4411 BOROUGH OF WALTHAMSTOW MEDICAL OFFICER OF HEALTH for the Year 1959 MELVILLE WATKINS, M.R.C.S., L.R.C.P., D.P.H. MEDICAL OFFICER OF HEALTH Borough of Walth amstow HEALTH DEPARTMENT TOWN HALL, FOREST ROAD, WALTHAMSTOW, E.I7 Telephone: LARkswood 2334 With the compliments of the Medical officer of Health BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1959 MELVILLE WATKINS, M.R.C.S., L.R.C.P., D.P.H. MEDICAL OFFICER OF HEALTH INDEX Page SECTION A - Statistics and Social Conditions of the Area 8 SECTION B - General Provision of Health Services in the Area 11 SECTION C - Sanitary Circumstances of the Area 13 SECTION D - Housing 19 SECTION E - Inspection and Supervision of Food 23 SECTION F - Prevalence and Control over Infectious Diseases 32 SECTION G - Miscellaneous 36 SECTION H National Health Service Act, 1946 - Part III Services 38 Page Acreage 8 Adulteration 26 Aged and chronic sick 12 Ambulance Facilities 12. 62 Ante-Natal Clinics 41, 45 Ante-Natal Care 43 Assessments 8 B.C.G. Vaccination 61 Birth Notifications 43 Births. 8, 44 'Brookscroft' Welfare 46 Care of Mothers and Young Children 41 Child Guidance 48 Chiropody 64 Clean Air Act, 1956 5 Clearance Areas 21 Committees 4, 39 Comparability Factor 10 Confinements 54 Convalescence 50,64 Conveniences, Public 37 Co-operation with Hospitals and General Practitioners 7, 54 Cremation 38 Daily Guardian Scheme 52 Day Nurseries 51 Deaths from Accidents in the Home 10 Deaths, Infants 8, 42 Deaths Causes of 9, 42 Dental Laboratory 41 Dental Treatment 40. 47 Diphtheria 33 Diphtheria Immunisation 59 Diseases of Animals Acts 29 Page Disinfections 14, 37 Disinfestaticn 17 Domestic Help 65 Domiciliary Chiropody 36 Dysentery 33, 34 Employment 10 Essex County Coincil Act, 1933 13 Factories Acts, 1937/48 31 Food and Drugs Act, 1955 26 Food Hygiene Regulations, 1955 28 Flooding 38 Food Inspection 23 Food Poisoning 29, 33, 34 Foot Clinic 64 Funeral Arrangements 37 Gas and Air Analgesia 54 General Dental Service 40 General Information 37 Hairdressers and Barbers 18 Health Centres 40 Health Visiting 55 Home Nursing 57 Hospital Accommodation 12 Housing Act, 1936 19 Housing, General 21 Housing Improvement Grants 19 Housing. Inspection 20 Housing Statistics 19 Ice Cream 24 Illegitimacy 44 Immunisation, Diphtheria, 59 Whooping Cough 61 Infant Mortality 8, 42 Page Infectious Diseases General 32 Inquests 38 Laboratory Facilities 11 Land Charges 19 Laundry Service for the Incontinent 37 Massage and Special Treatment Establishments 13 Maternal Mortality 8 Maternity Outfits 54 Meals on Wheels Service 36 Measles 33 Meat and other Foods 25 Medical Examinations 37 Medicaments 50 Mental Health 6 Midwifery 52 Milk (Special Designations) Orders and Regs 23 Moral Welfare 43 Mothercraft Classes 43 National Assistance Act 12 Notices, Sanitary 13 Notificatiai of Births 43 Nurseries and Child Minders (Reg.) Acts, 1948 51 Nutrients 50 Old People's Welfare 36 Ophthalmic Treatment 48 Orthopaedic Treatment 47 Outworkers 32 Paediatric Clinic 49 Pet Animals Act, 1951 29 Pneumonia 33 Poliomyelitis 33, 61 Population 8 Post Mortems 38 Post Natal Clinics 41, 45 Premature Infants 43 Prevention of Damage by Pests Act, 1949 29 Page Prevention of Illness 62 Public Health Act, 1936 13 Public Health Ins:pection 13 Phenylpyruvic Amentia 49 Rainfall 38 Rateable Value 8 Rehousing on Medical Grounds 22 Relaxation Classes (Ante- Natal) 43, 45 Rent Act, 1957 18 Rodent Control 29 Scabies Treatment 12 Scarlet Fever 33, 34 School Outbreaks 34 Sickroom Equipment 64 Smallpox Vaccination 59 Smoke Abatement 16, 17 Social Conditions 8 Special Premises 14 Staff 11, 40 Statistics 8, 19 Stillbirths 8 Sunlight Treatment 47 Swimming Baths 17 Tuberculosis 6, 34, 62 Vaccination, B. C. G. 61 Poliomyelitis 61 Smallpox 59 Verminous Conditions 12, 17 Vital Statistics 8 Walthamstow Association of Tuberculosis Care Help- ers 6, 63 Walthamstow Child Welfare Society 46 Water 13 Welfare Centres 45, 46 Welfare Foods 51 Welfare Services 68 Whooping Cough 94 Whooping Cough Immunisation 61 Women's Clinic 52, 4 HEALTH COMMITTEE 1959-60 Chairman: COUNCILLOR MRS. W. M. PALETHORPE Vice chairman: COUNCILLOR MRS. L. D. GURR Ex - officio: THE WORSHIPFUL THE MAYOR ALDERMAN S.N, CHAPLIN,J. P. THE DEPUTY MAYOR COUNCILLOR C.J. CROSBIE CHAIRMAN OF FINANCE COMMITTEE ALDERMAN ROSS WYLD, 0. B. E. , J. P. ALDERMAN THE LADY McENTEE, 0. B. E. , J. P. E. C. REDHEAD, J. P. , M. P. COUNCILLORS: COUNCILLORS: MRS. E.L. BALDWIN G. S. MACE MRS. J. C. BECKWITH C. B, REYNOLDS J.J. BRACKEN MRS. C. E. STANNARD MRS. S. CANDY P. F. A. WEBSTER J.H. HAMMOND D. WEINSTEIN G. E. KITCHEN A. F. WHICHER Medical Officer of Health. M. WATKINS, M.R. C. S. ,L.R.C.P. , 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. Deputy Chief Public Health Inspector: H.L. HUGHES, D. P. A. , M. A. P. H. I. Chief Clerk R. ROSE 5 TO THE MAYOR ALDERMEN AND COUNCILLORS OF THE BOROUGH OF WALTHAMSTOW MR. MAYOR, LADIES AND GENTLEMEN, I have the honour to submit my first Annual Report on the work of the Health Department for the year 1959. The extent of my responsibilities for the year is a short one since I only commenced duties in November. Dr. A. T. W. Powell, my predecessor, retired at the end of October after twenty-nine years' service as Medical Officer of Health to your Council, and I would like to record my indebtedness to him for the creation of an efficient and forward-looking Health Department. I have an added and personal reason for thanking him, since I was his Deputy for some years and learnt much under his tutelage. For completeness, the Report includes the work which is the responsibility of the Walthamstow Area Health Committee. Much of the content deals with the extent to which routine work has been accomplished. It is without drama and without glamour, unless some catastrophe occurs. Repetitive as the Report may be in each suceeding year, it does indicate an enormous amount of work done in a quiet and efficient manner. However, new responsibilities, extension of existing services and unusual trends in infectious diseases do take place, and it is fitting that attention should be drawn to these. clean air act. The most important additional public health responsibility of the Council which saw its beginning in 1959, was the implementation of the Clean Air Act of 1956. Approval was given in July to a programme, establishing in order of priority, smoke control areas to cover the whole Borough in eight years, and a beginning was made with a detailed survey of Area No. 1. This Act is comparable in public health importance to the passing of the Metropolis Water Act of 1852 which required all piped water to be filtered. Both conferred great benefits, but just as the 1852 Act did not achieve one hundred per cent safety of water supplies by filtration alone, so too, the Clean Air Act cannot produce complete freedom from air pollution since it excludes the internal combustion engine. Even so the result will be an immeasurably cleaner atmosphere, to the benefit of all and more especially to those suffering from chest diseases. 6 MENTAL HEALTH. The passing of the Mental Health Act this year is of great importance and concern to us all, although your Council has no direct responsibility for that section which deals with community care. The Act has been described as revolutionary and being ahead of public opinion. It is the result of a reappraisal of our attitudes towards mental illness. In this connection the words of the Chief Medical Officer of the Ministry of Health in his report of 1958 are worth quoting. He refers to "the silent revolution which has been taking place in the attitude of the Profession and Public to mental illness" and "Thus to the progress and development of modern psychiatry a new era (in mental health) has dawned comparable to that initiated by Chadwick and Simon in their attack on Pestilential Diseases a Century Ago' In the main, the Act deals with the future pattern of hospital treatment and management of the mentally ill and the subnormal. The problem of prevention of mental illness and the promotion of mental health has been our concern for years past in the maternity and child welfare, and educational fields. One small indication of our awareness of our responsibilities in this field is the account in the body of the Report of the institution of routine screening of babies by health visitors for a condition of mental subnormality known as phenylketonuria, which if detected and treated very early, has a good chance of being prevented. TUBERCULOSIS, Tuberculosis in Walthamstow in the past decade has followed the national trend of diminishing notification rates. This fact is now wellknown to the Public. This tends to have its dangers since it is frequently thought that tuberculosis is no longer a problem. Although this objective is attainable, it will not be formany years yet. Such attitudes breed apathy, just as the near elimination of diphtheria has caused a dangerous decline in the acceptance of immunisation against that disease, so there is the danger that the preventive aspects of tuberculosis is in danger of being neglected. Small signs of these attitudes are becoming evident as Miss Jennings, the Secretary of the Tuberculosis Care Society reports We have found it increasingly difficult to convince the public that there is still need for our work". Nor is this con fined to the general public. There is a fear that the younger chest physicians will concentrate too much on the clinical aspec ts of tuberculosis and other chest diseases, and having little 7 realisation of their part in the wider field of epidemiological control. We have reason to be grateful to the present and very experienced generation of chest physicians for their unfailing awareness of the importance of prevention and for their unstinting co-operation with the Health Department. The B.C.G. Scheme for the protection of thirteen year old school-children was extended this year to include all students above this age. This has entailed a great extension of our work and is another indication that although the incidence of tuberculosis is diminishing, our efforts at prevention are not. In fact there must be ever increasing vigilance. CO OPERATION. The National Health Service Act created a tripartite division of Health Services, viz. Hospital, General Practitioner and Local Health Authority Services. It was therefore inevitable that the three sections would tend to develop and progress in isolation at a time when for the good of the patient and efficiency of the Service, close co-operation was called for. Nowhere is this co-operation more vital than in midwifery, where all three Services have responsibilities. A Maternity Services Committee was set up by the Minister to consider the whole question of obstetric practice in this country, and one of its recommendations was the creation of Obstetric Liaison Committees at local level, centred around Hospital Management Committee areas. Such a committee was formed this year covering the Forest Hospital Management Group Area with professional representation from all three sections. Its function is "to ensure that the local provisions for maternity care in the area whether provided by the Hospitals, the Local Health Authority or General Practitioner Obstetricians, are used to the best advantage". Regular meetings are now taking place and have already proved of considerable value in that they are maintaining closer co-operation and a better understanding of each others problems, with obvious benefit to the patient. I wish to place on record my indebtedness to Members of the Committee and all members of the Staff for their great help and co-operation. I have the honour to be, Your obedient Servant, M. WATKINS Medical Officer of Health 8 A. - STATISTICS & SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar-General's Estimate, mid-year 1959) 113,000 Number of Assessments (31st December 1959) 39,750 Rateable Value (31st December 1959) £1,766,599 Estimated Product of a penny rate £7,120 Population. - The Registrar-General's Estimate of the home population at mid-year, 1959, is 113,000, a decrease of 1,000 on the previous year. The steady decline continues. This figure has been used for the calculation of the following statistics:- Live Births; Number 1,440 Rate per 1,000 population 12.7 Illegitimate Live Births per cent of total live births 3.5 Stillbirths: Number 31 Rate per 1,000 total live and stillbirths 21.0 Total Live and Stillbirths 1,471 Infants Deaths (deaths under 1 year) 27 Infant Mortality Rates: Total infant deaths per 1,000 total live births 18.7 Legitimate *' " " " legitimate live births. 17.2 Illegitimate infant deaths per 1,000 illegitimate live births. 58.8 Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 total live births) 10.4 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 total live births) 9.0 Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 29.9 Maternal Mortality (including abortion: Number of deaths 1 Rate per 1,000 total live and stillbirths 0.67 Deaths. - The Registrar General's classification of causes of death by sex totals is given on the following page. 9 Causes of Death as given by the Registrar-General for the Year 1959 Causes of Death Males Females Total 1958 1. Tuberculosis, Respiratory 4 - 4 7 2. Tuberculosis, other - - - - 3. Syphilitic Disease 4 4 8 5 4. Diphtheria - - - - 5. Whooping Cough - - - - 6. Meningococcal Infections - - - - 7. Acute Poliomyelitis - - - - 8. Measles - - - 1 9. Other Infective and Parasitic Diseases 3 - 3 1 10. Malignant neoplasm, stomach 20 19 39 30 11. Malignant neoplasm, Lung, bronchus 65 6 71 60 12. Malignant neoplasm, breast - 25 25 34 13. Malignant neoplasm uterus - 9 9 4 14. Other malignant and lymphatic neoplasms 60 47 107 116 15. Leukaemia aleukaemia 9 8 17 7 16. Diabetes 4 6 10 9 17. Vascular lesions of nervous system 44 84 128 128 18. Coronary disease angina 136 85 221 198 19. Hypertension with heart disease 4 12 16 24 20. Other heart disease 63 101 164 154 21. Other circulatory disease 23 27 50 48 22. Influenza 10 7 17 12 23. Pneumonia 53 36 89 74 24. Bronchitis 55 16 71 75 25. Other diseases of respiratory system 8 1 9 13 26. Ulcer of stomach and duodenum 11 4 15 18 27. Gastritis, enteritis and diarr- hoea. - 1 1 7 28. Nephritis and nephrosis 4 6 10 7 29. Hyperplasia of prostate 7 - 7 7 30. Pregnancy childbirth, abortion - 1 1 - 31. Congenital malformations 5 8 13 13 32. Other defined and ill-defined diseases 36 37 73 89 33. Motor Vehicle Accidents 7 3 10 4 34. All other accidents 10 8 18 13 35. Suicide 8 6 14 14 36. Homicide and operations of war - - - - Totals 1959 653 567 1220 Totals 1958 583 587 - 1170 The age distribution of Cancer deaths was as follows:- Under 1 yr. 1 4 yrs. 5-14 yrs, 15-24 yrs. 25-44 yrs. 45-64 yrs. 65 yrs. & over 2 3 1 3 8 91 160 10 The total number of deaths in 1959 (1,220) compares with 1,170 in 1958, the respective death rates being 10.8 and 10.2 per 1,000 population. The comparability factors for Walthamstow are given by the Registrar-General as follows:- Comparability factor for births 1.00 Comparability factor for deaths 1.06 The above factors, when applied to the crude rates, produce the following adjusted rates:- Live births 12.7 Deaths 11.4 DEATHS FROM ACCIDENTS IN THE HOME Thirteen deaths occurred in 1959 from this cause. Eight died in hospital and five at home. The ages and sexes were:Male 62, 78. 79, 83, 85, 88, Female 64, 67, 67, 73, 83, 89 95. In order to put these and other deaths in proper perspective,. the following comparison is made:- Cause of Death 1958 - 1959 (a) Suicide 14 14 (b) Motor Vehicle Accidents 13 10 (c) All other accidents 13 18 (d) Accidents in the home (included in ~line (c) 7 13 (e) Tuberculosis 7 4 (f) Poliomyelitis Nil Nil Employment According to information kindly supplied by Mr.L. A. Houseman, Manager of the Local Employment Exchange, approximately 340 men and 180 women were placed in employment every month during the year 1959 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 80.000. Of this number it is estimated that about 34,000 were employed in Walthamstow. During 1959, the average number of persons unemployed in the whole area was 900 men and 190 women, including 140 disabled men and 15 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 on returns rendered by certain employers showing the number of N.I. cards they hold. Caution should be exercised in comparing the number 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 Empl qyment Exchange in the area in which he lives. 11 B,- GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH Public Health Officers of the Authority The following changes in the Officers employed in the Health Department took place during the year Appointments: Dr. M. Watkins, M. R. C. S., L. R. C. P., D. P. H. 1.11. 1959 Mrs. G. Heath 13. 4. 1959 Resignations: Dr. A. T. VV. Powell, M. C. ,M. B., B. S. , D. P.H. 31.10.1959 Miss I. Jennings, S. R. N. , S. C. M. 11.10.1959 Mr. B. W. Goode 8. 3. 1959 Deceased: Mr. P. Parker 25. 2.1959 Laboratory Facilities Dr. Prank Marsh, Pathologist in charge of the Laboratory at Epping, has kindly supplied the following information in regard to work done for Walthamstow:- Bacteriology 54 units Haematology 43 units Owing to transport difficulties it became necessary to terminate the arrangements for pathological specimens to be sent to the Laboratory at St. Margaret's Hospital, Epping. For a number of years Dr. Marsh has been very helpful in discussing and giving advice on various epidemiological problems, and I would like to place on record my appreciation of the service rendered by him. 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 cut 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 Total Faeces and rectal swabs 1,126 Nose and throat swabs 200 Urine 2 Pood 7 Miscellaneous 14 Total 1,349 12 Ambulance Facilities. These are available from a local depot in Walthamstow which is administered centrally from Chelmsford, via the Control Centre at IIford. Treatment of Scabies and Verminous Conditions The arrangement, detailed in the report for 1953, with the Hackney Borough Council continued, and three cases were referred there during 1959 receiving three treatments at a total cost of £1. 2s. 6d. Hospital Accommodation (a) ACUTE CASES.-There were no major changes in 1959 in regard to the hospital accommodation available for the inhabitants of the Borough. (b) CHRONIC CASES.-Regional Hospital Boards have asked that Medical Officers of Health shall support when necessary on " social grounds" the recommendations of medical practitioners for the admission of the chronic sick to hospital. All possible help was given when requested. The following table shows the position in regard to hospital and hostel admissions considered and/or supported on "social" grounds. Total number of cases 69 New Cases 68 Brought forward from 1958 1 M O.H requests to Langthorne Hospital or Area Welfare Officer 35 Admitted to Hospitals 29 Admitted to Part III accommodation 13 Died before admission 4 Refused Hospital or Hoste1 accommodation 4 Cancelled or deferred 14 Waiting Part III accommodation 3 It is a pleasure again to record the unfailing help and consideration experienced from Dr. DeLargy at Langthorne Hospital, from Mr. R. S. J. Potter, Area Welfare Officer and my staff. (c) 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. Aged and Chronic Sick National Assistance Act, 1948 (Section 47) Five cases required consideration during 1959 in regard to possible action under this Section. 13 Consideration of two cases was deferred. One case was admitted to hospital and died the next day. The remaining two patients wefe admitted to welfare accommodation. 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. Public Health Act, 1936 - Nursing Homes:- There is no Nursing Home registered in the Borough as the last remaining Maternity Nursing Home closed in October, 1959. Essex County Council Act, 1933 (Establishments for Massage and Special Treatment) Three new licences were granted under the Act during 1959. 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. Close liaison in cases of suspected enteric fever still continues. Mr. W. Richards, Chief Public Health Inspector, contributes the following:- 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 13,485 3,122 1,891 733 816 * 170 156 * 19,618 *Includes notices outstanding from previous year. Of the 733 Intimation Notices served, 182 were in respect of business premises and the remainder (551) related to defects in private houses. Of the latter figure, 381 were complied with without resort to statutory procedure. It was found necessary to institute legal proceedings against owners for non-compliance with Abatement Notices served in respect of thirteen properties. The sum of £15. 2s. 6d. was awarded by the Justices in one case; this consisted of a daily penalty for 105 days following the non-compliance of a Court Order, and costs 14 of £2. Os. Od. Four Orders were made with costs of £6. 6s. Od. and in two other cases the hearings were adjourned sine die and then withdrawn, with costs of £2. 2s. Od. in one instance. In six cases the summonses were withdrawn. The following table shows the nature of work executed and improvements effected during the year:- Drains tested, 358; Drains reconstructed or repaired, 213; Drain obstructions removed, 101: Drains, means of access provided, 21; Drains, ventilation provided or improved, 10; Soil pipes renewed or repaird, 77; Rainwater pipes repaired or renewed, 68; Roofs repaired or renewed, 233; Gutterings repaired or renewed, 150; W. C. pans and traps provided, 135; W. C. s repaired or cleansed, 142; W. C. s light and ventilation improved, 4; Gully traps provided, 46; Waste pipes repaired or renewed, 41; New sinks provided, 24; Stoves and firegrates repaired or renewed, 35; Water supply re-instated, 6; Yard and forecourt pavings repaired, 47; Dirty houses cleansed, 5; Dirty rooms cleansed, 39; Floors repaired, 102; Ventilation under floors provided or improved, 19; Dampness remedied, 286; Offensive accumulations removed, 12; Manholes repaired or resealed, 76; Animals improperly kept, removed, 1; Miscellaneous repairs, 835. INFECTIOUS DISEASES Visits to premises, 616. DISINFECTIONS Rooms disinfected, 129; Articles disinfected, 6,180; Articles destroyed, 77. SPECIAL PREMISES Number Visits paid Factories (a) Non-power 55 82 (b) Power 469 205 (c) Other premises 16 16 Outworkers 529 529 Butchers 84 235 Bakers and Shops 45 94 Fishmongers, Fryers and Curers 36 79 Cafes and Caterers 104 184 Grocers 255 488 Greengrocers 89 109 Ice Cream Manufacturers and Vendors 349 297 Dairies and Milksellers 126 132 Laundries 1 3 Hairdressers 73 75 Rag Dealers 3 4 15 SPECIAL PREMISES (cont'd). Number Visits paid Piggeries 1 1 School Kitchens 20 78 Street Stalls 150 501 Stables 4 8 Schools 46 116 Public Houses 38 82 As a result of the regular periodical visiting of the above premises the following works were carried out BUTCHERS Cleansings, 14; Floors repaired and ventilated, 4; Accumulations removed, 2; New bins provided, 12; W. C. s repaired and cleansed, 3; Light and vsntilation improved, 1; Other improvements, 17. BAKERS Cleansings, 8; New ceilings fixed, 1; Floors repaired, 1; Other improvements, 10, FISHMONGERS Cleansings, 1; Other improvements. 5. CAFES and CATERERS Cleansings, 12; Floors repaired, 3; Other improvements, 15. GROCERS Store rooms cleansed, 12; Washing accommodation improved, 8; Other improvements, 29, GREENGROCERS Store rooms cleansed, 5; Washing accommodation improved, 3; Other improvements, 10. ICE CREAM MANUFACTURERS and VENDORS Cleansings. 4; Other improvements, 5. HAIRDRESSERS Cleansings, 5; Other improvements, 4. SCHOOL KITCHENS Other improvements, 4. 16 DAIRIES and MILKSELLERS Cleansings, 2; Fittings and other improvements, 3. STREET TRADERS Stalls improved, 65. PUBLIC HOUSES Cleansings, 6; Hot water supplied, 1; Hot water supply improved, 1. RAG DEALERS Cleansings, 2. STABLE PREMISES Accumulations removed, 1. PIGGERIES Cleansings, 1. Smoke Abatement Observations on smoke nuisance from premises in the Borough amounted to 92. Investigations were carried out in all cases new boiler plant being installed in some factories and improve^ ments being effected in others. Several applications were received under the provisions of the Clean Air Act, 1956, for prior approval of new boiler plants, and these were approved by the Council subject to certain modifications. Atmospheric pollution instruments for measurement of sulphur pollution are in operation at the Sir George Monoux Grammar School, in Willow Walk, in Blackhorse Lane and at the Woodford County High School. The readings of these instruments for the year are as follows:(the figures given are in milligrams of sulphur per day) Jan. Feb. Mar. Apr. May June Sir George Monoux Grammar School - - - - - - Willow Walk site 3.0 3.8 2.3 1.6 1.0 0.86 Woodford County High School 2.5 3.1 1.5 0.85 0.49 0.67 Blackhorse Lane Site 3.8 4.2 2.6 0.85 0.86 1.0 July Aug. Sept. Oct. Nov. Dec. Sir George Monoux Grammar School 0.62 - 0.66 1.8 3. 1 2. 1 Willow Walk site 0.87 0.77 0.7 1.4 3.0 2.4 Woodford County High School 0.79 0.41 0.43 1.1 1.7 2.9 Blackhorse Lane site 0.51 0.69 0.64 1.9 3.4 2.9 17 The instrument stolen from Sir George Monoux Grammar School was replaced and came into operation on the 1st July. The above figures are similar to those obtained by adjacent authorities and are lower than those given for Central London. The highest figure for Central London being 6.5. Another type of atmospheric pollution instrument has been installed at the Town Hall. This came into operation about the middle of the year and measures the amount of smoke pollution in the atmosphere. It is too early yet to give any figures for comparison from this instrument. SMOKE CONTROL AREAS The Council decided to make the whole of the Borough into a smoke control area within a period of eight years. The first area has been defined; it includes about 2,500 premises and by the end of the year about three-quarters of these had been surveyed. Verminous Premises The number of houses reported to be verminous remains comparatively small. Seventy-one rooms were disinfested and insecticides were issued free of charge to tenants of thirty houses. Swimming Baths and Pools (a) MUNICIPAL BATHS, HIGH STREET. Mr. B. M. F. Dixon, the superintendent and Engineer, kindly contributes the following:- "Prom January 1st to December 31st the Baths were open on 290 days. The number of Swimming Bath bathers was 155,661, the maximum load being on September 30th when we had 1,342. During this period we also had 86,320 Slipper Bath bathers. Sampling was carried out on three occasions with very good resul ts." (b) WHIPPS CROSS BATHING POOL.- This is a large open-air pool situated in Epping Forest, in the area of the Borough of Leyton and a few hundred yards from the Walthamstow boundary. It is administered by a joint Committee representing the two Boroughs. The pool is supervised by the Medical Officer of Health for Leyton, who kindly sends a copy of the analytical findings when samples are taken. 18 (c) SOUTH- WEST ESSEX TECHNICAL COLLEGE.- Sampling was carried out on two 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:- "Due to the wonderful weather conditions last year, attendance was very much higher than in previous years, and numbered in the region of 40,000 including school-children. Bacteriological and chemical analysis were excellent and can be recorded as the best ever." Hairdressers and Barbers Seventy three premises are registered under the Walthamstow Corporation Act, 1956. Inspections of these premises were carried out under the Bye-law requirements and most were found to be in a reasonable condition. Rent Act, 1957 Part I.- Applications for Certificates of Disrepair (1) Number of applications for certificates 101 (2) Number of decisions not to issue certificates - (3) Number of decisions to issue certificates (a) in respect of some but not all defects 66 (b) in respect of all defects 35 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 72 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule 1 (6) Number of certificates issued 35 Part II.- Applications for Cancellation of Certificates (7) Applications by landlords to Local Authority for cancellation of certificates 70 (8) Objections by tenants to cancellation of certificates 22 (9) Decisions by Local Authority to cancel in spite of tenants' objection 6 (10) Certificates cancelled by Local Authority 53 In addition to the above, ninety-six applications were received from landlords and tenants for certificates as to remedying, or failing to remedy, the defects set out in the undertaking given by the landlord. Of the ninety six applications, sixty seven certifi cates were issued and the remainder (29) were not granted. 19 Housing Act, 1936, Section 62. Applications for "permitted number" were received from landlords and certificates issued during the year respecting eighteen lettings. Local Land Charges Enquiries relating to outstanding sanitary notices were dealt with in 2,048 cases. D.- HOUSING Statistics The Borough Architect, P. 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 1959 Hoe Street Ward St. James Street Ward 78 flats - Higham Hill Ward 98 flats 17 houses High Street Ward - Hale End Ward 33 flats - Wood Street Ward 90 flats TOTAL 299 flats 17 houses Houses erected by Private Enterprise Hoe Street Ward 2 flats St. James Street Ward - - Higham Hill Ward 2 flats High Street Ward - 4 houses Wood Street Ward - 2 houses Hale End Ward 31 flats 4 houses TOTAL .. 35 flats 10 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:- Discretionary 227 Standard 91 Total number of grants and amounts approved by Council to owner/occupiers:- Discretionary 86 £19,303 Standard 29 £3,755 20 Applications received from Warner Estate Ltd.:- Discretionary 56 Total number of grants and amounts approved by Council to Warner Estate Ltd.:- Discretionary 42 £8,408 Summary Total number of applications:- Discretionary 283 Standard 91 Total number of grants:- Discretionary 128 Standard 29 Total amount of grants:- Discretionary £27,711 Standard £3,755 Inspection The Chief Public Health Inspector reports as follows I. INSPECTION OP DWELLING HOUSES DURING THE YEAR: - (1)(a) Total number of dwelling houses inspected for housing defects (under the Public Health or Housing Acts) 1,626 (b) Number of inspections made for the purpose 4,210 (2)(a) Number of dwelling houses (included under subhead (1) above) which are inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 18 (b) Number of inspections made for the purpose 23 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (N.B. These comprise individual unfit houses) 4 (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 551 II.-UNFIT HOUSES CLOSED:- (1) Under Sections 16(4), 17(1) and 35(1), Housing Act 1957 4 (2) Under Sections 17(3) and 26. Housing Act 1957 - (3) Parts of buildings closed under Section 18, Housing Act, 1957 2 21 III. UNFIT HOUSES MADE PIT AND HOUSES IN WHICH DEFECTS WERE REMEDIED:- (1) After informal action by local authority 381* (2) After formal notice under (a) Public Health Acts 156* (b) Sections 9 & 16, Housing Act, 1957 1* (3) Under Section 24, Housing Act, 1957 (* including those notices outstanding from previous years) Clearance Areas No Official Representations were made during the year. The present five year programme which terminates in July 1960 is practically complete. A further five year programme has been approved by the Council and this includes three areas of 302 houses. 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 1959:- No.of new properties made available for letting 282 Acquired 134 Normal vacancies 72 Nominations to private landlords 29 New properties at Canvey 71 Total 588 Families rehoused:- 1-bedroom group 172 2-bedroom group 216 3-bedroom group 181 4-bedroom group 19 Total 588 Property under management at November, 1959:- Pre-1939 houses and flats 1,615 New houses and flats 2,614 Prefabricated bungalows 388 Properties converted into flats 178 Properties improved 123 Properties acquired for improvement and conversion 743 Properties for Clearance and Demolition 95 Requisitioned dwellings 14 Halfway houses 5 22 General Properties 30 Commercial Properties 53 Garages 532 Total 6,390 The number of families rehoused in New Towns during 1959 was 68. The following extracts are taken from the Annual Report of the Housing Management Committee:- Rehousing.-During the period 31st October, 1958 to 1st November, 1959, 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 45 "D" Families living apart 11 "E" Irregular overcrowding 18 "K" Three or more families (relatives)in house - "H" Transfer of priority housing - "J" Special cases 53 "J" Rehousing subject to nomination 19 M.O H. Medical recommendations (T.B.) 7 M. o. H. Cases for consideration 30 Special requests for emergency accommodation 40 Total 223 Rehousing of Medical Cases. During 1959, twenty-four cases claiming rehousing priority for tuberculosis were investigated and reported upon. Of these, thirteen cases were added to the list. The position at the end of 1959 was as follows:- Class I Class 2 Class 3 Total On list at end of 1958 3 16 21 40 Added to list during 1959 5 1 7 13 8 17 28 53 Rehoused or removed from list during 1959 6 16 22 44 (Housing Register revised during the year) - - - - On list at end of 195S 2 1 6 9 23 In addition to the tuberculosis cases, twenty-five other cases were recorded as needing special consideration on medical grounds and twenty-four on general housing grounds. E.- INSPECTION AND SUPERVISION OF FOOD (a) Designated Milk. During the year 131 samples of milk were submitted to the Counties Laboratories for bacteriological examination, including Phosphatase, Methylene Blue and Turbidity tests. These samples of milk were mainly taken from roundsmen during the course of delivery, or on arrival at schools. They include the bi-monthly sampling of the two dairymen holding Pasteuriser's Licences. The following table gives details of samples of milk taken:- Grade No. of Samp1es Satis factory Results Unsatisfactory Void Pasteurised 82 74 1 7 Sterilised - - - - Tuberculin Tested Pasteurised 49 45 - 4 Totals 131 119 1 11 Biological Teat. Sixty-seven samples of raw milk, as delivered to Pasteurisers' Depots in the Borough, were submitted to the counties Laboratories for Biological Examination, on behalf of the Essex County Council. Sixty-three of the samples gave Negative results and four proved to be Inconclusive. THE MILK (SPECIAL DESIGNATION) (PASTEURISED & STERILISED MILK) REGULATIONS. 1949 & 1953. 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 62 Pasteurised 9 Sterilised 128 Sterilised 10 Tuberculin Tested 22 Tuberculin Tested 8 Licences (Plant). Pasteurisers 2 There are no Cow-keepers in the district. The number of Retail Milk Distributors is 126. 24 One hundred and thirty-two visits were paid to registered premises and a satisfactory standard of cleanliness was maintained. THE MILK (SPECIAL DESIGNATIONS) (SPECIFIED AREAS) ORDER, 1951. The above Order came into operation on the 1st October, 1951. All milk retailed within the Borough must either be Pasteurised or Sterilised. (b) Ice Cream. Sixty-five applications for Registration were received and were dealt with as follows Vendors, New 21 Vendors, Transfers 43 Application refused 1 Number on Register at end of year 349 Number of premises used for Manufacturing 5 ICE CREAM (HEAT TREATMENT, ETC.) REGULATIONS, 1947-51. The trade has continued to co-operate and a good standard has been maintained. POOD STANDARDS (ICE CREAM) ORDER, 1951. One sample of ice cream was taken and submitted to the Public Analysts who reported the following satisfactory result:- Fat Content 12. 2% BACTERIOLOGICAL EXAMINATION OP ICE CREAM. One hundred and eight samples were submitted for examination and for grading in accordance with the provisional test of the Ministry of Health, with the following results:- Grade I - 82 " II - 10 " III - 10 " IV - 6 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-two samples were examined for bacterial purity, six of which were unsatisfactory. 25 Examination for Metallic Contents Seven 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. The following is a summary of food surrendered and condemned as being unfit for human consumption. Where possible, the food was salvaged. 513 tins Evaporated Milk 4 tins Herrings 30 99 Pull Cream Milk 8 99 Silds 37 99 Skimmed Milk 2 99 Roes 49 99 Cream 53 99 Salmon 48 99 Baby Pood 2 99 Crab Paste 48 99 Creamed Rice 7 99 Syrup 1 tin Macaroni 2 jars Anchovy Paste 283 tins Soup 1 jar Salmon Spread 85 99 Coffee 1 99 Minced Chicken 288 99 Pineapple 1 99 Meat Extract 24 99 Cherries 1 99 Vegetable Extract 150 99 Oranges 8 jars Sandwich Spread 46 99 Fruit Salad 19 " Salad Cream 49 99 Apricots 8 99 Pickled Walnuts 8 99 Loganberries 17 99 Pickles 234 99 Peaches 5 99 Peanut Butter 14 99 Grapefruit 18 99 Cream 32 99 Pears 3 botts. Ketchup 25 99 Plums 5 pkts. Oats 38 99 Prunes 34 lbs. Marmalade 17 99 Gooseberries 21 lbs. Lemon Cheese 1 tin Strawberries 6 99 Cornflour 1 99 Blackberries 1 lb. Pepper 1 99 Rhubarb 28 lbs. Dried Peas 14 tins Pineapple Juice 56 99 Haricot Beans 12 99 Grapefruit Juice 300 99 Chestnuts 18 99 Fruit Drink 480 99 Pears 16 99 Orange Juice 12 99 Peaches 1 tin Tomato Juice 99 99 Blackberry & Apple Pie Pilling (tinned) 1 99 Vegetable Juice 1 99 Tongue 4½ 99 Prunes 18 tins Minced Beef Loaf 18¼ 99 Apricot Pulp (tinned) 2 99 Stuffed Pork Roll 13½ 99 Ham 4 99 Sausages 541½ 99 Ham (tinned) 1 tin Chicken 102¼ 99 Pork 568 tins Peas 109 99 Pork (tinned) 111 99 Beans 120 99 Beef 5 99 Broad Beans 566¾ 99 Luncheon Meat 31 99 Butter Beans 899 99 Corned Beef 15 99 Beetroot 24 99 Jellied Veal 15 99 Carrots 5 99 Lamb 10 99 Tomatoes 27y4 99 Chopped Pork 4 99 Macedoine 19 99 Lambs Plucks 1 tin Mushrooms 6 99 Ox Tongues 2 tins Vegetable Salad 13 h 99 Veal 2 99 Curried Beans 72& 99 Salt Beef 222 99 Baked Beans us 99 Lambs Tongues 1 tin Beans and Sausages 1J4 stone Roes 15 tins Pease Pudding 27 99 Skate 109 99 Stewed Steak 5 99 Cod 5 99 Irish Stew 2 99 Halibut 13 99 Ravioli 3 99 Plaice 31 99 Spaghetti 3 99 Dogfish 2 99 Spaghetti/Bolognese 1 gallor Prawns 13 99 Steak & Kidney Pudding 1 Salmon (11 lbs.) 4 99 Frankfurters 1 Goose (10 lbs.) 26 94 tins Pilchards 3 Chickens 7 99 Sardines 1 cwt Potatoes 8 99 Tuna Pish 144 Peaches 5 99 Crab Shellfish and Jellied Eels. The following samples were taken during the year for bacteriological examination:- Cockles 4 Mussels 1 Winkles 1 Jellied Eels 6 Seven of these samples were of an unsatisfactory standard and the necessary investigations were carried out. Cooked Meats. Sampling of these products continued during 1959, seventy-two samples being taken. Twenty-nine were classified as unsatisfactory because of bacteriological contamination which occurred during storage and exposure for sale. Mr. H.L. Hughes, Deputy chief Public Health Inspector, was presented with the Quinton Prize at the Annual Conference of the Association of Public Health Inspectors held at Margate in September. This prize is awarded by the Association for the best paper of the year on food. Mr. Hughes' paper was in respect of the examination of cooked meats. Miscellaneous Samples. Fifteen samples were submitted for bacteriological examination, consisting of the following:- Dried and Frozen Eggs 8 Double Cream 4 Calves Foot Jelly 1 Meat Pie 1 Single Cream 1 All these samples gave satisfactory results with the exception of one sample of Double Cream. (d) Adulteration, etc. Food and Drugs Act, 1955- During the year, one hundred and twenty seven samples of food and drugs were submitted to the Public Analysts. Nineteen samples were reported as being unsatisfactory, details respecting same are given below. 27 Description of Articles Brine (11 samples) Milk Meat after brining (4 samples) Cooked Salt Brisket Chicken Noodle Soup Lemon Juice Result of Analysis Excessive amount of zinc and in one case antimony Tainted Excessive amount of zinc Excessive amount of sodium nitrate Incorrectly labelled Incorrectly labelled Action Taken *See below None possible *See below Warning given None possible Matter taken up with Manufacturers and label amended. * A series of samples of brine from butcher shops were taken where butchers were using galvanised pails or dustbins as a receptacle for brine. The results proved that the saline nature of the brine corroded the zinc galvanising and the zinc was transferred to the brine, and thence to the meat being brined in the receptacle. To avoid contamination of meat with zinc in this fashion, all butchers in the borough have now been notified to abandon the use of galvanised containers for brine and have been advised to use polythene plastic bins instead. The following summary give details of food sampled and results of analyses:- No. Formal Satisfactory No. Unsatisfactory Informal Total Formal Informal Total Milk 13 1 14 - 1 1 Cream 1 1 2 - - - Butter 1 1 2 - - - Buttered Scones 1 - 1 - - - Ice Cream - 1 1 - - - Ice Lollies - 7 7 - - - Tea 1 2 3 - - - Coffee 1 - 1 - - - Lemon Juice - 1 1 - 1 1 Fruit Drink - 1 1 - - - Whiskey 2 - 2 - - - Sausages, Beef 1 - 1 - - - Sausages, Pork - 2 2 - - - Suet, Beef 1 - 1 - - - Meat before brining. - 7 7 - - - Meat after brining. - 11 11 - 4 4 Brine - 21 21 - 11 11 Salt Brisket Cooked - 1 1 - 1 1 Salt Block - 1 1 - - - Gravy Salt - 1 1 - - - Instant Icing - 1 1 - - - Custard Powder - 1 1 - - - Jam 1 3 - - - Honey - 1 1 - - - Cheese Spread with Shrimps - 1 1 - - - Ham and Beef Paste - 1 1 - - - Liver and Bacon Paste - 1 1 - - - Sardine and Tomato Paste - 1 1 - - - Chicken Noodle Soup Powder 1 - 1 1 - 1 Crab dressed - 1 1 - - - Tomatoes - 1 1 - - - Apples - 1 1 - - - Apricots Dried - 1 1 - - - 23  No. Satisfactory No. Unsatisfactory Formal In formal Total Formal Informal Total Currants 1 - 1 - - - Almond, Marzipan 1 1 2 - - - Digestive Lozenges - 1 1 - - - Analgesic Compound - 1 1 - - - Indigestion Tablets - 1 1 - - - Burn and Wound Cream - 1 1 - - - Iron and Yeast Tonic Tablets - 1 1 - - - Linseed Compound - 1 1 - - - Pepper - 1 1 - - - Bubble Gum 1 1 - - - 26 82 108 1 18 19 (e) Chemical and Bacteriological Examinations 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 for offences under the above Regulations, as follows:- Smoking on food premises (3 cases)-Penalties £9. Costs £3.3.0. Presence of foreign bodies in bread (2 cases)-Penalties £15. Costs £2. 12. 6. Presence of vermin in food - Penalties £30. Costs £3. 3. 0. Absence of water supply on Ice Cream Van - Penalty £1. 0. 0. Costs £1. 1. 0. Premises in insanitary condition - Penalty £5. One case in respect of contamination of food was withdrawn before Court hearing, as works required had been completed. Two appeals were lodged against the Council's requirements for the provision of washhand basins on food premises. The court dismissed both appeals. The following food premises are established in the Borough:- Butchers, 84: Bakers, 45; Fishmongers, 36; Cafes and Caterers, 104; Grocers, 255; Greengrocers, 89; Dairies and Milksellers, 126; Ice Cream Manufacturers and Vendors, 349. 29 There are two dairy premises in the area registered under the Milk and Dairies Regulations. The following inspections were carried out in respect of food premises: - Butchers, 235; Bakers, 94; Fishmongers, 79 Cafes and Caterers, 184; Grocers, 488; Greengrocers, 109, Dairies and Milksellers, 132; Ice Cream Manufacturers and Vendors, 297. Condemned food is destroyed at the Council's Depot at Low Hall Farm. The only exception to this is where sufficient meat is condemned and is worth salvaging, and it is then disposed of through reliable sources, being used mainly for soap manufacture. (g) Food Poisoning Outbreaks 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 1959. Diseases of Animals Acts Swine Fever (Infected Areas) Order, 1953. No licences were issued during the year. Fowl Pest Order, 1936. One order was issued during the year affecting the Borough. Foot and Mouth Disease Orders. No case occurred in the Borough and no movement licence was issued during the year. Pet Animals Act, 1951, Twenty-two premises are licensed in the Borough for the sale Pet Animals. These premises are licensed annually. Prevention of Damage by Pests Act, 1949, The agreed scheme of work has continued, and the two trained Operatives have been fully engaged under the general supervision of the Public Health Inspectors. The following is a summary of the work carried out during the year 1959:- 30 PREVENTION OF DAMAGE BY PESTS ACT. 1949 REPORT FOR THE YEAR ENDED 31st DECEMBER, 1959 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 34,438 4 5,250 39,714 II No. of Properties inspected by the Local Authority during 1959 as a result of:- (a) Notification 11 458 1 67 537 (b) Survey 13 350 - 15 378 (c) A visit primarily for some other purpose - - - - - III Total inspections carried out-including re-inspections. 105 2,351 5 710 3,166 IV No of Properties inspected (see Section II) which were found to be infested by. (a) Rats Major - - - 1 1 Minor 3 432 1 50 486 (b) Mice Major. - - - - - Minor 3 27 - 5 35 V No. of infested Proper ties (in Section IV) treated by the Local Authority. 6 459 1 56 522 VI No. of "Block" contro schemes carried out 1 - - - - 31 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 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 55 82 2 - Factories not included above in which Section 7 is enforced by the Local Authority 469 205 2 - Other premises in which Section 7 is enforced by the Local Authority 16 16 - - Totals 540 303 4 - 2.-DEFECTS FOUND IN FACTORIES, ETC.- Particulars No. of cases in which defects were found Pound 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) 10 8 - - - Overcrowding (Sec. 2) - - - - - Unreasonable Temp. (Sec. 3) - - - - - Inadequate Ventilation (Sec. 4) 1 1 - - - Ineffective drainage of floors (Sec. 6) - - - - - Sanitary Conveniences:(a) Insufficient 1 1 - - - (b) Unsuitable or Defective 26 26 - - - (c) Not separate for Sexes - - - Other offences (not including offences relating to Outwork) 1 - - - - Totals 39 36 - - - 32 NUMBER AND TRADES OF OUTWORKERS NOTIFIED 1959 Wearing Apparel (making of) 459 Brush making 9 Stuffed Toys 4 Household Linen 3 Artificial Flowers 9 Curtains and Furniture Cosaques, Christmas Crackers, etc 4 hangings 1 Furniture and Upholstery 4 Lampshades 2 Umbrellas etc 1 Boxes 33 Total 529 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 1959 was considerably more than in 1958 principally those of scarlet fever and measles. Disease St.James Street High Street Hoe Street Wood Street Hale End Higham Hill Total Scarlet Fever: 62 37 52 43 58 67 319 Whooping Cough 4 12 5 7 16 36 80 Measles 255 185 97 179 319 252 1,287 Diphtheria - - - - - - - Pneumonia 8 15 10 6 17 12 68 Meningococcal Infection - - - - - - - Acute Poliomyelitis: Paralytic - - - - - 2 1 Non Paralytic 1 - - - - - 1 Acute Infective Encephalitis _ - - - 1 - 1 Post Infectious Encephalitis - - - 1 - - 1 Dysentery 16 4 28 5 45 88 186 Ophthalmia Neonatorum - - - - - - - Puerperal Pyrexia 3 - 9 23 9 5 49 Smallpox - - - - - - - Paratyphoid Fever - - - - - 1 1 Typhoid Fever - - - - - - - Food Poisoning 1 2 6 2 7 8 26 Erysipelas 4 5 3 6 18 Malaria - - - - - - - Tuberculosis: Respiratory 9 4 9 7- 17 15 61 Meninges and Central Nervous System - - - - - - - Other Forms 2 2 - 2 1 7 Totals, 1959 365 259 223 273 494 493 2, 107 Totals, 1958 175 57 170 199 277 217 1,095 33 DIPHTHERIA There has been no confirmed case of Diphtheria in the Borough since 1950 and the last death from Diphtheria was in 1946. However, early in 1960 several "carriers" have been discovered in one of the Schools and I should feel happier if the percentage of immunisation acceptance were much higher than at present. DYSENTERY There were fewer cases of this disease notified than last year, but if through the medium of Health Education the public could be persuaded to be more hygienic, particularly as far as toilet routine is concerned, I feel sure the number of cases could be still further reduced. FOOD POISONING Twenty-six cases were notified and in addition eight cases were "ascertained" i.e. became known otherwise then by notification, by following up notified cases. None was fatal. There were two small familial "outbreaks" with two cases each and in each case the infecting agent was Salmonella , Typhimurium, Eighteen of the single cases were due to Salmonella , Typhimurium, three to Staphylococci and in one case the infecting agent was not identified. MEASLES The number of cases of Measles notified was 801 more than in 1958. This is due mainly to the fact that this disease reaches epidemic form only once in 2 or 3 years. There was no death recorded during 1959 as due to Measles. PNEUMONIA Notifications in respect of persons suffering from Pneumonia received during 1959 were 68 as compared with 42 during 1958. POLIOMYELITIS Three cases of poliomyelitis were notified during 1958. two being oaral.vtic and one non-oaralvtic. All were females aged 5 years. 5 vears and 11 years resnectively. After a period of hospitalisation and treatment all made satisfactory progress. SCARLET FEVER There was a considerable increase in the number of notifications of cases of scarlet fever, i.e. 319 as compared with 105 in 1958. For various reasons 18 cases were admitted to hospital, but mainly because the patient could not be isolated at home. 34 WHOOPING COUGH Although a slight increase occurred in the number of notifications received during 1959 compared with 1958, (i.e. 80 compared with 67) it was considerably less than 1957 (218). "OUTBREAKS" Suspected Food Poisoning at Forest School, Whipps Cross - Thirty-three boarders reported sick. All suffered from nausea and/or vomiting; thirteen had diarrhoea and eight had pyrexia (highest 100.6° F.). In addition a number of day boys were away, their parents having reported they were suffering from diarrhoea and sickness. One master had complained of nausea. Pood poisoning was not confirmed. Dysentery- During the three weeks ended 7th February 1959 eleven children attending Chapel End Infants' School and fourteen from Greenleaf Infants' School were notified as suffering from dysentery. Odd cases were notified from various other schools but in no case did the disease reach any alarming proportions. At Handsworth Day Nursery twenty-six children and 2 staff gave positive results. The first case occurred on January 6, and the Nursery was cleared by March 10th except for one child who was persistently positive, but was at last cleared on April 9 after three consecutive negative swabs. During the epidemic 155 rectal swabs were examined and 15 faecal specimens. Scarlet Fever- Seven cases of Scarlet Fever were notified in children attending Selwyn Avenue Infants' School during the period 28th September 1959 and 9th October 1959. Although several others suffered from Sore Throat no further cases occurred. TUBERCULOSIS The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1959:- Age Periods New Cases Deaths Pulmonary Non Pulmonary Pulmonary Non Pulmonary M. F. M. F. M. F. M. F. Under 1 year 1 - - - - - - - 1-4 years - - - - - - - - 5-9 " 1 1 2 - - - - - 10-14 " 1 1 - 1 - - - - 15-19 " 3 - - - - _ - - 20-24 " 3 2 1 - - - - - 25 34 " 5 3 1 - 1 _ - - 35-44 " 9 - - 1 3 _ - - 45-54 " 9 3 - 1 - - - - 55 64 " 7 2 - - - - - - 65 and over 9 1 - - - - - - 48 13 4 3 4 - - - Totals 61 7 4 68 4 35 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. 36 G MISCELLANEOUS 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 24,415 meals during 1959. Seven rounds are operated on Monday, Wednesday and Friday, and six rounds on Tuesday and Thursday. The meals are obtained from the Council's Catering Department and distributed by voluntary workers in cars hired by the Association. The scheme has been in operation in this form since March, 1948, and is an essential one for people who would not otherwise be able to get a cooked meal. The Association also provided eight 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. 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 1959, 57 patients received domiciliary treatment, and the total treatments given were 76 at a cost of £39.18s.Od. Thirteen of the patients were Male. 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. 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 during 1959. Bedsteads, 7; Mattresses, 20; Blankets, 4; Pillows, 6, Commodes, 2; Wheelchairs, 4; Sheets, 3. 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. 37 There is no doubt that the Laundry service for the Incontinent is a boom in those cases where friends and relatives are unable to cope with soiled linen and I am pleased to report that the number of cases dealt with during 1959 was less than in 1958. The number of cases dealt with was as follows:- Total number of cases 24 Average number of cases per week 10 Total number of articles laundered 9,959 Average number of articles per week 192 Total number of journeys 813 Funeral Arrangements. Arrangements were made with regard to the burial of two persons within the terms of the National Assistance Act, 1948. Medical Examinations, During the year the medical staff carried out 267 examinations of Borough Council employees in respect of the Superannuation and Sick Pay Schemes. Disinfection, The Council continued to provide facilities for steam disinfection for the Chingford and Leyton Corporations. General The Borough Architect, Engineer and Surveyor contributes the following information:- 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 Sel borne 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. 38 . Cremation. Facilities for cremation are available at the City of London Crematorium at Manor Park and also the Manor Park Crematorium, Manor Park. Inquests and Post Mortems Walthamstow Others Total Post Mortems only 119 234 353 Post Mortems and Inquests 24 47 71 Inquests only 5 64 69 Rainfall. The annual rainfall at the Perry Lane Station was 16.69ins. In 1958 it was 29. 45 ins. Flooding. Flooding occurred four times during the year, but only affected the whole Borough on one occasion. Relief to the Selborne Road area has been provided to the limited extent approved by the Ministry of Housing and Local Government. The Brooke Road Area Relief Scheme was commenced, and will be completed during the summer of 1960, and work on Low Hall Farm Storm Tanks will start in March, 1960, and will be completed during the year. In agreement with the Lee Conservancy Catchment Board, two overflows have been provided from the Dagenham Brook to the New Flood Channel. 39 SECTION H NATIONAL HEALTH SERVICE ACT, 1946 PART III SERVICES WALTHAMSTOW HEALTH AREA SUB-COMMITTEE (1959/60) Chairman: Councillor Mrs. W.M. PALETHORPE (Walthamstow Borough Council). Vice Chairman Councillor Mrs. L. D. GURR (Walthamstow Borough Council) Members. Nominated by- Essex County Council Alderman Mrs. M. BALL (Chair- Alderman Mrs. L.P BAILLEY, man, Health Committee, J. P. E.C.C.)- Alderman Mrs. B.K. LOWTON Councillor Mrs. L.FALLAIZE, Councillor Mrs. E.M BATES. J.P. (Vice-Chairman,Health Councillor Mrs. A.M.M BURRELL. Committee, E.C.C.). Alderman H.J.E.PALETHORPE Alderman S.N.CHAPLIN, J P Walthamstow Borough Council Alderman THE LADY McENTEE, Councillor G.E. KITCHEN O.B.E., J.P. Councillor C.B. REYNOLDS Councillor Mrs. E.L.BALDWIN. Councillor Mrs. C.E STANNARD Councillor Mrs. J.C.BECKWITH. . Councillor P.F.A. WEBSTER. Councillor J.J. BRACKEN. Councillor D. WEINSTEIN. Councillor Mrs. S. CANDY. Councillor A.F. WHICHER Councillor J.H. HAMMOND Executive Council for Essex F A WORTLEY, ESQ. Hospital Management Committee Mrs. BE. BOTTOMLEY, J P. Local Medical Committee for Essex Dr. W R. JOHN. Voluntary Organisations Mrs. L.A. BRAZIER Mrs. A. CORDELL. Mrs. M BROWN E.P MARR, ESQ Area Clerk G.A BLAKELEY ESQ 40 STAFF During the year 24 whole time members of the Health Area Staff resigned their appointments and 24 new appointments were made. HEALTH CENTRES (Section 21) HEALTH CENTRE SITES The general position remains as detailed in previous reports. GENERAL DENTAL SERVICE Mr. L. W. Elmer, L. D. S. and Mr. D. A. Clark, F. D. S. report:- The number of General Practice sessions is reduced compared with the previous year, but the volume of treatment carried out is better than was anticipated. "There are Staff losses to report. Mr. J. C. Timmis, L. D. S. left after almost 12 years with us and we thank him for all his,good work. Two of our dental attendants also left the service. Staff sickness has contributed to minor delays in the completion of denture cases, but I am pleased to report the staff position at the Dental Laboratory is now back to normal. The following is a summary of the work undertaken during tne years 1958 and 1959:- 1958 1959 Number of patients treated 941 690 Appointments made 5 441 4 250 kept 4 938 3 794 Plastic fillings 483 )2 239 467 )2 038 Amalgam fillings 1 756 )total 1,571 )total Inlays 10 7 Crowns 30 17 Scalines and gum treatments 489 445 Dressings 617 599 Extractions 761 514 General anaesthetics 151 111 Local anaesthetics 512 538 X rays 335 584 Impressions 775 577 Bites 202 147 Try ins 331 227 Pull upper dentures 128 )310 total 90 )215 total Full lower dentures 100 )dentures 56 )dentures Partial upper dentures 46 ) 36 ) Partial lower dentures 36 ) 33 ) Repairs 200 157 Minor Oral Surgery 58 39 Other operations 805 792 41 DENTAL LABORATORY The following work was undertaken during the year:- tures pairs Reline makes ances Crowns In1ays Study Mode1s General Dental Service 217 155 3 13 6 13 3 - Walthamstow Committee for Education 55 43 - 1 145 16 2 366 Leyton Com mittee for Education - - - - 7 - - Maternity and Child Welfare Patients 10 - - - - - - - CARE OF MOTHERS AND YOUNG CHILDREN (Section 22) ANTE NATAL AND POST NATAL SERVICES The following table summarises the attendances at Local Authority Clinics New Patients Ante Natal Post Natal Low Hall Lane Clinic 55 10 Silverdale Road Clinic 28 9 West Avenue Clinic 16 6 District Nurses Training Home and Midwives sessions held at Ante Natal Clinics .. 528 - Totals 627 25 Total Attendances Ante Natal Post Natal Low Hall Lane Clinic Silverdale Road Clinic 239 160 28 13 West Avenue Clinic 78 6 District Nurses' Training Home and Midwives" sessions held at Antenatal Clinics 2, 150 Totals 2,627 47 42 CAUSES or DEATH OF CHILDREN UNDER 1 YEAR OK AGE 1959 Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total deaths under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Totnl deaths under 1 year St .James St. High Street Hoe Street Wood Street Hale End Higham Hill. Total Influenza - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - Phthisis - - - - - - - - - - - - - - - - - Other forms of T. B. - - - - - - - - - - - - - - - - - T. B. Meningitis - - - - - - - - - - - - - - - - - Meningitis (Non-T. B.) - - - - - - - - - - - - - - - - - Convulsions - - - - - - - - - - - - - - - - - Bronchitis - - - - - - 1 - - 1 - - - 1 - - 1 Pneumonia 1 1 - - 2 2 2 - 1 7 2 1 2 1 - 1 7 Diarrhoea - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - Inattention at birth, wilful neglect - - - - - - - - - - - - - - - - - Suffocation (overlaying) Injury at birth - - - - - - - - - - - - - - - - - Atelectasis 1 - - - 1 - - - - 1 1 - - - - - 1 Congenital malformation 2 - - - 2 2 2 - - 6 1 - 6 - 1 1 6 Premature birth 7 - 1 - 8 - - - - 8 - - 3 1 2 2 8 Atrophy, debility, marasmus Inanition - - - - - - - - - - - - - - - - - Heart failure - - - - - - - - - - - - - - - - - Other causes 2 - - - 2 1 - - 1 4 - - - 2 - 2 4 Totals 13 1 1 - 15 5 5 - 2 27 4 1 8 5 3 6 27 43 BLOOD TESTS Routine blood tests were carried out for ante-natal patients as in previous years. 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, and in 1959 was extended to include expectant mothers booked for home confinement, or who are supervised at local authority ante-natal clinics. RELAXATION AND MOTHERCRAFT CLASSES 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. An additional class is now held on Fridays at 2 p.m. at the recently opened Higham Hill and Priory Court Health Services Clinic. NOTIFICATION OF BIRTHS 2, 205 births (701 of which belonged to other areas) were notified during the year under the Public Health Act, 1936. Notifications were received as follows: Doctors, 424; Midwives 1,779; Others, 2. Also included are 46 still-births, 16 of which belonged to other areas. Of the total, 12 occurred outside the Borough. CARE OF PREMATURE INFANTS During 1959, 82 live premature infants were born to residents of the Borough, 14 at home and 68 in hospitals and nursing homes. Of the 14 born at home, 2 were transferred to hospital. Of the remaining 12 who were nursed entirely at home, all survived the first 28 days of life. 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. 44 Miss E. Williams, Superintendent of the Home, contributes the following report:- "The table below summarises our work for the year. All these are new cases, and do not include the follow-up work arising from 1958 cases. The age group of the mothers is usually 16 - 19 years. We endeavour to place the very young (15 years) in our Maternity Home at Coggeshall. Admitted Adults Babies Total From Walthamstow 17 9 26 From rest of County 63 40 103 From outside County 6 2 8 Totas 86 51 137 Outdoor Work Walthamstow (Mothers and babies) 35 26 61 Other County cases 3 2 5 From outside County 2 - 2 Totals 40 28 68 In addition to the seventeen Walthamstow mothers admitted to the Home, Miss Williams made arrangements for ten others to enter homes elsewhere in the County. CARE OF ILLEGITIMATE CHILDREN 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 I1legitimate Legitima te I1legitimate 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 1959 1,389 51 24 3 17.2 58.8 45 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. Low Hall Lane. (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. Low Hall Lane E. 17. Wednesday 2 p.m. West Avenue, E. 17. Thursday 2 p.m. Silverdale Road, E.4. Friday 2 p.m. Priory Court, E. 17. (c) Child Welfare Clinics. Monday . 2 to 4 p.m. Higham Hill and Priory Court Health Services Clinic, 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. Higham Hill and Priory Court Health Services Clinic, 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. (d) Todd 1ers' Clinics Monday do. Silverdale Road, Highams Park, E.4. (twice monthly) Tuesday do. Higham Hill and Priory Court Health (alternate) Services Clinic, E.17. Friday do. The Welfare Centre. West Ave.,E.17. (alternate) Higham Hill and Priory Court Health ServicesC1 inic This is the first specially designed and equipped Health Services Clinics built in the Borough since 1929. It was officially opened on 12th December 1959. The premises occupy a site about 150 ft. by 85 ft. on the east of Countess Road, and will serve the neighbouring area. The new building was designed to rehouse a child welfare clinic held in a nearby Church hall, and enables a full range of Health Services to be provided including minor ailments, dental, ante-natal and chiropody services. The premises include a waiting hall 30 ft. x 21 ft. used also for Health Education purposes, a consulting room and various offices. It is anticipated that the total cost of the Project will be in the region of £14.000. 46 WALTHAMSTOW CHILD WELFARE SOCIETY This voluntary society with headquarters at 'Brookscroft' Forest Road, Walthamstow, was founded in 1914. The chief present-day object of the society is the physical and moral welfare of pre-school children, and is supported by voluntary funds with the assistance of a grant from the Local Health Authority. Clinics are held as follows:- Tuesdays and Fridays.. Massage, Remedial Excercises 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 details of 'Brookscroft' attendance's included in the following table have been compiled from information kindly supplied by Miss D. Carter:- SUMMARY OF ATTENDANCES AT ALL CHILD WELFARE CLINICS Clinic (Local Authority and Voluntary Schemes) First Attendances o f New Cases Re Attendances Grand Total Under lyear of age 1 year of age 2 5 years of age Total Under 1 year of age 1 year of age 25 years of age Total 'Brookscroft' 333 17 21 371 4949 1060 578 6589 6960 Low Hall Lane 310 25 27 362 4357 1057 1453 6867 7229 Penrhyn Ave. 224 13 5 242 2998 842 636 4476 4718 Silverdale Rd. 136 2 2 140 2182 668 753 3603 3743 West Avenue 215 13 19 247 2874 833 869 4576 4823 Winchester Rd. 97 9 5 111 1727 559 440 2726 2837 Totals 1315 79 79 1473 19087 5019 4729 28837 30310 The figures for Penrhyn Avenue include attendances at the Higham Hill and Priory Court Health Services Clinic during the two weeks of the year following 14th December, when Penrhyn Avenue was permanently replaced by the new clinic premises. 47 TREATMENT The facilities provided at the Education Authority's clinics are available for all children attending the infant welfare centres. (a) Orthopaedic - Miss H. Garratt, C. S. P., has kindly furnished the following information; DEFECTS SEEN AT ORTHOPAEDIC CLINIC IN CHILDREN UNDER FIVE YEARS OP AGE Scoliosis, Lordosis, Kyphosis 2 Genu Valgum 5 Genu Varum 4 Pes Valgus and Valgus Ankles 5 Other Congenital Defects 4 Taut Tendo Achilles 1 Overlapping Toes 2 Anterior Poliomyelitis 1 Cerebral Palsy 4 Congenital Dislocation of Hip 1 Talipes - (a) Equino Varus 1 (b) Metatarsus Varus 4 Miscellaneous (including Chest Conditions) 14 Osteomyelitis 1 Total 49 Number of Treatments given - 318 (b) Sunlight - Sunlight treatment was given at the Hale End Clinic to three children under five years of age for twenty-eight treatments. (c) Priority Dental Treatment • Patients inspected and treated during the year: Expectant Mothers Nursing Mothers Children under School age Patients examined 48 61 245 Patients found to require treatment 46 61 241 Patients who have commenced treatment 43 60 238 Patients wno have completed treatment 33 36 133 Patients awaiting treatment 3 1 1 Attendances for treatment 83 129 304 48 Types of treatment given: Expect ant Mothers Nursing Mothers Children under School age 1. Extractions: (a) permanent teeth 8 24 - (b) temporary " - - 236 2. Fillings: (a) permanent teeth 75 97 (b) temporary " - • 147 3. Inlays provided - - - 4. Crowns " - -- - 5. Anaesthetics administered: (a) local 3 14 1 (b) general:- (i) by medical officers 4 6 90 (ii) by others 2 3 13 6. (a) Scaling 11 19 1 (b) Prolonged scaling and gum treatment - - 1 7. Silver Nitrate treatment - - 50 8. Dressings 9 6 22 9. X-ray examinations - - - 10. Denture provided: (a) full - 4 - (b) partial 1 1 - 11. Dentures repaired - - - 12. Dentures remade: (a) full - - - (b) partial - - •- 13. Orthodontic appliances: (a) fixed - - - (b) movable - - - 14. Prophylactic treatment and other operations- Impressions — 8 - Bites - 3 - Try ins - 5 - Easing - 4 - Syringing - - - Polishing - - - Gum Treatments - »• 2 ( d) Ophthalmic Defects and Minor Ai lments - Children are given treatment either at the School Clinics or at specialist clinics. (e) child Guidance - The following report is contributed by Dr. Helen Gillespie, Consultant Psychiatrist at the Walthamstow Child Guidance Centre:- "Discussion groups for Health Visitors were started in October by our Psychiatric Social Workers, Miss Laquer and Miss Court, and are held fortnightly at this clinic for Health Visitors in the Leyton area. These promise to be of value for the promotion of mental health in a wider area than that 49 covered by our direct clinical activities. In these groups the Health Visitors discuss problems they meet in their work at the Maternity and Child Welfare Clinics and in their visiting areas. "Other groups were also started in December for the Medical Staff and Health Visitors attached to the Infant and Maternity Welfare Services in Walthamstow, and are held by Dr. Gillespie and Dr. Hoffman fortnightly. Children showing difficulties in their development which present problems to their mothers are discussed from the point of view of causation and better methods of handling by the Maternity and Infant Welfare Staff." "I would again like to stress the need for early reference to the clinic of pre-school children " ( f) Paediatric clinic - The fortnightly clinic, under the charge of Dr. Elchon Hinden, Paediatrician to Whipps Cross Hospital, continued during 1959 and thirty nine 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 1959:- Under five years New cases 13 Total attendances 39 Physical Defects: Cases seen 39 Referred to Hospital 4 Discharged 5 (g) Phenylpyruvic Amentia During the year arrangements were made at the request of the County Medical Officerof Health for the detection and treatment of Phenylpyruvic Amentia. The circular stated that "this is the biggest clearly defined group of cases of low grade mental deficiency after mongolism. It is usually classed as an hereditary disorder, but it is exceptional for the parents themselves to have the condition. The prognosis for life is fairly good, but for mental development it is extremely poor. There is a wide range of mental deficiency varying from that of dull intellect to idiocy, but up to the present time all recorded cases have been regarded as mental defectives. 50 "It has been demonstrated that in this disorder, as in cretinism for example, if treatment is initiated early enough the mental degeneration can be arrested, if not reversed, since it is the inability of the cells to deal with the offending chemical substance and not the mental defect which is primary. "It is uncertain at present exactly how this condition damages the brain. It may be due to the inability of the tissues to use certain metabolites so that, in effect, there is a shortage of these, or there may be an abnormal quantity of them producing a toxic effect. Whichever is the case, these metabolites appear in excess in the urine. The chief substance so excreted is phenylpyruvic acid and the detection of this is the basis of the test for early diagnosis." Instructions have therefore been given that the urine of all babies in the Borough should be tested when they are between four and six weeks old. Specimens from those attending child welfare clinics are taken and examined at the clinic, and in the case of children who do not normally attend such a clinic, a specimen is taken at home and examined subsequently. General Practitioners have been fully advised as to the arrangements. Diagnosed cases are expected to be very rare. The incidence of this condition may vary between 1 in 6,000 and 1 in 30,000 babies. (h) Convalescence - During 1959 two pre-school children were sent away on medical recommendation to convalescent homes. Similarly, one mother was sent away for a period of convalescence with her three young children. PROVISION OP NUTRIENTS AND MEDICAMENTS Details of nutrients and medicaments sold and issued free during 1959 are as follows:- Sales lbs. ozs. Free lbs. Issue ozs. Adexolin _ _ 35 0½ Bemax 129 4½ - Cow and Gate 4,424 - - Cod Liver Oil and Malt - - - - Farex.. 750 10 - - Ferrous Gluconate - - 20000 Tablets Ferrous Fumerate - - 4032 Tablets Glucodin 156 4 - - Lactagol 27 4 - - - Maltoline with Iron - 100 8 Marmite 808 12 . - Milk of Magnesia - - 26 - Mist Ferri et Amnion Cit. Pro Infantibus 5 12 Ostermilk 3,504 - Pregnavite . - - - Robinson s Ready Cooked Groats 366 - Scott's 'Twin Pack' 416 8 _ - Virol 600 8 - Trufood 516 _ - Value of Cash Sales - £2, 021. 18, Od. 51 DISTRIBUTION OF WELFARE FOODS The following table shows the distribution of welfare foods at individual centres: - DISTRIBUTION CENTRE National Dried Milk (Tins) Cod Liver Oil (Bottles) VItamin Tablets (Packets) Orange Juice (Bottles) Brookscroft Welfare Centre .. 2,835 887 583 6, 236 Low Hall Lane Health Services Clinic 2,065 629 347 4,861 Northcott House Distribution Centre 10,527 1, 345 1,468 15,438 Penrhyn Avenue Infant Welfare Centre (Higham Hill and Priory Court from 1412 59) 2, 363 677 432 4,882 Silverriale Road Health Services. Clinic 1, 224 543 375 4, 329 Thorpe Coombe Maternity Hospital . 82 1,064 3,861 West Avenue Health Services Clinic 2,471 644 517 5, 293 Winchester Road Infant Welfare Centre 681 452 251 3, 147 TOTAL issues at Distribution Centres 22, 166 5, 259 5,037 48,047 In addition, the following were issued to:- Hospitals (National Health Service) 551 40 288 Day Nurseries - 144 - 360 GRAND TOTAL OP ISSUES 22,717 5,403 5,077 48,695 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 8.7 35.0 43.7 Handsworth Avenue Day Nursery 9.2 27.1 36,3 Both day nurseries are approved for training in the care of children aged 0-5 years and have sixty places. Training During 1959 eight nursery students gained certificates awarded by the Royal Society for the Promotion of Health. Their future careers were as follows:- General nursing training 6 Private children's nursing 2 NURSERIES AND CHILD MINDERS (REGULATION) ACT, 1948 There were no registrations under the above Act during 1959. 52 DAILY GUARDIAN SCHEME This Scheme was begun in May, 1951, and Guardians are paid a retaining fee of Is. Od. per day (6d. per half day) by the County Council whilst they are caring for a child. Guardians are approved subject to a satisfactory health visitor's report. Details in respect of 1958 and 1959 are as follows:- 1958 1959 No. of Guardians on Register at end of year 20 20 No. of applications for services of Daily Guardians 68 56 Referred to Day Nurseries 58 42 Referred to Daily Guardian but nothing further heard 7 10 Placed with Daily Guardian 3 4 Continued in care of Daily Guardian from previous year 3 5 WOMEN'S CLINIC This Clinic continued on the same lines as in previous years at Thorpe Coombe Maternity Hospital, under the clinical charge of the Medical Registrar who states that the number of patients attending has been as follows:- New Cases Attendances 1958 7 138 1959 1 57 These patients have attended for contraceptive advice on medical grounds. RESEARCH The Department 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 twelve practising midwives in the Borough at the end of 1959 excluding those at Thorpe Coombe Maternity Hospital. Non-Medical supervision was carried out by the Superintendent of the Nurses' Training Home. 53 The following table shows the work done by Midwives during 1959 and excludes those at Thorpe Coombe:- Total No. of confinements attended 408 " Medical Aid Notices sent 11 " Twin Births notified 2 " Triplet" " Stillbirths notified 4 " Notifications of Artifical Feeding 30 " Discharging Eyes – " Deaths notified – Medical aid was summoned by midwives in domiciliary practice and private nursing homes on eleven occasions, and the details are as follows:- For complications during pregnancy:- Post maturity 1 For complications during labour:- Ruptured perineum 7 Premature labour Rise in temperature 1 Postpartum haemorrhage 1 Other conditions 1 Total 11 The table below shows the number of visits carried out by the district midwives and home nurse/midwives:- Ante Natal Examinations Deliveries in Visits Total Visits Patients Home Midwifes House L.H.A. Clinics G.P.s' Clinics Mid. Mat. District Midwives 954 - 1,903 1,349 50 262 4, 288 8,806 Home Nurse/ Midwives 88 - 247 697 7 80 467 1,586 Totals 1,042 - 2, 150 2,046 57 342 4,755 10,392 One midwife in private practice undertook nine cases as maternity nurse in a maternity home. Trilene, and Gas and Air Analgesia A total Of 360 patients on the 'district' received trilene or gas and air analgesia, representing a percentage of 90. 2 of district confinements. Maternity Outfits Outfits are issued for all home confinements. CONFINEMENTS There were 1,485 confinements of Walthamstow Mothers in 1959 compared with 1,380 in 1958. The percentage of hospital confinements remained practically unaltered at 73%. This percentage in fact has hardly varied over the last six years. During the year under review there were 401 home confinements, and of these 57 cases were solely undertaken by midwives. The remainder were doctors' 'booked' cases with, of course, a district midwife in attendance at the confinement. Details regarding the location of confinements of Walthamstow mothers during 1959 are given in the following table: - Bethnal Green Hospital 16 Forest Gate Hospital 14 North Middlesex Hospital, Edmonton 30 Mother's (Salvation Army) Hospital, Clapton 241 Thorpe Coombe Maternity Hospital 657 Wanstead Hospital 45 Total 1,003 Other Hospitals and Nursing Homes 81 In Hospital or Nursing Home 1,084 At Home 401 Total confinements 1,485 Co-operation with Hospitals and General Practitioners The report for 1956 details the steps taken to secure maximum co-operation with general practitioners, particularly with regard to help extended by health visitors, midwives and home nurses. I am pleased to state that during the year two new ante-natal clinics commenced at family doctors' surgeries, involving the attendance of a midwife at one and pupil midwives at the second. Health Visitors now attend five joint infant welfare sessions held by general practitioners, an increase of three since the date ofthe last report. The benefit of joint clinic sessions is mutual in that a useful exchange of information 55 and discussion is facilitated,and if necessary the doctor's advice can be augmented by relevant suggestion or explanation to the patient on the occasion of subsequent home visits. Health visitors and school nurses continued to make twice weekly visits to the paediatric wards at Whipps Cross Hospital. On each occasion rounds are made and Walthamstow cases discussed. Dr. E. Hinden, Paediatrician, at the Whipps Cross Hospital holds a fortnightly session at the Town Hall Clinic. Similarly weekly visits were made by the staff to Langthorne Hospital. Following the recommendations of the Maternity Services Committee (Cranbrook Report), Local Obstetric Liaison Committees were set up during 1959 for the purpose of ensuring that the local provisions for maternity care in the area provided by hospitals, local health Authorities and general practitioner obstetricians are used to the best advantage. Local liaison committees are formed of professional representatives of the three branches of the Health Services in the area, which, for convenience corresponds with that of the relevant Hospital Management Committee. Since Walthamstow mothers may be confined either in Walthamstow or a neighbouring area I attend two local Maternity Liaison Committees. HEALTH VISITING (Section 24) At the end of the year there was a staff of 13 holding joint appointments as health visitor/school nurse excluding the Superintendent. The equivalent of whole time health visitors was 9.35. This was equal to one whole-time district health visitor to 161 notified births. HOME VISITS Children under Five Years of Age. To ChiIdren under 1 vear of age ChiIdren 1 year of age ChiIdren 2 5 years of age TOTAL First Subse quent Total 1959 1,426 3, 029 4,455 2,447 4, 195 11, 097 1958 1,322 3, 188 4,510 2,778 4,566 11,854 OTHER VISITS Ante-Natal Visits Special Vi sits Un success ful Vi si t s TOTAL First Subse quent Total 1959 251 113 364 3, 389 2, 138 5,891 1958 297 100 397 2,609 1,544 4,550 56 The Superintendent Health Visitor, Mrs. J. Foulkes, S. R. N., S. C. M., H. V. Cert., reports as fo-llows:- " The work of the health visitors during 1959 followed a similar pattern to that of the previous year with a slight increase in the number of visits to the elderly people of the Borough. Visiting of this nature continues to produce evidence of loneliness* and this aspect was emphasised in a talk given to the Rotarians on the care of the aged. A rather interesting experimental scheme resulted. With the co-operation of the Health Visiting Staff and the Headmaster of William Morris Technical school the pupils of that school are visiting and making friends with elderly people in the district who are very appreciative. Every effort is made to maintain the high standard of mothercraft in the Borough and careful teaching in secondary modern schools has considerable value as an early preparation for motherhood. Health visitors have been giving mothercraft instruction in Walthamstow Schools for nearly 6 years and for the purpose of evaluation a questionnaire was produced for completion by the girls of one school. It is evident from the girls' answers that the lessons are profitable as well as popular, and such remarks as 'Mother is too busy to tell us', 'You can tell us the right way' and 'If we do not learn it here we shall not learn it anywhere else', give a clear indication of the need for such teaching. The function of the health visitor is increasingly that of health educator, and the scope and opportunity in this field expands year by year. An additional Ante-Natal Relaxation Class commenced recently and talks are given on various aspects of the preparation for motherhood. Details are given on page 43 Weekly classes were continued at the 'Carville' Home for unmarried mothers and babies in West Avenue Road, and the Sister Tutor from Thorpe Coombe Maternity Hospital kindly gave demonstrations on the use of the gas and air apparatus to each group of very young expectant mothers. Talks were given and films shown regularly throughout the year to groups of mothers at two of the Infant Welfare Clinics. In all the Welfare Centres display and exhibition material is used by Health Visitors with a flair for this work to illustrate chosen health topics and changes are made about once a month. Visits were again made to hospitals to maintain the fullest co-operation, and information is given on page 55k In addition I have continued to meet the Almoner of Connaught Hospital fortnightly and I am most grateful for the help she has given. 57 "The health visitors co-operated in the practical training of the fol lowing: - (a) Eight student nursery nurses visited infant welfare, ante-natal, minor alments, chiropody and other special clinics to meet the requirements of their training syllabus. The students 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 sessions at infant welfare clinics to comply with the rules of the Central Midwives Board. (c) Four health visitor students from the S. E. Essex Technical College carried out part of their practical training in the Borough. Two spent three months with the same two Health Visitors to maintain continuity in the work. Two others were given practical training in tuberculosis preventive medicine. (d) Final year student nurses from Connaught Hospital spent two days in the Public Health field for practical training. Eighteen students each spent half a day home visiting with the district nurse, half-a-day with the health visitor on selected visits and half a day at an infant welfare clinic. Arrangements were made for the students to observe and discuss minor ailment clinics, the chiropody service, and medical and hygiene inspection in schools. (e) I gave a series of four lectures on 'The social aspects of Disease' to final year Connaught Hospital student nurses according to the General Nursing Council syllabus. (f) A health visitor student from the Royal College of Nursing was given two weeks practical training in the Borough. The College also sent a student taking an administrative course, for two days, to receive instruction in the local administration of the health visitors work." HOME NURSING (Section 25) Miss N. Chadwick, S. R.N., S.C.M., H. V. Cert., Q.N., Superintendent of the District Nurses Training Home, reports as follows: - 58 "Staff at 31st December 1959 was - 1 Superintendent; S.R.N., S.C.M., H.V. Cert. Q.N. 1 Assistant Superintendent; S.R.N., S.C.M., H.V. Cert. Q.N. 10 Pull time S.R.N., S.C.M., Q.N. 4 " " S.R.N., S.C.M. 5 " " S.R.-N., Q.N. 2 " " S.R.N. Q.N. (male) 2 " " S.R.N. 1 Part time S.R.N. 4 " " S.E.A.N. "During the year 27 pupils from Thorpe Coombe Maternity Hospital entered training for district midwifery and all passed the examination. " Pinal year student nurses from Connaught Hospital visited the Home and attended patients with the district nurses, and enjoyed the experience very much. "Two new ante-natal clinics commenced during the year, Sister Roberts attending Dr. Bendeth's clinic monthly and the pupils attending Dr. Goddard's clinic whenever possible. There is still a further increase in the number of ante-natal bookings compared with last year. "Post graduate courses were attended during the year by 6 members of the nursing staff. " One Queen's candidate was trained during the year and obtained credit status in her practical examination. " In July a Review of District Nurses by the Queen Mother took place in the grounds of Buckingham Palace, and twelve nurses from the Home took part. "During October a .film strip was seen by nurses and midwives at the Town Hall embracing Midwifery, Care of Teeth and Prevention of Accidents in the Home etc. This was found most interesting and helpful. " In the early part of the year a very successful Tiny Tots Parade was held in the garden of the Home 29 entries being received. In mid summer nurses took part in the Borough Carnival and received a donation of £20. "A Carol service was held during the Christmas period and tea was attended by about thirty elderly people and at a later date 25 parcels were distributed to needy folk in the Borough." 59 VACCINATION AND IMMUNISATION (Section 26) VACCINATION AGAINST SMALLPOX The number and ages of persons vaccinated are shown below: - Age at date of Vaccination Under 1 year 1 year 2-4 years 5-14 years 15 years and over Total Primary 636 38 18 35 72 799 Secondary - - 9 38 195 242 Total 636 38 27 73 267 1,041 Vaccinated by General Practitioners 633 Vaccinated by County Staff 408 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 1959 was 44 per cent. VACCINAL CONDITION OP 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. of the staffs of the two hospitals in Walthamstow. The number vaccinated was as follows:- No. now employed Of those now employed No. successfully vaccinated within 3 years. Of those now employed No. vaccinated but not within 3 years. No. revaccinated during 6 mths. ended 30.9.59 Hospital 'A' 237 198 39 Hospital 'B' 69 25 27 1 DIPHTHERIA IMMUNISATION The following is a summary of the work carried out during the year: - Total number of immunisations completed:- (a) School age 134 (b) Pre-school age 913 Total 1,047 (c) Number already immunised having a reinforcing dose 589 60 Details of the immunisations included in the above total are set out below: - Number completed at Schools 199 " Welfare Centres 183 " Town Hall Clinic 57 " Brookscroft 89 by General Practitioners 519 Total 1,047 Forty five children included in the above table were given combined whooping cough/diphtheria antigen and One hundred and thirty four children were given whooping cough/diphtheria/tetanus antigen by general practitioners. Also Thirteen 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 0-1 Veer 1-2 Years 2-3 Years 3-4 Years 4-5 Years Total 0-5 Years School Age Grand Total Aim tted to Hospital* 1955 560 157 36 20 13 786 156 942 6 1956 73V 235 34 36 29 1 071 126 1 197 6 1957 752 178 52 22 44 1.048 302 1.350 4 1958 808 145 34 31 31 1,049 127 1, 176 2 1959 718 116 38 17 24 913 134 1, 047 2 *In no case was the diagnosis confirmed 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 50. The numbers of children under 15 years of age at 31st December 1959, who had completed a course of immunisation at any time before that date are shown in the following groups:- Under 1 (born 1959) 1-4 (born 1958-55) 5-9 (born 1954-50) 10-14(born 1949-45) 271 3,450 6,096 8, 944 Total immunised under 15 years 18,761 61 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 months 6-12 months 1-4 years 5 years and over Total Clinics, Nurseries and Welfare Centres 359 237 51 2 649 General Practitioners 123 212 41 5 381 Total 482 449 92 7 1, 030 In addition general practitioners gave thirty nine booster injections. The percentage of children immunised during the first year of life was 65. VACCINATION AGAINST POLI0MY3 LITIS During 1959 eligibility for vaccination included the age group six months to twenty-five years, expectant mothers and special groups. By the end of the year the number of persons who had received two doses since the inception of the scheme in 1956 was: - Children 19,078 Expectant Mothers 874 Young Persons 4,897 Other Groups 207 Total 25,056 of which the following were done in 1959:- Children 6,322 Expectant Mothers 532 Young Persons 4,870 Other Groups 140 Total 11,864 In addition, at the end of the year 16,176 persons had received third doses. B C.G. VACCINATION In 1959 the scheme described in the report of the School Medical Officer for 1954 was extended to include vaccination of children aged 14 years and upwards who are still at school aid also students attending Universities; Teacher Training Colleges 62 and Technical Colleges or other establishments of further education. During 1959 acceptances were received from 1,382 children out of 2,882 who were eligible, i.e., 47.9%. Details are as follows:- Heaf positive 99 Percentage positive 7.8 Heaf negative 1,168 Number absent from test 115 B. C. G. given 1,168 The percentages of children Heaf positive in previous years were: • 1954 1955 1956 1957 1958 17.6 13.0 14.2 13.8 11.6 By arrangement with the Chest Physician all the Heaf positive children were offered chest X-ray at the Chest Clinic. None were found to have active disease. TUBERCULOSIS VACCINE TRIALS (Medical Research Council) Dr. T.. M. Pollock, Physician-in-Charge of the vaccine trials, arranged for the annual follow-up of two groups to be made in May and December. Dr. Pollock reported that of a total of 598 young persons invited for the annual chest X-ray examination, 308 attended, i.e. 51%. Of these 49% completed the skin test. In addition, of the 264 who did not attend their previous checkup, 52 attended during 1959. AMBULANCE FACILITIES (Section 27) The Ambulance Service is administered centrally from Chelmsford via the Control Centre at IIford, 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 Pulbourne Road Depot. PREVENTION OF ILLNESS - CARE AND AFTER-CARE (Section 28) TUBERCULOSIS Dr. H. Ramsay, Consultant Chest Physician at the Walthamstow Chest Clinic, has contributed the following:- 63 " The figures of main interest are set out below. They refer, of course, to the combined attendances of Walthamstow and Chingford patients. Total Attendances 15,892 " New Cases 5,548 X-rays 13,101 " Screening 196 Miniature Camera 3,678 New Notifications 65 (Walthamstow only) "The figures generally are rather less for 1959 than for 1958. The weather was excellent over long periods of the year and this does reduce the numbers of those suffering from respiratory symptoms. " The number of patients screened is seen to be considerably less and reflects the almost complete abandonment of collapse therapy in the treatment of pulmonary tuberculosis. "The number of new notifications in the area has risen slightly and this again is a reminder that the disease is by no means eradicated and that much work in case finding and supervision generally still has to be undertaken. "Lung cancer has also risen and is the highest in recent years; a total of sixty cases was diagnosed, ten more than last year." 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:- "During the past twelve months there has been little change in the type of case we have been called upon to deal with. The middle-aged are still in the majority, but the younger families also require a good deal of assistance during the comparatively short period of treatment and rehabilitation. 'The grocery voucher continues to be the most useful means of giving regular help to a family, and has proved its value over a period of many years. Milk vouchers are now rarely issued, since the County Council's own scheme meets most requirements in this direction. There has, however, been a continuing need for help with clothing, particularly for male patients who have undergone a period of treatment, and are ready to return to work, and for the wives of patients who have been off work for long periods. 64 "Holidays have been arranged for a number of patients on the recommendation of the Chest Physician, in conjunction with the Health Department and the Spero Holiday Scheme. These have proved to be of real benefit both to those unlikely to return to work and in need of a change of scene,and to those requiring a final fillip before returning to employment after treatment. "The following analysis of help given over the year will indicate the range of assistance provided in addition to those items already mentioned:- Type of help given. No. of cases Cost Milk 3 £24. 0. 0. Grocery 38 £643. 0. 0. Fuel 40 £90. 0. 0. Fares to visit patients 12 £7. 0. 0. Clothing, Bedding, etc. 43 £93. 0. 0. Holidays 10 £78. 0. 0. Miscellaneous grants: - Pocket money, rent, rates, debts, Radio licences and repairs, home decoration and repairs, Christmas grants, and minor cash grants 115 £236. 0. 0. "We have found it increasingly difficult to convince the public that there is still a real need for our work, and, as a result, local financial support has fallen off to some extent. Although the prospects for the tuberculous patient are better now than they have ever been, and fear of the disease has been largely overcome, this is not the time to slacken our efforts. Local help on a personal and voluntary basis still plays a vital part in the welfare of the tuberculous patient and his family, and there will be work for a Tuberculosis Care Committee for many years to come." CONVALESCENCE FOR ADULTS The total of cases sent away for recuperative convalescence was forty nine. In addition, arrangements were made for twenty three patients who subsequently cancelled their applications for various reasons. SICK BOOM 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:- 65 "The Chiropody Service has again played its part in the comfort of Walthamstow, although the frequency of treatment for adults has been reduced to 3.06 visits per year, due to the large number requiring treatment. The total number of appointments booked at December 31st, including Low Hall Lane and Town Hall Clinics, was 4,674. "In April, Mr. A. E. Nicoll, M. Ch. S. left us after four years and has taken up residence in Canada. Mr. E. D. Patton, M. Ch. S. was appointed to take his place. "Since the introduction of the National Health Service Act, Chiropody has been limited, due to the economic state of the country, but last April the Minister of Health announced that he was now willing to allow extension via Local Authorities, which should help to improve the future Service provided staff can be recruited. "This year the clinics gave 18,774 treatments to 6,160 patients, 14,841 being females and 3,933 males. New patients amounted to 1,554 - 395 males and 1,159 females. The Children's Clinic gave 2,647 treatments to 709 children, making 3.7 visits per child. 2,316 of these treatments were forverruca pedis, 1,441 being given to girls and 875 to boys. New patients amount to 379 - 140 boys and 239 girls. "The footwear of the girls leaves much to be desired in a great many cases, as large numbers are wearing casual or slipper type shoes which cannot be fitted the correct length owing to the difficulty of keeping them on; thus function nd growth are being restricted. Here I feel parents need more guidance, and in some cases should set an example by their own footwear. "The non-ambulant have again been catered for. During the year 250 patients were brought to the Clinic by ambulance and once again the ladies outnumbered the gentlemen, i.e. 203 females and 47 males. In future it is hoped that more emphasis will be given to the domiciliary treatment of patients in this category." DOMESTIC HELP SERVICE (Section 29) The Domestic Help Organisers, Mrs. W. Pickard and Mrs. B. Oliver, report as follows:- "Demands for the Domestic Help Service in 1959 show a progressive increase, mainly for the chronic aged sick category which is still increasing. Many of these cases are are carried forward each year as they become more helpless accounting for a rise in daily attendances and hours of service given, particularly 66 during the winter months when fires are needed. "Tuberculosis cases have shown a further decrease but there has been more call for assistance in caring for children, mainly during the mothers' stay in hospital. Requests for assistance in maternity cases are also on- the increase. "The provision of 'Meals on Wheels' as a five day service has made it easier to plan the Domestic Help Service, allowing a greater number of completely bed-ridden cases to have the comfort of an early visit from the domestic help for fire and breakfast knowing that the mid-day meal will also be received. '•Excellent work has been carried out by the domestic helps in general, often under difficult conditions and inclement weather, and many tributes of appreciation have been received from grateful patients. There has been adequate staff in all areas and the standard of work has been most satisfactory. " In several cases split duty involving two or three attendances daily by the domestic helps has been necessary for completely helpless patients who need every assistance including special diets and personal attention. Excellent work has been done for these most deserving cases. "Following is a summary of the years figures. B/fwd. from 19 5 8 701 New cases 1959 616 Total 1. 317 Cases completed 561 Cases carried forward 756 " Staff employed at the end of 1959 was 190, including 5 full time workers. Every endeavour has been made to give adequate supervision and a total of 3,798 visits were made during the year, many whilst the domestic help was present. We would like to acknowledge the help and co operation received from family doctors and other domiciliary services which has resulted in the combined effort necessary to give help and comfort to those in need." L9 DOMESTIC HELP SERVICE, 1959 Maternity Acute Sick Tuber cul ous Chroi Aged lie Sick Ot her s Aged not sick Others Total Requests for help from new cases during the year 104 19 8 443 100 3 13 690 Total cases helped during the year 65 24 29 1,028 147 13 11 1,317 Cases being helped at the end of year who have received help for Under 3 mths. - 2 1 89 13 1 _ 106 3-6 " - 1 39 12 - 52 6-12 " - - - 99 11 3 - 113 Over 12 " - - - 10 436 35 4 485 Total carried forward to 1960 - 2 12 663 71 8 756 Hours of help provided during the year 3.013¼ 937¼ 3,591 150,721¼ 16,980 3/4 1,950 570½ 177,764 68 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 1959: - (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, 1959, was 175 (men 67, women 108), of whom 36 men and 41 women were admitted during 1959. (b) Admitted to temporary accommodation: Nine cases involving: men women 4 children 11 (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, and now employ special field officers for this purpose. 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 118 residents of the Borough at 31st December, 1959. (3) BLIND PERSONS The number of registered blind, partially sighted and defective sighted persons resident in the Borough on the 31st December, 1959, was as follows:- (a) Registered blind 245 (b) Partially sighted 71 (c) Defective sighted 20 69 all of whom were under the supervision of the County Council's Home Teachers. At the same date 6 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 thirty-three partially sighted persons employed in open industry and under the supervision of the Council's Placement Officer."