C4411(1) Walthamston WAL 47 BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1958 A. T. W. POWELL, M.C., M.B., B.S., D.P.H. MEDICAL OFFICER OF HEALTH Arthur Gaunt & Sons (Printers) Ltd., Market Place, Heanor. 14th .Oct.1959. BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER. OF HEALTH for the Year 1958 A. T. W. POWELL, M.C., M.B.. B.S., D.P.H. MEDICAL OFFICER OF HEALTH TOWN HALL, FOREST ROAD, LONDON, E.I7 Telephone—LARKSWOOD 2334 2 INDEX PAGE Section A.—Statistics and Social Conditions of the Area 14 Section B.—General Provision of Health Services in the Area 22 Section C.—Sanitary Circumstances of the Area 26 Section D.—Housing 33 Section E.—Inspection and Supervision of Food 44 Section F.—Prevalence and Control over Infectious Diseases 55 Section G.—Miscellaneous 65 Section H.—National Health Service Act, 1946—Part III Services 71 Health Centres 72 Care of Mothers and Young Children 73 Midwifery 87 Health Visiting 89 Home Nursing 91 Vaccination and Immunisation 93 Ambulance Facilities 99 Prevention of Illness, Care and After-Care 99 Domestic Help 105 page Accidents in the Home 21, 68 Acreage 14 Adulteration.. 48 Aged and chronic sick 25, 66 Ambulance Facilities 24, 99 Ante-Natal Clinics 73, 75, 79 Ante-Natal Care 74 Assessments 14 Atmospheric Pollution 6 Bacteriological Examinations 46, 50 B.C.G. Vaccination 98 Biological Tests 45 Birth Notifications 76 Birth Registrations 19 Births, Illegitimate 15 Birth Rate 15 Blind Persons 109 "Brookscroft" Welfare 80 Cancer deaths .20,21 Cancer Education 69 Care and After-Care 99 Care of Illegitimate Children 78 Child Guidance 83 Child Welfare Clinics 79, 88 Chiropody 66, 101 Clean Air Act, 1956 6, 31 Cleansing (Personal) 24, 86 Clearance Areas .36, 40 Committees 5, 71 Communicable Diseases 7 Comparability Factor 15 Confinements 75 Contact Examinations 101 Convalescence for Adults 101 Convalescence for Pre-School Children 84 Conveniences, Public 69 Cooked Meats 6,48,51 Co-operation with General Practitioners 8, 88, 93 Cremation 69 PAGE Daily Guardian Scheme 85 Day Nurseries 85 Deafness, Prevention of 109 Deaths 15,20,77 Deaths from Accidents in the Home 21 Deaths, Infants 15, 16,77 Death Rate 15 Deaths, Causes of 20, 77 Dental Laboratory Dental Treatment 81 Diphtheria 57 Diphtheria Immunisation 93, 95 Diseases of Animals Acts 52 Disinfections 27, 69 Disinfestation 31 District Midwifery 87 Domestic Help 9, 105 Domiciliary Chiropody 66 Employment 14 Emergency Unit 88 Essex County Council Act. 1933 26 Factories Acts, 1937/48 54 Family Doctors, co-operation with 88, 93 Food and Drugs Act, 1955 48 Food Hygiene Regulations, 1955 50 Flooding 8, 70 Food Inspection 44 Food Poisoning 52, 60 Foot Clinic 101 Funeral Arrangements 68 Gas and Air Analgesia 88 General Dental Service 23, 72 General Information 69 Geriatric Services 24 "Guard That Fire" Campaign 103 3 PAGE Hairdressers and Barbers 29, 32 Health Centres 72 Health Education 7, 9, 68, 102 Health Visiting 89 Home Nursing 8, 91 Home Visits 66, 89 Hospital Accommodation 24 Housing Act, 1936 33, 36 Housing, Closure and Demolition 36 Housing, General 37 Housing, Improvement Grants 34 Housing, Inspection 34 „ Need 38 ,, Old People 65 „ Priority for Tuberculosis 42 Housing Statistics 7, 33, 34 Ice Cream 46 Illegitimacy 78 Immunisation, Diphtheria 93, 95 „ Whooping Cough 93, 96 Infant Mortality 15, 16, 17, 76 Infectious Diseases General 25, 55 Infestation 86 Inquests 70 Integration of Health Services 6,22 Invalid Children's Aid Association 83 Laboratory Facilities 23, 24 Land Charges 33 Laundry Service for the Incontinent 67 Liaison with Hospital Services 6, 89 Lollies 46 Maternal Mortality 16, 18, 86 Maternity Homes 26 Maternity Outfits 88 Meals on Wheels Service 67 Measles 57 Meat and other Foods 46 Medical Aid 87 Medical Examinations 68 Medicaments 84 Midwifery 8, 87, 88 Milk Designated 44 Milk Inspection 44 Milk (Special Designations) Orders and Regs. 45 Milk Supply 44 Moral Welfare 78 National Assistance Act .25 Neo-Natal Mortality 16, 18, 76 Noise, Nuisance 54 Notices, Sanitary 26 PAGE Notification of Births 76 Nursery Nursing Certificate 85 Nurseries and Child Minders (Reg.) Acts, 1948 85 Nutrients 84 Old People's Welfare 65 Ophthalmic Treatment 83 Orthopaedic Treatment 81 Outworkers 55 Paediatric Clinic 83 Pet Animals Act, 1951 52 Poliomyelitis 59, 97 Population 14 Post-Mortems 70 Post-Natal Clinics 73, 79 Premature Infants 78 Prevention of Damage by Pests Act, 1949 52, 53 Prevention of Illness 99 Prevention of Tuberculosis. .65,101 Public Health Act, 1936 26 Public Health (Infectious Diseases) Regulations 61 Public Health Inspection 6, 26 Pupil Midwives 88 Queen's Institute of District Nursing—Training 92 Radioactivity 69 Rainfall 70 Rateable Value 14 Redevelopment and Clearance Areas 36 Rehabilitation 101 Rehousing on Medical Grounds 42 Relaxation Classes (Ante- Natal) 75, 79 Rent Act, 1957 32 Research 86 Rodent Control 52 Scabies Treatment 24 School Outbreaks 58 Sickness Benefit 65 Sickroom Equipment 101 Smallpox 93 Smoke Abatement 29 Social Conditions 14 Special Premises 27 Staff 10 Statistics 14, 15, 33 Stillbirths .. 15, 16, 18 Sunlight Treatment 81 Swimming Baths 31 4 page Toddlers' Clinic 75 Total Infant Mortality 17 Tonsils and Adenoids 83 Training of Nursery Nurses 85 Training of Pupil Midwives 88 Tuberculosis 62,98,99 Vaccination, B.C.G 98 „ Poliomyelitis 8, 93, 97 „ Smallpox 93 Verminous Conditions 24, 31 Vital Statistics 15,75 PAGE Walthamstow Association of Tuberculosis Care Helpers 9, 99 Walthamstow Child Welfare Society 80 Water 26 Welfare Services 108 Welfare Foods 8, 84 Whooping Cough 58 Whooping Cough Immunisation 93, 96 Women's Clinic 86 5 HEALTH COMMITTEE 1958-9 Chairman: Councillor Mrs. W. M. Palethorpe Vice-Chairman: Councillor O. F. J. McCarthy Ex-officio: The Worshipful The Mayor—Councillor C. J. Crosbie, J.P. The Deputy Mayor—Councillor J. W. Pringle, J.P. Chairman of Finance Committee—Alderman Ross Wyld, O.B.E., J.P. Alderman The Lady McEntee, O.B.E., J.P. „ E. C. Redhead, J.P., M.P. Councillors: Mrs. E. L. Baldwin J. J. Bracken Mrs. S. Candy F. H. Eiles Mrs. L. D. Gurr J. H. Hammond Councillors: G. E. Kitchen G. S. Mace C. B. Reynolds P. F. A. Webster D. Weinstein A. F. Whicher Town Clerk : G. A. Blakeley, Esq. 6 TO THE CHAIRMAN AND MEMBERS OF THE HEALTH COMMITTEE Madam Chairman, My Lady, Ladies and Gentlemen, I beg to present herewith my Twenty-Ninth and last Report as Medical Officer of Health to the Borough of Walthamstow on the health and health services of the Borough during 1958. Once again, by courtesy of the County Medical Officer, I am able to give details of the personal Health Services administered by the Walthamstow Health Area Sub-Committee of the County Health Committee. Vital statistics were on the whole very good with a new low record in the infant mortality rate at 15.4. The still-birth rate was 21.1 against 14.0 in the previous year, but on the other hand the neo-natal death rate was only 8.4 against 16.9, and the year was the second one without a maternal death. A table is included giving the quinquennial averages of the vital statistics back to 1930 and showing the improvement in the overall health position over the last quarter of a century, during which the infant mortality rate has been reduced from 49.0 to 23.0, the still-birth rate from 35.5 to 19.8, the neo-natal mortality rate from 25.6 to 16.4 and the maternal mortality rate from 3.92 to 1.2. Details are given of the integration of the health services, which appear to be the best possible having regard to the overall trichotomy. Old people's welfare is strictly a function of the Local Health Authority, but much is done by the Walthamstow Old People's Welfare Association and the Borough Council in regard to our ageing population, a problem which is becoming one of the most urgent in the field of Public Health. Fifty-nine cases required individual and special consideration as against forty-one last year in regard to the possibility of admission to an appropriate institution. Twelve cases required consideration in regard to the possibility of compulsory removal under the National Assistance Act, Section 47 as compared with four in the previous year. Fortunately, however, in only one case was an Order required. With regard to the work of the Public Health Inspectorate, the atmospheric pollution instruments installed in the town showed that, on the whole, the degree of sulphur dioxide contamination is considerably less than in some adjoining areas. A pilot survey was carried out in regard to a smoke control area consisting of 784 dwellings and action is now proceeding in regard to the submission of a definite area as a commencement in making the whole of the Borough a smokeless zone. Routine inspections were well maintained. With regard to inspection and supervision of food, routine sampling was well maintained. The Deputy Chief Public Health Inspector prepared a paper in regard to the sampling of cooked 7 meats for presentation to his Association and for publication later. His summary and conclusions are, with his agreement, included in this Report. Housing progress was well maintained and at the end of the year there were 5,384 properties under management by the Housing Department, i.e., an increase of 440 over 1957. Progress continued in regard to the redevelopment of slum clearance areas, and it will be remembered that last year's Report stated that all the actual inspections of dwellings in the five year programme had been completed during 1957. The redevelopment of areas 1 to 6 shows a "profit" of fifty-seven dwellings in regard to the sites of the 378 former dwellings in these areas. The contributions of my colleagues, the Borough Architect, Engineer and Surveyor, and the Housing Manager, and extracts from the annual reports to the Housing Management and the Reconstruction and Housing Committees are included, and show the great progress made. With regard to communicable diseases, their total incidence was slightly less than during 1957, there being more cases of dysentery, erysipelas and scarlet fever, but less of food poisoning, measles, poliomyelitis, pneumonia and tuberculosis. Bacillary dysentery was again prevalent from February onwards and 170 of the 230 total cases were under fifteen years of age. This continued incidence seems to be largely due to the neglect of parents in sending children to school in an unfit condition, in many cases bound up with the desire of the mother to continue at paid work and also to the continued neglect of adequately washing the hands after using the water closet. Reference is made to the chronic typhoid carrier for whom responsibility is shared between the Borough Councils of Chingford and Walthamstow. The carrier condition has now lasted for at least twenty-two years. Concerning tuberculosis, the increasing notifications for the last three years came to a stop during 1958 with an abrupt fall to the lowest incidence ever recorded and also the lowest death rate from tuberculosis. This distressing disease is by no means yet eradicated, but steady progress is being made. With reference to health education, the Borough Council took an active part in supplementing the work done through the Health Area Sub-Committee of the County Council. A list is given by the Borough Architect, Engineer and Surveyor of the public conveniences erected since 1922. It has been a matter of great pleasure to hear several expressions of appreciation from members of the public in regard to the excellent provision which has been made in Walthamstow and not least, the free facilities which have existed for many years. It seems to be an example which many other areas, might copy with advantage. 8 A commencement was made in regard to measures to reduce flooding due to abnormal rainfall. Turning to the Personal Health Services administered through the Health Area Sub-Committee, the routine work showed a satisfactory position with an increase in ante and post-natal examinations. There was a marked improvement in the number of expectant mothers with a haemoglobin level of under 70%. Infant deaths from prematurity were only six against sixteen in 1957, clearly a reflection of improving ante-natal care. The chief cause of infant mortality is congenital malformation, which so far has defied effective preventive measures. Attendances at welfare clinics were approximately 1,000 less than in 1957, but on the other hand allowance must be made for the increasing number of family doctors who are organising their own welfare clinics. Unfortunately the "uptake" of welfare foods continues to fall. Co-operation was given to the perinatal mortality survey organised by the National Birthday Trust and in regard to the investigation sponsored from Guy's Hospital into the transmission of antibodies. The home nursing and district midwifery services continued good work with over 69,000 home nursing visits and nearly 10,000 midwifery and maternity visits. Nearly 92% of expectant mothers confined on the district received analgesia. Over 16,000 domiciliary visits were paid by the health visitors and the Superintendent Health Visitor gives an interesting account of their work and the increasing co-operation with family doctors. Vaccination and immunisation continued to make progress and of children under one year 62% were immunised against diphtheria and 68% against whooping cough. The target for diphtheria immunisation is 75% below the age of one year and unfortunately there is now a general tendency to forget the continuing need for diphtheria immunisation in view of the more fashionable immunisation against poliomyelitis and whooping cough. From time to time sharp reminders are received as to what can happen in a community which may either wholly, or in part, be inadequately protected against diphtheria. One such outbreak occurred in a neighbouring borough last autumn and although there were only eleven cases, one was fatal and another gravely ill. Only two had been fully immunised and both these cases were mild. The control of the outbreak involved an immense amount of work with considerable disorganisation, and some 4,000 swabs were taken from some 1,800 persons before the outbreak was finally cleared. With regard to vaccination against poliomyelitis, considerable administrative difficulties followed from the extension of entitlement and from the variation in the make and availability of vaccine. In 9 spite of this by the end of 1958 over 13,000 children and expectant mothers had been vaccinated. Good progress was made in regard to B.C.G. vaccination. Reference must be made to the resignation of Miss A. Woolgar who had rendered fine service as the energetic Honorary Secretary of the Walthamstow Association of Tuberculosis Care Helpers for some eleven years. As regards chiropody, the facilities available are completely inadequate and could with advantage be doubled, since a period of thirteen/fourteen weeks elapses before appointments can be made for those requiring repeat treatment. The general authority given by the Ministry of Health in 1959 to expand facilities may carry a danger to areas like Walthamstow where well-established services are available, in that staff may be lost to other expanding areas unless the existing unrealistic salary scales are improved. With reference to health education, advantage was taken of all opportunities by the extension of talks at welfare clinics and schools, to adult organisations, and in connection with the National "Guard that Fire" campaign, which is fully described by Dr. Poole. The most difficult and urgent problem is to bring adequately to the attention of the public, and especially the adolescent, the danger which seems to result from excessive cigarette smoking. An eminent surgeon is recently reported to have stated that he is convinced that every heavy smoker will develop lung cancer unless heart disease or some other sickness claims him earlier. Another is reported to have recommended that after the age of forty years, every heavy smoker should have a chest X-ray examination at least every six months. The employment of a second Domestic Help Organiser has been of great value and has allowed more inspections and the "tidying up" of the Service generally. As the completion of twenty-nine years service in Walthamstow draws near, I wish to thank all members of the staff of the Department, for their good work. Despite the complications following from the Acts of 1944 and 1946, the Department has still continued to function as a single entity. I wish also to thank past and present Chairmen and Members of the Committees dealing with matters of health for their unfailing help and support, as well as the Town Clerk, other Chief Officers and Heads of Departments, and not least the Family Doctors practising in Walthamstow. It has been a happy and rewarding term of service. I have the honour to be, Your obedient Servant, A. T. W. POWELL, Medical Officer of Health. 10 STAFF OF THE HEALTH SERVICES WALTHAMSTOW BOROUGH COUNCIL Medical Officer of Health: A. T. W. Powell, M.C., M.B., B.S., D.P.H. (Part-time). Deputy Medical Officer of Health: G. H. Poole, M.B., B.S., D(Obst.)R.C.O.G., D.P.H. (Part-time). Chief Public Health Inspector: W. Richards, D.P.A., M.A.P.H.I., (a) (b) (c). Deputy Chief Public Health Inspector: H. L. Hughes, D.P.A., M.A.P.H.I., (a) (b) (c) Public Health Inspectors: R. A. Begley, M.A.P.H.I., (a) (b) (c) R. C. Bland, M.A.P.H.I., (a) (b) V. Croft, M.A.P.H.I., (a) (b) D. J. Cross, M.A.P.H.I., M.R.S.H., (a) (b) (c) A. J. Goffin, M.A.P.H.I., (a) (b) (c) B. W. Goode, M.A.P.H.I., (a) L. Joyce, M.A.P.H.I., (a) (b) D. R. King, M.A.P.H.I., (a) (b) E. J. Wilkins, M.A.P.H.I., (a) (b) Res. 24.3.1958 Student Public Health Inspectors: E. B. Beckett, Appointed 6.1.1958. B. J. English, Appointed 14.1.1958 (a) Public Health Inspectors Certificate. (b) Meat and Food Inspection Certificate. (c) Smoke Inspectors Certificate. Chief Clerk: R. Rose. Clerical Staff: Miss A. S. Horsnell. L. W. R. Kemp. F. G. T. Parker. Mrs. A. D. Sharp. Rodent Operatives: H. Newbury. W. Hill. Driver / Disinfectors: H. Thompson. E. W. Searle. Infectious Disease Nurse: Miss I. H. Jennings, S.R.N., S.C.M. Laundress: Mrs. D. A. Puleston (Part-time). 11 ESSEX COUNTY COUNCIL STAFF — 1958 Area Medical Officer: A. T. W. Powell, M.C., M.B., B.S., D.P.H. (Part-time). Assistant County Medical Officers of Health: G. H. G. Poole, M.B., B.S., D.(Obst.)R.C.O.G., D.P.H. (Part-time). Miss C. P. Dooley, L.R.C.P.I., & L.M., D.P.H. Mrs. M. Edwards, M.B., B.Ch., C.P.H. (Part-time). Mrs. J. H. W. Newman, M.B., Ch.B., D.(Obst.)R.C.O.G., D.P.H. (Part-time). G. B. Taylor, M.B., B.S., D.C.H., D(Obst.)R.C.O.G. (Apptd. 1.5.58. Res. 30.6.58). Miss J. P. Werren, M.B., B.S., D.C.H., D.(Obst.)R.C.O.G. Specialist Part-time Medical Officers (appointed by Regional Hospital Board): Ear, Nose and Throat Surgeon: A. N. Cammock, M.B., B.Ch., D.L.O. Ophthalmologist: H. Ho, M.R.C.S., L.R.C.P., D.L.O., D.O.M.S. Orthopaedic Surgeon: G. Rigby-Jones, M.C., T.D., M.A., M.B., B.Chir., F.R.C.S. Paediatrician: E. Hinden, M.D., M.R.C.P. Psychiatrists: Mrs. H. Gillespie, M.R.C.S., L.R.C.P. W. P. Gurassa, M.D., B.S., M.R.C.P. (from 27.1.58). Dental Officers: Miss D. Anklesaria, L.D.S. Mr. D. A. Clark, F.D.S. Mr. L. Elmer, L.D.S. Mrs. S. Forbes-Miric, L.D.S. (Part-time). Mr. R. Hyman, L.D.S. Miss S. Johnson, B.D.S. (Apptd. 25.1.58. Res. 18.5.58) Dental Attendants: Mrs. D. Rosser (Senior). Mrs. D. I. Allen (Part-time). Mrs. S. Dewey. Miss G. M. Hutchins. Miss N. F. Hutchinson. Dental Technicians: Mr. G. H. Higgins (Senior). Mr. W. Landes, Stat. Exam. (Part-time). Mr. R. T. Mills, L.D.S. (Part-time). Mr. R. V. Tait, L.D.S., Orthodontist (Part-time). Mr. G. P. L. Taylor, L.D.S. Mr. J. C. Timmis, L.D.S. Mrs. E. M. Labrom (Parttime). Mrs. M. S. G. Stewart (Part-time). Mrs. E. E. Wood Mrs. M. E. Wright. Mr. G. H. Allen. 12 Health Visitors I School Nurses. Mrs. J. M. A. Foulkes, Miss D. G. Legg. (Superintendent). Mrs. E. Levis (Part-time). Miss R. Boyd. Miss O. North. Miss E. L. Cunnington. Miss J. M. Palmer. Miss E. duRandt. Mrs. E. Rowston (Apptd. Mrs. E. M. Geary. 1.1.1958). Miss C. R. Douglas. Mrs. G. H. Salter. Mrs. J. L. Haynes, (Apptd Miss M. E. Waghorn. 1.9.19581. Miss A. Wuic,ht. Mrs. D. E. Lambert (Part-time). All the above are S.R.N., S.C.M. and H.V.Cert. Clinic Nurse: Mrs. P. Crisp, S.R.N. Auxiliary—Mrs. E. Lynch. Tuberculosis Visitors: Miss M. A. Campbell, S.R.N. Miss U. E. Price, S.R.N., S.C.M., B.T.A., Orth.Nursing Cert. District Nurse/Midwives and District Nurses: Miss N. Chadwick, S.R.N., S.C.M., Q.N., H.V.Cert. (Superintendent). Miss A. N. Stacey, S.R.N., S.C.M., Q.N. (Assistant Superintendent). Apptd. 1.2.1958. Miss M. M.Crowley, S.R.N., C.M.B. (Part I), Q.N. (Senior Nurse). Apptd. 1.3.1958 Mr. H. J. Butler, S.R.N., R.M.N. Q.N. Miss H. S. Chiu, S.R.N., S.C.M., Q.N. Mrs. W. C. Clinton, S.R.N., S.C.M., Q.N. Miss M. M. Connolly, S.R.N., S.C.M., Q.N. Miss J. P. Cross, S.R.N., S.C.M., Q.N. Apptd. 6.7.1958. Miss H. K. M. Felsztyn. S.R.N., S.C.M., Q.N. Mrs. V. C. Fitzgibbon, S.R.N., Q.N. Apptd. 5.2.1958. Miss M. Folan, S.R.N. Apptd. 29.12.1958. Mrs. M. H. Giles, S.R.N., S.C.M., Q.N. Mrs. M. R. Russ, S.R.N. Mrs. E. Law, S.E.A.N. (Part-time). Mrs. E. Lawlor, S.R.N., C.M.B. (Part I), Q.N. Apptd. 1.8.1958. Miss K. F. M. Lloyd, S.E.A.N. (Part-time). Mr. J. H. Moore, S.R.N., Q.N. Miss L. K. B. Newman, S.R.N., S.C.M., Q.N. Mrs. A. Norman, S.R.N. Mrs. M. Hollebrand, S.R.N., S.C.M., Q.N. Miss R. O'Halloran, S.R.N., S.C.M., Q.N. Mrs. R. O. Riopedre, S.E.A.N. (Part-time). Mrs. J. M. Shepherd, S.E.A.N. (Part-time). Mrs. P. Tharp, S.R.N., S.C.M., H.V.Cert. (Res. 10.11.1958). Mrs. L. Wale, S.R.N. Mrs. F. L. Walker, S.R.N. (Part-time). 13 District Midwives : Mrs. A. Gilbert, S.R.N., S.C.M. Miss N. Hodges, S.R.N., S.C.M., S.R.F.N. Miss O. Roberts, S.R.N., S.C.M. Mrs. M. Washbourne, S.R.N., S.C.M., S.R.F.N. Matrons of Day Nurseries: Mrs. D. Androvenda, S.R.N. Mrs. G. Moore, S.R.N., S.C.M., S.R.F.N. Chiropodists: R. J. King, M.Ch.S. (Senior). G. McCart, M.Ch.S. L. N. C. Martin, M.Ch.S. L. R. Skinner, M.Ch.S. Senior Administrative Assistant: F. J. Aylward. Administrative and Clerical Staff: Mrs. V. L. Aylward (Part- L. S. Humphrey. time). Res. 31.8.1958. Miss V. N. Jennings. Mrs. M. C. Board (WholeG. B. Martin. time from 24.2.1958). R. T. Prudden. G. J. S. Bradley. Miss I. T. Sparrow. Mrs. E. D. Browne. Mrs. A. S. Speechley, Miss G. M. Cooke. Retired 11.6.1958. Mrs. C. Craddock (PartMrs. I. M. Spencer time). time). Miss M. Game. Miss M. R. Stanley. R. A. C. Green. Mrs. D. M. Taylor. Mrs. C. M. Hall. Miss C. Thompson. Mrs. G. M. Hooper (PartMiss M. Warren. time). Miss E. Weatherill. Domestic Help Organisers: Mrs. B. I. Oliver (Apptd. 24.2.1958). Mrs. W. E. Pickard. Whole-time Domestic Helps: Mrs. A. E. Hill. Mrs. M. A. Starling. Mrs. S. H. Locke. Mrs. G. M. Veysi. Mrs. M. Marriott. Mrs. F. M. Wallis. Mrs. H. H. Mayer, 14 A.—STATISTICS & SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1958) 114,000 Number of Assessments (31st December, 1958)39,290 Rateable Value (31st December, 1958) £1,593,455 Estimated Product of a penny rate £6,350 Population.— The Registrar-General's Estimate of the home population at mid-year, 1958, is 114,000 a decrease of 1,300 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 1,247 families were so rehoused by the Housing Department alone between 1950/58. Employment.— According to information kindly supplied by Mr. L. A. Houseman, Manager of the local Employment Exchange, approximately 280 men and 180 women were placed in employment every month during the year 1958 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 80,500. Of this number it is estimated that about 35,000 were employed in Walthamstow. During 1958, the average number of persons unemployed in the whole area was 970 men and 240 women, including 130 disabled men and 20 disabled women. Note.— The figures of insured persons are based partly on the number of N.I. cards exchanged during the June to September quarter and partly in returns rendered by certain employers showing the number of N.I. cards they hold. Caution should be exercised in comparing the numbers of persons unemployed with the insured persons. An unemployed person need not necessarily register at an Employment Exchange in the area where his N.I. Card is exchanged. Normally an employed person's N.I. Card would be counted in the area in which he works, while if he became unemployed he would be likely to register at the Employment Exchange in the area in which he lives. 15 Extracts from Vital Statistics.—The Registrar-General's midyear 1958 estimate of the home population (viz., 114,000) has been used for the calculation of all vital statistics. Live Births Totals Male Female Legitimate 1,247 653 594 Birth rate per 1,000 of the estimated home population 11.3 Illegitimate 50 28 22 Totals 1,297 681 616 Illegitimate live births per cent of total live births 3.8 Stillbirths 28 Rate per 1,000 (live and still) births 21.1 Deaths 1,170 Death rate per 1,000 of the estimated home population 10.2 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 15.4 Legitimate infants per 1,000 legitimate live births 16.0 Illegitimate infants per 1,000 illegitimate live births Nil Deaths from measles (all ages) 1 Deaths from whooping cough (all ages) Nil Deaths from diarrhoea (under two years of age) Nil Pulmonary tuberculosis death rate 0.06 Non-Pulmonary tuberculosis death rate Nil The natural increase of population, i.e., excess of births over Deaths was 127. Deaths.— The Registrar-General's classification of causes of death by sex totals is given. The total number of deaths in 1958 (1,170) compares with d,324 in 1957, the respective death rates being 10.2 and 11.4 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 11.3 Deaths 10.9 16 INFANT DEATHS, NEO-NATAL MORTALITY AND STILLBIRTHS Year Live Births Live Birth Rate per 1,000 Population Stillbirths Neo-Natal Deaths Infant Deaths No. Per 1,000 total (live and still) births Per 1,000 population No. Per 1,000 live births No. Per 1.000 live births 1958 1,297 11.3 28 21.1 0.24 11 8.4 20 15.4 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 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 1958 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 Rates per 1,000 Births (Live and Still) Puerperal Sepsis Other Puerperal Causes Total Puerperal Sepsis Other Puerperal Causes Total j 1958 1,325 - - - - - - 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 17 If the infant mortality rate tor 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. 18 Years Census : Reg. Gen. Estimated Population 1911 124,597 L/B. rate (per 1,000 pop'n.) 1921 129,395 Neo-Natal Mortality Rate 1931 132,972 Stillbirth Rate (per 1,000 L/S) 1951 121,135 Infant Mortality Rate Maternal Mortality Rate MATERNAL MORTALITY, STILLBIRTHS & NEO-NATAL DEATHS The following table shows the maternal mortality, stillbirth and neo-natal death rates since 1930:— W'stow E/W. W'stow E/W. W'stow E/W. W'stow E/W. W'stow E/W. 1930 124,800 15.7 16.3 20.9 30.9 34.0 41 39 60 4.59 4.40 1931 132,965 14.5 15.8 26.1 31.5 29.4 41 56 66 0.51 4.11 1932 135,010 13.2 15.3 30.7 31.5 43.8 41 57 65 4.40 4.19 1933 135,600 12.3 14.4 29.3 32.2 37.4 41 53 63 5.30 4.52 1934 135,090 12.6 15.0 20.4 31.4 33.8 40 44 59 6.40 4.62 1935 134,490 12.4 15.0 21.5 30.3 33.0 41 37 57 3.0 4.15 Quinquennial Average: 134,631 13.0 15.1 25.6 31.4 35.5 41 49 62 3.92 4.32 1936 133,600 12.4 14.8 16.9 30.1 30.5 40 42 59 1.74 3.86 1937 131,900 12.7 14.9 20.8 29.7 34.5 39 51 58 3.57 3.37 1938 130,800 12.3 15.1 17.3 28.3 41.7 38 40 53 1.85 3.25 1939 130,000 12.3 14.8 17.4 28.2 37.0 38 29 51 1.29 3.10 1940 109,400 14.3 14.1 24.7 29.6 25.9 37 40 57 0.63 2.62 Quinquennial Average: 127,140 12.8 16.7 19.4 29.2 33.9 38 40 55 1.81 3.24 1941 94,170 13.8 13.9 23.7 29.0 26.1 35 45 60 6.89 2.79 1942 98,750 17.4 15.6 20.3 27.2 29.5 33 40 51 1.16 2.47 1943 100,500 18.1 16.2 26.2 25.2 30.7 30 40 49 4.92 2.30 1944 101,140 18.9 17.7 20.8 24.3 26.4 28 37 45 5.21 1.92 1945 103,320 16.5 15.9 21.0 24.7 31.6 28 38 46 1.74 1.80 Quinquennial Average: 99,576 16.9 15.8 22.4 26.1 28.8 31 40 50 3.98 2.26 1946 118,050 21.5 19.1 19.2 24.4 26.7 27 34 43 0.78 1.43 1947 122,470 21.8 20.5 13.1 22.7 21.6 24 29 41 1.49 1.17 1948 122,700 16.8 17.8 11.1 19.7 21.7 23 20 34 Nil 1.02 1949 123,400 14.9 16.7 16.9 19.2 14.5 23 29 32 1.09 0.97 1950 122,700 13.0 15.9 20.6 18.5 22.6 23 26 30 Nil 0.86 Quinquennial Average: 121,864 17.6 18.0 16.2 20.9 21.4 24 27 36 0.67 1.09 1951 120,900 13.5 15.5 14.0 18.8 22.7 23 23 30 1.22 0.81 1952 120,400 12.6 15.3 15.2 18.3 18.8 23 24 28 1.98 0.72 1953 119,400 12.2 15.5 18.6 17.6 25.5 22 28 27 1.37 0.75 1954 119,000 12.3 15.2 16.9 17.7 14.0 23 22 25 0.67 0.70 1955 117,800 11.3 15.0 17.5 17.2 17.9 23 20 25 0.76 0.64 Quinquennial Average: 119,500 12.4 15.3 16.4 17.9 19.8 23 23 27 1.20 0.72 1956 116,700 11.8 15.6 12.9 16.8 17.6 23 19 24 0.72 0.56 1957 115,300 11.4 16.1 16.6 16.5 26.4 22 24 23 Nil N/A 1958 1 14.000 11.3 16.4 8.4 TM/A 21.1 21 15 22 Nil N/a E/W—England and Wales. L./S- livo and Stillbiriths N //A Nor Availablc 19 REGISTRATION OF BIRTHS The Registrar-General's returns show the following registrations during the calendar year:— Live Births. Males Females Totals Legitimate 653 594 1,247 Illegitimate 28 22 50 Totals 681 616 1,297 The stillbirth rate for 1,000 population was 0.24. Of the 1,702 local registrations, 702 belonging to other areas are excluded, leaving a net total of 1,000. There were no nonnotified births during 1958. St. James Street High Street Hoe Street Wood Street Hale End Higham Hill Total M F M F M F M F M F M F M F Totals 57 50 56 57 91 89 65 71 139 108 114 03 522 478 Grand Totals 107 113 180 136 247 217 1,000 20 Causes of Death as given by the Registrar-General for the Year 1958 Whole District Causes of Death Males Females Total 1957 1. Tuberculosis, Respiratory 7 - 7 12 2. Tuberculosis, other — - — 1 3. Syphilitic Disease 4 1 5 7 4. Diphtheria — — — - 5. Whooping Cough — — — - 6. Meningococcal Infections — — — - 7. Acute Poliomyelitis — — — 1 8. Measles 1 - 1 - 9. Other Infective and Parasitic Diseases 1 - 1 3 10. Malignant neoplasm, stomach 15 15 30 49 11. Malignant neoplasm, Lung, bronchus 46 14 60 76 12. Malignant neoplasm, breast — 34 34 37 13. Malignant neoplasm, uterus — 4 4 11 14. Other malignant and lymphatic neoplasms 61 55 116 129 15. Leukaemia, aleukaemia 3 4 7 6 16. Diabetes 4 5 9 11 17. Vascular lesions of nervous system 54 74 128 158 18. Coronary disease, angina 105 93 198 180 19. Hypertension with heart disease 8 16 24 16 20. Other heart disease 59 95 154 177 21. Other circulatory disease 21 27 48 47 22. Influenza 7 5 12 21 23. Pneumonia 36 38 74 99 24. Bronchitis 55 18 73 75 25. Other diseases of respiratory system 10 3 13 11 26. Ulcer of stomach and duodenum 15 3 18 16 27. Gastritis, enteritis, and diarrhoea — 7 7 4 28. Nephritis and nephrosis 5 2 7 9 29. Hyperplasia of prostate 7 — 7 10 30. Pregnancy, childbirth, abortion — — — — 31. Congenital malformations 4 9 13 14 32. Other defined and ill-defined diseases 39 50 89 108 33. Motor vehicle accidents 2 2 4 11 34. All other accidents 6 7 13 15 35. Suicide 8 6 14 18 36. Homicide and operations of war — — — — Totals, 1958 .. 583 587 1,170 Totals, 1957 .. 690 634 — 1,324 The age distribution of Cancer deaths was as follows :— Under 1 yr. 1-2 yrs. 3-5 yrs. 6-15 yrs. 16-25 yrs. 26-45 yrs. 46-65 yrs. 65 yrs. & over — — — - - 6 100 145 21 CANCER DEATHS The following table shows deaths from Cancer (including Leukaemia and Aleukaemia) and death rates in England & Wales and Walthamstow during the years 1943 to 1958. The table has been prepared with the assistance of the Registrar General's office. Year Total Eng. & Wales Deaths Walthamstow Rate per 1,000 population Eng. & Wales Walthamstow 1943 73,566 235 1.9 2.3 1944 73,497 220 1.9 2.2 1945 75,712 207 2.0 2.0 1946 77,516 223 1.9 1.9 1947 79,784 234 1.9 1.9 1948 81,655 223 1.9 1.8 1949 83,204 209 1.9 1.7 1950 85,270 253 1.9 2.1 1951 86,080 206 2.0 1.7 1952 87,642 241 2.0 2.0 1953 87,924 211 2.0 1.8 1954 90,095 261 2.0 1.8 1955 91,337 272 2.0 2.3 1956 92,701 264 2.0 2.2 1957 94,007 308 2.0 2.6 1958 95,799 251 2.1 2.2 DEATHS FROM ACCIDENTS IN THE HOME Seven deaths occurred in 1958 from this cause. Six died in hospital and one at home. The ages and sexes were :— Male 64 and 87, Female 7 weeks, 70, 75, 78 and 86. in order to put these ana other aeatns in proper perspective, the following comparison is made :— Cause of Death 1955 1956 1957 1958 (a) Suicide 4 11 18 14 (b) Motor Vehicle Accidents 5 7 11 13 (c) All other accidents 14 12 15 13 (d) Accidents in the home (included in line (c) 10 6 6 7 (e) Tuberculosis 17 8 13 7 (f) Poliomyelitis Nil Nil 1 Nil 22 B.—GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH 1. Public Health Officers of the Authority The names and qualifications of the Staff of the Health Department employed by the Authority are given at the beginning of the Report. 2. Integration of Health Services Areas The area of decentralisation for Personal Health Services under the National Health Service Act, 1946 and for the School Health Service under the Education Act, 1944 coincide with that of the Borough as the Local Sanitary Authority. Most of the Members of the Borough Council's Health Committee are Members of the Health Area Sub-Committee of the County Council. Staff The same medical staff are available for these services and the Medical Officer of Health and the Deputy Medical Officer of Health have joint appointments with the County and Borough Councils. Hospital and other Services Three Members of the Local Sanitary Authority (and seven members of other Local Authorities) are Members of the Hospital Management Committee. The Medical Officer of Health is also a Member of the Hospital Management Committee, of the Group Medical Advisory Committee, and of the Divisional Executive of the British Medical Association. Local Offices of the Essex County Council There is a local office for the Duly Authorised Officers in the Mental Health Service, although this is directly controlled by the County Medical Officer at Chelmsford. Similarly there is a local office of the Welfare Department at Wanstead directly controlled again by the County Welfare Officer at Chelmsford. The local representatives of the Children's Department and for blind welfare share accommodation in the same building in Walthamstow with the Duly Authorised Officers. Medical and Nursing Staff Liaison Regular clinical meetings are arranged by the Divisional Executive of the British Medical Association and by the medical societies of the Connaught and Whipps Cross Hospitals. The medical and health visiting staff carry out periodic rounds with the paediatrician at Whipps Cross Hospital and with the 23 geriatrician at Langthorne Hospital. Health visitors and home midwives and nurses assist family doctors in those duties which are the responsibility of the Local Health Authority. In particular they assist at the ante-natal, child welfare and immunisation sessions held by general practitioners. The health visitors give regular talks at Thorpe Coombe Maternity Hospital and to student nurses in general training. Records School medical records are available to family doctors on request and the findings at all specialist clinics are conveyed to them. Many hospitals send summaries of their discharge reports in regard to children and more recently have notified accidents treated in hospitals. As and when required letters are sent to all general practitioners, especially when there are outbreaks of communicable diseases. Nineteen were issued during 1958 and referring to Poliomyelitis Vaccination, Sonne Dysentery, Food Poisoning, Perinatal Mortality Survey, Immunisation and Vaccination Records, Collection of Pathological Specimens, Precautions in regard to Communicable Diseases, Obstetric Emergency Unit, Winter Epidemics, and Emergency Supply of Sera. Training Thorpe Coombe Maternity Hospital is a Part I and Part II training school and is linked with the domiciliary midwifery service at "Carisbrooke" for the district training of Part II pupil district midwives. The student nurses at the Connaught Hospital undertake "field" training with the domiciliary services, as do student nursery nurses from the day nurseries. General Dental Service The dental officers of the Local Health Authority Dental Service, with others, carry out duties for the Executive Council at the Town Hall where there is a recognised Dental Health Centre. Voluntary Agencies There is close co-operation with all voluntary agencies in the Borough and there are periodic case conferences in relation to problem families and more frequent smaller case conferences of the individual officers most closely concerned. 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 :— 24 Specimens Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Total Rhesus, Group and Kahn — 1 3 2 4 — — 4 2 4 2 2 24 Haemoglobin 1 — — 1 2 1 — — — 2 3 — 10 Nose and throat swabs — 3 — — — — 1 — 1 — — — 5 Faeces 1 — — — — — — — — — — — 1 Urine — — — — — — — — — — — — — Totals 2 4 3 3 6 1 1 4 3 6 5 2 40 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 of specimens examined at the Colindale laboratories during the year were as follows:— Specimens Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec . Total Faeces and rectal swabs 24 143 87 24 18 202 21 1 37 23 172 165 98 1204 Nose and throat swabs 6 6 302 66 89 26 4 2 7 8 37 74 577 Urine — — — — — Food — 2 1 2 — 4 2 — 1 3 15 Miscellaneous — — 1 1 5 — 2 — — 2 — — 11 Totals . 30 151 391 93 112 232 219 39 31 182 205 122 1807 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 seven cases were referred there during 1958 receiving fifteen treatments at a total cost of £5 12s. 6d. 6. Hospital Accommodation (a) Acute Cases.—There were no major changes in 1958 in regard to the hospital accommodation available for the inhabitants of the Borough, 25 (b) Chronic Cases.—Regional Hospital Boards have askep 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. Total number of cases 60 New cares 59 Brought forward from 1957 1 M.O.H. requests to Langthorne Hospital or Area Welfare Officer 40 Admitted to Hospitals 29 Admitted to Part III accommodation 8 Died before admission 1 Refused Hospital or Hostel accommodation 5 Cancelled or deferred 15 Waiting Part III accommodation 2 It is a pleasure again to recoid 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 1958 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. 7. Aged and Chronic Sick National Assistance Act, 1948 (Section 47) Twelve cases required consideration during 1958 in regard to possible action under this Section. Consideration of five cases was deferred. Four cases were admitted to hospital, one of whom died in June, 1958 and the other three died in early 1959. In one case the patient went to live with her daughter and another was admitted to welfare accommodation. As a matter of urgency, a Magistrates' Order was obtained to secure the removal to hospital of Miss "E.B.," an elderly lady in need of care and attention, and her removal was effected on the 17th January, 1958. National Assistance (Amendment) Act, 1951 (Section 63) The Medical Officer of Health is authorised by the Council to make application for the necessary Orders in cases to which the Act applies. 20 8. Public Health Act, 1936—Nursing Homes :— No. of Homes No. of Patients provided for Maternity Patients Others Totals Homes first registered during the year — — — — Homes on register at the end of the year 1 4 — 4 There were no refusals or appeals. During the year two inspections were made by the medical staff. No difficulties in regard to supervision arose. 9. Essex County Council, Act, 1933 (Establishments for massage and special treatment) No new licence was granted under the Act during 1958. During the year the medical staff paid thirteen 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 1958. All dwelling houses in the area are supplied direct with piped water. Mr. W. Richards, Chief Public Health Inspector, contributes the following:— Staff Mr. E. J. Wilkins, Public Health Inspector, resigned during the year on being appointed to a similar position with the Borough of Hornsey. Mr. L. F. Joyce, Public Health Inspector, Leyton Borough Council, was appointed in his place. Appointments— Mr. E. Beckett, Student Public Health Inspector—6.1.1958. Mr. B. English, Student Public Health Inspector—14.1.1958 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 14,894 3,956 1,663 1,180 1,022* 233 158* 21,980 * Includes notices outstanding from previous year. 27 Of the 1,180 intimation notices served, 386 were in respect of business premises and the remainder (794) related to defects in private houses. Of the latter figure, 561 were complied with without resort to statutory procedure. It was found necessary to institute legal proceedings against owners for non-compliance with thirteen Abatement Notices. Six Orders were made by the Justices with costs amounting to £4 2s. Od. and in one case an Order was made with penalty of £5 and costs £6 4s. Od. In five instances the hearings were adjourned sine die and one summons was withdrawn. The following table shows the nature of work executed and improvements effected during the year :— Drains tested, 469; Drains reconstructed or repaired, 231; Drains, obstructions removed, 111; Drains, means of access provided, 17; Drains, ventilation provided or improved, 13; Soil pipes repaired or renewed, 65; Rain Water Pipes repaired or removed, 107; Roofs repaired or renewed, 329; Gutterings repaired or removed, 186; W.C. Pans and traps renewed, 213; W.C.s repaired or cleansed, 126; W.C.s light and ventilation improved 4; Gully traps provided, 37; Waste pipes repaired or renewed, 64; New sinks provided, 22; Stoves and Firegrates repaired or renewed, 68; Water supply taken off main, 2; Water supply reinstated, 16; Yard and forecourt pavings repaired. 49; Dirty houses cleansed, 11; Dirty rooms cleansed, 49; Floors repaired, 137; Ventilation under floors provided or improved, 22; Dampness remedied, 338; Offensive accumulations removed, 21; Manhcles repaired or resealed, 105; Miscellaneous repairs, 1,072; Animals improperly kept, removed, 5. Infections Diseasfs Visits to premises, 574. Disinfections Rooms disinfected, 106 ; Articles disinfected, 4,290 ; Articles destroyed, 86. Special Premises Number Visits Paid Factories (a) Non-power 95 43 (b) Power 480 317 (c) Other premises 9 13 Outworkers 684 480 Butchers 84 276 Bakers and Shops 46 78 Fishmongers, Fryers and Curers 37 98 Cafes and Caterers 100 207 28 Special Premises (cont.) Number Visils paid Grocers 263 440 Greengrocers 93 215 Ice Cream Manufacturers and Vendors 376 201 Dairies and Milksellers 124 149 Laundries 1 9 ???essers 72 47 Rag and Bone Dealers 3 9 Piggeries 1 1 School Kitchens 15 97 Street Stalls 138 347 Stables 17 5 Schools — 90 Public Houses 38 67 As a result of the regular periodical visiting of the above premises the following works were carried out:— Butchers Cleansings, 19; Accumulations removed, 4; New bins supplied, 2; W.C.s repaired and cleansed, 2; Light and ventilation improved, 1; Other improvements, 27; Floors repaired and ventilated, 2. Bakers Cleansing, 8; New ceilings fixed, 1; Floors repaired, 4; Other improvements, 9; Light and ventilation improved, 1. Fishmongers Cleansings, 4; Accumulations removed, 2; Other improvements, 11. Cafes and Caterers Cleansings, 15; Light and ventilation improved, 1; Floors repaired, 5; Other improvements, 31. Grocers Store rooms cleansed, 32; Washing accommodation improved, 8; Other improvements, 40. Greengrocers Store rooms cleansed, 3; Washing accommodation improved, 4; Other improvements, 9. Ice Cream Manufacturers and Vendors Cleansings, 6 ; Paving repaired, 1; Other improvements, 15. 29 Hairdressers Cleansings, 1; Other improvements, 3. School Kitchens Cleansings, 2; Other improvements, 2. Dairies and Milksellers Cleansings, 2. Laundries Cleansings, 1; Other improvements, 2. Street Traders Stalls improved, 14. Stable Premises Other improvements, 4; Pavings repaired, 1. Schools W.C.s repaired and cleansed, 9; Flush cisterns repaired, 1. Public Houses Other improvements, 1; Hot water supplied, 1; Hot water supply improved, 2; Cleansings. 3. Smoke Abatement The whole of the Clean Air Act, 1956 is now in operation. The Deputy Chairman of the Health Committee and myself were appointed as delegates of the Council to attend the annual conference of the National Society for Clean Air (late National Smoke Abatement Society) held at Llandudno in October. A series of papers was given on the various aspects of smoke abatement and considerable discussion arose on these subjects. The conference was very interesting and well worth attending. Observations on smoke nuisance from premises in the Borough amounted to seventy-three. Investigations were carried out in all cases—new boiler plant being installed in some factories and Improvements being effected in others. Atmospheric pollution instruments were in operation at the Sir George Monoux Grammar School and the Connaught Hospital from January to November. The instrument at the Sir George Monoux Grammar School was stolen in December and the Council have authorised its replacement. The Council decided to change the site of the instrument at the Connaught Hospital to Willow Walk in December and to instal an additional instrument at the Woodford County High School. This new instrument was operating from 1st December. 30 The readings of these instruments in milligrams of sulphur per day were as follows:— Jan. Feb. Mar. Apr. May June Sir George Monoux Grammar School 3.0 3.0 1.8 1.2 0.99 0.98 Connaught Hospital 2.6 1.9 1.7 0.9 0.76 0.74 Woodford County High School. — — — — — — Willow Walk — — — — — — July Aug. Sep. Oct. Nov. Dec. Sir George Monoux Gra mar School 0.64 1.4 1.0 2.4 2.1 — Connaught Hospital 0.75 1.1 1.2 2.2 2.7 — Woodford County High School — — — — — 2.5 Willow Walk — — — — — 3.7 These figures are lower than most of those given in respect of adjoining authorities and indicate that the sulphur pollution in the atmosphere in the Borough is low. Reports as high as 6.5 are given for Central London. The Council has decided to install another type of atmospheric pollution instrument at the Town Hall and this will be in operation early in the new year. Smoke Control Areas The Council decided in principle to make the whole of the Borough into a smoke control area. This will take many years to put into operation. The pilot survey of an area of approximately 750 premises was completed during the year. From this survey the Council decided to make a smoke control area around the Town Hall comprising approximately 2,500 properties. These properties are mainly dwellings house and inspections of these properties are proceeding. In December the Council defined their first projected Smoke Control area, which is to include portions of the Hale End, Higham Hill, Hoe Street and Wood Street Wards at their contiguous boundaries and with the following broad limits :— Prospect Hill; Shernhall Street (part); Spruce Hills Road; Sturge Avenue; Brookscroft Road; Chingford Road (part); Farnan Avenue; Hurst Road and part of The Drive. There is a total of 784 dwellings in the area, of which 497 are post-war Council dwellings, 33 are pre-war Council acquired dwellings, 122 are pre-war Council dwellings, and 132 are privately owned dwellings. There are also 5 public buildings, 2 commercial buildings and 3 industrial buildings. The size of this area is 117.4 acres. 31 Clean Air Act, 1956 Course of Instruction for Boiler House Operatives With the help and co-operation of Dr. H. Lowery, Principal, South-west Essex Technical College, a course of six lecture demonstrations was arranged at the College in the autumn. The Managements of all Plants in Walthamstow, which were thought to be capable of producing smoke, were circularised in May, July and August as to the requirements of the Act and the various Regulations issued in connection with it. The first circular drew attention to all the relevant documents and other useulf publications, the availability of technical advice from the Health Inspectors and from the National Industrial Fuel Efficiency Service, and preliminary information was given as to the projected course of lecture demonstrations, the fee for the course being two guineas. Eventually fifty persons were enrolled. Verminous Premises The number of houses reported to be verminous still remains comparatively small. Eighty-three rooms were disinfected and insecticides were issued free of charge to tenants of twenty-five 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, with the exception of the Swimming Bath, which was closed for two months for extensive repairs and redecorations, from March 3rd to April 26th, 1958. The number of Swimming Bath bathers was 122,873, the maximum load was on May 1st, when we had 997. During this period we also had 100,761 Slipper Bath bathers. "Sampling was carried out on three occasions with very good results." (b) Whipps Cross Bathing Pool.—This is a large open-air pool situated in Epping Forest, in the area of the Borough of Leyton and a few hundred yards from the Walthamstow boundary. It is administered by a joint Committee representing the two Boroughs. 32 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 six occasions with satisfactory results. (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:— "Once again, the success of the season was affected by adverse weather conditions. In point of fact, attendance was well-down on the previous year and numbered in the region of 20,000, including school-children. "Bacteriological and chemical analysis were excellent and can be recorded as the best ever." Hairdressers and Barbers Registration of these premises is now compulsory under the Srovisions of the Walthamstow Corporation Act, 1956. During the year seventy-two registrations were effected. Bye-Laws in respect of these premises have now been approved by the Ministry of Housing and Local Government and are now in operation. Rent Act, 1957 This Act 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 not carry out the works specified or does not give an undertaking to carry out the work, within six 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 twenty-one forms specified by the Act for use between landlord and tenant, the Council may be involved in thirteen of these. The following action was taken under the Act during 1958:— Part I.—Applications for Certificates of Disrepair— 33 (1) Number of applications for certificates 341 (10 withdrawn) (2) Number of decisions not to issue certificates 3 (3) Number of decisions to issue certificates— (a) in respect of some but not all defects 220 (b) in respect of all defects 108 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 247 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule Nil (6) Number of certificates issued 181 Part II.—Applications for Cancellation of Certificates— (7) Applications by landlords to Local Authority for cancellation of certificates 65 (1 under 1954 Act) (8) Objections by tenants to cancellation of certificates 19 (9) Decisions by Local Authority to cancel in spite of tenants' objection 1 (10) Certificates cancelled by Local Authority 44 (3 under 1954 Act) Housing Act, 1936, Section 62. Applications for "permitted number" were received from landlords and Certificates issued during the year respecting fourteen lettings. Local Land Charges Enquiries relating to outstanding sanitary notices were dealt with in 1,862 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 1958 Hoe Street Ward 28 Flats St. James Street Ward — — Higham Hill Ward 32 Flats — High Street Ward 12 Flats 2 Houses Hale End Ward 69 Flats 1 House Wood Street Ward 87 Flats — TOTAL 228 Flats 3 Houses 34 Houses erected by Private Enterprise Hoe Street Ward 4 Flats — St. James Street Ward 10 Flats — Higham Hill Ward 6 Flats 1 House High Street Ward — — Hale End Ward 14 Flats 6 Houses Wood Street Ward — 7 Houses TOTAL 34 Flats 14 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 100 Total number of grants and amounts approved by Council to owner/ occupiers 38 £7,718 Applications received from Warner Estate Ltd. 71 Total number of grants and amounts approved by Council to Warner Estate Ltd. 74 £14,884 Summary Total number of applications 171 Total number of grants 112 Total amount of grants £22,602 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) 1,673 (b) Number of inspections made for the purpose 4,964 (2) (a) Number of dwelling houses (included under head (1) above) which are inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 9 (b) Number of Inspections made for the purpose 13 (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) 35 (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 794 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 561 III.—Action under Statutory Powers during the Year:— A. Proceedings under Sections 9, 10, and 16 of the Housing Act, 1936 :— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 1 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 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 232 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners *158 (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 4 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil (3) Number of dwelling-houses where Demolition Orders withdrawn (houses made fit) Nil D. Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil * Including those notices outstanding from previous years. 36 (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 Housing Act, 1936 Unfit Houses The following number of premises were dealt with as follows:— Demolition Orders: 4 Closing Orders: Nil Clearance Areas No Official Representations were made during the year. The areas not yet dealt with under the five year programme which expires in 1960 are as follows:— 7. Brunner Road/Side Road/South Grove (66 dwelling houses). 8. Oatland Rise (13 dwelling houses). 9. Courtenay Place/St. James Path/Willow Walk (20 dwelling houses). The Council decided to purchase these properties by negotiation and by the end of the year most of the above properties were owned by the Council. It is proposed to demolish these premises at an early date. Slum Clearance Programme, 1954-59 The following statement shows the overall position in regard to the current Five Year Programme:— No. Site No. of dwellings represented Date represented No. of dwellings erected or projected Date of Completion, etc. 1 Vallentin Road 41 4.11.53 54 11.6.57 1a Short Road 27 4.1.58 2 Grange / Frederick / Lynmouth Roads 119 3.2.54 78 Under construction. 3 Chingford Lane/Payze's Cottages 17 7.4.54 33 2.3.59 3a Chingford Lane/Mill Lane, The Square, Farey's Row 15 7.4.54 28 27.5.58 4 West St./St. Stephen's Road 64 7.12.55 74 Being demolished. 5 Tenby/Southcote Roads 102 6.6.56 135 Rehousing proceeding 6 Parkstone Rd./Wyatts Lane 20 3.10.56 16 Being demolished. Total 378 445 37 Of the total of 445 new dwellings, 6 are bungalows, 11 are bed-sitters, 166 are one-bedroom, 260 are two-bedroom, and 2 are three-bedroom flats or maisonettes. There is, therefore, a nett profit of 67 dwellings, but some additional dwellings were added to those originally represented in order to produce a better area for development. Area 7; i.e., Brunner and Side Roads and South Grove—66 dwellings; Area 8: Oatland Rise—13 dwellings; Area 9: Courtenay Place, St. James' Path and Willow Walk—20 dwellings, have been inspected, but not yet represented pending negotiations in regard to acquisition. This statement has been compiled with the co-operation of the Borough Architect, Engineer and Surveyor. Slum Clearance Programme 1960/65 The Council decided that certain specific properties in three areas, i.e., two in St. James' Ward and one in Wood Street Ward should be provisionally included in the next five year programme. 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 1958:— "During 1958 major attention has again been given to the rehousing of families from Clearance Areas and the occupants of the properties included in the West Street/St. Stephens Road and Wyatts Lane/Parkstone Road Areas have been rehoused. Considerable strides have also been made with the transfer of families from the Tenby Road/Southcote Road/Newman Road Clearance Area. Additional to this, twenty-one tenants have been rehoused from prefabricated bungalows which stood in Langland Close. This land was held on a lease which has expired and will be returned to the owners immediately the work of reinstating the playing fields is complete. Exchanges also continue to be popular and thirty-one were arranged during the year, some of which resulted in securing vacant possession of the larger type of house, whilst others enabled tenants to move nearer to their places of employment, in some instances as far away as the south coast." No. of new properties made available for letting Acquired Normal vacancies Nominations to private landlords New properties at Canvey Total 234 122 84 31 31 502 38 Families rehoused :— 1-bedroom group 159 2-bedroom group 175 3-bedroom group 149 4-bedroom group 19 Total 502 Of the total number of families rehoused, in nine instances there was a medical recommendation made in respect of tuberculosis. Property under management at 31.12.58 (dwellings only):— Pre-1939 houses and flats 1,615 New houses and flats 2,223 Prefabricated bungalows 445 36 properties converted into flats 142 Properties improved 86 Properties acquired for improvement and conversion 523 Properties acquired for General Housing purposes 142 Properties for Clearance and Demolition 89 Requisitioned dwellings (67 licences) 55 Halfway houses 6 General properties 27 New properties, Canvey Island 31 Total 5,384 Total at the end of 1957 was 4,944. The numbers of families rehoused in the New Towns have been as follows :— 1950 8 1955 215 1951 48 1956 131 1952 153 1957 261 1953 165 1958 85 1954 181 Making a total of 1,247 The great majority have been rehoused in Harlow (848), followed by Basildon (146), Stevenage (105), Hemel Hempstead (54), Welwyn (34), Crawley (16), Bracknell (11), Swindon (33). 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. 39 Details of the occupations of all applicants interested in the New Towns are furnished to the Ministry of Labour. Total number of Applications on Housing Register (31.12.58), 3,785. The following extracts are taken from the Annual Report of the Housing Management Committee. Rehousing.—During the period 31st October, 1957 to 1st November, 1958 the Lettings Sub-Committee considered reports dealing with individual cases submitted in accordance with the Conditions of the Points Scheme :— Condition of Point Scheme "C" Families living with relatives 55 "D" Families living apart 5 "E" Irregular overcrowding 14 "K" Three or more families (relatives) in house 4 "H" Transfer of priority housing — "J" Special cases 39 "J" Rehousing subject to nomination 34 M.O.H. Medical recommendations (T.B.) 11 M.O.H. Cases for consideration 10 Special requests for emergency accommodation 42 214 Note : Of the thirty-nine special cases considered under Clause J of the points scheme fifteen were agreed for early rehousing. Housing Register Since the last report the revision of the Housing Register was completed and it is reasonable to say that the present Register containing 3,762 applications can be considered as being "live" applications. The number (987) of new applications received continues to be greater than the deletions from the Register due to rehousing or to applicants finding their own accommodation and the present figure shows a net annual increase of 362 applications. While applications are received from nearly all the newly-married couples a fair proportion of the increase is due to requests from families living in older property, who are desirous of having the modern conditions of Council property. Another factor is the effect of the Rent Act, 1957 on the rent of controlled properties. In June the Committee approved an amendment of the Points Scheme to provide for additional points being awarded to cases where moral overcrowding was occurring. 40 Transfers Transfers of families from Council controlled properties continues to be of major assistance in dealing with families rehoused from Clearance Areas and the new properties are chiefly utilised in this respect. In addition to the rehousing stated in the foregoing Schedule, two hundred and thirty-eight transfers were effected and this figure bears relationship to two-thirds of the new property that became available for letting during the period. The transfer list at present includes three hundred and sixty-one applications from tenants and these are analysed as follows :— 141 tenants who require larger acccmmodation. 34 tenants who require smaller accommodation. 186 tenants requesting change of accommodation. Exchanges During the period thirty-one exchanges were arranged and several resulted in securing vacant possession of the larger type of property. The Exchange Register continues to be popular and there are now 379 applicants. Since a revised system was introduced a little over a year ago there has been an increasing number of persons wishing to inspect the Register. Details are supplied and the applicants make their own enquiries with a view to finding a family with whom to exchange. Every proposal for exchange is fully investigated and sometimes necessitates journeying to other areas to check and verify conditions. Clearance Areas Since the last report the Newman Road/Southcote Road/Tenby Road Compulsory Purchase Order has been confirmed. Home investigations were immediately afterwards carried out and showed that 158 families had to be rehoused. Details of rehousing from that 158 families had to be rehoused. Details of rehousing from the Clearance Areas to date are as follows :— Bedroom accommodation Total Persons 1 2 3 Included in previous reports 69 116 79 264 874 Frederick St./Grange Road/ Lynmouth Road 3 2 2 7 19 West Street/St. Stephens Road 13 16 9 38 109 Wyatts Lane/Parkstone Road 6 7 7 20 65 Newman/Southcote/Tenby Roads 5 7 5 17 61 96 148 102 346 1,128 41 There has been an extension in the co-operative scheme with the London County Council, enabling several Walthamstow families from Clearance Areas to be allocated accommodation near to their places of work at Woking, Roehampton and Boreham Wood. In addition, nine families have been rehoused from properties declared unfit. Acquired Property Acquisition of property continues but more important is the increase in the number of these dwellings that are being improved or converted into smaller units of accommodation. Transfer of occupiers to permit of progress in this work shows a "housing profit" in that many give vacant possession of a five roomed house in return for one or two bedroom flats. During the period sixteen houses have been converted to give sixty-seven smaller units and twenty-four houses have been improved to give modern standards. The present number of vacated properties for this purpose indicates that next year's results must exceed current figures. Halfway Houses During the year two new halfway houses have been opened at 678 and 1011 Forest Road and both offer a high standard of accommodation. This gives a total of six halfway houses, providing accommodation for twenty-seven families. Out-of-Borough Development Considerable time has been expended in bringing details of the out-of-Borough development to the attention of the housing applicants and tenants of Council houses and the replies received are distinctly encouraging. So far 1,800 housing applicants have requested consideration for the accommodation to be erected outside the Borough. Invitations have been sent to the majority of tenants and 299 tenants have made specific request for transfer to the Estates at Canvey Island and Billericay. The development of the Canvey Island Estate in conjunction with the Dagenham Borough Council provided for the first dwellings to be handed over in August. It was reasonable that prospective occupiers should be able to view the Estate and three coach trips were arranged on the 25th June, 27th August and 29th October resulting in over 100 people having the opportunity of viewing and inspecting some of the houses nearing completion. 42 Rehousing of Medical Cases During 1958, thirty cases claiming rehousing priority for tuberculosis were investigated and reported upon. Of these, twenty cases were added to the list of cases. The position at the end of 1958 was as follows :— Class 1 Class 2 Class 3 Total On list at end of 1957 4 9 19 32 Added to list during 1958 4 10 6 20 8 19 25 52 Rehoused or removed from list during 1958 5 3 4 12 On list at end of 1958 3 16 21 40 In addition to the tuberculosis cases, twenty-eight other cases were recorded as needing special consideration on medical grounds and seventy-nine on general housing grounds. The following extracts are taken from the Annual Report of the Reconstruction and Housing Committee:— Erection of Dwellings.—During the period 1st November, 1957 to 31st October, 1958, progress with the erection of dwellings, etc. was as follows:— No. of units for which tenders were or had been approved No. of units on which work was commenced or was in progress No. of units completed Approximate value of scheme No. of units for which drawings were in course of preparation Totals 903 828 299 £ 2,183,617 344 Acquisition of Sites and Properties.—During the year the Council acquired 362 sites and properties of a total value of £261,639. The purposes for which they were acquired were as follows :— Housing Act, 1957—Part V (General Housing) 232 Housing Act , 1957—Part III (Slum Clearance) 78 Town Development Act, 1952 (Outbuilding) Town and Country Planning Act, 1947 (Redevelopment) 3 Requisitioned Properties 42 43 Housing Programme.—In January the Council agreed a programme for 1958 providing for the erection of 559 dwellings on various sites, including a further 251 at Outwood Common. The Ministry had already indicated that the Government's policy was to reduce the number of houses to be built over the next few years, but following a meeting which members of the Committee had with the Ministry on the 1st April, 1958, the Ministry indicated that they would be prepared to consider tenders for the erection of a further 360 dwellings for the calendar years 1958 and 1959, and that to provide continuity of work for the Building Works Department they would be prepared, within the total of 360, to consider the estimate of the Buildings Works Manager for the erection of sixty-two dwellings at The Drive, Stage VIIA, without the work being put out to tender. The Council accepted the Ministry's offer, but reserved the right to make further representations at a later date. Subsequently, schemes for the erection of sixty-two dwellings at The Drive, Stage VIIA by the Building Works Department and 149 at Outwood Common, twenty-one at Manor Road, seventy-eight at Frederick Street and Grange Road and forty-nine at Chingford Road and Knebworth Avenue were approved by the Ministry. Early in September the Ministry indicated that they would be prepared to give consideration to further tenders for the erection of houses submitted before the end of September and the schemes for the twenty-two dwellings at Whipps Cross and the four dwellings at the junction of Winns Avenue and Higham Hill Road have been submitted to the Ministry and have now been approved. Outbuilding. (a) Outwood Common. The contract for the first 149 houses on the southern part of the site was let on the 12th May, 1958, and work commenced on the 14th May, 1958. It is proposed to erect a total of 434 dwellings on this site. Negotiations with the other authorities in South-West Essex as to the allocation of the houses are actively proceeding. (b) Barn Hall, Wickford. It is proposed to erect a total of 326 dwellings on this site. Negotiations with the other authorities in South-West Essex as to the allocation of the houses are actively proceeding. 44 (c) Canvey Island.—This site is being developed by the Dagenham Borough Council on behalf of Dagenham and Walthamstow through a Joint Committee, and the road and sewer works for the first phase of 224 dwellings has now been completed. Rafts have been constructed for all the dwellings, 102 of which are roofed and twenty are completed. The official opening of the estate by Sir Humphrey Gale, Chairman of the Basildon Development Corporation, took place on Saturday, 26th July, 1958. It is expected that about seventy dwellings will be occupied by the end of the year. Conversion and Improvement of Properties.—During the year nineteen houses were converted into seventy-four fiats and improvements and repairs were completed in twenty-seven houses and two flats. Total cost of the work was £84,186. At the end of the year work was in progress in eleven houses being converted into forty-four flats and in fourteen houses, and two flats being improved and repaired. The total value of work in progress was £55,731. Schemes were also prepared during the year for the conversion of five houses into ten flats ; also for the improvement and repair of forty-one houses and seven flats. The Council has approved tenders valued at £45,629 for these schemes and work will be commenced when Ministry consent is received. Hoe Street Reconstruction Scheme.—The construction of the shops, offices and living accommodation on the northern corner of Hoe Street and Church Hill has been completed, the leases of the shops commencing in January and The Ross Wyld Hall, the final item in the scheme, being officially opened on the 30th October, 1958. E.—INSPECTION AND SUPERVISION OF FOOD The following is contributed by the Chief Public Health Inspector:— Designated Milk. During the year 138 samples of milk were submitted to the Counties Laboratories for bacteriological examination, including Phosphatase, Methylene Blue and Turbidity tests. These samples of milk were mainly taken from roundsmen during the course of delivery, or on arrival at schools. They include the bi-monthly sampling of the two dairymen holding Pasteuriser's Licences. 45 The following table gives details of samples of milk taken :— Grade No. of Samples RESULTS Satisfactory Unsatisfactory Pasteurised 87 85 2 Sterilised 1 1 Tuberculin Tested Pasteurised 50 49 1 TOTALS 138 135 3 Churn Rinsings. Eleven samples of churn rinsings were obtained from local dairies to establish the efficiency of the methods used for cleansing the churns. Nine were found to be satisfactory and two unsatisfactory. Biological Test. Sixty-three 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. Sixty-one of the samples gave Negative results, one gave Positive results and one proved to be Inconclusive. The Milk (Special Designation) (Pasteurised & 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 54 Pasteurised 5 Sterilized 130 Sterilized 6 Tuberculin Tested 17 Tuberculin Tested 2 Licences {Plant). Pasteurisers 2 There are no Cow-keepers in the district. The number of Retail Milk Distributors is 124. One hundred and forty-nine visits were paid to registered premises and a satisfactory standard of cleanliness was maintained. The Milk (Special Designations) (Specified Areas) Order, 1951. The above order came into operation on the 1st October, 1951. All milk retailed within the Borough must either be Pasteurised or Sterilised. 46 (b) Ice Cream. Thirty-two applications for Registration were received and were dealt with as follows:— Vendors, New 29 Vendors, Transfers 3 Number on Register at end of year 376 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 17.5 9.0 10.47 Bacteriological Examination of Ice Cream. One hundred and fourteen samples were submitted for examination and for grading in accordance with the provisional test of the Ministry of Health, with the following results:— Grade I 82 ,, II 17 „ III 12 „ IV 3 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). Thirty samples were examined for bacterial purity, two of which were unsatisfactory. Examination for Metallic Contents. Three samples of ice lollies were sent to the Public Analysts for examination for metallic contents and found to be free of same. (c) Meat and Other Foods. There are no slaughterhouses in the Borough. 47 The following is a summary of food surrendered and condemned as being unfit for human consumption. Where possible, the food was salvaged. 457 tins Evaporated Milk 1 tin Ox Tongue 19 ,, Full Cream Milk 1 „ Chicken 9 „ Skimmed Milk 2 tins Chicken Paste 6 „ Cream 1 tin Frankfurters 8 „ Goats Milk 2 tins Sausages 1 tin Milk Beverage 2 „ Sauerkraut 15 tins Baby Food 14 „ Broth 24 „ Peaches 146 „ Soup 8 „ Grapefruit 7 „ Marmalade 110 „ Pineapple 2 „ Jam 72 „ Plums 8 „ Sandwich Spread 109 „ Cherries 1 tin Lemon Curd 7 „ Rhubarb 2 tins Honey 1 tin Raspberries 1 tin Plum Pie Filling 5 tins Gooseberries 44 lb. Apricot Pulp (tinned) 55 „ Oranges 6 „ Fruit Pie Filling (tinned) 10 „ Prunes 2378 „ Beef 17 „ Apricots 52 „ Pork 11 „ Strawberries 339 „ Ham (tinned) 16 „ Fruit Salad 36 „ Pork (tinned) 10 „ Blackberries 629 „ Corned Beef 10 „ Grapefruit Juice 89 „ Pigs Kidneys 1 tin Orange Juice 150 „ Sheeps Liver 2 tins Pineapple Juice 18 „ Jellied Veal 1 tin Lemon Juice 72 „ Minced Pork 408 tins Peas 31 „ Ox Liver 172 „ Beans 7 „ Dried Fruit Salad 2 „ Macedoine 287 „ Prunes 29 „ Creamed Rice 180 „ Apples 1 tin Asparagus 1 Desiccated Coconut 2 tins Vegetable Salad 7 „ Tomato Puree (tinned) 20 „ Spaghetti 25 „ Dried Fruit 11 „ Beetroot 28 „ Rice 30 „ Carrots 168 „ Dried Potato 116 „ Tomatoes 4050 „ Onions 5 „ Tomato Juice 59 „ Flour 38 „ Pease Pudding 54 „ Cheese 1 tin Mushrooms 16 stone Skate 73 tins Pilchards 6 „ Whiting 4 „ Tuna Fish 1 „ Kippers 1 tin Brisling 3½ „ Crabs 9 tins Crab 7½ „ Dogfish 5 „ Sardines 3 „ Cod 2 „ Crawfish 3½ „ Haddock 1 tin Roes 4 „ Fish Pieces 4 tins Herrings 20 lb. Coley Fillets 6 „ Salmon 14 botts. Sauce 175 „ Luncheon Meat 8 „ Pickles 25 „ Beef Loaf 5 Fairy Cakes 56 „ Steak 1 Fruit Cake 1 tin Brisket 21 Honeycomb Balls 1 „ Stewed Mutton 3 packets Jelly 1 „ Minced Loaf 50 Chickens 5 tins Chopped Pork 48 Shellfish and Jellied Eels. The following samples were taken during the year for bacteriological examination:— Cockles 5 Mussels 9 Whelks 1 Jellied Eels 13 Three of these samples were of an unsatisfactory standard and the necessary investigations were carried out. Cooked Meats. Sampling of these products continued during 1958, seventy-three samples being taken. Twenty-four were classified as unsatisfactory because of bacteriological contamination which occurred during storage and exposure for sale. Miscellaneous Samples. Two samples of Dried Egg were submitted for bacteriological examination with satisfactory results. Three rinsings of ice cream equipment were taken during an investigation in an ice cream factory which gave information as to the efficiency of the methods of cleansing used in the factory. (d) Adulteration, etc.—Food and Drugs Act, 1955. During the year, one hundred and sixteen samples of food and drugs were submitted to the Public Analysts. Nine samples were reported as being unsatisfactory, details respecting same are given below :— Description of Article Result of Analysis Action taken Apples (3) Contaminated with excessive amounts of arsenic and lead spray residues. Warning given. Eldermint Life Drops Contained only half the stated amount of chloroform. Warning given. Milk Contaminated with minute globules of dirty mineral oil. Warning given. Milk Bottle Had a strong taint of pine disinfectant and contained a foreign body in form of a cork and metal tube. Warning given. Lemonade, Bottle of.. Unpleasant smell around stopper and contents not sterile. Warning given. Sausages, Pork Contained 180 parts per million of sulphur dioxide (undeclared). Warning given. Bronchial Balsam 59% deficient in chloroform. Warning given. 49 The following summary gives details of food sampled and results of analyses :— No. satisfactory No. unsatisfactory Formal Informal Total Formal Informal Total Milk 27 1 28 — 1 1 Coffee 2 — 2 — — — Tea 3 3 6 — — — Ginger Cordial — 1 1 — — — Pineapple Squash — 1 1 — — — Grapefruit Squash — 1 1 — — — Mix-a-Shake — 1 1 — — — Orange Drink 4 1 5 — — — blackcurrant Cordial — 1 1 — — — Lemonade, Bottles of — 1 1 — 1 1 Tonic Water — 1 1 — — — Wines — 2 2 — — — Brandy 1 — 1 — — — Gin 2 — 2 — — — Rum 1 — 1 — — — Whisky 7 — 7 — — — Apples — 1 1 2 1 3 Apricots — 1 1 — — — Dried fruit — 1 1 — — — Coconut, Desiccated — 1 1 — — — Coconut, Buttered — 1 1 — — — Almonds, Ground — 1 1 — — — Cream 1 1 2 — — — Butter — 1 1 — — — Jam 1 1 2 — — — Marmalade 2 — 2 — — — Jelly with Port Wine 1 — 1 — — — Marshmallows 1 — 1 — — — Ice Cream 2 1 3 — — — Lollies — 3 3 — — — Sweets — 1 1 — — — brazils, Butter 1 — 1 — — — Crab, dressed — 1 1 — — — Salmon Paste — 1 1 — — — Sauce — 1 1 — — — Tomato Ketchup — 1 1 — — — Black Pepper — 1 1 — — — Nutmegs, ground 2 — 2 — — — Pickling Spice — 1 1 — — — Spice, mixed — 1 1 — — — Saltpetre, granular — 1 1 — — — Sausages, Beef 2 — 2 — — — Sausages, Pork 1 — 1 1 — 1 Sausages, Pork, Veal an Beef 1 - 1 — — — Peas, processed — 1 1 — — — Chicklettes, Chicken and Potato Cakes 1 — 1 — — — Sponge Mixture — 1 1 — — — Soup powder — 1 1 — — — Chocolate Cake — 1 1 — — — Semolina — 1 1 — — — Eldermint Life Drops — — — 1 — 1 Indigestion Pills — 1 1 — — — Quinine Tonic Water — 1 1 — — — Damaroids 1 — 1 — — — Bronchial Balsam — — — 1 — 1 Milk Bottle — — — — 1 1 64 43 107 5 4 9 50 (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.I. (f) Food Hygiene Regulations, 1955. These Regulations came into operation on 1st January, 1956. A reasonable 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. Legal proceedings were instituted in two cases for offences under the above Regulations. A penalty of Four Pounds was imposed by the Court in the first case for failure to provide hot water and for a defective floor in a food shop. A penalty of Five Pounds was imposed in the second case in respect of a conviction for smoking whilst handling open food in a food shop. The following food premises are established in the Borough :— Butchers, 84 ; Bakers, 46 ; Fishmongers, 37; Cafes and Caterers, 100 ; Grocers, 263 ; 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. The following inspections were carried out in respect of food premises :— Butchers, 276 ; Bakers, 78 ; Fishmongers, 98 ; Cafes and Caterers, 207 ; Grocers, 440 ; Greengrocers, 215 ; Dairies and Milksellers, 149 ; Ice Cream Manufacturers and Vendors, 201. 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. 51 Cooked Meats. The Deputy Chief Public Health Inspector prepared a paper on this subject to be read at a meeting held at Walthamstow of the Northern Home Counties Centre of the Public Health Inspectors' Association. The paper will be published in due course, but the author, Mr. Hughes, has agreed to the inclusion in this Report of his summary and conclusions, which are as follows :— "A Proposed Code of Practice for the Handling and Sale of Cooked Meat Products. "Mention must be made here of the technique used by a well-known provision firm as it probably represents the best standard found in this field. The trade is heavy, and by good management they are able to sell the customer tinned cooked meats within, on average, forty-five minutes of opening. A special slicing machine is kept for cooked meat, which is cleansed several times daily. A notice above the machine forbids the assistant to handle either the cooked meats or the machine unless the hands have been washed immediately prior to use. Cooked meats are removed from the tin, sliced, interleaved with grease-proof paper and immediately returned to the refrigerator until required for the shop where their average time under protected display is about fifteen minutes. All manufactured cooked meats delivered to the shop are coded and they are sold within two days, or removed from sale at the end of that time. Except for pastry covered pies, the treatment of these manufactured cooked meats is the same as that described above for tinned meats. "Appendix III is a code of practice developed by us over the past four years as a result of practical experience. It is an amended resume of three circulars sent to all cooked meat retailers in this Borough "This code is designed to meet all classes of premises handling cooked meats, and by no means represents the ideal standard ; it is no more than a compromise between the best and worst standards found. Summary and Conclusions. "(1) It has been shown that in some cases grossly contaminated and stale cooked meats are being sold to the public. Some 33% of those sampled were found to be unsatisfactory. "(2) It has been shown that samples of cooked meats obtained from butchers' shops show the highest proportion of unsatisfactory results, and this may be due to cross contamination from raw to cooked meats. "(3) The routine sampling of cooked meats, with subsequent visits by the District Inspectors to interpret the results and to give guidance to the retailers, has resulted in significant improvement in the technique of handling cooked meats. 52 "(4) A working standard for the results of bacteriological examination of cooked meals is proposed. "(5) A code of practice for the handling of cooked meats during storage and sale is put forward for consideration. "(6) If the most recent statistics for food poisoning (3) are studied, they show that milk and ice cream, the two foods most widely sampled by Health Departments, now play practically no part in food poisoning outbreaks ; by far the greatest proportion of known vehicles of food infection are meats both raw and processed. The bacteriological supervision of the manufacture and retailing of processed meats is one of the newer fields of public health work which should receive increased attention by Public Health Inspectors." Mr. Hughes has been awarded the Quinton Prize of the Public Health Inspectors' Association for his paper. Ministry of Health Booklet—Clean Catering The attention of the proprietors and managers of all catering establishments in the Borough was drawn to this booklet. The covering letter referred in particular to Pages 29 and 30, which deals with "Germs in the Hands". A leaflet entitled "Food for Thought" was compiled by two members of the Health Inspectorate and was placed for distribution with an appropriate exhibit in the Town Hall foyer. (g) Food Poisoning Outbreaks. All notifications received were investigated. These are more fully referred to in the following section. Rag Flock and other Filling Materials Act, 1951. One application was approved under the above Act in 1958. Diseases of Animals Acts Swine Fever (Infected Areas) Order, 1953. No licences were issued during the year. Fowl Pest Order, 1936. No orders were issued during the year. Foot and Mouth Disease Orders. No cases occurred in the Borough and no movement licences were issued during the year. Pet Animals Act, 1951 Twenty-four 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 supervi io of the Public Health Inspectors. 53 The following is a summary of the work carried out during the year 1958 :— PREVENTION OF DAMAGE BY PESTS ACT, 1949 REPORT FOR THE YEAR ENDED 31st DECEMBER, 1958 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 34,320 4 4,957 39,299 II. No. of Properties inspected by the Local Authority during 1957 as a result of:— (a) Notification 10 415 2 90 517 (b) Survey 18 395 — 11 424 (c) A visit primarily for some other purpose - — — — — III. Total inspections carried out—including re-inspections 142 2,447 8 746 3,343 IV. No. of Properties inspected (see Section II) which were found to be infested by:— (a) Rats Major 1 - - 3 4 Minor 5 424 2 81 512 (b) Mice Major - — - - - Minor 2 52 - 17 71 V. No. of infested Properties (in Section IV) treated by the Local Authority 8 476 2 101 587 VI. Total treatments carried out — including re-treatments. (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 2 — — - — 54 Noise Nuisance in Streets.—The Health Committee considered further complaints regarding the alleged nuisance arising from the excessive playing of music in streets by ice-cream vendors. Resolved : That, if the Town Clerk is satisfied with the evidence in any one or more of these cases, the matter be reported to the Finance and General Purposes Committee for authority to institute legal proceedings. A successful prosecution resulted. Association of Public Health Inspectors.—One-Day Course Leave of absence was given to four Public Health Inspectors, to enable them to attend a one-day course of lectures on "Heating by Gas and Coke" at Watson House, Fulham. 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 95 43 3 - Factories not included above in which Section 7 is enforced by the Local Authority 480 317 9 - Other premises in which Section 7 is enforced by the Local Authority 9 13 1 — Totals 584 373 13 - 55 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) 15 18 - - - Overcrowding (Sec. 2) — — - - - Unreasonable Temp. (Sec. 3) — — - - - Inadequate Ventilation (Sec. 4) 1 1 - - - Ineffective drainage of floors (Sec. 6) 3 - - - - Sanitary Conveniences :— (a) Insufficient - - - - - (b) Unsuitable or Defective 24 30 - - — (c) Not separate for Sexes - — - - — Other offences (not including offences relating to Outwork) 18 18 - - - Totals 61 67 - - - NUMBER AND TRADES OF OUTWORKERS NOTIFIED 1958 Wearing Apparel (making of) 505 Household Linen 4 Lace, lace curtains 9 Curtains and Furniture hangings 2 Furniture and Upholstery 3 Paper bags 9 Boxes 50 Brush making 23 Carding, etc., of buttons, etc. 2 Stuffed Toys 25 Cosaques, Christmas Crackers, etc 42 Lampshades 4 Total 678 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 1958 was considerably less than in 1957. There were more cases of scarlet fever, dysentery and erysipelas, but fewer of whooping cough, measles, pneumonia, poliomyelitis, food poisoning and tuberculosis. 56 Disease All Ages 0-1 year 1-4 years 5-14 years 15-24 years 25-44 years 45-64 years 65yrs. &over 1958 1957 Scarlet Fever 105 89 — 28 75 1 1 - - Whooping Cough 67 217 11 27 29 — - - - Measles 486 1,394 11 202 269 3 - 1 - Diphtheria — — — — — - — - - Pneumonia 42 62 — — 5 1 7 18 11 Meningococcal Infection — 1 - - - - - - - Acute Poliomyelitis : Paralytic 2 18 - - 1 1 - - - Non-Paralytic — 4 - - - - - - - Acute infective encephalitis 1 - - 1 - - - - - Post infectious encephalitis - - - - - - - - - Dysentery 230 13 3 30 167 7 20 1 2 Ophthalmia Neonatorum — — — — — — - - - Puerperal Pyrexia 59 58 — — — 28 30 1 - Smallpox — 1 — — — — - - - Paratyphoid Fever - - - - - - - - - Typhoid Fever — — — — — — — — - Food Poisoning 28 39 — 2 7 1 9 7 2 Erysipelas 15 10 — — — — 1 10 4 Malaria — — - — - - — - - Tuberculosis : Respiratory 54 70 - - - 12 11 24 7 Meninges and Central Nervous System - 1 - - - - - - - Other Forms 6 8 — — 2 — 4 — — Totals, 1958 1,095 — 25 290 555 54 83 62 26 Totals, 1957 - 1,985 56 718 975 63 87 66 20 Disease St. James Street High Street Hoe Street Wood Street Hale End Higham Hill Total Scarlet Fever 15 2 7 13 34 34 105 Whooping Cough 15 6 15 17 6 8 67 Measles 14 8 89 79 176 120 486 Diphtheria — — — — — — - Pneumonia 6 7 9 2 9 9 42 Meningococcal Infection — — — — — — - Acute Poliomyelitis : Paralytic - - - - 1 1 2 Non-Paralytic — — — — — — - Acute infective encephalitis 1 - - - - - 1 Post infectious encephalitis - - - - - - - Dysentery 105 20 28 43 16 18 230 Ophthalmia Neonatorum — — — — — - — Puerperal Pyrexia 5 1 6 32* 7 8 59 Smallpox — — — — — — — Paratyphoid Fever — — — — — - — Typhoid Fever — — — — — - — Food Poisoning 2 2 5 8 9 2 28 Erysipelas 2 1 2 — 5 5 15 Malaria — — — - - — - Tuberculosis : Respiratory 9 8 9 5 13 10 54 Meninges and Central Nervous System - - - - - - - Other forms 1 2 — — 1 2 6 Totals, 1958 175 57 170 199 277 217 1,095 Totals, 1957 149 212 331 209 525 559 1,985 *Puerperal Pyrexia. 27 of these were Thorpe Coombe outside area patients. 57 The following is a summary of the Quarterly Returns made to the Ministry of Health :— Disease 1st quarter 2nd quarter 3rd quarter 4th quarter Total Scarlet Fever 36 22 13 34 105 Whooping Cough 26 11 22 8 67 Measles 4 83 131 268 486 Diphtheria — — — — - Pneumonia 15 8 5 14 42 Meningococcal Infection — — — — - Acute Poliomyelitis : Paralytic - 1 1 - 2 Non-Paralytic — — — — - Acute Infective Encephalitis — — — 1 1 Post Infectious Encephalitis — — — — — Dysentery 36 64 51 79 230 Ophthalmia Neonatorum — — — — - Puerperal Pyrexia 17 9 15 18 59 Smallpox — — — — — Paratyphoid Fever — — — — — Typhoid Fever — — — — - Food Poisoning 12 3 9 4 28 Erysipelas 3 5 3 4 15 Malaria — — — - - Tuberculosis : Respiratory 17 16 11 10 54 Meninges and Central Nervous System - - - - - Other forms 2 1 1 2 6 Totals 168 223 262 442 1,095 MEASLES The following table shows the incidence of measles in Walthamstow between 1932 (when the disease became notifiable) and 1958:— Yearly Averages Notifications Deaths 1932/35 (4 years) 427 10.75 1936/40 (5 „ ) 309 2.6 1941/45 (5 „ ) 714 1.4 1946/50 (5 „ ) 816 1.0 1951/55 (5 „ ) 1,372 0.4 1956/59 (3 „ ) 793 0.3 DIPHTHERIA Two cases were removed to hospital for observation, but neither was confirmed. The last confirmed case was in 1950 and the last death from diphtheria in 1946. 58 WHOOPING COUGH Of sixty-seven cases notified eleven, i.e. 16.4% were under one year of age. No death from whooping cough has occurred in Walthamslow over the last five years. The numbers of notifications of, and deaths from, this disease, as compared with England and Wales, during the past three years, are set out in the following table :— Year Notifications Deaths Walthamstow England and Walthamstow England and Wales Wales 1958 67 33,979 — 25 1957 218 85,017 — 88 1956 347 92,407 — 95 SCHOOL "OUTBREAKS" After a year fairly clear of dysentery (only thirteen cases were notified in 1957) there were outbreaks during 1958 at several schools, i.e. : February : Greenleaf Primary 13 June : Mark House Infants 53 July : Nursery School 10 „ Edinburgh Junior Mixed 11 No cases were notified during August and September and it was hoped that the infection had been cleared, but further cases followed in the autumn, i.e. : Woodside Junior Mixed 16 Mission Grove Infants 11 These school outbreaks are more fully written up in the Report of the Borough School Medical Officer. Over the whole year 230 cases were notified, 170 under fifteen years of age. The quarterly totals were as follows:—36, 64, 51 and 79 respectively. It seems clear that infection is mainly spread from case to case through the medium of the water closet seat, chain handles and door latches and handles, and failure to wash the hands adequately after using the water closet. 59 In two other nearby areas, there were also considerable outbreaks totalling 128 and 148 respectively. Dysentery became notifiable in 1932 and in the twenty-seven years up to and including 1958, there were 1,108 notifications, an average of forty-one per annum. The large majority of cases were in the age groups 1-5 years and 5-15 years, i.e., 328 and 358 respectively. In only four years were there no cases notified, and since the War, there has been a considerably increased incidence, the years and incidence being as follows :— Year No. of Cases 1951 159 1953 84 1954 159 1958 230 POLIOMYELITIS Two cases of poliomyelitis were notified during 1958, both paralytic, but did not need hospital treatment. Details are set out in the following table :— Age Sex Ward School Onset Date Notified Condition on follow-up 15 M HE McEntee Technical ? 14.4.58 Notified from Outpatients, Connaught Hospital, after infection period over. Received physiotherapy for dropped foot. 10 M HH Blackhorse Junior ? 19.9.58 Notified after poliomyelitis injection. Paresis left arm fully recovered. MENINGOCOCCAL INFECTION One case was notified but not confirmed at hospital. ACUTE INFECTIVE ENCEPHALITIS OR POST INFECTIOUS ENCEPHALITIS M. one year. James Street Ward. Notified and confirmed as Encephalitis and Chicken Pox. Discharged recovered. PARATYPHOID AND TYPHOID FEVER One case was notified but not confirmed. 60 FOOD POISONING Authority was given to arrange for all Medical Practitioners with surgeries in the Borough to be supplied with a copy of Ministry of Health Memorandum 188/Med. on the subject of steps to be taken in the investigation of food poisoning and the supply of information in connection therewith. Twenty-eight cases were notified and in addition ten were "ascertained", i.e., became known otherwise than by notification and mostly on following up notified cases. None was fatal. There were three small "outbreaks" i.e., two familial with seven and three cases respectively, of which the former was due to coagulase positive staphylococcus and the latter to an unknown agent. In neither case could the food at fault be determined. The third "outbreak" was due to Cl.welchii Type 1 and on investigating the notified case, six others were found, all of whom were infected at a works' canteen where the food had been reheated. Single cases totalled twenty notified and one ascertained. The majority of the infections were due to salmonellae, nine being typhi murium. Food suspected consisted of sausages (5), pork (2), fish or paste (3) and meat (2). ANNUAL RETURN OF FOOD POISONING 1. Local Authority : Borough of Walthamstow. Year: 1958. 2. (a) Food Poisoning Notifications (Corrected) as Returned to Registrar General. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 12 3 9 4 28 (b) Cases otherwise Ascertained. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 3 7 — — 10 (c) Fatal Cases. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total — — — — Nil 3. Particulars of Outbreaks. Details of each outbreak to be given as in Appendix D (ii). No. of outbreaks No. of cases Total No. of cases Family outbreaks Other outbreaks Notified Otherwise ascertained Agent identified* 1 1 4 9 13 Agent not identified 1 — 4 — 4 61 4. Single Cases. No. of Cases Total No. of cases Notified Otherwise ascertained Agent identified* 14 — 14 Agent not identified 6 1 7 * To be classified according to agents. (a) Chemical Poisons (type to be stated) (b) Salmonella (type to be stated) (c) Staphylococci (including toxin) (d) CI. Botulism (e) CI. welchii (f) Other bacteria (to be named) - 11 (Typhi murium 9, Untypable 2). 3 - 2 - Public Health (Infectious Disease) Regulations, 1927 The classical case of a typhoid carrier is that of "Typhoid Mary" a one-time cook in New York City. Cases of typhoid occurred with regularity in the various households in which she was employed, e.g., 1901—1 case ; 1902—9 cases ; 1904—4 cases ; 1906—6 cases. In addition she may well have been responsible for the New York outbreak in 1903 with 1,300 cases. In 1907 she was put under supervision, but broke her promise to report regularly and to give up her work as a cook. She then infected another twenty-five cases at a New York hospital, left hurriedly, but was ultimately found and given a job under supervision in the health laboratories, and died twenty years later. The Walthamstow counterpart is "Mrs. X" who, in 1938 (when she was fifty-eight years of age) was found to be working at a cafe in Walthamstow, but living in another area. In 1936 she had been under treatment at a fever hospital for typhoid, but discharged herself against medical advice and apparently without her carrier condition being cleared. After her discovery, notice was served on her under the 1927 Regulations to cease employment as a cook and joint compensation was agreed between the two authorities concerned. In 1939 she was employed as a convenience attendant and so continued until her retirement. The carrier condition was tested annually and almost without exception, there was a positive result each year between 1938 and 1958. Compensation at a modest sum still continues because "Mrs. X" is considered to be capable of undertaking work at home in connection with outside functions. Although her carrier condition is comparable with that of "Typhoid Mary," fortunately "Mrs. X" was discovered apparently before causing any known cases of typhoid. 62 TUBERCULOSIS The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1958 :— Age Periods New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. Under 1 year — — — — — — — — 1- 4 years - - - - - - - - 5- 9 „ — — - 2 — — - - 10-14 „ - - - - - - - - 15-19 „ 4 2 - - - - - - 20-24 „ 2 4 — — 1 — - - 25-34 „ 5 2 — 2 — — — — 35-44 „ 2 3 1 1 1 — — - 45-54 „ 3 1 — - 1 - - - 55-64 „ 16 4 — — 2 — — - 65 and over 6 — — — 2 — — — 38 16 1 5 7 — — — Totals 54 6 7 - 60 7 In 11 per cent. of the 54 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 54 cases investigated 22 were sputum positive on notification or soon after, i.e. 40 per cent. The percentages during 1953, 1954, 1955, 1956 and 1957 were 45.6, 42.0, 44.2, 36.6 and 40 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. 1958 38 16 1 5 60 7 - - — 7 1957 47 23 5 4 79 10 2 — 1 13 1956 43 28 3 3 77 4 1 3 — 8 Sixteen deaths occurred amongst persons whose names were on the tuberculosis register and of these the Registrar General ascribes 7 to pulmonary tuberculosis. 63 The period elapsing between notification and death and the number of cases not notified were as follows :— Under 3 months 3 to 6 months 6 to 9 months 9 to 12 months Over 12 months Not notified Notified after death Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. Pul. NonPul. — - 1 - — — — — 6 - 1 - - — Non-Notification of Tuberculosis There was one non-notified case in 1958, i.e. :— Male, 78 years, admitted to hospital 23rd March and died 26th August from chronic pulmonary infection, but sputum negative. Had been seen at a Chest Clinic between 1952-1954, but lesion was considered old and fibrotic and not warranting notification. 64 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. 65 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 seven years the weekly average of new claims was as follows. 1952 1953 1954 1955 1956 1957 1958 January 464 747 500 660 578 661 674 February 433 832 513 632 630 412 457 March 390 401 375 474 432 470 400 April 350 300 267 300 279 304 320 May 270 232 314 263 291 314 261 June 214 237 252 264 249 257 232 July 200 197 220 224 228 221 220 August 205 201 209 228 214 214 200 September 262 257 284 271 295 429 266 October 369 370 348 363 368 1,202 382 November 311 360 366 370 424 598 405 December 426 291 299 350 339 669 457 Average per week 323 363 327 360 357 479 346 (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). G .—MISCELLANEOUS 1. Old People's Welfare. The Town Clerk as Honorary Secretary of the Walthamstow Old People's Welfare Association, states that the Association's "Meals on Wheels" Service provided 19,501 meals during 1958. Six rounds are operated on Monday, Wednesday and Friday, but it is proposed to start a seventh round in the early part of 1959. The meals are obtained from the Council's Catering Department and 66 distributed by voluntary workers in cars hired by the Association. The scheme has been in operation in this form since March, 1958, and is an essential one for people who would not otherwise be able to get a cooked meal. The Association 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 Association continued to act as the co-ordinating body 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 1958. 35 patients received domiciliary treatment, and the total treatments given were 45 at a cost of £23 12s. 6d. Only 4 of the patients were Male. All the patients were over sixty years of age and 2 were over ninety 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 67 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. There is need for increased services in the following directions:— (1) "Meals on Wheels" daily (This matter is under consideration in 1959). (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, 3 ; Mattresses, 14 ; Blankets, 2 ; Bolsters, 2 ; Pillows, 5 ; Commodes, 2 ; Wheelchairs, 3 ; Sheets, 5. 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. 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 34 Average number of cases per week 14 Total number of articles laundered 7,123 Average number of articles per week 135 Total number of journeys 1,189 During the latter part of the year a twice weekly service was given to cases with severe faecal incontinence. 68 3. Funeral Arrangements. Arrangements were made with regard to the burial of five persons within the terms of the National Assistance Act, 1948. 4. Medical Examinations. During the year the medical staff carried out 224 examinations of Borough Council employees in respect of the Superannuation and Sick Pay Schemes. 5. Health Education. (a) Lectures were given by the staff of the Department. (b) 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. (c) Town Hall Foyer. During the year several special exhibits were arranged. (d) Lung Cancer. Sixty posters were shown on sites under the control of the Borough Council and 5,000 bookmarks were distributed through the Library Service. (e) "You, Me and Us" Exhibition. This was organised by the Walthamstow Methodist Circuit and took place between April 24th and 26th at Shern Hall, Shernhall Street. The Health Department, in conjunction with the County Health Department, organised an exhibit in regard to the health services and the facilities available for the elderly. (/) Accidents in the Home. The Borough Council gave consideration to the formation of a Home Safety Committee, but decided to take no action in this regard for the time being. The Council directed the Health Committee of the Health Department to undertake all measures in regard to publicity. All staff undertaking domiciliary duties were instructed to stress the need for fireguards and full advantage was taken in regard to the National "Guard that Fire" campaign in the autumn. This campaign is more fully referred to in the section dealing with the Health Area Services. (g) Burns and Scalds. The Ministry's Memorandum was circulated to all the staff of the Department and a form giving the name and address and the type of accident was agreed with the Hospital Service for reports to be made with the patient's consent of all such cases treated at hospitals. Follow up visits were then paid. 69 (h) Radioactivity. The Deputy Medical Officer of Health and eight of the Public Health Inspectors were authorised at the end of the year to attend (during 1959) a course of eleven Lectures on "Radioactivity and Its Hazards in Biology and Medicine" held at the Sir John Cass College, London, E.C.2. 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. General. The Borough Architect, Engineer and Surveyor contributes the following information :— (a) Public Conveniences. Erected Forest Road, Lloyd Park—Men and Women 1922 Forest Road, Higham Hill Road—Men and Women 1923 Wood Street—Men and Women 1933 Oak Hill—Men and Women 1949 Crooked Billet—Men and Women 1951 St. James Street Car Park—Men and Women 1951 Tamworth Avenue—Men and Women 1952 Larks Hall Road—Men and Women 1953 Selborne Road—Men and Women 1957 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. 70 (c) Inquests and Post Mortems. Walthamstow Others Total Post Mortems only 122 263 385 Post Mortems and Inquests 14 40 54 Inquests only 3 43 46 (d) Rainfall. The annual rainfall at the Ferry Lane Station was 29.45 ins. In 1957 it was 19.21 ins. (e) Flooding. The number of times heavy rainfall occurred during the year has been exceptional resulting in widespread flooding on five occasions and on a further four occasions a limited number of areas were subject to flooding. The following relief schemes have been completed during the year :— (1) Billet Road Relief Scheme. (2) Coppermill Lane Relief Scheme. (3) Essex Road Relief Scheme. During 1959-1960 it is proposed, subject to the approval of the Ministry of Housing and Local Government, to proceed with the following schemes :— (4) Brooke Road Relief Scheme. (5) Selborne Road Relief Scheme. (6) Low Hall Farm Storm Tanks. 71 SECTION H NATIONAL HEALTH SERVICE ACT, 1946 PART III SERVICES WALTHAMSTOW HEALTH AREA SUB-COMMITTEE (1958/59) Chairman : Councillor Mrs. W. M. Palethorpe (Walthamstow Borough Council). Vice-Chairman : Councillor O. F. J. McCarthy (Walthamstow Borough Council) Members : Nominated by :— Essex County Council Alderman Mrs. M. Ball (Chairman, Health Committee. E.C.C.). „ „ „ Councillor Mrs. L. Fallaize, J.P (Vice-Chairman, Health Committee, E.C.C.). „ „ „ Alderman Mrs. L. P. Bailey, J.P. „ „ „ Alderman Mrs. B. K. Lowton. „ „ „ Councillor Mrs. E. M. Bates. „ „ „ CouncillorMRS.A. M.M.Burrell. „ „ „ Councillor W. R. Baldwin. Walthamstow Borough Council Alderman The Lady McEntee, O.B.E., J.P. „ „ „ Councillor Mrs. E. L. Baldwin. „ „ „ Councillor J. J. Bracken. „ „ „ Councillor Mrs. S. Candy. „ „ „ Councillor C. J. Crosbie, J.P. „ „ „ Councillor F. H. Eiles. „ „ „ Councillor Mrs. L. D. Gurr. „ „ „ Councillor J. H. Hammond. „ „ „ Councillor G. E. Kitchen. „ „ „ Councillor C. B. Reynolds. „ „ „ Councillor P. F. A. Webster. „ „ „ Councillor D. Weinstein. „ „ „ Councillor A. F. Whicher. 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 .. Mrs. L. A. Brazier. „ „ Mrs. M. Brown. „ „ Mrs. A. Cordell. „ „ E. P. Marr, Esq. Area Clerk : G. A. Blakeley, Esq. 72 STAFF A list of the Health Area Staff appears at the begining of this Report. 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. and Mr. D. A. Clark, F.D.S. report:— "The year 1958 has seen a slight reduction in some aspects of treatment and in the number of sessions carried out compared with 1957. However, this is only to be expected, because, apart from some illness, one member of the staff resigned and another has been on study leave. "Enquiries for treatment continue to outnumber the number of appointments that can be offered. "The work carried out in the dental laboratory for the general practitioner service is very similar to last year, and details are given below." 1957 1958 Number of patients treated 953 941 Appointments made 5,910 5,441 „ kept 5,347 4,938 Plastic fillings 595 2,327 483 2,239 Amalgam fillings 1,732 total 1,756 total Inlays 8 10 Crowns 38 30 Scalings and gum treatments 511 489 Dressings 708 617 Extractions 861 761 General anaesthetics 228 151 Local anaesthetics 575 512 X-rays 641 335 Impressions 773 775 Bites 193 202 Try-ins 286 331 Full upper dentures 117 128 Full lower dentures 81 295 total 100 310 total Partial upper dentures 56 dentures 46 dentures Partial lower dentures 41 36 Repairs 190 200 Minor Oral Surgery 195 58 Other operations 1,026 805 73 DENTAL LABORATORY The following work was undertaken during the year :— Denlures Repairs Relinc Remakes Appliances Crowns Inlays Study Models Other Models General Dental Service 294 200 16 12 6 13 2 — 1,138 Walthamstow Committee for Education 46 34 - 205 11 2 438 - Leyton Committee for Education - - - - 21 1 - - - Maternity and Child Welfare Patients 16 1 — — — 1 — — — CARE OF MOTHERS AND YOUNG CHILDREN (Section 22) ANTE-NATAL AND POST-NATAL SERVICES The following table summarises the attendances at the Clinics held :— New Patients— Ante-Natal Post-Natal Thorpe Coombe Maternity Hospital 1,399 986 Low Hall Lane Clinic 44 4 Silverdale Road Clinic 40 11 West Avenue Clinic 20 - District Nurses Training Home and Midwives' sessions held at Ante-natal Clinics 540 - Totals 2,043 1,001 Total Attendances— Ante-Natal Post-Natal Thorpe Coombe Maternity Hospital 12,232 1,023 Low Hall Lane Clinic 247 13 Silverdale Road Clinic 181 19 West Avenue Clinic 61 - District Nurses' Training Home and Midwives' sessions held at Ante-natal Clinics 2,404 - Totals 15,125 1,055 74 Blood grouping/haemoglobin estimation and Rhesus and S.F.T. 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 3 Rhesus negatives and all S.F.T. tests were negative. The total of blood tests was 59 including 42 primary tests in respect of mothers, 7 secondary tests, 9 for haemoglobin only and 1 for P.C.V. etc. The blood groupings were A.22, B.2, 0.17 and AB.l. Haemoglobin estimations showed the following results:— 100+ = nil 60—69 = 2 90—99 = 6 50—59 = nil 80—89 = 23 40—49 = nil 70—79 = 17 i.e., 2 or 4.16% were under 70 compared with 15.9% in 1958. 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 reports for 1956 and 1957. The ante-natal co-operation card scheme introduced in 1957 is reported to be working well. Ante-Natal Care and Confinements. There were 1,380 confinements of Walthamstow mothers in 1958. against 1,416 in 1957. The percentage of hospital confinements remained practically unaltered at 74.1. This percentage in fact has hardly varied over the last five yearx. Home confinements were 357 against 348 in 1957 and of the 357 confinements, 86 were midwives' cases, the remaining 271 being doctors' "booked" cases with, of course, a midwife in attendance as a maternity nurse. Of the 86 midwives' cases 85 were attended by "Carisbrooke" midwives. Ante-natal examinations of midwives' cases were somewhat higher at 3,248. Ante-natal examinations of doctors' cases were also higher at 1967. 75 Ante-Natal Clinics. Details of ante-natal clinics held in Walthamstow are given on page 79 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 Clinic. One hundred and forty-seven sessions were held during the period under review involving a total of 990 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 1958:— At Thorpe Coombe Maternity Hospital 691 At other Hospitals and Maternity Homes 332 Total in Hospital, etc. 1,023 At Home 357 Total Confinements 1,380 In addition 675 out-area cases were confined at Thorpe Coombe. VITAL STATISTICS Walthamstow England and Wales (Provisional) Live birth-rate per 1,000 population 11.3 16.4 Still birth-rate per 1,000 total births 21.1 21.6 Infant mortality rate per 1,000 live births 15.4 22.5 Extracts from vital statistics are given more fully in Section "A" of this Report. 76 NOTIFICATION OF BIRTHS 2,078 births (688 of which belonged to other areas) were notified during the year under the Public Health Act, 1936. Notifications were received as follows: Doctors, 334; Midwives, 1,739; Others, 5. Also included are 36 still-births, 7 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 1958 was 11, i.e. a rate of 8.4 per 1,000 live births. INFANT MORTALITY The deaths of infants under one year were as follows:— Males Females Totals Legitimate 7 13 20 Illegitimate — — — Totals 7 13 20 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, 15.4; Illegitimate, Nil; Total, 15.4. Of the 20 deaths, 11 occurred in the first month of life, including 9 in the first week, the age group distribution being as under:— Hours Day Week Week Mth. Mth. Mth. Mth. Mth. Mth. Mth. Mth. Mih. 0—24 1—1 1—1 1—3 3—6 6—9 9—12 4 5 2 3 2 1 3 Two deaths occurred at home and eighteen in hospitals, and the principal causes of death were as follows:— Congenital Abnormalities, 8; Prematurity, 6 (including 2 cases of associated birth injury); Acute Pulmonary Conditions, 5; accidental death 1. Although the total numbers of infant deaths are now, fortunately, so low as largely to invalidate comparison between annual figures, it is gratifying to note that the preventative causes are being progressively eliminated. Only the single accidental death could be regarded as preventable It is pleasing to note also that prematurity was the chief cause in only six deaths in 1958 as against sixteen in 1957, since this may reflect continuing improvement in ante-natal care. Congenital abnormalities now account for the greater number of individual infant deaths, but so far no means of their prevention has been discovered. CAUSES OF DEATH OF CHILDREN UNDER 1 YEAR OF AGE1958 Under 1 week 12 weeks. 23 weeks. 34 weeks. Total deaths under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under 1 year. St. James St. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Total. Influenza – – – – – – – – – – – – – – – – – Measles – – – – – – – – – – – – – – – – – Whooping Cough – – – – – – – – – – – – – – – – – Diphtheria – – – – – – – – – – – – – – – – – Phthisis – – – – – – – – – – – – – – – – – Other forms of T.B. – – – – – – – – – – – – – – – – – T.B. Meningitis – – – – – – – – – – – – – – – – – Meningitis (Non T.B.) – – – – – 1 – – – 1 1 – – – – – 1 Convulsions – – – – – – – – – – – – – – – – – Bronchitis – – – – – – – – – – – – – – – – – Pneumonia – – – – – 1 1 1 1 4 1 – – – 1 2 4 Diarrhoea – – – – – – – – – – – – – – – – – Syphilis – – – – – – – – – – – – – – – – – Rickets – – – – – – – – – – – – – – – – – Inattention at birth, wilful neglect – – – – – – – – – – – – – – – – – Suffocation (overlaying) – – – – – 1 – – – 1 – – – – 1 – 1 Injury at birth – – – – – – – – – – – – – – – – – Atelectasis 3 – – – 3 – – – – 3 1 – – – – 2 3 Congenital malformation 4 – – – 4 – 1 – 2 7 1 – 1 – 3 2 7 Premature birth 2 1 – 1 4 – – – – 4 – – – 1 3 4 Atrophy, debility, marasmus – – – – – – – – – – – – – – – – – Inanition – – – – – – – – – – – – – – – – – Heart failure – – – – – – – – – – – – – – – – – Other causes – – – – – – – – – – – – – – – – – Totals 9 1 – 1 11 3 2 1 3 20 4 – 1 1 8 6 20 78 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 1958, 75 live premature infants were born to residents of the Borough, 22 at home and 53 in hospitals and nursing homes. Of the 22 born at home, 4 were transferred to hospital. Of the remaining 18 who were nursed entirely at home, 17 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 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 1958 1,247 50 20 Nil 15.4 Nil Quinquennial Average 1,307 52 26.4 1.2 19.9 23.0 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 sixteen mothers and their babies and has a high record of care and service. Miss E. Williams, Superintendent of the Home, contributes the figures set out below. 79 Details of Cases dealt with in 1958:— Admitted Adults Babies Total From Walthamstow 13 10 23 From rest of County 62 40 102 From outside County 2 2 4 Total 77 52 129 Outdoor Work— Walthamstow (Mothers and babies) 24 24 48 Other County cases 15 – 15 From outside County 3 2 5 Total 42 26 68 In addition to the thirteen Walthamstow mothers admitted to the Home, Miss Williams made arrangements for twelve others to enter homes elsewhere in the County. 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, Higham Park, E.4. Friday (alternate) do. The Welfare Centre, West Avenue, E.17. (Toddlers only). 80 Summary of Attendances at Child Welfare Clinics Clinic First Attendances of New Cases Re-Attendances Grand Total Under 1 year of age 1 year old 2-5 years of age Total Under 1 year of age 1 year old 2-5 years of age Total Markhouse Rd. 254 32 17 303 4,506 1,073 1,512 7,091 7,394 Penrhyn Ave. 232 9 3 244 3,074 904 799 4,777 5,021 West Avenue 159 15 15 189 2,272 912 859 4,043 4,232 Silverdale Rd. 127 4 2 133 2,127 642 1,441 4,210 4,343 Winchester Rd. 132 — — 132 2,102 570 459 3,131 3,263 Totals, 1958 904 60 37 1,001 14,081 4,101 5,070 23,252 24,253 Walthamstow Child Welfare Society Clinics are held as follows at "Brookscroft," Forest Road, E.17:— Tuesdays and Fridays Massage, Remedial Exercises and Sunlight Treatment. Wednesdays Weighing Clinic and Cookery Lecture. Thursdays Infant Welfare for old and new cases. Two doctors in attendance. Alternate Fridays Diphtheria and Whooping Cough Immunisation. The 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 1958 251 11 8 270 3,963 1,164 549 5,676 5,946 Forty-eight children were immunised against diphtheria and seventy against whooping cough during the year at "Brookscroft." 81 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 year old 2-5 years of age Total Local Authority Scheme 904 60 37 1,001 14,081 4,104 5,070 23,252 24,253 "Brookscroft" 251 11 8 270 3,963 1,164 549 5,676 5,946 Total 1958 1,155 71 45 1,271 18,044 5,265 5,619 28,928 30,199 TREATMENT The facilitieprovided 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 Scoliosis, Lordosis, Kyphosis 1 Perthes Disease 1 Athrogryposis Multiplex Congenitae 1 Genu Valgum 12 Genu Varum 5 Congenital Dislocation of Pes Valgus and Valgus Ankles 15 Hip 3 Talipes— Torticollis 1 (a) Equino Varus 1 Other Congenital Defects 2 (b) Metatarsus Varus 7 Spastic Paralysis 2 Miscellaneous (including Chest Conditions) 9 Taut Tendo Achilles 2 Overlapping Toes 2 Osteomyelitis 1 Total 65 Number of Treatments given — 457 (b) Sunlight.—Sunlight treatment was given at the Hale End Clinic to three children under five years of age for nineteen treatments. (c) Priority Dental Treatment.—Mr. G. P. L. Taylor, L.D.S., R.C.S., contributes the following:— "This year the amount of dental treatment provided for mothers and young children varies very little from that provided in 1957. 82 "The services of a dental hygienist were available on one half day per week, as before, and Mr. Hyman again treated the majority of mothers at the Guildsway Clinic. Most of the children received their treatment at the Town Hall." Patients inspected and treated during the year: Expectant Mothers Nursing Mothers Children under School age Patients examined 83 107 302 Patients found to require treatment 80 104 295 Patients who have commenced treatment 83 107 294 Patients who have completed treatment 45 54 178 Patients awaiting treatment — — — Attendances for treatment 152 231 412 Types of treatment given: Expectant Mothers Nursing Mothers Children under School age 1. Extractions: (a) permanent teeth 30 73 — (b) temporary „ — — 255 2. Fillings: (a) permanent teeth 137 147 — (b) temporary „ — — 182 3. Inlays provided — — — 4. Crowns „ — — — 5. Anaesthetics administered: (a) local 7 25 7 (b) general:— (i) by medical officers 8 19 112 (ii) by others 1 4 8 6. (a) Scaling 18 15 — (b) Prolonged scaling and gum treatment 1 4 7. Silver Nitrate Treatment 1 3 71 8. Dressings 16 20 26 9. X-ray examinations 2 4 — 10. Denture provided: (a) full — 9 — (b) partial – 5 — 11. Dentures repaired — 2 — 12. Dentures remade: (a) full 2 — — (b) partial — — — 13. Orthodontic appliances: (a) fixed — — — (b) movable — — — 14. Prophylactic treatment and other operations: Impressions 7 17 — Bites 1 6 — Try-ins — 9 — Easing 1 9 — Syringing — 1 1 Polishing — 1 — Gum Treatments — 1 — 83 (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:— "Only seven children were referred during the year. As in previous years I would like to stress the important preventive work that can be done with the early age group and the need for early reference to the clinic of children presenting problems in their emotional development". (g) Paediatric Clinic.—The fortnightly clinic, under the charge of Dr. Elchon Hinden, Paediatrician to Whipps Cross Hospital, continued during 1958 and thirty-three 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 1958:— Under five years New cases 18 Total attendances 33 Physical Defects Cases seen 33 Referred to Hospital .. 5 Discharged 7 (h) Invalid Children's Aid Association.—Miss H. Thompson, Secretary to the Essex 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 Local Health Authority — General Practitioners 2 Classification of above cases:— Anaemia, Debility, Asthma 1 84 (i) Convalescence.—During 1958 two children were sent away on medical recommendation to convalescent homes. In addition, two mothers were sent away for a period of convalescence each with her baby. PROVISION OF NUTRIENTS AND MEDICAMENTS Details of nutrients and medicaments sold and issued free during 1958 are as follows:— Sales Free Issue lbs. ozs. lbs. ozs. Adexolin — — 31 14* Bemax 105 3½ — — Cow and Gate 4,412 — 19 — Cod Liver Oil and Malt — — 2 — Farex 613 12 — — Ferrous Gluconate Tablets — — 22,000 Tablets Glucodin 95 12 — — Lactagol 57 4 — — Maltoline with Iron — — 165 8 Marmite 750 12 — — Milk of Magnesia — — 10 4 Mist Ferri et Ammon Cit. Pro Infantibus — — 5 Ostermilk 2,089 — — — Pregnavite — — 4 bott les Robinson's Ready Cooked Groats 357 — — — Scott's "Twin Pack" 371 — — — Virol 617 — — — Trufood 505 — — — Value of Cash Sales = £1,754 11s. 2d. DISTRIBUTION OF WELFARE FOODS At the end of the year, eight distribution centres were open for twenty sessions per week enabling beneficiaries to obtain supplies from one to four centres on any weekday. The following table shows the distribution of welfare foods at individual centres:— 85 DISTRIBUTION CENTRE National Dried Milk (Tins) Cod Liver Oil (Bottles) Vitamin Tablets (Packets) Orange Juices (Bottle) Brookscroft Welfare Centre 2,707 898 465 5,898 Markhouse Road Health Services Clinic 2,346 732 409 5,124 Northcott House Distribution Centre 11,033 1,371 1,576 15,428 Penrhyn Avenue Infant Welfare Centre 2,531 823 400 5,136 Silverdale Road Health Services Clinic 1,123 488 355 4,584 Thorpe Coombe Maternity Hospital — 52 1,259 4,527 West Avenue Health Services Clinic 2,306 727 440 5,186 Winchester Road Infant Welfare Centre 877 389 262 3,031 TOTAL issues at Distribution Centres 22,923 5,480 5,166 48,914 In addition, the following were issued to:- Hospitals (National Health Service) 567 – 180 576 Day Nurseries – 144 – 324 GRAND TOTAL OF ISSUES 23,490 5,624 5,346 49,814 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 12.1 32.8 44.9 Handsworth Avenue Day Nursery 10.4 25.0 35.4 Both day nurseries are approved for training in the care of children aged 0-5 years and have sixty places. Training.—During 1958 six nursery students gained certificates awarded by the Royal Society for the Promotion of Health. Their future careers were as follows:— General nursing training 4 Private children's nursing 1 Teaching 1 NURSERIES AND CHILD MINDERS (REGULATION) ACT, 1948 There were no registrations under the above Act during 1958. DAILY GUARDIAN SCHEME This Scheme was begun in May, 1951, and Guardians are paid a retaining fee of 1s. 0d. per day (6d. per half day) by the County Council whilst they are caring for a child. Guardians are approved subject to a satisfactory health visitor's report. 86 Details in respect of 1957 and 1958 are as follows:— 1957 1958 No. of Guardians on Register at end of year 20 20 No. of applications for services of Daily Guardians 43 68 Referred to Day Nurseries 36 58 Referred to Daily Guardian but nothing further heard 2 7 Placed with Daily Guardian 5 3 Continued in care of Daily Guardian from previous year 3 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 1957 14 109 1958 7 138 These patients have attended for contraceptive advice on medical grounds. RESEARCH The Department co-operated in the Perinatal Mortality Survey which was organised by the National Birthday Trust Fund in order to try to elucidate the reasons for the failure to produce any significant reduction in the incidence of still-birth and neonatal death. An explanatory letter was sent to all family doctors and all domiciliary midwives. Maternity home and hospital staffs were briefed in the type of information to be entered on the questionnaire. 87 Details were required of all the medical, obstetric and social factors for all live births occurring during the week 3rd to 9th March, 1958, for all still-births (i.e., after twenty-eight weeks' gestation), and all neonatal deaths (up to the 28th day of life) occurring between the first day of March and the last day of May (inclusive). In addition it was requested that every effort be made to obtain permission for post-mortem examination in the case of all such still-births and neonatal deaths which occurred during the month of March. The Department also continued to co-operate 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 thirty-two practising midwives in the Borough at the end of 1958, 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 1958 and includes those at Thorpe Coombe:— No. of confinements attended 1,734 „ Medical Aid Notices sent 709 „ Twin Births notified 11 „ Triplet „ „ — „ Stillbirths notified 23 „ Notifications of Artificial Feeding 15 „ „ „ Discharging Eyes — „ Deaths notified — Medical aid was summoned by midwives in domiciliary practice and private nursing homes on twelve occasions, and the details are as follows:— For complications during pregnancy:— Abortion 1 For complications during labour:— Ruptured perineum 5 Premature labour — Rise in temperature 1 Postpartum haemorrhage 1 Other conditions 4 Total 12 88 The table below shows the number of visits carried out by the district midwives and home nurse/midwives:— Ante-Natal Examinations Deliveries Patients' Homes Midwife's House L.H.A. Clinics G.P.S' Clinics Mid. Mat. Lying-in Visits Total Visits District Midwives 954 140 1,753 1,117 73 196 3,496 7,729 Home Nurse/ Midwives 190 – 511 550 13 73 791 2,128 Totals 1,144 140 2,264 1,667 86 269 4,287 9,857 One midwife in private practice undertook eleven cases as maternity nurse in a maternity home. Trilene, and Gas and Air Analgesia.—A total of 326 patients on the "district" received trilene or gas and air analgesia, representing a percentage of 91.8 of district confinements. Emergency Unit.—The Emergency Unit stationed at Thorpe Coombe Maternity Hospital was not called out to a Walthamstow case during 1958. 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". Twentyeight pupil midwives passed the examination of the Central Midwives' Board (Part II) during the year. Zoning.—The Borough is now divided into three Zones each of which has a team comprising:— 1 Full-time District Midwife (in charge). 2 District Nurse/Midwives. 2 Pupil Midwives. The teams hold midwives ante-natal clinics at the Infant Welfare Centres situated in the Zone. In this manner each member of the team is known to each patient and is familiar with the patient's ante-natal history. A copy of each ante-natal history card is kept at the District Nurses' Training Home to guard against loss, etc. The members of each team also attend Council Ante-natal Clinic sessions held by Assistant County Medical Officers. In addition, both District Midwives and District Nurse/Midwives attend Antenatal Clinics held by General Practitioner/Obstetricians in their surgeries for their "booked" patients. 89 CO-OPERATION WITH GENERAL PRACTITIONERS The report for 1956 details the steps taken in regard to cooperation with general practitioners, and particularly in regard to the help extended by health visitors, midwives and home nurses. HEALTH VISITING (Section 24) The establishment of health visitors was increased by one to sixteen including the Superintendent, but as most of the staff also carry out duties as school nurses the equivalent of whole-time health visitors at the end of the year was 11.9. This was equal to one whole-time district health visitor to 125 notified births. 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 1958 1,322 3,188 4,510 2,778 4,566 11,854 1957 1,319 3,440 4,759 3,095 5,027 12,881 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 as follows:— "During 1958 the health visiting staff concentrated their energies on all aspects of Health Education. Details of these activities are included in the report on Health Education on page 101 Other Visits Ante-Natal Visits Special Visits Unsuccessful Visits total First Subsequent Total 1958 297 100 397 2,609 1,544 4,550 1957 271 127 398 3,343 1,709 5,450 90 "All new babies born in the Borough are visited by routine and thereafter a system of selective visiting is followed. This type of visiting of the under five age group is possible because of the increased standard of mothercraft which has been achieved. Intensive case work of potential problem and problem families have had rewarding and encouraging results. "The increase in the number of elderly people has resulted in a further increase in visits. Additional visits have also been paid by the Health Visiting Staff to elderly people as a result of the greater number of referrals from hospitals for the follow-up and after-care of geriatric patients. "Co-operation with hospitals is a very important part of the health visitor's work and this is good in the Borough. Weekly visits are paid by the staff to Langthorne Hospital. Twice weekly visits are made to the paediatric wards at Whipps Cross Hospital, where Health visitors pay a round with the Paediatrician to discuss Walthamstow cases. The co-operation with Connaught Hospital is maintained by fortnightly sessions with the Almoner, who I see personally. "The co-operation between health visitors and general practitioners has improved throughout the year. Many problems are referred to the health visitors and they, in turn, call at the family doctors' surgeries to discuss cases on their lists. Two health visitors are present at two general practitioners' infant welfare sessions held weekly, and in the near future, another three health visitors will be in attendance at three other practitioners' infant welfare clinics. "Relaxation classes are held at the three ante-natal clinics and talks given on the physiology and hygiene of pregnancy, mechanism of labour and preparation for childbirth, as well as advice and instruction on diet, layette, ending with the film "My First Baby". Visual aids prove very useful in this important teaching. One health visitor received instruction in relaxation exercises, and a class was started at the "Carville" Home for unmarried mothers and babies in West Avenue Road. The request for this service came from Miss E. Williams, Superintendent of the Home, and the classes are proving valuable. "I must pay tribute to my staff for the wonderful way they have supported me in the past year. Three of our colleagues had major illnesses and were off duty for long periods of sick leave, but because of the extra efforts made by the remainder of the staff, no work was neglected. "The health visitors co-operated in the practical training of the following:— (a) Eight student nursery nurses visited infant welfare, ante-natal, minor ailments, chiropody and other special clinics to meet the requirements of their training syllabus. The students 91 accompanied health visitors in certain selected home visits with particular emphasis on breast feeding, artificial feeding and the toddler. (b) Pupil midwives from Thorpe Coombe Maternity Hospital attended the appropriate number of sessions at infant welfare clinics in accordance with the rules of the Central Midwives Board. (c) Four Health Visitor students from the South-East Essex Technical College carried out three months' practical training in the Borough covering a very wide syllabus. Two health visitor students were given practical training in tuberculosis (preventive medicine) home visiting and clinic work. (d) Final year students from the Connaught Hospital spent two days each in the Public Health field for practical training. Sixteen students each spent half a day home visiting with the district nurse, half a day with the health visitor on specially selected visits, including a first visit to a new baby, a toddler, an old person, a moderate problem family, and a hospital follow-up and after-care case. The students also attended at infant welfare centres, minor ailments clinics, and medical and hygiene inspections in schools. (e) I gave a series of four lectures to Final Year Connaught student nurses on "The social aspects of Disease". The lectures were attended by twenty students. (f) This year a programme was arranged for four Persian students from Dr. Barnardo's Homes and visits to clinics, welfare centres and schools organised. (g) A number of student teachers spent some time observing the various branches of the work of the health visitor. The periods ranged from one day to four days." 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:— "Staff at 31st December, 1958 was as follows:— 1 Superintendent ; Queen's S.R.N., S.C.M., H.V. Cert. 1 Asst. Superintendent ; S.R.N., S.C.M., Q.N. 8 Full-time Queen's S.R.N., S.C.M. 4 „ „ S.R.N., S.C.M. 6 „ „ S.R.N. 2 „ „ S.R.N. Queen's (Male). 2 „ „ S.R.N. Queen's Nurse. 1 Part-time S.R.N. 1 Full-time S.C.M. 4 Part-time S.E.A.N. 92 "During the year twenty-five pupils entered for district midwifery training and all passed. "Six nurses from Connaught Hospital visited the Home and one of these is at present doing midwifery training with the intention of applying for district training here in the future. "A visit was paid by Dr. Carlotta from the Phillipines who was interested in the district nurses' accommodation. "During September an interesting film strip on Posture and Lifting was shown to the nurses at the Home and they were asked for criticism and suggestions. "In November one of the nurses was invited by a Ward Sister of Great Ormond Street Children's Hospital to witness a postoperative dressing for imperforate anus on a baby four weeks old, with a view to the child being nursed at home, which nursing she successfully undertook. "Two Queen's candidates completed their district training and passed the examination in January, 1959. "There was an increase in the number of ante-natal bookings during the year compared with last year and good attendances by patients at all midwives' clinics. "Two specially adapted beds for home nursing of difficult cases were shown to all nurses and this type of bed will be made available where necessary. "At Christmas 1958 thirty-seven parcels of groceries etc., were distributed to needy and infirm persons in the Borough, through the nurses' social fund, and a Christmas Party was arranged for the old people. "The following gives details of home visits during the year:— New cases Total visits Medical 571 45,217 Surgical 191 9,629 Tuberculosis 19 2,313 Operations 2 2 Miscarriages 4 24 Out-Patients—Medical 21 270 Out-Patients—Surgical 4 9 Hypodermic Injections 474 11,436 Casuals 72 158 Last Offices 17 22 Specials 1 14 Total 1,376 69,094 93 "Liaison with General Practitioners.—Nine of the midwives worked with ten general practitioners in regard to ante-natal sessions held by the latter at their surgeries, and also with three other general practitioners who held ante-natal examinations in the patients' homes." VACCINATION AND IMMUNISATION (Section 26) During 1958 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 smallpox 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 200 Whooping Cough Immunisation 212 Vaccination 192 Total 604 Vaccination against Smallpox The number and ages of persons vaccinated are shown below:— Age at date of Vaccination Under 6 months 6-12 months year 2—4 years 5—14 years 15 years and over Total Primary 343 317 34 26 62 121 903 Secondary – – 1 6 20 186 213 Total 343 317 35 32 82 307 1,116 Vaccinated by General Practitioners 780 Vaccinated by County Staff 336 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 1958 was 51 per cent. (The rate for England and Wales for 1957 was 43 per cent.) 94 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 War period Post-war period 1930—1938 1939—1945 1946-53 1954-58 15.2 12.7 22.7 30 14.0 12.3 54.9 34 12.1 14.0 20.8 49 14.0 19.0 20.1 56 14.0 21.4 23 51 21.8 17.5 37 13.5 24.2 35 16.2 36 17.8 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 revaccination, 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. The number vaccinated was as follows:— No. now employed Of those now employed No. successfully vaccinated within 3 vrs. Of those now employed No. vaccinated but not within 3 yrs. No. revaccinated during 6 mths. ended 30.9.58 Hospital "A" 202 181 18 — Hospital "B" 76 41 34 — 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. 95 DIPHTHERIA IMMUNISATION, 1958 The following is a summary of the work carried out during the year:— 4 Total number of immunisations completed:— (а) School age 127 (b) Pre-school age 1,049 Total 1,176 (c) Number already immunised having a reinforcing dose 764 Details of the immunisations included in the above total are set out below:— Number completed at Schools 84 „ „ „ Welfare Centres 386 „ „ „ Town Hall Clinic 77 „ „ „ Brookscroft 48 „ „ by General Practitioners 581 Total 1,176 The urgency of poliomyelitis vaccination caused the temporary suspension in May of immunisation sessions in schools, but even so 1,176 immunisations were completed in 1958 compared with 1,350 during 1957. Reinforcing doses suffered a larger reduction from 1,245 to 764. Ninety-nine children included in the above table were given combined whooping cough/diphtheria antigen and ninety-eight children were given whooping cough/diphtheria/tetanus antigen by general practitioners. Also four children received "booster" doses. These prophylactics were not supplied by the County Council. During the past five years the numbers immunised in the various age groups were as follows:— Age at Immunisation Year 0-l year 1-2 years 2-3 years 3-4 years 4-5 years Total 0-5 years School Age Grand Total Admitted to Hospital* 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 1958 80S 145 34 31 31 1,049 127 1,176 2 In no case was the diagnosis confirmed 96 The corrected notifications and deaths from diphtheria for England and Wales have progressively decreased since immunisation commenced, and in 1957 reached the new low record of only 37 notifications with 6 deaths. In 1948 the corresponding figures were 3,575 notifications and 156 deaths. In Walthamstow there have been only two cases of confirmed diphtheria in the last twelve years, the last being in 1950. But 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 62. Number of children at 31st December, 1958, 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 1958) 267 1—4 (born 1957-1954) 3,506 5—9 (born 1953-1949) 6,646 10—14 (born 1948-1944) 8,840 Total immunised under 15 years 19,259 Letters were sent to the parents of all newly born children advising them of the need to avail themselves of the facilities for diphtheria immunisation and the Medical and Health Visiting Staffs have maintained a system of personal persuasion. IMMUNISATION AGAINST WHOOPING COUGH The numbers and age groups of children immunised during the year are shown in the following table:— Age at date of Final Injection Under 6 mths. 6—12 mths. 1 year 2—4 years 5 years and over Total Clinics, Nurseries and Welfare Centres 299 228 24 4 1 556 General Practitioners 118 235 38 19 12 422 Total 417 463 62 23 13 978 In addition general practitioners gave thirty-nine booster injections. The percentage of children immunised during the first year of life was 68. 97 VACCINATION AGAINST POLIOMYELITIS In November 1957 eligibility for vaccination included the age group six months to fifteen years, expectant mothers and special groups. In January 1958 an option of vaccination with North American tested vaccine was circulated to the parents of those children who were still awaiting vaccination with British vaccine. In May the Ministry of Health authorised the use of imported vaccine which, although tested and licensed in the country of origin, had not been tested in this country. Parents still awaiting British tested vaccine were given the option of accepting the untested vaccine, and in fact most did so. As a result administrative action became still further complicated, since consent forms had to be sorted out as between vaccinations to be done by the family doctor and those to be done by the Health Department, and again according to the type of vaccine selected, i.e., (a) British vaccine (b) Imported and British tested (c) Imported, but not British tested During the latter part of 1958 vaccination was made available to persons between the ages of six months and twenty-five years and, in addition, the administration of third doses seven months after the second dose, was advised. Plans were then made to give the maximum publicity to this extension of entitlement and a new "all-in" illustrated leaflet and consent form was devised. Publicity was given by advertisement and through the schools with the assistance of the Borough Education Officer and Head Teachers. In addition, posters were exhibited on all the Borough Council poster sites. During 1958 supplies of vaccine were somewhat erratic and there was unfortunately a gap of two months between 27th February and the 23rd April when no vaccine was received. In all, some 26,000 doses of vaccine were received during the year and over 10,000 doses were administered at the Central Clinic in the Town Hall. The remainder of the vaccine was issued to general practitioners. In November it was estimated that there were 16,500 persons eligible to receive vaccination in the 15/25 year age group, but at the same time over 11,000 young persons remained unvaccinated in the age group six months to fifteen years. All the vaccine administered has been singularly free from reaction. 98 Up to the end of the year the number of pessons who had received two doses was:— Children 12,756 Expectant Mothers 342 Young Persons 27 Other Groups 67 13,192 of which the following were done in 1958:— Children 9,894 Expectant Mothers 342 Young Persons 27 Other Groups 67 10,330 By the end of the year 1,694 persons had received third doses. It is of interest to note that most of the teenagers who were presented for poliomyelitis vaccination also showed evidence of previous B.C.G. vaccination. 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 1958 acceptances were received from 1,218 children out of 2,147 who were eligible, i.e., 56.7%. Details are as follows:— Heaf positive 131 Percentage positive 11.6 Heaf negative 995 Number absent from test 92 B.C.G. given 995 The percentages of children Heaf positive in previous years were :— 1954 1955 1956 1957 17.6% 13.0% 14.2% 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 February. Dr. Pollock reported that of 277 young persons invited for this sixth annual chest X-ray examination, 152 attended, i.e., 58% of the total invited. Of these 56% completed the skin test. Again of the 161 who did not attend the 1957 check-up, thirty-nine attended during 1958. 99 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 Waltham stow 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. Total Attendances 16,587 „ New Cases 6,409 „ X-rays 14,156 „ Screening 576 Miniature Camera 4,997 New Notifications 60 (Walthamstow only) "The overall figure of attendances at the Clinic is much the same as 1957. It is interesting, however, that while cases of tuberculosis decline the total of new cases referred is up by more than five hundred. Of these practically five thousand were dealt with in the first instance by miniature X-ray, about seven hundred of them contacts. The number recalled for full investigation was 582. The reduction in the amount of X-ray screening reflects the continuing fall in the number of cases under treatment by collapse measures. "The number of cases of tuberculosis notified during the year is the smallest on record, and gives a rate of 52.6 per 100,000 population. Lung cancer was diagnosed in fifty cases, a rate of 44 per 100,000 and a slight increase on 1957." Walthamstow and Chingford Association of Tuberculosis Care Helpers. Miss V. Jennings, Honorary Secretary of the Walthamstow and Chingford Association of Tuberculosis Care Helpers, contributes the following report:— 100 "Last year's report referred to the fact that many of the cases requiring our help were in the upper and middle age groups. This trend has continued, although there are, of course, still numbers of younger patients who need help and guidance over the shorter periods during which they now remain off work. "The following gives some indication of the material help given during the period covered by this report:— Type of help given No. of cases Cost £ Milk 4 23 Grocery 36 675 Fuel 46 98 Fares to visit patients 11 32 Clothing, Bedding, etc 50 83 Holidays 4 55 Handicrafts 6 8 Miscellaneous Grants:— Rent, rates, debts, Radio Licences etc 105 195 "A total of 143 cases were given help involving expenditure of our own funds, whilst others were put in touch with organisations better equipped to meet their needs. "It has not been easy to maintain the level of funds raised locally, but owing to the very great efforts made by the Seal Sale Secretary, revenue from this source has not fallen to the extent which might have been expected, and no case in need of assistance has had to be refused. "In May Miss A. Woolgar, who was then Secretary, accepted an invitation from the N.A.P.T. to address a conference at Reading University, and during the summer we were represented at the Commonwealth Conference on Tuberculosis and Diseases of the Heart and Chest. "Two Meetings of Essex Tuberculosis Care Committee Secretaries again took place at Chelmsford, and these continue to provide opportunity for the exchange of views and experience. "Following the decision of the N.A.P.T. to change its name to The Chest and Heart Association, we gave serious thought to our own position, but in view of the fact that we are not permitted to use monies derived from County Council grants for any but tuberculosis patients and their families, a separate fund would be required, and we felt that our income would be inadequate to meet the demands which would arise from an extension of the scope of our work at this stage. 101 "Although the outlook for the tuberculosis patient is no longer the demoralising one of past years, there is still plenty to be done, and those of us with personal knowledge of the patients and their families are well aware of the need for a live Tuberculosis Care Association in this district. "It was with great regret that we learned from Miss Woolgar that, after eleven years of service, owing to health reasons she was obliged to reduce her duties undertaken for the Committee, and this called for a redistribution of responsibilities. As Miss Woolgar understood the work in all its aspects, we were happy to be able to retain her services as Hon. Case Secretary, and appointed Mr. J. McGiverin as Hon. Treasurer as from November, 1958 during which month I also commenced duty." Rehabilitation of Tuberculous Patients. Financial responsibility for the one continuing case ceased on 31st January, 1958. Prevention. B.C.G. vaccination is referred to on page 97. 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 fifty-nine. In addition, arrangements were made for nine patients who subsequently cancelled their applications for various reasons. 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:— "Chiropody in the Walthamstow Health Area has maintained its popularity with more patients seeking treatment than the Service is equipped to deal with. The number of appointments booked still remains over four thousand, with thirteen to fourteen weeks between 102 treatments, except for adult verrucae cases, septic conditions, and acute pain, which have to be fitted in for extra treatment between existing appointments. In addition, there are patients who sometimes think that they alone should not wait thirteen weeks. In some cases where the patient is willing, or can afford to do so, and has a chronic condition, he/she attends a private chiropodist between visits here. "Once again ladies have outnumbered the gentlemen, and with the trend of shoes worn today, will continue to do so, and provide work for chiropodists for generations to come. "This year we gave 18,899 treatments to 6,117 patients, making a total of 3.08 visits per patient for the year, being an increase of 151 over 1957. Male treatments amounted to 4,081, females 14,818; of these 1,337 were new cases, the males accounting for 400 and females 937. "Adult treatments totalled 16,387; 3,037 male, 13,350 female, and of these 832 were new cases, 188 being male and 644 female. "During the year transport was again provided for the nonambulant, 265 treatments having been given, 204 to females and sixty-one to male patients. "The Children's Clinic still flourishes and is an important part of our work, but time is limited with only one session per week. In spite of this, however, 2,512 treatments were given to 699 children, making 3.5 treatments per patient; of these 1,044 were boys and 1,468 girls: new patients totalled 505, of which 212 were boys and 293 were girls. "Breaking these figures down again 2,157 treatments were given for verruca pedis, including 920 boys and 1,237 girls. New patients with verruca pedis during the year amounted to 359, i.e., 156 boys and 203 girls." HEALTH EDUCATION Throughout the year the Health Visiting Staff have carried out a regular series of talks at schools and welfare centres. The staff was increased by one owing to our large programme, and as a result mothercraft teaching in all secondary modern schools was extended throughout the school year except in one school. There has been an increase in the number of requests for talks to be given to young mothers' groups on a wide range of subjects. A health visitor arranged and gave a talk and film show to a parent/ teacher association. Group teaching of this nature is a valuable method of health education and reaches a larger number of the people as opposed to individual teaching of past years. 103 National "Guard that Fire" Campaign. This was held in November 1958 and after much preliminary preparation a "working party" was set up and met in October under the Chairmanship of Dr. G. Poole and included the local Station Fire Officer, representatives of the Education, Housing and Library Services, the Superintendent Health Visitor, the Chief Public Health Inspector and the Chief Administrative Assistant of the Area Health Services. In addition, Dr. Poole addressed a meeting of Head Teachers and obtained their promise of co-operation. The following is a summary of the action taken:— 1. Posters and Leaflets. The following numbers were exhibited or distributed:— (a) "Don't fool with fireworks"—60 posters at schools. (b) "Danger in the home"—approximately 1,000 leaflets. (c) "Burns and scalds"—approximately 1,000 leaflets via the Library Service to old people. (d) "Guard that Fire"—25,000 leaflets distributed via schools, Council and Warner Estate tenants. Posters referring to the dangers of fire were displayed at all schools and on all the Borough Council's advertisement hoardings, vehicles, etc. One thousand correspondence "stickers" bearing the "Guard that Fire" symbol were issued. 2. Film Shows. The Management of four local cinemas agreed to show short films or slides in support of the campaign. Arrangements were made for talks on the dangers of fire to be given at Old People's Clubs with the co-operation of the officers of the Essex County Fire Service, and at the Lloyd Park meeting a sound film was shown. 3. Exhibition and Displays. Displays were exhibited at six welfare centres and in the Town Hall foyer, the Town Hall School Clinic, the Central Library, and the Housing Department. A portable display was used to demonstrate talks given at eight old people's clubs and displays were also erected in the showrooms of the London Electricity Board and the North Thames Gas Board. Special displays on the forecourt of their shops were arranged by fifteen local tradesmen and a further twenty arranged window displays. 104 All local hardware stores and many other shops displayed the circular window label, and where possible shopkeepers were asked to keep a note of any increase in sales of fireguards attributed to the campaign. All shops (including secondhand shops) selling heating and cooking appliances were visited by Public Health Inspectors to ensure that the guards fitted complied with the regulation specification. 4. Talks and Discussions Duplicated notes for talks were supplied to all schools and to others interested. (i) Old People's Clubs—eight talks with the assistance of a Station Officer, Essex County Council Fire Brigade (Walthamstow Station). (ii) Schools—Talks were given by Head Teachers or Class Teachers in all departments of the Walthamstow schools. In addition, fourteen talks at seven schools were given by health visitors. Two parent/teacher meetings were addressed by a health visitor and fire officer. 5. Local Press. Full support was given by the " Walthamstow Guardian" and the "Walthamstow Post" including feature articles and the printing of the following poem spontaneously written by Christine Harvey, aged ten, after a school talk on fire guards. "Jemima was a lively girl She loved to dance and play and twirl, Jemima danced too near the flame Jemima felt a burning pain. No more can Jemima dance and play, She sits in her wheelchair all the day. It wasn't all Jemima's fault Her Mother and Father should have thought, Fire Guards a must should be In every home in this country." 6. Other Action. All officers of the County and Borough Councils who customarily visit homes—health visitors, home nurse/midwives, public health inspectors, housing inspectors, etc., and all members of the Home Help Service were briefed to look for fire hazards in all the homes they visited and to take appropriate action. 105 The Gas and Electricity Boards agreed to inspect free any apparatus connected to their supplies and often made no charge for small adjustments. Rubber stamps were prepared of the "Guard that Fire" medallion and were issued to the Town Clerk's, the Borough Treasurer's and Housing Departments, in addition to the Education and Health Offices, for the purpose of franking envelopes. 7. Results. Enquiries by the Chief Public Health Inspector from local tradesmen indicate that an average increase of 5 per cent. in local fire guard sales is attributable to the Campaign. The Domestic Help Organisers report several instances of fire guards being obtained as a result of representations made by their staff. While it is not possible to assess the full effect of the campaign, it was a valuable exercise in conducting a coordinated effort in Health Education. Great keenness and a good deal of unsuspected talent was displayed in the organisation of exhibits etc., and the ready co-operation of all taking part was most gratifying. The local campaign was directed by Dr. G. Poole, Deputy Medical Officer of Health and Assistant County Medical Officer. DOMESTIC HELP SERVICE Section 29) The Domestic Help Organisers, Mrs. W. Pickard and Mrs. B. Oliver, report as follows:— "Following the appointment of a second organiser, the subsequent division of the Borough into East and West areas proved most satisfactory. It was possible to give more time to the planning of rotas, keeping the domestic helps working in compact areas as much as possible—reducing the cost of travelling by a third. "At the same time the expenditure on domestic help wages has been reduced, although the hours of assistance provided has not significantly diminished and this is mainly attributable to the re-organisation referred to above. "More care and thought was given to the arrangement of the Service; all applications have been met, giving patients suitable assistance as speedily as possible. 106 "A total of 3,932 visits were made by the organisers during the year; much visiting time was absorbed by frequent supervision of cases where age and senility had produced a state of neglect in health and home. The domestic helps have nobly undertaken this difficult and often distasteful work with kindness and efficiency. "Requests for help have increased slightly, mainly for chronic aged sick. The number of tuberculosis cases has declinedbut hours of service for this category of patient have shown an increase due mainly to lack of help by relatives. "Fewer calls to help problem families and for care of children have been made than during last year. Maternity and acute sick cases compare on an average with those of 1957. "The following is a summary of the year's work:— Brought forward from 1957 664 New cases during 1958 543 Cases completed during 1958 506 Number of cases carried forward to 1959 701 "Supervision of staff during working periods was more frequently carried out, resulting in a good standard of work, less absenteeism and more co-operation from the domestic helps, and a special mention must be made of the excellent way in which the domestic helps kept the Service running during the difficult period of the 'bus strike in April-May, 1958. "Staff employed at the end of 1958 was 197, including six full-time workers. This is a decrease in number from 1957, but more regular part-time helps are working an average of twenty hours weekly, giving the requisite number of working hours required. "Applicants for employment were numerous except in the Woodford Green area. As a result of an advertisement made in the local press in November there has been sufficient response to provide a waiting list of suitable women prepared to work in this part of the Borough. "The satisfactory operation of the Service throughout the year has been greatly helped as a result of the willing assistance given by the health visitors, the Borough Council's 'Meals on Wheels' organisation, and tribute must also be paid to the co-operative attitude of the family doctors." 107 DOMESTIC HELP SERVICE, 1958 Maternity Acute Sick Tuberculous Chronic Sick Aged not Sick Others Total Aged Others Requests for help from new cases during the year 84 54 17 400 83 8 5 651 Total cases helped during the year 37 43 25 849 105 21 7 1,087 Cases being helped at end of year who have received help for : Under 3 mths. 1 6 5 95 14 4 – 125 3—6 ,, 1 – 2 41 4 – – 48 6—12 ,, – – 1 75 11 – – 87 Over 12 „ – – 10 393 34 4 – 441 Total carried forward to 1958 2 6 18 604 63 8 – 701 Hours of help provided during the year 2,240½ 2,044 3,680¼ 143,639¼ 16,866¾ 3,389½ 763 172,623¼ 108 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 provided to persons residing within the Borough of Walthamstow during the year 1958:— (1) Residential and Temporary Accommodation. (a) The number of residents from the Borough of Walthamstow in residential accommodation provided by or on behalf of the County Council on the 31st December, 1958 was 173 (men 64, women 109), of whom 22 men and 31 women were admitted during 1958. (b) Admitted to temporary accommodation : Nine cases involving: men 1 women 8 children 21 (2) Deaf and Dumb and Other Handicapped Classes. "The Welfare Committee has continued to develop the welfare services for permanently and substantially handicapped persons other than blind (about whom reference is made below) as provided for under Section 29 of the National Assistance Act, 1948. In addition to direct provision, such as special equipment on loan, grants towards the cost of structural alterations to meet special needs and assistance with holidays—under expert supervision—the fullest co-operation has been continued with specialised organisations in this field of welfare service, many of these bodies acting as the Council's agents in this connection. The register of handicapped persons, maintained by the Department, contained the names of 115 residents of the Borough at 31st December, 1958. (3) Blind Persons. "The number of registered blind, partially sighted and defective sighted persons resident in the Borough on the 31st December, 1958 were as follows:— (a) Registered blind 253 (b) Partially sighted 59 (c) Defective sighted 15 109 all of whom were under the supervision of the County Council's Home Teachers. At the same date five blind residents were participating in the Home Workers Scheme operated through the agency of the Royal London Society for the Blind and one was employed in a workshop for the blind. In addition, there were twenty-nine blind and fifteen partially sighted persons employed in open industry and under the supervision of the Council's Placement Officer." PREVENTION AND ALLEVIATION OF BLINDNESS Copies of the Memorandum on this subject issued by the Ministry of Health early in 1958 were distributed to all medical and nursing staffs. The following items were included in the instructions then issued. Special notes should be made on the infant welfare record cards of all babies whose history includes prematurity or maternal illness, especially rubella during pregnancy or toxaemia, haemorrhage, difficult labour, neonatal anoxia or jaundice. These cards should be conspicuously marked, e.g., with a red tab for follow-up purposes, and where there is any suspicion of visual defect, a report should be made to the medical officer for an ophthalmic examination to be arranged. Children whose parents suffer from myopia or who have a history of familial visual defect should be similarly treated. The vision of school children should be checked at regular intervals, but school nurses should ensure that any child absent at a routine medical inspection is not overlooked. The school nurse should also report every case of squint in order to ensure that adequate treatment is being or will be given. The health visitor will be increasingly concerned with the welfare of the elderly and should report to the family doctor any deterioration in the vision of old people. Elderly people may be unaware of the gradual failure of their vision, especially if, at first, one eye only is affected and incipient blindness can be detected much earlier by a trained observer. Defective vision is a most potent cause of accidents both at home and on the roads. Recent advances in the medical treatment of eye conditions has so improved the prognosis for many that it becomes increasingly important for early ophthalmological examination to be arranged. All blind and partially sighted persons should be encouraged to register so that they may benefit from the help available from the Ministry of Labour and the County Council, e.g., blind welfare workers and the voluntary bodies concerned with the welfare of the blind. WALTHAMSTOW VITAL STATISTICS 1881/1958 The following table shows the vast improvement in the public health of Walthamstow since 1881, i.e., over a period of seventy eight years. The averages given are for the five year periods stated except for the three year average for the years 1956/ 1958. Information available for the earlier years is somewhat sketchy and there is considerable discrepancy between the various estimates of population in the inter-censal years. The general picture up to the end of the Nineteenth Century is that of a rapidly growing London suburb following from the provision of railway facilities with Central London. There were thousands of artisan dwellings along unmade roads without any street cleansing, with overcrowding poverty and lack of the most elementary knowledge of hygiene, especially in regard to the nurture of infant life, a high birth rate and a high infant mortality rate. Although there were separate sewerage systems for surface water and sewage, the former became inadequate in heavy storms and the latter were badly constructed and ventilated. There was only intermittent refuse collection. Water was supplied by a private undertaking up to 1903. i.e. the East London Water Company. The supply was intermittent, inadequate and dirty with little or no redress on complaint. Most houses had water closets, but drinking water was often obtained from the same storage tank as the closet. Epidemics of communicable diseases occurred regularly, notably diphtheria, scarlet fever and typhoid with summer diarrhoea or gastro enteritis as a most fatal disease for young babies. Measles and whooping cough were also epidemic and often fatal, but not notifiable. Until 1901 when the District Isolation Hospital, i.e. Chingford Sanatorium" became available, there were no isolation hospital facilities. Mortality rates were high and modern methods of prevention diagnosis and treatment were unknown. Reviewing the various headings of the table in order, the natural" increase in population i.e. the excess of births over deaths diminished from a maximum of 2,200 in 1901/5 to only 108 in 1956/8. and at this rate there will soon be an excess of deaths. There has been an almost steady decline in birth and death rates, and after 1900 in the infant mortality rate to a new low record of only 15.4 in 1958. The infant mortality rate of 123 3 when applied to the 3442 infant deaths in 1901/5 represents an annual total of 424 deaths. If the 1956/58 average infant mortality nate were applied to the 1901/05 period, there would only have been 67 deaths in all. With regard to notifications and deaths from infectious disease, diphtheria has now almost disappeared, and therein lies the danger of complacency in neglecting immunisation. The last death from diphtheria was in 1946 and the last confirmed case in 1950. Scarlet fever, except in those few cases where it is followed by nephrite is now merely a nuisance, the last fatal case being in 1956, and since when have been 5,166 notified cases without a fatality. Enteric fevers, i.e., typhoid and paratyphoid, have practically disappear except for the infrequent case caused by a carrier. In 1896/1900 there was annual average of 100 cases of enteric fever with over 12 deaths annually The incidence of tuberculosis, since statistics were kept in 1911. shows incidence now to be only between one quarter and one fifth and the mortality be only one fourteenth of the earlier rates. The compulsory pasteurisation milk has almost eliminated (bovine) tuberculosis. Deaths from measles and whooping cough are now extremely rare. e.g,. threr deaths from measles and one from whooping cough in the last eight years compare with an average of 57 deaths each year from such diseases during the twenty [???] years 1891/1915. Diarrhoea and gastro enteritis, the chief causes of infant death in the [???] 19th century, and indeed until after the first World War, have now virtually disappeared as causes of infant death. At its worst during the ten year [???] 1896/1906 there was an average of 109 deaths each year from these causes among young children. There were only 3 deaths in all during the last eight years. On the debit side is the increase in deaths from cancer, especially cancer the lung the appearance of poliomyelitis (now fortunately being controlled vaccination) and an increase in bacillary dysentery and food poisoning (both to inadequate personal hygiene). The table shows the progress in regard to vaccination and immunisation. complete or substantial protection can be given now against smallpox, diphtheria whooping cough, tuberculosis and poliomyelitis. Following from the advent of the National Health Service, the attendances welfare centres have tended to fall as the family doctor becomes more interested in child welfare and health education. Finally, the average number of home visits paid by the staff of the Department as a whole, i.e. health visitors, home nurses, midwives and health inspectors was no less than 117 758 during each of the last three years, that is. an average of over one visit each year to every member of the population in the Borough A. T. W. POWELL July, 1959. WALTHAMSTOW Annual Averages during the five years stated Quin quennial period Popu 1ation New dwellings Births Deaths Natural increase Birth rate Death rate Deaths under 1 year Infant Mortality rate Notifications of Infectious Disease S.P. S.F. Diph. Enteric Fever Erysipelas E. L. C. S.M. Tuberculosis Polio Dysentery Food poisoning L. A. P. E. Total Pul. Non Pul. 1881/85 26720 1055 39.5 16.2 1886/90 41700 1476 616 860 35.4 14. 8 193 130.8 0.6 1891/95 53149 1823 820 1003 34. 3 15.4 251 137.7 5.2 326 152 62 86 1896/1900 79397 2503 1044 1459 31.5 13.1 386 151.6 – 356 271 100 98 1901/05 106186 3442 1242 2200 32.4 11.7 425 123.3 40.0 549 211 71 125 1906/10 114796 3454 1286 2168 29.9 11.2 353 101.4 – 599 216 26 107 1911/15 129830 3119 1420 1699 24.0 12.5 278 87.9 – 373 290 15 89 224 104 2.8 1916/20 129666 2540 1410 1130 19.0 11.4 174 69.9 – 329 366 6.0 58 261 67 6.6 1921/25 130199 114 58 172 2466 1290 1176 19.2 9.8 142 57.9 – 491 269 3.4 49 8.4 198 51 2.2 1926/30 124366 72 423 495 2025 1268 757 16.3 10.2 97 48.0 39.9 633 333 3.9 54 4 0 1.4 142 44 1.4 1931/35 134631 100 519 619 1758 1347 411 13.0 9.9 88 49.4 15.4 550 290 11 61 1.0 3.0 139 39 3.2 2 0 1936/40 127140 30 220 252 1638 1401 237 12.8 11.2 66 42. 6 – 217 65 5.4 54 1, 6 2.8 126 27 3.4 23 1941/45 99576 5 5 1695 1260 435 16.7 14.6 66 42.0 – 350 17 2. 2 28 – 10.2 130 26 1.0 48 1946/50 121864 219 54 273 2143 1299 844 18.6 10.6 61 27.6 – 192 5 2.6 35 – 5.0 127 17 9.9 7 1951/55 119500 135 49 184 1478 1225 253 12.3 10.2 35 23.7 – 232 – 1.8 30 0.6 3.2 86 13 9.0 86 19 1956/58 (3 years 115333 244 29 273 1337 1229 108 11.6 10.6 26 19.4 0.3 101 – 0.6 17 0.6 65 7 9.0 92 30 only) Key L. A. Local Authority P. E. Private Enterprise S. P. Smallpox S. F. Scarlet Fever Diph. Diphtheria E. L. Encephalitis Lethargica C. S. M. Cerebro Spinal Meningitis Pul. Pulmonary WALTHAMSTOW Annual Averages during the five years stated Quinquennial period Deaths from Immunisation & Vaccination Welfare Attendances Home Visits S.F. Diph. Measles whooping Cough Gastro Enteritis Enteric Fever Tuberculosis Pul. Non Pul. Influenza Cancer Suicide S.P. Diph. Whooping Cough B. C. G. Polio Muni cipal volun- tary Total Heal th Visiting 0.5 yrs. Home Nursing Mid wifery Sanitary Inspection Visits 1881/85 15.8 9.8 13 18 23.4 3.6 1886/90 6.0 34 18 25 40.6 6.4 52 1891/95 10.4 32 39 24 32.8 8.4 56 1896/1900 5.2 47.4 22 34 120 12.4 60 1901/05 11.2 25.4 40 29 99 12.4 92 53 1906/10 13.8 27.6 29 35 64.6 6.0 105 75 1911/15 4.6 23 30 24 59.6 2. 4 125 105 1916/20 2.0 19 16 16 27 1.4 138 117 1921/25 3.4 11 12 19 20 1.0 112 143 1926/30 4.0 12 10 10 7.4 0.4 95 14 29 164 19 17309 8312 25621 19867 1931/35 2.0 7 8.6 6 4 10.2 0.4 85 12 26 193 20 355 31358 10717 42075 14950 25220 1936/40 0.2 2 2.6 2. 2 9.0 0.2 72 12 26 210 15 1084 38853 12223 51076 15507 24302 1941/45 – 2 1.4 1 8 4.0 – 55 9.2 13 210 7 2009 37657 9316 46973 16439 15967 1946/50 – 1 1.0 2 0 3.0 – 47 5.8 12 228 15 498 2256 895 46781 12845 59626 16798 (3yr. only 48335 3yr. only) 12935) 22858 1951/55 –- – 0.4 0 2 0.6 – 20.2 1.6 12 238 9 837 1483 662 272 32455 8306 40763 16019 61872 8870 20050 1956/58 (3 years only) – – 0.3 – – – 8.0 1.3 14 274 14 3035 1274 1014 1024 4366 26102 5812 31914 13145 77133 8889 18591 Key L. A, Local Authority P. E. Private Enterprise S.P. Smallpox S. F. Scarlet Fever Diph. Diphtheria E. L, Encephalitis Lethargica C. S. M. Cerebro Spinal Meningitis