4411(1) WAL 51 BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year I960 MELVILLE WATKINS, M.R.C.S., L.R.C.P., D.P.H. MEDICAL OFFICER OF HEALTH BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year I960 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 12 SECTION C Prevalence and Control over Infectious Diseases 16 SECTION D Sanitary Circumstances of the Area 26 SECTION E Housing 32 SECTION F Inspection and Supervision of Food 36 SECTION G National Health Service Act, 1946 - Part III Services 47 Page Acreage 8 Adulteration 40 Aged and chronic sick 14, 49 Ambulance Facilities 13 Ante-Natal Clinics 61 Assessments 8 B C.G. Vaccination 50. 72 Birth Control 61 Birth Notifications 60 Births 8 'Brookscroft' Welfare 63, 66 Care of Mothers and Young Children 60 Chest Clinic 56 Child Guidance 63 Chiropody 7, 50, 73 Clean Air Act, 1956 7 Clearance Areas 34 Committees 4 Comparability Factor 11 Confinements 68 Convalescence 65, 74 Conveniences, Public 15 Co operation with Hospitals and General Practitioners 49 Cremation 15 Daily Guardian Scheme 65 Day Nurseries 65 Deaths from Accidents in the Home 11 Deaths. Infants 8 Deaths, Causes of 10 Dental Laboratory 60 Dental Treatment 62 Diphtheria 6, 16 Diphtheria Immunisation 71 Diseases of Animals Acts 43 Disinfections 15, 27 Disinfestation 30 Page Domestic Help 52, 75 Domiciliary Chiropody51 Employment 11 Factories Acts, 1937/48 45 Food and Drugs Act, 1955 40 Food Hygiene Regulations,1955 41 Flooding 15 Food Inspection 36 Food Poisoning 23 Funeral Arrangements 14 Gas and Air Analgesia67 General Dental Service 48, 59 General Information 15 Hairdressers 30 Health Education 74 Health Centres 48 Health Services Clinics 59, 66 Health Visiting 49, 69 Home Nursing 49, 70 Hospital Accommodation 13 Housing Act, 1936 31 Housing, General 34 Housing. Inspection 33 Housing Statistics 32 Ice Cream 37 Immunisation 50, 70 Improvement Grants 32 Infant Mortality 8, 9 Infectious Diseases 6, 13 16, 27 Inquests 15 Laboratory Facilities12 Land Charges 31 Laundry Service for the Incontinent 14 Massage and Special Treatment 14 Page Maternal Mortality 8 Meals on Wheels Service 14 Meat and other Poods 38 Medical Examinations 15, 76 Medicaments 64 Midwifery 48, 67 Milk 36, 37 Moral Welfare 55 Night Attendance 76 Noise Abatement 26 Notices, Sanitary 26 Nursing Homes 14 Nutrients 64 Old People's Welfare 14 Orthopaedic Treatment 61 Outworkers 46 Paediatric Clinic 61 Paratyphoid 6, 20 Pet Animals Act, 1951 43 Poliomyelitis 7, 24 Poliomyelitis Vaccination 50, 72 Population 8 Post Mortems 15 Post Natal Clinics 61 Premature Infants 60 Prevention of Damage by Pests Act, 1949 43 Prevention of Illness 50, 73 Public Health Act, 1936 14 Public Health Inspection 26 Page Rainfall15 Rateable Value 8 Rehousing on Medical Grounds 36 Rent Act, 1957 30 Rodent Control 43 Scabies Treatment 13 Sickroom Equipment 74 Smallpox Vaccination 70 Smoke Abatement 29 Social Conditions 8 Special Premises 27 Staff 12 Statistics 8 Stillbirths 8 Swimming Baths 30 Toddlers Clinics 49 Tuberculosis 24, 50, 73 Vaccination 50, 70 Verminous Premises 30 Vital Statistics 5, 8 Walthamstow Association of T.B. Care Helpers 56 W' stow Child Welfare Society 66 Water 26 Welfare Centres 63 Welfare Poods 64 Welfare Services 58 Whooping Cough Immunisation 72 4. HEALTH COMMITTEE 1960-61 Chairman: COUNCILLOR MRS. W.M. PALETHORPE Vice-Chairman: COUNCILLOR MRS. C.E. STANNARD Ex-officio: TOE WORSHIPFUL THE MAYOR - ALDERMAN W.R. BALDWIN, J.P. THE DEPUTY MAYOR - ALDERMAN S.N. CHAPLIN, J.P. CHAIRMAN OP FINANCE COMMITTEE - ALDERMAN ROSS WYLD, O.B.E.,J.P. ALDERMAN THE LADY McENTEE, O.B.E,, J. P. " E.C. REDHEAD, J. P. M.P. COUNCILLORS, MRS E.L. BALDWIN L.A. BAYLIS MRS. J.C. BECKWITH J.J. BRACKEN MRS. S, CANDY MRS. R, COLIN COUNCILLORS: F. FURBER MRS L. D GURR J,H. HAMMOND G.S. MACE C.B. REYNOLDS P.F.A. WEBSTER D, WEINSTEIN Medical Officer of Health: M. WATKINS, M R.C S. ,L.R C P D.P H (Part-time) Deputy Medical Office 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: N. SMITH 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 present herewith my Annual Report for 1960. As is customary, it includes an account of the services administered by the Walthamstow Health Area Sub-Committee on behalf of the Essex County Council. VITAL STATISTICS Judged by the simple yard sticks of Infant Mortality, Birth and Death Rates and overall incidence of Infectious Diseases compared with other years and with the rest of the country, the medico social state of our community appears to be satisfactory, but closer analysis reveals a few disquieting aspects. Although the excess of births over deaths was about 200, yet the Registrar General's estimate of the mid year population showed a decrease of 1,390. This is due entirely to a fairly substantial migration from the borough. This trend is not new and will probably continue until a balance is achieved between population and housing accommodation. The mere loss of population is not in itself a cause for regret if what it achieves is a better standard of accommodation for those that remain. But unfortunately it is the younger people, in the reproductive age groups, that are moving out, leaving a disproportionate number of the elderly who are less able to sustain the demands of a modern community. There will also be a tendency for the birth rate to fall, although it has remained about the same for the past few years. A study of the causes of death show a steady decline in the communicable diseases and a tendency to an increase in those caused by diseases of the heart and blood vessels and malignant growths. Even deaths due to accidents in the home and on the street now far outstrip those of infectious diseases. Of particular interest to us is the steadily increasing deaths from cancer of the lung as opposed to the levelling out of the numbers of deaths due to other cancers. More than half the 67 cases in Walthamstow occurred in the age group 45-64yrs, Research carried out for many years into this phenomenon has shown that the liability to lung cancer in a heavy smoker is forty times greater than that in a non-smoker, and the greater the number of cigarettes smoked the greater the risk. Even giving up smoking lessens the risk. Apparently cigarettes are implicated more than pipes or cigars. Since the war women have 6 been smoking as much as men, and this is reflected in the increasing incidence of lung cancer in women Unfortunately the smoking habit is being acquired at very early ages Some authorities have found that 25% of boys start smoking at the ages of 13 to 14, and as many as 47% at 14 to 15 yrs. Although it is not claimed that cigarette smoke is the causal factor, it seems clear that smoking is a potent factor in precipitating the disease in those who are susceptible. We have here therefore much scope for preventive action. INFECTIOUS DISEASES The total number of notified cases due to all causes was down during the year. This gratifying fall tends to confirm the prevalent belief that the traditional role of the M.O.H with regard to the control of communicable diseases is assuming less importance. The prodigous efforts of years in the improvement of all aspects of environmental health are now bearing fruit Yet there is much that remains. One cannot be complacent in the face of sporadic outbreaks of such dangerous diseases as diphtheria, and poliomyelitis, and the continued hazards of tuberculosis Even such a seemingly attenuated disease as scarlet fever can still cause complications such as kidney trouble and rheumatism and the occurrence of German measles in the expectant mother is known to cause congenital defects in the baby. These are but a few examples of the hazards that are still with us and of the reasons why our efforts at prevention must continue unceasingly Diphtheria The infrequency of diphtheria nowadays throws any outbreak that occurs into stark relief The one that occurred in the Higham Hill area this year, causing the death of a child, appears a good example of the unceasing watch that must still be exercised over all infectious diseases It affords us such a lesson that it is worth describing in full in the report The efforts to contain it involved long and tedious measures including the isolation in hospital of about seventy carriers A high immunisation rate could have avoided all this Paratyphoid Paratyphoid is not regarded as serious a disease as Typhoid Even so, the patients can be seriously ill, but what is more important it can result in prolonged absence from work with consequential economic embarrassment to the family. The disease is normally transmitted through food usually infected by man It is interesting to note that the bacteria have been isolated from quite a number of samples of imported dried eggs and 7 desiccated coconut. The risk of multiple cases occurring at the same time is therefore very real and it was with some apprehension that notification of the first case was received, especially as we were in the throes of the diphtheria outbreak. There were nine cases in all, due to the same strain of organism. Eight of the cases occurred within a short time of each other and appeared to be associated, but in spite of a vigorous search and intensive sampling of the foods that might have been implicated, the origin of the outbreak was, unfortunately, never discovered. A detailed account of the outbreak will be found in the report. Poliomye1itis The scheme for vaccination against poliomyelitis was extended this year to include everybody up to the age of 40. The response to vaccination varied enormously with the age ranges, being very disappointing in the 15 to 25 age group. Only two cases were notified this year in children aged 4 and 9 years. Neither had been immunised but fortunately both made a satisfactory recovery. CLEAN AIR The impetus given by the Council last year to the implementation of the provisions of the Clean Air Act has now gathered such momentum that there is every indication that the eight-year programme will be on schedule. CHIROPODY SERVICE During the year the Minister of Health gave local health authorities permission to establish chiropody services where they did not exist, and where already in existence, to extend them. Owing to the great foresight of the Walthamstow Council before the appointed day we were fortunate to be one of the few authorities where a chiropody service was in existence. With the shortage of chiropodists there was a danger that the extension of these facilities to other authorities would cause us to lose some of our staff. Fortunately we have maintained, and even increased, our establishment. An account appears in the report of the re-organisation that was effected to attain this. Once again I am indebted to the Chairman, Vice-Chairman, members of the Committee, and all staff, for their co-operation during the year. 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 1960) 111,610 Number of Assessments (31st December 1960) 40,170 Rateable Value (31st December 1960) £1,780,136 Estimated Product of a penny rate (1960/61) £7,200 Population. - The Registrar-General's Estimate of the home population at mid-year, 1960, is 111,610, a decrease of 1,390 on the previous year. The steady decline continues. This figure has been used for the calculation of the following statistics: - Live Births: Number 1,428 Rate per 1,000 population 12.79 Illegitimate Live Births per cent of total live births 3.8 Stillbirths: Number 19 Rate per 1,000 total live and stillbirths 13.1 Total Live and Stillbirths 1,447 Infants Deaths (deaths under 1 year) 26 Infant Mortality Rates: Total infant deaths per 1,000 total live births 18.2 Legitimate infant deaths per 1,000 legitimate live births 16.7 Illegitimate infant deaths per 1,000 illegitimate live births 54.5 Neo-natal Mortality Rate (deaths under 4 weeks per 1 000 total live births) 10.5 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 total live births) 9.1 Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 22.1 Maternal Mortality (including abortion): Number of deaths Nil Rate per 1,000 total live and stillbirths Nil Deaths. - The Registrar-General's classification of causes of death by sex totals is given on page 10. 9 Total Infant Mortality This is defined as the sum of the deaths that occur during child-birth and during the first year of life. The attached graph shows the position since 1930:- If the infant mortality rate for the quinquennium 1931/35, i.e. 49, had applied to the births during the quinquennium 1956/60 there would have been approximately 347 infant deaths insterd of 131. This represents a saving of 216 infant lives in the five-year period, or, say, 43 infant lives each year. 10 Causes of Death as given by the Registrar-General for the Year 1960 Causes of Death Males Females Total 1959 1. Tuberculosis, Respiratory 5 2 7 4 2. Tuberculosis, other 1 1 - 3. Syphilitic Disease 1 - 1 8 4. Diphtheria - 1 1 - 5. Whooping Cough - - - - 6. Meningococcal Infections - - - - 7. Acute Poliomyelitis - - - - 8. Measles - - - _ 9. Other Infective and parasitic Diseases 2 1 3 3 10. Malignant neoplasm, stomach 20 11 31 39 11. Malignant neoplasm, Lung, bronchus 61 6 67 71 12. Malignant neoplasm, breast - 33 33 25 13. Malignant neoplasm, uterus - 7 7 9 14. Other malignant and lymphatic neoplasms 58 42 100 107 15. Leukaemia, aleukaemia 4 5 9 17 16. Diabetes 1 4 5 10 17. Vascular lesions of nervous system 47 79 126 128 18. Coronary disease, angina 115 89 204 221 19. Hypertension with heart disease 6 20 26 16 20. Other heart disease 51 103 154 164 21. Other circulatory disease 23 33 56 50 22. Influenza 1 2 3 17 23. Pneumonia 24 45 69 89 24. Bronchitis 62 16 78 71 25. Other diseases of respiratory system 5 _ 5 9 26. Ulcer of stomach and duodenum 8 4 12 15 27. Gastritis, enteritis and diarrhoea 3 6 9 1 28. Nephritis and nephrosis 1 4 5 10 29- Hyperplasia of prostate 5 - 5 7 30. Pregnancy, childbirth, abortion - - - 1 31. Congenital malformations 12 3 15 13 32. Other defined and ill-defined diseases 32 41 73 73 33. Motor Vehicle Accidents 8 2 10 10 34. All other accidents 5 7 12 18 35. Suicide 6 4 10 14 36. Homicide and operations of war - - - - Totals 1960 566 571 1,137 Totals 1959 653 567 - 1,220 The age distribution of Cancer deaths was as follows: Deaths from Lung Cancer are shown separately but are also included in the total age groups. Under 1 yr. 1-4 yrs. 5-14 yrs. 15-24 yrs. 25-44 yrs. 45-64 yrs. 65-74 yrs. 75 & over Total deaths - - 1 1 6 102 75 62 Lung - Males _ _ _ _ _ 34 13 14 Females - - - - - 2 2 2 11 The total number of deaths in 1960 (1137) compares with 1220 in 1959, the respective death rates being 10.1 and 10.8 per 1,000 population. The comparability factors for Walthamstow are given by the Registrar-General as follows: - Comparability factor for births 1.01 Comparability factor for deaths 1.05 The above factors, when applied to the crude rates, produce the following adjusted rates: Live births 12.9 Deaths 10.6 Deaths from Accidents in the home Five deaths occurred in 1960 from this cause. Three died in hospital and two at home. The ages and sexes were:- Male 49. 73. 80. 80. Female 85 In order to put these and other deaths in proper perspective, the following comparison is made: Cause of Death 1959 1960 (a) Suicide 14 10 (b) Motor Vehicle Accidents 10 10 (c) All other accidents 18 12 (d) Accidents in the home (included in line (c) 13 5 (e) Tuberculosis 4 7 (f) Poliomyelitis Nil Nil Employment - According to information kindly supplied by Miss D.M. Rogerson, Manager of the Local Employment Exchange approximately 365 men and 145. women were placed in employment every month during the year 1960, 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 & WoOdford, was approximately 82,500 Of this number it is estimated that about 35.500 were employed in Walthamstow. During 1960, the average number of persons unemployed in the whole area was 750 men and 110 women, including 110 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 12 register at an Employment Exchange in the area where his N.I. card is exchanged. Normally an employed person's N.I. card would be counted in the area in which he works, while if he became unemployed he would be likely to register at the Employment Exchange in the area in which he lives. 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 From Miss M. Heffernan, S.R.N., S.C.M., B.T.A. 4. 1. 1960 Infectious Diseases Nurse Mr. A. Austin 1. 7. 1960 Rodent Operative Mr. G. Bowley 2. 2. 1960 Inspecting Assistant Mr. R. Hamilton 29. 2. 1960 Rodent Operative Mr. W. Potter 1. 3. 1960 Inspecting Assistant Mr. C. Rampling 12. 9. 1960 Pupil Public Health Inspector Mr. N. Smith 2. 8. 1960 Deputy Chief P.H. Inspector Resignations Mr. W. Hill 27. 2. 1960 Rodent Operative Mr. R. Hamilton 7. 5. 1960 Rodent Operative Mr. H. Hughes 31. 5. 1960 Deputy Chief P.H. Inspector Laboratory Facilities Arrangements continued with the Public Health Laboratory Service at Colindale. The number of specimens examined during the year was as follows:- Specimens Total Faeces and rectal swabs 814 Nose and throat swabs 8,154 Urine 1 Pood 2 Miscellaneous 10 Total 8,981 In addition over 10,000 swabs were examined in connection with the Diphtheria outbreak. This was a mammoth task and we have nothing but admiration for the way the Laboratory staff came to our assistance. The laboratory service is essential in the control of any such outbreak. 13 Ambulance Facilities These are available from a local depot in Walthamstow which is administered centrally from Chelmsford, via the Control Centre at Ilford. Treatment of Scabies and Verminous Conditions The arrangement, detailed in the report for 1953, with the Hackney Borough Council continued, and eight cases were referred there during 1960 receiving ten treatments. Hospital Accommodation (a) Acute cases. - There were no major changes in 1960 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 32 New Cases 30 Brought forward from 1959 2 M.O.H. requests to Langthorne Hospital or Area Welfare Otficer 13 Admitted to Hospitals 10 Admitted to Part III accommodation 7 Died before admission 1 Refused Hospital or Hostel accommodation 2 Cancelled or deferred 9 Waiting Part III accommodation 1 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. - St. Ann's Hospital, Tottenham, is the main hospital to which any infectious disease cases are admitted. Because of the lessening demand for this type of bed there has been a gradual reduction of infectious disease accommodation over the years, so when an outbreak of diphtheria occurs such as we had during the year the sudden demand for beds for the treatment of both cases and carriers is too great for that hospital to undertake. We were therefore very grateful for the ready assistance given by Honey Lane Hospital, Waltham Abbey, and the Eastern Fever Hospita1, Homerton, for admitting the large number of carriers which could not be accommodated elsewhere. 14 Aged and/or Chronic Sick NATIONAL ASSISTANCE ACT, 1948 (SECTION 47) Two cases required consideration during 1960 in regard to possible action under this Section. Consideration of one case was deferred, and the other patient died at home. Public Health Act, 1936 - Nursing Homes:- There is no Nursing Home registered in the Borough. Essex County Council Act, 1933 (Establishments for Massage and Special Treatment) One new licence was granted under the Act during 1960. During the year the medical staff paid sixteen visits to the establishments registered for massage and special treatment. Old People's Welfare Many services are still carried out by the Old People's Welfare Association and the Town Clerk as Honorary Secretary informs me that 34,334 meals were provided during 1960 by the Association s Meals on Wheels' service as compared with 24,415 during 1959. This service is of great benefit to those old people who would not otherwise be able to get a cooked meal. The Health Department also help in the care of old people and arrange for domiciliary chiropody treatment for those unable by reason of illness or infirmity to attend the County Council s Foot Clinic. In addition various items of equipment, where possible, were supplied- There is no doubt that the Laundry service for the Incontinent is a boon in those cases where friends Qr relatives are unable to cope with soiled linen and I am pleased to report that the number of cases dealt with during 1960 was less than in 1959. The number of cases dealt' with was as follows:- Total number of cases 21 Average number of cases per week 11 Total number of articles laundered 10,277 Average number of articles per week 201 Total number of journeys 974 Funeral Arrangements Arrangements continued with regard to burials within the terms of the National Assistance Act, 1948. 15 Medical Examinations During the year the medical staff carried out 173 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 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 Tamworth Avenue - Men and Women 1952 Larks Hall Road - Men and Women 1953 St. James Street Car Park - Men and Women 1955 Selborne Road - Men and Women 1957 Free Washing facilities continued to be available by the supply of soap and paper towels at the Public Conveniences. A charge of 2d. continues for the issue of cloth towels. No charges are made for the use of public conveniences. 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 89 188 277 Post Mortems and Inquests 21 64 85 Inquests only 2 67 69 Rainfall The annual rainfall at the Ferry Lane Station was 28.57 ins. In 1959 it was 16.69 ins. F1ooding Flooding occurred eight times during the year, affecting the whole Borough on four occasions. 16 Work continued on the Brooke Road Area Relief Scheme during the year, and the Low Hall Farm Storm Tanks were commenced in March. 1960. Both schemes will be completed during the summer of 1961. C. - 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. Disease St. James Street High Street Hoe Street Wood Street Hale End Higham Hill Total Scarlet Fever 34 30 20 14 34 46 178 Whooping Cough 25 23 27 24 71 72 242 Measles 31 10 11 74 19 53 198 Diphtheria - - - - - 5 5 Pneumonia 3 7 4 7 8 7 36 Meningococcal Infection - - - - - - - Acute Poliomyelitis. Paralytic - - - - - 2 2 Non-Paralytic - - - - - - - Acute Infective Encephalitis - - - - - - - Post Infectious Encephalitis 1 - - - - - 1 Dysentery 22 4 5 11 53 35 130 Ophthalmia Neonatorum - - - - - - - Puerperal Pyrexia 1 1 5 11 3 5 26 Smallpox - - - - - - - Paratyphoid Fever - 2 4 3 - 1 10 Typhoid Fever - - - - - - - Food Poisoning 1 20 9 1 8 28 67 Erysinelas 2 - - 2 3 5 12 Malaria - - - - - - - Tuberculosis: Respiratory 6 6 5 6 10 8 41 Meninges and Central Nervous System - - - - - - - Other Form 2 - 3 1 1 3 10 Totals, 1960 128 103 93 154 210 270 958 Totals, 1959 365 259 223 273 494 493 2,107 Diphtheria Outbreak In January an outbreak of diphtheria occurred, (the first in Walthamstow for ten years) which resulted in five clinical cases, with one death, and the discovery of 74 carriers. The infection, which was due to a virulent atypical mitis strain, was limited to children attending the Junior and infants departments of Roger Ascham School and to their families living within a circumscribed area. 17 Of the five clinical cases only one had been immunised (0.5. c.c. B.W. A.P. T. x 2) 7½ years previously. The other four, including the fatal case, had never been immunised. Of 59 carriers of school age 49 (84%) had been immunised, while of the school population at risk approximately 70% had been immunised. The first case R.C. a boy of 13, attending Sidney Chaplin Secondary Modern School, was reported by St. Ann's General Hospital on 16.1.60 as a case of faucial diphtheria. Case 2 (19.1.60), his sister, Y.C. aged 8, was found to have nasal diphtheria as a result of follow up of home contacts. She attended the Roger Ascham Junior School. Case 3 P.S. aged 8, was a boy in Y.C.'s class who developed the disease on 29.1.60 after having given negative nose and throat swabs a week before. Case 4 L.E. aged 3, was the sister of a boy in Y.C's class who was a carrier. She was diagnosed as acute diphtheria on 30.1.60 and was at once admitted to hospital. Unfortunately she died the next day. Case_5, the last confirmed case, occurred on February 8th when D.B. a boy of 6½ attending the Infants' Department, developed symptoms later confirmed as diphtheria. CONTROL OF THE OUTBREAK On the first notification, 16.1.60 (a Saturday morning) R.C's family were visited and nose and throat swabs taken by a health visitor. All these proved negative. All local doctors were informed, and this contributed to the early recognition of cases 3 and 5. On Monday, January 18th, R.C's school was alerted and his class and other school contacts were swabbed and Schick tested. All swabs were negative. Of the 44 children (aged 14) involved, 15 had never been immunised, 13 had received the primary course only, and 16 had received a booster dose in addition. Schick tests (4, absentees) showed 25 positives and 15 negative. No spread occurred at this school. On the same day R.C's family and their co-tenants were swabbed and Schick tested. Y.C. had a sanious nasal discharge and gave a positive swab while an aunt, M.G. aged 35, was found to be a carrier and excluded from work. Immunisation (1 c.c. P.T.) was offered to all contacts. Attention was now directed to Y.C's school Roger Ascham Junior, and 66 contacts were swabbed and Schick tested. Six positive swabs were obtained and Case 3, a class contact, was negative at that time but subsequently developed the disease (29.1.60). Of these children 74% had been immunised. 18 The discovery of six carriers in this group indicated the possibility of a widespread carrier state, and it was decided to swab the entire school of 350 children, including absentees and, later, to extend the mass swabbing to the adjacent infants school because of family contacts. The policy to be adopted was discussed with Dr. T.J.B. Geffen, Senior Medical Officer, Ministry of Health and Dr. C.E.D. Taylor, Director of the Public Health Laboratory, Colindale, and it was decided to control the spread of infection by removing carriers as well as cases from the community by admitting them to hospital as soon as possible This was particularly necessary since the affected district consisted of working class dwellings, including much Council property and consequently contained many large families with children attending a number of different schools This, coupled with the fact that many of the mothers were in employment, rendered the maintenance of proper isolation at home impossible. Children excluded on suspicion with strict instructions to remain indoors were often found playing with others in the streets. After the initial stages Schick testing was abandoned, since, with the very limited trained staff available, it was felt that the information gained from the test did not justify the amount of time spent as the large numbers involved would inevitably lead to delay in carrying out more active measures. In the two schools alone there were more than 600 children at risk and many of these were from families with a large number of home contacts Schick testing would have been of no assistance whatever in identifying possible carriers which was the most urgent task facing us. Passive immunisation with anti diphtheritic serum was not generally given, for the same reason, but active immunisation was offered to all for future protection although no immediate effect could be expected. As the outbreak dragged on for a further four months to the end of May it is certain that active immunisation of this compact community at the outset was amply justified. In order to detect carriers as quickly as possible repeated mass swabbings were carried out. The first three of these were of selected classes but the remaining sixteen covered whole schools (including Staffs) and disclosed 6, 4, 0, 0, 6, 8, 5, 3, 0, 0, 0, 2, 0, 2, 0, 0 carriers Two consecutive negatives were obtained from the infants school by May 3rd and from the juniors by June 2lst. In addition absentees (at one time amounting to 40%) home contacts of carriers and of children excluded on suspicion were swabbed at intervals of from 24 72 hours until three consecutive negatives were obtained from all members of the affected family. 19 Over ten thousand swabs were taken, representing a tremendous volume of work for the Public Health Laboratory as well as for my own staff, who worked at high pressure and put in a good deal of voluntary overtime. Conclusions This outbreak has demonstrated that a virulent strain can cause a widespread infection even when 70% of the community are immunised. The small number of cases prevents a statistically valid comparison, but it is striking that of the infected children who developed the disease only one in five had been immunised, while of those who did not (the carriers) four out of five had been immunised. The comparatively high index of immunisation (70%) among the children at risk was undoubtedly responsible for the occurrence of only five cases in the presence of over seventy infected persons, while the policy of concentrating on the early identification and prompt removal to hospital of all carriers reduced the infective pool. This was made possible only by the ready cooperation of the Public Health Laboratory Service and the admitting hospitals (St. Ann's, Honey Lane and the Eastern Hospital) as well as by the head teachers and staff of the schools concerned. Most of the parents of infected children were quite co-operative, but some were the reverse. One parent withdrew her children from one hospital without clearance and put up a tremendous resistance to proper control at home. Eventually she and her four children were all admitted together to another hospital. Suggestions and demands from parents varied from closing the schools to swabbing the entire adult population of Walthamstow. The decision not to close the schools was, in my view, amply justified by the limited amount of spread which occurred in the schools where the children were kept under surveillance and repeatedly swabbed to exclude carriers. No school spread occurred from Case 1, who infected, or was infected by, his sister (Case 2) or his aunt. Case 3, a class-mate of Case 2 who developed the disease ten days later, was presumably infected by the same source, possibly at school, case 4, the pre-school child, was undoubtedly infected by her brother, while in Case 5, the only one at the infants school, no definite source was incriminated. In favour of the occurrence of spread in the home rather than at school is the fact that whole families became carriers. In one family a parent and five children were infected, and in three 20 families a parent and four children. Almost always at least two of the family were carriers, and eight families accounted for thirty-one of these. Control of the adult carriers proved difficult but family doctors were most helpful in arranging treatment at home. Some anxiety was felt about one expectant mother who was advanced in pregnancy and booked for hospital confinement. Fortunately she was cleared from infection before admission. Within the schools themselves the spread was clearly related to the presence of cases rather than carriers, as shown by the following tables:- Junior School Class 1 4 5 6 7 8 9 10 Cases 0 0 0 0 2 0 0 0 Carriers 1 0 1 4 11 0 3 0 Infants School Class 1 2 3 4 5 6 J3* J4* Cases 0 0 1 0 0 0 0 0 Carriers 3 0 6 10 0 5 1 1 * Junior School classes accommodated in Infant building. Contact between classes was restricted as far as possible, e.g. at play and meal times, but some inter-class contact inevitably occurred especially out of school. The use of the schools for club meetings was suspended. The same, rather unusual, strain of diphtheria bacillus was found in aii those infected but the original source was never traced. Paratyphoid Outbreak On January 5th Notification was received that a nurse, K.M, aged 19, who had been in the sick bay in Connaught Hospital for a week, was suspected of having Paratyphoid Fever 'B' (Phage Type I). My Deputy at once visited her and obtained details of her relevant medical history and of her contacts during the previous four weeks. The diagnosis was not in doubt and she was transferred to the Infectious Diseases Unit at St. Ann s General Hospital the next day. Treatment was given with chloramphenicol in full dosage (G.1, 6 hrly.) for a week and at reduced dosage for a further fortnight. Apart from some peripheral neuritis no complications 21 occurred, but she continued to produce positive specimens and when a further course of treatment (Streptomycin, 5 days) still failed to eliminate the organisms she was sent home (to Ireland) to recuperate, rather than subject her immediately to a further barrage of antibiotics. The patient was told of the precautions she must observe as a carrier, and the County Medical officer of Health (in Ireland) was given details of her case. She was later admitted to a fever hospital there for further treatment but remained a chronic carrier for many months. This young lady had some weeks of acute illness, and several more of hospitalisation in the attempts to clear her of the carrier state which made her a danger to all with whom ihe came in contact. paratyphoid can be a serious illness with a mortality rate of up to 4 per cent but, from a Public Health point of view, its worst feature is its tendency to induce a chronic carrier state lasting for months or even years after the acute infection has subsided. No effort was spared, therefore, in attempting to trace the source of K.M's infection. Living in the Nurses' Home she had had little contact and few meals outside the hospital. These was all followed up without result but the hospital notified three more cases. The first of these, T.W, aged 53, was admitted soon after the Nurse. K.M. had been taken ill. He too, proved to have Paratyphoid 'B' (phage type I) but all his contacts were negative, and the most extensive enquiries failed to discover any common contact or source of infection (e.g. food) which they might have shared. The other two cases were girls, S.B, aged two and a half, and S.S. aged four. S.B. was admitted to Connaught on December 28th with a temperature of 104°, and S.S on the 29th. Again, no contact or common infecting source could be found, either with each other or with the two previous cases. All three were transferred to St. Ann's Hospital where they recovered, but both girls became persistent carriers. The fifth case was a lady of thirty three, E.L, who was admitted to Connaught Hospital on January 5th, having been ill at home with colicky abdominal pain, diarrhoea and vomiting, with a severe cough for about a month She too was transferred to St. Ann's on January 9th and made a complete recovery. The Ministry of Health, local health authorities, local hospitals and general practitioners were advised of the presence of an outbreak of Paratyphoid in the district, and four more cases came to light. C.F. (36) was sent in from Chingford Hospital where he had been admitted on January 6th after having 22 symptoms for about a week at home. He was admitted to St. Ann's on January 14th and required two courses of treatment to clear him of the infection. RF. (39) (no relation) had been ill since Christmas but responded to treatment at home, although his condition was confirmed as paratyphoid on January 18th. B. McN. (aged 37), another nurse, became ill on January 18th, and hers was the only case in which contact could be demonstrated, she having nursed cases 1, 3 and 4 some two to three weeks earlier. The final case, M.H. aged 24, was sent into St. Ann's on February 11th by her family doctor, who had suspected the condition within a few days of onset. Both these ladies recovered fully without complications. At first sight it seems extra-ordinary that eight cases of a comparatively rare infectious disease could occur in a circumscribed area within a few weeks of each other without some direct contact between them being discovered but, in fact, it is extremely difficult to trace the source of infection in this condition. Although it is a food borne infection and quite extensive outbreaks have occurred due to contaminated egg products and (more recently) desiccated coconut, it is most often spread by human carriers who may infect only one or two people at a time and who, moreover, may only excrete the organism intermittently and give repeated negative tests between episodes of excretion. Unlike bacterial food poisoning where the effects follow within a few hours of eating the affected food, Paratyphoid is a systemic infection whose symptoms may not develop for several days. The early symptoms of headache, loss of appetite, lassitude and feeling generally off colour are not very specific (especially on this occasion just after Christmas) and it was difficult to date' the onset in most of the cases with any accuracy Even where the date of onset was known witn certainty, as in the first case, (December 26th), the actual infection might have occurred from a day or two to almost two weeks before, so that the tracing of contacts was extremely difficult and examination of any suspicious foodstuff consumed, quite impossible Apart from the second nurse, who clearly picked up the infection from her patients, only one other promising lead was discovered The family of S.S. had suffered from a gastro intestinal upset during the first week in December, which they attributed to a ready cooked meat pie bought from a local trader s s father and grandmother were affected, but her mother, who had also consumed part of the pie, was not, but she (Mrs S.) was the only one of all the contacts of all the cases to produce a positive specimen She was, in fact, a symptomless carrier (subsequently cleared by prolonged treatment at home) and she, rather than the pie, may well have been the source of infection to her family. However, the pie supplier's premises were at 23 once inspected and the standard of hygiene found entirely satisfactory. Two pies were taken for bacteriological examination on January 11th and both were free from infection. Failing any common source of contact between the cases intensive sampling was carried out on foodstuffs liable to be contaminated with paratyphoid organisms and during the second week in January twenty-three samples of egg products and synthetic cream, etc., were examined by the bacteriologist. One sample proved to be infected with a food poisoning organism but none with paraty phoid. Towards the end of February information was received from a trade source that some supplies of desiccated coconut from Ceylon had been found to be contaminated with paratyphoid germs and this was later confirmed by the London Port Health Authority. This at once suggested a possible source of the local outbreak and we endeavoured to obtain samples of all supplies of desiccated coconut in the town. Forty-two samples were taken and two of these were contaminated with food poisoning organisms, but we again drew blank for paratyphoid. The outbreak ceased as abruptly as it began, and apart from McN. no secondary cases arose. We were most thankful for this as we were by this time coping with a more serious outbreak of diphtheria. The satisfaction in controlling effectively an outbreak of infectious disease is always tempered by some disappointment if the source of origin remains untraced but, for the reasons I have given, this is the usual experience with paratyphoid. The Chief Medical Officer, Ministry of Health, reported 379 cases during 1959 and, in describing a widespread outbreak, stated - "despite extensive investigations the vehicle of infection was not identified'. Sir John Charles went on to say 'Man remains the ultimate source of well-nigh all the infections causing the enteric fevers, and the transmission of the organisms concerned is closely related to the various means by which food and drink become contaminated by infected human excreta.* Vigorous enforcement of the provisions of the Food Hygiene Regulations, and continued efforts to educate the public, and especially food handlers, in personal hygiene, is our best defence against these costly outbreaks of enteric infections. FOOD POISONING Fifty seven cases were notified and in addition ten cases were ascertained' i.e. became known otherwise than by notification, by following up notified cases. None was fatal. There were three small familial 'outbreaks' , in each case the 24 infecting agent being Salmonella Typhi-murium, and two further 'outbreaks' occurred in which cases the infecting agent was cl. Welchii and Staphylococci. Five of the single cases were due to Salmonella Typhi-murium, one to Staphylococci and in one case the infecting agent was Salmonella Waycross. Poliomyelitis Only two cases of Poliomyelitis (paralytic) were notified during the year, one school-child and one pre-school child. Neither patient had been immunised. Tuberculosis The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1960:- Age Periods NEW CASES DEATHS Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F Under 1 year - - - - - - - - 1 -4 years - - - - - - - - 5-9 years - - 1 - - - - - 10-14 years - 1 - - - - - - 15-19 years - 1 - 1 - - - - 20-24 years - 4 - - - - - - 25 34 years 1 3 3 - - - - - 35-44 years 2 5 2 1 - 1 - 1 45-54 years 4 1 1 1 - - - 55-64 years 10 1 - - 3 - - - 65 and over 5 3 - 1 1 1 - - Totals .22 19 7 3 5 2 - 1 41 10 7 1 51 8 25 TUBERCULOSIS-NOTIFICATION AND DEATH RATES The following graph shows the trend of notification of tubercu losis 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. 26 D. - SANITARY CIRCUMSTANCES OF THE AREA Noise The 'Noise Abatement' Act came into force this year. It is designed to control and abate nuisances caused by noise and vibration. Noise is an inevitable concomitant of ever-increasing mechanisation, of bigger and faster vehicles of travel on land and in the air, and of a quickening tempo of life. The portable transistor radio set is fast becoming a normal appendage of one's apparel just as a collar and tie used to be. With these opportunities that modern age affords us for making bigger and better noises it is small wonder that the time has now come to consider the abat ment of sounds which are unnecessary, avoidable, and which can be mitigated. But in truth, to prove that a noise is a nuisance is bedevilled with complexities. The threshold of tolerence to noise varies enormously in individuals and what constitutes a pleasant sound to one may be intolerable to another. To prove a nuisance must therefore be subjective only, since no scientific evaluation of noise nuisance has yet been devised. It will only be by long experience of its actual working that the value of this Act can be assessed. There is no doubt that in certain circumstances noise can become intolerable and a serious hazard to health. 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 Servec Complied wi th Served Complied wi th 23,554 3,244 1,678 739 855* 181 210* 29,720 * Includes notices outstanding from previous year Of the 739 Intimation Notices served. 144 were in respect of business premises and the remainder (595) related to defects in private houses. 27 Of the latter figure, 414 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 twenty-six properties. Orders, each of twenty-eight days, were made in four cases; three cases were adjourned sine die and then withdrawn; in nineteen cases proceedings were withdrawn as the works were completed before the date of hearing and in three of these cases, costs of £1. 1. 0. were awarded. The following table shows the nature of work executed and improvements effected during the year:- Drains tested, 365; Drains reconstructed or repaired, 200; Drain obstructions removed, 92; Drains, means of access provided, 21; Drains, ventilation provided or improved, 9; Soil pipes renewed or repaired, 60; Rainwater pipes repaired or renewed, 68: Roofs repaired or renewed, 272; Gutterings repaired or renewed, 173; W.C. pans and traps provided, 102; W.C.s repaired or cleansed, 90; W.C.s light and ventilation improved, 1: Gully traps provided, 37; Waste pipes repaired or renewed, 47; New sinks provided, 20; Stoves and firegrates repaired or renewed, 34; Water supply re-instated, 15; Yard and forecourt pavings repaired, 56; Dirty houses cleansed, 6; Dirty rooms cleansed, 22; Floors repaired. 118; Ventilation under floors provided or improved, 22; Dampness remedied, 357; Water taken off main, 1; Offensive accumulations removed, 17; Manholes repaired or resealed, 76; Miscellaneous repairs, 930. Infectious Diseases Visits to premises, 300. Disinfections Rooms disinfected, 44; Articles disinfected, 4,632; Articles destroyed, 31. Special Premises Number Visits paid Factories (a) Non-power 53 20 (b) Power 477 218 (c) Other premises 14 2 Outworkers 420 420 Butchers 85 289 Bakers and Shops 42 158 Fishmongers, Fryers and Curers 36 103 Cafes and Caterers 91 296 28  Number Visits paid Grocers 241 503 Greengrocers 84 135 Ice Cream Manufacturers 5 56 Ice Cream Vendors 358 163 Dairies 2 22 Milksellers 130 168 Laundries 1 10 Ladies Hairdressers 35(Combined 14) 28 Gentlemen's Hairdressers 32 38 Rag Dealers 3 4 School Kitchens 20 85 Street Stalls 130 601 Stables 4 9 Schools 61 42 Public Houses 38 44 As a result of the regular periodical visiting of the above premises the following works were carried out:- Butchera Cleansings, ll Accumulations removed, 1; New bins provided, 4. W.C.s repaired and cleansed, 2; Other improvements, 17 Bakers Cleansings, 28; New ceilings fixed, 3; Floors repaired, 6, Other improvements, 23; Roofs repaired, 2; Light and ventilation improved, 1. Fishmongers Cleansings, 2, Accumulations removed, 1; Other improvements, 4- Cafes and Caterers Cleansings, 26. Floors repaired, 9: Other improvements, 43 Grocers - store rooms cleansed, 36, Washing accommodation improved, 11, Other improvements, 41. Greengrocers store rooms cleansed, 4; Washing accommodation improved, 4; Other improvements, 16. Ice Cream Manufacturers and Vendors Improvements, 5. Hairdressers Cleansings, 4, Other improvements, 8. Dairies• and MilkselIers - cleansings, 9; Fittings and other improvements 3. Laundries improvements, 3. Rag Dealers - cleansings. 2. School Kitchens - Improvements, 1. Street Traders Stalls improved, 49 Stables Cleansings, 1 Accumulations removed, 1. Public Houses - cleansings, 1 Hot water supply improved, 1. 29 Smoke Abatement Observations on smoke nuisance from premises in the Borough amounted to 40. Investigations were carried out in all cases; new boiler plant being installed in some factories and improvement 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 most of these were approved by the Council, subject to certain modifications being carried out. 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 atthe 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. April May June Sir George Monoux Gramnar School 4.3 2.8 1.7 1.2 1.1 0.98 Willow walk site 2.2 2.5 - 1.1 0.94 0.69 Woodford County High School 1.5 1.6 0.83 0.83 0.80 0.55 Blackhorse Lane site 2. 4 3.1 1.1 1.2 1.2 0.99 July Aug . Sept. Oct. Nov. Dec. Sir George Monoux Grammar School 0.71 0.79 1.0 1.4 2. 3 2.6 Willow Walk site 0.62 0.69 0.94 2.2 1.4 2.4 Woodford County High School 0.46 0.51 0.54 0.96 1.4 1.5 Blackhorse Lane site 0.85 0.83 1.1 2.0 2.8 2.3 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 7.2. An instrument for measuring smoke pollution is in operation at the Town Hall. Daily readings are taken and the figures obtained are in milligrams of solid matter per 100 cubic metres of air. The lowest average monthly reading was 3.0 milligrams in July and the highest monthly average reading was 17.5 milligrams in December. Smoke Control Areas The detailed survey in respect of Smoke Control Area No. 1 was completed during the year and details were submitted to the Ministry of Housing and Local Government for confirmation. This area was confirmed by the Minister and will come into operation on 1st June, 1961. By the end of the year, a number of fireplaces in this area had been converted to burn smokeless fuel. 30 The No.1 area is situated around the Town Hall and comprises 218 acres. The detailed survey in respect of Smoke Control Area No.2 is proceeding and will be completed early in 1961. This area adjoins No.l area and is bounded by the railway line from Hoe Street Station to Wadham Road, along Wadham Road to Chingford Road and along Hoe street to Hoe Street Station. It comprises an area of 346 acres. Verminous Premises - The number of houses reported to be verminous remains comparatively small. Sixty rooms were disinfested and insecticides were issued free of charge to tenants of twenty-seven houses. Swimming Baths and Pools - There are two public swimming baths and three school swimming baths within the Borough. The water used in these baths is obtained from the Metropolitan Water Board mains and is re-circulated and treated by filtration plants consisting of pressure filters, chlorination plants and in some cases aeration plants. The water in the baths is changed as often as necessary, depending on the amount of use. Samples of water from all these baths are taken at frequent intervals for both chemical and bacteriological examination. All samples taken during the year indicated that the water was suitable for bathing purposes Sewerage Arrangements for sewerage and sewage disposal in the district are reasonably adequate Hairdressers -Eighty-one 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 - This Act empowers the landlords of dwelling houses to increase rent provided the property is in good repair. On receipt of a notice of increased rent from the landlord, the tenant if he considers that the property is not in good repair, must serve a notice on the landlord specifying the works he considers should be carried out. If the landlord does not carry out the works specified or does not give an undertaking to carry out the work, within six weeks, the tenant may apply to the Council for a Certificate of Disrepair This Certificate if issued will enable the tenant to deduct any increase already paid from the date of the application to the Council and he need not pay the increased rent demanded 31 If the landlord has not carried out the undertaking given by him to the tenant in six months following the date of the undertak ing, the tenant is again entitled to make a deduction in his rent. If he desires a certificate stating that the undertaking has not been remedied, he may apply to the Council for same. This Certificate is also used when the landlord makes application to the Council stating that he has carried out the undertaking. There are twenty-one forms specified by the Act for use between landlord and tenant; the Council may be involved in thirteen of these. The following action was taken under the Act during 1960: Part I. - Applications for Certificates of Disrepair (1) Number of applications for certificates 43 (2) Number of decisions not to issue certificates 1 (3) Number of decisions to issue certificates (a) in respect of some but not all defects 26 (b) in respect of all defects 16 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 30 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule (6) Number of certificates issued 19 Part II. - Applications for Cancellation of Certificates (7) Number of applications by landlords to Local Authority for cancellation of certificates 28 (8) Number of objections by tenants to cancellation of certificates 8 (9) Number of decisions by Local Authority to cancel in spite of tenant's objection 1 (10) Number of certificates cancelled by Local Authority 21 In addition to the above, twenty-six applications were received from landlords and tenants for certificates as to remedying or failing to remedy, the defects set out on the undertaking given by the landlord. Of the twenty six applications, twenty-three certificates were issued and the remainder (3) were not granted. Housing Act, 1936, Section 62 Applications for permitted number' were received from landlords and certificates issued during the year respecting seventyone lettings. Local Land Charges Enquiries relating to outstanding sanitary notices were dealt with in 2,072 cases. 32 E. 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 1960 Hoe Street Ward _ St. James Street Ward _ _ Higham Hill Ward 38 Flats 1 House High Street Ward _ Hale End Ward 10 Flats Wood Street Ward.. 210 Flats Total 258 Flats 1 House Houses completed by Private Enterprise Hoe Street Ward - - St. James Street Ward - - Higham Hill Ward - - High Street Ward 20 Flats Hale End Ward 8 Flats 5 Houses Wood Street Ward 10 Flats Total 38 Flats 5 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 138 Standard 206 Total number of grants and amounts approved by Council to owner/occupiers:- Discretionary 99 £27,973 Standard 154 £17,530 33 Applications received from Warner Estate Ltd;- Discretionary 64 Total number of grants and amounts approved by Council to Warner Estate Ltd- Discretionary 66 £13,571 Summary Total number of applications:- Discretionary 202 Standard 206 Total number of grants:- Discretionary 165 Standard 154 Total amount of grants:- Discretionary £41,544 Standard £17,530 Inspection The chief Public Health Inspector reports as follows:- I. Inspection of dwelling houses during the year (1) (a) Total number of dwelling houses inspected for housing defects (under the Public Health or Housing Acts) 1,530 (b) Number of inspections made for the purpose 4 208 (2) (a) Number of dwelling houses (included under head (1) above) which are inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 .. .. •• 106 (b) Number of inspections made for the purpose .. 181 (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) 12 (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 595 34 II. Unfit houses closed:- (1) Under Sections 16(4), 17(1) and 35(1), Housing Act, 1957 12 (2) Under Sections 17(3) and 26, Housing Act, 1957 (3) Parts of buildings closed under Section 18, Housing Act, 1957 III. Unfit houses made fit and houses in which defects were remedied:- (1) After informal action by Local Authority 414* (2) After I'ormal notice under (a) Public Health Acts 210* (b) Sections 9 and 16, Housing Act. 1957 (3) Under Section 24, Housing Act, 1957 1 (* including those notices outstanding from previous years) Clearance Areas One official representation was made in November in respect of nine dwelling houses - this was confirmed by the Council and forwarded to the Ministry of Housing and Local Government for confirmation. This completes the five year programme 1955-60. Inspections of dwelling houses were carried out in respect of the first clearance area in the 1960/65 programme. This area will be dealt with in 1961. 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 1960:- No.of new properties made available for letting 281 Acquired 148 Normal vacancies 99 Nominations to private landlords 30 New properties at Canvey New properties at Billericay 46 Total 604 Families rehoused 1-bedroom group 190 2-bedroom group 227 3-bedroom group 163 4-bedroom group 24 Total 604 35 property under management at December 1960:- Pre-1939 houses and flats 1,615 New houses and flats 2,792 properties at Canvey Island 112 properties at Billericay 147 Prefabricated bungalows 202 properties converted into flats 253 Properties improved 188 Properties acquired for improvement and conversion 544 properties for Clearance and Demolition 55 Requisitioned dwellings - Halfway houses 4 General Properties 30 Commercial Properties 59 Garages 679 Total 6,680 The number of families rehoused in New Towns during 1960 was 84. The following extracts are taken from the Annual Report of the Housing Management Committee:- Rehousing - During 1960 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 65 'D' Families living apart 9 'E' Irregular overcrowding 43 'K' Three or more families (relatives) in house - 'H' Transfer of priority housing 'J' Special cases 41 'J' Rehousing subject to nomination 18 M.O.H. Medical recommendations (T.B.) 8 M.O.H. Cases for consideration 8 Special requests for emergency ion ion 35 Total 227 36 MEDICAL CASES During 1960, nine cases claiming rehousing priority for tuberculosis were investigated and reported upon. Of these six cases were added to the list. The position at the end of 1960 was as follows: Class I Class 2 Class 3 Class 4 Total On list at end of 1959 2 1 6 - 9 Added to list during 1960 1/3 2/3 2/8 1/1 1/15 Rehoused or removed from list during 1960 On list at end of 1960 2/1 1/2 -/8 1/- 4/11 In addition to the tuberculosis cases, twenty-nine other cases were recorded as needing special consideration on medical grounds and seventy-one on general housing grounds. F. - INSPECTION AND SUPERVISION OF FOOD Designated Milk During the year ninety 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 bimonthly sampling of the two dairymen holding Pasteuriser's Licences. The following table gives details of samples of milk taken:- Grade No. of Samples Satisfactory Result Pasteurised 45 45 Sterilised 5 5 Tuberculin Tested Pasteurised 40 40 Totals 90 90 The Milk (Special Designat ion) (Pasteurised and Steri1ised Milk) Regulations, 1949 and 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 71 Pasteurised 5 Sterilised 142 Sterilised 6 Tuberculin Tested 27 Tuberculin Tested 4 Licences (Plant) Pasteurisers 2 There are no cow-keepers in the district. The number of Retail Milk Distributors is 130. One hundred and ninety 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. Ice Cream Thirty-nine applications for registration were received and were dealt with as follows:- Vendors, New 17 Vendors, Transfers 21 Application refused 1 Number on Register at end of year 358 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. Food Standards (Ice Cream) Order, 1951. Three samples of ice cream were taken and submitted to the Public Analysts who reported the following satisfactory results:- Fat Content 10.0% 10.4% 5.7% 37 38 Bacteriological Examination of Ice Cream Ninety-four 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 - 66 Grade II 18 Grade III - 4 Grade IV - 6 Where unsatisfactory samples were talien, 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) Sixteen samples were examined for bacterial purity, one being unsatisfactory. 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 425 tins Evaporated Milk 1 jar Crab Spread 37 tins Pull Cream Milk 12 jars Salmon Spread 6 tins Skimmed Milk 1 jar Meat Extract 35 tins Cream 2 jars Pickles 1 tin Butter 1 bott.Mayonnaise 30 tins Baby Pood 2 botts. Ketchup 210 tins Soup 10 lb Apricots 91 tins Stewed Steak 333/4 lb. Apricot Pulp (tinned) 9 tins Steak & Kidney Pudding 30 lb Prunes 1 tin Steak & Kidney Pie 25 lb Dried Fruit 1 tin Irish Stew 41 lb Mincemeat 601 tins Minced Beef Loaf 19 lb Lemon Curd 9 tins Minced Beef and Onions 641/4 lb Coconut 9 tins Pease Pudding 30 lb Cheese 2 tins Potato Salad 10 lb Tea 6 tins Vegetable Salad 197 lb Potatoes 20 tins Carrots 952 lb Onions 61 tins Butter Beans 28 lb Dried Peas 517 tins Peas 2 lb Diced Carrots 154 tins Tomatoes 6 lb Haricot Beans 3 tins Runner Beans 710½ lb. Confectionery 31 tins Plums 14 lb Walnuts 200 tins Pineapple 1,0483/4 lb Corned Beef 16 tins Grapefruit 150 lb Corned Mutton 51 tins Fruit Cocktail 226 lb Chopped Pork 270 tins Peaches 808½ lb. Luncheon Meat 113 tins Mandarin Oranges 102 lb. Minced Beef Loaf 79 tins Pears 30 lb Jellied Veal 39 21 tins Rhubarb 1O¼ lb. Pork (tinned) 36 tins Prunes 7 lb Pork 16 tins Cherries 584 lb Ham (tinned) 15 tins Apricots 61½ lb. Ham 37 tins Loganberries 159 lb. Bacon 1 tin Strawberries 27 lb Lamb 10 tins Pineapple Juice 828½ lb. Beef 7 tins Orange Juice 9½ lb. Stewing Steak 7 tins Tomato Juice 1¾lb. Sheep's Tongues 3 tins Grapefruit Juice 197 lb. Sheep's Liver 24 tins Coffee 24 lb. Ox Tongues 39 tins Spaghetti 140 lb Pigs' Liver 298 tins Baked Beans 10 lb Lambs' Liver 5 tins Beans and Sausage 1½ lb Kidneys 44 tins Rice Pudding 9¾ lb Chicken (tinned) 1 tin Sultana Pudding 96 lb Chicken 1 tin Marmalade 1 stone Cod 75 tins Salmon 2 stone Haddock 101 tins Pilchards 41 stone Skate 1 tin Crab 9½ stone Crab 1 tin Shrimp 25 Chickens 3 tins Roes 270 Eggs 6 tins Silds 579 Ice Cream Cones 9 tins Sardines Shellfish and Jellied Eels The following samples were taken during the year for bacteriological examination:- Cockles .. .. .. 3 Mussels .. .. .. 2 Jellied Eels .. .. 7 Two of these samples were of an unsatisfactory standard and the necessary investigations were carried out. Cooked Meats Sampling of these products continued during 1960, sixty-six samples being taken. Twenty-two were classified as unsatisfactory because of bacteriological contamination which occurred during storage and exposure for sale. Miscellaneous Samples Seventy-five samples were submitted for bacteriological examination, consisting of the following:- Dried and Frozen Eggs .. .. 17 Synthetic Cream .. .. 5 Fresh Cream .. .. 1 Dried Milk .. .. 1 Cream Trifle and Sponge.. .. 2 Piping Jelly .. .. 1 Desiccated Coconut .. .. 42 Steak and Kidney Pies .. .. 2 Corned Beef .. .. 2 Water (Wells) .. .. 2 40 All these samples gave satisfactory results with the exception of one sample of Dried Egg and two samples of Desiccated Coconut. These three samples were found to contain salmonella organisms. Adulteration, etc. - Food and Drugs Act, 1955 During the year, one hundred and fifty-four samples of food and drugs were submitted to the Public Analysts. Five samples were reported as being unsatisfactory, details respecting same are given below:- Description of Articles Result of Analysis Action Taken Sarsaparilla Wine Alcohol 0.64% Misdescribed as ‘wine' Warning letter. Gin Water 4% Warning letter. Sausages, Beef Contained sulphur dioxide within prescribed limit. Warning letter regarding no notice of preservatives. Soup, Chicken Noodle 1% fat and lean chicken meat. (Chicken content low) No action possible. Rhubarb Excessive contamination of tin. Warning letter. Remaining stock withdrawn from sale. The following summary gives details of food sampled and results of analyses:- No. Satisfactory No. Unsatisfactory Formal Informal Total Formal Informal Total Milk 7 - 7 - - - Cream 1 4 5 - - - Butter - 3 3 - - - Margarine 1 - 1 - - - Tea 1 1 2 - - - Blackcurrant Drink 1 - 1 - - - Lemon Drink - 2 2 - - - Orange Drink - 1 1 - - - Sarsaparilla Wine - 1 1 - 1 1 Fruit Drink - 2 2 - - - Mix-a-shake - 1 1 - - - Gin 1 - 1 1 - 1 Whisky 7 - 7 - - - Rum 1 - 1 - - - Brine - 72 72 - - - Ox Tongue, Cooked - 1 1 - - - Beef, salt - 7 7 - - - Beef, Corned - 1 1 - - - Sausages, Pork 3 - 3 - - - Sausages, Beef 1 - 1 1 - 1 41  No. Sat is factory No. Unsatisfactory Formal Informal Total Formal Informal Total Chicken Croquettes - 1 1 - - - Soup, Chicken Noodle - 1 1 - 1 1 Soup, Mushroom - 1 1 - - - Fish Sticks - 1 1 - - - Pish Paste - 1 1 - - - Crab, Dressed - 1 1 - - - Rhubarb - 2 2 - 1 1 Sauce - 1 1 - - - Jam, Strawberry - 1 1 - - - Nutmeg, Ground - 1 1 - - - Pepper - 1 1 - - - Olive Oil - 1 1 - - - Cinnamon, Ground - 1 1 - - - Ice Cream 2 1 3 - - - Ice Lolly Syrup - 1 1 - - - Marzipan - 1 1 - - - Jelly - 2 2 - - - Gelatine - 1 1 - - - Pastilles, Fruit - 1 1 - - - Sherbet, Lemon 1 - 1 - - - Milk Gums 1 - 1 - - - Pear Drops 1 - 1 - - - Brandy Balls 1 - 1 - - - Custard Powder - 1 1 - - - Aspirin Tablets - 1 1 - - - Yeast, Brewers - 1 1 - - - Totals 32 122 154 2 3 5 A series of samples of brine has been taken from butchers shops to ascertain the suitability for brining purposes and to estimate the amount of metal absorbed from brining pails, etc. Many brines have been found to be of a poor standard, and excessive metal has been absorbed into the brine. Advice has been given to butchers on this matter and plastic containers have been substituted for metal. This work was carried out by Mr. H.L. Hughes, former Deputy Chief Public Health Inspector to the Council. He gave a paper on this matter to the Members of the Association of Public Health Inspectors at a meeting held at the Town Hall on 4th January, 1961. Chemical and Bacteriological Examination of Foods Chemical examinations. of food samples are carried out by the Public Analysts, Dr. J.H. Hammence, F.R.I.C. and Mr. P.S. Hall, A.R.I.C.. of 20, East cheap, London, E.C.3, and bacteriological examinations by the Counties Public Health Laboratories, Thresh House. Verulam Street, Gray's Inn Road, London, W.C.1. Food Hygiene (General) Regulations, 1960 These Regulations came into operation on 1st October, 1960. 42 A reasonably high standard continues to be maintained in the food premises within the Borough. It was found necessary to serve notices under the Regulations in a few cases, most of which had been complied with by the end of the year. The conditions laid down in the Regulations are being maintained throughout the district. The following food premises are established in the Borough:- Butchers, 85; Bakers, 42; Fishmonger 36; Cafes and Caterers, 91; Grocers, 241, Greengrocers, 84; Milk sellers, 130; Ice Cream Manufacturers 5 and Ice Cream Vendors, 358. 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, 289; Bakers, 158; Fishmongers, 103; Cafes and Caterers. 296; Grocers, 503; Greengrocers, 135; Dairies, 22, Milk sellers, 168 Ice Cream Manufacturers, 56 and Ice Cream Vendors, 163. 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. Legal Proceedings The following action was taken during 1960:Food Hygiene Regulations, 1955 Smoking on food premises (5 cases). Court awarded Penalties of £15 and Costs £3. 5. 0. Absence of water supply and nailbrushes on Ice Cream Vans (3 cases) One case of two summonses Court awarded £1 Penalty on each summonse: £l Penalty was given in another case and the third case was dismissed. Dirty conditions of premises and no wash hand basin (1 case of 4 sunmonses) Hearings were adjourned and then withdrawn. Dirty condition of premises (1 case). Court awarded Costs of £3. 3.0. Six summonses were issued in respect of alleged insufficiently protected food on street stalls but the hearings were adjourned by the Court. 43 Food and Drugs Act, 1955 Unfit food (1 case of 2 summonsed). Court awarded £10 Penalty on each summonse and £5. 5. 0. Costs. Dirty bandage on cut thumb of person selling food (1 case). Court awarded £1 Penalty and 10/- Costs. Milk and Dairies (General ) Regulations, 1959. Dirty milk bottle (l case). Court awarded £2 Penalty and £2. 2. 0. Costs. Rag Flock and other filling materials Act, 1951 No applications for approval were received during the year and all premises registered or licenced under the Act were inspected. Diseases of Animals Act Swine Fever (Infected Areas) Order, 1953 No licences were issued during the year. Fowl Pest Order, 1936 Two Orders were issued by the Minister of Agriculture, Fisheries and Pood during the year. No particular action was necessary by the Council. Foot and Mouth Disease Orders Four Orders affecting the Borough were issued by the Minister of Agriculture, Fisheries and Food. No cases occurred in the Borough and no particular action was necessary by the Council. Pet Animals Act, 1951 Twenty four premises are licensed in the Borough for the sale of pet animals. All licences are renewed annually and all premises were inspected during the year. 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 1960:- 44 PREVENTION OF DAMAGE BY PESTS ACT, 1949 Report for the year ended 31st December, 1960 Type of Property Non-Agricultural Agricultural Local Authority Dwel1ing houses All other (including business premises) Total I. Total No. of properties in Local Authority's district 18 34,676 5,476 40,170 4 II. No. of properties inspected as a result of:(a) Notification 29 474 103 606 - (b) Survey 11 320 12 343 - (c) A visit prim arily for some other purpose - - - - - III. Total inspections carried out including re-inspections 145 1,783 404 2,187 4 IV. No. of properties inspected (in Sect. II) which were found to be infested by. (a) Rats Major 1 - 12 13 - Minor 7 480 91 578 1 (b) Mice Major - - - - - Minor 5 62 6 73 - V. No. of infested properties (in Sect IV) treated by the Local Authority 13 542 109 664 1 VI. No of ‘Block' control schemes carried out 3 - - - - 45 Factories Acts, 1937 & 1948 The following tables show the work carried out under these Acts: - 1. INSPECTION OF FACTORIES, ETC. ("Including Inspections made by Public Health Inspectors; Premises 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 53 20 - - Factories not included above in which Section 7 is enforced by the Local Authority 477 218 2 - Other premises in which Section 7 is enforced by the Local Authority 14 2 - - Totals 544 240 2 - 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) 18 9 _ 2 _ Overcrowding (Sec 2) - - - - - Unreasonable Temp (Sec 3) . - - - - Inadequate Ventilation (Sec. 4) - - - - - Ineffective drainage of floors (Sec 6) 2 2 - - - Sanitary Conveniences (a) insufficient - - - - - (b) Unsuitable or Defective 19 19 - 2 - (c) Not separate for Sexes - - - - - Other offences (not including offences relating to Outwork) 4 3 - - - Totals 43 33 - 4 - 46 NUMBER AND TRADES OF OUTWORKERS NOTIFIED 1960 Wearing Apparel (making Brush making 12 of) 357 Stuffed Toys 3 Household Linen 1 Artificial Flowers 10 Paper Bags 13 Cosaques, Christmas Crackers, etc. 2 Furniture and Upholstery 2 Umbrellas etc. 3 Lampshades 3 Boxes 14 Total 420 47 SECTION G NATIONAL HEALTH SERVICE ACT, 1946 PART III SERVICES WALTHAMSTOW HEALTH AREA SUB COMMITTEE (1960/61) Chairman: Councillor Mrs, W.M. PALETHORPE (Walthamstow Borough Council) V ice-Chairman: Councillor Mrs. C.E. STANNARD (Walthamstow Borough Council) Members: Nominated by: - Essex County Council Alderman Mrs. M. BALL (Chair- Alderman Mrs. L.P. BAILEY, 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. Walthamstow Borough Council Alderman THE LADY McENTEE, Councillor P. FURBER, J.P O,B E., J P Councillor Mrs. L.D. GURR. Alaerman C. B. REYNOLDS. Councillor J.H. HAMMOND.. Councillor Mrs. E.L. BALDWIN. Councillor Mrs. J.C. OAKMAN. Councillor L.A. BAYLIS. Councillor Mrs. C.E. STANNARD. Councillor J.J. BRACKEN. Councillor P.F.A. WEBSTER. Councillor Mrs. S, CANDY. Councillor D. WEINSTEIN. Councillor Mrs. R. COLIN. Executive Council for Essex F.A. WORTLEY, ESQ. Hospital Management Committee Mrs. B.E. BOTTOMLEY, J.P. Local Medical Committee for Essex Dr. W.R. JOHN. Voluntary Organisations Mrs. L.A.. BRAZIER. Mrs. A. CORDELL. Mrs. M. BROWN. E.P. MARR, ESQ. Area Clerk G.A. BLAKELEY. ESQ 48 NATIONAL HEALTH SERVICE ACT (PART III) SERVICES The Local Health Authority functions under the National Health Service Act are administered by the Walthamstow Health Area Sub-Committee on behalf of the County Health Committee (Essex County Council). Details are given in statistical form on pages 59 to 76. Section 21 HEALTH CENTRES Reservation of Sites for Health Service Purposes Details have been given in previous reports of the six sites that have been reserved and defined under the County Development Plan as being required for health service purposes. During the year the Pretoria Avenue site was transferred to the Education Committee for the erection of a new three-form entry junior school. It is hoped that an alternative site will become available in the vicinity when the old Pretoria Avenue school is demolished. General Dental Service The work of the General Dental Service was further reduced during 1960 owing to the contraction of the dental staff. The total of sessions available per week for the treatment of the non-priority groups now amounts to the equivalent of less than one full-time surgeon. Mention is made of this matter because there appears to be an impression among the public that this service is larger than it really is. Section 23 MIDWIFERY During the year 24 pupil midwives from Thorpe Coombe Maternity Hospital undertook their district midwifery training at the Nurses' Homes, and all passed the examination. An additional midwife was appointed in November, and her services have been greatly appreciated. However, the advantage was largely offset by an increase in the number of home confinements from 399 to 447, especially since the increase has been maintained during the first six months of 1961. Arrangements were made for medical students from Thorpe Coombe Maternity Hospital to attend cases on the district with a midwife, and witness deliveries. Consent was obtained in each case from the patient and family doctor concerned. Non medical supervision was carried out by the Superintendent of the Nurses' Training Home. 49 Section 24. HEALTH VISITING The health visiting statistics are given on page 69 Expectant Mothers -The first visits to expectant mothers shows an increase. Information is now received from Thorpe Coombe Maternity Hospital of all patients booked for hospital confinement. Nevertheless the information is still lacking from some hospitals. This is unfortunate because the ante natal period gives the health visitor an excellent opportunity of establishing a sound relationship with the mother which is the basis of good health visiting. Co-operation with Hospitals etc, and General Practitioners- A great many telephone calls received by health visitors during the year from family doctors, almoners and others, shows the continued trend of direct and harmonious interchange between those concerned. The majority of these calls are requests for home visits and reports of one kind or another. Parents frequently telephone for advice and assistance. An increasing number of requests for early visits to those being discharged or admitted to hospitals gives the health visitor an opportunity to prevent or relieve distress. These requests provide a link between the patients, their homes and the hospitals. Toddlers Clinics - Children between the ages of two and five years are invited by appointment and are seen by a doctor. The aim of these periodic medical examinations is the detection and correction of minor defects, mental, physical or environmental. The numbers at each session are limited in order to preserve an unhurried character and to give the parents an opportunity of quiet discussion with the clinic doctor on any matter of concern to them and the child Aged and Chronic sick - Over recent years the number of visits paid shows a marked increase. Because of their nature and circumstances these visits are of necessity time consuming but essental and worthwhile. The care of older members of the community is a sphere in which general practitioners and health visitors must work closely together if the best service is to be given. Local liason between the general practitioner, district nurse, home help organiser and/or the geriatric team continues to be maintained in respect of social needs. Section 25 HOME NURSING During 1960 ten hospital and public health students visited the District Nurses' Home, and accompanied the nurses on their morning rounds. 50 Although there was a slight decrease in the total number of home nursing visits paid during the year (68,128 in 1959 compared with 67,170 in 1960), the average number of home visits per patient increased from 54 per year to 67. This was mainly due to lack of available family help. In some cases the home nurse was required to pay 3 visits a day over a long period to patients living alone. Also there were frequent requests from hospitals ana other sources to assist patients in getting up and putting to bed. Section 26. VACCINATION AND IMMUNISATION From 1st February the arrangements for vaccination against poliomyelitis were extended to include all persons who had not at the time of their application for vaccination reached the age of forty, and also to the following small groups: (a) Persons going to visit or reside in a country outside Europe, other than Canada or the United States of America. (b) Practising dental surgeons, dental students, dental hygienists, student hygienists. dental surgeons' chairside assistants, and their families. (c) Practising nurses not working in hospitals (those working in hospital are already eligible) and their families. (d) Public health staff who might come into contact with poliomyelitis cases, and their families. Statistical details are given on page 72 Tuberculosis Vaccine Clinical Trials As reported in previous years, during 1950 an approach was made by the Medical Research Council for co operation in carrying out trials of Anti-Tuberculosis Vaccine in order to obtain evidence of the value of B.C.G. Vaccine in persons exposed to the ordinary conditions of life in this country. The final visit to Walthamstow was made by the Medical Research Council team in July 1960. and details are given in my current Report on the School Health Service. Section 28. PREVENTION OF ILLNESS, CARE AND AFTER CARE Chiropody During 1960 an extensive re-organisation of the Chiropody Service provided in the Area was carried out. In order to provide treatment at places in the Area which would be more easily accessible to patients who, by the very nature of their chiropodial defect, suffer a restricted mobility. 51 it was decided in June to set up chiropody clinics at each of the four health services clinics, and a whole-time chiropodist working in a single-handed capacity, was appointed to each clinic. Three members of the existing staff of chiropodists previously employed at the main clinic at the Town Hall were transferred to these posts and the fourth post was filled by a newly appointed officer. Facilities continued to be available at the Town Hall but the whole-time equivalent of chiropodists working there was reduced to 1.6. In addition to their duties at the decentralised clinics, the single-handed chiropodist each commenced a weekly session devoted to the treatment in their own homes of those patients eligible to receive this facility because of age and/or medical condition and consequent inability to attend at a foot clinic. Since a single handed chiropodist works without the assistance of a receptionist to deal with appointments and the collection of fees, he cannot adequately deal with the same number of patients as a chiropodist who enjoys this assistance, and a reduction in the total number of treatments hitherto undertaken was inevitable. In order to restore the service to its former proportions, it became necessary to increase the overall number of chiropodists employed. This proved some what difficult in view of the shortage of chiropodists generally, which was aggravated by the decision of the Ministry of Health to approve the setting-up of chiropody services by those Local Health Authorities who had not previously been able to provide such a scheme. By the end of the year however, the whole-time equivalent of chiropodists employed in Walthamstow had risen from the original figure of 4. 6 to 5. 4 and much had been done to increase the number of weekly treatments. The position has been further improved in 1961 but the difficulty now is to provide adequate accommodation at the health services clinics to enable two chiropodists to work at each of them in order to reduce the waiting period between treatments to at least twelve weeks. This, it appears, will only be possible by the erection of new and more commodious premises, or by extension, where possible, of the existing buildings. 52 Section 29. DOMESTIC HELP SERVICE The demand for home help continues to increase and assistance was given for 181,602 hours compared with 177,764 hours the previous year. Most categories show a general increase, with a particular demand for help for maternity cases especially in the East Area. A directly provided Night Attendance Service was introduced at the beginning of the year to replace the existing agency arrangements. The types of cases offered assistance are limited to - (a) Patients residing alone who are seriously ill. (b) Patients seriously ill in their own homes where an aged husband or wife cannot provide the necessary assistance. (c) The relief of relatives who have. to give routine night attention to sick people. The new service is auxiliary to the Domestic Help Service and subject to supervision by the domestic help organisers. The demand for the service is not large. 53 WALTHAMSTOW CHILD GUIDANCE CENTRE Report on Children under Five Years of Age The following report is contributed by Dr. Helen Gillespie, Consultant Psychiatrist at the Walthamstow Child Guidance Centre: - “Fourteen children under five were referred to clinic in 1960. Primary reasons for referral: - Sleep disturbance 5 Unmanageable 4 Backwardness in speech 1 General unhappiness 1 Multiple complaints: Disturbance over sleep; feeding, head banging; tempers, etc. 1 Soiling and wetting 2 Analysis of problems found:- These are mostly forms of disturbance in the mother/child relationship. Typical disturbances were the following:- 1. Highly nervous mother, whose handling was uneven and whose child felt insecure with her. 2. Unwanted child and unhappily married mother. 3. Regression to infantile habits after the birth of a baby brother or sister, based on jealousy and need for attention. 4. Open aggression to younger brother or sister, and resentment of mother's apparent neglect of himself. 5. Over strict training, and general ignorance in mother of norms of child development. 6. Inherent backwardness in the child. 7. Impaired maternal capacity through brain damage or psychopathy. 54 Results of treatment of mother and child:- Of these 14 cases, 8 showed marked improvement and 2 were completely cured after a few attendance; 2 mothers failed to co operate and stopped attendance, and 2 of the patients are still under treatment. Comments:- During the course of my work in child guidance olinics I have always been impressed by the fact that the school children referred to me are generally found to have presented problems of behaviour and emotional maladjustment dating back from their pre school years, and indeed often to infancy. This being the case, it seems natural to suppose that some of these later manifestations of maladjustment have to be regarded as end results of a longcontinuing process of faulty adaptation, rather than a simple reaction to current stresses. It is true that some cases seen in the Child Guidance Clinic are of this simple reactive type and are easily dealt with, and absorb little of the Clinic's time. The more intractable cases are those with a long history dating back to early childhood. “It is with considerations of this sort in mind that I have always stressed the need for early reference to the clinic of children who present behaviour disturbance and developmental difficulties in infancy. In my experience the therapeutic results are strikingly superior in treatment of the young child as compared with treatment at a later age, for by that time the mutual interaction of parent and child may have led to patterns of behaviour and neurotic reaction in the child which are ingrained by habit and form, so to speak, a defensive armour which the child finds it very difficult to' be without. “An examination which I made in Walthamstow in 1954, of the histories of 100 school children selected at random at this clinic, showed that all but 1C of them had shown symptoms before the age of 5 years of the type characteristic of the children referred in their pre school years, and most of them had had two or three such symptoms. It is not unreasonable therefore, to suppose that suitable treatment at an early age might have prevented at least some of the later difficulties." 55 CHELMSFORD DIOCESAN MORAL WELFARE ASSOCIATION The ‘Carville' Home, now at 43 West Avenue Road, E. 17. is administered by the Walthamstow Deanery Branch of the above Association. The home provides accommodation for a total of 16 mothers and their babies. Miss 2, Williams, Superintendent of the Home, contributes the following details: - “The table below summarises our work for the year. All these are new cases, and do not include the follow-up work arising from 1959 cases. The age group of the mothers was 14-19 years. Admi tied Adults Babies Total From Walthamstow 14 12 26 From rest of County 65 47 112 From outside County 2 2 4 Totals 81 61 142 Outdoor work - Walthamstow (Mothers and babies') 40 14 54 Other County cases 10 6 16 From outside County 6 - 6 Totals 56 20 76 In addition to the fourteen Walthamstow mothers admitted to the Home, Miss Williams made arrangements for twelve others to enter homes elsewhere in the County. 56 WALTHAMSTOW CHEST CLINIC Dr. H Ramsay Consultant Chest Physician at the Walthamstow Chest Clinic, has contributed the following:- Total attendances for 1960 again showed a drop compared with the previous year, though new cases referred to the Clinic were only slightly less. These figures do show certain variations and there has again been a substantial increase in the first quarter of 1961. The total of new cases of tuberculosis was rather less, 59 respiratory, and 13 non respiratory cases being notified in the areas served by the Clinic, namely: Walthamstow and Chingford. ‘The work of the Clinic generally continues to cover diseases of the chest as a whole and the figure for lung cancer was again 60, the same as in 1959. The number of cases of tuberculosis remaining on the Clinic Register at 31.12. 1960 was:- Respiratory 1317 ) Total 1417 Non-Respiratory 100 ) “Building has now commenced on the new Chest Clinic at Whipps Cross Hospital. It is likely to be ready for occupation early next year. The figures of main interest are set out below. They refer, of course, to the combined attendances of Walthamstow and Chingford patients. 1959 1960 Total Attendances 15,892 13, 370 " New Cases 5,548 5, 249 " X rays 13, 101 12, 175 " Screening 196 67 Miniature Camera 3,678 3,640 New Notifications (Walthamstow Only) 65 55 WALTHAMSTOW AND CHINGFORD ASSOCIATION OF TUBERCULOSIS CARE HELPERS Miss. V. Jennings, Honorary Secretary of the Walthamstow and Chingford Association of Tuberculosis Care Helpers reports as follows:- The work of the Association has continued smoothly during 57 the year with no major changes. The types of cases we have had to deal with have been mixed but the major problem continues to be among the middle aged men who have difficulty in re-establishing them selves in employment, particularly where their previous work has been of the heavy unskilled type. In the case of the younger patients, several months off work may lead to difficulties for a time but in general we have been able to give help which proved adequate to resolve these difficulties and so to assist in a return to the previous job or to other employment which might be more suitable. “The grocery voucher remains the most effective means of general help to the family during the patient' s treatment and rehabilitation and helps reduce that financial strain which is inevitable when the breadwinner is off work for a long period, and particularly where no wages are payable. “Clothing has been provided for a nunber of patients and the stock of bedding held in the Clinic has been available for speedy issue as need arose. ‘We have continued our policy of helping patients and their families with holidays both through the Health Departments and through the Chest and Heart Association and believe expenditure in this direction to be well worth-while. ‘The re-housing of several patients gave us a good deal of pleasurable work and we are glad to record our thanks to the Housing Department for their ready co operation. ‘Our Seal Sale Secretary has an increasingly difficult task but it is the revenue from this source which finances our work through the winter months and every effort must be made to enlist local support for this, our only direct appeal for funds. Throughout the year we have received willing co-operation from the officers of the National Assistance Board whose sympathetic handling of the patients is much appreciated. The Glasspool Trust have also given generous help to those cases referred to them and in addition have made contributions to assistance arranged by ourselves. 58 COUNTY COUNCIL OF ESSEX WELFARE COMMITTEE RESIDENTIAL AND WELFARE SERVICES Mr. W.E. Boyce, County Welfare Officer has kindly prepared the following table and explanatory notes:- Extent to which services provided in 1960. Number of Walthamstow residents in accommodation provided under Section 21 (1) (a) National Assistance Act, 1948 Number admitted to Residential Accommodation during 1960. Number admitted to Temporary Accommodation under Section (1) (a) National Assistance Act 1948. Blind Persons, etc Other Classes of Handicapped Persons. Registered. Registered Number employed in: - Blind Partially Sighted Defective Sighted Home Workers i Scheme Workshops Open Industry Male Female Total Male Female Women Children 238 72 24 7 36 149 60 105 165 20 30 5 11 The above table indicates the extent to which the various services provided by the County Council under the provisions of the National Assistance Act 1948 have been afforded in 1960 to persons having residence in the Borough of Walthamstow, The County Council continue to develop the provision of residential accommodation for aged persons and a second home is now in the course of erection in Walthamstow and when it is completed will accommodate 62 aged persons. Welfare services are available for blind and handicapped persons in a variety of ways, these include home visitation by specialised field workers tuition in handicrafts, recreational and holiday facilities and, especially for the handicapped person the supply of home aids,gadgets and hoists, and in addition the Committee give financial aid towards the cost of structural alterations designed to assist the handicapped person in overcoming his disability It is also intended to open an occupational centre for physically handicapped persons for which purpose a property has been acquired in Walthamstow 59 STATISTICAL SUMMARY Section 21 Health Service Clinics Low Hall Lane, E. 17. (Opened in 1929) Higham Hill Priory Court, E. 17. (Opened in 1959) Silverdale Road, Highams Park, E. 4. (Adapted for Clinic purposes 1948) West Avenue, E. 17. (Opened as Health Services Clinic 1949) General Dental Service No. of sessions 504 Number of patients treated 476 Appointments made 3484 kept 3152 Plastic fillings 266 1337 total Amalgam fillings 1071 Inlays 2 Crowns 19 Scalings and gum treatments 365 Dressings 395 Extractions 360 General anaesthetics 83 Local anaesthetics 362 X-rays 285 Impressions 506 Bites 132 Try- ins 206 Full upper dentures 74 175 total dentures Full lower dentures 57 Partial upper dentures 26 Partial lower dentures 18 Repairs 188 Minor Oral Surgery 22 Other Operations 403 60 Dental Laboratory Dentures Repairs Reline Remakes Appliances Crowns Inlays General Dental Service 167 151 8 6 6 11 2 Walthamstow Committee for Education 43 36 – – 152 10 1 Leyton Committee for Education – – – – 19 – – Maternity and Child Welfare Patients 9 1 – 3 – Section 22 CARE OF MOTHERS AND YOUNG CHILDREN Notification of Births Domici1iary Institutional Live Still Live Still Notified births which occurred in the Area 446 6 1,453 15 Birth notifications transferred out to places outside the Area 1 – 755 6 Birth notifications transferred in from places outside the Area 1 378 6 Care of premature infants. (Weighing 5½lb or under) Born at Home 17 Born in Hospital or Nursing Home 59 61 Ante Natal and Post Natal attendances (Local Authority Clinics) New Patients - Ante Natal Post Natal Low Hall Lane Clinic 59 3 Silverdale Road Clinic 18 1 West Avenue Clinic 12 1 District Nurses Training Home and Midwives' sessions held at AnteNatal Clinics 389 – TOTALS 478 5 Total Attendances - Low Hall Lane Clinic 163 10 Silverdale Road Clinic 142 15 West Avenue Clinic 39 4 District Nurses' Training Home and Midwives' sessions held at Ante Natal Clinic 2, 334 – TOTALS 2,678 29 Birth Control (Medical Grounds) New cases 6 Total attendances 55 Orthopaedic and Physiotherapy Clinic (Children under School age) New cases seen by Orthopaedic Surgeon 26 Re-attendances 42 Children treated 10 Children attending for aftercare 18 Children attending for U. V. L. 1 Paediatric Clinic (Children under school age) New cases 15 Total attendances 30 Physical defects Number of cases 29 Discharged 7 Psychological disorders 1 62 Dental Clinics Patients inspected and treated during the year Expectant Mothers Nursing Mothers Children under school age Patients examined 17 29 107 Patients found to require treatment 16 28 104 Patients who have commenced treatment 16 27 87 Patients who have completed treatment 11 22 49 Patients awaiting treatment 2 1 18 Attendance for treatment 28 88 134 Types of Treatment Given Extractions (a) Permanent teeth 7 30 - (b) Temporary teeth - - 87 Fillings (a) Permanent teeth 23 53 - (b) Temporary teeth - - 44 Inlays provided - - - Crowns provided - - - Anaesthetics adminstered (a) Local 2 3 - (b) General (i) by Medical Offrs. 2 8 23 (ii) by Dental Officers 1 2 24 Scaling Prolonged scaling and gum treatment 6 8 2 Silver nitrate treatment - 37 Dressings 4 1 5 X-ray examinations - 2 - Dentures provided - (a) Pull - 1 (b) Partial 1 2 - Dentures repaired - - - Dentures remade (a) Pull - - - (b) Partial - 1 - Orthodontic appliances - (a) Fixed - - - (b) Movable - - - Prophylactic treatment and other operations - - 31 - 63 Child Welfare Brookscroft (Voluntary Scheme ) Low Hall Lane Higham Hill and Priory Court Si1verdale Road West Avenue Winchester Road Total UNDER 1 YEAR First attendances 255 313 286 154 213 117 1,338 Subsequent attendances 4,125 4,168 3,785 2,079 2,959 1,874 18,990 Total attendances 4,380 4,481 4,071 2,233 3,172 1,991 20,328 1 YEAR OF AGE - First attendances 17 17 12 1 11 1 59 Subsequent attendances 1,160 926 1,103 733 928 428 5,278 Total attendances 1,177 943 1,115 734 939 429 5,337 2-5 YEARS - First attendances 18 16 15 1 8 1 59 Subsequent attendances 466 1,540 987 753 1,066 494 5,306 Total attendances 484 1,556 1,002 754 1,074 495 5,365 Total attendances (all age groups) 6,041 6,980 6,188 3,721 5,185 2,915 31,030 Number examined by Clinic Doctor 737 1,219 1,028 328 485 289 4,086 Sessions held 104 152 114 117 120 51 658 64 Welfare Foods DISTRIBUTION CENTRE National Dried Milk (Tins) Cod Liver Oil (Bottles) Vitamin Tablets (Packets) e Juice (Bottles) Brookscroft Welfare Centre 2,356 934 578 6,328 Low Hall Lane Health Services Clinic 2,358 792 483 5,334 Northcott House Distribution Centre 8,833 1,204 1,577 15,307 Higham Hill and Priory Court Health Services Clinic 1,948 692 547 5,776 Silverdale Road Health Services. Clinic 1,266 563 442 4,532 Thorpe Coombe Maternity Hospital – 53 821 2,756 West Avenue Health Services Clinic 2,231 687 550 5,428 Winchester Road Infant Welfare Centre 673 411 263 2,810 TOTAL issues at Distribution Centres 19,665 5, 336 5,261 48, 271 In addition, the following were issued to:- Hospitals (National Health Service) 526 – – 66 Day Nurseries – 144 – 144 GRAND TOTAL OF ISSUES 20,191 5,480 5,261 48,481 Nutrients and Medicaments Sales Free Issue lbs. ozs. lbs. ozs. Adeiolin - - 37 - Bernax 117 5 - - Cow and Gate 4,924 - - - Farex 858 2 - - Ferrous Gluconate - - 6,000 tablets Ferrous Fumerate - - 1,008 tablets Glucodin 112 4 - - Lactagol 17 4 - - Maltoline with Iron - - 116 - Marmite 792 4 - - Milk of Magnesia - - 16 - Mist Ferri et Amnion. Cit. Pro Infantibus . 8 10 Ostermilk 4,041 - - - Robinson's Ready Cooked Groats 298 8 - - Scott's 'Twin Pack' 412 8 - - Virol 853 - - - Trufood 369 - - - S. M. A. 76 - - - Value of Cash Sales £2,173.6s. 5d. 65 Convalescence Mothers sent to Convalescent Home Children 1 Mothers and children 1 Mother with 1 child Day Nurseries There are two day nurseries in the Borough approved for training purposes each having accommodation for 60 children aged 0-5 years. HICHAM HILL HANDSWORTH AVE: TOTAL 0-2 yrs 2-5 yrs 0-2 yrs 2-5 yrs 0-2 yrs 2-5 yrs Number of approved places at end of year 20 40 20 40 40 80 Number of children on register at end of year 15 42 14 48 29 90 Total attendances during year 3,670 9,069 2,492 8,939 6,162 18,008 Average attendances 13.8 34.2 9. 4 33.7 23.2 67.9 48.0 43.1 91.1 Number of days open 265 265 Training Number of Students who gained certificate of National Nursery Examination Board 8 Future Careers: General Nursing Training 2 Private children's nursery 1 In Day Nurseries of other Authorities 5 Daily Guardian Scheme No. of Guardians on Register at end of year 19 No. of applications for services of Daily Guardians 43 Referred to Day Nurseries 39 Referred to Daily Guardian but nothing further heard 2 Placed with Daily Guardian 2 Continued in care of Daily Guardian from previous years 3 66 PROGRAMME OF CLINICS HELD AT DATE OF PUBLICATION MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY Town Hall A.M. Dental Foot Clinic Orthoptic Minor Ailment Dental Foot Clinic (School children) Ophthalmic Orthoptic Optician Dental Foot Clinic Ophthalmic (1st, 3rd & 5th) Orthoptic Minor Ailment Dental Foot Clinic Paediatric (1st & 3rd) Dental Foot Clinic Orthoptic Orthodontic Minor Ailment Dental Ophthalmic (2nd & 4th) Optician (2nd & 4th) Minor Ailment P.M. Dental Foot Clinic Ear. Nose & Throat Dental Foot Clinic Ophthalmic Optician Dental Foot Clinic Orthoptic Immunisation & Vaccination Dental Foot Clinic Ophthalmic Orthoptic Optician Dental Foot Clinic Ophthalmic Orthodontic Optician Evening Foot Clinic Foot Clinic General Dental Service Foot Clinic Foot Clinic General Dental Service Foot Clinic Orthodontic Silverdale Road A.M. Foot Clinic Minor Ailments Foot Clinic (School children) Foot Clinic Dental Foot Clinic Dental Foot Clinic P.M. Ante Natal/ Post Natal (twice monthly) Toddlers Clinic (twice monthly) Midwives Ante Natal Clinic Foot Clinic Infant Welfare Relaxation and Mothercraft Class Dental Foot Clinic Infant Welfare Dental Evening Foot Clinic Foot Clinic Higham Hill and Priory Court A.M. Foot Clinic Dental Foot Clinic (School children) Dental Foot Clinic Foot Clinic Foot Clinic Dental P.M. Dental Toddlers Clinic (alternate weeks) Foot Clinic Dental Infant Welfare Foot Clinic Dental Midwives Ante Natal Clinic Foot Clinic Infant Welfare Foot Clinic Relaxation and Mothercraft Class Evening Foot Clinic Foot Clinic Low Hall Lane A. M. Minor Ailment Foot Clinic Foot Clinic (School children) Foot Clinic Minor Ailment Foot Clinic Foot Clinic P.M. Infant Welfare Foot Clinic Relaxation and Mothercraft class Infant Welfare Foot Clinic Ante Natal/ Post Natal Foot Clinic Infant Welfare Foot Clinic Evening Foot Clinic Foot Clinic West Avenue A.M. Foot Clinic Foot Clinic (school children) Dental Foot Clinic Dental Foot Clinic Dental Foot Clinic P.M. Foot Clinic Infant Welfare Relaxation and Mother craft Class Foot Clinic Ante Natal / Post Natal (twice monthly) Infant Welfare Dental Toddlers Clinic (alternate weeks) Foot Clinic Evening Foot Clinic Foot Clinic Winchester Road P. M. Infant Welfare District Nurses Training Home, Carisbrooke Road P.M. Midwives Ante Natal Clinic Midwives Ante Natal Clinic Old Monoux School, High Street Speech Therapy. & Child Guidance Consultations daily (morning and afternoon) from Monday to Friday, (Orthopaedic Clinic, Wingfield House School Hale End Road Speech Therapy. & Massage & Treatment sessions daily (mornings and afternoon) from Monday to Friday Walthamstow Child Welfare Society (Voluntary Society) • Brookscroft" Forest Road P.M. Massage Remedial Exercises and Sunlight Treatment Weighing Clinic & Cookery Lecture Infant Welfare Infant Welfare Massage, Remedial Exercises and Sunlight Treatment Diphtheria & Whooping Cough Immunisation (Alternate weeks 67 Section 23 MIDWIFERY Cases attended by Council Midwives MIDWIVES  Domici1iary Midwives Home Nurse Midwives 1, Cases attended:- (a) No doctor booked or present at delivery 17 3 20 (b) No doctor booked but one present 2 1 3 (c) Doctor booked but not present 276 54 330 (d) Doctor booked and present 74 21 95 369 79 448 * 2. Cases delivered in institution but attended by Council Midwives on discharge 28 7 35 3. Ante Natal Examination. (a) Patients' Homes 1217 208 1425 (b) Local Health Authority Clinics 1758 576 2334 (c) General Practitioners' Clinics 1743 636 2379 4718 1420 6138 4. Lying in visits 4317 922 5239 * Including one case attended outside the Borough by arrangement Administration of Trilene, and Gas and Air Anal gesia Number of patients who received analgesia 403 Percentage of district confinements .. 89.95 Medical Aid Number of medical aid notices received 13 Place of Confinement During the year Walthamstow Mothers were confined as follows:- Forest Gate Hospital 18 Hackney Hospital 10 Mother' s (Salvation Army) Hospital, Clapton 221 North Middlesex Hospital Edmonton 29 Thorpe Coombe Maternity Hospital 695 Wanstead Hospital 44 Other Hospitals or Nursing Homes 62 Total 1,079 At Home: Council Midwife present 447 Family doctor but not Council Midwife present 3 Total Confined 1,529 69 Section 24. HEALTH VISITING During the year the Health Visitors made 14, 952 visits to homes: To expectant mothers:- First visits 359 Subsequent visits 72 To children under 1 year of age:- First visits 1,401 Subsequent visits 2,687 To children between the ages of 1 and 2 years: - First visits 282 Subsequent visits 1,824 To children between the ages of 2 and 5 years 3,559 Other visits: - To the aged 1, 349 Tuberculous households 12 After stillbirths 12 Special visits 1,289 Unsuccessful visits 2,106 Number of attendances by Health Visitors at Local Health Authority clinic sessions 796 Number of Health Education talks given in Schools 337 70 Section 25. HOME NURSING New cases Total visits Medical 528 48,692 Surgical 169 8, 314 Tuberculosis 19 1,286 Operations 1 2 Miscarriages - - Specials - 9 Out-Patients - Medical 17 166 Out-Patients - Surgical 2 3 Hypodermic Injections 233 8,622 Casuals 20 73 Last Offices 1 5 Totals 990 67,172 Section 26 VACCINATION AND IMMUNISATION Vaccination against Smallpox Age at date of vaccination Persons Vaccinated Persons Re-vaccinated Under 1 year 738 – 1 year 94 1 2-4 years 25 7 5-14 years 32 17 15 years and over 87 216 Total 870 241 Total vaccinated by local authority staff (included above) 447 49 71 Vaccinal Condition of Hospital Staff By courtesy of the Secretary of the Hospital Management Committee, information is available as to the vaccinal condition of the staffs of the two hospitals in Walthamstow. The number vaccinated was as follows: - No. now employed Of those now employed No. success fully vaccinated within 3 years. Of those now employed No. vaccinated but not within 3 years. No. revaccinated during 6 mths ended 31.3.60 Hospital 'A' 200 181 – – Hospital 'B' 83 25 50 2 Immunisation against Diphtheria Age at date of final injection Children who completed a full course of primary immunisation during the year Children who were given a re in forcing injection during the year Under 1 year 980 - 1-4 years 373 184 5-9 years 191 944 10-14 years 66 311 Total 1,610 1,439 Total immunised by local authority staff (included above) 834 747 The 1610 children who completed a full course of immunisation during the year received their injections at the following places:- Schools 147 Welfare Centres 490 Town Hall Clinic 100 Brookscroft 97 General Practitioners' Surgeries 776 The numbers of children under 15 years of age at 31st December 1960 who had completed a course of immunisation at any time before that date are shown in the following groups: Under 1 (born 1960) 752 1-4 (born 1959-56) 3,481 5-9 (born 1955-51) 5,606 10-14 (born 1950-46) 9,096 Total immunised under 15 years 18,935 72 Immunisation against Whooping Cough Age at time of the final injections Children who completed a full course of immunisation during the year Records of combined diphtheria-pertussis immunisation received Under 6 months 613 99 6-12 months 462 201 1-4 years 124 61 5 years and over 29 21 TOTAL (primary courses) 1,228 382 Total immunised by local authority staff (included above) 622 – Reinforcing injections 80 38 Poliomyelitis Vaccination Number of persons vaccinated (2 injections) Category During 1960 Total since scheme commenced (including vaccinations completed in 1960) Children born in years 1943/60 1,653 20,731 Persons born in years 1933/42 714 5,611 Persons born before 1933 who were under 40 years of age 2,360 2,360 Others 47 254 Expectant Mothers 218 1,092 Totals 4,992 30,048 Third doses (all groups) 8, 523 24,699 3. C. G. Vaccination Category Number Skin Tested Result of Heaf Test Vaccinated with B.C.G. Tuberculin Positive Tuberculin Negative Children under 14 years of age 829 96 733 732 Children 14 years and upwards 119 10 109 109 Students attending further education establishments 27 10 17 17 Totals 975 116 859 858 73 Section 28. PREVENTION OF ILLNESS, CARE AND AFTER CARE Chiropody New cases during year Cases being treated at end of year CIinic at tendances during year Domici1iary treatments during year Pre school children 2 2 – School children 507 388 2,567 Expectant Mothers 1 4 4 - Physically handicapped 1 6 8 - Aged (over 65 years of age) 232 1,316 4,413 218 Others 543 2,578 9,799 - Total 1,286 4,292 16,793 218 Tuberculosis Home visits and Clinics attended Tuberculosis Visitors Health Visitors Total of tuberculous households at end of year 1,026 _ Visits to tuberculous households during the year (excluding non access visits) 1,225 12 Attendance at Chest Clinic sessions during the year 693 - Extra Nourishment Number of new cases during year supplied with free milk 48 Total number being supplied free milk at end of year 112 Rehabilitation Number of cases receiving rehabilitation treatment for whom financial responsibility accepted 1 74 Loan of Sick Room Equipment Number of issues made to patients during year 228 Number of articles on loan at end of year which had been on on loan for:- (a) under 1 year 88 (b) 1 and under 2 years48 (c) 2 and under 5 years 35 (d) 5 years and over 8 Convalescence for Adults Number of applications during year 59 Length of stay: - One week – Two weeks 37 Three weeks 2 Pour weeks – Health Education Teaching to groups by Departmental Staff No of Sessions Total Attendances (a) Clinic, Welfare Centres, Relaxation Classes 200½ 1,612 (b) School 339 6,839 (c) Professional Organisations - - (d) Parent/Youth/General Adult Group 3 112 (e) Others 1½ 157 Total 544 8 720 Number of film shows given at sessions referred to above 22 Exhibitions in which department has participated 1 75 Section 29. DOMESTIC HELP Visits by Domestic Help Organisers Domestic Help Service Night at tendance Service First visits to homes 569 10 Re - visits to homes (a) Domestic help present 357 - (b) Night attendant present - - (c) Help/Attendant not present 2,590 9 Other visits 500 21 Help provided Maternity Acute Sick Tuber culosis Chronic Aged Sick Others Aged not sick Others Total Requests for help from new cases during the year 95 36 3 316 55 1 11 517 Cases not eligible for assistance or not requiring service 9 11 – 68 11 – 2 101 New cases helped during the year 86 25 3 248 44 1 9 416 Total cases completed during the year (a) 83 24 2 334 57 1 9 510 Cases being helped at end of year who have received help for. Under 3 months 4 3 - 49 6 - 1 65 3-5 months (incl) 1 1 1 40 9 - - 52 6-11 months (incl) - 3 4 140 9 - - 156 12 months & over - 10 461 53 8 - 532 Total (b) 5 7 15 690 77 8 1 803 Total cases helped during the year (i. e, total of (a) and (b) 88 31 17 1,024 134 9 10 1,313 Hours of help provided during the year 3,821 1,699 2 410 152,531 18,548 1,785 808 181,602 76 Night Attendance Service Seriously ill patients residing alone Inability of aged husband or wife to care for seriously ill patients at night. f of relatives who have to give routine night attention to sick people. Cases completed during the year and helped for: 4 weeks & under 1 2 3 Over 4 weeks - 1 Total (a) 1 2 4 Cases being helped at end of year who received help for:- Under 3 months - - 1 Over 3 months - - - Total (b) - - 1 Total cases helped during the year (i.e. total of (a) and (b) 1 2 5 Hours of attendance provided during year 32 68 476 MEDICAL EXAMINATION OF STAFF Category No of medical examinations County Council employees:- (a) Entrants to County Councils service 170 (b) Retirement on Superannuation 4 Walthamstow Borough Council employees 315 Entrants to teaching profession and training colleges 84 Others 8 Total 581 Printed in the Borough Treasurers Department