WAL 41 pick d AC 44 11(1) WALTHAMSTON BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1955 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 Pick d 10.7.56 MB 7 BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1 955 INDEX page Section A.—Statistics and Social Conditions of the Area 10 Section B.—General Provision of Health Services in the Area 17 Section C.—Sanitary Circumstances of the Area 22 Section D.—Housing 27 Section E.—Inspection and Supervision of Food 36 Section F.—Prevalence and Control over Infectious Diseases 46 Section G.—Miscellaneous 59 Section H.—National Health Service Act, 1946—Part III Services 66 Health Centres 67 Care of Mothers and Young Children 69 Midwifery 87 Health Visiting 90 Home Nursing 93 Vaccination and Immunisation 95 Ambulance Facilities 100 Prevention of Illness, Care and After Care 100 Domestic Help 107 page Accident in the Home 13, 107 Acreage 10 Adulteration 40 Aged and chronic sick 20 Ambulance Facilities 19, 100 Ante-Natal Clinics 69, 76 Assessments 10 Bacteriological Examination 36, 38, 42 B.C.G. Immunisation 102 Birth Notifications 72 Birth Registrations 16 Births, Illegitimate 10,11,75 Birth Rate 10 Cancer deaths 12 Cancer Education 63 Caravans 25 Care and After Care 99 Care of Illegitimate Children 75 Child Guidance 81 Child Welfare Clinics 76,77 Children Neglected 106 Chinese Egg Products 53 Chiropody 61, 105 Clean Food Campaign 42 Cleansing (Personal) 19, 87 Clearance Areas 31 Committees 4, 66 Comparability Factor 11 Confinements 71 Contact Examinations 102 Convalescence for Adults 104 Convalescence for Pre-Scbool Children 82 page Conveniences, Public 63 Co-operation with General Practitioners 89 Cremation 64 Daily Guardian Scheme 86 Day Nurseries 85 Deaths 10,11,12 Deaths, Infants 14,74 Death Rate 10,11 Deaths, Causes of 12 Dental Laboratory 68 Dental Treatment 79 Diphtheria 49 Diphtheria Immunisation 96 Diseases of Animals Acts 43 Disinfections 24 Disinfestation 26 District Midwifery 87 Domestic Help 107 Employment 10 Emergency Unit 89 Enteric Fever 51 Essex County Council Act 22 Food & Drugs Act, 1938 Factories Acts, 1937/48 45 Food Inspection 36 Food Poisoning 43,2 Foot Clinic 105 Funeral Arrangements 62 Gas and Air Analgesia 89 General Dental Service 68 General Information 64 page Health Centres 67 Health Education 62, 106 Health Visiting 90,92 Home Nursing 93 Home Visits 90 Hospitals 19 Housing Act, 1936 31 Housing, Closure and Demolition 31 Housing, General 34 Housing, Improvement Grants 28 Housing, Inspection 29 Housing Repairs and Rents Act, 1954 32 Housing Statistics 27 Hydrogen Cyanide Regulations, 1938 26 Ice Cream 37 Illegitimacy 75 Immunisation 95 Infant Mortality 11, 14,15, 72 Infectious Diseases 46 Infestation 87 Inquests 64 Integration of Health Services 17 Invalid Children's Aid Association 82 Laboratory Facilities 18 Laundry Service for the Incontinent 62 Liaison with Hospital Services 92 Malaria 51 Maternal Mortality 14,16 Maternity Homes 22 Maternity Outfits 89 Meals on Wheels Service 59 Measles 48 Meat and other Foods 38,39 Medical Aid 88 Medical Examinations 62 Medicaments 83 Meningococcal Infection 51 Midwifery 87 Milk Inspection 36 Milk Special Designations Order 37 Milk Supply 36 Moral Welfare 76 Morbidity 58 National Assistance Act, 1948, Sec. 47 20 Neo-Natal Mortality 14,72 Notices, Sanitary 23 Notification of Births 72 Nursery Nursing Certificate 85 Nurseries 6s? Child Minders (Reg.) Act, 1948 86 Nutrients 82 page Old People's Welfare 20, 59, 107 Ophthalmia Neonatorum 51 Ophthalmic Treatment 81 Orthopaedic Treatment 78 Outworkers 46 Pediatric Clinic 82 Pet Animals Act, 1951 43 Poliomyelitis 50 Population 10 Post-Mortems 64 Post-Natal Clinics 69, 76 Premature Infants 75 Prevention of Damage by Pests Act, 1949 43 Prevention of Illness 100 Prevention of Tuberculosis 58, 103 Pupil Midwives 89 Queens Institute of District Nursing—Training 93 Rainfall 64 Rateable Value 10 Redevelopment and Clearance Areas 31 Rehabilitation 103 Rehousing on Medical Grounds 36 Relaxation Classes 71 Rodent Control 43 Sanitary Inspection 23 Scabies Treatment 19 School Outbreaks 49 Sickroom Equipment 104 Smoke Abatement 25 Social Conditions 10 Staff 17,67 Statistics 10, 72 Still births 10, 14 Sunlight Treatment 79 Swimming Baths 26 Total Infant Mortality 15 Tonsils and Adenoids 81 Training of Nursery Nurses 85 Training of Pupil Midwives 89 Tuberculosis 55, 100 Vaccination 95 Virus Infections during Pregnancy 71 Vital Statistics 10, 72 Walthamstow Association of Tuberculosis Care Helpers 101 Walthamstow Child Welfare Society 77 Water 22 Welfare Services 110 Welfare Foods 84 Whooping Cough 48 „ „ Immunisation 99 Women's Clinic 87 HEALTH COMMITTEE 1955-56 Chairman: Alderman E. C. Redhead, M.P., J.P. Vice-Chairman: Mrs. W. M. Palethorpe Ex-officio: The Worshipful The Mayor—Alderman Lady C. McEntee, O.B.E., J.P. The Deputy Mayor—Councillor Mrs. S. Candy, J.P. 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 : Councillors : Mrs. G. F. G. Cowell. J. W. Pringle. A. W. Ellis, M.B.E. Mrs. C. E. Stannard. J. H. Hammond. A. F. Whicher. O. F. J. McCarthy. J. M. Wight. J. E. Nicholls. Town Clerk : 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. (until 31.8.55) G. H. G. Poole, M.B., B.S., D.P.H., D.(Obst.)R.C.O.G. (from 1.12.55) 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, I beg to present in the following pages a report on the Health and the Health Services of the Borough during 1955. By courtesy of the County Medical Officer I include details of the Personal Health Services administered by the Walthamstow Health Area SubCommittee of the County Health Committee. Before proceeding to review the more important items of the report, I must refer to the departure at the end of July, of Dr. Melville Watkins, formerly Deputy Medical Officer of Health, to take up the appointment of Medical Officer of Health, Divisional School Medical Officer and Area Medical Officer at Leyton. Dr. Watkins commenced duty in Walthamstow in August, 1941 and has given loyal and notable service to the people of Walthamstow. Dr. Geoffrey Poole was appointed in December to succeed Dr. Watkins as Deputy Medical Officer of Health and acts as Senior Assistant County Medical Officer of Health. In the interim Dr. A. W. Forrest, formerly Medical Officer of Health, Leyton, acted as Medical Officer of Health during the period 20th—27th October. The birth rate has again fallen and produced a new low record for the post-war years. The death rate was higher, but infant mortality produced a new low record of 20.5. Of the main causes of death those due to cancer totalled 272 against 261 in 1954, but among these, deaths due to cancer of the lung were 5 less. Deaths due to vascular (including cardiac) conditions were 523 against 528, but those from pneumonia and bronchitis were much higher at 158 against 114. Special reference is made to the 10 deaths from accidents in the home, but these deaths give no indication to the true picture of the largely avoidable suffering in those cases which fortunately were not fatal. The representation of old and worn out dwellings was continued and to date 192 have been agreed for demolition and (including these) a total of 541 has been included in the five year programme for possible clearance. Demolition has already begun, but in turn, the need to rehouse displaced families increases the pressure on the housing accommodation which becomes available. With reference to infectious diseases, the year was epidemic for measles, but showed a very low incidence of whooping cough and dysentery and a slightly increased notification of tuberculosis. Again there was no confirmed case of diphtheria (the last was in 1950), but complacency should not be allowed to obscure the need for more and earlier immunisation in infancy, and even more important the need for "booster" doses before entry to school. The facilities for whooping cough immunisation and now against poliomyelitis should not lessen the demand for protection against what could still become the greater danger, i.e., the recurrence of virulent diphtheria. Notifications of food poisoning were comparatively low, but there was one virulent family infection with salmonella typhi murium with five cases including one death. Reference is made to the salmonella infection of Chinese egg products issued to bakers and to school kitchens and its subsequent total prohibition in the latter. Reference is also made to old people's welfare and extracts are given from the report circulated by the Chairman and Secretary of the Committee. Once more the need is stressed for daily "Meals on Wheels," more domestic help and more hospital accommodation for the aged sick and welfare accommodation for the frail ambulant, especially during severe winter weather. There is most of all need of greater recognition of the responsibility by children for the care of their aged parents. The Sanitary Inspectorate under the Chief Sanitary Inspector have again done good work in regard to their duties generally, and particularly in the inspection of dwellings scheduled for clearance, and the improvement of food hygiene. The report includes many contributions from my colleagues and others and I would express my thanks not only for these, but also for another year of happy collaboration. The following comments refer to certain aspects of the Personal Health Services. There was some difficulty in regard to staffing, particularly medical, delay in regard to the commencement of the Health Services Clinic at Priory Court, difficulty in expanding the General Dental Service and Chiropody treatment, a fall in post-natal attendances both at Thorpe Coombe and at Local Authority Clinics, a further fall in the number of home confinements and in welfare attendances, in the numbers vaccinated and immunised (chiefly due to suspension during the months of poliomyelitis prevalence), and finally, the continued shortage of domestic helps with an increasing number of cases. On the credit side there was a new low record in infant mortality, a full year's work in the distribution of welfare foods with a total of over 137,000 "packages" distributed, an extension of ante-natal relaxation classes, a large increase in the number of services rendered by the District Midwives and Nurses, an extension of tuberculosis case finding by means of the Odelca Miniature Camera at the Chest Clinic, and finally, progress in B.C.G. vaccination of school leavers. It gives me great pleasure to commend again the good work of the staff of the department and the consideration of the Committees concerned and in particular of their Chairman, Alderman E. C. Redhead, M.P., J.P. Full co-operation has also been received from all the organisations and agencies in the town charged in any way with the health and well-being of the community and not least from the Family Doctors. Opportunity has been taken to take stock of the progress made in the last quarter of the century and comparative tables follow in regard to certain statistics for 1930 (the first full year of the Borough incorporation) and 1955, and setting out the facilities and services provided between these years. I have the honour to be, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. 8 SCHEDULE WALTHAMSTOW HEALTH SERVICES Comparison between 1955 and 1930 1955 1930 Population 117,800 124,800 Rateable Value £920,927 £645,572 Product of Penny Rate £3,700 £2,670 Infant Mortality 20.5 39 Notifications Deaths Notifications Deaths Diphtheria Nil Nil 509 22 Smallpox Nil Nil 189 Nil Tuberculosis 73 17 159 89 Measles 1185 1 Notifiable Not 28 *Cancer Not Notifiable 272 167 *Vascular Diseases 523 308 *The classification of causes of death has been materially altered during the period. The following headings show the additional facilities and services (stated alphabetically) operative in 1955 and not in 1930. The services in 1955 were provided jointly by the County and Borough Councils. B.C.G. vaccination against tuberculosis. Care and After Care and Measures for the Prevention of Illness. Child Welfare Centres, 2 in 1930, 6 in 1955, with over 10,000 more attendances in the latter year. Chiropody. Clean Food Campaign. Clearance Areas (resumption of pre-war programme). Contact examination in prevention of tuberculosis. Convalescence for Adults and Children. Conveniences Public, increased provision of and free service. Daily Guardian Scheme to supplement Day Nurseries. Day Nurseries. Diphtheria Immunisation. Dental Workshop. Dental Staff increase, i.e., 2 in 1930 and the equivalent of approximately l½ in 1955, and Dental treatment for adults. District Midwifery. Domestic Help Service. Funeral Arrangements. 9 Gas and Air Analgesia. Health Education. Home Nursing. Immunisation against Whooping Cough. Laundry Service for the Incontinent. Meals on Wheels for the Elderly. National Assistance Act 1948—Compulsory Removal. Nursery Nursing Training at Day Nurseries. Premature Infant Care. Pupil Midwifery Training. Queen's District Nursing Training. Rehabilitation. Rehousing on medical grounds. Relaxation Classes for Expectant Mothers. Rodent Control. Smoke Abatement. Vaccination against Smallpox. Welfare Foods Distribution. 10 A—STATISTICS & SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1955) 117,800 Number of Assessments (31st December, 1955) 37,794 Rateable Value (31st December, 1955) £920,927 Sum represented by penny rate £3,700 Population.-The Registrar-General's Estimate of the home population at mid-year, 1955, is 117,800 a decrease of 1,200 on the previous year. Employment.—According to information kindly supplied by Mr. Percy C. Graham, Manager of the local Employment Exchange, approximately 470 men and 270 women were placed in employment every month during the year 1955 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 1955, the average number of persons unemployed in the whole area was 560 men and 120 women, including 65 disabled men and 10 disabled women. Extracts from Vital Statistics.— The Registrar-General's midyear 1955 estimate of the home population (viz., 117,800) has been used for the calculation of all vital statistics. Total Males Females Legitimate 1,262 632 630 Birth rate per Live Illegitimate 49 25 24 1,000 of the Births Total 1,311 657 654 estimated home population 11.3 Stillbirths 24 Rate per 1,000 total (live and still) births 1.9 Deaths 1,188 Death rate per 1,000 of the estimated home population 10.0 Deaths from puerperal causes:— Puerperal Sepsis Deaths — Other Puerperal Causes 1 11 Death rate of infants under one year of age:— All infants per 1,000 live births 20.5 Legitimate infants per 1,000 legitimate live births 19.8 Illegitimate infants per 1,000 illegitimate live births 40.8 Deaths from measles (all ages) 1 Deaths from whooping cough (all ages) Deaths from diarrhoea (under two years of age) — Pulmonary tuberculosis death rate 0.11 Non-Pulmonary tuberculosis death rate 0.02 The natural increase of population, i.e., excess of births over deaths was 123. Deaths.—The Registrar-General's classification of causes of death by sex totals is given. The total number of deaths in 1955 (1,188), compares with 1,141 in 1954, the respective death rates being 10.0 and 9.5 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 10.87 Deaths 10.2 12 Causes of Death as given by the Registrar-General for the year 1955 Whole District Causes of Death Males Females Total 1954 1. Tuberculosis, Respiratory 10 4 14 10 2. Tuberculosis, other 2 1 3 1 3. Syphilitic Disease 2 1 3 6 4. Diphtheria — — — — 5. Whooping Cough — — — — 6. Meningococcal Infections 1 — 1 — 7. Acute Poliomyelitis — — — — 8. Measles 1 — 1 — 9. Other Infective and Parasitic Diseases 2 2 4 2 10. Malignant neoplasm, stomach 20 18 38 48 11. Malignant neoplasm, Lung, bronchus 48 5 53 58 12. Malignant neoplasm, breast — 31 31 26 13. Malignant neoplasm, uterus — 6 6 5 14. Other malignant and lymphatic neoplasms 66 72 138 115 15. Leukaemia, aleukaemia 5 1 6 9 16. Diabetes 3 3 6 6 17. Vascular lesions of nervous system 56 73 129 137 18. Coronary disease, angina 126 41 167 158 19. Hypertension with heart disease 10 24 34 15 20. Other heart disease 52 98 150 165 21. Other circulatory disease 10 33 43 53 22. Influenza 6 3 9 5 23. Pneumonia 44 28 72 54 24. Bronchitis 61 25 86 60 25. Other diseases of respiratory system 13 2 15 13 26. Ulcer of stomach and duodenum 19 5 24 25 27. Gastritis, enteritis and diarrhœa 3 5 8 7 28. Nephritis and nephrosis 5 4 9 5 29. Hyperplasia of prostate 8 — 8 15 30. Pregnancy, childbirth, abortion — 1 1 1 31. Congenital malformations 5 4 9 8 32. Other defined and ill-defined diseases 55 42 97 95 33. Motor vehicle accidents 3 2 5 9 34. All other accidents 9 5 14 14 35. Suicide 4 — 4 15 36. Homicide and operations of war 1 Totals, 1955 649 539 1,188 — Totals, 1954 580 561 — 1,141 The age distribution of Cancer deaths was as follows:— Under l yr. 1-2 yrs. 2-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 yrs. & over — — — 2 — 14 106 150 13 CANCER DEATHS The following table shows deaths from Cancer (including Leukaemia and Aleukaemia) and death rates in England and Wales and Walthamstow during the years 1943 and 1955. The table has been prepared with the assistance of the Registrar General's office. Year Total Deaths Rate per 1,000 population Eng. & Wales Walthamstow Eng. & Wales Walthamstow 1943 73,566 235 1.9 2.3 1944 73,497 220 1.9 2.2 1945 75,712 207 2.0 2.0 1946 77,516 223 1.9 1.9 1947 79,784 234 1.9 1.9 1948 81,655 223 1.9 1.8 1949 83,204 209 1.9 1.7 1950 85,270 253 1.9 2.1 1951 86,080 206 2.0 1.7 1952 87,642 241 2.0 2.0 1953 87,924 211 2.0 1.8 1954 90,095 261 2.0 1.8 1955 91,337 272 2.0 2.3 The average rate per 1,000 population in Walthamstow would approximate very closely that to England and Wales. Deaths from Accidents in the Home Ten deaths took place in 1955 following accidents in the home. Seven of the deaths were in hospital and three at home. Five were in elderly persons ranging from 67 to 90 years of age; one was a male aged 32 years, two were of school age, and two were children under school age, one of these being an infant of six months who was accidentally suffocated. Of the remaining nine deaths, five were from burns, three were from falls and one from asphyxia due to carbon monoxide (coal gas) poisoning. In order to put these deaths in proper perspective, the following comparison is made:— Cause of death 1954 1955 (a) Suicide 15 4 (b) Motor Vehicle Accidents 9 5 (c) All other accidents 14 14 (d) Accidents in the home (included in line (c)) 7 10 (e) Tuberculosis 11 17 (0 Poliomyelitis Nil Nil 14 INFANT DEATHS, NEONATAL MORTALITY AND STILLBIRTHS Year. Live Births. Live Birth Rate per 1,000 Population. Stillbirths. Neo-Natal Deaths. Infant Deaths. No. Per 1.000 total (live and still) births. Per 1,000 population. No. Per 1,000 live births. No. Per 1,000 live births. 1955 1,311 11.1 24 17.9 0.20 23 17.5 27 20.5 1954 1,474 12.3 21 14.0 0.17 25 16.9 33 22.3 1953 1,454 12.2 38 25.5 0.32 27 18.6 41 28.2 1925 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 The average mean annual infant mortality rate for the quinquennium 1931/35 was 49, and for the quinquennium 1946/50 it was 27. During the five years 1951/55 it fell to 23.6 i.e., less than half the rate for 1931/35. 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 1955 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 4.6.55 Pulmonary embolism due to post-natal phlebothrombosis. 32 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. 1955 1,335 - 1 1 - 0.74 0.74 194 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 15 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 :— TOTAL INFANT MORTALITY RATE INFANT MORTALITY RATE (-) STILLBIRTH RATE ( - - - ) 16 MATERNAL MORTALITY, STILLBIRTHS 8C 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) 1955 1954 1953 1952 1951 Maternal Mortality 0.76 0.67 1.37 1.98 1.22 Stillbirths 18.3 14.2 26.1 19.2 23.2 Neo-Natal Mortality 17.5 16.9 18.6 15.2 14.0 REGISTRATION OF BIRTHS The Registrar-General's returns show the following registra tions during the calendar year:— Live Births. Males. Females. Totals. Legitimate 632 630 1,262 Illegitimate 25 24 49 657 654 1,311 The stillbirth rate per 1,000 population was 0.20. Of the 1,467 local registrations, 453 belonging to other areas are excluded, leaving a net total of 1,014. There were no nonnotified births during 1955. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Total. m. f. m. f. m. f. m. f. m. f. m. f. m. P. Totals 53 63 45 64 88 81 73 65 125 115 119 123 503 511 Grand Totals 11 6 109 169 138 240 242 1.014 17 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: Dr. Geoffrey H. G. Poole, M.B., B.S., D.P.H.—Deputy 1.12.55. Resignations: Dr. M. Watkins, M.R.C.S., L.R.C.P., D.P.H.—Deputy M.O.H.—31.7.55. L. Joyce—District Sanitary Inspector—31.5.55. 2. Integration of Health Services. Circular letters were addressed to General Practitioners on five occasions and included twelve items, of which the following is a summary:— 1. Notification of Puerperal Pyrexia. Puerperal Pyrexia (Amendment) Regulations 1954. 2. The General Practitioner and the Health Visitor, together with a booklet "The duties of the Health Visitor in the National Health Service." 3. Poliomyelitis, incidence of : admission to hospita: copy of advice leaflet issued to affected households and contacts: consultant advice. 4. Bacteriological examinations, new arrangements. 5. Diphtheria anti-toxin : addresses for emergency supplies. 6. Poliomyelitis—Incidence of, and suspension of immunisation. 7. Diphtheria and diphtheria immunisation : recommencement of immunisation : need for booster doses. 8. The Family Doctor and the Health Visitor together with reprint of special article by Sir Selwyn Selwyn-Clarke, Principal Medical Officer, Ministry of Health. 9. Prevention of tuberculosis : visit of Mass Radiography Unit. 10. Diphtheria and diphtheria immunisation. 11. Chronic otorrhoea : Zinc ionisation treatment facilities. 12. Appointment of Deputy Medical Officer of Health, and availability outside office hours. 18 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 as one of its representatives on the Hospital Management Committee. 3. Laboratory Facilities. All Laboratory investigations were done at the Public Health Laboratory, at St. Margarets Hospital, Epping, up to 31st May, 1955. There was a morning collection Mondays to Fridays, with a special collection on Saturdays on request, specimens being 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:— Specimens Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. . Total Faeces and rectal swabs 6 4 7 3 7 13 - 3 5 1 49 Widal agglutinations 2 4 11 5 2 1 1 - - - - - 26 Rhesus, Group and Kahn 12 15 13 12 7 14 10 - 4 9 3 99 Haemoglobins 2 - 3 7 - - 1 1 1 1 - 1 17 Nose and throat swabs 165 201 71 8 2 - - - - 2 - - 449 Full Blood counts - 3 1 1 3 - - - - - - 1 9 Total 187 227 106 36 21 14 16 14 6 7 10 5 649 The transport facilities referred to above have been provided by the Hospital Management Committee which reluctantly had to terminate the arrangement owing to the cost involved. As from the 1st June, 1955, arrangements were made with the Public Health Laboratory Service at Colindale and through the kindness of Colonel Bensted, O.B.E., M.C., transport is provided when necessary from Mondays to Fridays, but not at weekends when any urgent examinations are carried out at the Connaught Hospital Laboratory through the courtesy of Dr. H. Caplin, Consultant Pathologist. The number of specimens examined at the Colindale laboratories during the latter part of the year were as follows:— Specimens June July Aug. Sept. Oct. Nov. Dec. Total Faeces and rectal swabs 29 17 13 12 4 36 42 153 Nose and throat swabs — 5 6 22 138 18 7 196 Widal agglutinations 3 7 8 4 2 2 — 26 Urine — — 2 2 — 1 — 5 Food 12 — 1 1 12 2 28 Miscellaneous — — — — 3 1 — 4 Totals 44 29 29 41 148 70 51 412 19 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 my report for 1953, with the Hackney Borough Council continued, and four cases were referred there during 1955 receiving eleven treatments at a total cost of £4 2s. 6d. 6. Hospital Accommodation. (a) Acute Cases.—There were no major changes in 1955 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 one outstanding case 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 1954 awaiting Hospital admission 3 No. of new cases considered during 1955 for Hospital Admission 30 No. of admissions to Hospital 21 No. of cases who died before admission 1 No. of cases cancelled or deferred 10 No. of cases outstanding at end of 1955 1 It is a pleasure again to record the unfailing help and consideration 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. 20 The percentage of Walthamstow residents admitted to Thorpe Coombe prior to the appointed day was of the order of 98—99. During 1955 Walthamstow admissions were 65%. (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). Eleven cases were under supervision during 1955 in regard to possible action under this section and two were brought forward from 1954:— Case 1 (M) Male, 81 years (Case 5/1954) position unaltered. Case 2 (F.A.G.) Male, 80 years (Case 7/1954). Application for Compulsory Removal was made to the Court on 28.3.55 and patient was removed to Part III accommodation on 30.3.55. Case 3 (A.P.) Female, 95 years. This case was brought to light by the other tenant in the house. Domestic help had already been supplied. Later a domiciliary visit was paid by the Geriatric Consultant at the request of the patient's doctor. There was no acute medical condition to warrant in-patient treatment in hospital. The Welfare Officer offered temporary accommodation in a hostel, but this was refused. Domestic help was continued satisfactorily until the patient died at the end of October, 1955. Case 4 (H.J.P.) Male, 56 years. Reported by sister in 1953 to be feeble-minded, suffered from ulcerated legs and since mother's death, was not cared for and living in unhygienic conditions. Home nursing was arranged and the patient was referred to the Duly Authorised Officer. Subsequently arrangements were made for the patient's admission to Part III accommodation and he was admitted in May 1955. On 27th August the patient discharged himself, but was re-admitted on 29th September. Case 5 (M.A.D.) Female, 42 years. Reported by Health Visitor as being verminous and "very strange." The Family Doctor was informed and after a visit reported patient was not certifiable. Arrangements made for a weekly bath, under supervision, at the local baths. The Family Doctor arranged for patient to be seen by psychiatrist who reported not certifiable and that no medical treatment was indicated. Case 6 (E.M.) Female 73 years. This case was brought to notice by the other occupier. Several visits were paid. The rooms were dirty and required redecoration. Institutional 21 ment refused. Case reported to Area Welfare Officer who subsequently persuaded patient to accept Part III accommodation. Admitted on 8th December, 1955. Case 7 (R.S.) Female, 54 years. Attention was drawn to this case by an anonymous letter. Home nursing arranged, but hospitalisation required. Provisional approval for Compulsory Removal obtained. Remained under the care of her doctor and Home Nurse. Case 8 (W.E.D.) Male, 80 years. Reported by principal tenant. Report sent to Area Welfare Officer who promised to try and persuade patient to accept residential accommodation. Admitted to Langthorne Hospital on 25th November, 1955. Case 9 (A.G.) Female, 88 years. This patient with rheumatoid arthritis referred by the Family Doctor who had arranged physiotherapy. The patient refused a period of convalencence. The Family Doctor was called by other tenants who had found the patient lying at the foot of the stairs. Arrangements made for admission to Langthorne Hospital where she was admitted on 30th November, 1955. The patient is reported to have stated "she is getting the very best care and attention and it is wonderful to have a warm bed and plenty of good food." Case 10 (F.J.T.) Female, 85 years. Grandson living in same house complained of way grandparents were living. Arrangements made for home nursing and laundry service for the incontinent put into operation as the patient refused to enter hospital. Refused examination by Family Doctor and Geriatric Consultant. Subsequently removed to Langthorne Hospital suffering from BronchcPneumonia, where she died on the same day, i.e., 22nd December, 1955. Case 11 (V.J.) Female, 73 years. Domestic Help Organiser reported patient virtually helpless from arthritis and although she had two recent falls, she refused to go to hospital. Domestic help, "Meals on Wheels" and Home Nursing were arranged. The Home Nurse and Domestic Help were requested to keep on reiterating the need for hospital treatment. The patient finally agreed to go to hospital and was removed early in January, 1956. The summaries given above are taken from the appropriate files, but it is hard to convey the measures 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 22 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 one was not in fact exercised and the patient entered hospital voluntarily. National Assistance (Amendment) Act, 1951. The Medical Officer of Health is authorised by the Council to make application for the necessary orders in cases to which the Act applies. 8. Public Health Act, 1936—Nursing Homes :— No. of Homes. No. of Patients provided for. Maternity Patients. Others. Totals. Homes first registered during the year - - - - Homes on register at the end of the year 1 4 - 4 There were no refusals or appeals. During the year four inspections were made by the medical staff. No difficulties in regard to supervision arose. Routine enquiries are made with regard to unregistered homes. 9. Essex County Council, Act, 1933 (Establishments for massage and special treatment). No new licence was granted under the Act during 1955, During the year the medical staff paid 12 visits to the establish' ments registered for massage and special treatment. 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 1955. All dwelling houses in the area are supplied direct with piped water. 23 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. 10,322 6,253 2,111 1,174 1,165* 210 256* 16,683 *Includes notices outstanding from previous year. Of the 1.174 intimation notices served, 254 were in respect of business premises and the remainder (920) related to defects in private houses. Of the latter figure, 713 were complied with with' out resort to statutory procedure. It was found necessary to institute legal proceedings against owners for non-compliance with forty-five Abatement Notices served under Section 93 of the Public Health Act, 1936. Orders were made by the Justices in fifteen cases with costs of 6s. to £3 3s. 0d. being awarded, four cases of which had further penalties ranging from £1 0s. 0d. to £5 0s. 0d. with costs of £1 11s. 6d. to £2 2s. 0d. In six cases, the summonses were withdrawn or dismissed, and twenty-four cases were adjourned sine die, five of which had costs ranging from £1 1s. 0d. to £2 2s. 0d. The following table shows the nature of work executed and improvements effected during the year:— Drains tested, 323; Drains reconstructed or repaired, 272; Drains, obstructions removed, 107; Drains, means of access provided, 26; Drains, ventilation provided or improved, 39; Soil pipes repaired or renewed, 89; Rain water pipes repaired or renewed, 136; Roofs repaired or renewed, 404; Gutterings repaired or renewed, 269; W.C. pans and traps provided, 212; W.C.s repaired or cleansed, 251; W.C.s light and ventilation improved, 26; Gully traps provided, 71; Waste pipes repaired or renewed, 137; New sinks provided, 77; Stoves and firegrates repaired or renewed, 191; Water supply taken off main, 1; Water supply reinstated, 13; Yard and forecourt pavings repaired, 104; Dirty houses cleansed, 13; Dirty rooms cleansed, 200; Floors repaired, 261; Ventilation under floors provided or improved, 70; Dampness remedied, 614; Offensive accumulations removed, 18; Animals improperly kept, removed, 2; Manholes repaired or resealed, 100; Miscellaneous repairs, 2075. Infectious Diseases. Visits to premises, 425. 24 Disinfections. Rooms disinfected, 97; Articles disinfected, 775; Articles destroyed, 53. Special Premises. Number Visits paid Factories (a) Non-power 63 141 (b) Power 485 474 (c) Other premises 23 34 Outworkers 550 300 Butchers 84 289 Bakers and Shops 43 143 Fishmongers, Fryers and Curers 37 133 Cafes and Caterers 103 341 Grocers and Greengrocers 365 660 Ice Cream Manufacturers and Vendors 330 268 Dairies and Milksellers 159 179 Laundries 1 3 Hairdressers 73 51 Rag and Bone Dealers 3 23 Piggeries 1 — Street Stalls Numerous 497 Stables 17 37 Schools — 61 Public Houses 38 68 As a result of the regular periodical visiting of the above premises the following works were carried out :— Butchers. Cleansings, 29; Floors repaired, 8; Accumulations removed, 4; New bins supplied, 19; W.C.s repaired and cleansed, 13; Light and ventilation improved, 1 ; Other improvements, 23. Bakers Cleansings, 30; New ceilings fixed, 1; Floors repaired, 4; Light and ventilation improved, 3; Roofs repaired, 4; Other improvements, 14. Fishmongers. Cleansings, 12; Drains cleared, 4; Accumulations removed, 3; Other improvements, 13. 25 Cafes and Caterers. Cleansings, 28; Light and ventilation improved, 4; Floors repaired, 6; Other improvements, 31. Grocers and Greengrocers. Stores cleansed, 60; Washing accommodation improved, 18; Other improvements, 77. Ice Cream Manufacturers and Vendors. Cleansings, 12; Paving repaired, 1; Special cleansings of utensils, 4 ; Other improvements, 13. Dairies and Milkshops. Cleansings, 4; Other improvements, 1. Laundries. Other improvements, 1. Hairdressers Cleansings, 5; Other improvements, 9. Rag and Bone Dealers. Cleansings, 2. Street Traders. Stalls improved, 11; Store-rooms improved, 3. Stable Premises. Cleansings, 13; Accumulations removed, 4; Roofs repaired, 3; Manure receptacles provided, 1; Pavings repaired, 1; Other improvements, 3. Public Houses. Cleansings, 7; Hot water supply improved, 1 : Other improvements, 1. Caravans. There are no authorised sites in the Borough. Smoke Abatement. New legislation has not yet been approved by Parliament but a Clean Air Bill has been published based on the recommendations of the Beaver Committee. It is anticipated that this Bill after amendment will be placed on the Statute Book during next year. The Chairman of the Health Committee and myself were appointed as delegates of the Council to the Annual Conference of the National Smoke Abatement Society held at Bournemouth in September. A series of papers was given on the various aspects of 26 smoke abatement and considerable discussion arose with respect to the proposed Clean Air Bill. This conference was very interesting and well worth attending. Complaints of smoke nuisances in the Borough amounted to 83. Investigations were carried out in all cases—new boiler plant being installed in some of the factory premises and in others, considerable improvement was effected. Verminous Premises. The number of houses reported to be verminous still remains comparatively small. Eighty-five rooms were disinfested and insecticides were issued free of charge to tenants of 47 premises. No notifications were received during the year under the Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1938. Swimming Baths and Pools. (a) Municipal Baths, High Street. Mr. W. Cantes, the Superintendent and Engineer, kindly contributed the following :— School attendances maintained the steady increase shown in previous years, the increase in 1955 being 8,713. 76 children qualified for the Royal Life Saving Society's bronze medallion and this achievement obtained for them the Education Committee's award of a pass for twelve months' free admission to the baths. During the year five samples of swimming bath water were taken for analysis and on each occasion a good report was received. The number of slipper bath bathers showed a decrease of approximately 3,000 compared with the previous year, probably because of the increase in the number of houses with bathrooms. From January 1st to December 31st the baths were open on 288 days. The number of swimming bath bathers during this period was 132,027. The maximum load was on July 14th when we had 1,033 bathers. During this period we also had 121,172 slipper bath bathers. (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. 27 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 four 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. (e) Woodford County High School.—Sampling was carried out with satisfactory results. (f) Kingfisher Pool—The Secretary kindly gives the follow ing particulars : — "A much improved season, but far from good owing to the short period of the heat wave. There was the odd occasion when the gates were closed, the Pool being full to capacity. Total attendances were in the neighbourhood of 20,000 which must be considered quite good." Bacteriological and chemical analyses were carried out on two occasions with satisfactory results. D.—HOUSING Statistics The Borough Architect, Engineer and Surveyor, F. G. South' gate, Esq., A.R.I.B.A., A.M.T.P.I., has kindly contributed the following in regard to statistics and improvement grants :— Houses erected by the Local Authority. 1955. Hoe Street Ward .... .... 10 Flats St. James Street Ward .... .... Nil Higham Hill Ward .... .... Nil High Street Ward .... .... Nil Hale End Ward .... .... 54 Flats 2 Houses Wood Street Ward .... .... 108 Flats 4 Houses TOTAL .... .... 172 Flats 6 Houses Houses erected by Private Enterprise. Hoe Street Ward .... .... 1 House St. James Street Ward .... .... Nil Higham Hill Ward .... .... Nil High Street Ward .... .... 20 Flats Hale End Ward .... .... 14 Houses Wood Street Ward .... .... 4 Houses TOTAL .... .... 20 Flats 19 Houses Note:—All were permanent houses and flats. In addition to the main building programme, improvements and conversions have been carried out in a number of Council owned properties. 28 Improvement Grants In June, 1954, the Council adopted in principle the provisions of the Housing Act 1949 and the Housing Repairs and Rents Act 1954 in regard to the improvement of housing accommodation, and consideration of applications for improvement grants began forthwith. Eighty-four applications were received in 1954 and 110 in 1955, i.e., a total of 194. The Borough Architect, Engineer and Surveyor comments as follows :— Applications received 194 Applications considered by Council : Approved 88 Disapproved 2 90 Schemes approved in principle and for which detailed Plans and Estimates are being prepared for submission to the Council 33 Detailed schemes received for sub- mission to Council 4 Applications in hand for examination in principle — Applications approved in principle and subsequently withdrawn for various reasons 67 194 Warner Estate Ltd. An application in respect of 98 half-house flats was under consideration by the Council and a decision was deferred. The application was subsequently withdrawn by Warner Estate Ltd. In March, 1955, the Council approved the application submitted by the Estate in respect of 22 half-house flats. Work has been completed in 18 of these and is in progress in the remaining four. A further application by the Estate in respect of 20 half-house flats was approved by the Council on the 25th November, 1955, and work is now proceeding. Summary Applications have been dealt with in respect of a total of 335 dwellings, of which 148 have been withdrawn or refused. 29 Grants totalling £18,925 have been approved by the Council. The benefit of Improvement Grants appeals to owneroccupiers who have every intention of remaining in their present accommodation and also to estate companies with estates of artisan class property, for example, Warner Estate Ltd., but it is disappointing to note that few applications have been received from other property owners. The properties which have been completed show a marked improvement both in amenity and compliance with the Council's current bye-laws. Allied with the Council's new building and redevelopment programme, the effort and expense may be regarded as a worthwhile contribution to the general improvement of the Borough's housing accommodation. 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) 1,563 (b) Number of inspections made for the purpose 4,980 (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 53 (b) Number of inspections made for the purpose 135 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 9 (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 920 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 *713 30 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 8 (2) Number of dwelling-houses which were rendered fit after service of formal notices: — (a) By owners 2 (b) By Local Authority in default of owners *4 (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 199 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) By owners *244 (b) By Local Authority in default of owners 1 C. Proceedings under Sections 11 and 13 of the Housing Act, 1936 : — (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders *6 (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 2 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit E. Proceedings under Section 10 of the Local Government (Miscellaneous Provisions) Act, 1953 : — (1) Number of dwelling houses where Closing Orders were determined *1 * Including those notices outstanding from previous year. 31 Housing Act, 1936 Unfit Houses The following premises were dealt with as follows :— Demolition Orders : Nil. Closing Orders: 56 Beulah Road 46 Pembroke Road (Basement) Local Government (Miscellaneous Provisions) Act, 1953. Under the provisions of this Act, Closing Order was made in respect of the whole of the following premises : — 50 St. Stephen's Road Clearance Areas In November 1953 the Council defined four clearance areas comprising 41 dwellings in Back, Collard, Short and Vallentin Roads (Wood Street Ward). These, together with 10 other dwellings and six cleared sites were included in two Compulsory Purchase Orders. The Ministry's Inquiry was held on the 11th January, 1955, and the Orders were confirmed on the 8th June, 1955, with modifications in respect of eight dwellings which were excluded from the Clearance Areas, were coloured "grey" and described as land which the Council was authorised to purchase compulsorily. The preliminary survey of 119 dwellings in Frederick Street, Grange and Lynmouth, Roads was completed in September, 1953, and an official representation was made in February, 1954, the Council declaring the area so defined to be a Clearance Area and approving a Compulsory Purchase Order which also included the cleared sites of three houses in Lynmouth Road. The Ministry's Inquiry was held on the 8th February, 1955, and the Order was confirmed on the 10th June, 1955. Two dwellings were coloured grey "with authority to purchase and 66 were excluded in view of previous purchase by the Council. The preliminary survey of unfit dwellings in the Chingford Lane area of the Hale End Ward was completed in December, 1953, and January, 1954. An official representation in regard to two clearance areas was made in April, 1954. That in respect of the Chingford Lane and Payze's Cottages area comprised 17 dwellings and the Council's Compulsory Purchase Order was confirmed by the Minister without modification on the 11th March, 1955. In regard to the second area, i.e., Mill Lane, The Square and Farey's Row (comprising 15 dwellings and two parcels of land, the Ministry's Inquiry was held on the 24th May, 1955 and the 32 Compulsory Purchase Order was confirmed by the Minister with modification on the 14th September, 1955. The modification excluded two dwellings already acquired by the Borough Council. The total dwellings comprised in these Compulsory Purchase Orders are 202. All the Orders were confirmed with 10 dwellings excluded as "grey" and 68 excluded owing to previous purchase by the Council. Housing Repairs and Rents Act, 1954 Slum Clearance.—Five-Year Programme In June the Health Committee and later the Council considered a joint report by the Chief Officers as to the proposals to be submitted to the Minister of Housing and Local Government for dealing with houses which appeared to be unfit for human habitation and liable to demolition within the next five years. The proposals were to the effect that 541 houses were estimated to be unfit for human habitation within the meaning of Section 9 of the Housing Repairs and Rents Act 1954, and suitable for action under Section 11 or Section 25 of the Housing Act 1936. These included 192 houses referred to above, i.e., 51 in Wood Street ward, 32 in Hale End ward and 119 in St. James's Street ward. There remained 349 houses which may be included in Clearance Areas still to be declared and which within the five years may be owned by the local authority or may be included in a clearance order or a compulsory purchase order to be submitted to the Minister. In December, the Walthamstow (St. Stephen's Road) Clearance Area 1955 and the Walthamstow (West Street and St. Stephen's Road) Clearance Area were approved by the Council. The two areas, which were contiguous, comprise 64 dwellings. Towards the end of 1955, house-to-house inspections commenced in regard to Tenby and Southcote Roads and a report will be submitted to the Council in due course. Extract from Form P. 13 (Housing) 1955 Part B. Houses not included in Clearance Areas Houses demolished or closed in the period. Number of (1) Housing Act, 1936 Houses persons displaced* (a) Demolished as a result of formal or informal procedure (Section 11) 6 20 (b) Closed in pursuance of an undertaking given by owners under Section 11 and still in force — — (c) Parts of building closed (Section 12) 2 12 (2) Housing Act, 1949 Closed as a result of closing orders under Sections 3(1) and 3(2) — — (3) Local Government (Miscellaneous Provisions) Act, 1953 Closed as a result of closing orders under Sections 10(1) and 11(2) 1 4 33 Repairs in the period Number of houses (4) Unfit houses rendered fit and houses in which defects were remedied during the period as a result of informal action by the local authority under the Housing or Public Health Acts 589 (5) Public Health Acts—action after service of formal notice : Houses in which defects were remedied (a) By owners 225 (b) by local authority in default of owners 13 (6) Housing Act, 1936—action after service of formal notice (Sections 9, 10, 11 and 16) : Houses made fit (a) By owners 2 (b) By local authority in default of owners 4 (7) Housing Repairs and Rents Act, 1954 Houses reconstructed, enlarged or improved and Demolition Orders revoked (Section 5) 1 Note: *A defective house remedied more than once during the period should be included once only. Housing Repairs and Rents Act, 1954 The following certificates were issued or refused under the provisions of the above Act :— Certificates of Disrepair issued 146 Certificates of Disrepair refused 7 Certificates of Revocation issued 138 Certificates of Revocation refused 29 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. Where the landlord had carried out the works specified on these Certificates, a Certificate of Revocation was issued, thus allowing an increase of rents. Housing Act, 1936, Section 62 Applications for "permitted number" were received from landlords and Certificates issued during the year respecting 21 lettings. Local Land Charges Enquiries relating to outstanding sanitary notices were dealt with in 1,759 cases. 34 General Mr. C. W. Rayner, the Council's Housing Manager, kindly gives the following details of rehousing, etc. carried out by his Department in 1955 :— No. of new properties made available for letting 184 Acquired 42 Normal vacancies 79 Nominations to private landlords 29 Total 334 Families rehoused :— 1-bedroom group 63 2-bedroom group 155 3-bedroom group 102 4-bedroom group 14 Total 334 Of the total number of families rehoused, in 15 instances there was a medical recommendation made in respect of tuberculosis. Property under management at 31.12.55 (dwellings only) : Pre-1939 houses and flats 1,615 New houses and flats 1,491 Prefabricated bungalows 503 Properties acquired for improvement 419 Properties acquired in Clearance Areas 86 General Properties 29 Requisitioned dwellings 284 Halfway houses 5 Hostels 6 Education Property 1 4,439 The total at the end of 1954 was 3,893. In addition to the families rehoused in Walthamstow, transfers and exchanges of accommodation amounted to 138 cases, and no fewer than 215 families are known to the Housing Department to have been rehoused in the new towns. 35 The numbers of families rehoused in the New Towns have been as follows :— 1950 8 1951 48 1952 153 1953 165 1954 181 1955 215 770 The great majority have been rehoused in Harlow (583), followed by Stevenage (66), Basildon (54) and Hemel Hempstead (45). The volume of work in connection with rehousing in New Towns continues to increase as applicants become convinced of the fact that New Towns are a success. All applicants interested in New Towns are circularised with full details of all employment vacancies as furnished by the Ministry of Labour. The following table will summarise the housing applications as at 31st December, 1955, the units of overcrowding and the accommodation required to meet the applications :— Applications : Walthamstow Borough Outside Borough Total 3 units overcrowding 13 9 22 2½ units overcrowding 5 5 10 2 units overcrowding 30 6 36 1½ units overcrowding 70 8 78 1 unit overcrowding 92 23 115 ½ unit overcrowding 195 75 270 Fully occupied 335 39 374 ½ unit under-occupied 543 93 636 1 unit under-occupied 687 92 779 1½ or more units underoccupied 2,751 284 3,035 Total 4,721 634 5,355 Accommodation required : 1 bedroom ... 1,765 278 2,043 2 bedroom ... 1,859 220 2,079 3 bedroom ... 977 120 1,097 4 bedroom ... 120 16 136 Total 4,721 634 5,355 36 Unfortunately the 531 applicants living in overcrowded accommodation will have to compete with the families from the 541 houses which have been scheduled for clearance during the next five years. 192 of these dwellings are in clearance areas which have already been agreed by the Ministry. Rehousing of Medical Cases During 1955, 38 cases claiming rehousing priority for tuberculosis were investigated and reported upon. Of these 19 cases were added to the list. The position at the end of 1955 was as follows :— Class 1 Class 2 Class 3 Total On list at end of 1954 8 10 12 30 Added to list during 1955 11 5 3 19 19 15 15 49 Rehoused or removed from List during 1955 11 6 3 20 On List at end of 1955 8 9 12 29 In addition to the tuberculosis cases 43 other cases were recorded as needing special consideration on medical grounds, and 61 cases on general housing grounds. E.—INSPECTION AND SUPERVISION OF FOOD The following is contributed by the Chief Sanitary Inspector :— (a) Milk Supply. Designated Milk. During the year 138 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 Pasteurisers' Licences. The following table gives details of samples taken Grade No. of Samples Results Satisfactory Unsatisfactory (Methylene Blue Test) Pasteurised 90 90 — Tuberculin Tested (Pasteurised) 45 44 1 Tuberculin Tested (Farm bottled) 2 2 — Lactachoc 1 1 — Totals 138 137 1 37 Biological Test Seventy-two 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, the tests of which were inconclusive. 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 54 Pasteurised 10 Sterilised 138 Sterilised 11 Tuberculin Tested 25 Tuberculin Tested 10 Licences (Plant). Pasteurisers 2 There are no Cow-keepers in the district. The number of Retail Milk Distributors is 159. One hundred and seventy-nine visits were paid to registered premises and a satisfactory standard of cleanliness was maintained. The Milk (Special Designations) (Specified Areas) Order, 1951. The above Order came into operation on the 1st October, 1951. All milk retailed within the Borough must be either Pasteurised or Sterilised. (b) Ice Cream. Thirty applications for Registration were received and were dealt with as follows Vendors, New 14 Vendors, Transfers 15 Refused 1 Number on Register at end of year 332 Number of premises used for manufacturing 13 Ice Cream (Heat Treatment, Etc.)—Regulations, 1947-51. The trade has continued to co-operate and a good standard has been maintained. 38 Food Standards (Ice Cream) Order, 1951. Two samples were taken and submitted to the Public Analysts who reported the following satisfactory results :— Fat content 10.9% 7.1% 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 ninth year. Twenty-one persons had blood specimens taken. No "Carriers" were found during the period under review. Bacteriological Examination of Ice Cream. Seventy-one 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 52 II = 11 III = 8 A relatively high standard was maintained throughout the Borough although one manufacturer had certain difficulties with respect to his plant. Investigations were carried out in this case and it appears that the trouble has been located. The plant is not in operation at present but it is anticipated that it will be operating early next year. This resulted in some samples being below standard. Where unsatisfactory samples were taken, the manufacturer was informed and further check samples taken as soon as possible. Where samples were taken of ice cream manufactured outside the district, copies of these reports were forwarded to the appropriate local authority. Lollies (Various). Twenty-one samples were examined for bacterial purity, eleven of which were unsatisfactory. (c) Meat and Other Foods There are no slaughterhouses operating in the Borough. 39 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. 979 tins Evaporated Milk 115 „ Full Cream Milk 144 „ Skimmed Milk 336 lbs. Dried Milk 17 tins Cream 6 „ Baby Food 2 „ Milk Beverage 893 „ Peas 230 „ Tomatoes 169 ,, Beans 15 „ Carrots 10 „ Vegetable Salad 7 „ Rhubarb 2 „ Butter Beans 306 „ Oranges 128 ,, Plums 101 „ Pineapple 99 „ Fruit Salad 62 „ Blackcurrants 60 „ Peaches 37 „ Apricots 34 „ Raspberries 30 „ Strawberries 24 „ Cherries 16 „ Pears 14 „ Loganberries 12 „ Grapefruit 6 ,, Damsons 6 „ Bilberries 6 ,, Blackberries 3 „ Apples 1 tin Prunes 1 „ Goosebrries 10 cases Apples 33 32 lbs. Bananas 110 „ Apricot Pulp (tinned) 19 ,, Beans (Haricot) 22 tins Jam 7 „ Marmalade 3 jars Peanut Butter 21 lbs. Lemon Curd 1 tin Sandwich Spread 1 „ Ox Tongue Spread 53 lbs. Mincemeat 21 tins Pease Pudding 12 „ Meat Pudding 3 ,, Steak and Kidney Pie 8 „ Spaghetti 26 jars Ketchup 3 „ Pickles 2 „ Salad Cream 67 tins Soup 5 „ Broth 4 „ Irish Stew 3 „ Ravioli 5 „ Creamed Rice 1 tin Macaroni 4 lbs. Parsley (dried) ¼ lb. Tea 100 lbs. Currants 22 „ Egg (frozen) 9 „ Egg (dried) 3 „ Egg Albumen 95 „ Lard 21 „ Dripping 28 „ Shredded Suet 17 „ Flour 598 Cheese 1 lb. Wholemeal Biscuits 3¼ lbs. Nougat 3 „ Chocolate 1 bott. Lemon Squash 16 tins Pilchards 8 „ Salmon 7 „ Tuna Fish 4 „ Crab 3 „ Herrings 3 „ Sardines 1 tin Crawfish 20 stone Haddock 9½ „ Dogfish 7½ „ Cod 7 „ Whiting 4 „ Herrings 3½ „ Roker 3 „ Crabs 3 „ Kippers 2½ „ Roe 2 „ Smoked Fillets (Cod) 11 „ Catfish 304 tins Luncheon Meat 31 „ Stewed Steak 26 ,, Minced Meat Loaf. 15 „ Pork. 8 „ Beef Loaf. 5 „ Tongue. 2 „ Brawn. 1 tin Minced Chicken 450 lbs. Corned Beef 341 „ Ham (tinned) 202 „ Jellied Veal (tinned) 48 „ Pork (tinned) 20 „ Lambs' Livers (tinned) 1167 ,, Beef 383 ,, Lamb 193 „ Bacon 160 „ Sheep's Livers 130 ,, Ox Cheeks 100 „ Melts 83 „ Pork 81 „ Kidneys 34 „ Veal 12 „ Sausages 11 „ Mutton ¾ lb. Liver Sausage ½ „ Pork Brawn 40 Shellfish and Jellied Eels. The following samples were taken during the year for bacteriological examination:— Cockles 17 Mussels 12 Jellied Eels 22 Most of the samples taken were of a reasonable standard. With respect to unsatisfactory samples, if the manufacturer was outside the Borough, a copy of the bacteriologist's report was sent to him with a request to improve conditions of manufacture. Investigations were carried out at the premises where these were within the Borough. Considerable works were carried out to one of these premises and in other cases advice was given. Further samples were taken of all unsatisfactory samples and these have shown considerable improvement. Cooked Meats. As the amounts of cooked meats exposed for sale to the public have increased very considerably recently, the Council decided that sampling of these products should be carried on. 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. During the year seventy-two samples were taken which included the following articles:— Pork Brawn, Corned Beef, Cooked Ham, Luncheon Meat, Jellied Veal, Cooked Pork, Raw Beef Sausages, Raw Pork Sausages, Liver Sausage, Luncheon Sausage, Pressed Brisket, Meat Brawn, Cooked Pork Sausage, Ox Tongue, Calves' Tongue, Beef Suet and Meat Pie. About one-third of these samples showed excessive contamination by bacteria. These bacteria indicated contamination by excessive handling, unnecessary exposure or improper storage. Advice to retailers was given in each of these cases and further sampling showed some improvement. A very marked improvement in these products was noticeable towards the end of the year. (d) Adulteration, etc.—Food and Drugs Act, 1938. During the year ninety-seven samples of food and drugs were submitted to the Public Analysts. 41 Five samples were reported as being unsatisfactory, details respecting same are given below:— Description of Article Result of Analysis Action Taken Cough Mixture (2) Not genuine (one sample Warning given. nearly devoid of Chloroform and the other 60% deficient of Chloroform). Blood & Anaemia Pills (2) Not genuine (metallic Warning given. coating objectionable). Bread and Butter Not genuine (fat used Prosecution. Fine £5 was Margarine). and Costs £3 3s. Od. The following summary gives details of food sampled and results of analyses:— No. examined No. unsatisfactory Formal Informal Total Formal Informal Total Milk 15 – 15 – – — Butter 1 1 2 – — – Margarine 1 – 1 – – Cooking Fat — 1 1 – – — Buttered Rolls 2 – 2 – – – Bread and Butter 3 – 3 1 – 1 Cooking Oil — 1 1 – – — Olive Oil — 1 1 – – — Cream 2 2 4 – — Jam — 2 2 – – — Jam Doughnuts — 1 1 – – — Meringue 1 — 1 – – — Sausages, Pork 8 – 8 – – — Sausages, Beef 2 — 2 – – — Sausages, Chipolata 1 — 1 – – — Lemon Squash — 1 1 – – — Lemon Juice 1 1 – – — Orange Squash 4 4 8 – – — Orange Juice — 1 1 – – — Sherry 2 — 2 – – — Whisky 12 – 12 – – — Brandy — 1 1 – – — Port 1 — 1 – - — Gin 1 — 1 – - Rum 1 — 1 – - - Ruby Wine — 1 1 – - — Ginger Wine, Brown — 1 1 – - — Tea 1 1 2 – - - Coffee 1 – 1 – - - Vinegar 1 - 1 – - - Ice Cream 2 - 2 – - - Pudding Mixture — 1 1 – – - Sago — 1 1 – – — Gelatine 1 – 1 – – - Almonds, Ground 2 – 2 – – - Ginger, Chinese Stem - 1 1 – – - Cockles — 1 1 – – - Piccalilli – 1 1 - - - Blackcurrant and Glycer' ine Tablets– — 1 1 — — — Blood and Anaemia Pills 1 1 2 1 1 2 Cough Mixture 1 1 2 1 1 2 Vitamin and Mineral Capsules — 1 1 - - - Yeast Tablets — 1 1 — — — 67 30 97 3 2 5 42 (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 continues to be maintained in the food premises within the Borough. It was found 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 being maintained throughout the district. A new Food and Drugs Act together with new Food Hygiene Regulations come into operation on the 1st January, 1956. This new legislation will give increased powers with respect to food premises. The following food premises are established in the Borough:— Butchers, 84 ; Bakers, 43 ; Fishmongers, 37; Cafes and Caterers, 103; Grocers and Greengrocers, 365 ; Dairies and Milksellers, 159; Ice Cream Manufacturers and Vendors, 330. Registration under Section 14 of the Food and Drugs Act, 1938, was approved by the Council in respect of the following premises 4, Garnet Way 122, Erskine Road 215, Fulbourne Road 60, Milton Road There are two dairy premises in the area registered under the Milk and Dairies Regulations, 1949. The following inspections were carried out in respect of food premises:— Butchers, 289; Bakers, 143; Fishmongers, 133; Cafes and Caterers, 341; Grocers and Greengrocers, 660 ; Dairies and Milksellers, 179; Ice Cream Manufacturers and Vendors, 268. 43 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. (g) Food Poisoning Outbreaks. Fifteen notifications were received and investigated. DISEASES OF ANIMALS ACTS Swine Fever (Infected Areas) Order, 1953. One Order was issued by the Ministry of Agriculture and Fisheries in May, restricting movement of swine without licence into or out of the Borough. One licence was issued allowing thirty pigs to be moved out of the Borough. The Order was withdrawn in August. Fowl Pest Order, 1936. No Orders were issued during the year in respect of the Borough. Three notices were served by an Inspector of the Ministry of Agriculture and Fisheries on premises in the Borough restricting movement of poultry into or out of those premises. These notices were withdrawn within a very short period. PET ANIMALS ACT, 1951 Twenty-three premises are licensed in the Borough for sale of pet animals. These premises are licensed annually. 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. 44 The following is a summary of work carried out during the year 1955:— Type of Property Local Authority Dwelling Houses Agricultural All other (including Business Premises) TOTAL I. Total No. of Properties in Local Authority's District 18 33,643 4 3,821 37,486 II. No of Properties inspected by the Local Authority during 1955 as a result of: (a) Notification 2 554 — 192 748 (b) Survey 13 262 — 1 276 (c) A visit primarily for some other purpose — — — — — III. No. of Properties inspected (see Section II) which were found to be infested by rats: (a) Major 1 — — 4 5 (b) Minor 1 270 — 172 443 IV. No. of Properties inspected (see Section II) which were found to be infested by mice 1 51 - 21 73 V. No. of Infested Properties (see Sections III and IV) treated by the Local Authority 2 321 - 193 516 VI. No. of Notices served with respect to: (1) Treatment — — — — — (2) Structural Works (i.e., Proofing) - 3 3 written - 4 written 37 26 verbal - — 26 VII. No. of cases in which default 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 7 — 5 13 Towards the end of the year a motor-cycle with "box' sidecar was provided at a cost of £163 to assist in the movement of personnel and materials. 45 PETROLEUM (CONSOLIDATION) ACT, 1928 Under the above Act two summonses were taken out against the same offender for the improper storage of petrol. On each summons he was fined £3 plus £1 1s. 0d. costs. FACTORIES ACTS, 1937 & 1948 The following tables show the work carried out under these Acts:— 1.—INSPECTION OF FACTORIES, ETC. Including Inspections Made by Sanitary Inspectors. Premises. No. on Register Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) (5) Factories in which Sec tions 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 63 141 20 — Factories not included above in which Section 7 is enforced by the Local Authority 485 474 31 — Other premises in which Section 7 is enforced by the Local Authority 23 34 5 — Totals 571 649 56 — 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 63 54 — 1 — Overcrowding — — — — — Unreasonable temperature 2 1 — 1 — Inadequate ventilation 2 1 — — — Ineffective drainage of floors — 1 — — — Sanitary Conveniences insufficient 10 5 — 2 — unsuitable or defective 90 86 — 3 — not separate for sexes 2 - - — — Other offences 7 4 1 — — Totals 176 152 1 7 — 46 NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1954 Wearing apparel, making Paper bags 5 of 445 „ Boxes 40 Household linen 11 Brush making 11 Curtains and furniture Carding, etc., of buttons, hangings 1 etc 2 Furniture and upholstery 2 Stuffed toys 19 Cosaques, Christmas File making 1 crackers, Christmas Umbrellas, etc 1 stockings, etc 3 Artificial flowers 8 Lampshades 1 Total 550 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 for 1955 was slightly smaller than in 1954. There were many more cases of measles, but fewer of other diseases, except tuberculosis (73 against 67), but of these, cases of pulmonary tuberculosis were approximately the same. There were 18 cases of poliomyelitis, of which 7 were paralytic. There was comparatively little bacillary dysentery (18 against 159). Notifications of food poisoning were probably far below the true incidence. Both these diseases can largely be prevented by strict personal hygiene, especially adequate hand washing after using the toilet. 47 All ages 0-1 year 1-4 years 5-14 years 15-24 years 25-44 years 45-64 years 65 years and over 1955 1954 Scarlet Fever 148 187 36 105 1 6 – – Whooping Cough 119 372 10 63 45 – 1 – – Measles 1185 834 26 575 577 6 1 – – Diphtheria — — – – Pneumonia 62 89 1 3 7 2 18 18 13 Meningococcal Infection 3 3 1 2 — — — — — Acute Poliomyelitis: Paralytic 7 3 3 1 – – – Non-Paralytic 11 — — 1 6 3 1 — — Acute infeotive encephalitis – 2 – – – – – – – Post infectious encephalitis — — — — — — — — — Dysentery 18 159 — 1 8 2 4 3 — Ophthalmia Neonatorum 4 5 4 — — — — — — Puerperal Pyrexia 72 71 — — — 35 37 — — Smallpox – – – – – – – – – Paratyphoid Fever 1 — — — 1 — — — — Typhoid Fever 1 1 — — — — 1 — — Food Poisoning 15 22 — 3 3 1 4 3 1 Erysipelas 26 34 — — — — 3 14 9 Malaria 1 2 — — — — 1 — — Tuberculosis: Respiratory 61 60 1 – 1 19 26 12 2 Meninges & Central Nervous System 1 3 – 1 – – – – Other forms 11 4 – 1 – 1 3 3 3 Totals, 1955 1746 – 43 688 757 71 106 53 28 Totals, 1954 1848 58 557 930 83 108 79 33 St. James Street High Street Hoe Street Wood Street Hale End Higham Hill Total Scarlet Fever 24 8 18 29 37 32 148 Whooping Cough 38 5 14 23 14 25 119 Measles 159 98 163 104 273 388 1185 Diphtheria – — – — – — — Pneumonia 11 8 4 3 13 23 62 Meningococcal Infection 2 1 — — — — 3 Acute Poliomyelitis: Paralytic 1 1 1 1 2 1 7 Non-Paralytic 2 3 1 1 2 2 11 Acute infeotive encephalitis – – – – – – – Post infectious encephalitis – – – – – – – Dysentery 1 5 – 4 3 5 18 Ophthalmia Neonatorum – 1 – 1 2 4 Puerperal Pyrexia 6 2 9 30 10 15 72 Smallpox — – – – — — – Paratyphoid Fever – – – 1 – – 1 Typhoid Fever – – 1 – – – 1 Food Poisoning – – 4 1 8 2 15 Erysipelas 6 3 5 – 6 6 26 Malaria – – – – – 1 1 Tuberculosis: Respiratory 8 6 10 4 13 20 61 Meninge Central Nervous System – – – – – 1 1 Other forms — — 4 1 4 2 11 Totals, 1955 258 141 234 203 385 525 1746 Totals, 1954 261 241 376 207 296 467 1848 48 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 63 38 14 33 148 Whooping Cough 19 29 54 17 119 A.P.M.—Paralytic — 1 4 2 7 ,, Non-Paralytic — 1 10 — 11 Measles 600 447 133 5 1185 Diphtheria — — — — — Pneumonia 21 16 3 22 62 Dysentery 2 5 9 2 18 Smallpox — — — — — Acute Encephalitis— Infective – – – – – Acute Encephalitis— Post Infectious – – – – – Typhoid Fever – – 1 – 1 Paratyphoid Fever – 1 — — 1 Erysipelas 5 8 3 10 26 Meningococcal Infection 2 — — 1 3 Food poisoning 2 8 4 1 15 Puerperal Pyrexia 16 14 16 26 72 Ophthalmia Neonatorum – 2 1 1 4 Malaria – – 1 – 1 Tuberculosis— Respiratory 22 23 10 6 61 Meninges & Central Nervous System – 1 – – 1 Other Forms 3 3 3 2 11 MEASLES Of the 1,185 cases of measles which were notified, 26 were under one year of age, 575 in the 1-4 years age group and 564 in the 5'9 years age group, i.e., 1,165 under 10 years of age WHOOPING COUGH Of 119 notified cases, 10 were under one year of age, 63 were in the 1'4 years age group and 45 in the 5-9 years age group. The incidence of whooping cough was the lowest since 1940 (excluding a very slightly lower incidence in 1943 when many children were evacuated and notifications were probably incomplete) . The incidence of whooping cough during the next few years will be of great interest and may afford some evidence as to the efficacy of whooping cough immunisation for the under fives in lessening the overall incidence in the community. There is now considerable evidence and experience that immunisation does protect the individual. 49 DIPHTHERIA Six cases were removed to hospital for observation but none was confirmed. There has been no death from diphtheria in the Borough for 9 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, and, equally important, " booster" doses should be given before entry to school and, ideally, again before transfer from the infant to the junior school. SCHOOL "OUTBREAKS" The year produced an average number of "Outbreaks" and brief particulars follow :— March—At a Girls' Secondary School. Twentynine cases of headache and nausea were reported, not connected with school meals and with no obvious common factor— probably epidemic nausea or "Winter" vomiting. June—At a Non-maintained Boys' School. Approximately 20 cases of nausea and vomiting including teachers, boarders, and domestic staff. There was a quick recovery. Two specimens showed the presence of coagulase — positive staphylococci—probably "Winter " vomiting. September—(a) At an Infants' School. A total of 21 cases between the 6th and 19th September and including 12 cases of sore throat, 3 of diarrhoea, and 2 each of headache and vomiting. Of those cases from whom throat swabs were taken four showed haemolytic streptococci. The cases were distributed all over the five classes and one teacher was affected. (b) At another Infants' School. Twenty-six cases between the 15th and 23rd September—19 with vomiting, 4 with sore throats, 2 with diarrhoea and vomiting and one with diarrhoea alone. All seven classes were affected— probably "Winter" vomiting. There was no apparent connection between the two schools. October—At a Girls' Secondary School. Two cases of nausea amongst children and two amongst the staff—apparently "Winter " vomiting. 50 POLIOMYELITIS Forty suspected cases of poliomyelitis were admitted to hospital and of these eighteen were confirmed, seven being paralytic. The hospital discharge notes showed that of the seven, four only had some limb weakness and of these only one needed instruments. There was no death. Onset of symptoms occurred in the first case in April, one in May, five in July, four in August, six in September and one in October. Poliomyelitis first became notifiable on 1st September, 1912, and up to 1946, the only year in which there was a greater incidence than the average for years 1946/54 was in 1916 when the total notified was 27, i.e., more than in the peak post-war year of 1947. AGE GROUPS WARDS Year Under 1 1-5 5-15 1525 2545 4565 65 over Totals S. Jms St. High St. Hoe St. Wood St. Hale End Hi. H. 1946 — — — — — — — — — — — — — — 1947 1 7 8 5 3 — — 24 8 2 2 2 5 5 1948 — 2 — — 1 3 1 — — — — 2 1949 1 6 10 — 2 — — 19 2 4 2 3 4 4 1950 1 5 1 1 4 1 — 13 4 1 2 3 3 — 1951 — 2 4 3 — — — 9 2 1 2 1 1 2 1952 — 5 3 — 2 — — 10 4 2 1 1 1 1 1953 — 3 2 1 2 — — 8 1 1 2 3 1 1954 — — — — — — — — — — — — — — 1955 — 4 9 4 1 — — 18 3 4 2 2 4 3 Even in 1947 when there was the biggest outbreak of infantile paralysis in our history— Road accidents killed 4,187. Poliomyelitis only 688. Road accidents injured 35,000. Poliomyelitis maimed only 1,000. The public can help greatly in reducing the incidence by :— (a) avoiding overcrowded places during epidemics, (b) strict attention to ordinary hygiene, such as scrupulous cleanliness, especially after using the toilet, and protection of food from flies. Medical authorities are agreed that the severity of the disease and the extent of paralysis are aggravated by over exertion and undue fatigue. This applies especially to children and young adults. Plenty of rest is indicated and avoidance of fatigue when there are suspicious symptoms and signs during epidemic periods. One non-paralytic case in a female child of 7 years notified in July is of interest because her mother suffered from paralytic poliomyelitis in October 1947. The mother was then considered to be three months pregnant and in March, 1948, gave birth to 51 twins, a boy and a girl, the latter being the notified case in 1955. The mother's attack in 1947 did not therefore protect the child eight years later; possibly because two types of virus were involved in the two cases. ENTERIC FEVER Two cases were notified and removed to hospital, but neither was confirmed. Two other cases were confirmed on bacteriological findings :— (a) M. 6 years : notified bacillary dysentery, yielded a faecal specimen positive for paratyphoid B and a strongly positive Widal test. (b) F. 38 years : admitted to hospital with stomatitis and pyrexia. Notified as a case of typhoid on August 3rd, 1955. This patient had been to a Youth Camp on the East Coast and helped with the cooking arrangements. There had been an outbreak of paratyphoid B at this camp about seven weeks previously. The outbreak may have been due to eating shell fish in spite of warning notices posted, since typhoid and paratyphoid B organisms had been recovered from the local sewage effluent. The patient admitted eating cockles whilst at the Youth Camp. MENINGOCOCCAL INFECTION Three cases were notified, the particulars being as follows :— Sex Age Ward Hospital Remarks 1. M. 1 yr. J Yes Died 2. M. 11/12 yrs. J Yes Recovered 3. F. 2 yrs. Hi Yes Recovered MALARIA One case of malaria was notified. The patient had had previous attacks of the disease which was contracted whilst serving in the Forces. OPHTHALMIA NEONATORUM Four cases were notified during the year. All were mild and there was no impairment of vision. 52 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 75 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 1955. 2. Food Poisoning Notifications (Corrected) Returned to R.G. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 2 8 4 1 15 3. Outbreaks Due to Identified Agents. Total Outbreak : 1 Total Cases : 6 Outbreak due to :—Salmonella Organisms. 4. Outbreaks of Undiscovered Cause. Total Outbreaks : Total Cases : 5. Single Cases. Agent Identified Unknown Cause Total Salmonella Typhi Murium 5 3 9 Salmonella 1 The most frequently identified agent was salmonella typhi murium sometimes called the "mouse" typhoid organism. The following account serves as a sharp reminder that the comparatively low fatality rate of this infection (say 1% of persons infected) cannot justify any complacency in regard to typhi murium infections. FOOD POISONING OUTBREAK On 2nd and 3rd June, three members of a family were affected with severe food poisoning, and on Saturday, 4th June, the youngest of the family, aged 12 years, died as a result of the 53 infection. A fourth member of the family became ill with the same infection on 6th June and a fifth on the 11th June. The surviving four persons were admitted to hospital and recovered. Investigations were commenced on the 4th June and were continued over the next fortnight. It was soon established that the organism responsible for the outbreak was Salmonella Typhi Murium and it is certain that the three persons first affected received their infection from food eaten in the day or so preceding their illness, whilst the last two cases were probably cross infections within the household. Some fourteen specimens of food and drink from the affected household were submitted to the Public Health Laboratory Service and of these one was found to be infected with the causative organism. This was a specimen of ham bought at a local shop by the family and eaten on 2nd June. This was, however, retrieved from the dustbin, and it is therefore uncertain whether the ham was infected before or after delivery to the household or even in the dustbin itself. Investigations were extended to the shop which supplied the ham and specimens of faeces were obtained from all persons working in the shop and also from the three cats in the shop. All these specimens gave negative results. The cats in the infected household also gave negative results. The Borough where the factory which supplied the suspected ham to the local shop was situated, were also contacted, and their investigations at the source also were without result. It must be reported that a further case of Salmonella Typhi Murium food poisoning occurred in a household in the same ward at approximately the same date as this family was affected. It proved impossible to find any common factor as the sources of food supply to the separate households were entirely different. Considerable time and effort were expended in these investigations and whilst no positive source of infection was traced, it was some satisfaction to know that every possible source of infection was checked. CHINESE EGG PRODUCTS In September the Medical Officer of Health of an adjoining Borough reported that Salmonella organisms had been found in a consignment and that 7-lbs. had been delivered to a Walthamstow baker. The remaining 3-lbs. were sampled and voluntarily surrendered for destruction. A week later it was reported that 54 contaminated samples had been found in two other sanitary districts in Greater London and accordingly on the 6th October, the Chief Sanitary Inspector circulated Walthamstow bakers advising them not to use this product. In November the Ministry of Health issued a circular of advice with regard to the use of Chinese Egg Albumen which had been agreed with the bakery trade. The advice given was considered locally to be too involved to secure co-operation from all workers in the bakery trade, and although the information contained in the Ministry's memorandum was circulated to the local bakery trade, the previous advice as to non-use was not withdrawn. Later in November the School Meals Supervisor drew attention to Chinese Dried Egg which had been delivered to Walthamstow School Kitchens. It was at once agreed with the Borough Education Officer to suspend use pending sampling. Salmonella organisms were found in two out of twelve batches delivered to the school kitchens and the negative batches were released, but further use of Chinese egg products in the School Meals Service was prohibited and arrangements were made to obtain Danish supplies ; these also to be subject to sampling. The circumstances were reported to the Health Committee on the 2nd December last and the action taken was approved, and similarly to the School Management Committee on the 12th December, 1955, which also approved the action taken. No case of food poisoning associated with these products was reported. It is of interest and concern to note that in August, 1955, 14 persons at Worthing suffered from paratyphoid apparently associated with Chinese frozen whole egg. In August and September, another 14 persons at Weymouth and in South Dorset suffered a similar illness, also associated with the same product. The medical investigators of the outbreak in reporting on it conclude as follows :— Summary "Two outbreaks of paratyphoid fever due to Salmonella paratyphi B phage type 3a are described. The vehicle of infection was cakes filled with a proprietary imitation cream used in two bakeries. The same phage type of paratyphoid bacillus was found in unopened cans of Chinese frozen whole egg used in the bakeries, in some members of the staff, and in the patients. It is suggested that the imitation cream was contaminated within the bakery by Salmonella paratyphi B from the frozen whole egg. The dangers of the use of a contaminated product in a bakery are discussed." 55 TUBERCULOSIS The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1955 :—- Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year – 1 – – – – – – 1- 4 years – – 1 – – – – – 5- 9 — – 1 – — – – – 10-14 „ 1 – – – – – – – 15-19 „ 6 5 – – – – – – 20-24 „ 2 6 – 1 1 – – – 25-34 „ 8 6 1 – 1 1 1 — 35-44 „ 8 4 1 1 — 1 – — 45-54 „ 6 2 2 – 1 1 – — 55-64 „ 2 2 1 – 3 – 1 – 65 and over 2 — — 3 4 1 – 1 35 26 7 5 10 4 2 1 Totals 61 12 14 3 73 17 As each new case of pulmonary tuberculosis has been notified, enquiry has been made as to the infectivity of the patient. Of 61 cases investigated, 27 were sputum positive on notification or soon after, i.e. 44.2%. The percentages during 1953 and 1954 were 45.6 and 42.0 respectively 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. 1955 35 26 7 5 73 10 4 2 1 17 1954 37 23 3 4 67 7 3 1 – 11 Twentyeight deaths occurred amongst persons whose names were on the tuberculosis register and of these the Registrar General ascribes 17 to tuberculosis, i.e. 14 pulmonary and 3 non-pulmonary. 56 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 - 10 1 2 1 — 1 Non-Notification of Tuberculosis During 1954 there was no failure to notify tuberculosis before death from that cause, but in 1955 there were three. Details are as follows :—- Case 1. Female, aged 80 years : died in hospital in the provinces from senility and tuberculous polyarthritis. Case 2. Female, aged 67 years : died en route to hospital from recrudescent pulmonary tuber' culosis. Post mortem showed old bronchitis with recent tuberculosis and death followed the onset of pulmonary oedema. Case 3. Male, aged 89 years : died in hospital two days after admission from cardiac failure and cavitating tuberculosis of the lungs (P.M.). It is still not sufficiently known that according to the series of regulations on the subject through the years since 1913, a case of tuberculosis should be notified in each sanitary district; moreover, the latest regulations (those of 1952) omit for the first time the previous proviso which excused the doctor knowing of a case from notifying if he had reason to believe it had already been notified. It has recently been stated that the number of unknown and non-notified infective cases of tuberculosis may be larger than the number of known infective cases. 57 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. 58 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 include 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 four years the weekly averages of new claims were as follows. The extraordinary consistency of those for the months of June to November will be noted. 1952 1953 1954 1955 January 464 747 500 660 February 433 832 513 632 March 390 401 375 474 April 350 300 267 300 May 270 232 314 263 June 214 237 252 264 July 200 197 220 224 August 205 201 209 228 September 262 257 284 271 October 369 370 348 363 November 311 360 366 370 December 426 291 299 350 Average per week 323 363 327 360 (The large number of claims in January and February, 1953, apparently reflected the delayed effects of the severe "smog" experienced in December, 1952.) After a cold and wet winter, the weather became cold but dry and sunny in March. Then followed almost continued sunshine, even into October, followed by mild, wet weather up to Christmas. In spite of this amazing summer, the average weekly sickness claims in the months June to October inclusive were slightly more during 1955 than during 1954 and 10% more than in 1952 and 1953. 59 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 15,415 meals during 1955. Five rounds are now operated on Monday, Wednesday and Friday. The meals are obtained from the Council's Catering Department 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. More meals could apparently be served if more volunteers were available to help. 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. The following extracts are from a report circulated by the Chairman, Alderman Ross Wyld, O.B.E., J.P., and the Secretary, Mr. G. A. Blakeley, of the Walthamstow Old People's Welfare Committee :— Chiropody, Hearing Aids and Spectacles These services are available in the ordinary way through the National Health Service but if there is genuine difficulty in getting an elderly patient to hospital or an optician for eye testing, a visit to the house can be arranged. Housing In Council dwellings and requisitioned property, the Council tries to meet the need of elderly people for ground floor accommodation. Generally the Council does not believe in segregating elderly people from the others but prefers that they should mix in an ordinary neighbourhood. Domestic Help There is a great shortage of helpers, but where domestic help is needed, the Health Department endeavours to arrange for this to be provided. It is, however, to be recognised with regret, that in some cases, relatives seem anxious to avoid giving the help which they should provide themselves and prefer leaving the matter to the Local or County Councils. 60 Workshop Preliminary steps are in hand for setting up a workshop for the elderly and further details will be made available later. THE UNWELL BUT NOT NEEDING HOSPITAL Home Nursing Service and Night Sitters-in Wherever possible the Health Department provides assistance in these directions, but there is need for more people to provide this very necessary service. After-care following hospital treatment The Health Department gives assistance where these cases are known and to the extent that services can be made available. Hostels The County Council is responsible for providing hostels for those elderly persons who need such accommodation. There are a number of hostels in Essex but at present the only hostel in Walthamstow is at "Brookfield" (now "Spackman House"), Oak Hill. More premises of this kind are needed, but the County Council find it very difficult to get premises large enough to be worthwhile staffing, as in these cases it is necessary to have at least one qualified person resident at the hostel. ("The Hydro" in Forest Road was rejected as being too small and one or two other premises in the Borough have similarly been found unsuitable). Laundry for the Incontinent. This service has been a boon to those afflicted in this way and to those who have to look after them. Particulars can be obtained from the Health Department. Sick Room Equipment. Special equipment such as invalid chairs, commodes, etc., can be made available by the Health Department if required. Invalid Chairs. Chairs of this kind are available from certain of the churches and through the British Red Cross Society and the St. John Ambulance Association. In addition, the Old People's Welfare Committee have one or two chairs. Geriatric Clinics. These clinics are very helpful in assisting invalids to become fit again and to get about instead of lying helplessly in bed. At present this type of assistance is available only at Langthorne Hospital. 61 FOR THE PERMANENTLY ILL There is a need for more hospital accommodation for those who are permanently ill—particularly on geriatric lines—and there seems at present to be a gap in the health services in this respect. Provision is made to treat those Who are temporarily sick. Provision is made for those who are not well, but for those who are permanently ill there seems to be insufficient official provision. HELPERS More helpers are still wanted for the Meals on Wheels Service, as Domestic Helps, and as Night Sitters-in. DOMICILIARY CHIROPODY In order to assist those elderly persons unable by reason of illness or infirmity to attend the County Council's Foot Clinic, even with the aid of transport, the Walthamstow Old People's Welfare Committee have agreed to accept financial responsibility for chiropody treatment to be provided in their own homes. During 1955, fifteen patients received domiciliary treatment, and the total treatments given were 19 at a cost of £9 19s. 6d. The ages of the persons concerned were :— Males 64 years to 90 years Females 67 years to 89 years The approval of the family doctor as to the need for treatment and as to non-ambulancy is sought. 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 at clinics and in the home. (4) Companion' ship, sitters-in and occupational therapy. (5) Increased Part III accommodation and long and short stay annexes. (6) More Hospital beds for the aged and chronic sick. 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 was 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 62 steam disinfected and given to persons in need. The following items were supplied: Bedsteads 2; Mattresses 4; Bolsters 2; Pillows 4; Commode 1; and Chairs 4. (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. 2. Laundry Service for the Incontinent The commencement of a "pilot" scheme was described in last year's report. Experience in 1955 has conclusively proved the need for this service. The additional equipment authorised at the end of 1954, i.e., a steam washing machine and a hydro extractor were installed in 1955. Further improvements were also authorised at the end of 1955 with a view to the possible extension of the service to permit a twice weekly collection, but this will be entirely dependent on the recruitment of suitable staff. The number of cases dealt with and the approximate cost were as follows :— Total number of cases 14 Average number of cases per week 4.5 Total number of articles 2,436 Average number of articles per week 47 Total number of journeys 460 Total cost of collection, delivery and laundering (i.e. excluding equipment) £131 approx. 3. Funeral Arrangements. No burials were carried out during the year within the terms of the National Assistance Act, 1948. 4. Medical Examinations. During the year the medical staff carried out 312 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. 63 Clean Food and Health Exhibition.—The County and Borough Councils co-operated with the Walthamstow Chamber of Commerce during their shopping week by staging an exhibit in the hall of the Juvenile Employment Bureau in High Street. The Exhibition referred to the Clean Food Campaign of the Borough Council and the Personal Health Services of the Essex County Council, with special emphasis on the following :— Vaccination against Smallpox Immunisation against Diphtheria and Whooping Cough The Work of the Health Visitor Tuberculosis—Prevention of Dental Hygiene The Home Nursing and Midwifery Services Accidents in the home. The Exhibition was open to the public daily between 1-5 p.m. from the 8th to the 15th October. Details of the Exhibition were circulated by the Borough Education Officer to the Heads of all secondary schools and some 625 children visited in organised school parties. Attendances on the part of the public were disappointing. 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. The new public convenience in Larks Hall Road was opened in February, 1955. During the year the public conveniences at Courtenay Place and Markhouse Road/South Grove were demolished, and have been superseded by the new public conveniences constructed at St. James Street Car Park. During 1955, 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. 64 (b) Cremation. Facilities for cremation are available at the City of London Crematorium at Manor Park and also the Manor Park Crematorium, Manor Park. Negotiations continued with adjoining Local Authorities. (c) Rainfall. The annual rainfall at Ferry Lane Station was 19.38 ins. (d) Inquests and Post Martems. Walthamstow Others Total Post Mortems only 87 224 311 Post Mortems and Inquests 8 35 43 Inquests only 5 47 52 GENERAL INFORMATION Duly Authorised Officers: Essex County Council Offices, West Avenue, E.17. (Telephone : COPpermill 2418) Office Hours : Mondays to Fridays 9 a.m. to 5.30 p.m. Saturdays 9 a.m. to 12.30 p.m. Children's Officer (Local Representative): Essex County Council Offices, West Avenue, E.17. (Telephone: COPpermill 2455) Office Hours: Mondays 10 a.m. to 12 noon. Wednesdays 6 p.m. to 8 p.m. Social Welfare Department: Essex County Council Offices, 35 Wanstead Place, E.ll. (Telephone: WANstead 0031) 65 Home Visitor for the Blind (Walthamstow South): Essex County Council Offices, West Avenue, E.17. (Telephone: COPpermill 2455) Home Visitor for the Blind (Walthamstow North): 1la, The Ridgeway, Chingford, E.4. (Telephone: SILverthorn 8118) Registrar of Births and Deaths : 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. 66 SECTION H NATIONAL HEALTH SERVICE ACT, 1946 PART III SERVICES WALTHAMSTOW HEALTH AREA SUB-COMMITTEE (1955/56) Chairman : Alderman E. C. Redhead, M.P., J.P. (Walthamstow Borough Council). Vice-Chairman : Councillor Mrs. W. M. Palethorpe (Walthamstow Borough Council). Members : Nominated by— Essex County Council — Alderman K. E. B. Glenny, O.B.E. (Chairman, Health Committee, E.C.C.). „ „ „ — Councillor Mrs. S. M. Bovill (Vice-Chairman, Health Committee, E.C.C.). ,, „ „ — Councillor Mrs. E. M. Bates. „ „ „ Councillor Mrs. A. M. M. Burrell „ „ „ Councillor H. J. E. Palethorpe. „ ,, „ Councillor F. J. Vaughan. Walthamstow Borough Council Alderman Mrs. L. P. Bailey, J.P. „ „ „ Alderman The Lady McEntee, O.B.E., J.P. Alderman A. E. Manning. „ „ „ | Alderman W. H. Shaw. | „ „ „ Councillor Mrs. G. F. G. Cowell. „ „ „ Councillor A. W. Ellis, M.B.E. „ „ „ Councillor J. H. Hammond. „ „ „ Councillor O. F. J. McCarthy. „ „ „ Councillor J. E. Nicholls. „ „ „ Councillor J. W. Pringle. „ „ „ Councillor Mrs. C. E. Stannard. „ „ „ Councillor A. F. Whicher. „ „ „ Councillor J. M. Wight. 67 Hospital Management Committee Mrs. B. E. Bottomley, J.P. Local Medical Committee for Essex Dr. W. R. John. Voluntary Organisations Dr. M. Cohen (Walthamstow District Nursing Charitable Association). „ E. P. Marr, Esq. (Walthamstow Child Welfare Society). Mrs. M. Osora (Invalid Children's Aid Association). Mrs. A. Cordell (Walthamstow and Chingford Association of Tuberculosis Care Helpers). STAFF During the year, 30 whole-time members of the Health Area Staff resigned their appointments and 24 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. Following the resignation of Dr. Watkins and Dr. Poole's promotion, a vacancy for an Assistant County Medical Officer of Health remained unfilled until the end of the year. There was considerable difficulty following from staff sickness. Miss D. Anklesaria, L.D.S., was given leave of absence without pay for one year to undertake a post-graduate course at Boston, U.S.A. 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. Part of the Priory Court Health Centre site is to be used for the erection of a Health Services Clinic. Working drawings are in hand. Adjoining is a community centre which is already functioning. 68 GENERAL DENTAL SERVICE The Senior Dental Officer reports as follows :— "Once more I have to report that far more work could have been carried out if it had been possible to extend the number of sessions devoted to this service. "It is with great regret that I must report it has been necessary to refuse literally scores of patients weekly and that it has been possible to accept only those patients who have attended previously. Even these have had to wait far too long for their treatment. "This is particularly unsatisfactory as dental surgeons have been available to carry out at least some of the extra work, but neither space nor dental attendants can be found for their employment. "The number of dental sessions undertaken during the last two years have been :— 686 in 1954 and 642 in 1955." Herewith is a summary of the work carried out during the years 1954 and 1955: — 1954 1955 Number of patients treated .... 725 831 Appointments made .... 4,548 4,867 „ kept .... 4,054 4,396 Plastic fillings 2,125 total 437 381 1 2,048 total Amalgam 1,688 1,667 Inlays .... 4 9 Crowns .... 21 29 Scalings and gum treatments .... 387 441 Dressings .... 758 515 No. of teeth extracted .... 755 752 General anaesthetics .... 222 211 Local „ .... 418 462 X-rays .... 440 509 Impressions .... 627 609 Bites .... 168 170 Try-ins .... 213 221 Full upper dentures 262 total dentures f 96 77 214 total dentures „ lower „ 64 56 Partial upper dentures 60 51 lower „ 42 30 Repairs .... 195 211 DENTAL LABORATORY Herewith is a list of the appliances completed for the General Dental Service : 1954 1955 New Dentures 253 229 Orthodontic Appliances 1 2 Crowns 8 12 Repairs 207 211 Inlays 2 1 69 During the year the following work was carried out for the Walthamstow and Leyton Committees for Education :— Walthamstow Leyton Orthodontic Appliances 220 38 Dentures 59 — Crowns 12 5 Repairs 50 7 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 22 Dentures 36 Repairs 15 The following work was undertaken for Maternity and Child Welfare Patients :— New Dentures 34 Dentures remade 9 Crowns 3 Repairs 4 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 1,207 865 Low Hall Lane Clinic 103 29 Silverdale Road Clinic 37 15 West Avenue Clinic 33 8 District Nurses' Training Home and Midwives' Homes 343 — Totals 1,723 917 70 Total Attendances— Ante-Natal Post-Natal Thorpe Coombe Maternity Hospital 10,805 1,000 Low Hall Lane Clinic 503 41 Silverdale Road Clinic 210 20 West Avenue Clinic 181 14 District Nurses' Training Home and Midwives' Homes 2,844 — Totals 14,543 1,075 Blood grouping/Hæmoglobin estimation and Rhesus and Kahntests 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, i.e., when they were unable to attend at the ordinary weekly clinic All Rhesus negative expectant mothers attending ante-natal clinics were and are advised to have their confinements in hospital. Blood pressure estimations were done at every examination, in order to obtain warning of possible toxaemia. Midwives in domiciliary practice may in extreme urgency, and when unable to obtain immediate medical aid, summon the Obstetric Flying Squad direct. Except in doctors' booked cases, patients with any serious abnormality can be referred to the Consultant Obstetrician at Thorpe Coombe Maternity Hospital. A letter of advice was sent to every Rhesus negative expectant mother 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 22 Rhesus negatives and all Kahn tests were negative. The total of blood tests was 196—first tests 147 mothers and 9 fathers with 29 confirmatory tests and 11 for haemoglobin only. The groupings were 0.75, A.50, B.13 and AB.9. Haemoglobin estimations showed the following results :— 100+ = nil 60—69 = 11 90—99 = 19 50—59 = 2 80—89 = 70 40—49 = 2 70—79 = 48 i.e., 15 or 9.8% were under 70. 71 Instructions to midwives require that where haemoglobin estimations were found to be 65% or less, patients should be referred to their family doctors with a request that they might 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. Details of Ante-natal Clinics held in Walthamstow are given on page 75 of this Report. Relaxation Classes. Relaxation classes have been continued at Markhouse Road Welfare Centre on Tuesdays at 2 p.m. and at West Avenue Weifare Centre at 2 p.m. on Wednesdays. A new class was started during the year at Silverdale Road Health Centre Clinic and this is held on Thursdays at 2 p.m. 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. Eightyfive sessions were held during the period under review involving a total of 420 attendances. Toddlers' Clinic. The toddlers' clinic continued 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 ceased but the follow up continued. CONFINEMENTS The following table shows the location of confinements during 1955 :— Thorpe Coombe Maternity Hospital 1,142 Other Hospitals and Maternity Homes 353 Total in Hospital, etc. 1,495 At Home 327 Total Confinements 1,822 72 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 (Provisional) Live birth-rate per 1,000 population 11.1 15.0 Still birth-rate per 1,000 total births 17.9 23.1 Infant mortality rate per 1,000 live. births 20.5 24.9 Extracts from vital statistics are given more fully in Section "A" of this Report. NOTIFICATION OF BIRTHS 1,842 births (449 of which belonged to other Areas) were notified during the year under the Public Health Act, 1936. Notifications were received as follows: Doctors 307; Midwives 1,515; Others 20. Also included are 34 stillbirths, 10 of which belonged to other areas. Of the total, 10 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 1955, 23 infants died in the first four weeks of life, a rate of 17.5. INFANT MORTALITY The deaths of infants under one year were as follows Males. Females. Totals. Legitimate 19 6 25 Illegitimate 2 — 2 Totals 21 6 27 The death rates of infants under one year of age per 1,000 live births in Walthamstow when calculated on the totals given by the Registrar General are therefore :— Legitimate, 19.0; Illegitimate, 1.5; Total, 20.5 73 The corresponding total figure for England and Wales for the year was 24.9. Of the 27 deaths 23 occurred in the first month of life of which 19 were in the first week, the age group distribution being as under: Hours Day Week Week Mth. Mth. Mth. Mth. Mth. Mth. Mth. Mth. Mth. 0—24 l—1 1—1 1—3 3—6 6—9 9—12 12 7 4 3 1 0 0 Two deaths occurred at home and the remaining twenty-five in hospital. Of the total of 27 only six can be classified as avoidable. Prematurity was the sole, or the chief contributory cause with atelectasis in 16 cases whose average weight at birth was less than four pounds and all of these deaths were regarded as unavoidable. Respiratory infections which might have been prevented were the cause of four deaths and congenital abnormalities or injury during birth contributed significantly to six deaths, only one of which could be considered preventable. The remaining death was due to an avoidable home accident. The great majority of infant deaths were again due to premature birth, but the infant mortality rate in the Borough continues to fall slowly and compares very favourably with that for England and Wales as a whole. 74 CAUSES OF DEATH OF CHILDREN UNDER 1 YEAR OF AGE—1955 Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total deaths under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under 1 year. St. James St. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Total. Influenza - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - Phthisis - - - - - - - - - - - - - - - - - Other forms of T.B. - - - - - - - - - - - - - - - - - T.B. Meningitis - - - - - - - - - - - - - - - - - Meningitis (Non-T.B.) - - - - - - - - - - - - - - - - - Convulsions - - - - - - - - - - - - - - - - - Bronchitis - - — — — 1 — — — 1 - - 1 — - - 1 Pneumonia 2 1 1 — 4 — — — — 4 1 2 - 1 - - 4 Diarrhoea - - - - - - - - - - - - - - - - - syphilis - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - Inattention at birth, wilful neglect - - - - - - - - - - - - - - - - - Suffocation (overlaying) - - - - - - 1 - - 1 - - - - 1 - 1 Injury at birth - - - - - - - - - - - - - - - - - Atelectasis 10 - — — 10 — — — — 10 2 — 1 2 3 2 10 Congenital malformation 1 - — 1 1 — — — 9 — — - 1 - 1 2 Premature birth 4 1 — 1 6 - — — — 6 2 - 2 1 1 - 6 Atrophy, debility, marasmus - - - - - - - - - - - - - - - - - Inanition - - - - - - - - - - - - - - - - - Heart failure - - - - - - - - - - - - - - - - - Other causes 2 - — — 2 1 — — — 3 1 1 — — 1 — 3 Totals 19 2 1 1 23 3 1 — — 27 6 3 4 5 6 3 27 75 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 1955, 79 live premature infants were born to residents of the Borough, 12 at home and 67 in hospitals and nursing homes. Of the 12 born at home, 5 were transferred to hospital. Of the remaining 7 who were nursed entirely at home, all survived the first twenty-eight days of life. 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 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 1955 1,262 49 25 2 19.8 40.8 Totals 1951 to 1955 (5 yrs.) 7,122 266 167 8 23.4 30.0 76 MORAL WELFARE The "Carville" Home (formerly 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. In November the Home was transferred to adapted premises at 43 West Avenue Road where the same accommodation is provided, but with more convenient bathing and sanitary facilities. Miss E. Williams, the Superintendent, submits the following contribution regarding the work carried out in 1955:— "During the year it was necessary to undertake more outdoor work than usual in connection with the illegitimate children of married mothers. "We are now settled in our new home and appreciate all the help given by the Health Department. Considering our upheaval the work has progressed so far as the amount of help given is concerned." Details of cases dealt with are as follows:- Admitted Adults Babies Total From Walthamstow 14 9 23 From rest of County 41 23 64 From outside the County 15 8 23 Totals 70 40 110 Outdoor work— Walthamstow Cases (Mother and baby placed) 44 19 63 Other Essex Cases 6 6 12 MATERNITY AND CHILD WELFARE CENTRES 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. 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. Thursday 2 p.m. Silverdale Road, E.4. 77 (c) Child Welfare Clinics. Monday 2 to 4 p.m. St. John's Church Hall, Penrhyn Avenue, E.17. Monday „ Low Hall Lane, Markhouse Road, E.17. Tuesday „ The Welfare Centre, West Avenue, E.17. Tuesday „ Memorial Hall, Winchester Road, Highams Park, E.4. Wednesday „ Low Hall Lane, Markhouse Road, E.17. Wednesday „ Silverdale Road, Highams Park, E.4. Thursday ,, St. John's Church Hall, Penrhyn Avenue, E.17. Thursday „ The Welfare Centre, West Avenue, E.17. Friday „ Low Hall Lane, Markhouse Road, E.17. Friday „ Silverdale Road, Highams Park, E.4. Friday ,, The Welfare Centre, West Avenue, E.17. (Toddlers only). In addition, the Walthamstow Child Welfare Society holds massage and sunlight sessions. * These sessions temporarily transferred to Silverdale Road Welfare Centre pending completion of alterations at the Memorial Hall. Summary of Attendances at Child Welfare Clinics Clinic First Attendances of New Cases Re-Attendances Grand Total Under 1 yr. of age 1 yr. old 2-5 yrs. of age Total Under 1 yrs. of age 1 yrs. old 2-5 yrs. of age Total Markhouse Rd. 285 16 27 328 4,787 1,317 1,638 7,742 8,070 Penrhyn Ave. 233 3 12 248 3,711 1,182 1,198 6,091 6,339 West Avenue 203 15 26 244 2,740 713 837 4,290 4,534 Silverdale Rd. 189 21 38 248 3,454 1,680 3,373 8,507 8,755 Totals 1955 910 55 103 1,068 14,692 4,892 7,046 26,630 27,698 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. 78 The percentage of attendances at "Brookscroft" to the total of child welfare attendances in the Borough during 1955 was 20.5. The percentage of new cases at "Brookscroft" to the number of live births in the Borough was 19.4. These percentages denote that roughly one'fifth of the child welfare attendances in the Borough during 1955 were at "Brookscroft," i.e., a proportion consistent with the fact that there were five welfare centres functioning in the Borough. 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 Re-Attendances Grand Total Under 1 yr. of age 1 yr. old 2-5 yrs. of age Total Under l yr. of age 1 yr. old 2-5 yrs. of age Total 1955 266 12 15 293 4,733 1,334 800 6,867 7,160 Fifty-nine children were immunised against diphtheria and 49 against whooping cough during the year at "Brookscroft." Summary of Attendances at all Child Welfare Clinics First Attendances Re-Attendances Grand Total Under 1 yr. of age 1 year old 2-5 years of age Total Under 1 yr. of age 1 yr. old 2-5 years of age Total Local Authority Scheme 910 55 103 1,068 14,692 4,892 7,046 26,630 27,698 "Brookscroft" 266 12 15 293 4,733 1,334 800 6,867 7,160 Total 1955 1,176 67 118 1,361 19,425 6,226 7,846 33,497 34,858 TREATMENT The facilities provided at the Education Authority's Clinics are available for all children attending the Welfare Centres. (a) Orthopa?dic.— Miss Garratt, C.S.P., has kindly furnished the following information with respect to children under five years of age:— 79 Defects Seen at Orthopaedic Clinic in Children Under Five Years of Age Anterior Poliomyelitis 4 Overlapping Toes 7 Surgical Tuberculosis 1 Perthes Disease 1 Scoliosis, Lordosis, Kyphosis 8 Digitus Varus 1 Genu Varum 22 Arthrogryposis Multiplex Pes Valgus and Valgus Congenital 1 Ankles 19 Congenital Dislocation or Torticollis 1 Hip 1 Talipes Other Congenital Defects 3 (a) Calcaneo Valgus 2 Miscellaneous (including (b) Metatarsus Varus 5 chest conditions).— 6 Total 86 Number of Treatments given— 633. (b) Sunlight.— Sunlight treatment was given at the Hale End Clinic to 11 children under 5 years of age for 106 treatments. (c) Priority Dental Treatment.— The Senior Dental Officer reports:— "As forecast last year, the numbers of expectant and nursing mothers have decreased and with them a small decrease in the total of young children referred for treatment. "Once again quite a high proportion of the mothers and children were in need of conservation work as opposed to extraction and the provision of dentures. It is of interest that many of the mothers attending had attended the clinic regularly from school age and had continued regular inspection and treatment at General Dental Service sessions during adolescence. These patients naturally needed very little treatment and have vindicated the policy of continuing the dental service to school-leavers in their earlier and dentally critical years." The number of Dental Sessions have been as follows:— 1955 174 1954 187 The total of expectant and nursing mothers who received dental treatment during 1955 expressed as a percentage of live births was 16.6. The Regional Hospital Board made available the services of a specialist anaesthetist for three sessions per week. Towards the end of the year the County Council approved a proposal that dental staff could volunteer for evening sessions for the "priority" groups, i.e., expectant and nursing mothers and 80 children under five years of age. No offers were forthcoming largely because the dental staff already undertake a total of eight evening sessions per week for the General Dental Service. 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 210 119 341 Patients found to require treatment 206 114 326 Patients who have commenced treatment 189 111 301 Patients who have completed treatment 120 100 265 Patients awaiting treatment 3 — 7 Attendances for treatment 360 369 445 Types of treatment given: Expectant Mothers : Nursing Mothers Children under School age 1. Extractions : (a) permanent teeth 122 125 — (b) temporary „ — — 320 2. Fillings: (a) permanent teeth 137 146 — (b) temporary „ — — 269 3. Inlays provided — — — 4. Crowns „ — 3 — 5. Anaesthetics administered : (a) local 10 30 11 (b) general:— (i) by medical officers 5 11 54 (ii) by others 54 32 104 6. (a) Scaling 87 23 1 (b) Prolonged scaling and gum treatment 10 7 7 7. Silver Nitrate Treatment 6 10 114 8. Dressings 55 40 50 9. X-ray examinations 8 11 — 10. Dentures provided: (a) full — 15 — (b) partial 1 18 — 11. Dentures repaired — 4 — 12. Dentures remade: (a) full 1 5 — (b) partial — 3 — 81 Types of treatment given— continued Expectant Mothers : Nursing Mothers Children under School age 13. Orthodontic appliances: (a) fixed - 1 — (b) movable - — — 14. Prophylactic treatment and other operations: Impressions 11 64 — Bites 6 32 — Try-ins 6 28 — Easing 2 17 — Polishing 71 13 — Gum Treatments 58 9 1 Syringing — 8 1 Excision of Roots 3 — — 15. Number of treatments included above in 6 or 14, carried out by Oral Hygienist 205 28 — The services of the Dental Hygienist were available on two days per week. Apart from chairside work for the priority groups, talks were given at Thorpe Coombe Maternity Hospital. (d) Tonsils and Adenoids.— Children are treated at various hospitals. (e) Ophthalmic Defects and Minor Ailments.— Children are given treatment either at the School Clinics or by special appointment. (f) Child Guidance.— The special fortnightly 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:— "The number referred during the year was 12. "The work there continues to give gratifying results, and I am confirmed in my view that this is a rewarding field of work for reasons which I have outlined in previous reports. Nevertheless, the number of cases referred to this clinic remains disappointingly low, in spite of the increasing public recognition of the importance of this type of work. "A greater number of referrals of suitable problems would be welcome." 82 (g) Pediatric Clinic.— The fortnightly clinic, under the charge of Dr. Elchon Hinden, Paediatrician to Whipps Cross Hospital, continued during 1955 and 32 children under five years of age were seen. Dr. Hinden's report on the work of this clinic is included in the Annual Report of the Borough School Medical Officer. The following details are given in regard to the children under 5 years who attended the clinic during 1955:— Under 5 years New cases 32 Total attendances 47 Physical Defects: Cases seen 30 Referred to Hospital 9 Discharged 3 Psychological Disorders: (a) Enuresis — (b) Other 2 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:— Children referred for convalescence by:— Under five years Hospitals 1 Local Health Authority 1 General Practitioners 9 11 Classification of Above Cases:— Under five years Anaemia, Debility 4 After effects of acute or infectious illness or operation — Diseases of: Ear, Nose and Throat 4 Eyes 2 Other defects 1 11 83 Children referred for visiting, advice, help or follow up: Under five years Voluntary Bodies 1 Orthopaedic Clinic 1 2 (i) Convalescence.— During 1955, four 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, 3 mothers and their babies were sent away for a period of convalescence. PROVISION OF NUTRIENTS AND MEDICAMENTS Details of nutrients and medicaments sold and issued free during 1955 are as follows:— Sales Free Issue lbs. ozs. lbs. ozs. Adexolin 30 13½ Bemax 194 10½ - — Cow and Gate 2,855 — - — Cod Liver Oil Emulsion — — - 8 Cod Liver Oil and Malt — — 25 — Farex 923 2 — Ferrous Gluconate Tablets — — 21,000 Gentian Violet Tablets — — 2,000 Glucodin 159 — - — Lactogol 45 14½ - — Iron Sulphate Compound Tablets — — 11,000 Maltoline with Iron — — 355 - Marmite 849 8 - — Milk of Magnesia — — 8 8 Mist Ferri et Ammon Cit. Pro Infantibus - - 14 2 Ostermilk 1,101 — - — Ostocalcium Tablets — — 5,000 84  Sales Free Issue lbs. ozs. lbs. ozs. Robinson's Groats 229 — — — Sodium Citrate Tablets — — 9,000 Scott's "Twin Pack" 445 8 — - Virol 718 8 — — Value of Cash Sales £1,228 19s. lOd. DISTRIBUTION OF WELFARE FOODS At the end of the year, eight Distribution Centres were open for twenty-two sessions per week enabling beneficiaries to obtain supplies from one to four centres on any weekday. The following table shows the distribution of welfare foods at individual centres:— DISTRIBUTION CENTRE National Dried Milk (Tins) Cod Liver Oil (Bottles) Vitamin Tablets (Packets) Orange Juice (Bottles) Brookscroft Welfare Centre 4,469 1,811 532 9,944 Markhouse Road Infant Welfare Centre 5,074 1,849 516 8,666 Northcott House Distribution Centre 14,668 3,257 1,439 23,380 Penrhyn Avenue Infant Welfare Centre 5,024 1,800 473 9,607 Silverdale Road Infant Welfare Centre 2,627 2,083 569 12,647 Thorpe Coombe Maternity Hos' pital - 119 1,244 3,997 Town Hall Distribution Centre 1,550 546 203 3,200 West Avenue Infant Welfare Centre 4,022 1,492 647 7,543 TOTAL issues at Distribution Centres 37,434 12,957 5,623 78,984 In addition, the following were issued to:— Hospitals (National Health Service) 423 36 720 Day Nurseries — 252 — 936 Nursery School — — —- 72 GRAND TOTAL OF ISSUES 37,857 13,245 5,623 80,712 85 DAY NURSERIES The following table shows the average attendances at the Day Nurseries during 1955 (Mondays to Fridays only). Month Nurseries Under 2 yrs. Over 2 yrs. Total January Higham Hill 9.7 31.6 41.3 Handsworth Ave. 7.2 29.3 36.5 February Higham Hill 8.1 24.5 32.6 Handsworth Ave. 9.0 27.6 36.6 March Higham Hill 15.4 33.6 49.0 Handsworth Ave. 9.0 29.6 38.6 April Higham Hill 15.6 34.7 50.3 Handsworth Ave. 11.4 32.5 43.9 May Hignam Hill 17.6 35.5 53.1 Handsworth Ave. 11.3 33.8 45.1 June Higham Hill 18.9 38.4 57.3 Handsworth Ave. 11.7 38.3 50.0 July Higham Hill 15.0 39.3 54.3 Handsworth Ave. 8.8 35.4 44.2 August Higham Hill 9.5 32.6 42.1 Handsworth Ave. 9.7 40.3 50.0 September . Higham Hill 8.9 29.5 38.4 Handsworth Ave. 11.3 41.8 53.1 October Higham Hill 11.3 38.9 50.2 Handsworth Ave. 9.1 36.4 45.5 November Higham Hill 13.2 37.7 50.9 Handsworth Ave. 10.2 40.7 50.9 December Higham Hill 13.4 34.4 47.8 Handsworth Ave. 10.8 36.4 47.2 Average Higham Hill 13.0 34.3 47.3 Whole Year Handsworth Ave. 10.0 35.2 45.2 Both Day Nurseries are approved for training in the care of children aged 0—5 years. Both have 60 places. Training.— During 1955, eight Nursery Students gained their Certificates of the Royal Sanitary Institute and one failed. Their future careers were as follows:— 3 (including one student who failed her examination) entered General Nursing Training. 2 continued as Staff Nursery Nurse with other Authorities. 1 intended to train as a Dental Surgeon and has obtained a position with this intention in view. 1 is working in an office until she obtains a Day Nursery appointment. 1 did not wish to continue Nursery work for domestic reasons. 1 married. 86 Scarlet Fever at Handsworth Avenue Day Nursery. Three cases of scarlet fever occurred in October. All parents were advised and all staff and children were swabbed. Five carriers were excluded. Daily visits were made by the medical staff until no further cases occurred. NURSERIES AND CHILD MINDERS (REGULATION) ACT, 1948 There were no registrations under the above Act during 1955. 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. Details in respect of 1954 and 1955 are as follows:- 1954 1955 No. of Guardians on Register at end of year 19 20 No. of applications for services of Daily Guardian 32 40 Referred to Day Nurseries 26 28 Referred to Daily Guardian but nothing further heard 4 3 Placed with Daily Guardian 7 9 Continued in care of Daily Guardian from previous year 3 4 These thirteen children were in the care of a Daily Guardian for periods as follows: (Five of the children continued to be cared for in 1956.) Duration of Care (in weeks): 1 2 3 4 5 7 9 11 12 13 14 15 16 17 No. of Children: 1955 1 1 — 2 — 1 — — 1 1 — — — 1 1954 1 1 2 1 — Duration of care (in weeks) (contd.): 20 28 31 32 33 37 38 40 45 47 48 49 52 No. of Children: 1955 — 1 — - — — 1 - 1 - 1 — 1 1954 — — 2 — 1 — — 1 — — — — 1 87 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. 1954 25 314 1955 11 261 These patients have attended for contraceptive advice on medical grounds. This is only a part of the work done at the clinic which is largely for gynecological conditions. MIDWIFERY (Section 23) There were 31 practising midwives in the Borough at the end of 1955, 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 1955:— No. of confinements attended as a Midwife 1,213 confinements attended as a Maternity Nurse 278 Medical Aid Notices sent 537 Twin Births notified 15 Stillbirths notified 6 Notifications of Artificial Feeding 16 ,, Discharging Eyes — „ Deaths notified 1 88 The previous table includes the following numbers in regard to work done at Thorpe Coombe Maternity Hospital:— Midwifery cases 1,021 Maternity cases 121 Mcdical Aid Notices 487 The percentage of Medical Aid Notices were:— All cases 36.6 Maternity Hospital Midwives 42.6 Other Midwives 14.3 The conditions for which Medical Aid was summoned by Midwives in domiciliary practice and private nursing homes have been summarised and are as follows- For complications during pregnancy:— Antepartum haemorrhage 3 Other conditions 7 Total 10 For complications during labour:— Prolonged second stage 1 Ruptured perineum 12 Premature labour 2 Rise in temperature 2 Postpartum haemorrhage 1 Abnormal presentation 2 Adherent placenta 1 Other conditions 9 Total 30 For complications in regard to the infant:— Jaundice 1 Inflamed eyes 1 Prematurity 1 Cyanosis 2 Other conditions 5 Total 10 89 The table below shows the number of visits carried out by the District Midwives and Home Nurse/Midwives:— Ante-Natal Examinations Deliveries Lying-in Visits Total Visits Patients Homes Midwife's House Clinic Mid. Mat. District Midwives 1,319 532 1,214 170 113 3,208 6,556 Home Nurse/ Midwives 271 — 1,098 22 27 464 1,882 Totals 1,590 532 2,312 192 140 3,672 8,438 One midwife in private practice undertook 21 cases as maternity nurse. Gas and Air analgesia- A total of 288 patients on the District received gas and air analgesia, representing a percentage of 86.7 of district confinements. Emergency Unit.— This Unit, stationed at Thorpe Coombe Maternity Hospital, was called out to 5 Walthamstow cases during 1955. Maternity Outfits.- Outfits are issued for all home confinements. 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 25 pupils successfully underwent Part II training during 1955. 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. Co-operation with General Practitioners.— An enquiry made during the year revealed that there is an exchange of detailed case information, that there are personal discussions between doctors 90 and midwives in regard to their patients and that doctors and midwives work together at Ante-Natal sessions. Three of the midwives co-operate with five of the doctors on the obstetric list in holding ante-natal clinics at doctors' surgeries. During 1955 arrangements were made to notify all General Practitioners, irrespective of whether or not they were on the obstetric list, when any person known to be on their list had made a booking with a midwife for a confinement at home. The results of all examinations were communicated either then or later, i.e., blood grouping, Haemoglobin, Rhesus and Kahn, the purpose being to advise the General Practitioner in preparation for any possible call for medical aid from the midwife. In addition, the expectant mother was given a card recording the blood group and the Rhesus result. HEALTH VISITING (Section 24) Health Visiting Staff.— The role of the Health Visitor in assisting the General Practitioner was stressed in a letter to the latter and a copy of an address given to Health Visitors by Sir Selwyn Selwyn-Clarke, K.B.E., a Principal Medical Officer of the Ministry of Health, was circulated at the same time. The equivalent of whole-time Health Visitors at the end of the year was 10.35 and one Superintendent. This was equal to one whole-time district Health Visitor to 135 notified births. Most of the Health Visitors also carry out duties as School Nurses. Home Visits To Children under 1 year of age Children 1 year of age Children 2-5 years of age TOTAL First Subsequent Total 1955 1,309 4,100 5,409 3,521 5,981 14,911 1954 1,491 4,632 6,123 3,856 6,617 16,596 The following table shows the number and nature of visits paid in 1955. 91 Ward Visits to Children under 1 year Visits to Children under 1 year of age Visits to Children 2—5 years of age Grand Total Unsuccessful Visits Ante-Natal Visits Other Visits Total Visits First Visits Subsc quent Visits Total Visits First Visits Subsequent Visits Total Visits (i) (2) 0) (4) (5) (6) (7) — — (8) (9) Cols. 6-9 St. James Street 208 385 593 282 646 1,521 301 50 41 91 371 2,284 High Street 158 285 443 226 520 1,189 166 30 25 55 179 1,589 Hoe Street 221 514 735 303 763 1,801 515 45 3 48 336 2,700 Wood Street 152 471 623 332 912 1,867 560 42 41 83 344 2,854 Hale End 291 1,556 1,847 1,144 1,789 4,780 334 69 61 130 249 5,493 Higham Hill 279 889 1,168 1,234 1,351 3,753 694 82 11 93 722 5,262 Totals 1955 1,309 4,100 5,409 3,521 5,981 14,911 2,570 318 182 500 2,201 20,182 Totals 1954 1,491 4,632 6,123 3,856 6,617 16,596 2,844 529 191 720 2.387 22,547 92 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, the Population Investigation of the Royal College of Obstetricians and Gynaecologists and Institute of Child Health (University of London), and iastly, Breast Feeding. Liaison with Hospital Services.—Health visitors and school nurses, as well as medical staff, continued to attend ward rounds of Dr. Hinden, Pediatrician, Whipps Cross Hospital, who holds a fortnightly session at the Town Hall Clinic. The Health Visitor and the General Practitioner. -Every ooportunity has been taken to make known the ways in which the Health Visitor can help the Family Doctor. General.— The Superintendent Health Visitor, Mrs. J. Foulkes, S.R.N., S.C.M., H.V.Cert., reports the following:— "This has been another busy year for the Health Visiting Staff. Visits to the aged and to problem families have taken up more of the Health Visitors' time than formerly. " Health Education is making an increasing demand on the energies of the Health Visitor and during the year more time was again devoted to the teaching of Mothercraft to school girls and expectant mothers. Mothercraft talks for girls are now being given or have been arranged in all secondary modern Schools in the Borough. This instruction is given to prepare for approaching parenthood and to avoid, if possible, the ignorance which leads to so many problems. "The Health Visiting Staff have again co-operated in the practical training of students. "Eight final year students from nearby hospitals have been given practical training in the Public Health field, involving home visiting, attendance at Infant Welfare Clinics and a Case Conference held to discuss cases visited by the students. "In the period under review, two Health Visitor Students from the South East Essex Technical College have carried out three months of their practical training in the Borough. They were allocated to specific Health Visitors who correlated the practical and theoretical work of the students. " Four Student Nursery Nurses visited Infant Welfare, Antenatal and other clinics in order to meet the requirements of the National Nursery Examinations Board, and were instructed and advised by Members of the Health Visiting Staff. "Throughout the year pupil midwives from Thorpe Coombe Maternity Hospital attended the Welfare Clinics. Each pupil 93 was required to attend a minimum of four sessions in order to satisfy the rules of the Central Midwives Board. " Although there is still a general shortage of Health Visitors, we are very fortunate in Walthamstow in having almost a full complement of staff." HOME NURSING (Section 25) Queen's Training.- Three nurses passed their Queen's examination during 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. Welhrock, S.R.N., S.C.M., M.T.D., reports as follows "The year 1955 has been a very busy one in district nursing. We were pleased to welcome visitors to see the extensive alterations in the Home, which have been very well worth while and have been very much appreciated by the Nurses and patients alike. "We have been very busy with nursing. The numbers have increased, particularly with the giving of injections. These form a very large proportion of the nurses' work. Injections of all description are given "Quite a large number of children have been attended. It is interesting to note that quite a lot of our patients are from 80 to over 90 years of age. "We were again able to take some Student Nurses in General Nursing Training to see District Nurses at work. "Staff at the 31st December, 1955 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. 8 Full-time Queen's S.R.N., S.C.M. 1 „ „ S.R.N., S.C.M., H.V. Certificate. 6 „ „ S.R.N., S.C.M. 1 „ „ Queen's, S.R.N. 2 „ „ S.R.N. 1 „ ,, Queen's S.R.N. (Male) 1 „ „ S.R.N. 1 Part-time S.R.N., S.C.M. 1 „ „ S.R.N. 4 „ „ S.E.A.N. "During the year 33 pupils entered for District Midwifery training. 94 "The following gives details of Home Visits during the year:— New cases Total visits Medical 644 44,946 Surgical 195 8,886 Tuberculosis 31 2,110 Operations 6 27 Miscarriages 1 12 Specials 5 67 Out-Patients— Medical 41 308 Out-Patients— Surgical 12 57 Hypodermic Injections 681 15,567 Casuals 69 183 Last Offices 19 39 Total 1,704 72,202 Prior to the War, the District Nurses Home at Carisbrooke Road (then administered by the Walthamstow District Nursing Association) provided a certain number of maternity beds in one of the two houses. It seems fitting therefore to refer here to the fact that a baby girl "A.M.", who was born prematurely at Caris brooke in June, 1934, and who at birth weighed only 16¾ ounces, celebrated her 21st birthday in June, 1955. Even in these days of thermostatically controlled incubators, it is regarded as a near miracle when a baby under 2lbs. can be saved and up to 1950 there were only six well authenticated cases of survival of babies with a birth weight of 16 ounces or under. It is a tribute to the skill and care which was then given, especially when the case notes reveal that by modern standards and practice the methods of feeding were somewhat unorthodox. At six months the weight was 9½lbs. and at the first birthday, 18lbs. Trilene Analgesia.— At the beginning of December, a representative of the manufacturers gave a demonstration to the medical and midwifery staff in regard to the Emotril apparatus which was to be supplied for the administration of Trilene. The apparatus was to be used for a period of twelve months in order to decide whether this type of analgesia should be substituted for gas and air analgesia when gas and air apparatus requires renewal. Up to the end of the year three patients had been given Trilene. 95 VACCINATION AND IMMUNISATION (Section 26) During 1955 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 against smallpox 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 7 years. A "booster" dose should also be given against whooping cough before school entry and re- vaccina tion performed. Experience in other parts of the country has shown the absolute need for reinforcing or "booster" doses, especially against diphtheria. The following were the attendances during the weekly Town Hall Clinic:— Diphtheria Immunisation 230 Whooping Cough Immunisation 188 Vaccination 385 Total 803 This represented an average of 19.6 attendances per session. There are two attendances for each vaccination and diphtheria immunisation, and three for each whooping cough immunisation. No clinics were held during August, September and October owing to the prevalence of poliomyelitis in this and the adjacent Boroughs. VACCINATION The number and ages of persons vaccinated are shown below:— Age at date of Vaccination Under 6 months 6-12 months 1 year 2—4 years 5—14 years 15 years and over Total Primary 357 84 15 15 14 64 549 Secondary — — — 4 14 175 193 Total 357 84 15 19 28 239 742 96 The total for 1954 was 648. Vaccinated by General Practitioners 541 Vaccinated by County Staff 201 There were 441 vaccinations in children under one year in 1955 compared with 432 in 1954. The vaccinations under one year during 1955 represented approximately 34% of babies surviving to the age of one year. For the purpose of comparison, similar figures have been calculated for the past four years as follows :— Year Percentage 1954 30 1953 36 1952 35 1951 37 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 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 of the ambulance service, especially those who would be expected to deal with smallpox in the event of cases occurring, were again offered facilities for vaccination and re-vaccination. The number vaccinated was 12. DIPHTHERIA IMMUNISATION 1955 The following is a summary of the work carried out during the year:— Total number of immunisations completed : (a) School age 156 (b) Pre-school age 786 Total 942 97 (c) Number already immunised having a rein- forcing dose 1,292 Details of the immunisations included in the above total are set out below:— No. completed at Schools 132 „ ,, Welfare Centres 254 ,, Town Hall Clinic 105 „ ,, „ " Brookscroft" 59 „ „ by General Practitioners 392 Total 942 The total for 1954 was 1,352, but immunisation was suspended during August, September and October on account of the prevalence of Poliomyelitis. 171 children included in the above figures were given combined whooping cough/diphtheria injections and 44 children were given whooping cough/tetanus/diphtheria injections by General Practi' doners. These prophylactics were not supplied by the County Council. There have been only two confirmed cases of diphtheria in the last nine 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. vC 00 During the past five years the numbers immunised in the various age groups were as follows :— Age at Immunisation Notified Cases Year 0—1 year 1—2 years 2—3 years 3—4 years 4—5 years Total 0 5 years School Age Grand Total Admitted to Hospital Diagnosis Confirmed Deaths 1951 670 442 59 22 19 1,212 265 1,477 11 - - 1952 723 361 48 24 18 1,174 412 1,586 10 — - 1953 610 324 36 16 19 1,005 191 1,196 13 — — 1954 685 300 58 29 21 1,093 259 1,352 6 — — 1955 560 157 36 20 13 786 156 942 6 — — Number of children at 31st December, 1955, who had completed a course of immunisation at any time before that date (i.e., at any time since 1st January, 1941):— Under 1 (born 1955) 69 1—4 (born 1954-1951) 3,670 5—9 (born 1950-1946) 8,663 10—14 (born 1945-1941) 7,089 Total immunised under 15 years 19,491 99 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 years and over Total Clinics, Nurseries and Welfare Centres 91 285 35 16 1 428 General Practitioners 47 171 38 14 7 277 Total 138 456 73 30 8 705 The total for 1954 was 1,039 and parents seemed somewhat keener on whooping cough immunisation for the under one's than on having them protected against smallpox and diphtheria. Immunisation was suspended during August, September and October on account of the prevalence of Poliomyelitis. In addition 32 children received a booster dose. Six cases of whooping cough were notified in children who had been previously immunised. These children were visited and an assessment made of the severity of the attack according to the criteria of the Medical Research Council. Details are given below:— Date of birth Date immunised Date notified Remarks M.R.C. classification 23.1.54 3.8.54 27.1.55 No whoop; 2 dozen coughing spasms in 24 hours. 4 19.8.53 15.3.54 24.8.55 Indefinite whoop; only one spasm at night 2 10.1.54 24.6.54 28.10.55 No whoop; 3 spasms in 24 hours coughing 2 21.1.51 28.11.51 9.11.55 3 whoops in 24 hours 4 15.10.54 5.5.55 7.12.55 No whoop; 1 spasm coughing in 24 hours 0 14.4.54 21.10.54 23.12.55 Whooped twice only; 4 spasms in 24 hours coughing 3 0 = no recognisable stage between the pre-paroxysmal stage and the paroxysmal stage. 2 = Atypical. 3 = considered mild ; less than 10 paroxysms in 24 hours. 4 = moderate ; more than 10 paroxysms in 24 hours. 100 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 Consultant at the Walthamstow Chest Clinic, has contributed the following:— "There have been no important changes in the work of the Chest Clinic during the year. The Odelca camera has continued to be very useful in making it possible for a large number of cases to be referred by General Practitioners for chest films. The usefulness of this scheme can be judged by the fact that over the last two years about one quarter of all notifications of respiratory tuberculosis in the district have come through the miniature radiography scheme. "The following figures give an estimate of the work as a whole:- Total attendances 16,693 Total new case attendances 8,895 Total X-ray examinations 13,049 Miniature Camera 4,340 "The actual number of cases notified during 1955 is higher than in 1954. The overall incidence of the disease throughout the country has, of course, fallen in recent years, but there will certainly still be variations from year to year. It is a warning that the problem of tuberculosis should not yet be regarded as of minor importance." Tuberculosis Case Conferences.—These Conferences started in June, 1953, at approximately monthly intervals and 6 were held during 1955. 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. 101 Other action in regard to Ascertainment and Follow-up:— (1) A chest X-ray examination on appointment is required in regard to those persons in contact with groups of children. Annual re-examination is carried out as far as possible. (2) 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. 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:— "The work of the Association has continued on much the same lines as in 1954, with grants being made as occasion arose while funds permitted. "During the twelve months covered by this report, substantial help was given in 182 cases, apart from small occasional grants or gifts. The greatest item of expenditure continued to be that on grocery vouchers, but considerable sums were also spent on clothing and bedding. The amount spent on fares to visit patients in hospital remained at a high level and seems likely to continue so while the main centre for chest surgery is so far away as Broomfield. "During the autumn, our activities were somewhat restricted by lack of funds, but we were able to maintain the nourishment grants and where other assistance was urgently required, this was obtained through the close liaison existing between our Association and the Glasspool Trust, whose help is always available to us. "As a result of increased activity on the part of the Social Sub-Committee, very satisfactory revenue was derived from Whist Drives, Dances, etc., making it possible for Christmas grants to be made from the Social Committee's account. "By making use of the N.A.P.T.-Spero Scheme, it was possible to arrange holidays for a few patients, either in specially selected boarding houses with their families, or in the Spero holiday homes reserved for the tuberculous. In some cases, the cost of the holiday was met entirely from our own funds, while in others it was shared with the County Council under their provisions for recuperative holidays. "On two occasions during the year, members were able to attend study-days arranged by the N.A.P.T. Delegates were also sent to the N.A.P.T. Commonwealth Health and 102 culosis Conference, the Secretary attending full-time and individual members taking advantage of the special sessions concerned with tuberculosis care work. These opportunities of seeing and hearing other aspects of tuberculosis work, of comparing our own methods with those of other similar bodies and broadening our outlook on the work generally, have been most useful. "The following figures may give some indication of the main items of material help given in direct grants from our funds, a great deal of additional assistance being obtained by reference of cases to the appropriate statutory authority, or through application to some charitable organisation more suited to the individual case." Assistance given No. of Patients Cost £ Milk 10 53 Grocery 36 475 Fuel 47 77 Fares to visit patients 17 147 Clothing, bedding, etc. 33 281 Miscellaneous grant 22 57 B.C.G. Vaccination of Schoolchildren. Vaccination of schoolchildren in the year preceding their fourteenth birthday continued. The scheme was fully described in the report of the School Medical Officer for 1954. During 1955 acceptances were received from 857 children out of 1,654 who were eligible, i.e., 51%. Details are as follows :— Heaf positive 109 Heaf negative 740 Absent from test 8 857 Vaccinated, 728 ; absent or not done, 12. 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. Contact Examinations. First examinations of contacts in 1955 were 94 examinations to 73 total notifications. In 1954 there were 140 examinations to 67 notifications. 103 Rehabilitation of Tuberculous Patients. Financial responsibility was accepted for the rehabilitation of one case at the British Legion village from 1st February to 25th July when responsibility was suspended owing to his re-admission to hospital. Prevention. B.C.G. vaccination and Contact examinations are referred to above. In addition there were Chest X-ray examinations for all persons in contact with groups of children, especially teachers, Mass X-ray examinations, special examinations by means of the Odelca apparatus at the Chest Clinic for patients referred by Family Doctors and the rehousing of infectious cases. The following information in regard to the infectivity of tuberculosis is taken, with his permission, from an article by Professor F. R. G. Heaf, M.D., F.R C.P., David Davies Professor of Tuberculosis, University of Wales, and merits wide publicity:— "There is always a danger in extremes, and an exaggeration of the infectivity of tuberculosis can cause as great harm and 'hardship as the neglect of preventive measures. The medical profession has not been guiltless in encouraging unnecessary ostracism of persons with arrested or even quiescent tuberculosis. "There is evidence that there has been a progressive increase in the last ten years in the number of children and young adults who escape infection. "Although the child in contact with a known infectious case of tuberculosis runs a six times greater risk of being infected than one in a non-tuberculous household, there are still from 30 per cent. to 40 per cent. of children living in tuberculous environments who escape infection up to the age of 14 years. "Against this apparent low rate of infectivity, we must place the numerous references in the literature of school children becoming infected through a teacher with active pulmonary tuberculosis. "The evidence before us indicates that the tubercle bacillus does not infect children so frequently as it used to, in spite of the fact that tuberculous patients live longer and that there is only a slight fall in the number of new cases. "It does not take much imagination to realise that the ambulant infectious patient will be likely to infect more people than a bedridden one, whose target area will not be greater than a semi-circle about six feet in diameter around the bed. "We must come to the conclusion that it is the age of the person infected and the magnitude and nature of the primary infection that is of paramount importance. After that has been 104 overcome, continuous frequent infections over a period may break down resistance, particularly in infants and adolescents. but apart from those age-groups, the development of active disease in adults is mainly due to endogenous exacerbation of an existing lesion. "It is not my intention that you should think that infection does not matter, on the contrary, it means that the utmost care must be exercised to prevent primary infection and reduce frequent droplet infection to the minimum, because who can know the state of his neighbour's resistance to infection, or whether any particular infection will be a primary one. I must emphasise that we ourselves who work among the tuberculous can be fairlv certain that we shall not break down with tuberculosis if we observe the rules that lead to general good health and are sure that we are tuberculin positive. There is, among the general population at present, an exaggerated fear of infection very often in the age-groups that are least susceptible, whereas precautionary measures are not always taken to the extent they might be to protect the groups that are most vulnerable, namely the infants, adolescents and tuberculin-negative persons. "The control of tuberculous infection is largely a matter of commonsense, to which must be added the knowledge that it is the individual's inherent resistance to the infection that mainly decides the development of disease. It is therefore necessary, at all times, and by all means, to maintain this resistance at the highest possible level, as well as to capture and kill the bacillus wherever we may find him outside the body." CONVALESCENCE FOR ADULTS The total of cases sent away for recuperative convalescence was 66. The length of convalescence was five days in one case, one week in two cases, two weeks in 62 cases, and three weeks in one case. One patient discharged herself after a stay of only five days. Recovery of cost or part-cost was made. 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. Several gifts of invalid chairs were made by a Member of the Health Area Sub-Committee. 105 CHIROPODY SERVICES Mr. R. King, Chief Chiropodist, reports the following:— "The year under review has shown progress, firstly by the appointment of a part-time chiropodist available for seven sessions per week distributed between the Town Hall Central Clinic and Low Hall Lane. These additional sessions were commenced on June 1st. "During the early part of the year, the new dressing cubicles became available and have been much appreciated. The accommodation in the treatment room is still rather cramped and full privacy is not available to each patient. "The total number of treatments given during the year amounted to 18,617 for 5,677 patients. Of the 18,617 treatments, 12,833 were given to women, 3,304 to men and 2,480 to children, making an average of 3.7 treatments per patient for the year. The adult proportion of the 5,677 amounts to 4,981, representing an average of 3.2 per patient. "The large preponderance of female patients stresses the results of the inadequacy or unsuitability of female footwear and in particular the court and the slipper type of shoes are considered to have a very bad effect. "Attendances at the Tuesday morning children's clinic have increased, the total number of children being 696 with 2,480 treatments, an average of 3.5 treatments per child. "The number of patients requiring transport increased, but a medical certificate is always required before the arrangement of transport. There was a total of 245 such cases, an increase of 53 over 1954 and consisting of 210 women and 35 men. "The period between appointments averages about thirteen weeks and the number of booked appointments at the end of the year was no fewer than 3,979. With the seasonal summer demand, the interval between treatments increases. "The number of patients failing to keep their appointments without notification increased and many patients also arrived late for their appointments. Although this represented only a small proportion of the whole, it gave rise to considerable dislocation which could easily have been avoided by consideration on the part of the patients concerned." 106 CHILDREN NEGLECTED OR ILL TREATED IN THEIR OWN HOMES (Ministry of Health Circular 78/50 and Prevention of Break-up of Families—Ministry of Health Circular 27/54) All possible action has been taken in regard to neglected and ill-treated children and to "problem families." Such action was facilitated by the appointment of a Woman Visitor to assist the Male Inspector of the N.S.P.C.C., whose area headquarters are situated in Walthamstow. Help in regard to the increasing number of problem families was much appreciated. Full contact has always been maintained with all organisations and persons who are interested or can help in any particular case. The number of such organisations and/or persons totals at least 15 and as urgent action became necessary from time to time, it was found more convenient to discuss such action with those persons who were directly involved in any particular aspect rather than to try and convene regular and full case conferences. Apart from the Family Doctor, the persons who contributed most were the Health Visitor and the Domestic Help, and where appropriate, the Home Nurse. Amongst the domestic helps, both whole-time and part-time, there were many who were considered ideally suitable to help in rehabilitation, but such were the demands on the service and the shortage of helps generally, that it was not always possible to allocate the most suitable help for any problem family requiring such help. Arrangements were made to maintain a register and full records of these families. HEALTH EDUCATION Throughout the year the Health Visiting Staff have carried out a regular series of lectures and film shows to expectant and nursing mothers, on subjects such as Breast-feeding, Home Safety, Child Development, etc. The Health Visitors have also given lectures and film shows to girls of school leaving age on Mothercraft. Between the 8th and 15th October, the County and Borough Councils co-operated with the Walthamstow Chamber of Commerce, who were holding a "Shopping Week" by providing an exhibition in the Old Monoux School Building, High Street. The exhibition referred to the Clean Food Campaign of the Local Sanitary Authority, and the Personal Health Services provided by the Essex County Council with special emphasis on the following:— Vaccination against Smallpox. Immunisation against Diphtheria.. Health Visiting Services. Home Nursing and Midwifery Services. Prevention of Tuberculosis. Dental Hygiene. Accidents in the Home. 107 Vaccination Exhibition and Film Show. - With the cooperation of the County Medical Officer, a vaccination topic was exhibited at the various Welfare Centres in the Borough and at the Central School Clinic at the Town Hall between the 21st November and the 16th December, 1955, and a film was shown in conjunction with the Exhibition. Prevention of Accidents in the Home.—In June a circular was addressed to the Head Teachers of Secondary Schools, pointing out that in ten years in England and Wales there were 60,000 deaths from home accidents as compared with 48,000 deaths from road accidents, that there was, unfortunately, little information in regard to non-fatal accidents, and that the majority of home accidents were preventable. It was felt that the schools could play an important part in drawing attention to the elementary precautions which could and should be taken in the home. A list of suggestions was therefore sent out to the Head Teachers of Secondary Schools with a view to their incorporation in the Housecraft Syllabus for Girls and in the Science Syllabus for Boys. In addition it was stated that there were a number of film strips available on the subject and chat where necessary it would be possible to arrange for school nurses to give talks on the subject. OLD PEOPLE'S WELFARE Visit to Langthorne Hospital In November eight each of the Health Visitors, Home Nurses and Domestic Helps attended a talk and dinner at Langthorne Hospital given by Dr. DeLargy, Consultant Geriatrician. Reference was made to the healthy aged, the infirm and the acutely ill, the increasing percentage of the population who were reaching old age, and the basic necessities of old people, i.e., occupation, home life, affection and the "need to be needed." Dr. DeLargy stressed the harm resulting from prolonged bed rest and that the chief single cause of making old people nonambulant was comparatively minor foot conditions remediable by chiropody. One of the more potent causes of incontinence in the elderly was the difficulty and disinclination of using the outside " backyard " toilet, which exists in so many houses. DOMESTIC HELP SERVICE (Section 29) Repeated advertisement was carried out and towards the end of the year and at the beginning of 1956 (with the help of the Housing Manager of the Borough Council) a special appeal was circulated to over 2,500 tenants of Council property. The response to all these measures was insignificant and did not relieve the need for more help. 108 The Local Nursing Division of the St. John Ambulance Brigade extended without fee their lectures on Home Nursing to Domestic Helps, 12 of whom completed the course. The Organiser and 7 of the Helps obtained the Home Nursing certificate at the end of the course. The liaison with Hospital Almoners is improving; the insufficiency of helps is appreciated by them. Mrs. C. M. Hall, Domestic Help Organiser, reports as follows : "1955 was an extremely busy year as applications for domestic help increased continuously and it was very difficult at times to meet the demand for assistance, particularly at the beginning and end of the year. The service continues to be administered as in previous years and more cases than ever before were dealt with. A total of 2,498 visits were made. There were 12 fulltime and up to 230 part-time helps. Although so many helps are continuously employed, unfortunately there are never enough to meet the immediate demand without a waiting period and at times in an emergency, a full-time help may have to be transferred from her usual duties to meet the greater need. Liaison with Hospital Almoners is now much better, as the Almoners are learning to realise the shortage of helps is very real and explain to departing patients that there may be a waiting period before help can be provided. The helps work well with the Home Nurses and between them a great deal is done to help the sick. The number of cases carried forward into the New Year is more than ever before, and as recruiting through advertising was very disappointing, the need for more helps continues. Below is a summary of the year's work Brought forward from 1954 637 New cases during 1955 429 Cases completed during 1955 359 Number of cases carried forward to 1956 708 During the year two helps attended a training course for domestic helps at Chelmsford and both were successful in obtaining a certificate. A total of eight helps have now attended this course and without exception have enjoyed it and found it stimulating and helpful in their daily duties. The aged chronic sick grow in number and continue to absorb much of the available labour. Fortunately the number of tuberculous cases needing domestic help continued low and all requests were met. The foregoing figures indicate an ever upward trend in the number of requests for help and the care of the aged is a problem to all concerned as the labour situation becomes more difficult. The Domestic Help Service will continue to play a big part in the comfort of sick and infirm people, and the helps deserve a 'Well done ' for a good year's work." DOMESTIC HELP SERVICE, 1955 Maternity Acute Sick Tuberculous Chronic Sick Aged Others Aged not Sick Others Total Requests for Kelp from new cases during the year 75 52 10 282 73 10 9 511 Total cases helped during the year 63 30 17 749 148 53 5 1,065 Cases being helped at end of year who have received help for:— Under 3 mths. 2 3 1 57 6 2 - 71 3—6 „ — 2 2 31 9 1 — 45 6—12 „ — — 1 98 15 1 —. 115 Over 12 „ — — 4 380 56 37 — 477 Total carried forward to 1956 2 5 8 566 86 41 — 708 Hours of help provided during the year 3,459 1,504 2,108 132,120 25,294 9,024 941 174,450 109 110 COUNTY COUNCIL OF ESSEX—WELFARE COMMITTEE WELFARE SERVICES Mr. G. E. Pegram, O.B.E., County Welfare Officer, kindly contributes the following:— "The statistics set out below 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 1955:— (1) Residential and Temporary Accommodation. (a) Admitted to hostels and other residential establishments: Men, 31; Women, 27. (b) Admitted to temporary accommodation: Men, 4; Women, 10; Children, 17. (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, 1955, were as follows (i) Registered as blind 246 (ii) Partially sighted 51 (iii) Defective sighted 13 all of whom were under the supervision of the County Council's Home Teachers. During the year six 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-seven blind and sixteen partially sighted persons in open industry. "The County Council's Scheme for welfare services for handicapped persons (general classes) and the deaf and dumb and hard of hearing are operating with the co-operation of voluntary organisations specialising in this field of work, but of course, the implementation of such Schemes is necessarily a gradual although progressive process." The Part III accommodation controlled by the Welfare Department at Langthorne Hospital is now known as Wessex House and Brookfield is now known as Spackman House. The accommodation at the latter has been increased to take 14 men and 31 women. The accommodation, furnishing and care afforded are all of a very high standard.