A C 4411 (1) WACTHAM Sackd WAL 43 BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1956 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 67979 Bckd By P. C. 2.8.57 mby BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1956 INDEX page Section A.— Statistics and Social Conditions of the Area 8 Section B.— General Provision of Health Services in the Area 16 Section C.— Sanitary Circumstances of the Area 19 Section D.—- Housing 28 Section E.— Inspection and Supervision of Food 36 Section F.— Prevalence and Control over Infectious Diseases 46 Section G.— Miscellaneous 58 Section H.— National Health Service Act, 1946—Part III Services 64 Health Centres 65 Care of Mothers and Young Children 67 Midwifery 84 Health Visiting 87 Home Nursing 89 Vaccination and Immunisation 90 Ambulance Facilities 97 Prevention of Illness, Care and After - Care 97 Domestic Help 102 page Accidents in the Home 12, 102 Acreage 8 Adulteration 40 Aged and chronic sick 18, 58 Ambulance Facilities 17, 97 Ante-Natal Clinics 67, 73 Assessments 8 Bacteriological Examination 36, 38, 42 B.C.G. Immunisation 99 Birth Notifications 69 Birth Registrations 15 Births, Illegitimate 9, 10, 72 Birth Rate 9 "Brookscroft" Welfare 74 Cancer deaths 11, 12 Cancer Education 61 Caravans 23 Care and After - Care 97 Care of Illegitimate Children 72 Census, 1951 8 Child Guidance 77 Child Welfare Clinics 73, 74, 75 Chiropody 60, 100 Clean Air Act, 1956 23 Cleansing (Personal) 17, 83 Clearance Areas 32 Committees 4, 64 Comparability Factor 10 Confinements 69 Contact Examinations 100 Convalescence for Adults 100 Convalescence for Pre-School Children 79 Conveniences, Public 62 Co-operation with General Practitioners 86 Cremation 62 Daily Guardian Scheme 83 Day Nurseries 82 Deaths 9, 10, 11 page Deaths from Accidents in the Home 12 Deaths, Infants 10, 13, 14 Death Rate 9 Deaths, Causes of 11, 71 Dental Laboratory 66 Dental Treatment 75 Diphtheria 48 Diphtheria Immunisation 92 Diseases of Animals Acts 43 Disinfections 21, 61 Disinfestation 23 District Midwifery 84 Domestic Help 102, 104 Dysentery 53 Employment 9 Emergency Unit 86 Enteric Fever 49 Essex County Council Act, 1933 19 Factories Acts, 1937/48 45 Family Doctors, co-operation with 86 Food and Drugs Act, 1955 40 Food Hygiene Regulations, 1955 42 Flooding 62 Food Inspection 36 Food Poisoning 43, 51 Foot Clinic 60, 100 Funeral Arrangements 61 Gas and Air Analgesia 86 General Dental Service 65 General Information 62 Health Centres 65 Health Education 61, 101 Health Visiting 60, 87 Home Nursing 89 Home Visits 87 Hospital Accommodation 18 Housing Act, 1936 32 page Housing, Closure and Demolition 31 Housing, General 33 Housing, Improvement Grants 29 Housing, Inspection 29 Housing Repairs and Rents Act, 1954 31 Housing Statistics 28 Ice Cream 37 Illegitimacy 72 Immunisation 90 Imported Eqg Products 50 Incidence of Mongolism 84 Infant Mortality 10, 13, 14, 70 Infectious Diseases (General) 46 Infestation 23, 83 Inquests 62 Integration of Health Services 16 Invalid Children's Aid Association 79 Laboratory Facilities 17 Laundry Service for the Incontinent 61 Liaison with Hospital Services 88 Mass Radiography 55 Maternal Mortality 13, 15, 84 Maternity Homes 19 Maternity Outfits 86 Meals on Wheels Service 60 Measles 48 Meat and other Foods 38 Medical Aid 85 Medical Examinations 61 Medicaments 80 Meningococcal Infection 53 Midwifery 84 Milk Inspection 36 Milk Special Designations Order, 1951 37 Milk Supply 36 Moral Welfare 72 National Assistance Act, 1948, Sec. 47 18 National Assistance (Amendment) Act, 1951 19 Neo-Natal Mortality 13, 15, 69 Notices, Sanitary 20 Notification of Births 69 Nursery Nursing Certificate 82 Nurseries and Child Minders (Reg.) Acts, 1948 83 Nutrients 80 Old People's Welfare 18, 58, 105 Ophthalmia Neonatorum 53 Ophthalmic Treatment 77 Orthopaedic Treatment 75 Outworkers 46 Pediatric Clinic 79 Pet Animals Act, 1951 43 page Poliomyelitis 49, 97 Population 8 Post-Mortems 62 Post-Natal Clinics 67, 73 Premature Infants 72 Prevention of Break-up of Families 101 Prevention of Damage by Pests Act, 1949 43 Prevention of Illness 97 Prevention of Tuberculosis 57, 100 Public Health Act, 1936 19, 44 Public Health Inspection 20 Pupil Midwives 86 Queen's Institute of District Nursing—Training 89 Rainfall 62 Rateable Value 8 Redevelopment and Clearance Areas 32 Rehabilitation 100 Rehousing on Medical Grounds 36 Relaxation Classes 68, 73 Rodent Control 43 Scabies Treatment 17 School Outbreaks 49 Sickness Benefit 57 Sickroom Equipment 100 Smoke Abatement 24 Social Conditions 8 Special Premises 21, 22 Staff 16, 45 Statistics 9, 69 Stillbirths 9, 13, 15 Sunlight Treatment 75 Swimming Baths 26 Toddlers' Clinic 69 Total Infant Mortality 14 Tonsils and Adenoids 77 Training of Nursery Nurses 82 Training of Pupil Midwives 86 Tuberculosis 54, 56, 97 Vaccination 90, 91, 97 Verminous Premises 23 Virus Infections during Pregnancy 69 Vital Statistics 9, 69 Walthamstow Corporation Act, 1956 27 Walthamstow Association of Tuberculosis Care Helpers 98 Walthamstow Child Welfare Society 74 Water 19 Welfare Services 105 Welfare Foods 81 Whooping Cough 48 „ „ Immunisation 94 Women's Clinic 84 HEALTH COMMITTEE 1956-7 Chairman: Councillor Mrs. W. M. Palethorpe, Vice-Chairman: Councillor J. E. Nicholls. Ex-officio: The Worshipful The Mayor—Alderman G. R. Lowton, J.P. The Deputy Mayor—Alderman the Lady McEntee, O.B.E., J.P. Chairman of Finance Committee—Alderman Ross Wyld, O.B.E., J.P. Alderman Mrs. L. P. Bailey, J.P. „ G. S. Mace. „ E. C. Redhead, J.P., M.P. Councillors: Mrs. E. L. Baldwin. J. J. Bracken. Mrs. S. Candy. Mrs. G. F. G. Cowell. F. H. Eiles. A. W. Ellis, M.B.E. Councillors : J. H. Hammond. O. F. J. McCarthy. J. W. Pringle. Mrs. C. E. Stannard. A. F. Whicher. Town Cler: G. A. Blakeley, Esq. Medical Officer of Health, Borough School Medical Officer and Area Medical Officer: A. T. W. Powell, M.C., M.B., B.S., D.P.H. Deputy Medical Officer of Health : G. H. G. Poole, M.B., B.S., D.P.H., D.(Obst.)R.C.O.G. Chief Public Health Inspector, Petroleum Officer and Chief Inspector, Diseases of Animals Acts: W. R. Richards, M.R.S.I., M.P.H.I.A. TO THE CHAIRMAN AND MEMBERS OF THE HEALTH COMMITTEE My Lady, Ladies and Gentlemen, I present herewith a report on the health and the Health Services of the Borough during 1956, and again by courtesy of the County Medical Officer, I give details of the Personal Health Services. A comparison is given of the changing picture of health and disease in the Borough over the past twenty-seven years. The vital statistics are again favourable and there are new low records in regard to infant mortality, which for the first time has fallen below 20, still-births and deaths of infants in the neo-natal period. A table is given showing the cancer deaths rate for England 6? Wales and Walthamstow, and also in regard to fatal accidents in the home. Reference is made to the increase in the work in regard to institutional accommodation for the aged and chronic sick and to the cases requiring consideration for possible compulsory removal under Section 47 of the National Assistance Act, 1948. In accordance with the appropriate legislation, the former Sanitary Inspectors are now designated Public Health Inspectors. During the year consideration was given to the increase in the number of Student Public Health Inspectors. Reference is made to smoke abatement, attendance of Public Health Inspectors at special courses, and the special report of the London and Home Counties Smoke Abatement Advisory Council. Reference is also made to the Walthamstow Corporation Act and those sections dealing with the provision of bathrooms, to the speedier repair of defective premises, sealing of drains and sewers before the demolition of property, storage for street trading purposes, the restoration of water supplies, and the regulations in regard to the premises of hairdressers and barbers. A summary is given of the progress in the clearance of unfit houses, and it is of interest to note that over two-thirds of the properties included in the five-year programme have already been represented for demolition. The Housing Manager contributes a report in regard to rehousing in Walthamstow and acknowledgment must be made of his helpful co-operation in regard to all cases with a medical aspect, and especially the rehousing of the tuberculous. The Public Health Inspectorate have paid increasing attention to the inspection and supervision of food, especially in regard to cooked meats, about one-fifth of which showed considerable contamination; even so, there was a marked improvement when compared with 1955. With regard to infectious disease, there has been no confirmed case of diphtheria since January, 1950, but the need still remains for immunisation before the first birthday and for booster doses before school entry. An average number of cases of poliomyelitis were notified and confirmed, and fortunately there was only slight residual paralysis in one case. Five cases of paratyphoid were associated with cream-filled cakes and again with imported egg products. These cases were part of a larger outbreak affecting the eastern part of Greater London. There were two considerable epidemics of food poisoning due to Clostridium welchii. Dr. Betty Hobbs made a close study of one outbreak and made recommendations. The whole of the "field" investigations in regard to cases of food poisoning were made by the Public Health Inspectorate. Reference is made to the risk attending on the use of imported egg products, especially Chinese, and the action taken. Although 10 more cases of pulmonary tuberculosis were notified in 1956, the total of 71 compares very favourably with that of 159 in 1930. Reference is made to old people's welfare, the increasing need for accommodation for the aged and chronic sick, and for domiciliary chiropody for the elderly housebound. The laundry service for the incontinent continued to serve a real need. The year was one of excessive rainstorms with consequential flooding. The action proposed is described by the Borough Engineer. With regard to the Personal Health Services administered by the Walthamstow Health Area Sub-Committee, the following are the matters for comment:— Mr. L. W. Elmer, L.D.S., Senior Dental Surgeon, retired after 24 years fine service in Walthamstow, but fortunately he remains to undertake sessions in the General Dental Service. In his report Mr. Elmer states that of some 200 expectant mothers referred for examination and treatment, only one needed complete artificial dentures and only seven needed partial dentures. A marked change from recent years when the majority referred from Welfare Centres required full dentures. Dr. Gillespie in her report on child guidance of pre-school children stresses the need for advice and treatment at the earliest possible age. An account is given of scarlet fever and tonsillitis at a Day Nursery and the occurrence of nephritogenic types of hæmolytic streptococci and the freedom from apparent kidney damage of the children infected. The Superintendent Health Visitor reports on the teaching of mothercraft in all secondary schools and the training of nursing and other staff in "field" work. The Superintendent of Home Nursing and Midwifery reports that there were over 84,000 visits paid by the Home Nurses. With regard to immunisation, vaccination against poliomyelitis was begun and although there was an increase in vaccination against smallpox, the acceptance rate is still lamentably low and would afford no general protection to the community in the event of an epidemic. A conference was called in regard to problem families, but difficulties cropped up in regard to calling a further meeting. The need for additional domestic help assistance recurs each winter. I have great pleasure in commenting on the good work of the staff of the Department, the consideration of the Committees concerned, and in particular of your Chairman, Councillor Mrs. Palethorpe. Co-operation has again been received from all the organisations and agencies in the Borough which are charged with the health and well-being of the community, and not least from Family Doctors. I have the honour to be, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. 8 A.— STATISTICS & SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1956) 116,700 Number of Assessments (31st December, 1956) 38,649 Rateable Value (31st December, 1956) £1,665,231 Estimated Product of a penny rate £6,500 Population.— The Registrar-General's Estimate of the home population at mid-year, 1956, is 116,700 a decrease of 1,100 on the previous year. The following comparison between the years 1930 and 1956 illustrates the changing picture in health and disease. 1956 1930 Population 116,700 124,800 Rateable Value £1,665,231 £645,572 Product of Penny Rate £6,500 £2,670 Infant Mortality 18.7 39 Notifications Deaths Notifications Deaths Diphtheria Nil Nil 509 22 Smallpox Nil Nil 189 Nil Tuberculosis 77 8 159 89 Measles 498 - Not Notifiable 28 *Cancer Not Notifiable 264 167 *Vascular Diseases 561 308 *The classification of causes of death has been materially altered during the period. CENSUS, 1951 Report on Usual Residence and Workplace The publication of this Report during 1956 yielded information of interest in regard to the Borough and which briefly is as follows:— The enumerated occupied population amounted to 39,572 Males and 21,068 Females, a total of 60,640. 9 A table is included summarising workplace movements and giving a comparison of the resident and day population. Out of a resident population of 121,200, 56,990 males and 64,210 females, 32,515 resident persons worked elsewhere and 16,909 persons resident elsewhere worked in Walthamstow. This produced an aggregate of 49,424 inward and outward workplace movements or 408 per 1,000 resident population. The estimated day population was 105,594. Of the 32,515 persons resident in the Borough but working elsewhere, the workplace of 8,688 was in Essex, Leyton predominating with a total of 3,647; 19,204 persons worked in London and of these 4,916 in the City, the next highest totals being 2,516 in Hackney and 2,269 in the City of Westminster ; 4,173 persons worked in Middlesex and of these 1,977 worked in Tottenham. In regard to persons working in the Borough and resident elsewhere, the total was 16,909, i.e., 12,722 from Essex including 3,511 from Chingford, 4,528 from Leyton and 1,570 from Wanstead and Woodford. There were 1,894 from London and 1,847 from Middlesex. Employment.— According to information kindly supplied by Mr. Percy C. Graham, Manager of the local Employment Exchange, approximately 350 men and 220 women were placed in employment every month during the year 1956 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 1956 the average numbers of persons unemployed in the whole area was 680 men and 200 women, including 110 disabled men and 15 disabled women. Extracts from Vital Statistics.—The Registrar-General's midyear 1956 estimate of the home population (viz., 116,700) has been used for the calculation of all vital statistics. Total Males Females Live Births Legitimate 1,335 699 636 Birth rate per 1,000 of the estimated home population 11.8 Illegitimate 53 29 24 Totals 1,388 728 660 Stillbirths 25 Rate per 1,000 total (live and still) births 17.6 Deaths 1,195 Death rate per 1,000 of the estimated home population 10.2 10 Deaths from puerperal causes:— Puerperal Sepsis Deaths — Other Puerperal Causes 1 Death rate of infants under one year of age:— All infants per 1,000 live births 18.7 Legitimate infants per 1,000 legitimate live births 19.4 Illegitimate infants per 1,000 illegitimate live births — Deaths from measles (all ages) — Deaths from whooping cough (all ages) — Deaths from diarrhoea (under two years of age) — Pulmonary tuberculosis death rate 0.04 Non-Pulmonary tuberculosis death rate 0.02 The natural increase of population, i.e., excess of births over deaths was 193. Deaths.— The Registrar-General's classification of causes of death by sex totals is given. The total number of deaths in 1956 (1,195) compares with 1,188 in 1955, the respective death rates being 10.2 and 10.0 per 1,000 population. The comparability factors for Walthamstow are given by the Registrar-General as follows:— Comparability factor for births 1.00 Comparability factor for deaths 1.09 The above factors, when applied to the crude rates, produce the following adjusted rates:— Live births 11.8 Deaths 11.1 11 Causes of Death as given by the Registrar-General for the year 1956 Whole District Causes of Death Males Females Total 1955 1. Tuberculosis, Respiratory 4 1 5 14 2. Tuberculosis, other 3 — 3 3 3. Syphilitic Disease 4 1 5 3 4. Diphtheria — — — — 5. Whooping Cough — — — — 6. Meningococcal Infections -— — — 1 7. Acute Poliomyelitis — — — — 8. Measles — — — 1 9. Other Infective and Parasitic Diseases 1 - 1 4 10. Malignant neoplasm, stomach 20 11 31 38 11. Malignant neoplasm, Lung, bronchus 54 9 63 53 12. Malignant neoplasm, breast — 32 32 31 13. Malignant neoplasm, uterus — 6 6 6 14. Other malignant and lymphatic neoplasms 66 59 125 138 15. Leukaemia, aleukaemia 4 3 7 6 16. Diabetes 4 7 11 6 17. Vascular lesions of nervous system 56 88 144 129 18. Coronary disease, angina 111 71 182 167 19. Hypertension with heart disease 7 8 15 34 20. Other heart disease 61 106 167 150 21. Other circulatory disease 26 27 53 43 22. Influenza 4 5 9 9 23. Pneumonia 32 38 70 72 24. Bronchitis 64 22 86 86 25. Other diseases of respiratory system 10 1 11 15 26. Ulcer of stomach and duodenum 13 7 20 24 27. Gastritis, enteritis and diarrhoea - 4 4 8 28. Nephritis and nephrosis 3 6 9 9 29. Hyperplasia of prostate 6 — 6 8 30. Pregnancy, childbirth, abortion 1 1 1 31. Congenital malformations 6 — 6 9 32. Other defined and ill-defined diseases 38 55 93 97 33. Motor vehicle accidents 7 — 7 5 34. All other accidents 7 5 12 14 35. Suicide 3 8 11 4 36. Homicide and operations of war - - - — Totals, 1956 614 581 1,195 — Totals, 1955 649 539 — 1.188 The age distribution of Cancer deaths was as follows:— Under 1 yr. 1-2 yrs. 2-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. 65 yrs. over — — — 2 1 13 112 136 12 CANCER DEATHS The following table shows deaths from Cancer (including Leukaemia and Aleukaemia) and death rates in England & Wales and Walthamstow during the years 1943 and 1956. The tables 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 1956 92,701 264 2.0 2.2 The average rate per 1,000 population in Walthamstow would approximate very closely that to England and Wales. DEATHS FROM ACCIDENTS IN THE HOME Six deaths took place in 1956 from accidents in the home ; three of the deaths occurred in hospital and three at home. The ages of the persons concerned were ten months, 3, 58, 69, 74 and 78 years. The two children died from asphyxia, two of the adults from drug poisoning, one from a fall and one from burns. This total is in marked contrast with 1955 when there were ten deaths following accidents in the home, no fewer than five being from burns and three from falls. In order to put these deaths in proper perspective, the following comparison is made:— Cause of death 1954 1955 1956 (a) Suicide 15 4 11 (b) Motor Vehicle Accidents 9 5 7 (c) All other accidents 14 14 12 (d) Accidents in the home (included in line (c) 7 10 6 (d) Tuberculosis 11 17 8 (f) Poliomyelitis Nil Nil Nil 13 INFANT DEATHS, NEO-NATAL MORTALITY AND STILLBIRTHS Year. Live Births. Live Birth Rate per 1,000 Population. Stillbirths. Neo-natal Deaths. Infant Deaths. No. Per 1,000 total (live and still) births. Per 1,000 population. No. Per 1,000 live births. No. Per 1,000 live births. 1956 1,388 11.8 25 17.6 0.21 18 12.9 26 18.7 1955 1,311 11.3 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 1952 1,512 12.6 29 18.8 0.24 23 15.2 37 24.5 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 1952/56 it fell to 22.8 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 1956 one death was classified as being due to pregnancy, child bearing or associated therewith. The details are included in the following table:— Date of Death Certified Cause of Death Age 17.8.56 Pulmonary embolism due to pelvic Phoebe-thrombosis (following childbirth) 39 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. 1956 1,413 - 1 1 - 0.70 0.70 1955 1,335 - 1 1 — 0.74 0.74 1954 1,495 - 1 1 — 0.66 0.66 1953 1,492 - 2 2 — 1.34 1.34 1952 1,541 — 3 3 — 1.95 1.95 14 TOTAL INFANT MORTALITY This is defined as the sum of the deaths that occur during child-birth and during the first year of life. The attached graph shows the position since 1930 :— 15 If the infant mortality rate for the quinquennium 1931/35, i.e., 50, had applied to the births during the quinquennium 1951/55 there would have been approximately 369 infant deaths instead of 171. This represents a saving of 198 infant lives in the five-year period, or, say, 40 infant lives each year. MATERNAL MORTALITY, STILLBIRTHS & NEO-NATAL DEATHS The following table shows the maternal mortality, stillbirth and neo-natal death rates for the past fivp years :— Rate (per 1,000 live births) 1956 1955 1954 1953 1952 Maternal Mortality 0.72 0.76 0.67 1.37 1.98 Stillbirths 18.0 18.3 14.2 26.1 19.2 Neo-Natal Mortality 12.9 17.5 16.9 18.6 15.2 REGISTRATION OF BIRTHS The Registrar-General's returns show the following registra^ tions during the calendar year:— Live Births. Males. Females. Totals. Legitimate 699 636 1,335 Illegitimate 29 24 53 Totals 728 660 1,388 The stillbirth rate per 1,000 population was 0.21. Of the 1,570 local registrations, 545 belonging to other areas are excluded, leaving a net total of 1,025. There were no nonnotified births during 1956. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Total. Totals M. F. M. F. M. F. M. F. M. F. M. F. M. F. 68 54 51 40 90 92 74 75 134 141 107 99 524 501 Grand Totals 122 91 182 149 275 206 1,025 16 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: Mrs. D. Puleston, part-time Laundress—2.7.56. Resignations : Mr. G. Eve, Higher General Division Clerk—13.6.56. 2. Integration of Health Services. The arrangements detailed in the Report for 1954 continued. Circular letters were addressed to General Practitioners on ten occasions and included seventeen items, of which the following is a summary:— 1. Vaccination against Poliomyelitis. Notification of Tuberculosis. 2. Vaccination against Poliomyelitis. Supply of Tetanus Anti-toxin. 3. Poliomyelitis. Supply of Gamma Globulin. Collection of Laboratory Specimens during holiday periods 1956. 4. Vaccination against Poliomyelitis. 5. Vaccination against Poliomyelitis. 6. Paratyphoid Fever. 7. Paratyphoid Fever. Poliomyelitis. 8. Poliomyelitis. 9. Medical Care of Children suffering from Epilepsy, Provision of Convalescence: Respective responsibility of Regional Hospital Boards and Local Health Authorities. 10. Collection of Laboratory Specimens during Christmas, 1956. Exclusion from School on account of Infectious Illness. 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. In May a meeting of Medical Practitioners working in the area of the Forest (Group 11) Hospital Management Committee 17 was convened by the Chairman of the Medical Advisory Committee of the Group. The notice convening the meeting included the following:— "It has been widely felt that those working in the Hospitals and the Public Health Services and the General Practitioners should meet from time to time to discuss their common problems and see in what way they can help each other." 3. Laboratory Facilities. 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. Sep t. Oct. Nov. Dec. Total Rhesus, Group and Kahn 5 6 2 3 5 5 - 1 2 - 4 7 40 Haemoglobins - - 1 - - - - - - - - - 1 Nose and throat swabs 9 8 21 21 17 8 7 3 8 14 16 14 146 Totals 14 14 24 24 22 13 7 4 10 14 20 21 187 Arrangements continued with the Public Health Laboratory Service at Colindale and 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 year were as follows:- Specimens Jan. Feb. Mar. Apr May June July Aug . Sept. Oct. Nov. Dec. Total Faeces and rectal swabs 31 13 43 68 83 37 43 36 12 21 28 16 431 Nose and throat swabs 12 4 9 10 17 4 2 4 77 59 11 74 283 Urine - 1 1 — 1 — — 1 — — — — 4 Food — 8 1 7 4 6 1 2 1 2 1 — 33 Miscellaneous — 1 — 1 2 1 3 — — 3 1 5 17 Totals 43 27 54 86 107 48 49 43 90 85 41 95 768 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 the report for 1953, with the Hackney Borough Council continued, and three cases were referred there during 1956 receiving seven treatments at a total cost of £1 12s. 6d. 18 6. Hospital Accommodation. (a) Acute Cases.— There we're no major changes in 1956 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 vear. The following table shows the position in regard to hospital admissions considered and/or supported on "social" grounds. No. of cases at end of 1955 awaiting hospital admission 1 No. of new cases considered during 1956 53 No. of admissions to hospital or Part III accommodation 37 No. of cases who died before admission 3 No. of patients who refused hospital admission 3 No. of cases cancelled or deferred 9 No. of cases waiting Part III accommodation 1 No. of cases outstanding at end of 1956 1 It is a pleasure again to record the unfailing help and consideration experienced from Dr. DeLargy at Langthorne Hospital, and from Mr. R. S. J. Potter, Area Welfare Officer. (c) Maternity.— The percentage of Walthamstow residents admitted to Thorpe Coombe Maternity Hospital prior to the appointed day was nearly 100. During 1956 Walthamstow admissions were 60 per cent, of the total. (d) Infectious Diseases.— Patients from Walthamstow are mainly admitted to St. Ann's Hospital, Tottenham. No difficulties have been noted. The Consultant Physician in Infectious Diseases has been very ready with Domiciliary Consultations, and has sent me helpful discharge reports. 7. Aged and Chronic Sick. National Assistance Act, 1948 (Section 47) Four cases were brought forward from 1955 and 14 further cases came to notice during 1956 as possibly requiring action under this Section. The position at the end of the year may be summarised as follows 19 Died at Home 1 Admitted to hospital 12 (of these 5 died) Admitted to Part III accommodation 3 Admitted to Nursing Home 1 Remaining under observation at the end of the year 1 Authority for application to the Court was obtained in five cases, but four were not, in fact, exercised, and the patients 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. Total. 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 three 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 1956. 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 20 suspected cases of enteric fever. The Board then arranged special tests at the addresses concerned. All were negative in 1956. All dwelling houses in the area are supplied direct with piped water. Mr. W. Richards, Chief Public Health Inspector, contributes the following:— Staff. The title "Sanitary Inspector" was abolished by the Sanitary Inspectors (Change of Designation Act) 1956, the new designation being "Public Health Inspector." This new designation became operative as from August, 1956. One pupil Public Health Inspector is at present training with the Council and this number is to be increased to three next year. Facilities have been afforded for the post-graduate training of a student taking a course for the Diploma in Public Health. Public Health Inspectors' Examination. The Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board has been reconstituted as the Public Health Inspectors' Education Board and is now the responsible body for the qualification of Public Health Inspectors. Public Health Inspection of the Area No. of inspections made. No. of nuisances remedied. No. of complaints received. No. of Intimation Notices No. of Statutory Notices. Total Visits. Served. Complied with. Served. Complied with. 9,647 6,046 1,928 1,355 1,297* 265 248* 16,736 * Includes notices outstanding from previous year. Of the 1,355 intimation notices served, 388 were in respect of business premises and the remainder (967) related to defects in private houses. Of the latter figure, 703 were complied with without resort to statutory procedure. It was found necessary to institute legal proceedings against owners for non-compliance with thirty Abatement Notices served under Section 93 of the Public Health Act, 1936. Nine Orders were made by the Justices with costs amounting to £9 9s. Od. and in three cases, Orders were made with penalties amounting to £45 and costs to £9 9s. Od. In eleven cases, the summonses were adjourned sine die with costs amounting to £6 10s. 6d. and seven summonses were withdrawn with costs amounting to £1 3s. Od. Under Section 46 of the Public Health Act, 1936, one summons was heard at Court, resulting in £1 fine. 21 The following shows the nature of work executed and improve ments effected during the year:— Drains tested, 386; Drains reconstructed or repaired, 294; Drains, obstructions removed, 115; Drains, means of access provided, 36; Drains, ventilation provided or improved, 41; Soil pipes repaired or renewed, 89; Rain water pipes repaired or renewed, 130; Roofs repaired or renewed, 420; Gutterings repaired or renewed, 246; W.C. pans and traps provided, 231; W.C.s repaired or cleansed, 191; W.C.s light and ventilation improved, 26; Gully traps provided, 83; Waste pipes repaired or renewed, 124; New sinks provided, 58; Stoves and firegrates repaired or renewed, 159; Water supply taken off main, 3; Water supply reinstated, 17; Yard and forecourt pavings repaired, 89; Dirty houses cleansed, 5; Dirty rooms cleansed, 189; Floors repaired, 203; Ventilation under floors provided or improved, 64; Dampness remedied, 504; Offensive accumulations removed, 29; Manholes repaired or resealed, 111; Miscellaneous repairs, 2,023. Infectious Diseases. Visits to premises, 474. Disinfections. Rooms disinfected, 27; Articles disinfected, 1,415; Articles destroyed, 61. Special Premises. Number Visits paid Factories (a) Non-power 58 103 (b) Power 468 363 (c) Other premises 11 24 Outworkers 714 254 Butchers 85 271 Bakers and Shops 42 150 Fishmongers, Fryers and Curers 38 155 Cafes and Caterers 98 364 Grocers 268 601 Greengrocers 92 141 Ice Cream Manufacturers and Vendors 335 166 Dairies and Milksellers 158 97 Laundries 1 14 Hairdressers 78 43 Rag and Bone Dealers 3 14 Piggeries 1 — 22 Special Premises (contd.) Number Visits paid Street Stalls Numerous 393 Stables 17 35 Schools — 44 Public Houses 37 53 As a result of the regular periodical visiting of the above premises the following works were carried out:— Butchers. Cleansings, 34; Floors repaired, 12; Accumulations removed, 6; New bins supplied, 23; W.C.s repaired and cleansed, 17; Light and ventilation improved, 3; Other improvements, 54. Bakers Cleansings, 41; New ceilings fixed, 4; Floors repaired, 4; Light and ventilation improved, 3; Roofs repaired, 6; Other improvements, 38. Fishmongers. Cleansings, 27; Drains cleared, 1; Yards repaved, 3; Accumulations removed, 9; Other improvements, 34. Cafes and Caterers. Cleansings, 55; Light and ventilation improved, 9; Floors repaired, 6 ; Other improvements, 73. Grocers. Store rooms cleansed, 42; Washing accommodation improved, 41; Other improvements, 84. Greengrocers. Store rooms cleansed, 12; Washing accommodation improved, 4 ; Other improvements, 11. Ice Cream Manufacturers and Vendors. Cleansings, 13; Special cleansings of utensils, 4; Paving repaired, 4 ; Other improvements, 13. Dairies and Milksellers. Cleansings, 4; Pavings relaid, 1; Other improvements, 3. Laundries. Special cleansing, 1 ; Other improvements, 3. Hairdressers. Cleansings, 4 ; Other improvements, 3. Rag and Bone Dealers. Cleansings, 5 ; Accumulations removed, 3. 23 Street Traders. Stalls improved, 9 ; Store rooms improved, 6. Stable Premises. Cleansings, 10; Accumulations removed, 5; Roofs repaired, 3 ; Pavings repaired, 1; Other improvements, 6. Schools. Special cleansings, 2 ; Other improvements, 7. Public Houses. Special cleansings, 15 ; Hot water supplied, 1 ; Hot water supply improved, 5. Verminous Premises. The number of houses reported to be verminous still remains comparatively small. Seventytwo rooms were disinfested and insecticides were issued free of charge to tenants of twentyeight premises. No notifications were received during the year under the Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1938. Caravans. A special report was made in regard to the caravans in Trigg's Yard, Folly Lane. No adequate measures were advised to deal with the itinerant caravans using the grass verge of Folly Lane. Smoke Abatement. A new Clean Air Act has been passed by Parliament and part of this Act comes into operation on 1st January, 1957. This Act gives considerable new powers to local authorities. A Member of the Health Committee and myself were appointed as delegates of the Council to attend the annual conference of the National Smoke Abatement Society held at Southport in October. A series of papers was given on the various aspects of smoke abatement and considerable discussion arose with respect to the proposed new Clean Air Act. This conference was very interesting and was well worth attending. Observations on smoke nuisances in the Borough amounted to 150. Investigations were carried out in all cases, new boiler plant being installed in some cases and considerable improvements being effected to boiler plant in others. Four District Public Health Inspectors attended a course of six lectures in regard to atmospheric pollution. These lectures were held at the Northampton Polytechnic in London. Authority was given by the Council for two District Public Health Inspectors to attend a Course arranged at the Coal Utilization Centre in regard to the design and installation of domestic heating apparatus. This latter course will be held early in the new year. 24 Authority was given by the Council to instal two atmospheric j pollution instruments for detecting the sulphur content in the air. These instruments will be in operation from 1st January next. Report of LONDON & HOME COUNTIES SMOKE ABATEMENT ADVISORY COUNCIL Town Survey Section 1 (Borough of Walthamstow) A copy of the report prepared by Mr. H. G. Clinch, M.B.E., F.R.S.H., was sent to the Borough Council, whose observations and comments were invited by the Executive Committee of the Smoke Abatement Advisory Council. The following extracts are taken from the Report:— Page 1 The areas surrounding Walthamstow and particularly the industrial areas produce air pollution in Walthamstow whatever the quarter of the wind, but particularly when it blows from Leyton and Hackney. There are nearly 40,000 persons employed in the Borough with a large exodus in the morning, possibly balanced by an equally large entry. Page 4 There are 599 factories in the Borough employing 20 or more persons. The annual fuel consumption is as follows :— Solid Fuel Public Electricity Generation 12,100 tons Industrial Premises 38,300 tons of coal Total coal 50,400 tons 8,800 „ „ coke, „ coke 8,800 „ etc. ,, solid fuel 59,200 „ Liquid Fuel Fuel Oil General Industrial Premises Creosote-pitch Mixture Total liquid 342 tons 2,905 tons fuel 3,147 tons Total fuel consumption by industry 62,347 tons No estimate of the proportion of fuel for steam raising for power is possible. There is a large coke consumption for metallurgical work. 25 The number of factories and employees suggests that the public electricity supply provides a large proportion of motive power, especially in the light industries. Page 6 During inspections comparatively little visible smoke was observed from factory chimneys and nothing required a report to the Chief Sanitary Inspector. The investigator is of the opinion that there is a huge emission of oxides of sulphur from some of the industrial plants and for which there appears to be no remedy. None of the flue gases is washed. Page 7 It is estimated that some four million pounds of sulphur dioxide per annum are emitted by industry and some 4.5 million pounds from domestic chimneys, i.e., a total of over 8-J million pounds per annum. Thirty-seven per cent, of the prevailing wind is from the south-west, i.e., bearing the products of combustion from London to Walthamstow. The investigator considers that there is a real risk of a dangerous build-up of excessive oxides of sulphur if a layer of warm air overlays a cool lower layer. The possibility of a warning system is suggested. Page 8 It is stated that it is not possible to estimate the amount of sulphur dioxide discharged at ground level by Diesel engines and vehicles, but it is considerable and continuing. Page 10 The investigator is of the opinion that his Committee should consider an approach to the Borough Council with a view to the measurement of atmospheric pollution for at least one year— (a) at the Town Hall, and (b) on the high ground of Highams Park. Page 11 With regard to the two railways running through the town, the former L.M.S. line produces no serious pollution, but the former L.N.E.R. line from Liverpool Street to Chingford has old locomotives and inexperienced firemen. There is reported to have been an excessive emission of smoke in the vicinity of Wood Street and Highams Park Stations and in this connection attention is drawn to Section 276 of the Local Government Act, 1933, which may empower proceedings. 26 It is also advised that an approach might be made to the Locomotive Superintendent at Stratford. Special observation is being kept to record engine numbers, etc., with a view to obtaining evidence, since locomotive smoke is very objectionable. Page 12—Domestic Smoke and Fuel Consumption During 1954 this was— Coal Coke, Coalite, Phurnacite &? Briquettes Total 65,700 tons 16,700 tons 82,400 tons The tonnage per house was 2.48 and per household 2.12 and attention is drawn to the small consumption of solid smokeless fuel. Attention is drawn to the fact that an application was made to the Ministry of Fuel and Power for a larger allocation of smokeless fuel to the Borough. "All night" burning fires give rise to a far greater pollution than ever before and there is a ready sale for these fires. Gas coke is used for space heating, but probably more because of the shortage of coal than for any other reason. For burning on open fires, it should be broken or screened to the correct size, i.e., not larger than l£in. to 2in. The only remedy for the domestic smoke now being produced is a large increase in the solid smokeless fuel supply suitable for the ordinary grate and there appears to be no grounds for optimism. Swimming Baths and Pools. (a) Municipal Baths, High Street. Mr. W. Cantes, the Superintendent and Engineer, kindly contributes the following :— " The number of slipper bathers showed a decrease of approximately 3,700 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 295 days. The number of swimming bathers during this period was 138,533. The maximum load was on September 24th when we had 969 bathers. During this period we also had 117,477 slipper bath bathers." During the year three samples of swimming bath water were taken for analysis and on each occasion a good report was received. (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 two 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 on two occasions with satisfactory results. (e) Woodford County High School.—Sampling was carried out on two occasions with satisfactory results. (f) Kingfisher Pool.—The Secretary kindly gives the following particulars: — "The Season started off in May with reasonable Pool attendance figures. From June onwards attendances were extremely poor, solely due to abnormal summer weather conditions. Aggregate attendance figures were in the neighbourhood of 14,000 including school-children. Bacteriological and chemical analyses were carried out on two occasions with satisfactory results." WALTHAMSTOW CORPORATION ACT, 1956 This local Act received the Royal Assent on 2nd August, 1956, and amongst the sixty-nine Sections, the following have bearing on the Public Health:— Section 19— Provision of Bathrooms. The Council may reject plans of a house if the plans do not provide for a fixed bath or shower bath in a bathroom. Section 20— Defective Premises. This Section permits the Council to secure the speedier repair of a house or the roof of any building which is in such a state as to be prejudicial to health or a nuisance where there would be unreasonable delay in following the nuisance procedure of the Public Health Act, 1936. Section 23— Drains and Sewers. This Section gives authority to the Council as from the 1st January, 1957, to seal or take up and remove drains and sewers before the demolition of premises. Section 34—Street Trading Licences. This Section permits the making of bye-laws relating to the storage and sanitary provision (while at the place of intended sale, exposure or offering for sale) of articles or things intended to be sold or exposed or offered for sale under the authority of a street trading licence. 28 Section 50—Supply of Water. Where the Metropolitan Water Board in the exercise of their right to cut off the water supply to any inhabited house cease to supply any such house by reason of the defective state of a supply pipe or fittings the Council may execute such works as they think expedient in the circumstances of the case to remedy the defect and the expenses reasonably incurred by the Council in executing such works shall be recoverable summarily as a civil debt. Section 53—Hairdressers and Barbers. As from 1st January, 1957, hairdressers and barbers and their premises are to be registered and the Council may make bye-laws for the purpose of securing— (a) the cleanliness of premises registered under this section and of the instruments, towels, materials, and equipment used therein; and (b) the cleanliness of persons employed in such premises in regard to both themselves and their clothing. D.—HOUSING Statistics The Borough Architect, Engineer and Surveyor, F. G. Southgate, Esq., A.R.I.B.A., A.M.T.P.I., has kindly contributed the following in regard to statistics and improvement grants:— Houses completed by the Local Authority 1956 Hoe Street Ward Nil St. James Street Ward Nil Higham Hill Ward 6 Flats High Street Ward 2 Houses Hale End Ward 40 Flats Wood Street Ward 198 Flats TOTAL 244 Flats 2 Houses Houses erected by Private Enterprise. Hoe Street Ward Nil St. James Street Ward Nil Higham Hill Ward Nil High Street Ward Nil Hale End Ward 2 houses Wood Street Ward 4 houses TOTAL 6 houses Note:— All were permanent houses and flats. 29 In addition to the main building programme, improvements and conversions have been carried out in a number of Council owned properties. 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, 110 in 1955 and 114 in 1956. The Borough Architect, Engineer and Surveyor comments as follows:— Applications received from owner/ occupiers 78 Total number of Grants and amount approved by Council to owner/ occupiers 45 £6,323 Applications received from Warner Estate Ltd 36 Total number of Grants approved and amount for Warner Estate Ltd. 32 £5,983 Summary Total number of applications 114 Total number of grants 77 Total amount of grants £12,306 Inspection The Chief Public Health Inspector reports as follows:— 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) 1,744 (b) Number of inspections made for the purpose 5,199 (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 202 (b) Number of inspections made for the purpose 217 30 (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 967 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 703 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 1 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners *4 (b) By Local Authority *1 (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 263 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners *207 (b) By Local Authority 36 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 5 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 (3) Number of dwelling houses where Demolition Orders withdrawn (houses made fit) Nil D. Proceedings under Section 12 of the Housing Act, 1936— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil * Including those notices outstanding from previous year. 31 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil E. Proceedings under Section 10 of the Local Government (Miscellaneous Provisions) Act, 1953:— (1) Number of dwelling houses where Closing Orders were made 3 Housing Act, 1936 Unfit Houses The following premises were dealt with as follows:— Demolition Orders: 46 and 48, Brunner Road 1 and 2, Chapel Street 190, Wood Street Closing Orders: Nil. Local Government (Miscellaneous Provisions) Act, 1953. Under the provisions of this Act, Closing Orders were made in respect of the whole of the following premises:— 43 and 45, Brandon Road 29, South Grove. Housing Repairs and Rents Act, 1954 The following certificates were issued or refused under the provisions of the above Act:— Certificates of Disrepair issued 62 Certificates of Disrepair refused 6 Certificates of Revocation issued 56 Certificates of Revocation refused 14 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. 32 Housing Act, 1936, Section 62 Applications for "permitted number" were received from landlords and Certificates issued during the year respecting 4 lettings. Local Land Charges Enquiries relating to outstanding sanitary notices were dealt with in 1,525 cases. Clearance Areas In the Report for 1955, the position was discussed up to and including the Chingford Lane Clearance Areas. In December, 1955, the West Street and St. Stephen's Road area was officially represented to and agreed by the Council. The Representation covered two contiguous areas comprising 64 dwellings, and nine of these were acquired by the Council before the Inquiry. In January, 1957, all the dwellings were confirmed as "red" property except for four dwellings coloured "grey." The census showed that there were 53 per cent, under occupation according to the permitted numbers. In June, 1956, official Representations were made in regard to the Newman, Southcote and Tenby Road areas and comprising 102 dwellings. The census showed there were 54 per cent, under occupation according to the permitted numbers. The Inquiry in regard to these areas was held on the 5th March, 1957. In October, 1956, official Representation was made in regard to the Parkstone/Wyatts Lane areas comprising 20 dwellings. The census showed 56 per cent, under occupation according to the permitted numbers. The Inquiry has not yet been held. At the end of the year surveys were being done in respect of parts of Brunner Road, South Grove, and Side Road, and official Representation will be made in 1957. This area will comprise approximately 59 dwellings. The progress made in regard to the clearance of unfit property may be summarised as follows:— No. Location No. of dwellings Date represented Date of Inquiry Date confirmed Excluded from Order l Vallentin & Short Rds. 41 4.11.53 11.1.55 8.6.55 8* 2 Grange/Frederick/ Lynmouth Rds. 119 3.2.54 8.2.55 10.6.55 68* 3 Chingford Lane:— (Payxe's Cottages) 17 7.4.54 11.3.55 _ 3a (Mill Lane, The Square 15 Farey's Row) 7.4.54 24.5.55 14.9.55 2* 4 West St./St. Stephen's Road 64 7.12.55 18.9.56 25.1.57 4 5 Tenby/Southcote Rds. 102 6.6.56 5.3.57 — — 6 Parkstone Rd./Wyatts Lane 20 3.10.56 — — — * Compulsory purchase authorised or already acquired. 33 The total of the dwellings already represented is 378 out of a total of 541 in the five-year programme which was approved by the Minister of Housing and Local Government in January, 1956 ; 192 properties had then already been dealt with. Thus the Representations already made cover over two-thirds of the five-year programme. In the clearance areas up to and including the Tenby Road areas, there were 435 families occupying 358 dwellings. As in previous years, the experience of 1956 in the inspection of houses for possible clearance has continued to show vast improvement in the internal condition of many of the houses. When compared with pre-war conditions in the same areas, attractive decorations were commonplace, new fireplaces with tiled surrounds were frequent and occasionally the installation of baths and properly fitted bathrooms with internal water closets were observed, and all at the tenants expense. These internal conditions were in marked contrast to gross structural defects. The utmost help and co-operation have invariably been received from both tenants and owner-occupiers. General Mr. C. W. Rayner, the Council's Housing Manager, kindly gives the following details of rehousing, etc. carried out by his Department in 1956:— "For the twelve months to December there has been considerable concentration on the rehousing of families from the clearance areas. "Prior to the 1st January, 1956, I arranged for the rehousing of all the families from the Vallentin Road clearance area, but during the year in question rehousing from clearance areas has been as follows:— 53 families from the Frederick Street/Grange Road area. 35 families from the Chingford Lane, etc., area. 35 families from the Back Road/Collard Road/Short Road area. 123 "There are still a number of families to be rehoused from Frederick Street/Grange Road and with the possible confirmation of orders in respect of West Street/St. Stephen's Road and the Tenby Road, area, it would seem that the emphasis on rehousing from the clearance areas will continue. "This procedure is naturally having an adverse effect upon the rehousing of families from the Housing Register and, 34 although housing applicants when told of this fact feel some- ; what aggrieved, they do at least appreciate the logic of the situation." No. of new properties made available for letting 245 Acquired 72 Normal vacancies 73 Nominations to private landlords 30 Total 420 Families rehoused:— 1-bedroom group 176 2-bedroom group 138 3-bedroom group 92 4-bedroom group 14 Total 420 Of the total number of families rehoused, in five instances there was a medical recommendation made in respect of tuberculosis. Property under management at 5.1.57 (dwellings only):— Pre-1939 houses and flats 1,615 New houses and flats 1,736 Prefabricated bungalows 495 12 properties converted into flats. 49 Properties improved 52 Properties acquired for improvement and conversion 368 Properties acquired for General Housing purposes 101 Properties for Clearance and Demolition 98 Requisitioned dwellings (217 licences) 182 Halfway houses 5 General properties 29 Education property 1 Total 4,731 Total at the end of 1955 was 4,439. 35 In addition to the families rehoused in Walthamstow, transfers and exchanges of accommodation amounted to 188 cases, and no fewer than 131 families are known to the Housing Department to have been rehoused in the new towns. 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 1956 131 901 The great majority have been rehoused in Harlow (648), followed by Basildon (88), Stevenage (81), Hem el Hempstead (46), Welwyn (18), Crawley (10), Bracknell (6), Swindon (4). 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. Details of the occupation of all applicants interested in the New Towns are furnished to the Ministry of Labour. The following table will summarise the housing applications as at 31st December, 1956, the units of overcrowding and the accommodation required to meet the applications:— Applications : Walthamrtow Borough Outside Borough Total 3 units overcrowding 17 4 21 2½units overcrowding 12 3 15 2 units overcrowding 36 7 43 1 ½ units overcrowding 72 10 82 1 unit overcrowding 112 21 133 ½ unit overcrowding 230 72 302 Fully occupied 377 34 411 ½ unit under-occupied 521 89 610 1 unit under occupied 702 95 797 1½ or more units under occupied 2,865 241 3,106 Total 4,944 576 5,520 36 Accommodation required: 1 bedroom 1,856 247 2,103 2 bedroom 1,968 196 2,164 3 bedroom 993 115 1,108 4 bedroom 127 18 145 Total 4,944 576 5,520 Rehousing of Medical Cases During 1956, 44 cases claiming rehousing priority for tuberculosis were investigated and reported upon. Of these 16 cases were added to the list. The position at the end of 1956 was as follows:— Class 1 Class 2 Class 3 Total On list at end of 1955 8 9 12 29 Added to list during 1956 5 5 6 16 13 14 18 45 Rehoused or removed from list during 1956 5 4 3 12 On list at end of 1956 8 10 15 33 Classification depends on the infectivity of the case, the number of young children/adolescents in the infected household and overcrowding. In addition to the tuberculosis cases 31 other cases were recorded as needing special consideration on medical grounds and 66 cases on general housing grounds. E—INSPECTION AND SUPERVISION OF FOOD The following is contributed by the Chief Public Health Inspector:— (a) Milk Supply. Designated Milk. During the year 137 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 Pasteurised 93 93 Tuberculin Tested Pasteurised 44 44 Totals 137 137 37 Biological Test Seventy one 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 one sample which gave a positive result. 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 53 Pasteurised 10 Sterilised 139 Sterilised 11 Tuberculin Tested 24 Tuberculin Tested 10 Licences (Plant). Pasteurisers 2 There are no Cow keepers in the district. The number of Retail Milk Distributors is 158. Ninety-seven 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. Twenty-four applications for Registration were received and were dealt with as follows:— Vendors, New 10 Vendors, Transfers 14 Number on Register at end of year 335 Number of premises used for manufacturing 5 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. Four samples of ice cream were taken and submitted to the Public Analysts who reported the following satisfactory results:— Fat content 8.9 9.13 10.9 6.25 Bacteriological Examination of Ice Cream. Eighty-seven 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 = 74 II = 9 „ III = 3 „ IV = 1 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-two samples were examined for bacterial purity, two of which were unsatisfactory. Examination for Metallic Contents. Four samples of ice lollies were sent to the Public Analysts for examination for metallic contents and found to be free of same. (c) Meat and Other Foods There are no slaughterhouses operating in the Borough. The following is a summary of food surrendered and condemned as being unfit for human consumption. Where possible, the food was salvaged. 1085 tins Evaporated Milk 15 jars Sauce 268 „ Skimmed Milk 1 jar Mayonnaise 32 ,, Full Cream Milk 100 tins Soup 10 „ Dried Milk 4 „ Broth 63 „ Cream 59 „ Creamed Rice 2 „ Milk Beverage 33 lbs. Pearl Barley 1 tin Baby Food 17 „ Sago 1241 tins Peas 3 tins Coffee 39 665 tins Tomatoes 28 Eggs 485 „ Beans 14 lbs. Liquid Egg 80 „ Carrots 9 „ Lard 19 „ Vegetable Salad 257 „ Flour 16 „ Rhubarb 180 „ Sultanas 3 „ Beetroot 17 „ Cheese 3 „ Tomato Juice 83 tins Pilchards 10 lbs. Tomato Puree (tinned) 11 „ Crab 40 „ Peas 8 „ Shrimps 28 „ Haricot Beans 2 „ Tuna Fish 95 tins Pineapple 2 „ Salmon 2 „ Pineapple Juice 2 „ Crawfish 82 „ Grapefruit 2 „ Lobster 14 „ Grapefruit Juice 2 „ Roes 80 „ Oranges 31 stone Whiting 19 „ Orange Juice 19J „ Skate 56 „ Cherries 6 „ Dogfish 49 „ Gooseberries 3J „ Roker 45 „ Fruit Salad 3 „ Haddocks 41 „ Loganberries 7 lbs. Cod 41 „ Strawberries 1216 tins Luncheon Meat 40 „ Plums 49 „ Stewed Steak 31 „ Peaches 43 „ Meat Pudding 21 „ Apricots 26 „ Steak 6? Kidney Pudding 21 „ Raspberries 4 „ Steak Kidney Pie 19 „ Prunes 13 „ Beef Loaf 18 „ Pears 5 „ Sausages 2 „ Blackcurrants 3 „ Pork 2 „ Damsons 2 „ Braised Hearts 2 „ Apples 2 „ Tongue 1 tin Bananas 1 tin Minced Chicken 21 lbs. Apricot Pulp (tinned) 972 lbs. Corned Beef 31 tins Jam 225 „ Ham (tinned) 2 „ Marmalade 503 „ Beef 6 jars Peanut Butter 400 „ Lamb 12 „ Meat Paste 155 „ Lambs' Livers 3 „ Salmon Spread 107 „ Pork 2 „ Fish Paste 92 „ Baoon 1 jar Sandwich Spread 90 „ Melts 41 tins Pease Pudding 8 „ Briskett 7 „ Spaghetti 12 Turkeys (218 lbs.) 23 jars Ketchup In addition to the above, a large quantity of foodstuffs in a warehouse was contaminated by sewage due to flooding by storm on three occasions. Shellfish and Jellied Eels. The following samples were taken during the year for bacteriological examination:— Cockles 1 Mussels 3 Jellied Eels 8 40 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. 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, the Council decided that sampling of these products should continue. 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-one samples were taken which included the following:— Faggots, Pork Brawn, Black Sausage, Tongue, Corned Beef, Jellied Veal, Luncheon Meat, Cooked Ham, Roast Pork, Meat Pie, Veal and Ham Pie, Breakfast Sausage, Boiled Bacon, Silverside, Tinned Ham and Brisket. About one-fifth 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 compared with those of last year. (d) Adulteration, etc.—Food and Drugs Act, 1955. During the year, ninety-six samples of food and drugs were submitted to the Public Analysts. Five samples were reported as being unsatisfactory, details respecting same are given below:— 41 Description of Article Result of Analysis Action Taken Sausages (Pork) Meat content low— 57%. Warning given. Ice Cream Fat 6.25% but not made Warning given. wholly from milk as claimed. Chocolate Infested with small insect Prosecution. Fine £10. larvae. Costs £2 2s. Od. Cut Loaf Unsatisfactory. Dirty W arning given. dough. Butter Mints Unsatisfactory. Fat only Warning given. 0.13%. Misdescribed as " butter The following summary gives details of food sampled and results of analyses:— No. unsatisfactory Formal Informal Total Formal Informal Total Milk 13 — 13 — — - Arrowroot — 1 1 — — - Butter 2 1 3 — — - Buttered Bun 1 — 1 — — - Buttermints — - - — 1 1 Butteroons — 1 1 — — - Sweets — 1 1 — — — Chocolate 1 — 1 1 — 1 Chocolate Coconut Ice — 1 1 — — - Cream 3 1 - — — — Cake Decorations 1 — 1 — — — Marzipan 1 1 — — — Meringues 1 — 1 — — — Glace Cherries — 1 1 — — — Peel — 1 1 — — — Nutmeg — 1 1 — — — Cinnamon — 1 1 — — - Olive Oil — - - — — - Curry Powder — 1 1 — — — Soup, Desiccated — 1 1 — — - Matzo Meal — 1 1 — — - Pepper — 1 1 — — — Horseradish Sauce — 1 1 - — - Cheese Spread 1 — 1 — — - Jam, Apricot 1 — 1 - — - Chicken and Ham Paste — 1 1 — — - Marmalade 1 — 1 — — — Steak and Kidney Pie 1 — 1 — — — Cut Loaf — 1 1 — 1 1 Ice Cream 3 1 4 1 - 1 Lollies — 4 4 - - - 42 (e) Chemical and Bacteriological Examination of Foods. Chemical examinations of food samples are carried out by the I Public Analysts, Mr. G. Taylor, F.R.I.C., Dr. J. H. Hammence, F.R.I.C., and Mr. P. S. Hall, A.R.I.C., of 20, Eastcheap, London, E.C.3, and bacteriological examinations by the Counties Public Health Laboratories, 66, Victoria Street, London, S.W.I. (/) Food Hygiene Regulations, 1955. These Regulations came into operation on 1st January, 1956. A reasonably high standard continues to be maintained in the food premises within the Borough. It was found necessary to serve notices under the Regulations in a few cases, most of which had been complied with by the end of the year. Court proceedings were instituted in two cases for non-compliance with the Regulations and penalties of £35 with £5 5s. Od. costs were imposed. The conditions laid down in the Regulations are being maintained throughout the district. The following food premises are established in the Borough :— Butchers, 85 ; Bakers, 42 ; Fishmongers, 38 ; Cafes and Caterers, 98 ; Grocers, 268 ; Greengrocers, 92 ; Dairies and Milksellers, 158 ; Ice-Cream Manufacturers and Vendors, 335.  No. unsatisfactory Formal Informal Total Formal Informal Total Coffee 1 1 2 — — — Coffee and Chicory - 1 1 — — — Tea 3 1 4 — — — Orange Drink 4 — 4 - — — „ Squash — 2 2 — — — Grape Juice 1 — 1 — — — Wine — 1 1 — — — Whisky 8 - 8 - - — Rum 2 - 2 - — — Gin 1 — 1 - — — Sausages, Pork 1 1 2 1 — 1 ,, Beef 1 — 1 - — - Tonic Tablets 1 — 1 - — - Anaemia Pills 1 1 2 - — — Tonic Elixir 2 — 2 — — — Linctus 1 — 1 - — - Laxative Tablets 1 — 1 - — - Slimming Tablets 1 — 1 - — - Stomach Digestive Powder 1 — 1 - — - Foam Crystals — 1 1 — — — Totals 60 36 96 3 2 5 43 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, 271; Bakers, 150; Fishmongers, 155; Cafes and Caterers, 364; Grocers, 601; Greengrocers, 141; Dairies and Milksellers, 97; Ice-Cream Manufacturers and Vendors, 166. 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, and it is then disposed of through reliable sources, being used mainly for soap manufacture. (g) Food Poisoning Outbreaks. Forty-two notifications were received and investigated. Diseases of Animals Acts Swine Fever (Infected Areas) Order, 1953. No licences were issued during the year under the above Order. Fowl Pest Order, 1936. No Orders were issued during the year in respect of the Borough. Pet Animals Act, 1951 Twenty-four 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 Public Health Inspectors. 44 The following is a summary of the work carried out during the year 1956:— Type of Property Local Authority Dwelling Houses Agricultural All other (including Business Premises) TOTAL 1. Total No. of Properties in Local Authority's District 18 34,052 4 4,632 38,706 II. No. of Properties inspected by the Local Authority during 1956 as a result of: (a) Notification 6 438 - 110 554 (b) Survey 12 225 — 8 245 (c) A visit primarily for some other purpose - - - - - III. No. of Properties inspected (see Section II) which were found to be infested by ats: (a) Major 1 - - 3 4 (b) Minor 3 420 — 92 515 IV. No. of Properties inspected (see Section II) which were found to be infested by mice 2 36 - 23 61 V. No. of Infested Properties (see Sections III and IV) treated by the Local Authority 6 456 - 118 580 VI. No. of Notices served with respect to: (1) Treatment - 1 - - 1 (2) Structural Works (i.e., Proofing) — 1 — — 1 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 5 PUBLIC HEALTH ACT, 1936, SECTION 154 Two cases were taken to the Courts with respect to dealers exchanging toys for rags to children. Penalties of £8 with Costs of £2 2s. Od. were imposed. 45 FACTORIES ACTS, 1937 8C 1948 The following tables show the work carried out under these Acts:— 1.—INSPECTION OF FACTORIES, ETC. Including Inspections Made by Public Health Inspectors. Premises. No. on Register Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) (5) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 58 103 17 - Factories not included above in which Section 7 is enforced by the Local Authority 468 363 13 - Other premises in which Section 7 is enforced by the Local Authority 11 24 1 - Totals 537 490 31 - 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 66 57 — 3 — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation 4 2 — 1 — Ineffective drainage of floors — — — — — Sanitary Conveniences insufficient 5 1 — — — unsuitable or defective 93 98 — 4 — not separate for sexes 3 — — — — Other offences 20 22 - — — Totals 191 180 — 8 — 46 NUMBER AND TRADES OF OUTWORKERS NOTIFIED DURING 1956 Wearing apparel, making of 535 Household linen 4 Lace, lace curtains and nets 9 Curtains and furniture hangings 2 Furniture and upholstery 2 Umbrellas, etc 1 Artificial flowers 8 Total Paper bags 9 Boxes 50 Brush making 19 Carding, etc., of buttons, etc 2 Stuffed toys 26 Cosaques, Christmas crackers, Christmas stockings, etc. 43 Lampshades 4 714 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 1956 was considerably smaller than in 1955. There were fewer cases of measles, of scarlet fever, and poliomyelitis. Notifications of pulmonary tuberculosis were higher at 71 against 61 in 1955. There was little more bacillary dysentery (33 against 18). 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 Disease All ages 0-1 year 1-4 years 5-14 years 15-24 years 25-44 years 45-64 years 65 years and over 1956 1955 Scarlet Fever 111 148 2 28 75 5 1 Whooping Cough 347 119 35 124 185 2 1 Measles 498 1,185 14 197 286 1 — Diphtheria —- — — — — — Pneumonia 65 62 — 2 6 6 14 26 11 Meningococcal Infection 1 3 — 1 Acute Poliomyelitis: Paralytic 3 7 2 — 1 Non-Paralytic — 11 Acute infective encephalitis Post infectious encephalitis Dysentery 33 18 2 4 21 — 4 2 — Ophthalmia Neonatorum 4 4 4 Puerperal Pyrexia 81 72 — — — 41 40 — Smallpox Paratyphoid Fever 1 1 — — — — 1 — Typhoid Fever 1 1 — — — — 1 — Food Poisoning 24 15 3 4 3 6 8 .—. Erysipelas 28 26 — — 2 . — 7 11 8 Malaria — 1 Tuberculosis: Respiratory 71 61 — 3 1 10 31 23 3 Meninges & Central Nervous System 1 1 1 Other forms 5 11 — — 2 1 1 1 — Totals, 1956 1,274 58 364 582 62 113 73 22 Totals, 1955 1,746 43 688 757 71 106 53 28 Disease St. James Street High Street Hoe Street Wood Street Hale End Higham Hill Total Scarlet Fever 2 9 10 21 43 26 111 Whooping Cough 40 37 31 58 102 79 347 [Measles 88 21 85 118 153 33 498 Diphtheria — — — — — — — Pneumonia 15 21 9 4 10 6 65 Meningococcal Infection — — 1 — — — 1 Acute Poliomyelitis: Paralytic - - 1 - 1 1 3 Non-Paralytic —. — — - — — — Acute infective encephalitis - - - - - - - Post infectious encephalitis - - - - - - - Dysentery 1 1 1 10 8 12 33 Ophthalmia Neonatorum - - 1 1 1 1 4 Puerperal Pyrexia 4 1 11 44 11 10 81 Smallpox - - - - - — - Paratyphoid Fever - - - - — 1 1 Typhoid Fever — — — — 1 — 1 Food Poisoning 2 5 4 2 11 24 Erysipelas 7 6 2 1 4 8 28 Malaria — — — — — — — Tuberculosis: Resoiratory 8 9 8 13 13 20 71 Meninges & Central Nervous System - - 1 - - - 1 Other forms 1 — — — 2 2 5 Totals, 1956 168 110 165 272 349 210 1,274 Totals, 1955. 258 141 234 203 385 525 1,746 48 The following is a summary of the Quarterly Returns made to the Ministry of Health:— Disease 1st qtr. 2nd qtr. 3rd qtr. 4th qtr. Total Scarlet Fever 55 24 14 18 111 Whooping Cough 26 96 134 91 347 Acute Poliomyelitis: Paralytic 1 — 1 1 3 Non-Paralytic — — — — — Measles 13 160 37 288 498 Diphtheria — — — — — Dysentery 12 8 9 4 33 Meningococcal Infection — — — 1 1 Acute Pneumonia 32 13 8 12 65 Smallpox — — — — — Acute Encephalitis: Infective — — — — — Acute Encephalitis: Post Infectious — — — — — Typhoid Fever — — 1 — 1 Paratyphoid Fever — *(5)1 — — 1 Erysipelas 8 3 8 9 28 Food poisoning I 6 12 5 24 Tuberculosis: Respiratory 20 14 14 23 71 Meninges & Central Nervous System - 1 - - 1 Other Forms 1 3 1 — 5 Puerperal Pyrexia 35 14 11 21 81 Ophthalmia Neonatorum 3 — — 1 4 Malaria — — — — — Totals 207 343 250 474 1,274 * 4 later withdrawn as notified in hospital outside Walthamstow. MEASLES 1956 was an inter-epidemic year but even so 498 cases were notified. WHOOPING COUGH Of 347 cases notified, 35, i.e. over 10 per cent., were under one year of age. It is hoped that eventually immunisation will reduce the incidence in the first year of life. DIPHTHERIA Six cases were removed to hospital for observation but none was confirmed. There has been no death from diphtheria in the Borough for 10 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 "booster" doses should be given before entry to school and, ideally, again before transfer from the infant to the junior school. 49 SCHOOL "OUTBREAKS" The year produced an average number of "Outbreaks" which are fully reported in the Report of the Borough School Medical Officer. POLIOMYELITIS Nine suspected cases of poliomyelitis were reported and six were admitted to hospital; of these three were confirmed as paralytic cases. There was apparently little residual paralysis except in one case where there was slight paralysis of the left leg. In addition, an adult female, who was admitted to hospital in June with marked neck stiffness was finally diagnosed as a case of encephalomyelitis of the "Royal Free" type. Onset in the confirmed cases occurred in February, August and November. Poliomyelitis first became notifiable on September 1st, 1912 : the highest incidence was in 1916 when the total notified was 27. Under AOF. G ROUPS Totals S. Jms' High WARDS Hale Hi. H 15' 25- 45- Hoe Wood Year 1 1*5 5-15 25 45 65 St. St. St. St. End 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 1()56 — 2 — — 1 — 3 — — 1 — 1 1 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. Rest and avoidance of fatigue are advisable when there are suspicious symptoms and signs during epidemic periods. ENTERIC FEVER Five cases of paratyphoid fever and o e of typhoid fever occurred in Walthamstow residents, but four were notified from hospitals outside the Borough and are, therefore, excluded from the notification totals. The five cases of paratyphoid type "B" were all associated with cream filled cakes made by two confectioners apparently using foreign egg products. The ages and onset are as follows:— Sex Age Ward Onset Bacteriology 1 Male 7 yrs. H.H. 26.4.56 Paratyphoid "B" "Taunton' 2 „ 13 yrs. W. 1.5.56 do. 3 Female 10 yrs. Hi. 24.5.56 do. 4 „ 1 yr. H.H. 23.5.56 do. 5 „ 31 yrs. H.H. 10.6.56 do. 50 Cases 1- 3 were associated with one confectioner and 4—5 with another. The mother of case 2 became a chronic carrier for some months, but was at last cleared. The mother of case 4 became infected from her baby. In cases 1—3, the confectionery was supplied by a firm with multiple branches in East London and South West Essex and the total number of cases in Greater London was considerable. The probability is that the infected foreign egg products contaminated bakehouse machinery which was not properly cleansed with boiling water after use. In turn the artificial cream (which is normally sterile when received from the manufacturer) became cross-infected. Further reference is made under "Imported Egg Products." The single case of typhoid fever was in a male, aged 44 years, who appears to have contracted the infection abroad. This was due to Vi-phage Type C.4 and this was apparently the first recorded instance of this type in the country. In spite of the closest enquiries into his itinerary, no source of infection could be suggested. Imported Egg Products Several cases of paratyphoid fever notified in May again focussed attention on the risk of using these products. These cases were part of a considerable outbreak (of over 40 cases) which affected East London and Metropolitan Essex and which were associated with cream filled confectionery from bakeries where imported egg products were in use. In the Report for 1955, reference was made to the finding of Salmonella organisms in two out of twelve batches of Chinese dried egg supplied to the school kitchens and to the action of the Committee for Education in prohibiting the use of such products. A circular letter was sent to all bakers and confectioners in 1955 advising them, if possible, not to use these products. This was followed in November, 1955, by a letter setting out a statement prepared by the bakery trade as to the precautions to be taken in dealing with Chinese albumen. Amongst the advice given was the need to cleanse all utensils in boiling water, to avoid infecting other utensils and for operatives to wash hands and arms before handling other foodstuffs. In view of the 1956 series of paratyphoid cases, the Health Committee instructed in June that bakers and confectioners were again to be circularised on the danger of using imported egg products and the precautions which were necessary if they were used. This was all the more necessary because the enquiries at Walthamstow in connection with the cases of paratyphoid clearly showed that this advice was not being followed. 51 A further suggestion was made that each consignment should be held pending sampling by the Health Department. In August, 1956, a third circular was addressed to bakers and confectioners in view of several apparently isolated cases of food poisoning in the Borough. This circular stated that the risk of food poisoning would continue until ingredients are free of harmful bacteria, and until such safety is assured, the only weapon is scrupulous cleanliness and the separation of imitation cream (which is safe and pure as it arrives from the manufacturer) from other bakery products, especially imported egg products. In effect this means separate equipment and personnel to deal exclusively with imitation cream. FOOD POISONING "Notified" Cases. Forty-two cases of food poisoning were notified by medical practitioners during the year. The organisms concerned in the various "incidents" were Salmonella Typhi Murium 9, Salmonella Enteriditis 5, Coagulase Positive Staphylococci 4, Clostridium Welchii 2, Staphylococci + Salmonella Typhi Murium 1. In the remainder the causal organisms were not identified. The vehicles possibly implicated were the following :—tinned fish, tinned meat, tinned chicken, boiled ham, stewed steak (precooked), meat pie, pork sausage, pork pie, peasepudding and minced meat. One case was fatal in an adult male who died following infection from Cl. welchii Type A.8. Apparently at that time there was no recorded fatality of this kind in the medical literature. " Ascertained " Cases. (a) Three single cases and five cases in one family came to the attention of the Department other than by notification. The causal organisms were not identified. (b) Eight cases (of which only 2 were "notified") occurred in a cafe used by workers from an industrial concern after the consumption of pre-cooked stewed steak which gave a growth of CI. welchii. All the six cafe employees gave negative specimens, but four of the patients produced Cl. welchii type 3. In two cases the infection was contracted abroad. (c) In April five children were absent from one of the Special Schools. Food and faecal specimens were examined, but all were negative. The symptoms described resembled those of Cl. welchii food poisoning, i.e. diarrhoea and pain without vomiting. A fuller account of the following outbreaks is given in the 52 report of the Borough School Medical Officer for 1956. (d) In May an outbreak of food poisoning was reported from a secondary modern school. At least three adults and 32 children were involved. The meal comprised boiled boned mutton, vegetables and gravy, Bakewell tart and custard, the causal organism being Cl. welchii. Dr. Betty Hobbs, of the Central Public Health Laboratory, Colindale, carried out a series of investigations and experiments and advised as follows:— "As it seems fairly certain that a proportion of meats are reaching canteens already contaminated with heat-resistant Cl. welchii, then measures to protect consumers against this hazard must be taken. "Such measures may be described as follows:— (1) Cook the meat in such a way that all heat-resistant spores are destroyed, i.e., by pressure cooking or by the thorough roasting of small-sized joints. (2) Cook, cool rapidly and maintain in the refrigerator until required. (3) Cook and keep hot above 60°C. either inside a hot-plate or in the steamer when the presence of gravy should make little difference. "The same recommendations should apply to gravies and stews. "The results of our experiments in the School Kitchen are of much practical use and we are most grateful for the willing help of all concerned." (e) In October the parent of a girl attending a High School, and as a result of a food hygiene lecture attended by the parent some two years previously, reported that her child appeared to be suffering from food poisoning. The investigation showed that 52 persons were affected on the Friday but were all back at school on the Monday except for the child referred to above. 233 persons had eaten at the first sitting, the meal consisting of cold roast pork, salad, chocolate pudding and sauce. Contrary to instructions, the meat was eaten on the day following cooking although stored in a refrigerator overnight. Bacteriological proof was obtained in two cases and all symptoms and signs pointed to Cl. welchii, infection ; the organism was untypable. Again, contrary to instructions, the sample meal which should have been retained over the week-end, was thrown away before examination could be carried out. In addition to the 42 "notified" cases there were 106 "ascertained" cases, i.e. a total of 148. The following information is in the form required by the 53 Ministry of Health:— 1. Local Authority: Walthamstow. Year: 1956. 2. Food Poisoning Notifications (Corrected) Returned to R.G. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 10 8 13 11 42 3. Outbreaks due to Identified Agents. Total outbreaks—6. Total cases—14. Outbreaks due to:— (a) Chemical Poisons: Nil. (b) Salmonella Organisms: 3. (c) Staphylococci (including toxin): 2. (d) Cl. botulinum: Nil. (e) Other bacteria: Cl. welchii 1. 4. Outbrea\s of Undiscovered Cause'. Total outbreaks—2. Total cases—6. 5. Single Cases. Agents identified—14. Unknown cause—8. Total—22. Salmonella Typhi Murium: 7. Salmonella Enteriditis: 4. Staphylococci: 2. Cl. welchii: 1. MENINGOCOCCAL INFECTION Two cases were notified, but one was not confirmed. The other one, F. l½ years, was removed to hospital and recovered. DYSENTERY Forty-nine cases were notified, and thirty-three were confirmed. OPHTHALMIA NEONATORUM Four cases were notified, 2 M., 2 F. Three recovered but one male died in hospital at four days old from ophthalmia neonatorum and melaena neonatorum. 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 76 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-compensation continues to be paid. 54 TUBERCULOSIS The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1956:— Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year - - 1 - — — — — 1— 4 years 1 2 - - - - - - 5— 9 ,, — — 1 - — - — — 10-14 „ 1 — 1 - - - - - 15-19 „ — 2 - - - - - - 20-24 „ 4 4 — 1 — — — — 25-34 „ 7 11 — 1 — — — — 35-44 „ 7 6 — - — 1 — — 45-51 „ 10 — — 1 1 — — - 55-64 „ 10 3 — - 1 — 3 — 65 and over 3 — — — 2 — — - 43 28 3 3 4 1 3 — Totals 71 6 6 3 77 8 In 32 per cent, of the 71 notified pulmonary cases there was a history of close contact with other tuberculous cases. As each new case of pulmonary tuberculosis has been notified enquiry has been made as to the infectivity of the patient. Of 69 cases investigated 26 were sputum positive on notification or soon after, i.e. 36.6 per cent. The percentages during 1953, 1954 and 1955 were 45.6, 42.0 and 44.2 respectively. The returns for the past three years are compared below:— New Cases. Deaths. Pulmonary. NonPulmonary. Total. Pulmonary. NonPulmonary Total. M. F. M. F. M. F. M. F. 1956 43 28 3 3 77 4 1 3 - 8 1955 35 26 7 5 73 10 4 2 1 17 1954 37 23 3 4 67 7 3 1 — 11 Fourteen deaths occurred amongst persons whose names were on the tuberculosis register and of these the Registrar General ascribes 8 to tuberculosis, i.e. 5 pulmonary and 3 non Pulmonary. 55 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 - - - - - - 5 2 — - — - Non-Notification of Tuberculosis There were no known cases of non-notified tuberculosis during the year and no cases were notified after death. Mass Radiography The Mass Radiography Unit re-visited Walthamstow during the year and was based at the Old Monoux School building in High Street. Organised groups were seen and public sessions were held. In addition two factories in the Borough were visited. The detailed findings are set out below:— MASS RADIOGRAPHY SURVEY WALTHAMSTOW, 1956 High Street (Old Monoux School)— Male Female Total Organised Groups (including two factories): Number of Miniature films 2,226 1,725 3,951 Recalled for large films 65 38 103 Public Sessions: Miniature films 950 1,359 2,309 Recalled for large films 47 51 98 Totals: Miniature films 3,176 3,084 6,260 Large films 112 89 201 Pulmonary Tuberculosis:— 1. Presumed healed—requiring no further action 21 16 37 2. Occasional supervison 10 1 11 3. Close clinic supervision 1 — 1 4. Requiring immediate treatment 5 1 6 (Seven male and one female cases were notified.) Other abnormalities include:— Pneumonia 2 3 5 Pneumokoniosis 1 — 1 Pulmonary fibrosis 8 4 12 Pleural thickening with calcification 7 3 10 Acquired heart abnormalities 2 10 12 Pneumatocele 1 - 1 Bronchial Carcinoma 1 1 2 Sarcoidosis 1 — 1 56 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. 57 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 Public Health Inspection, both to improve living conditions and to investigate possible sources of infection. SICKNESS BENEFIT 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 five years the weekly averages of new claims were as follows. The extraordinary consistency of those for the months of June to October will be noted. 1952 1953 1954 1955 1956 January 464 747 500 660 578 February 433 832 513 632 630 March 390 401 375 474 432 April 350 300 267 300 279 May 270 232 314 263 291 June 214 237 252 264 249 July 200 197 220 224 228 August 205 201 209 228 214 September 262 257 284 271 295 October 369 370 348 363 368 November 311 360 366 370 424 December 426 291 299 350 339 Average per week 323 363 327 360 357 (The large number of claims in January and February, 1953, reflected the delayed effects of the severe "smog" experienced in December, 1952.) In January, 1956, there was fog, frost, and damp followed by the very cold and frozen fortnight in mid-February. March to May was mild and sunny and better than the cold, dull rainy "summer" that followed. Weather conditions improved in the autumn reverting to damp and fog in December. 58 G.—MISCELLANEOUS 1. Old People's Welfare. 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 18,727 meals during 1956. Six 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. The scheme has been in operation in this form since March, 1948, and is an essential one for people who would not otherwise be able to get a cooked meal. The Committee also provided seven old people's clubs in different parts of the Borough and shared the expense of a club at Woodford Green with the Wanstead and Woodford Old People's Welfare Association. The Committee continued to act as the co-ordinating committee for old people's welfare and maintained close liaison with other statutory authorities engaged in this work. Accommodation for the Aged and Chronic Sick The cold "snap" during February, 1956 produced a large increase in the number of cases coming to the knowledge of the Health Department and requiring care and attention. The Health Committee instructed that a special report was to be made for the Finance and General Purposes Committee in March. This stated that 16 of the 24 cases reported in January and February required admission either to hospital as sick persons, or to welfare accommodation as frail ambulant persons; ages ranged between 60 and 95 years. Not only was there difficulty in obtaining accommodation, but in some cases where it became available, there was refusal on the part of the person concerned to accept the offer made. In some cases home nursing, domestic help and "Meals on Wheels" had to be arranged over the weekend. It is of interest to note that the effect of cold weather on general "medical" practice was commented on in the" British Medical Journal" on the 27th December, 1956. The inquiry indicated that severe cold weather brought about a marked increase in the volume of work in the practice concerned, both surgery attendances and home visiting. The co-operation of the hospital and welfare services was always admirable, but the difficulty appears to be wholly one of insufficient accommodation. Even so, Walthamstow is fortunate in participating in the geriatric service and accommodation available at Langthorne Hospital which, however, appears to have far too large a "catchment" area. 59 In particular the position is eased by Dr. DeLargy's scheme at Langthorne Hospital for rehabilitating the aged and relieving their relatives. Priority of admission is decided by means of domiciliary visits, and whereas the Family Doctor often thinks in terms of permanent accommodation in hospital, many relatives have stated to Dr. DeLargy that they had no wish to shelve their responsibilities, but only wanted a rest, especially a night's unbroken sleep. This specialised accommodation at Langthorne Hospital is for 24 women and 10 men, and admissions and discharges alternate each six weeks. The scheme is fully described in the issue of "The Lancet" 23rd February, 1957. Some years ago a directive was issued by the Regional Hospital Board that all hospitals should reserve 10 per cent. of their accommodation for the aged and chronic sick, but this does not appear to have been properly observed, which is quite understandable in hospitals primarily dealing with the acute sick. The only real solution is the provision of more and adequate geriatric units. Aids for the Elderly, Disabled and Handicapped In October the Central Council for the Care of Cripples kindly arranged for their travelling exhibition to visit Walthamstow. The exhibition is housed in a motor van designed for the purpose and contained a large variety of very simple "gadgets." Particulars were circularised to all who are concerned with this group of persons, but attendances were somewhat disappointing. Emergency Assistance for Tenants living alone (The following is extracted from the report of the Housing Manager to the Lettings Sub-Committee of November, 1956):— During the summer enquiries have been made of the occupiers of all the one-bedroom flats, bed-sitting room flats and flatlets, suggesting that the occupiers—who generally are elderly—should furnish information regarding the name and address of their doctor and of persons who might be notified in case of need. So far, a little over 50 per cent. of the tenants have responded and arrangements are in hand for a further communication to be sent to each person who has failed to give the necessary information. Meanwhile, each tenant of these small properties has been provided with a card bearing the letters "S.O.S." which can be exhibited in a window of their home whenever help is required. New Accommodation for the Elderly Dr. DeLargy met representatives of the Architect's and Housing Departments to discuss the medical requirements in this matter. Particular reference was made in regard to the advisability fpr baths to be as low as possible. The heights of the table, 60 draining board and gas cooker should always be the same, so that the old people could slide articles from one to the other as far as possible. In addition, the top of the sink should also be at the same level. 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 1956 17 patients received domiciliary treatment, and the total treatments given were 21 at a cost of £11 0s. 6d. The ages of the persons concerned were:— Males (2) 80 years. Females (15) 80 years to 90 years. The agreement of the family doctor as to the need for treatment and as to non-ambulancy is sought. General. The need appears to be for increased services in the following directions, especially those which help with domiciliary treatment:— (1) "Meals on Wheels" daily. (2) Ample home nursing and domestic help facilities, including week-end help. (3) Increased chiropody facilities at clinics and in the home. (4) Companionship, 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 steam-disinfected and given to persons in need. The following items were supplied: Bedsteads, 4; Mattresses, 8; Blankets, 3; Pillows, 3; Commodes, 2; Chairs, 2; and Wheel-chair, 1. 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. 61 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. Experience in 1956 has conclusively shown the increasing need for this service. A part-time laundress was appointed to deal with this work. The number of cases dealt with was as follows:— Total number of cases 21 Average number of cases per week 7 Total number of articles 3,218 Average number of articles per week 62 Total number of journeys 701 3. Funeral Arrangements. No burial was 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 259 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. Food Hygiene.—Two lectures were arranged for the school kitchen and dining staffs and were given by the Deputy Medical Officer of Health and the Chief Public Health Inspector. Full details are given in the Report of the Borough School Medical Officer for 1956. 6. Cancer Education. The leaflet of advice printed in the 1951 Report is available for distribution. 7. Disinfection. The Council agreed to provide facilities for steam disinfection for the Leyton Corporation on the terms applicable to the Chingford Corporation. 62 8. General. The Borough Architect, Engineer and Surveyor contributes the following information:— (a) Public Conveniences. Tenders were obtained during the year, for the erection of a Public Convenience at the Selborne Recreation Ground, Selborne Road, E.17. During 1956, free washing facilities continued to be available by the supply of soap and paper towels at the Public Conveniences. A charge of 2d. continues for the issue of cloth towels. No charges are made for the use of public conveniences. (b) Cremation. Facilities for cremation are available at the 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 24.15 in. (d) Inquests and Post Mortems. Walthamstow Others Total Post Mortems only 85 230 315 Post Mortems and Inquests 16 72 88 Inquests only 4 53 57 (e) Flooding. This year, which has been abnormal in the number of excessive rainstorms, has indicated clearly the weakness of the existing sewerage svstem. Flooding has occurred in various parts of the Borough, details of which are given below. Following on a report to the Council in June, 1952, it was agreed to engage technical staff to carry out the surveys and collect data for the preparation of a new main drainage scheme. One Principal Assistant Engineer and one Assistant Engineer were engaged; it has not been possible, however, to recruit the balance of the staff. Up to date approximately 50 per cent. of the Borough has been surveyed and the information plotted, this work has been seriously impeded by the lack of suitable Junior Assistants. By the end of this year, it is anticipated that the survey will be completed for the southern part of the Borough, so that designs can be prepared for this area, which is the worst one. 63 Pending the completion of the survey and the design of the main system, it has been possible to prepare some smaller schemes on the perimeter of the area which will alleviate flooding conditions and will, in due course, form part of the major scheme. These are:— (1) Reconstruction of foul sewer, Hale End; (2) Billet Road Relief Sewer; (3) Shernhall Street Relief Sewer; (4) Chingford Road Relief Sewer; (5) Coppermill Lane Relief Sewer; (6) Storm Tanks, Brook Road/Raglan Road. Various small sections of sewers have been reconstructed and a new Venturi flume built at Low Hall Farm to record flow. Designs are being prepared for the construction of new storm water tanks at Low Hall Farm, together with a new automatic pumping station. 64 SECTION H NATIONAL HEALTH SERVICE ACT, 1946 PART III SERVICES WALTHAMSTOW HEALTH AREA SUB-COMMITTEE (1956/57) Chairman: Councillor Mrs. W. M. Palethorpe (Walthamstow Borough Council). Vicc-Chairman: Councillor J. E. Nicholls (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 Mrs. L. P. Bailey. Walthamstow Borough Council Alderman G. S. Mace. „ „ „ Alderman The Lady McEntee, O.B.E, J.P. „ „ „ Councillor Mrs. E. L. Baldwin. „ „ „ Councillor J. J. Bracken. „ „ „ Councillor Mrs. S. Candy. „ „ „ Councillor Mrs. G. F. G. Cowell. „ „ „ Councillor A. W. Ellis, M.B.E. „ „ „ Councillor J. H. Hammond. „ „ „ Councillor O. F. J. McCarthy. „ „ „ Councillor J. W. Pringle. „ „ „ Councillor Mrs. C. E. Stannard. „ „ „ Councillor A. F. Whicher. „ „ „ Councillor F. H. Eiles. 65 Executive Council for Essex F. A. Wortley, Esq. Hospital Management Committee' Mrs. B. E. Bottomley, J.P. Local Medical Committee for Essex Dr. W. R. John. Voluntary Organisations Dr. R. C. Fergus (Walthamstow District Nursing Charitable Association). „ „ E. P. Marr, Esq. (Walthamstow Child Welfare Society). „ „ Mrs. M. Osora (Invalid dren's Aid Association). „ „ Mrs. A. Cordell (Walthamstow and Chingford Association of Tuberculosis Care Helpers). STAFF During the year 29 whole-time members of the Health Area Staff resigned their appointments and 23 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. Mr. L. W. Elmer, L.D.S., Senior Dental Officer, retired at the end of the year after twenty-four years' service in Walthamstow. HEALTH CENTRES (Section 21) HEALTH CENTRE SITES The general position remains as detailed in the previous reports, i.e., six sites have ben 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 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, but the scheme is held up by the "credit squeeze." GENERAL DENTAL SERVICE The Senior Dental Officer reports as follows:— "My report must, I regret to say, be a repetition of that which I made last year, a story of a consistent but regrettable inability to undertake the treatment of large numbers of patients who asked for appointments. 66 "I can only hope that in 1957, with a few more sessions available, there will be a reduction in the numbers of disappointed applicants." Herewith is a summary of the work undertaken during the years 1955 and 1956:— 1955 1956 Number of patients treated 831 941 Appointments made 4,867 5,008 „ kept 4,396 4,533 Plastic fillings 381 2,048 413 1,944 Amalgam fillings 1,667 total 1,531 total Inlays 9 7 Crowns 29 28 Scalings and gum treatments 441 450 Dressings 515 549 Extractions 752 756 General anaesthetics 211 138 Local anaesthetics 462 638 X-rays 509 588 Impressions 609 591 Bites 170 166 Try-ins 221 234 Full upper dentures 771 851 Full lower dentures 56 214 total 53 220 total Partial upper dentures 51 dentures 48 dentures Partial lower dentures 30 34 Repairs 211 154 DENTAL LABORATORY The following work was undertaken during the year:- Dentures Repairs Re-line Orthodontic Inlays Orthodontic Remakes Appliances Crowns Splints Study Models Other Models General Dental Service 231 221 4 2 4 13 1 - - 1,265 Walthamstow Committee for Education 41 42 - - 219 12 1 5 714 - Leyton Committee for Education 21 6 - - 35 - - - - - Maternity and Child Welfare Patients 23 - - - - 2 - - - - Regional Hospital Board (Connaught and Harts Hospitals) 21 14 - 4 - - - 10* - - * Bite splints for correction of temporo mandibular disorders. 67 CARE OF MOTHERS AND YOUNG CHILDREN (Section 22) ANTE-NATAL AND POST-NATAL SERVICES The following table summarises the attendances at the Clinics held:— New Patients— Ante-Natal Post-Natal Thorpe Coombe Maternity Hospital 1,309 803 Low Hall Lane Clinic 28 10 Silverdale Road Clinic 23 25 West Avenue Clinic 11 7 District Nurses Training Home and Midwives' Homes 289 — Totals 1,660 845 Total Attendances— Ante-Natal Post-Natal Thorpe Coombe Maternity Hospital 11,799 1,030 Low Hall Lane Clinic 237 27 Silverdale Road Clinic 122 32 West Avenue Clinic 74 11 District Nurses' Training Home and Midwives' Homes 3,249 — Totals 15,481 1,100 Blood grouping/haemoglobin estimation and Rhesus and Kahn tests were carried out for all patients attending ante-natal clinics, except when interim ante-natal care is carried out on behalf of maternity hospitals. 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 Maternity Hospital on Sunday mornings (by courtesy of Miss Rodway, F.R.C.O.G., 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 68 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 7 Rhesus negatives and all Kahn tests were negative. The total of blood tests was 49—first tests 43 mothers and 1 father, and in addition 4 confirmatory tests and 1 for haemoglobin only. The groupings were A.18, B.3, O.21 and AB.l. Hæmoglobin estimations showed the following results:— 100+ = nil 60—69 = 4 90—99 = 6 50—59 = nil 80—89 = 22 40—49 = nil 70—79 = 10 i.e., 4 or 9.5% were under 70. 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 have been advised that blood specimens could be taken from their patients either at an ante-natal clinic or a weekly clinic at the Town Hall. Routine chest X-ray examination is always advised and carried out if the expectant mother agrees. During the year, 906 patients were referred to the Chest Clinic from Thorpe Coombe, and 62 from other ante-natal clinics. Two were found suitable for treatment and confined at the special unit at Black Notley Sanatorium. Ante-Natal Clinics. Details of ante-natal clinics held in Walthamstow are given on page 73 of this Report. Relaxation Classes. Relaxation classes have been continued at Markhouse Road Welfare Centre on Tuesdays at 2 p.m., at West Avenue Welfare Centre at 2 p.m. on Wednesdays, and at Silverdale Road Health Services Clinic 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 69 mechanism of labour. The classes are held in conjunction with the ante-natal clinics at the respective welfare centres. One-hundredand-fifty sessions were held during the period under review involving a total of 855 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 The follow-up continued. CONFINEMENTS The following table shows the location of confinements during 1956:— Thorpe Coombe Maternity Hospital 1,256 Other Hospitals and Maternity Homes 380 Total in Hospital, etc 1,636 At Home 331 Total Confinements 1,967 VITAL STATISTICS Walthamstow England & Wales (Provisional) Live birth-rate per 1,000 population 11.8 15.7 Still birth-rate per 1,000 total births 17.6 23.0 Infant mortality rate per 1,000 live births 18.7 23.8 Extracts from vital statistics are given more fully in Section "A" of this Report. NOTIFICATION OF BIRTHS 1,992 births (529 of which belonged to other Areas) were notified during the year under the Public Health Act, 1936. Notifications were received as follows: Doctors, 350; Mid' wives, 1,623: Others, 19. Also included are 30 still-births, five of which belonged to other areas. Of the total, 11 occurred outside the Borough. NEO NATAL MORTALITY The number of infants dying under one month during 1956 was 18, i.e., a rate of 13 per 1,000 live births. 70 INFANT MORTALITY The deaths of infants under one year were as follows:— Males Females Totals Legitimate 16 10 26 Illegitimate — — — Totals 16 10 26 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, 18.7; Illegitimate, nil; Total, 18.7. Of the 26 deaths 18 occurred in the first month of life including 12 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 7 5 6 2 3 0 3 Four deaths occurred at home, one in a Day Nursery and 21 in hospital. Two deaths, including the one at the Day Nursery, were accidental, due to inhalation of fluid, and were the subject of inquests. Principal causes of death were: Prematurity, 13; Congenital abnormality, 5; Birth injury, 3; Infectious and other conditions, 3. None of the deaths were considered to be preventable and of the 13 ascribed to prematurity the average birth weight was 2 †b 12oz. The Infant Mortality Rate for Walthamstow of 18.7 compares very favourably with that for England and Wales for 1956 (23.8) and is the lowest ever recorded in the Borough. 71 CAUSES OF DEATH OF CHILDREN UNDER 1 YEAR OF AGE—1956 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. 8 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 - - - - - - - - - - - - - - - - - Pneumonia - - - - - 1 - - - 1 - 1 - _ - 1 Diarrhoea, - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - Inattention at birth, wilful neglect - - - - - - - - - - - - - - - - - Suffocation (overlaying) - - - - - - - - - - - - - - - - - Injury at birth 2 - - - 2 1 — - - 3 - - - - 2 1 3 Atelectasis - - - - - - - - - - - - - - - - - Congenital malformation 2 - 1 - 3 - 1 - 1 5 9 - 1 - - 2 5 Premature birth 8 4 - - 12 - 1 - - 13 - 1 1 7 2 2 13 Atrophy, debility, marasmus - - - - - - - - - - - - - - - - - Inanition - - - - - - - - - - - - - - - - - Heart failure - - - - - - - - - - - - - - - - - Other causes — — - 1 1 - 1 - 2 4 1 - 1 — 1 1 4 Totals 12 4 1 1 18 2 3 — 3 26 3 2 3 7 5 6 26 72 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 1956, 77 live premature infants were born to residents of the Borough, 13 at home and 64 in hospitals and nursing homes. Of the 13 born at home, five were transferred to hospital. Of the remaining eight who were nursed entirely at home, all survived the first twenty-eight days of life. 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 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 1956 1,335 53 26 Nil 19.4 Nil Totals 1952 to 1956 (5 years) 6,871 268 159 5 23.1 18.6 MORAL WELFARE The "Carville" Home, now at 43 West Avenue Road, E.17, is administered by the Walthamstow Deanery Branch of the Chelmsford Diocesan Moral Welfare Association. The home provides accommodation for a total of 16 mothers and their babies and has a high record of care and service. Miss E. A. Williams, Superintendent, submits the following report on the work carried out during 1956:— "May I once again express my indebtedness for the help and co-operation of the staff of the Health Department. Their ever ready help lightens our work, and we have had a very busy year." 73 Details of cases dealt with are as follows:— Admitted Adults Babies Total From Walthamstow 14 14 28 From rest of County 51 34 85 From outside County 8 4 12 Total 73 52 125 Outdoor Work— Walthamstow (Mothers and babies) 30 30 60 Walthamstow (Other cases) 31 — 31 Other County cases 7 — 7 Total 68 30 98 MATERNITY AND CHILD WELFARE CENTRES The following list gives details of Clinics held at the various Centres situated in the Borough (a) Ante-Natal 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. (c) Child Welfare Clinics. Monday 2 to 4 p.m. St. John's Church Hall, Penrhyn Avenue, E.17. Monday do. Low Hall Lane, Markhouse Road, E.17. Tuesday do. The Welfare Centre, West Avenue, E.17. *Tuesday do. Memorial Hall, Winchester Road, Highams Park, E.4. Wednesday do. Low Hall Lane, Markhouse Road, E.17. Wednesday do. Silverdale Road, Highams Park, E.4. Thursday do. St. John's Church Hall, Penrhyn Avenue, E.17. Thursday do. The Welfare Centre, West Avenue, E.17. Friday do. Low Hall Lane, Markhouse Road, E.17. Friday do. Silverdale Road, Highams Park, E.4. Friday do. The Welfare Centre, West Avenue, E.17. (Toddlers only). 74 In addition, the Walthamstow Child Welfare Society holds massage and sunlight sessions. These sessions transferred back from Silverdale Road Welfare Centre on 2.10.56 after 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 year of age 1 year old 2-5 years of age Total Under 1 year of age 1 year old 2-5 years of age Total Markhouse Rd. 321 13 17 351 5,064 1,295 1,538 7,897 8,248 Penrhyn Ave. 234 10 14 258 3,667 1,207 1,069 5,943 6,201 West Avenue 217 16 15 248 3,506 834 766 5,106 5,354 Silverdale Rd. 208 12 9 229 3,518 1,107 2,764 7,389 7,618 Winchester Rd. 23 2 — 25 351 122 194 667 692 Totals, 1956 1,003 53 55 1,111 16,106 4,565 6,331 27,002 28,113 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 and Whooping Cough Immunisation. The percentage of attendances at "Brookscroft" to the total of child welfare attendances in the Borough during 1956 was 18.2. The percentage of new cases at "Brookscroft" to the number of live births in the Borough was 18.3. These percentages denote that nearly one-fifth of the child welfare attendances in the Borough during 1956 were at "Brookscroft." 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 1 yr. of age 1 yr. old 2-5 yrs. of age Total 1956 254 9 19 282 4,113 999 838 5,950 6,232 Seventy-eight children were immunised against diphtheria and 73 against whooping cough during the year at "Brookscroft." 75 Summary of Attendances at all Child Welfare Clinics First Attendances Re-Attendances Grand Total Under 1 yr. ot 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 1,005 53 55 1,111 16,106 4,565 6,331 27,002 28,113 "Brookscroft" 254 9 19 282 4,113 999 838 5,950 6,232 Total 1956 1,257 62 74 1,393 20,219 5,564 7,169 32,952 34,345 TREATMENT The facilities provided at the Education Authority's clinics are available for all children attending the welfare centres. (a) Orthoposdic. — Miss H. Garratt, C.S.P., has kindly furnished the following information with respect to children under five years of age Defects Seen at Orthopaedic Clinic in Children Under Five Years of Age Anterior Poliomyelitis 5 Overlapping Toes 3 Surgical Tuberculosis 1 Perthes Disease 2 Scoliosis 4 Athrogryposis Multiplex Genu Valgum 16 Congenitae 1 Genu Varum 4 Congenital Dislocation of Hip Pes Valgus and Valgus Ankles 11 Talipes— (a) Calcaneo Valgus 1 Torticollis 1 (b) Metatarsus Varus 4 Other Congenital Defects 2 Miscellaneous (including Claw Toes 1 Chest Conditions) 16 Total 73 Number of Treatments given—555. (b) Sunlight.—Sunlight treatment was given at the Hale End Clinic to 9 children under 5 years of age for 90 treatments. (c) Priority Dental Treatment.—The Senior Dental Officer reports:— "Following the trend of recent years the numbers of expectant and nursing mothers and young children who have been referred for treatment and received it has decreased. There are two possible reasons for this, either the numbers seen at the Welfare Centres by 76 the doctors present fewer cases of dental defects, or just possibly, the standard of what may be classed as dental fitness has varied with changes of medical staff. "The first reason is, I hope, the correct one, but the second cannot, of course, be ruled out entirely. "There is at least one hopeful trend. Among some 200 expectant and nursing mothers referred, it was found that one only needed a complete artificial denture and it was only found necessary to fit seven partial dentures. "This is certainly a complete change from the times, not very long ago, when the great majority of women referred from the Welfare Centres were in such poor dental condition that they needed full dentures. "The number of Dental Sessions has been as follows:- 1956 189 1955 174 "The total of expectant and nursing mothers who received dental treatment during 1956 expressed as a percentage of live births was 13.6. "In May, 1956, one evening session per week was commenced for expectant and nursing mothers and children under five years of age. "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 95 121 272 Patients found to require treatment 89 115 241 Patients who have commenced treatment 81 109 222 Patients who have completed treatment 52 81 168 Patients awaiting treatment — 1 3 Attendances for treatment 202 326 382 Types of treatment given: Expectant Mothers Nursing Mothers Children under School age 1. Extractions: ('a) permanent teeth 42 88 - (b) temporary „ — — 140 2. Fillings: (a) permanent teeth 94 147 — (b) temporary „ — — 222 3. Inlays provided 1 2 4. Crowns „ — 4 — 77  Expectant Mothers Nursing Mothers Children under School age 5. Anaesthetics administered: (a) local 11 26 7 (b) general:— (i) by medical officers 7 11 27 (ii) by others 9 8 19 6. (a) Scaling 21 16 1 (b) Prolonged scaling and gum treatment 6 1 - 7. Silver Nitrate Treatment 1 5 71 8. Dressings 24 30 57 9. X-ray examinations 4 2 — 10. Dentures provided: (a) full 1 19 — (b) partial 1 1 — 11. Dentures repaired 1 3 — 12. Dentures remade: (a) full — 1 — (b) partial 3 4 — 13. Orthodontic appliances: (a) fixed — — — (b) movable — — — 14. Prophylactic treatment and other operations: Impressions 8 40 — Bites 6 16 — Try-ins 5 32 — Easing 4 24 — Polishing 11 4 1 Gum Treatments 15 3 5 Syringing 1 1 — Inspections 2 6 — 15. Number of treatments included above in 6 or 14, carried out by Oral Hygienist 30 14 - The services of the Dental Hygienist were available on two half-days per week." (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. The following report is contributed by Dr. Helen Gillespie, Senior Psychiatrist at the Walthamstow Child Guidance Clinic :— " Only 9 new cases were referred during 1956. This 78 pares unfavourably with the already low figure of 12 children referred in the previous year. I find this extremely disappointing; I previously stressed the view that the referral and treatment of children in pre-school years holds out the best hope of solving the problems common to all child guidance clinics of excessive pressure of work, due largely to problems which might have been prevented had appropriate guidance or treat' ment been provided at an earlier stage. Progressive medicine concentrates on prevention, and this principle is of particular application in the field of child psychiatry, where it is almost universally admitted that the foundations of mental health or ill health are laid down during the first five years of life. "In child guidance clinics dealing largely with children of school age, and in schools for maladjusted pupils one is continually impressed with the magnitude of the problem and with the fact that in most cases one can see clearly that the problem originated in the very early years, long before the child is brought for advice. One's experience in handling such problems when they are, in fact, brought in the pre-school period, encourages one to believe that in many cases the later problem could have been averted had the earlier one been dealt with in good time. When one considers the expense incurred by public authorities, not merely in the running of child guidance clinics, but also the costly residential schools for maladjusted pupils, one realises how much scope there is here, not only for better medicine but also for national economy. In this way, I believe, in the long run the present excessive demand for places at schools for maladjusted pupils might be diminished, and the places there be made available for those children far whom this form of education is unavoidable. "I would like to stress in connection with this mental health work the need for co-operation between the infant welfare services and the Child Guidance Clinic. The staff at the Child Guidance Clinic would always be happy to help the health visitors or any other persons concened in the social and medical welfare of young children, with discussions of problem families or arranging psychiatric interviews for particular parents and children at the West Avenue or Walthamstow Child Guidance Clinic. I am glad to record that in the course of the year the clinic staff were invited to give talks at "Brookscroft" Maternity and Child Welfare Centre on June 12th, and at the Nursery Association at Leyton on November 20th. "Further to the subject of prevention, I believe that the provision of more nursery schools to which children could go who show signs of early maladjustment in their homes, would often provide a satisfactory means of solving their problems. The present housing shortage with consequent overcrowding and restriction of the child's normal activities, leads to frayed 79 tempers on the part of parents and children, and this is frequently at the root of disturbed relationships. This is generally described by naughtiness on the part of the child and by producing in him feelings of resentment and injustice leading to further ' naughtiness,' and thus to a vicious circle." (g) Pediatric Clinic.—The fortnightly clinic, under the charge of Dr. Elchon Hinden, Paediatrician to Whipps Cross Hospital, continued during 1956 and 28 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 five years who attended the clinic during 1956:— Under 5 years New cases 28 Total attendances 57 Physical Defects: Cases seen 28 Referred to Hospital 11 Discharged 8 Psychological Disorders: (a) Enuresis — (b) Other — Referred to Hospital — Discharged 5 (h) Invalid Children's Aid Association.—Mrs. E. Dick, 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 2 General Practitioners 4 7 80 Classification of above cases:— Under five years Anaemia, Debility 1 After effects of acute or infectious illness or operation 2 Diseases of: Ear, Nose and Throat 3 Other defects 1 7 One child was referred by a voluntary body for visiting, advice, help and followup. (i) Convalescence.—During 1956 two children were sent away on medical recommendation to convalescent homes. As in previous years the arrangements were normally made through the local branch of the Invalid Children's Aid Association. In addition, two 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 1956 are as follows:— Sales Free Issue lbs. ozs. lbs. ozs. Adexolin — — 40 6 Bemax 182 ½ — — Cow and Gate 3,724 — — — Cod Liver Oil and Malt — — 23 — Farex 810 10 — — Ferrous Gluconate Tablets — — 29,000 — Gentian Violet Tablets — — 1,000 — Glucodin 121 4 — — Lactogal 51 — — Iron Sulphate Compound Tablets — — 1,000 — Maltoline with Iron — — 245 8 Marmite 955 4 — — Milk of Magnesia — — 11 — Mist Ferri et Ammon Cit. Pro Infantibus — — 28 14 81  Sales Free Issue lbs. ozs. lbs. OZS. Ostermilk 1,506 — — — Ostocalcium Tablets — — 1,000 — Robinson's Groats 244 — — — Sodium Citrate Tablets — — 5,000 — Scott's "Twin Pack" 473 2 — — Virol 712 8 — — Calcium & Vitamin D Tablets — — 1,000 — Trufood 41 — — — Value of Cash Sales—£1,444 15s. 2d. DISTRIBUTION OF WELFARE FOODS At the end of the year, eight distribution centres were open for 22 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 4,976 1,759 595 11,481 Markhouse Road Infant Welfare Centre 4,999 1,588 659 8,457 Northcott House Distribution Centre 16,161 2,894 1,605 26,609 Penrhyn Avenue Infant Welfare Centre 4,258 1,201 402 8,838 Silverdale Road Infant Welfare Centre 3,622 1,617 548 12,724 Thorpe Coombe Maternity Hospital — 62 1,477 4,851 West Avenue Infant Welfare Centre 4,612 1,621 658 8,556 Winchester Road Infant Welfare Centre 332 179 30 950 TOTAL issues at Distribution Centres 38,960 10,921 5.974 82,466 In addition, the following were issued to:— Hospitals (National Health Service) 466 - - 324 Day Nurseries — 252 — 1,080 GRAND TOTAL OF ISSUES 39,426 11,173 5,974 83,870 82 DAY NURSERIES During the year the average attendances at the day nurseries (Mondays to Fridays only) were as follows Under2 yrs. Over 2 yrs. Total Higham Hill Day Nursery 11.8 30.5 42.3 Handsworth Avenue Day Nursery 7.2 35.0 42.2 Both day nurseries are approved for training in the care of children aged 0-5 years and have 60 places. Training.—During 1956 seven nursery students gained certificates awarded by the Royal Society for the Promotion of Health. Their future careers were as follows :—- General nursing training 3 Staff nursery nurses (including 1 who obtained employment with another Authority) 3 Private children's nurse 1 Scarlet Fever and Tonsillitis, Handsworth Avenue Day Nursery.—On the 18th September a child was notified from the Day Nursery to be suffering from scarlet fever and several cases of sore throat followed. As a result all staff and children were swabbed on the 26th September and of fiftysix persons swabbed, seven yielded Haemolytic Streptococci Group A. The subsequent typings were Type 1 (5), Type 3 (1), Type 12 (1). Daily visits were paid each morning by the medical staff until October 16th, and twenty suspects were excluded until bacteriologically cleared. The co-operation of parents was excellent. A child with scarlet fever was released in due course from home isolation and returned to the Day Nursery on the 23rd October after five weeks. In the light of subsequent experience, it is a matter of regret that no typing of the organism was done, nor clearance swabs taken. Between the 28th and 30th November the same child and three others were absent from the Nursery with sore throats. Subsequently of these three children a brother and sister were notified as scarlet fever and later another child. Daily medical visits were again paid and suspects were excluded until the Nursery was cleared early in January, 1957. All parents were circularised by letter on the 30th November and their co-operation again sought in keeping children with 83 suspicious symptoms and signs at home and advising consultation with their family doctor. Selective swabbing was undertaken on the 6th December and of fourteen taken, one member of the staff yielded Group A Haemolytic Streptococci Type (12). The brother and sister with scarlet fever yielded Type (4) and were cleared only in January, 1957. The child who had suffered from scarlet fever in September was also Type (4) and was a persistent carrier until January. Two other children were also Type (4) carriers, but were cleared by the end of the year. In view of the fact that two types (4) and (12) of nephrite genie haemolytic streptococci were met with in these cases, instruc tions were given for urine tests to be carried out and all fortunately gave negative results. In order to give an added safeguard, urine tests will, as far as possible, be done annually. NURSERIES AND CHILD MINDERS (REGULATION) ACT, 1948 There were no registrations under the above Act during 1956. DAILY GUARDIAN SCHEME This Scheme was begun in May, 1951, and Guardians are paid a retaining fee of 1s. 0d. 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 1955 and 1956 are as follows:— 1955 1956 No. of Guardians on Register at end of year 20 19 No. of applications for services of Daily Guardians 40 49 Referred to Day Nurseries 28 34 Referred to Daily Guardian but nothing further heard 3 8 Placed with Daily Guardian 9 7 Continued in care of Daily Guardian from previous year 4 5 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). 84 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 1955 11 261 1956 7 210 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 gynaecological conditions. INCIDENCE OF MONGOLISM An enquiry was made during the year into the number of mongol children born between 1951 and 1955. Ten such children were known, of whom one had died. MIDWIFERY (Section 23) There were 38 practising midwives in the Borough at the end of 1956, 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 1956:— No. of confinements attended as a Midwife 1,235 ,, confinements attended as a Maternity Nurse 353 „ Medical Aid Notices sent 652 „ Twin Births notified 15 „ Stillbirths notified 19 „ Notifications of Artificial Feeding 14 „ „ „ Discharging Eyes — „ Deaths notified 1 The previous table includes the following numbers in regard to work done at Thorpe Coombe Maternity Hospital:— 85 Midwifery cases 1,145 Maternity cases 105 Medical Aid Notices 628 The percentage of Medical Aid Notices were All cases 22.2 Maternity Hospital Midwives 51.0 Other Midwives 7.1 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 For complications during labour:— Ruptured perineum 12 Premature labour 2 Rise in temperature 2 Postpartum haemorrhage 2 Other conditions 1 Total 19 For complications in regard to the infant:— Cyanosis 1 Other conditions 1 Total 2 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 903 602 1,219 68 145 2,481 5,418 Home Nurse/ Midwives 145 — 1,428 22 92 1,026 2,713 Totals 1,048 602 2,647 90 237 3,507 8,131 86 One midwife in private practice undertook 11 cases as maternity nurse. Trilene, and Gas and Air analgesia.—A total of 278 patients on the District received trilene or gas and air analgesia, representing a percentage of 85.0 of district confinements. Emergency Unit.—This Unit, stationed at Thorpe Coombe Maternity Hospital, was called out to one Walthamstow case during 1956. Maternity Outfits.—Outfits are issued for all home ments. 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." Twentyfour pupil midwives passed the examination of the Central Midwives' Board (Part II) during the year. The advantages of assisting in the district training of pupil midwives from Thorpe Coombe is that during this training they work with the home nurses at the District Nurses' Home and after completing their midwifery training may choose to 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 Arrangements were continued 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, hemoglobin, 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. The following additional arrangements existed for the close integration of the Local Authority Health Services with the work of the general practitioner. Midwives attend joint ante-natal sessions with general practitioners, and expectant mothers can be referred to the Local Authority ante-natal clinics for the taking of blood specimens only, or for instruction in relaxation and health education. The health visitors in several cases attend joint baby welfare sessions held by 87 general practitioners and there is a growing contact for special visits. A recent analysis showed that in one month there were 30 contacts between 14 general practitioners and health visitors. In the case of Home Nursing, the nurses work directly under the instructions of the family doctor. In the School Health Service there is a two-way letter of communication between the school medical officers and the family doctors and there is frequent contact in regard to the reference of children to the five specialist clinics in the School Health Service. A copy of the report of the consultant is always sent to the general practitioner. There is also contact in regard to the use of the auxiliary services, e.g., physiotherapy, speech therapy and chiropody and reference by the general practitioner for convalescence and special schooling. General practitioners are kept informed of the incidence of infectious and communicable disease by means of periodic circular letters and the Public Health medical officers are available at any time for domiciliary consultations, and the health visitors for taking specimens. HEALTH VISITING (Section 24) The equivalent of whole-time health visitors at the end of the year was 11.15, including the Superintendent. This was equal to one whole-time district health visitor to 141 notified births. Most of the health visitors also carry out duties as school nurses. Home Visits Children under Five Years of Age. To Children under 1 year of age Children 1 year of age Children 2-5 years of age TOTAL First Subsequent Total 1956 1,381 4,331 5,712 3,201 5,888 14,801 1955 1,309 4,100 5,409 3,521 5,981 14,911 88 Other Visits Ante-Natal Visits Special Visits Unsuccessful Visits TOTAL First Subsequent Total 1956 299 164 463 2,963 2,590 6,016 1955 318 182 500 2,201 2,570 5,271 Liaison with Hospital Services.—Health visitors and school nurses, as well as medical staff, continued to attend ward rounds af Dr. E. Hinden, Paediatrician, Whipps Cross Hospital, who holds a fortnightly session at the Town Hall Clinic. General.—The Superintendent Health Visitor, Mrs. J. Foulkes, S.R.N., S.C.M., H.V.Cert., reports the following:— "During 1956 health visiting followed a similar pattern to that of the previous year. Visits to the aged and to problem families again took up a large part of the time. This is to be expected because of the increase in the number of aged people. "Health education, a very important part of the health visitor's work, demanded a lot of their energies. Mothercraft talks are now being given in all secondary modern schools in the Borough. Relaxation classes are held weekly at three of the ante-natal clinics in the Borough and instruction given in the preparation for the confinement, the mechanism of labour, and the use of gas and air apparatus. Discussions were stimulated on suitable layettes, the importance of well-balanced diets, and fresh air and exercise during pregnancy. "The Health Visiting Staff co-operated in the practical training of the following:— (a) Final year nursing students from The Connaught Hospital spent two days each in the Public Health field for practical training. They spent a half day home visiting, and for the remainder of the time attended at infant welfare clinics and minor ailment clinics. This year the field widened to include medical and hygiene inspections in schools. (b) Two health visitor students from South East Essex Technical College carried out three months of their practical training in the Borough. Again they were allocated to specific health visitors in order to preserve continuity and to correlate their practical and theoretical work. (c) Another two health visitor students were given practical training in the tuberculosis field. 89 (d) During the year, seven student nursery nurses visited infant welfare, ante-natal, minor ailments and other special clinics in order to meet the requirements of their training syllabus. Certain selected home visits were paid by health visitors accompanied by student nursery nurses to permit them to observe breast feeding and artificial feeding in the home. (e) Pupil midwives from Thorpe Coombe Maternity Hospital attended four sessions at infant welfare clinics in accordance with the rules of the Central Midwives Board. (f) The first training course for domestic helps was held at the South West Essex Technical College in July for two weeks. The Superintendent Health Visitor gave lectures on Food Values, Prevention of Infection and Accidents, First Aid in the Home, and also the Care of Infants and Children. Selected domestic helps from Chingford, Leyton and Walthamstow attended the course. (g) A Senior Health Visitor from Jamaica on a National Association for the Prevention of Tuberculosis scholarship spent two weeks in the Borough observing the Health Services. We were pleased to welcome Mrs. deLeon to exchange information. (h) A health visitor from India on a special scholarship visited various clinics. "There were no changes in the Health Visiting Staff this year and we have a full establishment despite the general shortage of health visitors." HOME NURSING (Section 25) Queen's Training.-Two nurses passed their Queen's examination and at the end of the year four more nurses commenced Queen's training, although the examination will not take place until 1957. Theoretical work was carried cut at the Lady Rayleigh Home, Leytonstone, and practical work at " Carisbrooke." General.—The Superintendent of the District Nurses' Home, Miss E. G. Welbrock, S.R.N., S C.M., M.T.D., reports as follows:— "The year 1956 has been a very busy one and our nursing visits again show an increase. "We have been able to supply 49 parcels to needy patients from the Nurses' own funds, mainly Beetle Drives, Jumble Sales and Raffles. "We were again able to take some student nurses in general nursing training to see district nurses at work. 90 "Staff at the 31st December, 1956, 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. 6 Full-time Queen's S.R.N., S.C.M. 1 „ „ S.R.N., S.C.M., H.V. Certificate. 8 „ „ S.R.N., S.C.M. 1 „ „ Queen's S.R.N. 4 „ „ S.R.N. 2 ,, „ Queen's S.R.N. (Male). 1 Part-time S.R.N. 3 „ „ S.E.A.N. 1 „ „ R.F.N. "During the year 26 pupils entered for district midwifery training and all passed. "The following gives details of home visits during the year:— New cases Total visits Medical 709 52,912 Surgical 216 11,028 Tuberculosis 30 2,588 Operations 1 1 Miscarriages 1 10 Out-Patients—Medical 18 87 Out-Patients—Surgical 1 4 Hypodermic Injections 653 17,542 Casuals 87 194 Last Offices 25 66 Total 1,741 84,432 VACCINATION AND IMMUNISATION (Section 26) During 1956 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 against smallpox and poliomyelitis. Most medical practitioners in the town also participated in the 91 County Council's scheme for vaccination and immunisation against diphtheria and whooping cough, a fee of 5/- being payable on the completion of a report. The following were the attendances during the weekly Town Hall Clinic:— Diphtheria Immunisation 207 Whooping Cough Immunisation 218 Vaccination 290 Total 715 Vaccination against Smallpox 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 580 106 43 30 30 71 860 Secondary — — — 6 11 197 214 Total 580 106 43 36 41 268 1,074 The total of 1,074 is a marked improvement on 742 in 1955, but even so the "Vaccination acceptance rate," i.e., the percentage of primary vaccinations under the age of one year completed in 1956 relative to the live births for the year was only 49 per cent. (The rate for England and Wales for 1955 was 36.4.) The attention of the medical and health visiting staff was again drawn to the low acceptance rates and it was pointed out that they have excellent opportunities to convince mothers of the need for vaccination. Instructions were given that at each home visit the position in regard to all protective measures would be specifically stated on the records and pressure was to be continued to secure maximum acceptance rate. Vaccinated by General Practitioners 637 Vaccinated by County Staff 437 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 18. 92 Vaccinal Condition of Hospital Staff By courtesy of the Secretary of the Hospital Management Committee, information is available as to the vaccinal condition of the staffs of the two hospitals in Walthamstow. The percentage vaccinated was as follows :— No. successfully No. vaccinated vaccinated but not within 3 years within 3 years Unvaccinated Hospital "A" 27.6 61.1 11.1 Hospital " B" 25.3 65.3 9.3 DIPHTHERIA IMMUNISATION 1956 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 1,071 Total 1,197 (c) Number already immunised having a reinforcing dose 1,023 Details of the immunisations included in the above total are set out below:— Number completed at Schools 94 „ „ „ Welfare Centres 365 „ „ „ Town Hall Clinic 98 „ „ „ Brookscroft 78 „ „ by General Practitioners 562 Total 1,197 The total for 1955 was 942, but immunisation was suspended during August, September and October on account of the prevalence of poliomyelitis. 235 children included in the above figures were given combined whooping cough/diphtheria injections and 41 children were given whooping cough/tetanus/diphtheria injections by general practitioners. These prophylactics were not supplied by the County Council. There have been only two confirmed cases of diphtheria in the last ten years, the last being in 1950, 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, since the target of immunisation in this group is 75% of babies before reaching the age of one year. The percentage of children immunised in this age group was 53. 93 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 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 - - 1956 737 235 34 36 29 1,071 126 1,197 6 - - Number of children at 31st December, 1956, who had completed a course of immunisation at any time before that date (i.e., at any time since 1st January, 1942):— Under 1 (born 1956) 179 1—4 (born 1955-52) 3,364 5—9 (born 1951-47) 8,151 10—14 (born 1946-42) 7,897 Total immunised under 15 years 19,591 94 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 98 402 69 22 2 593 General Practitioners 67 285 61 13 7 433 Total 165 687 130 35 9 1,026 The total for 1955 was 705 but immunisation was suspended during August, September and October on account of the prevalence of poliomyelitis. In addition general practitioners gave 44 booster injections. The percentage of children immunised during the first year of life was 61.3. Whooping Cough Immunisations in Walthamstow 1942/1955. The following statement shows the number of immunisations carried out in the various years, the Authority responsible being the Borough Council until the Appointed Day under the National Health Service Act, 5th July, 1948, and thereafter the Essex County Council. L.S.A. or L.H.A. M.R.C. G.P.s Total 1947 ...... 47* — — 47 1948 ..... 99* — — 99 1949 526 738 — 1,264 1950 ...... 285 242 68 595 1951 ...... 432 — 62 494 1952 ..... 405 — 115 520 1953 ..... 502 — 252 754 1954 ...... 737 — 302 1,039 1955 ..._ 428 — 277 705 3,461 980 1,076 5,517 * At Day Nurseries only. 95 1942 and subsequent.—Trials were carried out at a wartime day nursery in conjunction with Dr. Maclean of St. Mary's Hospital, who supplied the vaccine. 56 were immunised and there was a limited "follow-up" and as far as is known, none of the children contracted whooping cough. Later, immunisation was extended to other wartime day nurseries as they were opened, but ceased as supplies of vaccine became difficult to obtain. The Medical Research Council Scheme commenced in March, 1949, and ceased in June, 1951. On the 1st April, 1953, the Local Health Authority Scheme was extended to provide whooping cough vaccine for general practitioners, but at least back to 1949 general practitioners were undertaking immunisation against diphtheria and whooping cough with a combined prophylactic and the numbers given reflect only the record cards which were returned by general practitioners. A combined prophylactic is obtained by the general practitioners on Form E.C.10 through the Executive Council. Many such immunisations are probably not included in the table above. The vaccine used in Walthamstow has been "Glaxo suspended." Whenever a case of whooping cough is notified in an immunised child, it has been the practice to complete a follow-up card and these are classified in accordance with the M.R.C. criteria as to the severity of the attack. Statistical Investigation. In April, 1956, Dr. Logan, Chief Medical Statistician to the General Register Office, wrote that he had been making a statistical investigation into the variation in the notification rates for whooping cough in different parts of the country over the period 1944/54. One municipal borough was chosen at random in each administrative county and Walthamstow came within this selection. Information was requested as to the organised programme which had been instituted and in what years. In addition, an estimate was requested of the numbers immunised each year from 1944 to 1954. On the completion of the analysis, it was found unfortunately that the results were inconclusive. The difference in the incidence of whooping cough (as recorded by notifications) between those areas which have had and those which have not had an official local immunisation scheme does not reach the level of statistical significance. This may be partly due to the fact that there is an unknown amount of immunisiation being carried out by general practitioners, especially in those areas where there is no official scheme organised by local authorities. 96 Medical Research Council Trials. In August, 1956, a report on the relation between protection in children and results of laboratory tests was published in the medical press. The report was prepared by the medical officers of the Medical Research Council who were in charge of the organisation of the whooping cough trials. This report was addressed to the Whooping Cough Immunisation Committee of the Medical Research Council and to the Medical Officers of Health of the ten Local Authorities concerned, of which Walthamstow was one. The Walthamstow trials took place between 1948 and 1951 and children were allocated to a vaccine group in succession as their names were received. After the injections had been completed, arrangements were made for each child to be visited monthly for about 24 months. Special visits were paid when it was known that a child was being exposed to pertussis or had symptoms which might be those of the early stages of the disease. Swabs were taken from vaccinated children with coughs and also so far as possible from infective cases to which vaccinated children were exposed. The doctors and nurse-investigators visiting children during the follow-up period did not know which vaccine a child had received. Vaccines tested in Walthamstow were V.l, V.2, V.3, and 979 children completed a course of three injections. Children 6-18 months old were given three doses of vaccine intramuscularly with an interval of one month between injections. The first two doses were each 0.5 ml., the third 1 ml., and the total dose, in terms of the U.S.A. opacity standard, was approximately 70,000 million organisms. Consent forms were received from the parents of 11,093 children in all areas ; 9,794 (88%) of the children completed the course of three injections. The report concludes with the following summary:— In two series of field trials, 14 pertussis vaccines were tested for their protective potency in 28,799 children. The vaccines used in the first series of trials were poor, but those in the second series gave substantial protection, which was maintained for at least two and a half to three years after vaccination. At the same time as the field trials were in progress, laboratory tests were made in which the vaccines were tested for their ability to protect mice against intracerebral pertussis infection. Some of the vaccines were also tested for their ability to produce specific agglutinin in mice and children. A comparison between the field and laboratory results showed good correlation between the potency of vaccines in protecting children and their ability to protect mice against intracerebral infection. There was also evidence of a correlation between protection in 97 dren and ability to produce agglutinin in children. It is concluded that in future only those pertussis vaccines which have been shown, by the intracerebral mouse-protectioin test, to have an adequate potency in relation to the British standard pertussis vaccine should be issued for use in children. VACCINATION AGAINST POLIOMYELITIS The Ministry's scheme was announced in January, 1956, and registrations were invited in March in regard to children born during the years 1947 to 1954. Registrations were 1,685 boys and 1,501 girls, a total of 3,186 representing approximately 25% of children in these age groups. Vaccination began in May and 114 children of pre-school age, i.e. born during 1952/54 were vaccinated and 205 of school age, i.e. born 1947/51 ; a total of 349. In addition 15 children had one dose. AMBULANCE FACILITIES (Section 27) The Ambulance Service is administered centrally from Chelmsford via the Control Centre at Ilford, and (as far as informa' tion is available), it appears to be adequate for the needs of the Borough. The Local Service has continued from the Ambulance Depot, which is situated at the Borough Council's Fulbourne Road Depot. PREVENTION OF ILLNESS —CARE AND AFTER-CARE (Section 28) TUBERCULOSIS Dr. H. Ramsay, Consultant Chest Physician at the Walthamstow Chest Clinic, has contributed the following :— "The work of the clinic during the year has been on similar lines to previous years. There have been no particular developments though the tendency is for the overall amount of work carried out to increase still further. The miniature camera unit continues to be helpful in dealing with the larger number of new cases referred to the clinic and it is now quite an easy procedure for X-ray of the chest to be arranged in any case where the general practitioner desires it. "After the sharp fall in the number of notifications up to 1954 there has been a slight rise over the last two years; this would appear to be no more than a normal variation, but it acts as a warning that maximum effort in the field of tuberculosis control is still necessary. 98 "The following are the figures of main interest. They refer, of course, to the combined attendances of Walthamstow and Chingford patients. Total attendances 17,540 „ new cases 5,547 „ X-rays 13,731 „ screening 2,954 Miniature camera 5,146 New notifications 77 (Walthamstow only) "Slightly more than two-thirds of these totals were Walthamstow cases." Schoolchildren examined:— Boys Girls Examined for the first time 112 138 Referred by School Medical Officer 19 27 Referred by Private Practitioners 66 69 Examined as contacts 27 42 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:— "There have been no major changes in the work of the Association in the course of the year. We have continued to make grants for extra nourishment where this appears desirable; clothing and bedding have been issued where need has arisen; fares to visit patients in hospital have been met as in previous years and many minor grants have been made where investigation has proved that this would be helpful. These small grants include payment of radio licences, cost of shoe repairs, provision of tools to enable a man to return to employment, fees for correspondence courses—either as diversional therapy or in preparation for return to work—small debts, etc. "In co-operation with the Health Department, we have made use of the NAPT-Spero holiday scheme for patients and their families, where necessary taking responsibility for a share of the cost as well as meeting travelling expenses. "Our financial position has been very satisfactory and our activities have not, therefore, been hampered as they were for a time during 1955. The Christmas Seal Sale proved more difficult than usual in view of the many appeals, both local and 99 national, which were placed before the public at the same time as our own ; but in spite of this, the proportion of our income received from voluntary sources has this year exceeded that derived from the County Council's grants and we hope to be able to maintain this position in the future. "During the summer, we were again able to send representatives to the study day organised by the NAPT and found this a useful means of contact with others engaged in similar work elsewhere. "Throughout the year our work has been integrated with that of the Chest Clinic staff and there has been close liaison with those other bodies, both statutory and voluntary, which have an interest in the families with whom we are concerned. The help received from them is gratefully acknowledged. "In work of the kind we undertake, numbers of cases and amounts of money spent are little indication of its scope nor of what we regard as its value, but the following figures may, nevertheless, be of interest." Type of help given. No. of cases Cost £ Milk 4 33 Grocery 37 675 Fuel 47 80 Fares 13 87 Clothing, furniture, bedding 39 111 Holidays 4 37 Occupational therapy 5 4 Miscellaneous grants 109 179 B.C.G. Vaccination of Schoolchildren Vaccination of schoolchildren in the year preceding their four' teenth birthday continued. The scheme was fully described in the report of the School Medical Officer for 1954. During 1956 acceptances were received from 1,268 children out of 1,591 who were eligible, i.e., 79.7%. Details are as follows:— Heaf positive 176 Heaf negative 1,064 Absent from test 28 Vaccinated: 1,053; absent or not done, 11. Contact Examinations. First examinations of contacts in 1956 were 147 examinations to 77 total notifications. In 1955 there were 256 examinations to 73 100 notifications (and not as stated in last year's report), i.e., 3.5 examinations per case. Rehabilitation of Tuberculous Patients. Financial responsibility was accepted for the rehabilitation of one case at the British Legion Village commencing on 2nd July, 1956. 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. Dr. Ramsay again drew the attention of family doctors to the facilities of the Odelca Miniature X-ray apparatus at the Chest Clinic and suggested that every case where there was the slightest suspicion of a chest condition should be referred for examination, especially in the middle-aged and the elderly with persistent chest symptoms. In 1955/56 approximately one-quarter of the cases of tuberculosis were found through the Miniature Radiography Unit. CONVALESCENCE FOR ADULTS The total of cases sent away for recuperative convalescence was 71. 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 bedpans, thermometers and feeding cups, etc. Special items of equipment are provided when necessary. CHIROPODY SERVICES Mr. R. King, Chief Chiropodist, reports as follows:— "The year 1956 has again been very busy as is shown by the increase in numbers seeking treatment. "The waiting period between treatments for adults is three months, which in many cases is too long, and the number of treatments per person for the year has gone down from 3.2 in 1955 to three treatments in 1956. The number of appointments booked at 31st December, 1956, was 4,276; an increase of 297. "The number of treatments given amounted to 19,614 given to 6,164 patients; the adult proportion of these was 17,023 treatments given to 5,495 patients. This was made up 101 as follows—13,636 women and 3,387 men ; of these 1,117 were new patients. "Transport for the non-ambulant has again be provided and fulfils a very necessary part of the Chiropody Service. Through this means 236 treatments were given, 195 to women and 41 to men, being a decrease of nine treatments from 1955." PREVENTION OF BREAK-UP OF FAMILIES As a result of the various circulars on this matter issued by the Home Office and the Ministries of Health and Education, a conference was convened in November, 1956, at which the follow' ing departments, services and organisations were represented:— The County Council's Children's, Health and Welfare Departments. The Borough Council's Education and Housing Depart' ments. The Local Medical Committee. The Probation Department. National Assistance Board. The Invalid Children's Aid Association. National Society for Prevention of Cruelty to Children. The Glasspool Trust. A lengthy discussion took place concerning 15 cases which appeared the most urgent for consideration, and an exchange of information as to the action already taken and contemplated. It emerged that in the majority of the cases the general situation was appreciated and that the officers having statutory duties were taking active steps to improve the position and to prevent any break-up of the families. The chief factors emerging were illegitimacy and delinquency. HEALTH EDUCATION Throughout the year the Health Visiting Staff have carried out a regular series of talks at schools and welfare centres. Weekly mothercraft talks were given during each term in all secondary modern schools in the Borough. Films and demonstration materials were used in conjunction with the lectures. Relaxation classes were held weekly at three ante-natal clinics, and instruction given in the preparation for motherhood, ante-natal care, the mechanism of labour and child development, etc. Visual aids again proved useful. Efforts have again been made to provide interesting and useful health education topics for display at the welfare centres. 102 Prevention of Accidents in the Home. Between the 5th and 10th November a Home Safety Week was held in Greater London. In Walthamstow an article on home accidents was prepared for publication in the local Press, talks were given by health visitors at old people's clubs and leaflets were distributed. Because of the general demand for visual aids during Home Safety Week, it was impossible to obtain suitable films, but these were obtained later and shown to six old people's clubs during December. DOMESTIC HELP SERVICE (Section 29) Owing to the sickness of the Area Domestic Help Organiser from the end of May until mid'October, arrangements were made through the courtesy of the County Medical Officer of Health for the County Domestic Help Organiser, Miss G. Jenkins, to take over supervision of the Domestic Help Service in Walthamstow for about 10 weeks. This proved very helpful in ensuring the smooth running of the Service, due particularly to the fact that Miss Jenkins was able to use her car for the purpose of visiting patients and helps, and gave the benefit of her experience in this work. During the remainder of Mrs. Hall's absence her duties were undertaken in an efficient manner by the Domestic Help Service Clerk, Mrs. M. Smitten, who was provided with part-time temporary clerical assistance. Mrs. C. M. Hall, Domestic Help Organiser, reports as follows with regard to the year under review:— "The number of applications for domestic help in the area during 1956 showed an increase on previous years and the provision of assistance to all categories of sick people continued unabated. The service continues to be administered as in previous years and the number of visits carried out was 1,832. "For various reasons the number of full-time helps decreased from twelve to eight and the present practice is to engage more regular part-time helps rather than take on more full-time: during the year an average of 217 part-time helps were working each week. During the summer months recruiting was good which made the general situation easier, but the latter months of the year saw the usual increase in demand, but up to the end of the year all requests were met. "The number of cases carried forward into the New Year shows that the need for domestic help is greater than ever and 103 that this service is essential to the welfare of the sick and aged. "Below is a summary of the year's work:— Brought forward from 1955 708 New cases during 1956 402 Cases completed during 1956 397 Number of cases carried forward to 1957 713 "The number of aged chronic sick still increases and continues to absorb a large proportion of the help available. The number of applications from tuberculous patients decreased slightly over the year and all requests for help were met : maternity applications were satisfactorily dealt with. "It will be seen from the foregoing figures that the need for domestic help is still increasing, but that much has been done during the year to ease the conditions and anxieties particularly of the aged and infirm." Recruitment. In view of the continuing need for an adequate "panel" of domestic helps, some 5,000 copies of a special appeal were circulated by duplicated letter to practically every tenant of a Council dwelling. This was done with the willing co-operation of the Borough Council's Housing Manager. The appeal was in regard both to the Domestic Help Service and the scheme for Night Attendance upon the Sick, but the result was very disappointing. Training. The Local Nursing Division of the St. John Ambulance Brigade again made available without fee to Domestic Helps their course of lectures on home nursing. Five Domestic Helps completed the course and three obtained certificates. In July a programme of training for domestic helps was held at the South West Essex Technical College, the first course to be held in Walthamstow. This was organised by the County Health Department in conjunction with the Technical College, and the local Superintendents of Health Visiting and Home Nursing assisted in the instruction of home duties. Four helps from this area attended and obtained a certificate. 104 DOMESTIC HELP SERVICE, 1956 Maternity Acute Sick Tuberculous Chronic Sick Aged Others Aged not Sick Others Total Requests for help from new cases during the year 85 55 13 271 42 8 6 480 Total cases helped during the year 67 45 21 806 117 50 4 1,110 Oases being helped at end of year who have received help for: Under 3 mths. 4 4 2 32 3 2 1 48 3—6 1 — 1 31 .—. 1 34 6—12 — — 8 73 10 — 1 92 Over 12 „ — — 4 455 52 28 — 539 Total carried forward to 1957 5 4 15 591 65 31 2 713 Hours of help provided during the year 4,330¾ 1,899½ 3,282¾ 142,174½ 22,833 7,275¾ 226½ 182,022¾ 105 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 1956:— (1) Residential and Temporary Accommodation. (a) Admitted to hostels and other residential establishments: Men, 14; Women 25. (b) Admitted to temporary accommodation : Men, 2; Women, 10 ; Children, 20. (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, 1956, were as follows:— (i) Registered as blind 255 (ii) Partially sighted 57 (iii) Defective sighted 18 all of whom were under the supervision of the County Council's home teachers. During the year eight blind residents participated in the Home Workers' Scheme operated through the agency of the Royal Society for the Blind, and one blind resident was employed in a workshop for the blind. In addition, there were twenty-nine blind and eighteen partially sighted residents employed in open industry. (3) Deaf or Dumb and other Handicapped Classes. "During the year in question the Welfare Committee continued to develop its activities in respect of welfare services for handicapped persons (other than Blind as mentioned above) as provided for under Section 29 of the National Assistance Act, 1948, with the support of voluntary organisations acting as the Council's agents in this connection."