411(1) WALTHAMSTON AK5/9/58 WAL 45 BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1957 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 REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1957 INDEX page Section A.—Statistics and Social Conditions of the Area 10 Section B.—General Provision of Health Services in the Area 17 Section C.—Sanitary Circumstances of the Area 21 Section D.—Housing 28 Section E.—Inspection and Supervision of Food 36 Section F.—Prevalence and Control over Infectious Diseases 46 Section G.—Miscellaneous 60 Section H.—National Health Service Act, 1946—Part III Services 64 Health Centres 65 Care of Mothers and Young Children 67 Midwifery 82 Health Visiting 83 Home Nursing 86 Vaccination and Immunisation 88 Ambulance Facilities 94 Prevention of Illness, Care and After-Care 94 Domestic Help 99 page Accidents in the Home 13 Acreage 10 Adulteration 40 Aged and chronic sick 20, 60 Ambulance Facilities 18, 94 Ante-Natal Clinics 67,69,73 Ante-Natal Care 68 Assessments 10 Bateriological Examination 38, 42 B.C.G. Vaccination 93, 94 Biological Tests 37 Birth Notifications 70 Birth Registrations 16 Births, Illegitimate 10 Birth Rate 10 Blind persons 102 " Brookscroft" Welfare 74 Cancer deaths 12,13 Cancer Education 62 Care and After-Care 94 Care of Illegitimate Children 72 Child Guidance 77 Child Welfare Clinics 73, 74, 75 Chiropody 60,97, 98 Clean Air Act, 1956 24 Cleansing (Personal) 18, 81 Clearance Areas 31 Committees 6,64,65 Comparability Factor 11 Confinements 68, 69 Contact Examinations 97 Convalescence for Adults 97 Convalescence for Pre-School Children 78 Conveniences, Public 63 Cooked Meats 40 Co-operation with General Practitioners 83, 87 Cremation 63 page Daily Guardians 81 Daily Guardian Scheme81 Day Nurseries 80 Deafness, Prevention of 99 Deaths 10, 11 Deaths from Accidents in the Home 13 Deaths, Infants 10, 71 Death Rate 10 Deaths, Causes of 12,71 Dental Laboratory 66 Dental Treatment 75, 76, 77 Diphtheria 48 Diphtheria Immunisation 88, 91 Diseases of Animals Acts 43 Disinfections 22, 62 Dtsinfestation 25 District Midwifery 82 Domestic Help 99, 100, 101 Domiciliary Chiropody 60 Dysentery 48 Employment 10 Emergency Unit 83 Essex County Council Act, 1933 21 Factories Acts, 1937/48 45 Family Doctors, tion with 83, 87 Food and Drugs Act, 1955 40 Food Hygiene Regulations 1955 42 Flooding 63 Food Inspection 36 Food Poisoning 43, 50, 51 Foot Clinic 97, 98 Funeral Arrangements 62 Gas and Air Analgesia 83 General Dental Service 65, 66 pack General Information 63 Geriatric Services 19 Hairdressers and Barbers 26 Handicapped Persons 102 Health Centres 65 Health Education 62,99 Health Visiting 61, 83, 84, 85 Home Nursing 86 Home Safety 62 Home Visits 84 Hospital Accommodation 19 Housing Act, 1936 28, 31 Housing, Closure and Demolition 3 1 Housing, General 32 Housing, Improvement Grants 28 Housing, Inspection 29 „ Need 35 „ Old People 36,60 „ Priority for Tuberculosis 34 Housing Repairs and Rents Act, 1954 26 Housing Statistics 28 Ice Cream 38 Illegitimacy 72 Immunisation, Diphtheria 88, 91 „ Whooping Cough 88,92 Infant Mortality 11, 14, 15,70,71 Infectious Diseases General 19, 46 Infestation 81 Influenza 54, 55 Inquests 63 Integration of Health Services 17 Invalid Children's Aid Association 77 Laboratory Facilities 17, 18 Land Charges 28 Laundry Service for the Incontinent 62 Liaison with Hospital Services 84 Lollies 38 Mass Radiography 57 Maternal Mortality 14, 16,81 Maternity Homes 20 Maternity Outfits 83 Meals on Wheels Service 61 Measles 11,47,48 Meat and other Foods 39 Medical Aid 82 Medical Examinations 62 Medicaments 78, 79 Midwifery 82, 83 Milk Designated 37 Milk Inspection 36 page Milk Special Designations Order, 1951 37 Milk Supply 36 Moral Welfare 72 National Assistance Act, 1948, Sec. 47 20 National Assistance (Amendment) Act, 1951 20 Neo-Natal Mortality 14, 16. 70 Notices, Sanitary 21 Notification of Births 70 Nursery Nursing Certificate 80 Nurseries and Child Minders (Reg.) Acts, 1948 81 Nursing Homes 20 Nutrients 78, 79 Old People's Welfare 60,61 Ophthalmic Treatment 77 Orthopaedic Treatment 75 Outworkers 46 Pediatric Clinic 77 Pet Animals Act, 1951 43 Poliomyelitis 49, 50, 92, 93 Population 10 Post-Mortems 63 Post-Natal Clinics 67, 73 Premature Infants 72 Prevention of Damage by Pests Act, 1949 43, 44 Prevention of Illness 94 Prevention of Tuberculosis 59 Public Health Act, 1936 20 Public Health (Infectious Diseases) Regulations 52 Public Health Inspection 21 Pupil Midwives 83 Queen's Institute of District Nursing—Training 86, 87, 88 Rainfall 63 Rateable Value 10 Redevelopment and Clearance Areas 31 Rehabilitation 97 Rehousing on Medical Grounds 34 Relaxation Classes (Ante- Natal) 69, 73 Rent Act, 1957 26, 27 Research 82 Rodent Control 43, 44 Scabies Treatment 18 School Outbreaks 48 Sickness Benefit 59 Sickroom Equipment 97 Smallpox 52, 88, 89, 90 Smoke Abatement 24 Social Conditions 10 page Special Premises 22 Staff 17,65 Statistics 10, 28, 69 Stillbirths 10, 14, 16 Sunlight Treatment 75 Swimming Baths 25 Toddlers' Clinic 69 Total Infant Mortality 15 Tonsils and Adenoids 77 Training of Nursery Nurses 80 Training of Pupil Midwives 83 Tuberculosis 55,56,57,58,94,97 Vaccination, B.C.G. 93 „ Poliomyelitis 92,93 „ Smallpox 88, 89, 90 page Verminous Premises 25 Vital Statistics 10,69 Walchamstow Association of Tuberculosis Care Helpers 95, 96 Walthamstow Child Welfare Society 74 Water 21 Welfare Services 100 Welfare Foods 79, 80 Whooping Cough 48 Whooping Cough Immuni sation 88,92 Women's Clinic 81 HEALTH COMMITTEE 1957-8 Chairman : Councillor Mrs. W. M. Palethorpe. Vice-Chairman: Councillor J. E. Nicholls. Ex-ficio : The Worshipful The Mayor — Councillor J. W. Pringle, J.P. The Deputy Mayor—Alderman G. R. Lowton, J.P. Chairman of Finance Committee—Alderman Ross Wyld, O.B.E., J.P. Alderman Mrs. L. P. Bailey, J.P. „ The Lady McEntee, O.B.E., J.P., „ G. S. Mace. E. C. Redhead, J.P., M.P. Councillors: Councillors: Mrs. E. L. Baldwin. O. F. J. McCarth. J. J. Bracken. Mrs. C. E. Stannard. Mrs. G. F. G. Cowell. D. Weinstein. F. H. Eiles. A. F. Whicher. J. H. Hammond. 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.H., M.A.P.H.I, Deputy Chief Public Health Inspector : H. L. Hughes, M.A.P.H.I. TO THE CHAIRMAN AND MEMBERS OF THE HEALTH COMMITTEE My Lady, Ladies and Gentlemen, I beg to present herewith a report on the health and Health Services of the Borough during 1957, and again by courtesy of the County Medical Officer, I give details of the Health Services administered by the Walthamstow Health Area Sub'Committee of the County Health Committee. The vital statistics for 1957 were, unfortunately, not good. With a population smaller by 1,400, there were 129 more deaths, increasing the death rate from 10.2 in 1956 to 11.4 in 1957. Infant mortality rose from 18.7 to 24.1. In January three cases of Flexner dysentery occurred at one of the oldest schools of our schools and one with about the worst sanitary accommodation. Flexner dysentery can be a very much more serious disease than its milder counterpart Sonne, but fortunately there was no further spread. In February a sharp outbreak of ringworm of the scalp and skin occurred at one of the schools and attached residential institution. Fortunately this outbreak was also soon contained. At the beginning of July a case of hemorrhagic smallpox was notified and later was certified to have died of it. The staff of the Department was fully extended in combating this serious threat. Before the "All Clear" was given considerable outbreaks of both food poisoning and epidemic vomiting and nausea were reported at a group of schools, and considerable work and anxiety resulted before the situation was brought under control. In October influenza reached its peak amongst all age groups, and at the end of the year, and within seven weeks of each other, occurred the deaths from an acute infection of the upper respiratory tract of two young children attending the same class at school. Over most of the year cases of poliomyelitis occurred, including one fatal case, and from time to time there were sporadic and small outbreaks of food poisoning, all of which required immediate investigation and action. The problems of the aged requiring domiciliary services or admission to hospital or institution caused considerable anxiety, because in almost every case of difficulty, the help of the Health Department was sought by relatives, family doctors, or other agencies. There appears to be a long waiting list for welfare accommodation and accommodation for the aged sick is frequently at a premium. The establishment of Public Health Inspectors was, fortunately, maintained during the year and there was recruitment of two Student Public Health Inspectors, who had to undertake to remain in the Council's service for a minimum period of two years after qualification. With regard to the Clean Air Act, 1956, a conference of Local Authorities took place at Leyton. Two lead peroxide instruments were installed for the measurement of atmospheric pollution. The average reading over the whole year for Walthamstow was 1.80, which is below the National average of 1.83, itself a very low figure when compared with recorded readings of 6.8 elsewhere. Hairdressers and barbers became registerable as from the 1st January. Bye-laws were prepared and awaited confirmation at the end of the year. The operation of the Rent Act, 1957, entailed considerable additional work, no less than 323 certificates being applied for between the 6th July and the end of the year. Of these only 34, or say 10% required the issue of a Certificate of Disrepair. The remainder were met by agreement between the landlord and tenant with some stimulation on the part of the Health Inspectors. During the year inspection of all the dwellings in the five-year programme of unfit houses was completed. Before formal Representation, as many of these properties as possible are being acquired by agreement. The impressive progress in the provision of new housing accommodation is shown in the reports of the Borough Architect, Engineer and Surveyor and of the Housing Manager. Miss E. G. Welbrock, Superintendent of the District Nurses' Home and Non-Medical Supervisor of Midwives, retired on 2nd October, 1957, after employment in this capacity since 21st May, 1951. Previously Miss Welbrock had been employed at the Nurses' Home by the Walthamstow District Nursing Association from January, 1935, to February, 1939, as Maternity Home Sister and Assistant Superintendent, and as Assistant Superintendent from April, 1940, to September, 1948. In all Miss Welbrock held senior nursing posts in Walthamstow for 16 years and has rendered fine service to the community. With regard to the services administered by the Health Area Sub-Committee, the work done in the General Dental Service and the Dental Laboratory showed an increase, and it became possible to book new patients towards the end of the year. Arising out of Ministry of Health Circular 9/56 in regard to ante-natal care, local consultations were convened by the Chairman of the Hospital Management Committee and the whole question of co-operation was reviewed. An "ante-natal co-operation card" was brought into use as a result of the consultations. Vaccination against smallpox received a sharp stimulus follow' ing a case of notified smallpox. The need for adequate protection against smallpox should constantly be borne in mind in view of the repeated importation from abroad of virulent smallpox. Progress in regard to immunisation against diphtheria was maintained but still falls short of the target of 75% of infants to be immunised before reaching the age of one year. Parental demand is rather greater during the first year of life for immunisation against whooping cough, the percentages being 63 against 55 for diphtheria. Good progress was made with vaccination against poliomyelitis and 2,413 cases were completed during 1957. More could have been achieved if supplies of vaccine had been adequate. "B.C.G." vaccination continued and 1,026 school leavers were protected. The follow-up scheme of the B.C.G. trials under the Medical Research Council continued. For the third year in succession, there was an increase in the number of new cases of tuberculosis notified, and Dr. Ramsay draws attention to the increased work of the Chest Clinic which results from reduced mortality as a result of modern treatment and the attention now given to chest diseases generally. In fact the number of cases of lung cancer discovered at the Chest Clinic was more than half the new cases of tuberculosis. At the chiropody clinics there were 4,078 male attendances as compared with 14,670 female attendances, largely the result of unsuitable footwear used by females, especially during adolescent and young adult life. The health visiting, home nursing and domestic help services are reported upon by the sectional heads and all continued to alleviate the suffering and hardship of the elderly sick and to postpone the time when institutional admission becomes a necessity. Once again 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. 10 A.—STATISTICS & SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1957) 1 15,300 Number of Assessments (31st December, 1957) 38,842 Rateable Value (31st December, 1957) £1,574,994 Estimated Product of a penny rate £6,255 Population.—The Registrar-General's Estimate of the home population at mid-year, 1957, is 115,300 a decrease of 1,400 on the previous year. The peak population for Walthamstow, i.e., 135,600 was reached in 1933, then there was a steady decrease to 130,000 in 1939. During the War of 1939/45 the population fluctuated between 109,400 and 94,170, and then in 1946 recovered with demobilisation to 118,050, reaching a peak post-War population of 123,500 in 1949. Since then there has been a steady decline each year largely accounted for by outward transfers, especially to the New Towns, since no fewer than 1,162 families were so rehoused by the Housing Department alone between 1950/57. Employment.—According to information kindly supplied by Mr. Percy C. Graham, Manager of the local Employment Exchange, approximately 350 men and 170 women were placed in employ ment every month during the year 1957 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 83,000. Of this number it is estimated that about 38,000 were employed in Walthamstow. During 1957, the average number of persons unemployed in the whole area was 730 men and 200 women, including 115 disabled men and 15 disabled women. Extracts from Vital Statistics.—The Registrar-General's midyear 1957 estimate of the home population (viz., 115,300) has been used for the calculation of all vital statistics. Total Males Female Live Legitimate 1,267 630 637 Birth rate per Births Illegitimate 58 27 31 1,000 of the Totals,1,325 657 668 estimated home population 11.4 Stillbirths 36 Rate per 1,000 (live and still) births 26.4 Deaths 1,324 Death rate per 1,000 of the estimated home population 11.4 11 Deaths from puerperal causes:— Puerperal Sepsis Deaths Nil Other Puerperal Causes Nil Death rate of infants under one year of age:— All infants per 1,000 live births 24.1 Legitimate infants per 1,000 legitimate live births 23.6 Illegitimate infants per 1,000 illegitimate live births 34.4 Deaths from measles (all ages) Nil Deaths from whooping cough (all ages) Nil Deaths from diarrhoea (under two years of age) Nil Pulmonary tuberculosis death rate 0.10 Non-Pulmonary tuberculosis death rate 0.008 The natural increase of population, i.e., excess of births over deaths was one. Deaths.—The Registrar-General's classification of causes of death by sex totals is given. The total number of deaths in 1957 (1,324) compares with 1,195 in 1956, the respective death rates being 11.4 and 10.2 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 1.07 The above factors, when applied to the crude rates, produce the following adjusted rates :— Live births 11.4 Deaths 12.1 12 Causes of Death as given by the Registrar-General for the Year 1957 Whole District Causes of Death Males Females Total 1956 1. Tuberculosis, Respiratory 10 2 12 5 2. Tuberculosis, other — 1 1 3 3. Syphilitic Disease 6 1 7 5 4. Diphtheria — — — — 5. Whooping Cough — - — — 6. Meningococcal Infections — — — — 7. Acute Poliomyelitis — 1 1 — 8. Measles — — — — 9. Other Infective and Parasitic Diseases 1 2 3 1 10. Malignant neoplasm, stomach 32 17 49 31 11. Malignant neoplasm, Lung, bronchus 64 12 76 63 12. Malignant neoplasm, breast — 37 37 32 13. Malignant neoplasm, uterus 1 11 11 6 14. Other malignant and lymphatic neoplasms 76 53 129 125 15. Leukaemia, aleukaemia 5 1 6 7 16. Diabetes 2 9 11 11 17. Vascular lesions of nervous system 65 93 158 144 18. Coronary disease, angina 105 75 180 182 19. Hypertension with heart disease 6 10 16 15 20. Other iheart disease 77 100 177 167 21. Other circulatory disease 21 26 47 53 22. Influenza 11 10 21 9 23. Pneumonia 47 52 99 70 24. Brondhitis 53 22 75 86 25. Other diseases of respiratory system 7 4 11 11 26. Ulcer of stomaoh and duodenum 9 6 16 20 27. Gastritis, enteritis and diarrhoea 2 2 4 4 28. Nephritis and nephrosis 6 3 9 9 29. Hyperplasia of prostate 10 — 10 6 30. Pregnancy, childbirth, abortion - - - 1 31. Congenital malformations 6 8 14 6 32. Other defined and ill-defined diseases 49 52 108 93 33. Motor vehicle accidents 8 3 11 7 34. All other accidents 6 9 15 12 35. Suicide 6 12 18 11 36. Homicide and operations of war - - - - Totals, 1957 690 634 1,324 Totals, 1956 614 581 — 1,195 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 15 99 192 13 CANCER DEATHS The following table shows deaths from Cancer (including Leukaemia and Aleukaemia) and death rates in England fe? Wales and Walthamstow during the years 1943 and 1957. The table has been prepared with the assistance of the Registrar General's office. Year Total Eng.& Wales Deaths Walthamstow Rate per 1,000 Eng. &Wales population 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 1957 94,007 308 2.0 2.6 DEATHS FROM ACCIDENTS IN THE HOME Six deaths occurred in 1957 from this cause. Five died in hospital and one at home. The ages and sexes were:— Female 2, Male 43 and 53, Female 70, Male 86, Female 89. The child died by drowning in a garden water tank and four deaths followed from fractures, all of which occurred in the home. The remaining death was caused by a fall from a ladder. In order to put these and other deaths in proper perspective, the following comparison is made:— Cause of Death 1954 1955 1956 1957 (a) Suicide 15 4 11 18 (b) Motor Vehicle Accidents 9 5 7 11 (c) All other accidents 14 14 12 15 (d) Accidents in the home (included in line (c)) 7 10 6 6 (e) Tuberculosis 11 17 8 13 (f) Poliomyelitis Nil Nil Nil 1 14 INFANT DEATHS, NEO NATAL MORTALITY AND STILLBIRTHS Year. Live Births. Live Birth Rate per 1,000 Population. No. Stillbirths. Neo-Natal Deaths. Infant Deaths. Per 1,000 total (live and still) births. Per 1,000 population. No. Per 1,000 live births. No. Per 1,000 live births. 1957 1,325 11.4 36 26.4 0.31 22 16.6 32 24.1 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 The average mean annual infant mortality rate for the quinquennium 1931/35 was 49, for the quinquennium 1946/50 it was 27, and for the quinquennium 1951/55 it was 23.6. The table showing the classification of infant deaths is given in the section of the report dealing with the care of mothers and young children (Section 22). MATERNAL MORTALITY During 1957 no death was classified as being due to pregnancy, childbearing or associated therewith. The maternal mortality rates (per 1,000 total births) for the past five years have been given as follows :— Year. Total Births Registered. Deaths. Total. Rates per 1,000 Births. (Live and Still) Puerperal Sepsis. Other Puerperal Causes. Puerperal Sepsis. Other Puerperal Causes. Total. 1957 1,361 - - - - - - 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 15 TOTAL INFANT MORTALITY This is defined as the sum of the deaths that occur during child-birth and during the first year of life. The attached graph shows the position since 1930 16 If the infant mortality rate for the quinquennium 1931/35, i.e., 49, 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 and neo-natal death rates for the past five years:— Rate (per 1,000 live births) 1957 1956 1955 1954 1953 Maternal Mortality Nil 0.72 0.76 0.67 1.37 Stillbirths 27.1 18.0 18.3 14.2 26.1 Neo-Natal Mortality 16.6 12.9 17.5 16.9 18.6 REGISTRATION OF BIRTHS The Registrar-General's returns show the following registrations during the calendar year:— Live Births. Males Females Totals Legitimate 630 637 1,267 Illegitimate 27 31 58 Totals 657 668 1,325 The stillbirth rate for 1,000 population was 0.31. Of the 1,668 local registrations, 650 belonging to other areas are excluded, leaving a net total of 1,018. There were no nonnotified births during 1957. 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 56 52 49 53 104 102 56 73 117 125 124 107 506 512 Grand Totals 108 102 206 129 242 231 1,018 17 B.—GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. 1. Public Health Officers of the Authority The names and qualifications of the Senior Public Health officers employed by the Authority are given at the beginning of the Report. The following changes in the officers employed by the Authority took place during the year Appointments : Mr. D. Cross District Public Health Inspector 1.1.1957 Mr. E. Wilkins do. do. do. 1.4.1957 Mr. G. Bethell Student Public Health Inspector 19.8.1957 Mr. G. Littlechild do. do. do. 19.8.1957 Resignations : Mr. S. Muggeridge District Public Health Inspector 31.1.1957 Mr. G. Littlechild Student Public Health Inspector 22.11.1957 Mr. G. Bethell do. do. do. 31.12.1957 2. Integration of Health Services. The arrangements detailed in the Report for 1954 continued. Circular letters were addressed to General Practitioners on twentyfive occasions and referring to the following matters :— Poliomyelitis and vaccination. Influenza and Vaccination. Dysentery (Flexner and Sonne). Food Poisoning. Child Guidance. Prescriptions for Diabetic Persons. Verrucas. Diphtheria and Whooping Cough „. Immunisation. Ringworm. Priority Dental Treatment. Pathological Specimens. Infective Hepatitis. Streptococcal Infection. Smallpox. Laryngotracheobronchitis. 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 :— 18 Specimens Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct.. Nov. Dec. Total Rhesus, Group and Kahn 10 3 2 6 - 2 1 2 3 1 - - 30 Haemoglobin - - - - - - - - 1 2 - - 3 Nose and throat swabs 13 11 7 9 - 24 16 - - - - - 80 Faeces 1 - - - - - - - - - - - 1 Urine — — — — - 1 1 — — — — — 2 Totals 24 14 9 15 — 27 18 2 4 3 — - 116 Frequent meetings took place with Dr. Marsh to consider and discuss the various epidemiological problems which arose during the year. 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 ot specimens examined at the Colindale laboratories during the year were as follows:— Specimen Jan, Feb. Mar. Apr May June July Aug Sept. Oct. Nov. Dec. Total Faeces and rectal swabs 38 37 32 15 14 22 82 64 25 28 35 16 408 Nose and throat swabs 38 9 17 20 15 10 3 2 10 2 83 416* 625 Urine — — 1 — 1 — — — — — 1 3 Food — — 1 — 2 3 4 2 3 — 6 1 22 Mis' cellaneous 1 1 2 — 2 3 3 — 2 — 3 — 17 Totals 77 47 53 35 34 38 92 68 40 30 127 434 1075 *The large number of nose and throat swabs taken during November and especially during December were in respect of the deaths of two children attending Copper Mill School. 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 twenty-three cases were referred there during 1957 receiving twenty-nine treatments at a total cost of £11 12s. 6d. 19 6. Hospital Accommodation. (a) Acute Cases.—There were no major changes in 1957 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. The following table shows the position in regard to hospital and hostel admissions considered and/or supported on "social" grounds. No. of cases outstanding at end of 1956 1) No. of new cases considered during 1957 41 f 42 No. of admissions to hospital or Part III accommodation 241 No. of cases who died before admission 4 No. of patients who refused hospital or hostel admission 3 41 No. of cases cancelled or deferred 6 No. of cases waiting Part III accommodation 4 No. of cases outstanding at end of 1957 1 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 1957 Walthamstow admissions were only 50 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 helpful discharge reports. (e) Geriatric Services and the Chronic Sick.—In June a meeting was convened by the Leytonstone Hospital Group and was held at Langthorne Hospital. The meeting was attended by members and officers of all the local health, welfare and sanitary authorities in the area served by the hospital, of the local Medical Committees of Essex, East and West Ham, of the National Assistance Board, and of the various voluntary organisations and the Hospital Management Committee. 20 The Chairman explained the concern of the Hospital Management Committee with the apparent overlapping of the services provided by voluntary and official organisations and the desirability of establishing closer liaison. Attention was drawn to the need for more hostels with sufficient ground floor accommodation, for increased laundry services for the aged and for home visiting. The meeting agreed that there was need for co-ordination and that a Co-ordinating Committee be set up to consider the matter and to make recommendations. 7. Aged and Chronic Sick. National Assistance Act, 1948 (Section 47) One case was brought forward from 1956 and 4 cases required consideration during 1957 in regard to possible action under this Section. The 1956 case was admitted to hospital towards the end of 1957, but discharged early in 1958. Consideration of cases 2 and 3 was deferred. Case 4 was admitted to hospital and died in July. In case 5, the patient was sent to hospital after a fall, but was not admitted. Admission became necessary within a few hours, and the patient died three days later. Authority for application to the Court was obtained in one case, but was not exercised, since the patient entered hospital voluntarily. National Assistance (Amendment) Act, 1951 The Medical Officer of Health is authorised by the Council to make application for the necessary orders in cases to which the Act applies. 8. Public Health Act, 1936—Nursing Homes No. of Homes. No. of Patients provided for. Maternity Patients. Others. Totals. Homes first registered during the year - - - - Homes on register at the end of the year 1 4 - 4 There were no refusals or appeals. 21 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 1957. During the year the medical staff paid 12 visits to the establishments registered for massage and special treatment. C—SANITARY CIRCUMSTANCES OF THE AREA Water.—The authority responsible is the Metropolitan Water Board. Routine tests are carried out by the Board, and the usual practice was continued of notifying the Board of all actual or suspected cases of enteric fever. The Board then arranged special tests at the addresses concerned. All were negative in 1957. All dwelling houses in the area are supplied direct with piped water. Mr. W. Richards, Chief Public Health Inspector, contributes the following :—- Staff. Mr. S. E. Muggeridge, District Public Health Inspector, resigned early in the year and Mr. E, J. Wilkins, Public Health Inspector, Luton, was appointed in his place. Mr. B. Goode, Pupil Public Health Inspector with the Council qualified in July, and was appointed Public Health Inspector in August. Two Pupil Public Health Inspectors were appointed during the year, both resigned in December without qualifying. Two new pupils are being appointed early next year. 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. 6,463 3,613 1,426 814 846* 149 183* 17,056 *Includes notices outstanding from previous year. 22 Of the 814 intimation notices served, 285 were in respect of business premises and the remainder (529) related to defects in private houses. Of the latter figure, 380 were complied with without resort to statutory procedure. It was found necessary to institute legal proceedings against owners for non-compliance with 15 Abatement Notices. Nine Orders were made by the Justices with costs amounting to £20 5s. Od. and fines of £15 10s. Od. and in one case penalties of £57 and £2 2s. Od. costs were given. In four instances the summonses were withdrawn, and one summons was adjourned sine die. The following shows the nature of work executed and improvements effected during the year:— Drains tested, 374; Drains reconstructed or repaired, 213 ; Drains, obstructions removed, 113 ; Drains, means of access provided, 19 ; Drains, ventilation provided or improved, 22; Soil pipes repaired or renewed, 42; Rain Water Pipes repaired or renewed, 63; Roofs repaired or renewed, 254; Gutterings repaired or renewed, 172; W.C. Pans and traps provided, 167 ; W.C.s repaired or cleansed, 108; W.C.s light and ventilation improved, 8; Gully traps provided, 44; Waste pipes repaired or renewed, 44; New sinks provided, 24; Stoves and Firegrates repaired or renewed, 50; Water supply taken off main, 5; Water supply reinstated, 11; Yard and forecourt pavings repaired, 52; Dirty houses cleansed, 12; Dirty rooms cleansed, 87; Floors repaired, 119; Ventilation under floors provided or improved, 32; Dampness remedied, 317; Offensive accumulations removed, 18; Manholes repaired or resealed, 43; Miscellaneous repairs, 1,104; Animals improperly kept removed, 16. Infectious Diseases. Visits to premises, 2,230 (including 1,708 Smallpox contact visits). Disinfections. Rooms disinfected, 171 ; Articles disinfected, 1,415 ; Articles destroyed, 61. Special Premises. Visits Number paid Factories (a) Non-power 56 24 (b) Power484 289 (c) Other premises 11 15 Outworkers 687 350 Butchers 86 250 Bakers and Shops 44 91 23 Special Premises (contd.) Visits Number paid Fishmongers, Fryers and Curers 37 106 Cafes and Caterers 103 289 Grocers 267 528 Greengrocers 93 142 Ice Cream Manufacturers and Vendors 354 148 Dairies and Milksellers 157 114 Laundries 1 5 Hairdressers 66 42 Rag and Bone Dealers 3 6 Piggeries 1 3 School Kitchens 15 71 Street Stalls Numerous 298 Stables 17 11 Schools — 61 Public Houses 37 86 As a result of the regular periodical visiting of the above premises the following works were carried out:— Butchers. Cleansings, 20 ; Accumulations removed, 4; New bins supplied, 10; W.C.s repaired and cleansed, 2; Light and ventilation improved, 1; Other improvements, 38. Bakers Cleansings, 18; New ceilings fixed, 2; Floors repaired, 2; Roofs repaired, 2 ; Other improvements, 30. Fishmongers. Cleansings, 21 ; Yards repaved, 3 ; Accumulations removed, 2 ; Other improvements, 27. Cafes and Caterers. Cleansings, 42; Light and ventilation improved, 1; Floors repaired, 5 ; Other improvements, 58. Grocers. Store rooms cleansed, 21; Washing accommodation improved, 15 ; Other improvements, 48. Greengrocers. Store rooms cleansed, 7; Washing accommodation improved, 6 ; Other improvements, 17. 24 Ice Cream Manufacturers and Vendors. Cleansings, 9; Special cleansings of utensils, 1; Paving repaired, 1 ; Other improvements, 16. Hairdressers. Cleansings, 1; Other improvements, 3. Rag and Bone Dealers. Cleansings, 2. Street Traders. Stalls improved, 7; Store rooms improved, 1. Stable Premises. Cleansings, 1; Accumulations removed, 2; Other Improvements, 3. Schools. W.C.s repaired and cleansed, 12. Public Houses. Special cleansings, 12 ; Hot water supplied, 1. Smoke Abatement. No further sections of the Clean Air Act came into force during this year. 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 Hastings in October. A series of papers was given on the various aspects of smoke abatement and considerable discussion arose with respect to Smoke Control Areas and their administration. This Conference was very interesting and well worth attending. Observations on smoke nuisance from factories in the Borough amounted to 118. Investigations were carried out in all cases, new boiler plant being installed in some factories and considerable improvement being effected in others. Two District Public Health Inspectors attended a course arranged at the Coal Utilization Centre in regard to the design and installation of domestic heating apparatus. Two instruments for measuring Sulphur pollution in the atmosphere were installed on the 1st January, one at the Monoux Grammar School and the other at the Connaught Hospital. Readings of the instruments were as follows:— 25 Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sep. Oct. Monoux Grammar School 1.5 2.4 1.7 .94 .75 .83 .82 .72 1.3 2.1 Connaught Hospital 2.4 2.6 2.0 .89 .26 .76 .69 .67 .81 1.7 Nov. Dec. Monoux Grammar School 2.5 3.1 Connaught Hospital 1.8 3.5 Milligrams of Sulphur per Day. These figures are lower than most of those given in respect of surrounding authorities and indicate that Sulphur pollution in the atmosphere in the Borough is low. Reports as high as 6.8 are given for Central London. Verminous Premises. The number of houses reported to be verminous still remains comparatively small. Thirty-five rooms were disinfested and insecticides were issued free of charge to tenants of twenty houses. No notifications were received during the year under the Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1938. Swimming Baths and Pools. (a) Municipal Baths, High Street. Mr. B. M. F. Dixon, the Superintendent and Engineer, kindly contributes the following :— "From January 1st to December 31st, the Baths were open on 294 days. The number of swimming bath bathers during this period was 133,771. "The maximum load was on June 18th, when we had 1,046 bathers. During this period we also had 112,695 slipper bath bathers." Sampling was carried out on one occasion with a satisfactory result. (b) Whipps Cross Bathing Pool.—This is a large open-air pool situated in Epping Forest, in the area of the Borough of Leyton and a few hundred yards from the Walthamstow boundary. It is administered by a joint Committee representing the two Boroughs. The pool is supervised by the Medical Officer of Health for Leyton, who kindly sends a copy of the analytical findings when samples are taken. (c) South-West Essex Technical College.—Sampling was carried out on two occasions with satisfactory results. 26 (d) Forest School. 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 commenced on May 15th, and pool attendances were not particularly good, having regard to the prevailing weather. "However, for the three warmer weeks in June, attendances were very high indeed, and the overall figure for the Season was in the neighbourhood of 25,000 including school-children. "Bacteriological and chemical analyses were carried out on two occasions with satisfactory results.'' Hairdressers and Barbers. Under the provisions of the Walthamstow Corporation Act, 1956, hairdressers and barbers and their premises had to be registered by the Council from 1st January, 1957. During the year 66 Registrations were effected. Power is also given to the Council by the Walthamstow Corporation Act to make bye-laws in respect of these premises. During this year bye-laws were submitted to the Ministry of Housing and Local Government for approval. The Ministry Approval had not been received by the end of the year. Housing Repairs and Rent Act, 1954. The following Certificates were issued or refused under the provisions of the above Act:— (a) Certificates of Disrepair Issued 12 (b) Certificates of Disrepair Refused 3 (c) Certificates of Revocation Issued 26 The sections of the Act relating to Certificates of Disrepair were repealed by the Rent Act, 1957 from 6th July. Rent Act, 1957. This Act came into operation on 6th July, 1957, and empowers the landlords of dwelling houses to increase rent provided the property is in good repair. On receipt of a notice of increased rent from the landlord, the tenant if he considers that the property is not in good repair, must serve a notice on the landlord specifying the works he considers should be carried out. If the landlord does 27 not carry out the works specified or does not give an undertaking to carry out the work, within 6 weeks, the tenant may apply to the Council for a Certificate of Disrepair. This Certificate if issued will enable the tenant to deduct any increase already paid from the date of the application to the Council, and he need not pay the increased rent demanded. There are 21 forms specified by the Act for use between landlord and tenant, the Council may be involved in 13 of these. The following Certificates were issued under the Act during 1957:— RENT ACT, 1957 FIRST SCHEDULE 6th July—31st December, 1957 Part I.—Applications for Certificates of Disrepair— (1) Number of applications for Certificates 323 (4 later withdrawn) (2) Number of decisions not to issue Certificates 1 (3) Number of decisions to issue Certificates— (a) in respect of some but not all defects 204 (b) in respect of all defects 114 (4) Number of undertakings given by Landlords under paragraph 5 of the First Schedule 135 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Nil (6) Number of Certificates issued 34 Part II.—Applications for Cancellation of Certificates— (7) Applications by Landlords to Local Authority for cancellation of Certificates 7 (8) Objections by tenants to cancellation of Certificates 1 (9) Decisions by Local Authority to cancel in spite of tenants' objection 1 (10) Certificates cancelled by Local Authority 7 (issued under 1954 Act) 28 Housing Act, 1936, Section 62. Applications for "permitted number" were received from landlords and Certificates issued during the year respecting 9 lettings. Local Land Charges. Enquiries relating to outstanding sanitary notices were dealt with in 1,886 cases. 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 1957 Hoe Street Ward 24 Flats - St. James Street Ward 6 Flats — Higham Hill Ward 30 Flats — High Street Ward Nil Hale End Ward Nil Wood Street Ward 194 Flats TOTAL 254 Flats — Houses Houses erected by Private Enterprise. Hoe Street Ward — Flats 2 Houses St. James Street Ward 10 Flats Higham Hill Ward Nil High Street Ward — Flats 2 Houses Hale End Ward 6 Flats 13 Houses Wood Street Ward — Flats 1 House TOTAL 16 Flats 18 Houses Note:—All were permanent houses and flats. In addition to the main building programme, improvements and conversions have been carried out to a number of Council owned properties. Improvement Grants Applications received from owner/ occupiers 79 Total number of Grants and amount approved by Council to owner/ occupiers 32 £6,696 29 Applications received from Warner Estate Ltd 117 Total number of Grants and amount approved by Council to Warner Estate Ltd 116 £19,983 Summary Total number of applications 196 Total number of grants 148 Total amount of grants £26,679 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) 1,265 (b) Number of inspections made for the purpose 3,976 (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 104 (b) Number of Inspections made for the purpose 95 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (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 529 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 380 30 III.— Action Under Statutory Powers During the Year: — A. Proceedings under Sections 9, 10, and 16 of the Housing Act, 1936: — (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:—• (a) By owners Nil (b) By Local Authority Nil (c) Withdrawn—premises vacated and undertaking not to allow future occupation Nil B. Proceedings under the Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 149 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners *183 (b) By Local Authority Nil C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil (3) Number of dwelling houses where Demolition Orders withdrawn (houses made fit) Nil D. Proceedings under Section 12 of the Housing Act, 1936:— (1) Number or separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil * Including those notices outstanding from previous years. 31 E. Proceedings under Section 10 of the Local Government (Miscellaneous Provisions) Act, 1953:— (1) Number of dwelling houses where Closing Orders were made 2 Housing Act, 1936 Unfit Houses The following number of premises were dealt with as follows:— Demolition Orders: Nil. Closing Orders: Nil. Local Government (Miscellaneous Provisions) Act, 1953. Under the provisions of this Act, Closing Orders were made in respect of the following premises:— 182 and 184 Boundary Road. Clearance Areas In the report for 1956 the position was discussed up to and including the Parkstone Road and Wyatts Lane Representation, i.e., Area 6. In January, 1957, Area 4, i.e., West Street and St. Stephen's Road was confirmed for clearance with four dwellings excluded from the Order. Areas 1—4 included a total of 256 dwellings. The position at the end of 1957 was as follows :— Serial No. Locatlion No. of dwellings Survey completed Representation Dates of Inquiry Confirmation No. of dwellings excluded from Order 5 Tenby/Southcote 'Roads 102 16.4.56 6.6.56 5.3.57 28.10.57 11* 6 Parkstone Rd./ Wyatts Lane 20 11.8.56 3.10.56 Nil 5.7.57 Nil 7 Brunner & Side Roads/South Grove 66 12.2.57 Not yet represented† 8 Oatland Rise 13 2.7.57 do. 9 Courtenay Placel St. James' Path Willow Walk 20 15.8.57 do. *Compulsory purchase authorised. †Dwellings being acquired or acquisition attempted before representation. The Grand total of dwellings in Areas 1—9 is 477. In June, 1957, 54 new dwellings in the Vallentin Road Clearance Area were completed and occupied. 32 Area No. 2, i.e., Grange, Frederick and Lynmouth Roads, was mostly cleared by the end of the year, and building was actively proceeding on the cleared sites of Area 3, i.e., Chingford Lane, Payzes Cottages, Mill Lane, the Square and Farey's Row, with a total of 57 flats and 4 maisonettes to be completed early in 1958. By the end of the year the whole of the dwellings included in the five year programme had been surveyed, but oflicial Representations were still outstanding in regard to Areas 7, 8 and 9 pending negotiations with regard to the acquisition of as many properties as possible. As in previous years the experience in 1957 continued to show much improvement in the internal condition of most of the houses as compared with conditions before the War and the utmost help and co-operation were received from both tenants and owner/ occupiers. General Mr. C. W. Rayner, A.I.Hsg., the Council's Housing Manager, has kindly contributed the following details of rehousing carried out by the Housing Department in 1957:— "For the twelve months to December concentration on rehousing of families from the Clearance Areas has continued. Prior to 1st January, 1957, rehousing from Clearance Areas had been completed in respect of:— (a) Vallentin Road. (b) Chingford Lane/Mill Lane/Payzes Cottages. (c) Back Road/Collard Road/Short Road "A start had been made on the rehousing of families from the Frederick Street/Grange Road Clearance Area and during the year this was completed, while in addition a number of families have been dealt with from the West Street/St. Stephen's Road and Wyatts Lane/Parkstone Road Areas. "Progress, therefore, in connection with the five year programme for slum clearance is proceeding satisfactorily. Naturally, this rehousing continues to have its effect on the rehousing of families from the Housing Register, but with the shortage of building land within the Borough, this is obviously the solution to the eventual rehousing of families living in adverse conditions." No. of new properties made available for letting 252 Acquired 36 Normal vacancies 86 Nominations to private landlords 96 Total 470 33 Families rehoused:— 1-bedroom group 139 2-bedroom group 209 3-bedroom group 107 4-bedroom group 15 Total 470 Of the total number of families rehoused, in 11 instances there was a medical recommendation made in respect of tuberculosis. Property under management at 28.12.57 (dwellings only):— Pre-1939 houses and flats 1,615 New houses and flats 1,988 Prefabricated bungalows 477 13 properties converted into flats 56 Properties improved 61 Properties acquired for improvement and conversion 394 Properties acquired for General Housing purposes 108 Properties for Clearance and Demolition 85 Requisitioned dwellings (144 licences) 127 Halfway houses 4 General properties 29 Total 4,944 Total at the end of 1956 was 4,731. In addition to the families rehoused in Walthamstow, transfers and exchanges of accommodation amounted to 206 cases, and no fewer than 261 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 34 1954 181 1955 215 1956 131 1957 261 Making a total of 1,162 The great majority have been rehoused in Harlow (807), followed by Basildon (119), Stevenage (97), Hemel Hempstead (53), Welwyn (33), Crawley (16), Bracknell (10), Swindon (27). 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, 1957, the units of overcrowding and the accommodation required to meet the applications:— Applications: Total 2+ units overcrowding 44 1J units overcrowding 48 1 unit overcrowding 115 2 unit overcrowding 179 Fully occupied 199 unit under-occupied 409 1 unit under-occupied 344 1½or more units under occupied 2,045 Total 3,383 Accommodation required: 1 bedroom 1,153 2 bedroom 1,381 3 bedroom 849 Total 3,383 Rehousing of Medical Cases During 1957, 30 cases claiming rehousing priority for tuberculosis were investigated and reported upon. Of these, 19 cases were added to the list. The position at the end of 1957 was as follows:— 35 Class 1 Class 2 Class 3 Total On list at end of 1956 8 10 15 3 3 Added to list during 1957 3 7 9 19 11 17 24 52 Rehoused or removed from list during 1957 7 8 5 20 On list at end of 1957 4 9 19 32 In addition to the tuberculosis cases, 30 other cases were recorded as needing special consideration on medical grounds and 91 cases on general housing grounds. Housing Need and Provision of New Building In July it was estimated that the housing need was for 3,371 dwellings and that 2,771 only could be provided in the Borough having regard to projected clearance in the ten-year programme. At the end of November a revision of applications on the housing register showed a total of 3,342 applicants and that 1,460 (approximately 44%) were agreeable to out of Borough housing on the estates to be built at Billericay and Canvey Island. During the year, tenders for 416 dwellings received Ministerial approval. Tenders for an additional 262 dwelings (including 149 at Outwood Common, Billericay) were obtained and were awaiting approval, and drawings for a further 161 dwellings, were in course of preparation. The whole of these 839 new dwellings represented an approximate capital cost of £1,503,228. Tenders had been accepted for 224 dwellings at Canvey Island, half of which are to be for Walthamstow applicants. In addition, authority was given for the lease or purchase of up to 100 dwellings (including 49 already bought) in order to rehouse occupants of requisitioned properties. By the end of the first week in January, 1958, the 2,000th post-war newly erected dwelling came into management by the Housing Department. It was decided to seek Ministerial approval during the ensuing year to a programme of 308 new dwellings within the Borough and 251 at Billericay—a total of 559. Between 1st April, 1945, and 31st December, 1957, private builders had completed 576 dwellings in Walthamstow. This statement has been compiled with the co-operation of the Borough Architect, Engineer and Surveyor and the Housing Manager. 36 Housing of Old People In September consideration was given to a letter from the County Council referring to Ministry of Housing & Local Government Circular 18/57. After considering a report by the Housing Manager on the accommodation then occupied by elderly people and the welfare work carried out by his Department, the Council agreed that :— Approval be given in principle to the suggestion of the Housing Manager that on each estate where dwellings have been designated for use only for the housing of persons over the age of 65 in the case of men and 60 in the case of women there should be one tenant in residence who would provide his or her services as required, particularly in the case of illness, and who would be required to report to the Housing Manager on any matters upon which assistance could be given or departmental action taken, remuneration being given for the additional duties undertaken. The Housing Manager was asked to submit detailed proposals in respect of estates where he considers an arrangement on the lines suggested by him could be operated. In November after further consideration it was agreed that—the block of 40 flatlets on the Hylands estate and the nine houses in Carisbrooke Road which have been converted into 31 flatlets be designated for use only for the housing of persons over the age of 65 in the case of men and 60 in the case of women. It was understood that as far as possible one tenant would be in residence who would provide services as required, but particularly in cases of illness. In December Ministry of Housing & Local Government Circular 55/57 in regard to housing accommodation for old people was fully reported by the Town Clerk to the Council's Reconstruction 6? Housing Committee and to the Housing Management Committee. This Circular stressed the need to provide one-bedroom dwellings both in new and converted properties with flexibility in the provision of sanitary, cooking and food storage facilities. E.—INSPECTION AND SUPERVISION OF FOOD The following is contributed by the Chief Public Health Inspector:— (a) Milk Supply. Designated Milk. During the year 127 samples of milk were submitted to the Counties Laboratories for bacteriological examination, including Phosphatase, Methylene Blue and Turbidity tests. 37 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 of milk taken:— Grade No. of Samples RESULTS Satisfactory Unsatisfactory Pasteurised 79 78 1 Tuberculin Tested Pasteurised 48 46 2 TOTALS 127 124 3 Biological Test Seventy-nine 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. Fifty-seven of the samples gave negative results, two gave positive results whilst twenty proved to be inconclusive, but on repeat samples being taken were negative. The Milk (Special Designation) (Pasteurised 6? Sterilised Milk) Regulations, 1949 & 1950. The Milk (Special Designation) (Raw Milk) Regulations, 1949 Licences for the sale of milk under Special Designations were granted as follows :— Dealers' Licences. Supplementary Licences. Pasteurised 58 Pasteurised 9 Sterilized 136 Sterilized 11 Tuberculin Tested 26 Tuberculin Tested 9 Licences (Plant). Pasteurisers 2 There are no Cow-keepers in the district. The number of Retail Milk Distributors is 158. One hundred and fourteen 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. 38 (b) Ice Cream. Twenty-six applications for Registration were received and were dealt with as follow:— Vendors, New 13 Vendors, Transfers 12 Manufacturers, New 1 Number on Register at end of year 348 Number of premises used for manufacturing 6 Ice Cream (Heat Treatment, Etc.)—Regulations, 1947-51. The trade has continued to co-operate and a good standard has been maintained. Food Standards (Ice Cream) Order, 1951. Three samples of ice cream were taken and submitted to the Public Analysts who reported the following satisfactory results :— Fat Content 11.2 10.3 10.3 Bacteriological Examination of Ice Cream. One-hundred-an-eight samples were submitted for examination and for grading in accordance with the provisonal test of the Ministry of Health, with the following results :— Grade I = 86 „ II = 11 „ III = 6 „ IV = 5 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, six of which were unsatisfactory. Examination for Metallic Contents. Six samples of ice lollies were sent to the Public Analysts for examination for metallic contents and found to be free of same. 39 (c) Meat and Other Foods There are no slaughterhouses 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. 1437 tins Evaporated Milk 83 „ Full Cream Milk 158 „ Skimmed Milk 10 „ Cream 9 „ Baby Food 643 „ Peas 345 ,, Tomatoes 1 tin Tomato Juice 307 tins Beans 42 ,, Beetroot 32 ,, Rhubarb 32 „ Carrots 12 „ Vegetable Salad 5 „ Asparagus 1 tin Macedoine 2600 lbs. Onions 153 tins Plums 111 „ Pineapple 61 ,, Cherries 40 ,, Peaches 37 „ Grapefruit 31 „ Oranges 11 „ Orange Juice 8 „ Grapefruit Juice 5 ,, Pineapple Juice 25 „ Fruit Salad 19 „ Strawberries 16 „ Apricots 8 „ Loganberries 8 „ Prunes 7 „ Gooseberries 5 ,, Mandarins 4 „ Raspberries 2 „ Blackberries 1 tin Apples 1 ,, Pears 94 lbs. Apricot Pulp (tinned) 20 „ Apricots 33 jars Jam 4 tins Syrup 3 „ Marmalade 38 jars Fish Paste 22 „ Tea Savouries 10 „ Sandwich Spread 9 ,, Peanut Butter 1 jar Salmon Spread 49 tins Pease-Pudding 29 „ Creamed Rice 13 „ Spaghetti 1 tin Mustard 38 lbs. Salt 23 jars Pickle 4 „ Salad Cream 3 „ Ketchup 113 tins Soup 5 „ Broth 1 tin Stew 8 doz. Eggs 10 lbs. Butter 2 pkts. Cake Mix 96 „ Desiccated Coconut 3 „ Jelly 5 lbs. Chocolate 68 tins Pilchards 64 „ Shrimps 21 „ Silds 13 „ Tunafish 11 „ Crab 5 „ Herrings 3 „ Salmon 1 tin Crawfish 1 „ Roe 9 stone Skate 4½ „ Catfish 3 „ Haddocks 3 „ Cod 2J „ Kippers 197 tins Luncheon Meat 67 „ Stewed Steak 14 „ Steak 6s? Kidney Pudding 12 „ Sausages 9 „ Chicken 7 „ Minced Pork 6 „ Meat Pudding 5 ,, Beef Loaf 1 tin Minced Beef 1 „ Frankfurters 1 pkt. Steakette 790 lbs. Corned Beef 6 „ Corned Mutton 311 ,, Ham (tinned) 74 „ Pork (tinned) 33 „ Jellied Veal 966 „ Beef 304 ,, Lamb 196 „ Pork 120 „ Lambs' Livers 37 „ Pigs' Kidneys 20 „ Sheep's Livers 15 Ox Kidneys 3 Chickens (6¾ lb) 40 Shellfish and Jellied Eels. The following samples were taken during the year for bacteriological examination:— Cockles 2 Mussels 4 Jellied Eels 5 All samples were of a satisfactory standard. 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, 66 samples were taken. About one-third of these samples showed excessive contamination by bacteria. Miscellaneous Samples. Six samples of Cream and two of Chinese Egg Powder were submitted for Bacteriological examination with satisfactory results. (d) Adulteration, etc.—Food and Drugs Act, 1955. During the year, one hundred and ten samples of food and drugs were submitted to the Public Analysts. Seven samples were reported as being unsatisfactory, details respecting same are given below:— Description of Article Result of Analysis Action Taken Butter Mints Containing only 0.1% of total fat—misdescribed as "Butter Mints." Warning given. Orange Squash Sulphur Dioxide content was excessive—being 250 parts per million in excess of the maximum permissible quantity. Warning given. Orange Drink Contained foreign matter consisting of mixture of mould growth, quartz sand and miscellaneous dirt. Warning given. 41 Description of Article Result of Analysis Action Taken Chocolate Flavouring Contained benzoic acid—no provision is made in Public Health (Preservative, etc., in Food) Regulations for use of benzoic acid preservative in flavourings. Warning given. Milk Contained foreign matter in form of minute dark coloured particles. Warning given. Rusks Infested with living maggots and webbing. Warning given. Ginger Wine Contained insufficient alcohol to justify description of "Ginger Wine." Warning given. The following summary gives details of food sampled and results of analyses:— No. satisfactory No. unsatisfactory Formal Informal Total Formal Informal Total Butter Mints - - — 1 — 1 Butter 2 2 4 — - — Orange Squash — 1 1 — 1 1 Orange Drink 1 2 3 - 1 1 Milk 17 — 17 - -— — Sterilised Milk — — — 1 — 1 Sterilised Cream 2 1 3 — - - Double Cream 2 1 3 — - - Ice Cream 1 2 3 — — — Ice Lollies — 6 6 - — — Tea 4 1 5 - - - Coffee 1 — 1 — - — Coffee and Chicory 1 — 1 - — — Lacta Choc — 1 1 — — — Pepper Compound — 1 1 - — — Mustard — 1 1 — - - Tomato Ketchup — 1 1 — — - Horseradish Relish — 1 1 — - — Paste, Lobster & Tomato — 1 1 - - — Paste, Anchovelle Fish — 1 1 - — — Sausages, Pork 4 — 4 — - — Sausages, Beef 1 — 1 - - - Rolls, Buttered 1 — 1 - - — Butter Beans 1 — 1 - - — Chicken, Minced — 1 1 — — - Pudding, Meat 1 — 1 — - - Jelly — 1 1 - — - Crab, Dressed — 1 1 — - — Pie Filling — 1 1 — - - Rusks — — — - 1 1 Almonds, Ground 1 — 1 - - — Chocolate Crunch 1 — 1 - - — Honey — 1 1 - - - 42  No. satisfactory No. unsatisfactory Formal Informal Total Formal Informal Total Syrup, Strawberry Flavour 2 - 2 - - - Chocolate Flavouring - - — — 1 1 Cochineal - 1 1 — - — Coconut Oil - 1 1 - — — Whiskey 15 - 15 - — - Sherry — 1 1 - - — Ruby Wine — 1 1 - — - Cider — 1 1 - — - Tonic Water — 1 1 - - - Light Ale — 1 1 — — - Lager — 1 1 - - - Gin 4 - 4 - — - Ginger Wine — - — 1 - 1 Balsom — 1 1 - - - Soap, Toilet — 1 1 - - - Tonic Elixor — 1 1 — - - Tablets, Iron Tonic 1 — 1 — - - Tablets, Herbal 1 — 1 — — — Totals 64 39 103 3 4 7 (e) Chemical and Bacteriological Examination of Foods. Chemical examinations of food samples are carried out by the Public Analysts, Mr. G. Taylor, F.R.I.C., 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.1. (f) 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. The conditions laid down in the Regulations are being maintained throughout the district. The following food premises are established in the Borough:— Butchers, 86; Bakers, 44; Fishmongers, 37; Cafes and Caterers, 103; Grocers, 267; Greengrocers, 93; Dairies and Milksellers, 157; Ice Cream Manufacturers and Vendors, 354. There are two dairy premises in the area registered under the Milk and Dairies Regulations, 1949. 43 The following inspections were carried out in respect of food premises:— Butchers, 250; Bakers, 91; Fishmongers, 106; Cafes and Caterers, 289; Grocers, 528; Greengrocers, 142; Dairies and Milksellers, 114; Ice Cream Manufacturers and Vendors, 148. 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. Sixty notifications were received and investigated. Diseases of Animals Acts Swine Fever (Infected Areas) Order, 1953. No licences were issued during the year under this Order. Fowl Pest Order, 1936. No orders were issued in respect of the Borough during the year. Foot and Mouth Disease Orders. The borough was included in an infected area due to an outbreak of the disease at Barnet. No cases occurred in the Borough and no movement licences were issued. Pet Animals Act, 1951 Twenty-two premises are licensed in the Borough for the 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. The following is a summary of the work carried out during the year 1957:— 44 PREVENTION OF DAMAGE BY PESTS ACT, 1949 REPORT FOR YEAR ENDED 31st DECEMBER, 1957 Type of Property Local Authority Dwelling Houses Agricultural All other (including Business & Industrial) TOTAL I. Total No. of Properties in Local Authority's District. 18 34,263 4 4,720 39,005 II. No. of Properties inspected by the Local Authority during 1957 as a result of :— (a) Notification 6 366 - 99 471 (b) Survey 18 316 - 7 341 (c) A visit primarily for some other purpose. - - - - - III. Total inspections carried out—including reinspections. 338 1,976 - 656 2,970 IV. No. of Properties inspected (see Section II) which were found to be infested by:— (a) Rats Major 1 — — 4 5 Minor 3 398 - 70 471 (b) Mice Major — — - — Minor 3 30 - 29 62 V. No. of infested Properties (in Section IV) treated by the Local Authority. 7 428 - 103 538 VI. Total treatments carried out — including retreatments. (To be completed only if figures are readily available.) - - - - - VII. No. of notices served under Section 4 of the Act:— (a) Treatment - - - - - (b) Structural Work (i.e. Proofing.) - - - - - VIII. No. of cases in which default action was taken following the issue of a notice under Section 4 of the Act. - - - - - IX. Legal Proceedings - - - - - X. No. of "Block" control schemes carried out. 5 45 FACTORIES ACTS, 1937 & 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. Number of No. on Register 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 56 24 5 Nil Factories not included above in which Section 7 is enforced by the Local Authority 484 289 10 Nil Other premises in which Section 7 is enforced by the Local Authority 11 15 Nil Nil Totals 551 328 15 Nil 2.—DEFECTS FOUND IN FACTORIES, ETC. Particulars No. of cases in which defects were found Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Legal Proceedings Instituted (1) (2) (3) (4) (5) (6) Want of Cleanliness (Sec. 1) 20 21 - - - Overcrowding (Sec. 2) — — - - - Unreasonable Temp. (Sec. 3) — — - - - Inadequate Ventilation (Sec. 4) 1 2 - - - Ineffective drainage of floors (Sec. 6) 1 1 - - - Sanitary Conveniences:— (a) Insufficient 1 - - - - (b) Unsuitable or Defective 49 43 - - - (c) Not separate for Sexes — — - - - Other offences (not including offences relating to Outwork) 5 3 - - - Totals 77 70 - - - 46 NUMBER AND TRADES OF OUTWORKERS NOTIFIED 1957 Wearing Apparel (making of) 502 Household Linen 4 Lace, lace curtains 9 Curtains and Furniture hangings 2 Umbrellas, etc 2 Artificial Flowers 10 Furniture and Upholstery 3 Handbags 5 Paper bags 9 Boxes 50 Brush making 21 Carding, etc., of buttons, etc. 2 Stuffed Toys 24 Cosaques, Christmas Crackers, etc. 40 Lampshades 4 Total 687 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 incidence for 1957 was considerably larger than in 1956. There were more cases of poliomyelitis, food poisoning and measles, but fewer of scarlet fever, whooping cough, dysentery, puerperal pyrexia and erysipelas. 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 1957 1956 Scarlet Fever 89 111 - 17 70 1 1 - - Whooping Cough 217 347 14 88 113 1 1 - - Measles 1,394 498 41 597 753 2 1 - - Diphtheria — — — —- - — - — - Pneumonia 62 65 — 2 2 6 13 28 11 Meningococcal Infection 1 1 — — 1 — — — - Acute Poliomyelitis: - - - - Paralytic 18 3 — 7 4 2 4 1 - Non-Paralytic 4 — — — 4 — — — - Acute infective encephalitis - - - - - - - - - Post infectious encephalitis — — - - - - - - - Dysentery 13 33 1 2 4 1 4 — 1 Ophthalmia Neonatorum — 4 - - - - - - - Puerperal Pyrexia 58* 81* — — — 28 30 — - Smallpox 1 — — — — — — — 1 Paratyphoid Fever — 1 - - - - - - Typhoid Fever — 1 - - 17 - - - - Food Poisoning 39 24 — 4 5 7 6 - Erysipelas 10 28 — — — — 1 7 2 Malaria - - - - - - - Tuberculosis: Respiratory 70 71 — — 6 16 21 23 4 Meninges & Central Nervous System 1 1 - 1 - - - - Other forms 8 5 — - 1 1 4 1 1 Totals, 1957 1,985 - 56 718 975 63 87 66 20 Totals, 1956 — 1,274 58 364 582 62 113 73 22 * These include "out'area" cases confined in the Borough. Disease St. James Street High Street Hoe Street Wood Street Hale End Higham Hill Total Scarlet Fever 9 3 6 8 37 26 89 Whooping Cough 20 15 20 25 44 93 217 Measles 95 169 256 114 375 385 1,394 Diphtheria - - - - - - - Pneumonia 13 3 13 4 13 16 62 Meningococcal Infection 1 — - — — — 1 Acute Poliomyelitis: Paralytic — 5 1 3 7 2 18 Non-Paralytic — 2 - 1 1 — 4 Acute infective encephalitis - - - — - — — Post infectious encephalitis - - - - - - - Dysentery 3 2 - 2 1 5 13 Ophthalmia Neonatorum — — - — — — — Puerperal Pyrexia 1 4 9 35 3 6 58 Smallpox — — 1 — — — 1 Paratyphoid Fever — - - — — — — Typhoid Fever — — - — — — — Food Poisoning 1 1 3 3 28 3 39 Erysipelas —- - 5 2 — 3 10 Malaria — — - — — — — Tuberculosis: - Respiratory 5 7 15 10 14 19 70 Meninges & Central Nervous System - - - 1 - 1 Other forms 1 1 2 1 2 1 8 Totals, 1957 149 212 331 209 525 559 1,985 Totals, 1956 168 110 165 272 349 210 1,274 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 39 22 7 21 89 Whooping Cough 64 44 78 32 218* Measles 1,329 69 15 3 l,416† Diphtheria — — — — — Pneumonia 23 7 7 25 62 Meningococcal Infection 1 — — — 1 Acute Poliomyelitis: Paralytic 5 10 3 18 Non-Paralytic 1 — 3 — 4 Acute Infective Encephalitis — — — — — Post Infectious Encephalitis - — — — — Dysentery 7 5 1 — 13 Ophthalmia Neonatorum — — — — — Puerperal Pyrexia 18 8 15 17 58 Smallpox — — 1 — 1 Paratyphoid Fever — — — — — Typhoid Fever — — — — — Food poisoning 1 4 28 6 39 Erysipelas 4 1 5 — 10 Malaria — — — — — Tuberculosis: Respiratory 23 13 17 17 70 Meninges & Central Nervous System - - 1 1 Other Forms 3 2 2 1 8 Totals 1,518 175 189 126 2,008 * 1 notification relates to 1956. f 12 notifications relate to 1956. DIPHTHERIA Four cases were removed to hospital for observation, but none was confirmed. The last confirmed case was in 1950 and the last death from diphtheria in 1946. WHOOPING COUGH Of 217 cases notified 14, i.e., 6.4%, were under one year of age No death from whooping cough has occurred in Walthamstow over the last four years. SCHOOL " OUTBREAKS " The year produced an average number of " Outbreaks " which are more fully reported in the Report of the Borough School Medical Officer. These comprised a few cases of Flexner dysentery, an outbreak of ringworm at a school and associated residential institution, an outbreak of food poisoning due to salmonella typhi murium at a group of schools, influenza and lastly two deaths from acute infection of the respiratory tract of children attending the same class at an infants' school. 49 POLIOMYELITIS—1957 Case No. Age Sex Ward School Onset Dates Notified Hospital Paralytic or Nonparalytic Condition on follow-up after discharge from Hospital 1 21 M Hi - 7. 1.57 11. 1.57 9. 1.57 P Bulbar. Had tracheotomy—good recovery. L. facial palsy and mild weakness rt. arm. Fit for part' time work 1.4.57. 2 16 M HH - 8. 1.57 14. 1.57 12. 1.57 P Good recovery. 3 7 M Hi Blackhorse Road Primary 27. 1.57 1. 2.57 31. 1.57 NP Complete recovery. 4 31 F He - 2. 2.57 12. 2.57 11. 2.57 P Severe, Attended a Keep Fit class on Feb. 7th (many contacts). Transferred to R.N. Orthopædic Hospital, Stanmore, in May with four limbs paralysed. Still in hospital at end of year. 5 7 F Hi Coppermill Infants' 11. 2.57 16. 2.57 16. 2.57 P Many "Brownie" contacts. Very slight limp on discharge. Complete recovery expected. 6 10 M Ho Greenleaf Junior Mixed 17. 2.57 4. 3.57 25. 2.57 P Many "Scout" contacts (not those of case 5). Slight facial weakness and speech impairment, weakness in one leg. 7 6 M Hi Coppermill Infants' 26. 1.57 6. 7.57 28. 1.57 NP Notified in February as Meningoencephalitis—onset 26th Jan. Polio virus grown 13 th March— Type I. 8 1.3/12 F W — 18. 7.57 25. 7.57 24. 7.57 P Paralysis of left leg. 9 11 F HE Selwyn Avenue Girls' 24. 7.57 1. 8.57 1. 8.57 NP At school and "Guides" when possibly infectious— Uneventful recovery. 10 9 M W Woodside Junior Mixed 23. 7.57 6. 8.57 4. 8.57 NP Complete recovery. 11 25 M HE - 6. 8.57 12. 8.57 9. 8.57 P Required respirator treatment on admission. On discharge mild weakness both arms and moderate weakness of both legs. 12 6 M HH Roger Ascham Infants' 10. 8.57 13. 8.57 14. 8.57 P Tonsillectomy 9.7.57. Onset 11.8.57. Type I virus. Weakness Rt. leg. Wearing a caliper. 13 40 M HE — 10. 8.57 19. 8.57 20. 8.57 P Weakness left arm and leg. Limps. 14 3 F Hi — 21. 8.57 22. 8.57 23. 8.57 P Died Polioencephalitis 24.8.57. 15 2 F Hi — 22. 8.57 26. 8.57 22. 8.57 P Attended Day Nursery. Type I. Weakness both legs on discharge. 16 5 M W Maynard Infants' 19. 8.57 28. 8.57 28. 8.57 P Onset 19.8.57. Hospital 28.8.57. Mother expectant, given 15 ml. Gamma globulin 30.8.57. Baby born 26.9.57 and given 5 ml. Gamma globulin same day. Both remained well. Patient slight limp left leg. 17 3 F HE — 27. 8.57 2. 9.57 2. 9.57 P Left arm slight weakness. Caliper left leg. 18 2 F HH — 28. 8.57 2. 9.57 2. 9.57 P Slight limp. Type I virus grown from sister. 19 2 F HE — 30. 8.57 2. 9.57 2. 9.57 P Attended other Day Nursery to No. 15. No disability. Type I virus. 20 30 M Hi — 27.10.57 1.11.57 1.11.57 P Weakness right arm and leg. 21 53 M HE — 9.11.57 18.11.57 18.11.57 P Good progress—weakness left foot—caliper. 22 4 M W — 23.12.57 30.12.57 30.12.57 P Complete recovery. Age Groups St. James Street High Street Hoe Street Wood Street Hale End Higham Hill 0—1 1-4 5—14 15—24 25-44 45-64 65 & over Total 1957 - 7 7 3 4 1 - 22 — 7 1 4 7 3 50 POLIOMYELITIS Twenty-two cases of poliomyelitis were notified during 1957, one being fatal and four being non-paralytic. This followed a very light incidence during 1956 when only three cases were notified, one each in February, August and November. Notifications in 1957 continued steadily throughout the year with a break between the beginning of March and the end of July and with a peak incidence of eight cases notified in August. The 22 cases represent an incidence of 19 per 100,000 which is relatively light compared with the experience of the worst areas in the country since at the end of the year there were seven sanitary districts with rates over 100 and ranging up to 179 per 100,000 population. Eighteen were paralytic on notification. There was complete recovery in three cases and major disability only in one case. Details of age, sex, ward and condition on discharge are given in the table on page 49. Type I virus was grown in four cases and the same virus in the sister of a fifth case. One case occurred at each of the two Day Nurseries but there was no spread. Case 16 illustrates the successful use of gamma globulin in protecting an expectant mother and later her baby. There was complete recovery in eight cases. FOOD POISONING Thirty-nine cases of food poisoning were notified by general practitioners during the year, but 5 were not confirmed, leaving a nett total of 34. The large majority (28) were in the third quarter. In all there were seven outbreaks, five of which were due to identified agents, Salmonellae in two, Staphylococci or Toxin in three. In addition there were 34 further cases "ascertained" during the course of investigation into these outbreaks. The first outbreak occurred in May-5 cases in one family-all of whom had eaten re-heated pork chops. No agent was identified. The second affected only 5 pupils out of some 267 at risk at the canteen of a Higher Education Institution. Doughnuts were suspected and the agent was probably a toxin. The third outbreak included at least 38 notified and ascertained cases due to Salmonella typhi murim out of 483 at risk who had eaten school meals from a kitchen supplying three departments. The symptoms were mild to moderate, but four were admitted to hospital, some as cases of appendicitis. Of 29 food handlers, 18 were ultimately found to be infected. The outbreak is very fully described in the report of the Borough School Medical Officer and 51 was fully investigated with the help of Dr. Betty Hobbs, of Colindale. Australian "boned" meat was suspected, but not proved The next was a family outbreak of 3 cases probably associated with a girl who attended one of the departments concerned in the previous outbreak. The fifith outbreak, also in July, related to 6 cases in two related families, but neither food nor agent was identified. Apparently "boned" meat, possibly Australian had been eaten. The sixth outbreak (in August) included 3 cases probably caused by eating cold boiled bacon kept for four days between cooking and eating and which yielded a coagulase positive staphylococcus, as did two of the patients. The last outbreak also concerned two related families who had eaten pork. A coagulase staphylococcus was grown from one patient. During the year a questionnaire was completed for the Ministry of Health in regard to the adequacy of notification of food poison' ing. This showed that from six practices of up to twelve medical practitioners (with total lists of over 25,000 patients) who were regarded as regularly notifying cases of food poisoning, there were 75 notifications in the six years 1951/56. This compared with only 48 notifications from the remaining 73 doctors practising in the Borough and with lists of approximately 119,000. During these six years three references had been made in circular letters to medical practitioners stressing the need to notify food poisoning immediately and preferably by telephone. Early in 1958 copies of the Revised Memorandum 188/Med. in regard to food poisoning were circularised to General Practitioners. ANNUAL RETURN OF FOOD POISONING NOTIFICATION 1. Local Authority: Borough of Walthamstow. Year: 1957. 2. Food Poisoning Notifications (Corrected) Returned to R.G. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 1 4 28 6 39 3. Outbreaks due to Identified Agents. Total outbreaks—5. Total cases—28. Outbreaks due to:— (a) Chemical Poisons: Nil. (b) Salmonella Organisms: 2. (c) Staphylococci (including toxin): 3. (d) C1. botulinum: Nil. (e) Other bacteria: Nil. 52 4. Outbreaks of Undiscovered Cause. Total outbreaks—2. Total cases—3. 5. Single Cases. Agents identified—7. Unknown cause—6. Total—13. (5 notified but not confirmed.) Public Health (Infectious Diseases) Regulations, 1927 Part-compensation continued to be paid (since March, 1938) in conjunction with an adjoining local authority to a chronic carrier, in order to prevent her from following her occupation as a cook. The carrier is now 77 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, since the carrier condition continued during 1957. SMALLPOX About 10 a.m. on Friday, the 5th July, the Medical Officer of Health, Hackney, telephoned to state that a patient from Walthamstow had been admitted to a hospital in Hackney in the early hours of the morning and that a specialist in infectious diseases considered she was suffering from smallpox. Immediate arrangements were made to transfer the patient to the smallpox hospital at Dartford. It was added she was very ill and might not survive the journey. Shortly afterwards a medical officer of the Ministry of Health confirmed this information and was invited to Walthamstow to discuss and consider the position and the action to be taken. The Department had already been alerted on the 28th June following a communication from the Chief Medical Officer of the Ministry of Health that a case of smallpox had occurred in Tottenham and this information had immediately been circularised to family doctors in Walthamstow. Subsequently contacts of the Tottenham cases living in Walthamstow were notified and eighteen came under supervision. The Deputy Chief Public Health Inspector was detailed to make immediate enquiries at the patients home and these revealed that she had apparently first become ill on Monday, the 1st July, and that she had visited an old people's meeting at Lloyd Park on the afternoon of the same day, at the Gospel Hall, Higham Hill, on the afternoon of Tuesday, the 2nd July, and at the Friends' Hall, Greenleaf Road, on the afternoon of Wednesday, the 3rd July. The routine plan of action necessary in such an emergency was followed and arrangements made to prepare lists of the names and 53 addresses of all known primary contacts, which subsequently totalled approximately 475. On Friday afternoon confirmation of the diagnosis was received from the smallpox hospital at Dartford that the patient was in fact considered to be suffering from smallpox and had died of it. Following from enquiries of the secretaries of the various meetings which the patient had attended, a list of names and addresses of contacts was prepared and all of these were visited by public health inspectors and health visitors during Saturday and Sunday. An explanatory letter outlining the position and advising vaccination or re-vaccination of all contacts was delivered, together with a leaflet of general advice. All persons living in the same house as primary contacts, or otherwise exposed to special risk were similiarly advised. Special vaccination sessions were arranged at the Town Hall on Saturday afternoon and evening, Sunday all day, and on Monday, Tuesday and Wednesday mornings and afternoons and by the end of the emergency 1,466 vaccinations or re-vaccinations had been done at the Town Hall vaccination clinics and 154 at welfare centres. In addition 4,142 had been done by family doctors at their surgeries. On the Friday afternoon a circular letter was addressed to all doctors practising in Walthamstow and to neighbouring Medical Officers of Health, giving the history and facts and stating that the medical staff would be on continuous call to see any suspect case, especially adult and unvaccinated cases of chicken-pox which may closely resemble smallpox. This advice had also been stated in the circular letter addressed to family doctors on the 29th June notifying them of the Tottenham case. In view of the need to offer immediate vaccination to all direct contacts, authority was obtained to issue a statement to the Press and the B.B.C. stating the facts and the arrangements which had been made for vaccination over the weekend. The help of the Press and the B.B.C. was readily forthcoming. A further circular was addressed to family doctors and others concerned on the Saturday morning stating that in the opinion of the specialists who had seen the patient, the clinical diagnosis and cause of death was smallpox. A notification of smallpox and a certified copy of the entry of death stating the cause of death to be smallpox were later received but laboratory confirmation was lacking. The modern method of control in such outbreaks is to vaccinate and re-vaccinate as soon as possible all primary or direct contacts and in addition all those residing in or using the same house, so that if the primary contact develops smallpox, an immune ring of secondary contacts in the same dwelling will have been built up. 54 In spite of the closest enquiries no link was established between the Walthamstow case and the cases in Tottenham and other parts of London, and therefore the possibility of mild and unrecognised case(s) of smallpox at large in the community had to be allowed for. A visit was paid to the Old People's Meeting at Lloyd Park Pavilion on Monday, the 8th July, in order to advise those attending, to try to reassure them, and to get further information. The meetings at Gospel Hall and The Settlement, normally held on Tuesdays and Wednesdays, were cancelled by the organisers. Throughout, the closest co-operation was received from the Chairmen of the Health, Finance and General Purposes and Education Committees, and from Councillor Crosbie in regard to the compilation of the many contacts at the Lloyd Park meting. The work of the staff of the Department, both Borough and County, was exemplary. The Council subsequently placed on record appreciation of the valuable work undertaken by the Staff of the Department following the notification of this case. INFLUENZA In mid September a letter from the Chief Medical Officer, Ministry of Health requested immediate information of any outbreak and suggested daily contact with medical practitioners with large lists, with Medical Officers or Managers of all large industrial undertakings and with the Education Officer in regard to schools. It was stated that as from the 17th September the Manager of the local office of the Ministry of Pensions and National Insurance would telephone if and when new sickness benefit claims either exceeded 30 per cent of those for the previous week or when they first reached 200 per cent of the average weekly number during the period 4th April, 1956, to the 4th December, 1956. All these suggestions were implemented at once and weekly returns were readily obtained in regard to the weekly claims of sickness benefit from the Walthamstow office of the Ministry of Pensions and National Insurance, from the Establishment Officer of the Borough Council as a large employer of labour, from the Borough Education Officer in regard to children absent from school and finally from the Day Nurseries in regard to pre-school children. Contact was also made with those family doctors who had previously agreed to act as "spotters" and enquiries were made from thirteen industrial undertakings employing over five hundred persons. A letter of advice was compiled and was circularised by the Borough Education Officer to the head teachers of all schools and referring to the method of spread, the need for the prompt ex- 55 elusion of all affected persons, for adequate ventilation, and the avoidance of combining classes and holding general assemblies. At the same time all family doctors in the Borough were advised as to the general position and in regard to the availability of Influenza vacccine. At the suggestion of the County Medical Officer consideration was given to the possibility of the medical and nursing members of the departmental staff assisting family doctors since the Home Nursing and Domestic Help Services were already fully extended. Assistance was also readily forthcoming from the British Red Cross Society and the St. John Ambulance Brigade in regard to home nursing during the evenings and at weekends. The progress of the outbreak in Walthamstow is given in the table which follows. By the time vaccine was received the outbreak was virtually over. One hundred and seventy-four applications were received for vaccination and 83 persons received their first dose but only 20 elected to receive the second dose. There appeared to be considerable reluctance to accept vaccination, and more so by those vaccinated to come for the second dose. Influenza Week Ending Increase on Sick Benefit Claims (%) W.B.C. (1,200 employed) New Cases Influenza School Absentees % on Roll Deaths Influenza Bronchitis Pneumonia 28. 7.57 83 N.A. 15.1 - - - 5.10.57 128 12 16.2 1 — 3 12.10.57 233 12 19.5 3 — 4 19.10.57 354 19 21.9 2 - 3 26.10.57 343 32 19.6 4 2 5 2.11.57 292 22 10.4 — 1 2 9.11.57 147 12 7.8 — — 2 16.11.57 77 5 10.1 - - — The attendances at Day Nurseries throughout were average for the time of year. Staff were more affected with Influenza than children. There were 1,202 Sick Benefit claims made on the Ministry of Pensions and National Insurance during October, 1957, as compared with an average of 479 per month over the whole year. TUBERCULOSIS The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1957:- 56 Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year — — — — — - — — 1- 4 years — — 1 — — - — - 5- 9 „ — 1 1 - - - - - 10-14 „ 2 3 - - - - - - 15-19 „ 1 1 - - - - - - 20-24 „ 6 3 - 1 - - — - 25-34 „ 7 5 — 2 3 - — - 36-44 „ 7 2 1 1 1 1 — — 45-54 „ 11 2 - - - - - - 55-64 ,, 9 1 1 — 2 1 — - 65 and over 4 - 1 — 4 - — 1 Totals 47 23 5 4 10 2 — 1 70 9 12 1 79 13 In 12 per cent. of the 70 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 70 cases investigated 28 were sputum positive on notification or soon after, i.e. 40 per cent. The percentages during 1953, 1954, 1955 and 1956 were 45.6, 42.0, 44.2 and 36.6 respectively. The returns for the last three years are compared below:— Year. New Cases. Deaths. Pulmonary. NonPulmonary. Total. Pulmonary. NonPulmonary. Total. M. F. M. F. M. F. M. F. 1957 47 23 5 4 79 10 2 — 1 13 1956 43 28 3 3 77 4 1 3 - 8 1955 35 26 7 5 73 10 4 2 1 17 Fourteen deaths occurred amongst persons whose names were on the tuberculosis register and of these the Registrar General ascribes 10 to pulmonary tuberculosis. The period elapsing between notification and death and the number of cases not notified were as follows:— 57 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 — 9 — 2 1 — — Non-Notification of Tuberculosis Four deaths registered in 1957 from tuberculosis had not previously been notified, and details are given below:— 1. Male, 70 years, admitted to hospital December, 1956, following pneumonia and heart trouble : sputum negative, died 29.1.57. Cause of death after post-mortem examination: (a) coronary thrombosis; (b) pulmonary tuberculosis. 2. Female, 67 years, a refugee; contracted pneumonia and pleurisy in 1952. She was considered to be a case of bronchiectasis and was sputum negative. Cause of death—bronchitis and tuberculous fibrosis. The tuberculosis was considered to be quiescent. 3. Male, 77 years, an old case of chronic tuberculosis previously under the care of former Tuberculosis Dispensary. Apparently discharged as healed. Cause of death after post-mortem examination: (a) senility; (b) chronic pulmonary tuberculosis. 4. Male, 70 years, admitted to hospital December, 1957, for dyspnoea and haemoptysis, died within twenty-four hours from acute bronchitis, congestive heart failure, pulmonary tuberculosis. He had been admitted to sanatorium in 1918 when tuberculosis first diagnosed, but condition not notified in Walthamstow. i Mass Radiography The Mass Radiography Unit revisited several factories in Walthamstow during the year. 58 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. 59 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 Housing 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 six years the weekly average of new claims was as follows. The consistency of those for the months of June to October will be noted up to 1957 when Influenza supervened in the Autumn. 1952 1953 1954 1955 1956 1957 January 464 747 500 660 578 661 February 433 832 513 632 630 412 March 390 401 375 474 432 470 April 350 300 267 300 279 304 May 270 232 314 263 291 314 June 214 237 252 264 249 257 July 200 197 220 224 228 221 August 205 201 209 228 214 214 September 262 257 284 271 295 429 October 369 370 348 363 368 1,202 November 311 360 366 370 424 598 December 426 291 299 350 339 669 Average per week 323 363 327 360 357 479 (The large number of claims in January and February, 1953, reflected the delayed effects of the severe "smog" experienced in December, 1952. The incidence of Influenza is reflected in the October, 1957 figure). 60 G.—MISCELLANEOUS 1. Old People's Welfare. The Town Clerk as Honorary Secretary of the Walthamstow Old People's Welfare Association, states that the Committee's "Meals on Wheels" Service provided 19,722 meals during 1957. 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 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. In particular the position is eased by Dr. DeLargy's scheme at Langthorne Hospital for rehabilitating the aged and relieving their relatives by the "Six Weeks In—Six Weeks Out" Scheme. 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. 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 Association has agreed to accept financial responsibility for chiropody treatment to be provided in their own homes. During 1957 23 patients received domiciliary treatment, and 61 the total treatments given were 28 at a cost of £14 14s. 0d. The ages of the persons concerned were:— Males (1) 70 years Females (22) 62 years to 90 years. The agreement of the family doctor as to the need for treatment and as to non-ambulancy is sought in each case before arranging treatment. General. 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." The number of visits to the aged has increased and the domiciliary services, including the Laundry Service for the Incontinent, have helped to keep old people in their own homes or eased the burden of the family caring for their parents thereby preventing possible institutional care being sought. The Glasspool Trust has again been ready to help in cases of hardship, particularly with the supply of bedding. Once again there is need for increased services in the following directions:— (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 welfare accommodation and long and short stay annexes. (6) More hospital beds for the aged and chronic sick and geriatric units. 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, 5; Mattresses, 8; Blankets, 3; Pillows, 4; Commodes, 3; Chairs, 4; Waterproof Sheets 2. 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. 62 2. Laundry Service for the Incontinent. Experience in 1957 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 22 Average number of cases per week 9.3 Total number of articles laundered 5,460 Average number of articles per week 105 Total number of journeys 951 3. Funeral Arrangements. Arrangements were made with regard to the burial of two persons within the terms of the National Assistance Act, 1948. 4. Medical Examinations. During the year the medical staff carried out 217 examinations of Borough Council employees in respect of the Superannuation and Sick Pay Schemes. 5. Health Education. Lectures were given by the staff of the Department. Miss H. Rodway, F.R.C.O.G., Obstetrician Superintendent at Thorpe Coombe Maternity Hospital, arranged the usual course of mothercraft lectures. In each case the speaker was a medical or nursing specialist. 6. Cancer Education. The leaflet of advice printed in the 1951 Report is available for distribution. 7. Disinfection. The Council continued to provide facilities for steam disinfection for the Chingford and Leyton Corporations. 8. Home Safety. In accordance with the Ministry of Housing and Local Government Circular No. 13/57 the Housing Manager was authorised to arrange for the purchase of a supply of suitable fireguards, so that one could be provided in respect of every new dwelling as from the date of the first letting and that he be authorised to inform all Council tenants that suitable fireguards could be purchased from the Council. 63 9. General. The Borough Architect, Engineer and Surveyor contributes the following information:— (a) Public Conveniences. The Public Convenience at the Selborne Recreation Ground was opened during the year. The High Street Men's and Women's and Selborne Road underground conveniences were closed during the year. 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) Inquests and Post Mortems. Walthamstow Others Total Post'Mortems only 109 305 414 Post'Mortems and Inquests 14 45 59 Inquests only 10 48 58 (d) Rainfall. The annual rainfall at the Ferry Lane Station was 19.21 in. (e) Flooding. During the year many areas of the Borough were flooded during two heavy storms and flooding on a more limited scale occurred with two other less severe storms. No progress has been made on the preparation of major relief schemes due to staff shortage. The one senior assistant left last April and has not been replaced and the remainder of the staff have been fully occupied in the following schemes:— (1) Billet Road Relief Sewer—almost completed. (2) Shernhall Street Relief Sewer—completed. (3) Chingford Road Relief Sewer—completed. (4) Coppermill Lane Relief Sewer—in progress. The following schemes have been prepared for carrying out during 1958 (5) Essex Road Relief Sewer. (6) Brooke Road Area Storage Tank (7) Storm Water Tanks, Low Hall Farm Preliminary Plans only. 64 SECTION H NATIONAL HEALTH SERVICE ACT, 1946 PART III SERVICES WALTHAMSTOW HEALTH AREA SUB-COMMITTEE (1957/58) Chairman: Councillor Mrs. W. M. Palethorpe (Walthamstow Borough Council). Vice'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.). „ „ „ Alderman Mrs. L. P. Bailey, J.P. „ „ „ Alderman Mrs. B. K. Lowton. „ „ „ Councillor Mrs. E. M. Bates. „ „ „ Councillor Mrs. A. M. M. Burrell Councillor H. J. E. Palethorpe. 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. M. W. Brown. „ „ „ Councillor Mrs. G. F. G. Cowell. „ „ „ Councillor F. H. Eiles. „ „ „ Councillor J. H. Hammond. „ „ „ Councillor O. F. J. McCarthy. „ „ „ Councillor J. W. Pringle. „ „ „ Councillor Mrs. C. E. Stannard. „ „ „ Councillor D. Weinstein. „ „ „ Councillor A. F. Whicher. 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. E. Dick (Invalid Children's Aid Association). „ „ Mrs. A. Cordell (Walthamstow and Chingford Association of Tuberculosis Care Helpers). Area Clerk: G. A. Blakeley, Esq. STAFF During the year 21 whole-time members of the Health Area Staff resigned their appointments and 19 new appointments were made. The apparent inconsistency between the numbers of resignations and appointments is accounted for by the difference between the number of vacancies at the beginning and end of the year. HEALTH CENTRES (Section 21) HEALTH CENTRE SITES The general position remains as detailed in the previous reports, i.e., six sites have been defined in the Borough on the basis of one centre per 20,000 population each to serve an area with a radius of one mile. GENERAL DENTAL SERVICE Mr. L. W. Elmer, L.D.S., reports as follows:— "It is with pleasure that I am able to report that the amount of work for all types of operation shows a fairly substantial increase for 1957 as compared with the previous year. "This is at least in part, due to an increase in the number of sessions worked which has been achieved in spite of the resignation of one dental officer towards the end of the year. "It was, however, only during the last month or two that it was possible to give appointments to new patients. "It is particularly pleasant to note that with the same staff 66 the dental laboratory has been able to produce an increasing number of new dentures and other appliances. This was managed by the technicians without any decline in their usual high standard of craftmanship." Herewith is a summary of the work undertaken during the years 1956 and 1957:— 1956 1957 Number of patients treated 941 953 Appointments made 5,008 5,910 „ kept 4,533 5,347 Plastic fillings 413 1,944 595 2,327 Amalgam fillings 1,531 total 1,732 total Inlays 7 8 Crowns 28 38 Scalings and gum treatments 450 511 Dressings 549 708 Extractions 756 861 General anaesthetics 138 228 Local anaesthetics 638 575 X-rays 588 641 Impressions 591 773 Bites 166 193 Try-ins 234 286 Full upper dentures 85 117 295 total dentures Full lower dentures 53 220 total 81 Partial upper dentures 48 dentures 56 Partial lower dentures 34 41 Repairs 154 190 Minor Oral Surgery — 195 Other operations - 1,026 DENTAL LABORATORY The fallowing work was undertaken during the year:— Dentures Repairs Re-line Remakes Appliances Crowns Inlays Study Models Other Models General Dental Service 292 180 27 6 - 18 8 - 1,448 Walthamstow Committee for Education 63 43 - - 254 18 2 726 - Leyton Committee for Education - 6 - - 41 - - - - Maternity and Child Welfare Patients 16 1 - - - 1 1 - - Regional Hospital Board (Connaught and Harts Hospitals) 51 13 2 - 16* - - - - * 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 1,363 949 Low Hall Lane Clinic 36 8 Silverdale Road Clinic 24 6 West Avenue Clinic 11 1 District Nurses Training Home and Midwives' Homes 401 - Totals 1,835 964 Total Attendances— Ante-Natal Post-Natal Thorpe Coombe Maternity Hospital 12,677 1,019 Low Hall Lane Clinic 164 11 Silverdale Road Clinic 157 12 West Avenue Clinic 67 2 District Nurses' Training Home and Midwives' Homes 2,939 - Totals 16,004 1,044 Blood grouping/hæmoglobin 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. There were 4 Rhesus negatives and all Kahn tests were negative. The total of blood tests was 43—all first tests in respect of mothers, and in addition 3 secondary tests and 15 for hæmoglobin only. The groupings were A.21, B.4, O.10 and AB.3. Hæmoglobin estimations showed the following results:— 100+ = nil 90—99 = 4 80—89 = 15 70—79 = 18 i.e., 7 or 15.9% were under 70. 60—69 = 4 50—59 = 3 40—49 = nil 68 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. Ante-Natal Care. The arrangements in regard to the scope of ante-natal supervision were detailed in the report for 1956. Following the issue of Ministry of Health Circular 9/56, consultations on a professional basis late in 1956 took place at the request of the Chairman of the Group Hospital Management Committee. Discussions were between consultant obstetricians in the Group, representatives of family doctors and of the Health Services' medical staff. The recommendations made included clarification of the arrangements for ante-natal supervision and of the confinement, the routine and freqency of examinations and tests, including X-ray examination of the chest, education in the preparation for childbirth, and instruction in relaxation exercises. In addition an "ante-natal co-operation card" was suggested which was to be carried by the patient until the confinement and presented on admission to the hospital. A sealed envelope was designed to be carried by the patient and provision was made for the date of each examination to be clearly marked by the medical attendant or midwife. Failure to attend an examination was to be followed up at once either by the doctor, the midwife, or health visitor as appropriate. The "co-operation card" was brought into use during 1957 and the scheme is reported to be working well. Ante-Natal Care and Confinements. There were 1,416 confinements of Walthamstow mothers in 1957 against 1,373 in 1956. The percentage of hospital confinements remained practically unaltered at 75.4. This percentage in fact has hardly varied over the last four years. Home confinements were 348 against 331 in 1956 and of the 348 confinements, 104 were midwives' cases, the remaining 244 being doctors "booked" cases with, of course, a midwife in attendance as a maternity nurse. Of the 104 midwives' cases 98 were attended by "Carisbrooke" midwives. 69 Ante-natal examinations of midwives' cases were somewhat lower at 2,726, but ante-natal examinations of doctor's cases were much higher at 1,893. 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 Health Services Clinic on Tuesdays at 2 p.m., at West Avenue Health Services Clinic 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 mechanism of labour. The classes are held in conjunction with the ante-natal clinics at the respective Health Services Clinics. One hundred and fifty-four sessions were held during the period under review involving a total of 769 attendances. Toddlers' Clinic. The toddlers' clinic continued at West Avenue Health Services Clinic and sessions are held fortnightly on a Friday afternoon. CONFINEMENTS The following table shows the location of confinements of Walthamstow mothers during 1957:— At Thorpe Coombe Maternity Hospital 710 At other Hospitals and Maternity Homes 358 Total in Hospital, etc. 1,068 At Home 348 Total Confinements 1,416 In addition 631 out-area cases were confined at Thorpe Coombe. VITAL STATISTICS Walthamstow England & Wales (Provisional) Live birth-rate per 1,000 population 11.4 16.1 Still birth-rate per 1,000 total births 26.4 22.4 Infant mortality rate per 1,000 live births 24.1 23.0 Extracts from vital statistics are given more fully in Section "A" of this Report. 70 NOTIFICATION OF BIRTHS 2,066 births (642 of which belonged to other areas) were notified during the year under the Public Health Act, 1936. Notifications were received as follows: Doctors, 353; Midwives, 1,699; Others, 14. Also included are 51 still-births, 15 of which belonged to other areas. Of the total, 13 occurred outside the Borough. NEO NATAL MORTALITY The number of infants dying under one month during 1957 was 22, i.e. a rate of 16 per 1,000 live births. INFANT MORTALITY The deaths of infants under one year were as follows:— Males Females Totals Legitimate 13 17 30 Illegitimate 2 — 2 Totals 15 17 32 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, 22.6; Illegitimate, 1.5; Total, 24.1. The death rate of illegitimate infants per 1,000 illegitimate live births was 34.4. Of the 32 deaths, 21 occurred in the first month of life, including 17 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 1—1 1—1 1—3 3—6 6—9 9—12 8 9 4 8 3 — - Two deaths occurred at home and thirty in hospitals and the principal causes of death were as follows:— Prematurity, 16; Acute Pulmonary Conditions, 5; Congenital Abnormalities, 9; All Other Causes, 2. Although the Infant Mortality Rate for Walthamstow shows some increase on last year (18.7) it must be appreciated that the number of deaths is now so small that a small fluctuation from year to year produces a marked effect on the rate. It is gratifying to record that no deaths were attributable to 71 CAUSES OF DEATH OF CHILDREN UNDER 1 YEAR OF AGE—1957 Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total deaths under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under 1 year. St. James St. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Total. Influenza - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - Phthisis - - - - - - - - - - - - - - - - - Other forms of T.B. - - - - - - - - - - - - - - - - - T.B. Meningitis - - - - - - - - - - - - - - - - - Meningitis (Non-T.B.) - - - - - - - - - - - - - - - - - Convulsions - - - - - - - - - - - - - - - - - Bronchitis — — - - — — 1 — — 1 — — — 1 — — 1 Pneumonia - — 1 - 1 3 — — — 4 1 1 — — 2 — 4 Diarrhoea - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - Inattention at birth, wilful neglect - - - - - - - - - - - - - - - - - Suffocation (overlaying) - - - - - - - - - - - - - - - - - Injury at birth - - - - - - - - - - - - - - - - - Atelectasis 1 - - - 1 - - - - 1 - - - - - 1 1 Congenital malformation 2 -— 2 - 4 4 1 — — 9 2 2 1 1 1 2 9 Premature birth 14 1 - - 15 1 — — — 16 1 2 1 — 6 6 16 Atrophy, debility, marasmus - - - - - - - - - - - - - - - - - Inanition - - - - - - - - - - - - - - - - - Heart failure - - - - - - - - - - - - - - - - - Other causes - - - - - - - - - 1 - 1 - - - - 1 Totals 17 1 3 — 21 8 3 — — 32 4 6 2 2 9 9 32 72 accident or to injury and none of the deaths could be considered avoidable. Prematurity was again the chief cause of death in 16 cases, whose average weight at birth was only 3 lb. 4 oz., while the progressive reduction in all avoidable causes of infant deaths throws into prominence the number due to this cause, and to congenital malformations which this year were responsible for no less than nine of the thirty-two deaths. 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 1957, 79 live premature infants were born to residents of the Borough, 12 at home and 67 in hospitals and nursing homes. Of the 12 born at home, five were transferred to hospital. Of the remaining seven who were nursed entirely at home, all survived the first 28 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 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 1957 1,267 58 30 2 23.6 34.4 Totals 1953 to 1957 (5 years) 6,692 260 152 7 22.7 26.9 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. 73 Miss E. Williams, Superintendent of the Home, contributes the figures set out below. Details of Cases dealt with in 1957:— Admitted Adults Babies Total From Walthamstow 16 9 25 From rest of County 52 43 95 From outside County 5 5 10 Total 73 57 130 Outdoor Work— Walthamstow (Mothers and babies) 22 22 44 Walthamstow (Other cases) 6 — 6 Other County cases 8 8 16 From outside County 2 2 4 Total 38 32 70 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. Thursday „ „ 2 p.m. West Avenue, E.17. Thursday (weekly) 2-3 p.m. Markhouse Road, E.17. (In addition, clinics are held at the District Nurses' Home, 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 Summary of Attendances at Child Welfare Clinics Clinic First Attendances of New Cases Re-Attendances 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 Grand Total Markhouse Rd. 291 20 21 332 4,695 1,049 1,637 7,381 7,71 Penrhyn Ave. 202 3 7 212 2,745 1,055 1,057 4,857 5,06 West Avenue 217 12 21 250 3,041 909 1,031 4,981 5,23 Silverdale Rd. 111 — 9 120 2,205 779 1,799 4,783 4,90 Winchester Rd. 114 — 2 116 1,726 465 718 2,909 3,02 Totals, 1957 935 35 60 1,030 14,412 4,257 6,242 24,911 25,94 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 ture Thursdays Infant Welfare for old and new cases. Two doctors in attendance Alternate Fridays Diphtheria and Whooping Cough Immunisation. The work done during the calendar year is shown in the following table compiled from information kindly supplied by Miss D. Carter:— Year First Attendances 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 1957 279 13 9 301 4,133 1,080 746 4,959 5,260 Forty-seven children were immunised against diphtheria and 31 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. of age 1 year old 2-5 years of age Total Under 1 yr. of age 1 yr. old 2-5 years of age Total Local Authority Scheme 935 35 60 1,030 14,412 4,257 6,242 24,911 25,941 "Brookscroft" 279 13 9 301 4,133 1,080 746 4,959 5,260 Total 1957 1,214 48 69 1,331 18,545 5,337 6,988 29,870 31,201 TREATMENT The facilities provided at the Education Authority's clinics are available for all children attending the infant welfare centres. (a) Orthopaedic. — 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 3 Overlapping Toes 3 Scoliosis, Lordosis, Kyphosis 2 Perthes Disease 1 Athrogryposis Multiplex Congenitae 1 Genu Valgum 21 Genu Varum 8 Congenital Dislocation of Hip 2 Pes Valgus and Valgus Ankles 13 Talipes— Torticollis 1 (a) Equino Varus 1 Other Congenital Defects 4 (b) Metatarsus Varus 5 Claw Toes 1 Miscellaneous (including Chest Conditions) 10 Spastic Paralysis 2 Total 78 Number of Treatments given — 496 (b) Sunlight.—Sunlight treatment was given at the Hale End Clinic to 3 children under 5 years of age for 18 treatments. (c) Priority Dental Treatment.—Mr. G. P. L. Taylor, L.D.S., R.C.S., contributes the following:— "There appears to be an increase in the number of young children treated, particularly those requiring extractions under general anaesthesia. 76 "Again the majority of mothers were treated by Mr. Hyman at the Guildsway Clinic. "The following figures give details of the work done during the year by the whole dental staff Patients inspected and treated during the year: Expectant Mothers Nursing Mothers Children under School age Patients examined 98 83 275 Patients found to require treatment 94 75 252 Patients who have commenced treatment 93 74 241 Patients who have completed treatment 52 40 131 Patients awaiting treatment — - 1 Attendances for treatment 169 247 416 Types of treatment given: Expectant Mothers Nursing Mothers Children under School age 1. Extractions: (a) permanent teeth 26 40 — (b) temporary „ — — 262 2. Fillings: (a) permanent teeth 117 165 — (b) temporary „ — — 140 3. Inlays provided — — — 4. Crowns „ 1 1 — 5. Anaesthetics administered: (a) local 10 21 7 (b) general:— (i) by medical officers 8 2 68 (ii) by others 5 15 47 6. (a) Scaling 12 26 — (b) Prolonged scaling and gum treatment - - - 7. Silver Nitrate Treatment — 5 19 8. Dressings 21 19 38 9. X-ray examinations 1 7 — 10. Dentures provided: (a) full — 2 — (b) partial 2 9 — 11. Dentures repaired — 3 — 12. Dentures remade: (a) full — — — (b) partial — — — 13. Orthodontic appliances: (a) fixed — — — (b) movable — — — 77 Children Expectant Nursing under School Mothers Mothers age 14. Prophylactic treatment and other operations: Impressions 13 24 — Bites 7 8 — Try-ins 2 5 — Easing 3 15 — Polishing — 1 — Gum Treatments — — — Syringing — 3 — 15. Number of treatments included above in 6 or 14, carried out by Oral Hygienist 9 6 — The services of the Dental Hygienist were available on one half-day 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 following report is contributed by Dr. Helen Gillespie, Senior Psychiatrist at the Walthamstow Child Guidance Clinic:— "The psychiatrist has discontinued her special attendances at the West Avenue Health Services Clinic in view of the small number of patients referred and owing to pressure of work at the Child Guidance Clinic. We are, however, always prepared to give priority to any child under five referred from the Maternity and Child Welfare Clinics, and will be glad to see them at short notice. I would again like to urge early reference of parents and young children in need of psychiatric help. In this way we can sometimes prevent the problems from becoming intractable." (g) Pediatric Clinic.—The fortnightly clinic, under the charge of Dr. Elchon Hinden, Pædiatrician to Whipps Cross Hospital, continued during 1957 and 38 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 1957:— 78 Under 5 years New cases 24 Total attendances 47 Physical Defects: Cases seen 38 Referred to Hospital 15 Discharged 8 (h) Invalid Children's Aid Association.—Miss E. M. Starkey, 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 — 3 Classification of above cases Under five years Anaemia, Debility 1 Bronchitis or pneumonia 1 Rheumatism, chorea, heart 1 3 (i) Convalescence.—During 1957 two children were sent away on medical recommendation to convalescent homes. As in previous years the arrangements were made through the local branch of the Invalid Children's Aid Association. In addition, one mother was sent away for a period of convalescence with her baby. PROVISION OF NUTRIENTS AND MEDICAMENTS Details of nutrients and medicaments sold and issued free during 1957 are as follows:— 79 Sales Free Issue lbs. OZS. lbs. OZS. Adexolin — — 35 0½ Bemax 143 15 - - Cow and Gate 4,194 — - - Cod Liver Oil and Malt — — 27 — Farex 658 2 Ferrous Gluconate Tablets — — 17,000 tablets Gentian Violet Tablets — — 1,000 tablets Glucodin 104 12 Lactogal 64 12 — — Iron Sulphate Compound Tablets — — 1,000 tablets Maltoline with Iron — — 264 8 Marmite 861 12 Milk of Magnesia — — 15 — Mist Ferri et Ammon Cit. Pro Infantibus — — 16 10 Ostermilk 1,651 — 21 - Ostocalcium Tablets — — 1,000 tablets Pregnavite — — 1 bottle Robinson's Groats 70 — - - Robinson's Ready Cooked Groats 183 8 - - Scott's "Twin Pack" 370 13 — — Virol 626 — - - Trufood 224 — — — Value of Cash Sales = £1,616 2s. l0d. DISTRIBUTION OF WELFARE FOODS At the end of the year, eight distribution centres were open for 20 sessions per week enabling beneficiaries to obtain supplies from one to four centres on any weekday. 80 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 Markhouse Road Health Services 3,914 1,432 541 10,450 Clinic 3,743 1,170 461 8,552 Northcott House Distribution Centre 12,777 2,367 1,667 27,239 Penrhyn Avenue Infant Welfare Centre 3,424 956 317 8,377 Silverdale Road Health Services Clinic 1,404 909 363 8,808 Thorpe Coombe Maternity Hospital West Avenue Health Services — 54 1,286 4,378 Clinic 4,061 1,390 586 9,725 Winchester Road Infant Welfare Centre 1,094 512 207 4,905 TOTAL issues at Distribution Centres 30,417 8,790 5,428 82,434 In addition, the following were issued to:— Hospitals (National Health Service) 456 - 80 336 Day Nurseries — 324 — 1,044 GRAND TOTAL OF ISSUES . 30,873 9,114 5,508 83,814 DAY NURSERIES During the year the average attendances at the day nurseries (Mondays to Fridays only) were as follows:— Under 2 yrs. Over 2 yrs. Total Higham Hill Day Nursery 10.6 29.4 40.0 Handsworth Avenue Day Nursery 9.1 24.0 33.1 Both day nurseries are approved for training in the care of children aged 0-5 years and have 60 places. Training.—During 1957 seven nursery students gained certificates awarded by the Royal Society for the Promotion of Health. Their future careers were as follows:— General nursing training 2 Nursery nursing (including 1 who obtained employment at a nursery school) 2 Private children's nursing 3 81 NURSERIES AND CHILD MINDERS (REGULATION) ACT, 1948 There were no registrations under the above Act during 1957. DAILY GUARDIAN SCHEME This Scheme was begun in May, 1951, and Guardians are paid a retaining fee of 1s. Od. 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 1956 and 1957 are as follows:— 1956 1957 No. of Guardians on Register at end of year 19 20 No. of applications for services of Daily Guardians 49 43 Referred to Day Nurseries 34 36 Referred to Daily Guardian but nothing further heard 8 2 Placed with Daily Guardian 7 5 Continued in care of Daily Guardian from previous year 5 3 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). 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 1956 7 210 1957 14 109 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 gynæcological conditions. 82 RESEARCH The Department co-operated with Dr. H. J. B. Atkins of Guy's Hospital in regard to a "study in the Transmission of Maternal Antibodies." MIDWIFERY (Section 23) There were 31 practising midwives in the Borough at the end of 1957, 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 1957 and includes those at Thorpe Coombe:— No. of confinements attended 1,697 „ Medical Aid Notices sent 624 „ Twin Births notified 7 Triplet „ „ 1 ,, Stillbirths notified 38 „ Notifications of Artificial Feeding 10 ,, „ Discharging Eyes — ,, Deaths notified — Medical aid was summoned by midwives in domiciliary practice and private nursing homes on 16 occasions, and the details are as follows:— For complications during pregnancy:— Antepartum haemorrhage 1 For complications during labour:— Ruptured perineum 4 Premature labour — Rise in temperature — Postpartum haemorrhage 1 Other conditions 6 Total 11 For complications in regard to the infant:— Cyanosis 1 Prematurity 2 Other conditions 1 Total 4 83 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 Visit. Patients' Homes Midwife's House L.H.A. Clinics G.P.s' Clinics Mid. Mat. District Midwives 771 470 746 632 73 122 2,211 5,025 Home Nurse Midwives 140 — 1,723 137 25 122 1,507 3,654 Totals 911 470 2,469 769 98 244 3,718 8,679 One midwife in private practice undertook 11 cases as maternity nurse in a maternity home. Trilene, and Gas and Air Analgesia.—A total of 304 patients on the "district" received trilene or gas and air analgesia, representing a percentage of 88.8 of district confinements. Emergency Unit.—The Emergency Unit stationed at Thorpe Coombe Maternity Hospital was not called out to a Walthamstow case during 1957. Maternity Outfits. Outfits are issued for all home confinements. Training of Pupil Midwives.—Thorpe Coombe Maternity Hospital is a training school for both Parts I and II, the latter in association with home confinements on the "district." Twenty seven pupil midwives passed the examination of the Central Mid' wives1 Board (Part II) during the year. CO-OPERATION WITH GENERAL PRACTITIONERS The report for 1956 details the steps taken in regard to CO' operation with general practitioners, and particularly in regard to the help extended by health visitors, midwives and home nurses. 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 137 notified births. 84 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 1957 1,319 3,440 4,759 3,095 5,027 12,881 1956 1,381 4,331 5,712 3,201 5,888 14,801 Other Visits Ante-Natal Visits Special Visits Unsuccessful Visits TOTAL First Subsequent Total 1957 271 127 398 3,343 1,709 5,450 1956 299 164 463 2,963 2,590 6,016 Liaison with Hospital Services.—Health visitors and school nurses, as well as medical staff, continued to attend ward rounds of 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:— "The health visiting staff during 1957 have been very busy in the promotion of positive health. The pattern was similar to previous years and once again much energy was devoted to visiting the. elderly, expectant mothers and children under five years and to the concentrated supervision of problem families. The number of visits to the aged has increased and an effort was made to improve liaison between the Geriatric Unit at Langthorne Hospital and the health visitors. This resulted in weekly visits being paid to Langthorne Hospital to discuss cases, obtain information regarding discharges, and in return give information concerning home circumstances. 85 "The health visiting staff again gave help and advice to widows with children and to unmarried, separated and divorced mothers who are dependent on their own earnings. It is very important that children should remain with their mothers, and the day nurseries are able to play a valuable part in this respect by caring for such children while the mother goes out to work. "Co-operation has continued between the health visitors and the general practitioners in Walthamstow. I am pleased to be able to report that 20 general practitioners have on occasions contacted the appropriate health visitor during the year and a similar number of family doctors have been telephoned or visited to discuss cases on their lists. "Health education continues to play an important part in the work of the health visitor. Mothercraft talks were again given in all secondary modern schools. "Relaxation classes were held at the three ante-natal clinics and talks given on the physiology and hygiene of pregnancy, mechanism of labour and preparation for motherhood, as well as advice on layettes, nutrition in pregnancy and the use of the gas and air apparatus. Three further members of the health visiting staff have received instruction so that reliefs will be available in the event of staff absences through holidays and sickness. During the year regular lectures have been given by health visitors to expectant mothers at Thorpe Coombe Maternity Hospital. "Requests have been received from several churches for talks to be given their young mothers' groups on such subjects as "Accidents in the Home," " First Aid," "Children going into hos' pital," etc. A health visitor was asked to give a talk to the parents of the children who attend the Nursery School and another member of the health visiting staff was asked to speak to boys and girls at Marsh Street Youth Centre. Talks of this nature are a valuable method of health teaching and the audiences usually respond well, asking interesting and intelligent questions which last for some time after the talk is concluded. "The health visiting staff co-operated in the practical training of the following:— (a) On two occasions I was asked to lecture to domestic helps who were attending a special course of instruction arranged at County Hall, Chelmsford. The subjects I was asked to deal with were as follows: 'Care of the Infant and Toddler,' 'Accidents in the Home,' 'Food Values' and 'First Aid.' (b) Final year nursing students from the Connaught Hospital spent two days each in the Public Health field for practical training. Fifteen students each spent half a day home visiting and for the remainder of the time attended at 86 infant welfare centres, minor ailment clinics, medical and hygiene inspections in schools. (c) Three health visitor students, two from South-East Essex Technical College and one from Battersea Polytechnic, 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. (d) Three health visitor students were given practical training in the tuberculosis field, both in home visiting and clinics. (e) 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. (f) Pupil midwives from Thorpe Coombe Maternity Hospital attended four sessions at infant welfare clinics in accordance with the rules of the Central Midwives Board. "We are still fortunate in maintaining a reasonable level of staffing despite the general shortage of health visitors. At the end of the year we nominally had a full establishment, but one member unfortunately had been absent for a prolonged period of sickness. During 1957 one member of the staff transferred to Harlow and was replaced by a health visitor from Yorkshire." HOME NURSING (Section 25) Miss N. Chadwick, S.R.N., S.C.M., H.V. Cert., Superintendent of the District Nurses' Training Home, reports as follows:— "Queen's Training.—During the year four nurses took their Queen's examination and were all successful. In July a male nurse commenced his Queen's training, the examination taking place in 1958. "Carnival Week.—We held a successful 'Tiny Tots' Parade in the garden of the Home. All the nurses took part in the Carnival held in aid of local charities. "We were able to supply 41 parcels to needy patients from the Nurses' own funds, chiefly obtained through Beetle Drives, Jumble Sales and Raffles. 87 "We again took some student nurses in general nursing training to see district nurses at work. Persian students from Dr. Barnardo's Homes have also visited the Home, and letters of appreciation have subsequently been received. "Staff at the 31st December, 1957, was as follows:— 1 Superintendent; Queen's S.R.N., S.C.M., H.V. Cert. 11 Full-time Queen's S.R.N., S.C.M. 1 „ „ S.R.N., S.C.M., H.V. Cert. 4 „ „ S.R.N., S.C.M. 1 „ „ Queen's S.R.N. 3 „ „ S.R.N. 2 „ ,, Queen's S.R.N. (Male). 1 Part-time S.R.N., S.C.M. 1 „ „ S.R.N. 3 „ „ S.E.A.N. 1 „ „ R.F.N. "During the year 29 pupils entered for district midwifery training. "The following gives details of home visits during the year:— New cases Total visits Medical 644 51,066 Surgical 154 9,914 Tuberculosis 33 2,025 Operations 11 19 Miscarriages 2 19 Out-Patients—Medical 31 397 Out-Patients—Surgical 3 92 Hypodermic Injections 583 14,803 Casuals 126 273 Last Offices 18 51 Specials 5 9 Total 1,610 78,668 "Liaison with General Practitioners.—Seven of the midwives worked with 10 general practitioners in regard to antenatal sessions held by the latter at their surgeries, and also with 3 other genera! practitioners who held ante-natal examinations in the patients' homes. 88 "Prevention of Bed Sores.—Arising out of an article in the Medical Press describing a new technique for the prevention of bed sores in the elderly, a trial was carried out with a silicone barrier cream. "One of the nurses reported excellent results and 3 others reported improvement. Another considered there was no particular advantage in regard to treatment, but that the barrier cream did seem to prevent extension of the bed sores. Only one considered there was no improvement." VACCINATION AND IMMUNISATION (Section 26) During 1957 immunisation against diphtheria and whooping cough and vaccination against smallpox were available at all welfare centres and at the special clinic held weekly at the Town Hall. Most medical practitioners in the town also participated in the County Council's scheme for vaccination against smallpoix and poliomyelitis, and immunisation against diphtheria and whooping cough, a fee of 5/-d. being payable on the completion of a report. The following were the attendances during the weekly Town Hall Clinic:— Diphtheria Immunisation 202 Whooping Cough Immunisation 200 Vaccination 240 Total 642 Vaccination against Smallpox The number and ages of persons vaccinated are shown below:— Age at date of Vaccination Under 6 months 6-12 months l year 2—4 years 5—14 years 15 years and over Total Primary 505 242 147 424 1,405 1,567 4,290 Secondary - 1 4 36 415 2,171 2,627 Total 505 243 151 460 1,820 3,738 6,917 Vaccinated by General Practitioners 4,938 Vaccinated by County Staff 1,979 89 The total of 6,917 is, of course, very much increased over that of former years because of the notification of a case of smallpox in July. During the period 6th to 10th July inclusive, 1,403 vaccinations were done at special sessions at the Town Hall, 130 at welfare centres, and 2,466 tubes of lymph were issued to family doctors. The "Vaccination acceptance rate," i.e., the percentage of primary vaccinations under the age of one year relative to the number of live births for the year 1957 was 56 per cent. (The rate for England and Wales for 1956 was 38.4 per cent.) It is often stated that the abolition of compulsory vaccination by the National Health Service Act, 1946, has had an adverse effect on infant vaccination. The percentage of such vaccinations has been summarised back to the year 1930 and the position is as follows:— Vaccination Acceptance Rate Pre-war period 1930—1938 War period 1939—1945 Post-war period 1946—1957 15.2 12.7 22.7 14.0 12.3 54.9 12.1 14.0 20.8 14.0 19.0 20.1 14.0 21.4 23 21.8 17.5 37 13.5 24.2 35 16.2 36 17.8 30 34 49 56 The highest and lowest acceptance rates of infant vaccinations in the pre-war period were 21.8 and 12.1 respectively in spite of 268 cases of variola minor during the years 1930-1934. During the war period these rates were very similar at 24.2 and 12.3 respectively. During the post-war period, there was an abnormally high acceptance rate in 1947, i.e., nearly 55% probably due to the demobilisation of many fathers who were convinced of the preventive value of vaccination and advised their wives accordingly. The following year the rate fell sharply to 20.8 with the operation of the National Health Service Act and the end of compulsory vaccination. It fell again in 1949, but since then varied between 23% and 37% except for a great improvement to 49% during 1956 and following from the propaganda carried out by the s'.aff of the Department. In 1957 the rate rose to 56%. 90 In other words, contrary to the view of many people, the removal of the requirement for compulsory vaccination has not had an adverse effect on the acceptance rate and the 1956/57 figures show what can be achieved by propaganda. The great value of vaccination before the age of one year (say at four months) is less discomfort and less risk, and revaccination performed in later life will have less discomfort and less risk. The longer the period between vaccination and re'vaccination, the greater the risk of a sore arm. It must be remembered that to travel to certain foreign countries an International Certificate is necessary stating that vaccination has been performed within three years. The most important reason, however, is that the only way to offset the risk of repeated importation of smallpox from abroad is by maintaining a well-vaccinated community. In these days of air travel the risk can only be avoided by infant vaccination followed by re-vaccination on entering and again on leaving school. For members of the Armed Forces a routine is usually laid down, e.g., re-vaccination at five-yearly intervals while on home service and two-yearly intervals during the period of overseas service. Doctors, nurses and public health inspectors likely to have to deal at short notice with cases of smallpox should be regularly vaccinated, and preferably annually. 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 44. In addition 45 members of the staff were vaccinated or re-vaccinated following a case of notified smallpox. 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 number vaccinated was as follows:— Of those now Of those now employed No. employed No. No. re- successfully vaccinated but vaccinated No. now vaccinated not within during 6 mths. employed within 3 yrs. 3 yrs. ended 30.9.57 Hospital "A" 222 176 — 176 Hospital "B" 82 42 34 13 91 DIPHTHERIA IMMUNISATION, 1957 The following is a summary of the work carried out during the year:— Total number of immunisations completed : (a) School age 302 (b) Pre-school age 1,048 Total 1,350 (c) Number already immunised having a reinforcing dose 1,245 Details of the immunisations included in the above total are set out below:— Number completed at Schools 225 „ „ „ Welfare Centres 354 „ „ ,, Town Hall Clinic 87 „ „ „ Brookscroft 57 „ „ by General Practitioners 627 Total 1,350 The total for 1956 was 1,197. 252 children included in the above figures were given combined whooping cough/diphtheria antigen and 119 children were given whooping cough/tetanus/diphtheria antigen by general practitioners. These prophylactics were not supplied by the County Council. There have been only two confirmed cases of diphtheria in the last 11 years, the last being in 1950, and no death. The number of children immunised, especially in the 0—1 age group, falls short of the target of immunisation in this group, i.e., 75 %. The percentage of children immunised in this age group was 55. During the past five years the numbers immunised in the various age groups were as follows:— Age at Immunisation 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* 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 1957 752 178 52 22 44 1,048 302 1,350 4 * In no case was the diagnosis confimed. 92 Number of children at 31st December, 1957, who had completed a course of immunisation at any time before that date (i.e., at any time since 1st January, 1943):— Under 1 (born 1957) 303 1—4 (born 1956-53) 3,537 5—9 (born 1952-48) 7,217 10—14 (born 1947-43) 8,557 Total immunised under 15 years 19,614 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. The publicity material issued by the Ministry of Health was displayed on the Borough Council's notice boards during the period when advertisements appeared in the local Press. 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 205 275 32 11 2 525 General Practitioners 101 264 65 24 9 463 Total 306 539 97 35 11 988 In addition general practitioners gave 47 booster injections. The percentage of children immunised during the first year of life was 63. VACCINATION AGAINST POLIOMYELITIS This scheme was first announced in January, 1956, and initially provided for the vaccination of children born only in the years 1947 to 1954 inclusive. The number of children registered in Walthamstow to receive protection was 3,180. In May, 1957 the Minister of Health authorised the offer of vaccination to children born in the years 1955 and 1956, and also recommended that a further opportunity should be given to the parents of children born in the years 1947 to 1954 to register them if they had not hitherto accepted the offer of vaccination. 93 Following the announcement of this extension of the scheme, 1,841 more children were registered in Walthamstow, bringing the total number up to 5,021. Vaccination began in May, 1956, with the 1947/54 group and vaccination has been offered to the parents of all children who were registered in 1956 and to many of those registered subsequently. Three hundred and forty-nine vaccinations were completed in 1956. Up to 31st Decmber, 1957, 2,862 children had received two doses of vaccine, given either by their family doctor or by the medical staff of the Health Department, and a further 525 children had received their first injection. During November, 1957, it was announced that the scheme for vaccination could be further extended to include children born in the years 1943 to 1946 inclusive and those born in 1957 who had reached the age of 6 months. Vaccination is now available therefore, to every child between the age of 6 months and the 15 th birthday. In addition, expectant mothers are now a first priority for vaccination and certain special groups of individuals who are particularly exposed to the risk of infection are also eligible for vaccination. The number of children vaccinated has been governed by the availability of supplies of vaccine, which at first was produced in England by only one firm. Recently, however, production of vaccine has been commenced by a second British manufacturer and it is hoped that there will now be a substantial increase in the amount available from these sources. In order to cope with the extended programme of vaccination, it was found necessary to supplement the supply of British vaccine with Salk vaccine manufactured in Canada and the U.S.A. First supplies of this material were received in mid-January, 1958. The position at the end of each calendar year was as follows:— Year Running Totals of First dose only Completed Cases 1956 349 15 1957 2,862 525 The vaccine has been singularly free from reaction of any kind. B.C.G. VACCINATION Vaccination of schoolchildren in the year preceding their fourteenth birthday continued. The scheme was fully described in the report of the School Medical Officer for 1954. During 1957 94 acceptances were received from 1,246 children out of 1,926 who were eligible, i.e., 64.7%. Details are as follows:— Heaf positive 165 Percentage positive 13.8 Heaf negative 1026 Number absent from test 55 B.C.G. given 1026 The percentage of children Heaf positive in previous years were:— 1954 1955 1956 17.6% 13.0% 13.8% TUBERCULOSIS VACCINE TRIALS (Medical Research Council) Dr. T. M. Pollock, Physician-in-Charge of the vaccine trials arranged for the annual follow-up in Walthamstow to be made in June. Subsequently Dr. Pollock reported that of 202 young persons invited for this fifth annual chest X-ray examination, 117 attended, i.e., 58% of the total invited. Of these, 69% completed the skin test. Of the 115 who did not attend the 1956 check-up 32 attended during 1957. AMBULANCE FACILITIES (Section 27) The Ambulance Service is administered centrally from Chelmsford via the Control Centre at Ilford, and (as far as information is available), it appears to be adequate for the needs of the Borough. The Local Service has continued from the Ambulance Depot, which is situated at the Borough Council's Fulbourne Road Depot. PREVENTION OF ILLNESS — CARE AND AFTER-CARE (Section 28) TUBERCULOSIS Dr. H. Ramsay, Consultant Chest Physician at the Walthamstow Chest Clinic, has contributed the following:— " The figures of main interest are set out below. They refer, of course, to the combined attendances of Walthamstow and Chingford patients. 95 Total attendances 16,542 „ new cases 5,885 „ X-rays 13,502 „ screening 1,418 Miniature camera 5,314 New notifications 81 (Walthamstow only) Schoolchildren examined for the first time Boys Girls Referred by School Medical Officer 23 16 „ „ Private Practitioners 81 90 Examined as Contacts 43 36 "There is a slight fall in the total attendances which I think is chiefly accounted for by the drop in the number of cases attending for refills to artificial pneumothorax or pneumoperitoneum. There has, in fact, again been some increase in the total number of new cases referred for investigation. There has also been a slight increase in the number of new cases of tuberculosis actually notified. This is the third year in succession where there has been such an increase, though it is not of any great extent. "It will be seen that the work of the Clinic generally continues to be very considerable and shows no real sign of falling off. The dramatic drop in the tuberculosis death rate does tend to suggest to some people that much less now needs to be done over the field of tuberculosis work as a whole. This is certainly not so as regards the Chest Clinic and both in the field of tuberculosis and the wider field of chest diseases generally, a great deal of work is being done. "For instance, a total number of 48 cases of cancer of the lung was diagnosed at the Clinic during the year: this is a little more than half the total notifications of tuberculosis. At the beginning of 1957 it was estimated that there were in Walthamstow 8.4 cases of tuberculosis per 1,000 population." Walthamstow and Chingford Association of Tuberculosis Care Helpers. Miss A. Woolgar, Honorary Secretary of the Walthamstow and Chingford Association of Tuberculosis Care Helpers, contributes the following report:— "The year has not been an easy one from any point of 96 view and a review of the applications which have been dealt with shows some change in the general situation. "Many of those who required our help were longstanding cases in the middle and upper age-groups, needing general assistance over an indefinite period, with little likelihood of a return to independence. On the other hand there were young families where the patient might be expected to return to employment, perhaps within a year, but where the problems to be faced in the meantime were formidable. These problems were particularly difficult to resolve in instances where housepurchase had been undertaken as the only means of obtaining a home for a growing family, the sudden illness of the bread' winner creating a situation which could not adequately be covered by the statutory services. In such cases a good deal of financial help was required to enable the patient to settle down to the required period of treatment without undue worry, and constant contact with the family had to be maintained." "During the period covered by this report, 142 persons received material assistance as follows : Type of help given. No. of cases Cost £ Milk 4 21 Grocery 42 727 Fuel 50 170 Fares to visit 9 43 Clothing, furniture, bedding 44 120 Holidays 9 122 Handicrafts 5 8 Miscellaneous grants: (Rent, rates, debts, etc.) 112 156 "The fact that a great deal of publicity has been given to the fall in the death-rate from tuberculosis, has obscured the fact that there are actually more people requiring our help, and has given the impression that financial help is no longer needed. As a result of his there has been a falling-off in local revenue, particularly as regards the Christmas Seal Sale, the income from which has dropped to an extent which is not entirely attributable to the many other seals now available. "Although we have not, so far, had to restrict the help we give, any further reduction in local support would make the future position precarious. In spite of the widespread impression that tuberculosis is no longer a problem, for the individual or family concerned, life, for them, is far from simple. Recent statistical returns show that there has actually 97 been a small increase in the number of new cases in this district, and it is obvious that the work of the Tuberculosis Care Association will be needed for some years to come if the treatment of patient and the care of his family are not to suffer." Rehabilitation of Tuberculous Patients. Financial responsibility was accepted for the rehabilitation of two cases at the British Legion Village. Responsibility for one ceased on 31st August, 1957, and one case was continuing at the end of the year. Prevention. B.C.G. vaccination is referred to on page 93. 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 re-housing of infectious cases. CONVALESCENCE FOR ADULTS The total of cases sent away for recuperative convalescence was 62. 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 service has again been popular, and is fulfilling a real need amongst all age groups of both sexes. "Unfortunately in April we lost the services of Mr. A. Nicoll, M.Chs., at the Town Hall. This has meant the loss of three sessions per week, with the resulting reduction in the number of treatments given, and with the number of appointments booked totalling 4,466, gives room for thought in regard to recruitment of staff. This Clinic has been fortunate in not having lost any full-time chiropodists during the last twelve years, whereas most other Chiropody Clinics have to employ part-time staff. 98 "The Clinic accommodation is still causing difficulty, especially in cases of emergency, and this on occasions has actually stopped the work of the Clinic, with the consequent disorganisation of appointments. "Patients who fail to keep appointments without prior notice, and those who arrive late are still with us and appear to give no thought to the inconvenience caused, or the waste of an appointment which someone else would have willingly kept. "During the year 6,110 patients received 18,748 treatments, making an overall attendance of adults and children of 3.06 treatments per patient for the year. "The Children's Clinic has increased, having given 2,652 treatments to 738 children, making 3.5 treatments per child. "Adult attendances have kept up, 5,372 patients received 16,096 treatments, making 2.9 treatments per patient; of these 888 were new cases. Transported cases have shown a rise, i.e. 236 female patients and 56 male, making a total of 292. The attendances show that of the 18,748 treatments given only 4,078 were males, thus leaving 14,670 to the credit of the females, which does rather point to the old, old question of Shoes." Shoes The following extract from the Annual Report for 1957 of Dr. R. G. Davies, Medical Officer of Health, Huddersfield, is of interest:— “Many girls who have perfect feet at their ten-yearold examination have severe deformities by the time they reach school leaving age, many of such a degree that they may eventually require operative treatment. The present day fashion of continued all day wear of shoes of a 'slip on' or 'casual' type, which must of necessity be too small so that they can stay on, or cause cramping of the toes to keep them on can during these formative years cause hallux valgus, painful bunions and curling under of the toes, sometimes of such a degree that the nails are walked on. From an economic aspect only it is doubtful if in years hence the country can afford comparatively young, middle aged, and elderly women hobbling round on deformed feet. The strange fact is that the young girl of today, who would laugh at a whale-bone corset of Victorian days, treats her feet in the same way as her great-great-grandmother treated her waist." 99 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 demon' stration 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. Further details regarding health education activities are included in the report of the Superintendent Health Visitor on page 84. THE PREVENTION AND ALLEVIATION OF DEAFNESS In June, 1957, the Ministry of Health issued a memorandum on this subject and sufficient copies were obtained for circulation to, all medical, health visiting, school nursing and home nursing staff. The importance of early recognition and adequate treatment and training was stressed and the provision of a suitable hearing aid if indicated. Congenital deafness has been noticed to occur in children exposed to noxious influences during the early months of intrauterine life and a note is made on the Welfare Clinic Record Card of all babies whose mothers give a history of infectious illnesses (particularly rubella during the pregnancy) of hæmorrhage, toxaemia, difficult labour, neonatal anoxia, or jaundice. Record Cards in these cases are conspicuously marked for follow-up and the baby's hearing tested before it is a year old. Where deafness is suspected, a report is made so that further tests can be arranged. DOMESTIC HELP SERVICE (Section 29) Mrs. C. M. Hall, the Area Domestic Help Organiser was, unfortunately, sick from the 2nd April, 1957 until the end of the year, but fortunately Mrs. W. Pickard assumed duty as additional Organiser as from 1st April and additional clerical assistance was arranged. Much help was also received through the courtesy of the County Medical Officer from the County Domestic Help Organiser, Miss G. Jenkins. 100 Mrs. Pickard contributes the following report:— "During 1957 the Domestic Help Service has continued to give valuable assistance to all categories of sick and aged people. New applications have shown an increase throughout the year and all cases have been dealt with as expeditiously as possible. The hours of service given to patients suffering from tuberculosis have increased, but there has been a slight decline in the number of maternity cases assisted. "Help for problem families, care of children and assistance for harassed mothers has been adequately given by specially selected domestic helps well suited to this work. "The following is a summary of the year's work:— Brought forward from 1956 713 New cases during 1957 433 Cases completed during 1957 482 Number of cases carried forward to 1958 664 "It will be noticed that there are fewer cases to carry forward to 1958 because a greater number of completions were made than during the previous year. "Visits, both first and re-visits, totalled 3,289. The aim was to visit households every two months and to endeavour to include at least one visit when the domestic help was present, and this was achieved in most instances. "Recruitment of personnel was steady and applicants were of an extremely good standard generally. The total number of domestic helps in employment is 205, including 6 working full-time." 101 DOMESTIC HELP SERVICE, 1957 Maternity Acute Sick Tuberculous Chronic Sick Aged Others Aged not Sick Others  Requests for help from new cases during the year 84 57 22 310 67 18 13 571 Total cases helped during the year 64 38 34 877 117 40 9 1,179 Under 3 mths. 2 2 3 69 7 3 3 89 Cases being helped at end of year 3-6 „ — — 1 21 4 — 1 27 who have received help for: 6-12 „ — 2 4 49 7 4 — 66 Over 12 „ — 1 7 431 33 10 — 482 Total carried forward to 1957 2 5 15 570 51 17 4 664 Hours of help provided during the year 2,975 3,388¼ 2,956½ 139,881¾ I7,586½ 5,814¼ 391¼ 172,994 102 COUNTY COUNCIL OF ESSEX—WELFARE COMMITTEE WELFARE SERVICES Mr. W. E. Boyce, 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 1957:— (1) Residential and Temporary Accommodation. (a) Admitted to hostels and other residential establish' ments: Men, 29 ; Women, 24. (b) Admitted to temporary accommodation : Men, 1; Women, 5; Children, 16. (2) Blind Persons. "The numbers of registered blind, partially sighted and defective sighted persons resident in the Borough on the 31st December, 1957, were as follows:— (i) Registered as blind 251 (ii) Partially sighted 49 (iii) Defective sighted 13 all of whom were under the supervision of the County Council's Home Teachers. On the same date six blind resi' dents were participating in the Home Workers' Scheme operated through the agency of the Royal Society for the Blind, and one was employed in a workshop for the blind. In addition, there were twentyseven blind and fifteen partially sighted residents employed in open industry. (3) Deaf or Dumb and other Handicapped Classes. "The Welfare Committee has continued to develop its activities in respect of welfare services for permanently and substantially handicapped persons (other than blind, as mentioned above) as provided for under Section 29 of the National Assistance Act, 1948, and in addition to direct provision such as special equipment on loan, grants towards the cost of structural adaptations to meet special needs, etc., the fullest co'operation has been maintained with specialised organisations in this field of welfare services, many of these bodies acting as the Council's agents in this connection."