre, West Avenue, E.17. (Toddlers only). Friday „ St. John's Church Hall, Penrhyn Avenue, E.17 In addition, the Walthamstow Child Welfare Socicty holds massage and sunlight sessions. Summary of Attendances at Child Welfare Clinics Clinic. First Attendances of New Cases. Re-attendances. Grand Total. Under lyr. of age. 1-5 yrs. of age. Total. Under 1 yr. of age. 1-5 yrs. of age. Total. Markhouse Road 369 45 414 6,099 3,957 10,056 10,470 Penrhyn Avenue 252 23 275 3,909 2,712 6,621 6,896 West Avenue 250 61 311 3,102 1,565 4,667 4,978 Winchester Road 127 36 163 1,801 2,067 3,868 4,031 Silverdale Road 98 34 132 1,917 2,448 4,365 4,497 Totals 1954 1,096 199 1,295 16,828 12,749 29,577 30,872 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 * These sessions temporarily transferred to Silverdale Road Welfare centre pending completion of alterations at the Memorial Hall. 69 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 Cases. Re-attendances. Grand Total. Under 1 yr. 1-5 yrs. Total. Under 1 yr. 1-5 yrs. Total. 1954 308 33 341 4,828 2,247 7,075 7,416 Ninety-nine children were immunised during the year at "Brookscroft." Summary of Attendances at all Child 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 1,096 199 1,295 16,828 12,749 29,577 30,872 "Brookscroft" 308 33 341 4,828 2,247 7,075 7,416 Total 1954 1,404 232 1,836 21,656 14,996 36,652 38,288 TREATMENT The facilities provided at the Education Authority's Clinics are available for all children attending the Welfare Centres. (a) Orthopaedic.—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 2 Surgical Tuberculosis 1 Scoliosis, Lordosis, Kyphosis 4 Genu Valgum14 Genu Varum 9 Pes Valgus and Valgus Ankles 31 Spastic Paralysis 1 Torticollis 2 Talipes— (a) Equino Varus 1 (b) Calcaneo Valgus 3 (c) Pescavus 1 Overlapping Toes 6 Other Congenital Defects 3 Miscellaneous (including chest conditions) 6 Total 84 Number of Treatments given–904. 70 (b) Sunlight.—Sunlight treatment was given at the Hale End Clinic to 15 children under 5 years of age for 155 treatments. (c) Priority Dental Treatment.—The Senior Dental Officer reports as follows :— "Last year I suggested that the number of expectant and nursing mothers appeared to have reached its peak and it would seem that this assumption was correct as there has been a considerable drop in the number of mothers and young children referred for dental treatment. Of those referred a higher proportion of both mothers and children needed conservative work only and fewer mothers had need of extractions and dentures. This is a pleasant contrast to the early days of this service when the attendance of an expectant or nursing mother automatically involved large numbers of extractions and the provision of artificial dentures. Now the majority of those attending for conservative work are those whose teeth were attended to in school and in the Forces." The number of Dental Sessions have been as follows:— 1954 187 1953 242 1952 193 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 263 128 375 Patients found to require treatment 258 124 355 Patients who have commenced treatment 226 120 293 Patients who have completed treatment 122 89 268 Patients awaiting treatment 8 1 1 Attendances for treatment 453 339 494 Types of treatment given : Expectant Mothers Nursing Mothers Children under School age 1. Extractions : (a) permanent teeth 193 128 – (b) temporary – – 289 2. Fillings : (a) permanent teeth 204 162 – (b) temporary „ – – 197 71 Types of treatment given—continued Expectant Mothers Nursing Mothers Children under School age 3. Inlays provided – – – 4. Crowns „ 1 2 – 5. Anæsthetics administered : (a) local 21 25 6 (b) general:— (i) by medical officers on County Staff 19 4 17 (ii) by others 76 38 193 6. (a) Scaling 104 15 1 (b) Prolonged scaling and gum treatment 19 8 6 7. Silver Nitrate Treatment 2 8 82 8. Dressings 60 37 53 9. X-ray examinations 5 11 – 10. Dentures provided: (a) full – 15 – (b) partial 1 10 – 11. Dentures repaired 1 1 – 12. Dentures remade: (a) full – – – (b) partial 1 1 – 13. Orthodontic appliances: (a) fixed – – – (b) movable – – – 14. Prophylactic treatment and other operations: Impressions 20 44 – Bites 7 12 – Try-ins 5 19 – Easing 3 20 – Polishing 60 7 – Gum Treatments 60 7 – Syringing 11 – – 15. Number of treatments included above in 6 or 14, carried out by Oral Hygienist 213 25 – The services of the Dental Hygienist were available on two days per week. Apart from chair side work for the priority groups, talks were given at Thorpe Coombe Maternity Hospital. (d) Tonsils and Adenoids.—Children are treated at various hospitals. 72 (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 :— "I am glad to report that there has been an increase in the number of children referred for treatment at this clinic. 14 cases were referred during 1954 as against 10 in 1953. "It is hoped that full advantage will be taken during the coming year in making use of the facilities offered at this clinic for preventive mental health work. "Of the cases referred, 7 were closed after a satisfactory result was achieved, 4 are still under treatment and 3 children have lapsed in their attendance. Two other children referred during the previous year are still attending for treatment. "The following is an analysis of cases treated : Behaviour disturbance 8 Habit disorder 6 (g) Pediatric Clinic.—The fortnightly clinic, under the charge of Dr. Elchon Hinden, Pædiatrician to Whipps Cross Hospital, continued during 1954, and 32 children under five years of age were seen. Dr. Hinden reports as follows:— "The work of the clinic has continued along the same lines as in previous years. The majority of the children seen are suffering from abnormalities of growth and development, or from behaviour disorders. Organic disease is rarely encountered, but the disability and embarrassment caused by these functional derangements is very considerable. "Obesity is a condition which is often referred to the clinic. In many instances the child was sent by an Orthopaedic surgeon, who first saw the patient because he was suffering from knock-knee. This is almost an invariable accompaniment of obesity, and it is very hard to cure while the child remains heavy. Unfortunately, the weight of the child is equally difficult to control. Rarely do we find gross glandular disturbance in these children; in the great majority of cases, the obesity is familial. One or both of their parents are overweight, and so are other relations, too. The children are big 73 as well as fat, and I believe that their size is 'normal' for their genetic constitution. It follows that to reduce their weight is really to make them unnaturally thin, and this is nearly always a fruitless task, unless the children are prepared to undertake really drastic dieting. This calls for a degree of selfcontrol that very few children (and not many adults, either) possess. Most of the girls reach puberty early, and thereafter their rate of growth slows down considerably, so that soon their age catches up with their weight, and their appearance becomes more normal. The boys take longer to mature and the delay at times causes parental anxiety about their poor genital development; but this nearly always rights itself in time. "Parents are often very concerned about the obesity, but as a rule the children are not bothered by their excessive size, were it not that their school-mates point the finger of scorn at them. This can make them very self-conscious, and is responsible for a great deal of distress. I have known a child request a change of school in order to escape the mockery. Children can be very cruel to each other. "I should like to thank the Assistant School Health Officers for referring the children to me, and the General Practitioners for granting them permission to do so; and my colleagues the Pathologist and Radiologist at Whipps Cross Hospital for kindly offering me the facilities of their laboratories." Under 5 years New cases 32 Total attendances 53 Physical Defects: Cases seen 36 Referred to Hospital 9 Discharged 13 Psychological Disorders : (a) Enuresis 1 (b) Other 1 Referred to Hospital – Discharged 1 (h) Invalid Children's Aid Association.—Mrs. Osora, Secretary to the local branch of the Association, kindly reports that the following cases of children under five years of age were dealt with by her Association:— 74 Children referred for convalescence by:— Under five years Hospitals 2 Local Health Authority 2 General Practitioners 2 6 Classification of Above Cases:— Under five years Anaemia, Debility 3 After effects of acute or infectious illness or operation 1 Diseases of: Ear, Nose and Throat 1 Abscess of neck 1 6 Children referred for visiting, advice, help or follow up : Under five years Hospitals 3 Voluntary Bodies 5 General Practitioners 1 Parents 4 I.C.AA. Branches 2 15 (i) Convalescence.— During 1954, two 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. 75 PROVISION OF NUTRIENTS AND MEDICAMENTS Details of nutrients and medicaments sold and issued free during 1954 are as follows:— Sales Free Issue lbs. ozs. lbs. ozs. Adexolin – – 29 5¼ Bemax 155 5 – – Cow and Gate 2,517 – – – Cod Liver Oil Emulsion – – 17 8 Cod Liver Oil and Malt – – 39 – Farex 662 8 – – Fersolate Tablets – – 33,000 Tablets Gentian Violet Tablets – – 720 Tablets Glucodin 122 8 – – Lactogol 60 9 – – Magnesia – – 17 – Maltoline with Iron – – 161 – Marmite 833 – – – Mist Ferri et Ammon Cit Pro Infantibus – – 13 4 Ostermilk 781 – – – Ostocalcium Tablets – – 5,830 Tablets Robinson's Groats 250 – – – Scott's "Twin Pack" 431 11 – – Sodium Citrate Tablets – – 16,030 Tablets Virol 934 – – – Value of Cash Sales £1,128 15s. 6d. DISTRIBUTION OF WELFARE FOODS Distribution of Welfare Foods, i.e., National Dried Milk, Orange Juice, Cod Liver Oil and A. & D. Vitamin Tablets, became the responsibility of the Local Health Authority on 28th June, 1954. Prior to that date distribution in Walthamstow was made from the local office of the Ministry of Food, the Council's Infant Welfare Centres and the Town Hall. Staff employed in distributing the Welfare Foods at the Council's Welfare Centres were supplied from the local office of the Ministry of Food, which also arranged for supplies to the Centres. Distribution continued to take place from the local Food Office until its closure at the end of July, 1954, when the remaining stock was transferred to the Council's temporary Central Store at the Old Town Hall. At the end of August a permanent Central Store was opened at Northcott House, High Street, Walthamstow in a well situated 76 position and a full time Clerk/Storekeeper was appointed to take charge of the premises. Bulk supplies of Welfare Foods from the Ministry of Food Depot at Edmonton are delivered to the Central Store and issues made to the various distribution centres throughout the Borough. An additional distribution centre was opened each weekday morning at Northcott House, commencing on 30th August, 1954. These sessions were later increased to include Tuesday and Friday afternoons. By December the distribution at this centre exceeded that at any other local distribution centre. At the end of the year, eight Distribution Centres were open for 24 sessions per week enabling beneficiaries to obtain supplies from one to four centres on any weekday. DAY NURSERIES The following table shows the average attendances at the Day Nurseries during 1954 (Mondays to Fridays only). Month Nurseries Under 2 yrs. Over 2 yrs. Total January Higham Hill 12.4 36.4 48.8 Handsworth Ave. 5.5 41.6 46.6 February Higham Hill 14.6 33.9 48.5 Handsworth Ave. 5.0 36.5 41.5 March Higham Hill 17.4 28.7 46.1 Handsworth Ave. 4.4 32.1 36.5 April Higham Hill 16.8 32.5 49.3 Handsworth Ave. 5.1 36.4 41.5 May Hignam Hill 15.6 26.6 42.2 Handsworth Ave. 8.4 38.0 46.4 June Higham Hill 15.0 25.0 40.0 Handsworth Ave. 6.4 36.0 42.4 July Higham Hill 17.3 28.7 46.0 Handsworth Ave. 5.3 32.2 37.5 August Higham Hill 15.2 32.0 47.2 Handsworth Ave. 5.4 32.3 37.7 September Higham Hill 17.4 32.8 50.2 Handsworth Ave. 7.7 35.5 43.2 October Higham Hill 17.5 33.3 50.8 Handsworth Ave. 7.6 28.9 36.5 November Higham Hill 16.5 33.3 49.8 Handsworth Ave. 9.2 30.8 40.0 December Higham Hill 15.5 33.5 49.0 Handsworth Ave. 8.8 31.0 39.8 Average Higham Hill 16.0 31.3 47.3 Whole Year Handsworth Ave. 6.5 34.2 40.7 Both Day Nurseries are approved for training in the care of children aged 0—5 years. Both have 60 places. 77 Training. During 1954, six Nursery Students gained their Certificates of the Royal Sanitary Institute and none failed. Their future careers were as follows :— 2 continued as Staff Nursery Nurses with other authorities. 1 continued as Staff Nursery Nurse at Walthamstow. 1 entered General Nursing training. 1 continued as Staff Nursery Nurse at a Residential Nursery. 1 entered a Teachers' Training College. 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, but the premises were not used for the reception of children during 1954. 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 1954 No. of Daily Guardians on Register at end of year 8 19 19 19 No. of applications for services of Daily Guardian 25 23 26 32 Referred to Day Nurseries 10 — 20 21 Referred to Daily Guardian but nothing further heard 6 11 5 4 Placed with Daily Guardian 9 12 1 7 Continued in care of Daily Guardian from previous year — 2 8 3 These 10 children were in the care of a Daily Guardian for periods as follows :— (Six of the children continued to be cared for in 1955.) Duration of Care (in weeks) : 1 2 3 4 5 7 9 11 12 13 14 15 16 17 20 31 32 33 37 38 40 47 49 52 No. of Children 1954 1 1 2 1 — — — — — — — — — — — 2 — 1 — — 1 — — 1 1953 2 — — — — — — — — 1 — — — 1 1 — 1 — — 1 — 1 — 1952 1 1 — — 1 1 1 1 — 1 1 2 — — — — 1 — 1 — 1 1 — 1951 1 4 1 — — — — — 2 — — — 1 — — — — — — — — — — — 78 INFESTATION The steps taken to combat infestation include cleanliness inspections and treatment at Clinics (which includes the supply of Suleo 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 years at Thorpe Coombe Maternity Hospital, under the clinical charge of Miss Helen Rodway, F.R.C.O.G., who states that the number of patients attending has been as follows :— New Cases. Attendances. 1950 34 475 1951 19 444 1952 24 411 1953 28 337 1954 25 314 MIDWIFERY (Section 23) There were 32 practising midwives in the Borough at the end of 1954, including those at Thorpe Coombe Maternity Hospital. Medical supervision was carried out by the Medical Staff and non'medical supervision by the Superintendent of the Nurses Training Home. The following table shows the work done by Midwives during 1954 :— No. of confinements attended as a Midwife 1,273 confinements attended as a Maternity Nurse 270 „ Medical Aid Notices sent 511 ,, Twin Births notified 19 ,, Stillbirths Notified 6 Notifications of Artificial Feeding 12 ,, Discharging Eyes 1 „ Deaths Notified 3 79 The previous table includes the following numbers in regard to work done at Thorpe Coombe Maternity Hospital :— Midwifery cases 1,063 Maternity cases 94 Medical Aid Notices 463 The percentage of Medical Aid Notices were :— All cases 33.1 Maternity Hospital Midwives 40.0 Other Midwives 12.4 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 :— Antepartum haemorrhage 4 Other conditions 2 Total 6 For complications during labour : — Prolonged first and second stage 1 Ruptured perineum 18 Premature labour 1 Rise in temperature 1 Post partum haemorrhage 3 Abnormal presentation 3 Other conditions 6 Total 33 For complications in regard to the infant: — Asphyxia 1 Jaundice 1 Inflamed eyes 2 Prematurity and feebleness 1 Cyanosis 2 Other conditions 2 Total 9 80 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 1,318 364 812 180 115 3,152 5,941 Home Nurse/ Midwives 59 — 896 28 31 476 1,490 T otals 1,377 364 1,708 208 146 3,628 7,431 Two midwives in private practice undertook 2 cases as mid' wives, and 30 cases as maternity nurses. Gas and Air Analgesia.—A total of 318 patients on the District received gas and air analgesia, representing a percentage of 89.8 of District confinements. Emergency Unit.—This Unit, stationed at Thorpe Coombe Maternity Hospital, was called out to 2 Walthamstow cases during 1954. Maternity Outfits.—361 outfits were issued. Training of Pupil Midwives.—Thorpe Coombe Maternity Hospital is a training school for both Parts I and II, the latter in association with home confinements on the " district." A total of 27 pupils successfully underwent Part II training during 1954. An Inspecting Officer of the Central Midwives Board carried out during the year an inspection of the district arrangements for Pupil Midwifery Training in connection with Thorpe Coombe Maternity Hospital. Satisfaction was expressed with the arrange' ments made, but there was some concern that at the time of the inspection the number of district cases was not adequate for the number of pupils requiring training. The excessive number of Pupil Midwives was due to a sudden influx and steps were taken to obtain assistance from certain Midwives in the Forest Area who were given recognition as teachers of Pupil Midwives for this purpose. The co-operation of the Central Midwives Board, the Area Medical Officer, Forest Division and the Superintendent of the Lady Rayleigh Training Home at Leyton was much appreciated in overcoming the difficulty. 81 It is very necessary to assist in the district training of Pupil Midwives from Thorpe Coombe because during this training they work with the home nurses at the District Nurses Home and after completing their midwifery training, many take up temporary home nursing and some proceed to train as Queen's Nurses and to remain on the staff at the District Nurses' Home as Queen's Nurses. 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 160 notified births. 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. 1954 1,491 4,632 6,123 10,473 16,596 1953 1,447 3,719 5,166 9,445 14,611 The following table shows the number and nature of visits paid in 1954. 82 Ward Visits to Children under 1 year Visits to Children under 1 year of age Visits Co Children 2—3 years Grand Total Unsuccessful 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 243 335 578 277 649 1,504 306 84 35 119 354 2,283 High Street 175 336 511 244 584 1,339 163 37 22 59 240 1,801 Hoe Street 227 548 775 286 794 1,855 606 109 1 110 518 3,089 Wood Street 212 587 799 378 1,029 2,206 677 55 37 92 333 3,308 Hale End 320 1,627 1,947 1,188 1,550 4,685 286 93 56 149 292 5,412 Higham Hill 314 1,199 1,513 1,483 2,011 5,007 806 151 40 191 650 6,654 Totals 1954 1,491 4,632 6,123 3,856 6,617 16,596 2,844 529 191 720 2,387 22,547 Totals 1953 1,447 3,719 5,166 3,238 6,207 14,611 2,474 417 126 543 2,127 19,755 83 Health Visiting— Investigations.— 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. The Health Visitor and the General Practitioner.—In June an invitation was addressed to all Medical Practitioners practising in the Borough to attend a meeting at the Town Hall in order to meet the Health Visitors and the Medical Staff of the Department. The invitation was accompanied by a list of suggestions indicating ways in which the Health Visitor might help the family doctor. An interesting meeting resulted and nineteen family doctors attended. General.—The Superintendent Health Visitor, Mrs. J. Foulkes, S.R.N., S.C.M., H.V.Cert., reports the following :— " The year has been a busy one for the Health Visitors. The welfare of the Old People now plays an ever increasing part in their work and the number of visits is much greater this year. During 1954 the Health Visitors paid 554 visits to Aged and Chronic Sick persons compared with 224 visits in 1953. " Considering the present scarcity of Health Visitors, we are very fortunate in Walthamstow in being only one Health Visitor short of our establishment, which reflects favourably on local conditions." HOME NURSING (Section 25) Queen's Training.—Three nurses passed their Queen's examination and three more were due to sit the examination at the end of the year. Theoretical work was carried out at the Lady Rayleigh Home, Leytonstone, and practical work at " Carisbrooke." General.—The Superintendent of the District Nurses' Home, Miss E. G. Welbrock, S.R.N., S.C.M., M.T.D., reports as follows :— The number of visits to patients increased. For seven months of the year we lived at Highams Park during the time when alterations were being carried out at Carisbrooke ", but we were all very happy to return to our own home in time for Christmas. 84 " The Staff on the 31st December, 1954 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. 5 Full-time Queen's S.R.N., S.C.M. 1 „ „ S.R.N., S.C.M., H.V. Certificate. 9 „ „ S.R.N., S.C.M. 2 „ „ S.R.N. 1 „ „ Queen's S.R.N. 1 „ „ Male Queen's S.R.N. 1 „ „ „ S.R.N. 1 Part-time Queen's S.R.N., S.C.M. 1 „ „ S.R.N., S.C.M. 1 „ „ S.R.N. 4 „ „ S.E.A.N. " The following gives details of Home Visits during the year :— New Total cases visits Medical 823 40,033 Surgical 231 10,198 Tuberculosis 23 2,053 Operations 10 17 Miscarriages 3 17 Specials 18 173 Casuals 89 195 Last Offices 18 27 Hypodermic Injections 417 11,905 Totals 1,632 64,618 In January, 1954 the Health Area Sub-Committee invited tenders for additions and alterations to the Nurses' Home at Carisbrooke Road and authorised the acceptance of the lowest tender at £4,992. This amount had to be increased subsequently owing to unforeseen additional work which was required having regard to the fact that two rather old houses were being dealt with. The total cost worked out at £5,795. The alterations embraced the fire precautions which had been suggested by the County Fire Prevention Services and comprised the following :— 1. Alteration of two existing ground floor rooms to provide general and midwifery district rooms respectively with all necessary sanitary conveniences and sterilising equipment. 85 2. Ground floor extension to provide examination, patients' waiting and staff drying rooms together with sanitary accommodation for patients. 3. Corridor connections between the three floors of the two semi-detached houses. 4. Adaptation of two existing rooms to provide an enlarged dining room adjoining the kitchen and with kitchen improvements. 5. Excavation of underground heating chamber to date fully automatic gas fired boilers. 6. Provision of wash basins in fifteen bedrooms. 7. Overhauling and enlargement of central heating system. 8. Redecorating throughout. 9. Erection of smoke stop doors on landings. Work was commenced in June 1954 and completed in midDecember and during this period the staff was temporarily accommodated in a large house loaned by the Borough Council in Castle Avenue, Highams Park. Before re-occupation, considerable refurnishing was carried out at an estimated cost of £1,200. The architectural work was carried out by the Borough Architect, Engineer and Surveyor for Walthamstow and the refurnishing by the County Supplies Officer. VACCINATION AND IMMUNISATION (Section 26) During 1954 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. Most medical practitioners in the town also participated in the County Council's scheme for vaccination and immunisation against diphtheria and whooping cough, a fee of 5/- being payable for the completion of a report. 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 " dose should also be given against whooping cough before school entry and re-vaccination performed. 86 The following were the attendances during the weekly Town Hall Clinic:- Diphtheria Immunisation 366 Whooping Cough Immunisation 270 Vaccination 451 Total 1,087 This represented an average of 20.5 attendances per session. There are two attendances for each vaccination and diphtheria immunisation, and three for each whooping cough immunisation. VACCINATION The number and ages of persons vaccinated are 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 362 70 17 10 15 40 514 Secondary — — 1 6 7 120 134 Total 362 70 18 16 22 160 648 The total for 1953 was 800. Vaccinated by General Practitioners 419 Vaccinated by County Staff 229 There were only 432 vaccinations in children under one year in 1954 as compared with 515 in 1953. The vaccinations under one year during 1954 dropped to approximately 30% of babies surviv ing to the age of one year. For the purpose of comparison, similar percentages have been calculated for the past five years as follows :— Year Percentage 1953 36 1952 35 1951 37 1950 23 1949 18 The low proportion of babies vaccinated is a matter of grave concern in view of the risk of importation of smallpox by air and sea, and also because of the extra risk and discomfort of vaccination 87 for the first time during adult or adolescent years which is now required for service in the armed forces and before travelling abroad. 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 10. DIPHTHERIA IMMUNISATION The following is a summary of the work carried out during the year :— Total number of immunisations completed : (a) School age 259 (b) Pre-school age 1,093 Total 1,352 (c) Number already immunised having reinforcing dose 1,530 Details of the immunisations included in the above total are set out below :— No. completed at schools 223 No. completed at welfare centres 468 No. completed at Town Hall Clinic 157 No. completed at " Brookscroft " 99 No. completed by general practitioners 405 Total 1,352 The total for 1953 was 1,196. 146 children included in the above figures were given combined whooping cough/diphtheria injections by General Practitioners. This prophylactic was not supplied by the County Council. There have only been two confirmed cases of diphtheria in the last eight 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. 88 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 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 — — 1954 1,474 685 300 58 29 21 1,093 259 — 1,352 46.5 42.5 96.1 75.3 6 — — Number of children at 31st December, 1954, who had completed a course of immunisation at any time before that date (i.e., at any time since 1st January, 1940) :— Under 1 (born 1954) 176 1— 4 (born 1953-1950) 4,055 5— 9 (born 1949-1945) 8,507 10—14 (born 1944-1940) 6,626 Total immunised under 15 years 19,364 89 Publicity Campaign. Following the receipt of Ministry of Health Circular 5/54 on the subject of diphtheria immunisation publicity campaigns, arrangements were made for the showing of slides at local cinemas, giving details of the immunisation facilities available in Walthamstow. In addition, advertisements giving similar informaton were inserted in the two local newspapers. Letters were sent to the parents of all newly born children advising them of the need to avail themselves of the facilities for diphtheria immunisation and the Medical and Health Visiting Staffs have maintained a system of personal persuasion. 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 mths. 1 year 2—4 years 5 and over Total Clinics, Nurseries and Welfare Centres 174 423 82 56 2 737 General Practitioner 35 168 60 24 15 302 Total 209 591 142 80 17 1,039 The total for 1953 was 754 and parents are somewhat unfortunately becoming keener on whooping cough immunisation for the under one's than on having them protected against smallpox and diphtheria. In addition 12 children received a booster dose. Only three cases of whooping cough notified during the year gave a history of previous immunisation. All three cases were visited and an assessment made of the severity of the attack in accordance with the criteria of the Medical Research Council. All three cases were in category O which showed less than 5 paroxysms in 24 hours. Details are given below :— Date of Birth and Date Immunised Remarks 28.9.49 Mar./May, 1950 Notified 21.5.54. Whooping spasms only two or three per 24 hours. Medical Research Council classification O. 9.2.52 Aug./Oct., 1952 Notified 8.4.54. No whooping spasms. M.R.C. classification O. 90 Date of Birth and Date Immunised Remarks 9.2.54 Sept./Oct., 1954 Notified 24.12.54, i.e., too soon after notification for immunisation to be fully effective. Only 2 whooping spasms per 24 hours. M.R.C. classification O. During 1953 there were 692 notifications of whooping cough and of these 286 were in the 0—5 age group, twenty-two had been immunised against whooping cough and of these, twelve would be classified as O, eight had mild attacks and only two had severe attacks. During 1954 there were 372 notifications of whooping cough and of these 185 were in the 0—5 age group. The fact that only three immunised children showed symptoms and signs of mild infection, shows the measure of reliability of immunisation and the prophylactic used. AMBULANCE FACILITIES (Section 27) The Ambulance Service is administered centrally from Chelmsford via the Control Centre at Ilford, and (as far as information is available), it appears to be adequate for the needs of the Borough. The Local Service has continued from the Ambulance Depot, which is situated at the Borough Council's Fulbourne Road Depot. PREVENTION OF ILLNESS —CARE AND AFTER-CARE (Section 28) TUBERCULOSIS Dr. H. Ramsay, Physician in charge of the Walthamstow Chest Clinic has contributed the following :— " The work of the clinic has proceeded on the usual lines during 1954, including the routine use of the Odelca miniature X-ray unit. The B.C.G. scheme has also been maintained. There have been no major innovations but the amount of work has as usual considerably increased. The following figures may be of interest :— New patients attending during 1954 5,386 Total attendances 16,550 " One very encouraging feature is the continued drop in notifications and in the number of deaths from tuberculosis in the Borough. This steady improvement has been noticeable for some 91 years past, but last year the figures were really remarkable by comparison with pre-war figures. As regards the country as a whole the same marked drop in the number of deaths has been noted, but notifications of new cases tended to remain stable. Some improvement in this figure has however been recorded during the last two years. " It is important to appreciate that the amount of work necessary to maintain control, and to improve the situation further, is still very considerable. The number of cases on clinic registers requiring supervision does not fall and the total amount of work necessary as regards diagnosis, treatment, prevention and general care remains high and increases. This fact should be remembered in considering what further developments might still be required. It is too early to suppose that no further effort is necessary." Tuberculosis Case Conferences.—These Conferences started in June, 1953 at approximately monthly intervals and 9 were held during 1954. The Conferences afforded opportunities for the staff of the Chest Clinic and of the Health Department to meet and discuss new notifications, hospital admissions and discharges, the contacts register, non-notifications and medical priority in re-housing. 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) Case finding by the tuberculin patch testing of school entrants was continued in 1954. Walthamstow and Chingford Association of Tuberculosis Care Helpers. Miss A. Woolgar, Honorary Secretary of the Walthamstow and Chingford Association of Tuberculosis Care Helpers, contributes the following report :— " During the past year we have continued our policy of doing what we can to ensure that those families which are our special responsibility are adequately nourished, adding such other help as appears necessary or desirable from time to time. 92 " In the early part of the year we found that the wives of a number of patients were in need of clothing and substantial grants were made to enable them to be properly clad for the cold weather. The moral effect of this, both on the patients and their wives, amply justified the expenditure. " In May several members of the Committee attended the Regional Conference of Care Workers in which the Secretary took part. The Conference, held at Southend, was organised by the National Association for the Prevention of Tuberculosis to enable members of the Care Committees to meet and discuss their work and mutual problems. The experience proved interesting and useful and we propose to take advantage of any further opportunities which arise to widen the knowledge of individual members. " Talks to local organisations have been continued at intervals throughout the year and have again led to an increase in interest and understanding of our work which is reflected in the financial support received. " The Social Committee has extended their activities, organising several successful events to raise funds, and it is anticipated that these will increase still further in the New Year. " The following is a summary of the practical help provided, but we place an equal value on the advice and encouragement we are able to give throughout the patient's illness and during the time of his resettlement." Assistance to Patients, etc. :— No. of patients assisted Amount £ Milk 6 45 Groceries 32 435 Fuel 22 200 Fares 29 184 Clothing, furniture, etc. (inc. bedding) 82 427 Holidays 6 53 Occupational Therapy 15 20 Other Assistance *** see under 29 206 *** Hire purchase and debts. Removals. Rent and mortgage. Textbooks and tools. House repairs. Conference fees. Radio rental and licences. Pocket money. Cash grants. Sickroom equipment. Homework equipment. 93 B.C.G. Vaccination of Schoolchildren.—The most important step taken in 1954 was the commencement of B.C.G. vaccination of schoolchildren in the year preceding their fourteenth birthday. The scheme is fully described in the report of the School Medical Officer and by the end of the year 825 acceptances had been received from 1,548 children eligible, i.e. over 53%. Details are as follows :— Mantoux positive 145 Mantoux negative 635 Absent from test 45 825 Vaccinated 630, absent 5. Nursing arrangements at Chest Clinic. Three Tuberculosis Visitors provided by the County Council are employed at the Chest Clinic. They combine nursing duties for the Regional Hospital Board at the Chest Clinic and domiciliary visits to patients for the County Council. The appointment of an extra clerk by the Regional Hospital Board in order to deal with patients' records, appointments and filing, served to reduce the amount of clerical work previously done by the Tuberculosis Visitors, and thereby allowing more time for home visiting. Library Facilities. Nine Tuberculous patients were loaned 118 books during 1954 by the service provided by the St. John and Red Cross library service. Contact Examinations. First examinations of contacts in 1954 were 140 examinations to 67 total notifications. In 1953 there were 181 examinations to 117 notifications. Rehabilitation of Tuberculosis Patients. Financial responsibility for the rehabilitation of two cases at the Papworth Village Settlement continued until 31st March, 1954, when the patients had completed three years' colonisation. CONVALESCENCE FOR ADULTS The total of cases sent away for recuperative convalescence was 84. The length of convalescence was two weeks in 81 cases, three weeks in 1 case and four weeks in 1 case. One patient was discharged after 3 days as unsuitable. Recovery of cost or part-cost was made. 94 SICK-ROOM EQUIPMENT There are two main depots for sick-room equipment, one at the District Nurses' Home in Carisbrooke Road and the other at the British Red Cross Society Headquarters in Forest Road. During the year routine issues were made of items of equipment such as bed-pans, thermometers and feeding cups, etc. Special items of equipment are provided when necessary. CHIROPODY SERVICES A joint whole-time appointment with the Leyton Health Area Sub-Committee was agreed during the year for seven additional weekly sessions. No appointment had been made at the time of writing this report. Mr. R. King, Chief Chiropodist, contributes the following: — " As in past years the Chiropody Service continued with four whole-time Chiropodists, with daily services for adults and one session per week for children. Annual leave and sickness were again covered by locum tenens chiropodists. " During the year the Clinic gave 17,432 treatments, an increase of 485 over 1953. Of 17,432, 15,047 were adults and 2,385 children, made up as follows :— Women 11,938 ; Men 3,109 ; Children 2,385. " The number of booked appointments has increased from 2,127 at 31st December, 1953 by 1,532 to 3,659 at 31st December, 1954. Unfortunately the average waiting time for new appointments and between normal treatments is 12 weeks ; this does not include children who attend without appointment. " 2,385 treatments were given at the special clinic for school children, an increase of 258 over 1953 made up as follows :— Girls 1,611 ; Boys 774. " Of the above 24 were girls and 11 boys over 15 years. " Transport has again been provided for elderly people who were unable to travel by public conveyance and during the year 182 patients attended by this means. Women 157 ; Men 25. " This shows an increase of 41 such treatments over 1953. " Demand for treatment has increased, not only by the 1,529 new patients, but by the return of old patients, who have not attended for some years. 95 " I should like to mention the co-operation we have received from the family doctors in the area, and also from the Superintendent Health Visitor and her staff in visiting the elderly patients." HEALTH EDUCATION (a) At Schools. This is referred to in the report of the Borough School Medical Officer and included talks to Parents' Associations and lectures on good grooming to Senior Girls' Departments. (b) Display Material. A portable exhibit was loaned by the Crusader Insurance Company for approximately one month in the Spring. The exhibit stressed safety in the home and was displayed at several Welfare Centres. (c) Films. During the year attention was drawn by the Ministry of Health to a film dealing with sensitivity to antibiotics and an improved injection technique. Arrangements were made to show this and four otljer Health Education films to the medical and nursing staffs of the Forest, Leyton and Walthamstow Health Areas in October and approximately eighty persons attended. The antibiotic film was of particular interest to home nurses, especially as two of the staff from the Walthamstow District Nurses' Home undergoing their Queen's training at the Leytonstone Home appeared in the film. (d) General Nursing Council—Training Syllabus. The Superintendent Health Visitor reports as follows :— " It was agreed and arranged in Essex that a series of lectures on the social aspects of disease be given by selected Health Visitors to 3rd year student nurses in hospitals in or near their area. The practical work for the student nurses was also discussed and it was decided that the students should have two days practical work in the Public Health field. " I arranged with the Matron of Connaught Hospital to give the first series of four lectures in January, 1954. The subjects of these lectures were :— 1 Positive Health : Social Background of Ill-health.' ' The Local Authority's contribution to the Maintenance of Positive Health.' ' Diseases with special social significance and the role of the medico-social worker in prevention and after care. 96 ' The Hospital in relation to the patient's home, work and responsibilities.' " The practical work was to include one half-day home visiting with a Health Visitor and one half-day with a Home Nurse, one half-day at a Welfare Clinic during an Infant Welfare session and one half-day at a Case Conference to discuss all cases visited by the student nurses." Ten student nurses took part and the comments of the persons concerned are given below :— Matron, Connaught Hospital :— " I would like to say that they have appreciated and enjoyed this Course very much indeed, and they all assure me that it has. given them a much wider knowledge of the work done for the patients outside, the Hospital. I feel sure that this Course will be influential in interesting some Nurses to take up Health Visiting or Queen's District Nursing after completion of their general training." Superintendent Health Visitor :— " The Student Nurses of Connaught Hospital enjoyed the lectures and practical work. I was impressed by the great amount of interest shown by them and the intelligent questions they asked at the Case Conferences. " I agree that the Course should prove influential in interesting certain of the nurses to take up either health visiting or district nursing and act as a stimulus in that direction. " Apart from this, it also makes them realise the patient is not just a bed number with an illness but an individual having a home, friends and background, which is part of their lives. To have lasting benefit from treatment in hospital, it is essential to bring all these into the picture." Superintendent Home Nurse :— " The Nurses came and went out with the Queen's Sisters. All enjoyed their visit and were very interested in the work of the District Nurses. I am quite sure it will be the means of encouraging them to take up either health visiting or district nursing." 97 DOMESTIC HELP SERVICE (Section 29) Difficulties continue in regard to the recruitment of whole and part-time workers and there was unavoidable delay during the winter months in meeting all requests for help. At the end of the year attempts were made without success to recruit more whole-time workers in order to replace the large number of part-time workers. Although the work of the latter is quite satisfactory, their numbers, which at one time rose to nearly 200, took up much administrative time and energy. Difficulties also arose in regard to extra transport facilities to enable the Organiser to pay more frequent supervisory visits to the homes of patients. Mrs. C. M. Hall, Domestic Help Organiser, reports as follows :— " During 1954 the Domestic Help Service continued to develop even further and met more requests for help than ever before. The Service continues to be administered as in previous years with more pressure from all sources. During the year 2,535 visits were made—357 more than in 1953. There were 15 full time and up to 196 part-time helps employed at any one time. Recruitment of full time helps was disappointing and more are still needed, although those at present engaged are working very we'll. The number of cases carried forward into 1955 is 637, i.e., 120 more than were carried forward from the previous year. " During 1954 five Domestic Helps attended a two weeks' training course at Chelmsford and all were successful in obtaining a certificate. These Domestic Helps enjoyed the Course, found it stimulating and informative and it is hoped that more such Courses will be arranged during 1955." " It will be seen from the foregoing figures that the number of cases carried forward into the new year is larger than ever ; the visiting becomes a greater problem as the number of Chronic Sick increases, but the demand for this essential service goes on unabated and has been well met; the appreciation of hundreds of people is a sound reward for the help provided. " The following table gives additional particulars of the work done during 1954 :— " Below is a summary of the year's work : Brought forward from 1953 New cases during 1954 Cases completed during 1954 Number of cases carried forward to 1955 517 402 282 637 98 DOMESTIC HELP SERVICE, 1954 Maternity Acute Sick Tuberculosis Chronic Sick Aged Others Aged not Sick Others Total Requests for help from new cases during the year 80 57 12 256 39 13 3 460 Total cases helped during the year 70 41 20 616 98 66 8 919 Cases being helped at end of year who have received help for i— Under 3 mths. — 4 — 39 8 2 — 53 3—6 „ — 5 4 34 6 2 1 52 6—12 „ — — 3 107 4 4 — 118 Over 12 „ — — 7 315 48 44 — 414 Total C/Forward to 1955 — 9 14 495 66 52 1 637 Hours of help provided during the year 3,313 1,962½ 3,243½ 113,168¼ 21,881 11,826 879 156,273¼ 99 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 1954 :— (1) Residential and Temporary Accommodation. (a) Admitted to hostels and other residential establishments : Men, 14 ; Women, 20. (b) Admitted to temporary accommodation : Men, 8 ; Women, 12 ; Children 23. (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, 1954, were as follows :— (i) Registered as blind 214 (ii) Partially sighted 44 (iii) Defective sighted 14 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 one blind person was employed in the Workshops for the Blind. In addition, there were twenty-four blind and ten partially sighted persons in open industry. " The County Council's Scheme for welfare services for other handicapped persons, including the deaf and dumb and those hard of hearing, are now operating with the co-operation of voluntary organisations specialising in this field of work, although, at this early stage, it is not possible to provide detailed statistical information."