ac.4411(1) 2nd copy WA-53 BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1961 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 1961 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 9 SECTION B - General Provision of Health Services in the Area 13 SECTION C - Prevalence and Control over Infectious Diseases 18 SECTION D Sanitary Circumstances of the Area 19 SECTION E - Sanitary Circumstances of the Area - Statistics 24 SECTION F National Health Service Act, 1946 Part III Services 54 Page Acreage 9 Adulteration of Food 34 Aged and chronic sick 42 Ambulance Facilities 14 Ante Natal Clinics 64 Assessments 9 B.C.G. Vaccination 75 Birth Control 64 Birth Notifications 64 Births 9 'Brookscroft' Welfare 70 Care of Mothers and Young Children 55, 64 Chest Clinic 59 Chiropody 44, 58, 75 Clean Air Act, 1956 6 Clearance Areas 21 Committees 4, 53 Comparability Factor 12 Confinements 72 Convalescence 69, 76 Conveniences, Public 15 Cremation 16 Daily Guardian Scheme 69 Day Nurseries 69 Deaths from Accidents in the Home 12 Deaths, Infants 9 Deaths. Causes of 11 Dental Laboratory 63 Dental Treatment 66 Diphtheria Immunisation 73 Diseases of Animals Acts 23 Disinfections 15, 25 Page Disinfestation 20 Domestic Help 47, 58, 76 Domiciliary Chiropody 75 Employment 12 Factories Acts, 1937/59 37 Food and Drugs Act, 1955 22 Food Hygiene Regulations,1960 22,35 Flooding 16 Pood Inspection 31 Food Poisoning 17 Funeral Arrangements 15 Gas and Air Analgesia 71 General Dental Service 54, 63 General Information 15 Hairdressers 20 Health Education. 56, 76 Health Centres 54 Health Services Clinics 63, 70 Health Visiting 56, 72 Home Nursing 45, 57, 73 Hospital Accommodation 14 Housing Act, 1936 21 Housing, General 29 Housing, Inspection 28 Housing Statistics 27 Ice Cream Immunisation 57, 73 Improvement Grants 27 Infant Mortality 9, 10 Infectious Diseases 5, 14, 16 Inquests 16 Laboratory Facilities 13 Page Land Charges 21 Laundry Service for the Incontinent 48 Legal Proceedings 23 Legislation 15 Massage and Special Treatment 14 Maternal Mortality 9 Meals on Wheels Service 15 Meat and other Poods 22, 32 Medical Examinations 15, 78 Medicaments 68 Midwifery 55, 71 Milk 21 Moral Welfare 58 Night Attendance 77 Notices, Sanitary 24 Nursing Homes 14 Nutrients 68 Old People's Welfare 7, 14, 39 Orthopaedic Treatment 65 Outworkers 37 Paediatric Clinic 65 Pet Animals Act, 1951 24 Poliomyelitis 17 Poliomyelitis Vaccination 74 Population. 9 Post Mortems 16 Post Natal Clinics 64 Premature Infants 64 Prevention of Damage by Pests Act, 1949 24, 36 Page Prevention of Illness 58, 75 Public Health Inspection 19, 24, 49 Rainfall 16 Rateable Value 9 Rehousing on Medical Grounds 30 Rent Act, 1957 20, 26 Rodent Control 36 Sampling of Pood 22 Scabies Treatment. 14 Sickroom Equipment 76 Smallpox Vaccination 73 Smoke Abatement 6, 19, 25 Social Conditions. 9 Special Premises 25 Staff 13 Statistics 5, 9, 63 Stillbirths 9 Swimming Baths 20 Toddlers Clinics 70 Tuberculosis 17, 75 Vaccination 57, 73 Verminous Premises 20 Vital Statistics 5, 9 W' stow Assn.of T.B.Care Helpers 60 Water 5 Welfare Centres 56, 67, 70 Welfare Foods 68 Welfare Services 62 Whooping Cough Immunisation 74 4 HEALTH COMMITTEE 1961 - 62 Chairman: COUNCILLOR MRS. W.M. PALETHORPE Vice Chairman. COUNCILLOR MRS. C. E. STANNARD Ex- officio: THE WORSHIPFUL THE MAYOR - ALDERMAN E. C. REDHEAD, J.P. , M. P. THE DEPUTY MAYOR - ALDERMAN W. R. BALDWIN CHAIRMAN OF FINANCE COMMITTEE - ALDERMAN ROSS WYLD, O. B. E. , J. P. ALDERMAN THE LADY McENTEE, 0. B. E., J.P. (Deceased) ALDERMAN G. S. MACE ALDERMAN C. B. REYNOLDS COUNCILLORS. MRS, E.L. BALDWIN L, A, BAYLIS J.J. BRACKEN MRS. R. COLIN W. G. FREWIN COUNCILLORS: F. FURBER J. H. HAMMOND MRS. J.C. OAKMAN MRS. B.M. REYNOLDS E. ROSOMAN D. WEINSTEIN Medical Officer of Health: M. WATKINS,. M.R.C.S. , L. R. C.P. D.P. H. (Part- time) Deputy Medical Officer of Health: G. H. POOLE, M. B., B. S., D(Obst.) R. C. O. G., D. P. H. (Part-time) Chief Public Health Inspector W. RICHARDS, D. P. A. , M. A. P. H. I. Deputy Chief Public Health Inspector: 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 my Annual Report for the year 1961. vital statistics The mid year population according to the Registrar General s report was about 2,800 less than the previous year This contrasts with a reduction of 1,400 between the years 1959/60. In spite of this the number of births increased from 1,428 to 1,529 but in contrast the total deaths from all causes also rose from 1,137 to 1,323, the birth rate was considerably less than the national average and the death rate slightly more The infant Mortality Rate of 15.7 per thousand live births is much reduced from last year s figure and considerably less than the national figure. We must not read too much into this since the numbers are so small that one or two deaths more or less would alter the rate considerably. It may be remembered that the figure in 1958 was 15.4. There were no maternal deaths during the year, Of the total deaths the conditions that claimed most lives were again diseases of the heart and blood vessels and cancer Of the 285 cancer deaths 81 (28.4%) were due to lung cancer. Nearly 45% of the deaths were in the age group 75 and over infectious diseases The overall incidence of infectious diseases again followed the lower trends of recent years. Measles was prevelant during the first quarter of the year also, for some inexplicable reason, dysentery. Of the more dangerous diseases such as diphtheria and poliomyelitis no cases were recorded. In spite of this favourable picture, last year s outbreak of diphtheria is a reminder that we can never afford to relax our vigilance and should always be ready for the unexpected. Water- water A safe and pure water supply has always ,been one of our prime public health functions, and the receipt of Dr. Windle Taylor' s report as Chief Medical Officer to the Metropolitan Water Board on the "Results of the Bacteriological, Chemical, and Biological Examination of the London Water for 1959/60 is therefore a salutary reminder of this, and at the same time of much that we take for granted a commodity which is essential for life itself. 6 The provision of such vast quantities of water to so many millions of people is mainly an engineering problem but its purity and safety is equally important if we are to prevent the occurrence of the water-borne diseases which affected us in the past. The older Medical Officers of Health will remember being directly responsible for the chemical and bacteriological examinations of their water supplies; and an outbreak of enteric would send them scurrying to double check its safety. We have got so used to the high standards of safety set by the Board that if we are confronted with an outbreak these days the water supply is almost the last vehicle of infection we suspect. True we still receive in the Department many complaints of foreign bodies in water, bad tastes, bad smells infection, etc., but they are almost all due to domestic storage conditions and not the main supply How often have dead birds and rats been found in cisterns? The Water Board can hardly be blamed for these. One is tempted to regard the examination and security of the quality and purity of water supplies as routine matters but as the Report shows, new hazards and problems present themselves. Establishments of the Atomic Energy Authority discharge their waste into the Thames, from which source is extracted the bulk of London s supply. Tests for radio activity are therefore an added responsibility Fortunately figures do not show any difference between Thames waters and those from other sources. Again attention has recently been drawn to the presence in sewage polluted water of disease producing viruses. Viruses seem to be more resistant to chlorination than bacteria. These are just a few of the newer hazards and responsibilities that have to be contended with. The rarity of water-borne diseases and the never failing water supply tends to make us forget the enormous amount of work that goes on to produce for us a safe and wholesome product but at least one person in Walthamstow maintains a keen interest in our water supply. Alderman Tom Smith has been for many years the BOrough s representative on the Water Board, and we are delighted to know that his great concern and diligence as a member on our behalf has been rewarded by the conferment upon him of the Vice Chairmanship. SMOKE CONTROL Smoke Control Order No 1 came into operation on the 1st June, 1961 It is not anticipated that the concentration of smoke and sulphur dioxide in the atmosphere will show a significant reduction from that of the last few years until an appreciable area of the Borough is under control. 7 Yet the Annual Report of the Department of Industrial and Scientific Research gives us much encouragement in our efforts. It shows that smoke-free areas can and do exist near areas of high pollution, so that benefits, however small, are obtained with the coining into existence of each succeeding area. This may be an appropriate time to include in the Report a coloured map of the phased programme of smoke control areas for the whole town. It should prove useful for reference purposes, but it is hoped that it may prove possible during the next few years to accelerate the programme. CARE OF THE ELDERLY Most of the narrative in this year's Report is devoted to the responsibilities of both the Public Health and the Area Health departments towards the aged. The topic suggested itself,following a small sample survey carried out by health visitors on the social and medical needs of old people,the results of which are reproduced in later pages. It is often of value to concentrate on some specific function of the Department from time to time. It enables one to give a critical appraisal of work done, and to assess how far it meets the changing demands for the particular service. Our investigations so far as they have gone suggest that in Walthamstow the general standard of care of the elderly is good, but there are still too many without a normal home background who have been consigned to a life of wasteful living in virtual isolation, which can lead to inertia, frailty,squalor and complete resignation. The causes are multiple but whatever they are the result is almost the same. They have no sense of belonging to the community, become extremely suspicious and resistant to any help offered. The problem is to find the cases and having found them, to induce them to accept assistance. The worst cases are usually reported as needing care and attention and subject to compulsory removal under Section 47 of the National Assistance Act,but thanks to the supporting services of health visitors, domestic helps,home nurses, chiropodists, and such dedicated voluntary assistances given as Meals on Wheels, not one case was dealt with by removal during the year. Effective preventive action can only be taken following early information regarding such cases, but unfortunately there are limiting factors such as shortage of staff. Just as with so many other conditions, prevention is better than cure, so our aim with the elderly should be to maintain them active, interested, and useful members of the community. The Ministry of Housing and Local Government issued an excellent circular during the year on the services for old people. 8 It gave a comprehensive picture of how co operation in this work could be achieved between housing, local health and welfare authorities and voluntary organisations My report endeavours to show the contributions made by the Public Health Department and the Local Health Authority For the sake of continuity the contributions of the staffs of the various departments have been placed together Acknowledgments Once again I would like to express my gratitude for the support given by all members of the Health and Area Health Committees, also for the co operation of members of staff and especially those who have contributed to this report. I have the honour to be Your obedient Servant, M. WATKINS Medical Officer of Health A STATISTICS & SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar General s Estimate, mid year 1961) 108,860 Number of Assessments (31st December 1961) 40,176 Rateable Value (31st December 1961) £1,788,829 Estimated Product of a penny rate (1961/62) £7,240 population. - The Registrar-General's Estimate of the home population at mid-year 1961 is 108 860. a decrease of 2,750 on the previous year. The steady decline continues. This figure has been used for the calculation of the following statistics Live Births: Number 1,529 Rate per 1,000 population 14.0 Illegitimate Live Births per cent of total live births 5.1 Stillbirths Number 27 Rate per 1,000 total live and stillbirths 17.3 Total Live and Stillbirths 1,556 Infants Deaths (deaths under 1 year) 24 Infant Mortality Rates: Total infant deaths per 1,000 total live births 15.7 Legitimate infant deaths per 1 000 legitimate live- births 15.1 Illegitimate infant deaths per 1,000 illegitimate live births 25.6 Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 total live births) 9.8 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) 26,3 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 11 10 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 1935. 11 Causes of Death as given by the Registrar General for the Year 1961 Causes of Death Males Females Total 1960 1. Tuberculosis, Respiratory 5 2 7 7 2. Tuberculosis, other 1 - 1 1 3. Syphilitic Disease 1 1 2 1 4. Diphtheria - - - 1 5. Whooping Cough. - - - - 6. Meningococcal Infections - - - - 7. Acute Poliomyelitis - - - - 8. Measles - - - - 9. Other Infective and Parasitic Diseases 1 1 3 10. Malignant neoplasm, stomach 21 19 40 31 11. Malignant neoplasm, Lung, bronchus 74 7 81 67 12. Malignant neoplasm, breast - 23 23 33 13. Malignant neoplasm, uterus - 10 10 7 14. Other malignant and lymphatic neoplasms 61 60 121 100 15, Leukaemia, aleukaemia 6 4 10 9 16. Diabetes .. 1 9 10 5 17. Vascular lesions of nervous system 61 93 154 126 18. Coronary disease, angina .. 156 95 251 204 19. Hypertension with heart disease 11 19 30 26 20. Other heart disease 68 97 165 154 21. Other circulatory disease. 23 39 62 56 22. Influenza 2 7 9 3 23. Pneumonia 41 45 86 69 24. Bronchitis 57 25 82 78 25. Other diseases of respiratory system 10 10 5 26. Ulcer of stomach and duodenum 10 6 16 12 27. Gastritis, enteritis and diarrhoea 2 4 6 9 28. Nephritis and nephrosis 4 2 6 5 29. Hyperplasia of prostate 8 - 8 5 30. Pregnancy, childbirth, abortion - - - - 31. Congenital malformations 5 2 7 15 32. Other defined and ill defined diseases 36 59 95 73 33. Motor Vehicle Accidents 10 3 13 10 34. All other accidents 6 7 13 12 35. Suicide 3 1 4 10 36. Homicide and operations of war - - - - Totals 1961 684 639 1, 323 - Totals 1960 566 571 - 1, 137 The age distrbution 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 6 110 94 73 Lung Males - - - 4 33 29 8 Females - - - - 2 3 2 12 The total number of deaths in 1961 (1,323) compares with 1,137 in 1960, the respective death rates being 12 15 and 10.1 per 1,000 population. The comparability factors for Walthamstow are given by the Registrar-General as follows:- Comparability factor for births 1.03 Comparability factor for deaths 1.04 The above factors, when applied to the crude rates, produce the following adjusted rates:- Live births 14.4 Deaths 12.6 Deaths from Accidents in the home Six deaths occurred in 1961 from this cause. All died in hospital. The ages and sexes were:- Female: 60, 71, 74, 75, 95 Male: 66 In order to put these and other deaths in proper perspective, the following comparison is made:- Cause of Death 1961 1960 (a) Suicide 4 10 (b) Motor Vehicle accidents 13 10 (c) All other accidents 13 12 (d) Accidents in the house (included in line (c)) 6 5 (e) Tuberculosis 7 7 (f) Poliomyelitis Nil Nil Employment Miss D.M. Rogerson, Manager of the Local Employment Exchange has kindly contributed the following information:- "I am afraid we do not keep separate records relating to the ages of the people we find jobs for, but in fact we are able to place men and women in their 70's. 1. Insured population of the borough of Walthamstow, Leyton, Chingford and Wanstead and Woodford:- approximately 46,200 men, 38,800 women. 2. Insured population of the borough of Walthamstow:approximately 20,700 men, 16,200 women. 3. The number of persons placed in employment in the whole area during 1961: approximately 4,000 men, 1,600 women. These figures include approximately 270 disabled men and 75 disabled women. 4. The average number of persons unemployed in the whole area during 1961: 860 men. 164 women. These figures include approximately 90 disabled men and 15 disabled women. 13 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, as an unemployed person need not necessarily register at an Employment Exchange in the area where his N.I. card is exchanged. Normally an employed person's N.I. card would be counted in the area in which he works, while if he became unemployed he would be likely to register at the Employment Exchange in the area in which he lives." 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 Mr. A.H. Hall, Rodent Operative 27.11.1961 Miss N.M. Tomlinson, S.R.N., S.P.N. , C.M.B. Infectious Diseases Nurse 4. 9.1961 Resignations Mr. E.W. Beckett, Public Health Inspector (supernumary) 31.12.1961 Mr. B.J. English, Public Health Inspector 5. 2.1961 Mr. H.J. Newbury, Rodent Operative 30.11.1961 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 396 Nose and throat swabs 119 * Urine 3 Food - Miscellaneous 5 Total 523 * The reason for the considerable reduction in the number of Nose and Throat swab examinations during 1961 is explained by the fact that during 1960 there was unfortunately a Diphtheria outbreak which necessitated numerous swabbings. 14 Ambulance Facilities These are available from a depot situated at whipps Cross 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 four cases were referred there during 1961 receiving seven treatments. Hospital Accommodation (a) Acute Cases. - There were no major changes in 1961 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 35 New Cases 33 Brought forward from 1960 2 M.O. H. requests to Langthorne Hospital or Area Welfare Officer 8 Admitted to Hospitals 7 Admitted to Part III accommodation 7 Died before admission 5 Refused Hospital or Hostel accommodation 7 Cancelled or deferred 7 Waiting Part III accommodation - It is a pleasure again to record the unfailing help and consideration experienced from Dr. DeLargy at Langthorne Hospital, from Mr. R.N. Weston, 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 from this area. 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) No new licence was granted under the Act during 1961. During the year the medical staff paid fourteen visits to the establishments registered for massage and special treatment. Old people s welfare The contributions under this heading made by the members of the staffs of the various sections appear on page 39. 15 The Town Clerk, as Honorary Secretary of the Old People's Welfare Association reports that "the Meals on Wheels figures for the year 1961 were 34,877, including the Free Christmas Dinner given annually. 250,928 dinners had been delivered at the end of March, 1962, since the scheme commenced in March 1948." Funeral Arrangements Arrangements continued with regard to burials within the terms of the National Assistance Act. 1948. Legislation The following Acts of Parliament came into operation during 1961 Public Health Act. 1961 Housing Act 1961 Factories Act, 1961 Land Drainage Act, 1961 Consumer Protection Act. 1961 Rivers (Prevention of Pollution) Act, 1961. Home Safety Act 1962 Medical Examinations During the year the medical staff carried out 183 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 Willow Walk Men and Women 1961 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 charge is made for the use of public conveniences. 16 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 Morterns Walthamstow Others Total Post Mortems only 127 237 364 Post Mortems and Inquests 13 44 57 Inquests only 1 74 75 141 355 496 Rainfall The annual rainfall at the Ferry Lane Station was 23,82 inches In 1960 it was 28.57 Flooding Flooding occurred 3 or 4 times during the year. There was no severe storm that would lead to widespread flooding of the Borough, Co - PREVALENCE OF AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES General The following table shows the 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 28 18 25 16 19 21 127 Whooping Cough 8 5 2 4 13 7 39 Measles 108 149 223 218 380 297 1,375 Diphtheria - - - - - - - Pneumonia 3 9 8 11 10 12 53 Meningococcal Infection - - 1 - - - 1 Acute Poliomyelitis Paralytic - - - - - - - Non Paralytic - - - - - - - Acute Infective Encephalitis - - - - - - - Post Infectious Encephalitis - - - - - - - Dysentery 5 2 1 2 29 5 44 Ophthalmia Neonatorum 1 - - - - - 1 Puerperal Pyrexia 1 - 3 97 1 1 103 Snallpox - - - - - - - Paratyphoid Fever - - - - - 1 1 Typhoid Fever - - - - - - - Food Poisoning - 2 4 1 4 15 26 Erysipelas 2 1 1 1 1 2 8 Malaria - - - - - - - Tuberculosis Respiratory 4 6 7 6 11 8 42 Meninges and Central Nervous System - - - - - 1 1 Other Forms 4 1 1 1 7 Totals, 1961 164 192 275 357 469 371 1,828 Totals, 1960 128 103 93 154 210 270 958 17 FOOD POISONING Twenty-six cases were notified and in addition two cases were 'ascertained' i.e. became known otherwise than by notification, by following up notified cases. None was fatal. There was one small familial 'outbreak' , in which the infecting agent was Salmonella Typhi -murium. Pour of the single cases were due to Salmonella Typhi murium, and in one case the infecting agent was Salmonella Welternden. Poliomyelitis No case of Poliomyelitis was notified during the year. Tuberculosis The following table shows particulars of new cases of tuberculosis and of all deaths from the disease in the Borough during 1961: - Age Periods NEW CASES DEATHS Pulmonary Non. Pulmonary Pulmonary Non. Pulmonary M F M F M F M F Under 1 year - - - - - - - - 1-4 years - 1 - - - - - - 5-9 years - 1 - - - - _ _ 10-14 years 1 1 - 1 - - - - 15-19 years 1 1 - _ - 20-24 years 6 1 - 1 - - - - 25-34 years 4 1 - 1 1 1 - - 35-44 years 4 4 2 1 - _ - - 45-54 years 1 1 2 1 - 55-64 years 3 2 1 1 - - 1 - 65 and over 8 1 - - 2 - - - Totals 28 14 3 5 5 2 1 - 42 8 7 1 50 8 IS tuberculosis-notification and death rates The following graph shows the trend of notification of tuber culosis since 1935,- 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. 19 D. SANITARY CIRCUMSTANCES OF THE AREA mr. w. Richards., Chief public Health Inspector, reports as follows public Health inspection of the Area During the year 572 Intimation Notices were served; 123 were in respect of business premises and 449 related to defects in private houses. Of the latter figure, 324 were complied with without resort to statutory procedure. These notices required the carrying out of various repair works and resulted in better housing conditions and improved conditions in factories. It was found necessary to institute legal proceedings against owners for non-compliance with Abatement Notices served in respect offourteen properties. An Order, of twenty-eight days, was made in one case; one case was adjourned sine die with costs of £2.2s.0d. and in twelve cases proceedings were withdrawn as the works were completed before the date of hearing. Large numbers of food premises and various other types of premises were inspected and various works were carried out to these premises. These works resulted in improved hygienic conditions. Smoke Abatement Observations in respect of smoke nuisances from premises amounted to 92. Investigations were carried out in all cases and steps taken to abate the nuisance. New boiler plant was installed in some factories and improvements effected in others. Atmospheric pollution instruments are in operation, for measurement of sulphur in the atmosphere, at the Sir George Monoux Grammar School,in Willow Walk, in Blackhorse Lane and at the Woodford County High School. The recordings of the above instruments are similar to those obtained by adjacent authorities and are lower than those given for Central London. 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. Smoke Control Areas The detailed survey in respect of Smoke Control Area No. 2 was completed during the year and the Order was confirmed by the Minister of Housing and Local Government. This Order will come into operation next year. By the end of the year a number of fireplaces in this area had been converted to burn smokeless fuels. 20 The detailed survey in respect of Smoke Control Area No. 3 was completed in October and the Council made a Smoke Control Order in respect of this area in November. This Order was submitted to the Minister of Housing and Local Government for confirmation. The inspection of dwelling houses in Smoke Control Area No. 4 was commenced in October and was still proceeding at the end of the year. The coloured map of the phased programme appears facing this page Verminous premises The number of dwelling houses reported to be infested with vermin remains comparatively small. Seventy-nine rooms were disinfected and insecticides were issued free of charge to eighty-four tenants. 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 recirculated 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. The Walthamstow Baths Manager submits the following: Information Prom January 1st to December 31st the Public Baths were open on 294 days. The number of Swimming Bath bathers was 163,289 whilst 84,024 hot baths were provided. 7,871 Pensioners took advantage of the free bathing facilities. Swimming attendances continue to increase. Sampling was carried out with very good results. Sewerage Arrangements for sewerage and sewage disposal in the district are reasonably adequate. Hairdressers Eighty-two 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 21 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. If the landlord has not carried out the undertaking given by him to the tenant in six months following the date of the undertaking, 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. Housing Act, 1936 Section 62 Applications for "permitted number" were received from landlords and certificates issued during the year respecting eight lettings. Local Land Charges Enquiries relating to outstanding sanitary notices were dealt with in 1,855 cases. Clearance Areas The Council are purchasing large numbers of dwelling houses which are included in the 1960-65 slum clearance programme. When all the dwellings in a proposed clearance area have been purchased by the Council, the tenants will be rehoused, the dwellings demolished and the site redeveloped. Milk supplies During the year seventy eight samples of milk were taken and 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. All milk sold within the Borough must be either tuberculin tested or heat treated. Licences to sell milk by retail were issued in respect of a number of premises. 22 Ice Cream There are five manufacturers of ice cream within the district and a large number of premises for the sale of ice cream. These premises are licensed and are subject to regular inspection. A high standard of hygiene is maintained. Samples of ice cream are taken for both chemical and bacteriological examination. Those taken for chemical examination complied with the legal requirements for fat content etc. and samples taken for bacteriological examination were mostly of a high standard. A number of samples of iced lollies were also taken for bacteriological examination and most of these were of a reasonable standard. Where reports showed that any of these samples were unsatis factory, the manufacturer was informed and further check samples were taken as soon as possible. If the manufacturer was outside the district, copies of the reports were sent to the local authority of the district where the article was manufactured. Meat and other Foods There are no slaughterhouses in operation in the Borough. A considerable amount of various types of food was inspected a certain quantity of which was condemned as unfit for human consump tion. Sampling of Food for Bacteriological Examination Various types of food were sampled including shellfish, jellied eels, cooked meats, cream, corned beef and meat pies. Most of these samples were found to be in a satisfactory condition although some improvement could be effected in the case of cooked meats. Food and Drugs Act 1955 During the year. 104 samples were submitted to the Public Analysts for chemicarl examination. 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.e., of 20. Eastcheap London. EC.3 and bacteriological examinations by the Counties Public Health Laboratories, Thresh House. Verulam Street. Gray s Inn Road, London. W.C.I. Food Hygiene (General) Regulations 1960 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 main tained throughout the district. 23 There are two dairy premises in the area registered under the Milk and Dairies Regulations. 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 1961: Food Hygiene Regulations, 1955/1960 Dirty condition of shelves in food premises (1 case). Court awarded Penalty of £15. Smoking on food premises (5 cases). One case, Court awarded Penalty of £15, £5 Penalty was given in two cases with £1.10s.0d. costs each, £2 Penalty was awarded in another case with £1.10s.0d, costs, and one case was withdrawn. Smoking whilst handling open food (1 case). Court awarded Penalty of £5 and £1.10s.0d costs. In another case of absence of water and towels, Penalty of 10s. was awarded on each account and 10s.6d. costs. Food and Drugs Act 1955, Sections 2. 8 and 106 One case of selling food unfit for human consumption was given an Absolute Discharge with £3.3s.0d. costs. One case of selling food not of the substance demanded was given an Absolute Discharge with £3.3s.0d. costs. One case of selling "thick cream" which was sub-standard was awarded Penalty of £10. Milk and Dairies (General) Regulations 1959, Regulation 27 (1) One case of a dirty milk bottle was given an Absolute Discharge and 4s. 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 Acts Swine Fever (Infected Areas) Order, 1953 No licences were issued during the year Absence of nail brushes (2 cases) Absence of soap (2 cases) Absence of towels (1 case) Absence of water (1 case) Dirty condition of sink (1 case) Penalty of £1 in each case was awarded, with £1. 10s. Od costs. 24 Fowl Pest Order, 1936 No Order was issued during the year Foot and Mouth Disease Orders No Order was issued during the year pet Animals Act 1951 Seventeen 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. E STATISTICS public Health Inspection of the Area No, of in spections made No, of nuisances remedied No, of complaints received No,of Intimation Notices No,of Statutory Notices Total visi ts Served Complied wi th Served Compli ed wi th 23,419 2,783 1,783 572 649* 125 134* 30 153 * Includes notices outstanding from previous year The following table shows the nature of work executed and improvements effected during the year: Drains tested, 332; Drains reconstructed or repaired, 176; Drain obstructions removed. 86; Drains, means of access provided, 12; Drains ventilation provided or improved, 13, Soil pipes renewed or repaired. 74; Rainwater pipes repaired or renewed, 55; Roofs repaired or renewed. 222; Gutterings repaired or renewed, 137; W. C pans and traps provided, 102; W C's repaired or cleansed. 104, W.C's light and ventilation improved 5 Gully traps provided 21; Waste pipes repaired or renewed, 38; New sinks provided. 20' Stoves and firegrates repaired or renewed, 22; Water supply re instated, 14 Yard and forecourt pavings repaired 48; Dirty houses cleansed, 5; Dirty rooms cleansed. 26; Floors repaired. 105; Ventilation under floors provided or improved 25: Dampness remedied 282 Offensive accumulations removed. 17 Manholes repaired or resealed, 77; Miscellaneous repairs 725: Animals improperly kept removed, 3. Infectious Diseases Visits to premises. 27; 25 Disinfections Rooms disinfected, 14; Articles disinfected, 4,381; Articles destroyed, 15. Special Premises Number ' Visits paid Factories (a) Non-power 31 62 (b) Power 481 496 (c) Other premises 25 2 Outworkers 471 471 Butchers 86 231 Bakers and Shops 43 82 Fishmongers, Fryers and Curers 34 100 Cafes and Caterers 93 355 Grocers 231 580 Greengrocers 79 165 Ice Cream Manufacturers 5 65 Ice Cream Vendors 384 258 Dairies 2 25 Milksellers 132 204 Laundries 1 7 Ladies' Hairdressers 37(Combined) 37 1) Gentlemen's Hairdressers 31 14) 45 Rag Dealers 3 4 School Kitchens 20 88 Street Stalls 161 361 Stables 1 3 Schools 61 34 Public Houses 38 57 Smoke Abatement Readings from atmospheric pollution instruments for the year are as follows: (the figures given are in milligrams of sulphur) per day). jan: Feb: March April May June Sir George Monoux Grammar School 2.6 2.7 2. 1 1.6 0.93 0.86 Willow Walk site 1.7 1.8 1.8 1.5 0.89 0.56 Woodford County High School 1.6 1.4 1.5 0.81 0. 54 0.55 Blackhorse Lane site 2.6 3.0 2.6 1.2 0.71 0.90 July Aug: Sept: Oct: Nov: Dec: Sir George Monoux. Grammar School 0.65 0.70 1.3 1.1 2.0 2.6 Willow Walk site 0. 57 0.58 0.86 1.4 1.8 2. 1 Woodford County High School 0. 43 0.44 0.66 0.86 1.3 1.5 Blackhorse Lane site 0.56 0.61 1.5 1.8 2. 1 2.4 The above figures are similar to those obtained by adjacent authorities and are lower than those given for Central London, the highest figures for Central London being 7.2. 26 Rent Act, 1957 The following action was taken under the Act during 1961: Part I Applications for Certificates of Disrepair (1) Number of applications for certificates 19 (2) Number of decisions not to issue certificates (3) Number of decisions to issue certificates (a) in respect of some but not all defects 10 (b) in respect of all defects 9 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 9 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule (6) Number of certificates issued 10 Part II - Applications for Cancellation of Certificates (7) Number of applications by landlords to Local Authority for cancellation of certificates 15 (8) Number of objections by tenants to cancellation of certificates 1 (9) Number of decisions by Local Authority to cancel in spite of tenant's objection (10) Number of certificates cancelled by Local Authority 12 In addition to the above, fifteen 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 fifteen applications, thirteen certificates were issued and the remainder (2) were not granted. As a result of the regular periodical visiting of the above premises, the following works were carried out: Butchers - Cleansings, 11; Accumulations removed, 2; New bins provided, 7; W.C's repaired and cleansed, 1; Other improvements, 16; Floors repaired and ventilated, 1. Bakers - Cleansings, 4; Floors repaired, 2; Other improvements, 7 Fishmongers - Cleansings, 1; Accumulations removed, 3; Other improvements, 3. Cafes and Caterers - Cleansings, 35; Floors repaired, 4; Kitchen light and ventilation improved. 3; Other improvements. 31. Grocers Store rooms cleansed. 7; Washing accommodation improved 4; Other improvements, 18. Greengrocers Store rooms cleansed, 10; Washing accommodation improved, 1; Other improvements, 10. Ice Cream Manufacturers and Vendors Cleansings, 3; Improvements, 3; 27 Hairdressers - Improvements, 2. Dairies and Milksellers - Cleansings, 2; Fittings and other improvements, 1. Laundries - Cleansings, 3. School Kitchens - Improvements, 1. Street Traders - Stalls improved, 1. Public Houses - Cleansings, 5; Hot water supplied, 1. HOUSING The Borough Architect, F.G. Southgate Esq., A R I B.A., A.M.T.P.I, has kindly contributed the following in regard to statistics and improvement grants:- Houses completed by the Local Authority 1961 Hoe Street Ward 76 Flats 12 Houses St. James Street Ward - - Higham Hill Ward - - High Street Ward - - Hale End Ward 6 Flats Wood Street Ward 83 Flats 165 Flats 12 Houses Houses completed by Private Enterprise Hoe Street Ward 2 Flats 2 Houses St. James Street Ward - - Higham Hill Ward 6 Flats High Street Ward 1 House Hale End Ward 11 Flats 10 Houses Wood Street Ward 4 Houses 19 Flats 17 Houses Note: All were permanent houses and flats In addition to the main building programme improvements and conversions have been carried out at a number of Council owned properties. Improvement Grants Applications received from owner/occupiers:- Discretionary 122 Standard 106 28 Total number of grants and amounts approved by Council to owner/occupiers: Discretionary 127 Standard 35 £30,466 £ 3,890 Applications received from Warner Estate Ltd. Discretionary 57 Total number of grants and amounts approved by Council to Warner Estate Ltd. Discretionary 50 £ 9,840 Summary Total number of applications Discretionary Standard 179 106 Total number of grants: Discretionary Standard 177 35 Total amount of grants: Discretionary Standard £40,306 £ 3,890 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) 1,646 (b) Number of inspections made for the purpose 4,422 (2) (a) Number of dwelling houses (included under sub-head (1) above) which are inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 62 (b) Number of inspections made for the purpose 105 (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) 13 (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 449 29 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 1961:- No. of new properties made avaiable for letting 177 Acquired 157 Normal vacancies 116 Nominations to private landlords 49 New properties at Canvey 45 New properties at Billericay 161 Total 705 Families rehoused:- 1-bedroom group 202 2-bedroom group 241 3-bedroom group 235 4-bedroom group 27 Total 705 Property under management at December 1961:- Pre-1939 houses and flats 1,613 New houses and flats 2, 969 Properties at Canvey Island 157 Properties at Billericay 308 Prefabricated bungalows 102 Properties converted into flats 287 Properties improved 234 II. Unfit houses closed:- (1) Under Sections 16(4),17(1) and 35(1), Housing Act, 1957 13 (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 324 * (2) After formal notice under (a) Public Health Acts 134 (b) Sections 9 and 16, Housing Act,1957 2 (3) Under Section 24. Housing Act, 1957 * including those notices outstanding from previous years 30 Properties acquired for improvement and conversion 556 Properties for Clearance and Demolition 114 Requisitioned dwellings - Halfway houses 4 General Properties 30 Commercial Properties 90 Garages 907 Total 7,371 The number of families rehoused in New Towns during 1961 was 62. The following extracts are taken from the Annual Report of the Housing Management Committee:- Rehousing During 1961 the Lettings Sub-Committee considered reports dealing with individual cases submitted in accordance with the Conditions of the Points Scheme:- Conditions of Points Scheme 'C' Families living with relatives 48 'D' Families living apart 5 'E' Irregular overcrowding 60 'K' Three or more families (relatives) in house - 'H' Transfer of priority housing - 'J' Special cases 52 'J' Rehousing subject to nomination 36 M.O.H. Medical recommendations (T.B.) 6 M.O.H. Cases for consideration 6 Special requests for emergency accommodation 41 Total 254 MEDICAL CASES During 1961, six 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 1961 was as follows:- Class 1 Class 2 Class 3 Class 4 Total On list at end of 1960 1 2 8 - 11 Added to list during 1961 2 2 1 1 6 3 4 9 1 17 Rehoused or removed from list during 1961 1 1 - 1 3 On list at end of 1961 2 3 9 - 14 In addition to the tuberculosis cases, fifteen other cases were recorded as needing special consideration on medical grounds and seventy on general grounds. 31 Inspection and Supervision of Food Details of Milk Samples taken: Grade No. of Samples Satis fac tory Results Unsatisfactorv Results Pasteurised 44 42 2 Sterilised 6 6 - Tuberculin Tested Pasteurised 28 27 1 Totals 78 75 3 Milk (Special Designations) Regulations 1960. As from the 1st January, these Regulations brought into force new forms of licences and period of duration. The following licences are in operation to 31st December, 1965. Pasteurisers' Licences 2 Dealers' Licences: Tuberculin Tested: 2 Dealers' Pre packed Milk Licences: Sterilised 123 Pasteurised 79 Tuberculin Tested 22 There are no cow keepers in the district. The number of Retail Milk Distributors is 132. Two hundred and four visits were paid to registered premises and a satisfactory standard of cleanliness was maintained. Ice Cream Thirty-six applications for registration were received and were dealt with as follows; Manufacturer, Transfer 1 Vendors, New 16 Vendors, Transfers 17 Application refused 2 Number on Register at end of year 384 Number of premises used for manufacturing 5 Food Standards (Ice Cream) Order, 1951 Five samples of ice cream were taken and submitted to the Public Analysts who reported the following satisfactory results Fat Content 10.0% 10,0% 10,6% 11.4% 11.7% 32 Bacteriological Examination of Ice Cream Seventy-nine 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- 53 Grade II - 19 Grade III - 2 Grade IV - 5 Lollies (Various) Eleven 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. 317 tins Evaporated Milk 81 tins Full Cream Milk 1 tin Skimmed Milk 11 tins Cream 5 tins Drinking Chocolate 3 tins Coffee 872 tins Soup 116 tins Baby Foods 12 tins Junior Foods 107 tins Creamed Rice 1 tin Macaroni 1 tin Custard Powder 90 tins Treacle Pudding 3 tins Fruit Pudding 68 tins Date Pudding 79 tins Christmas Pudding 96 tins Mincemeat 3 tins Curried Beans 685 tins baked Beans 32 tins Butter Beans 30 tins Beans & Pork 11 tins Spinach 10 tins Pease Pudding 39 tins Macedoine of Vegs 1405 tins Peas 125 tins Spaghetti 6 tins Vegetable Salad 24 tins Cut Potatoes 39 tins Carrots 106 tins Salmon 1 tin Sardines 56 tins Pilchards 1 tin Crab 68 tins Fish Cakes 48 tins Lemon Curd 26 tins Marmalade 23 tins Gherkins 64 jars Jam 2 jars Salmon Spread 23 jars Pickles 136 botts Sauce 16½ lb. Sausages 1½ lb. Liver Sausage 2% lb. Breakfast Sausage 8½ lb. Plucks 30 lb. Ox Tongues 81 lb. Ox Liver 50 lb. Ox Cheeks 5½ lb. Lambs Tongues 17½ lb. Minced Pork 230 lb. Steak 676 lb. Corned Beef 72 lb. Corned Mutton 438 lb. Luncheon Meat 282 lb. Chopped Pork 19 lb. Cooked Bacon 13 lb. Ham 362½ lb. Ham (tinned) 33 12 tins Beetroot 133 tins Tomatoes 9 tins Ravioli 11 tins Meat and Vegetables 3 tins Stew 33 tins Stewed Steak 29 tins Beef & Dumplings 10 tins Meat Pudding 1 tin Steak & Kidney Pie 8 tins Sausages 85 tins Fruit Cocktail 64 tins Grapefruit Juice 6 tins Pineapple Juice 19 tins Orange Juice 2 tins Lemon Juice 40 tins Tomato Juice 4 tins Raspberries 345 tins Pineapple 209 tins Peaches 4 tins Gooseberries 7 tins Cherries 14 tins Rhubarb 48 tins Apricots 18 tins Grapes 178 tins Mandarin Oranges 21 tins Grapefruit 84 tins Plums 111 tins Pears 63 tins Prunes 48 tins Youngberries 2 tins Shrimps 102 lb.Pork (tinned) 185¾ lb. Pork 767 lb. Beef 11 lb. Veal 18 lb. Jellied Veal 14¼ lb. Fruit Pie Filling 6¾ lb. Fruit Cocktail ll¼ lb. Tomato Puree 192 lb. Jam 15½ lb. Confectionery 448 lb. - ditto 256½ lb. Tapioca 4 lb. Dried Prunes 4½ lb. Apricots 60 lb. Split Peas 28 lb. Potatoes 207 lb. Biscuits 213½ lb. Spiced Buns 87 lb. Enriched Bread 22 lb. Cocoa Bread 24 lb. Sugar 2¾ tons Bananas 7½ stone Cod 1½ stone Haddocks 3 stone Whiting 8¼ stone Skate 72 Sausage Rolls 5 Pork Pies 7 Steak & Kidney Pies 130 Sugar Cakes 130 Chickens Shellfish and Jellied Eels The following samples were taken during the year for bacteriological examination:- Escallops 1 Cockles 7 Mussels 5 Jellied Eels ... .. 10 Whelks 1 Winkles 1 One of these samples was of an unsatisfactory standard and the necessary investigations were carried out. Cooked Meats Sampling of these products continued during 1961, eighty four samples being taken. Twenty-four were classified as unsatisfactory because of bacteriological contamination which occurred during storage and exposure for sale. 34 Miscellaneous Samples Twenty-one samples were submitted for bacteriological examination, with the following results:- Satis factory Unsatisfactory Creamed Confectionery 6 3 3 " (Synth) 1 1 - Dried Milk 2 2 - Cornflour 1 1 - Blancmange 6 5 1 Custard 2 2 - Jelly 3 3 - Adulteration, etc. - Food and Drugs Act,1955. During the year, one hundred and four samples of food and drugs were submitted to the Public Analysts. Four samples were reported as being unsatisfactory, details respecting same are given below:- Description of Articles Result of Analysis Action taken Beef Sausages No declaration of preservatives. Warning letter Tapioca Infected with mould organisms. Warning letter Cream Contained insufficient milk fat to justify description of " Thick Cream " Prosecution Penalty £10 Pork Sausages No declaration of preservatives Warning letter The following summary gives details of food sampled and results of analyses:- No. Formal Satis factor Informal y Total No. Formal Unsatis factory Informal Total Milk 8 1 9 _ . - Cream - 3 3 1 - 1 Butter 1 1 2 - - - Margarine - 3 3 - - - Milk, Evaporated - 2 2 - - - Coffee - 2 2 - - - Beer - 1 1 - - - Whisky 7 - 7 - - - Gin 4 - 4 - - - Cider - 1 1 - - - Grapefruit Juice - 1 1 - - - Orange Drink - 1 1 - - - Gluco Juice - 1 1 - - - Cornish Cream Ice 1 - 1 - - - Ice Cream 1 3 4 - - - Ice Lolly 1 1 2 - - - Sausage, Pork 4 - 4 1 - 1 Sausage, Beef 2 2 4 1 - 1 Meat, Cooked, Pickled - 2 2 - - - 35  No, Formal Sat is factory Informal Total No. Formal Unsat is factory Informal Total Pork, Pickled 1 - 1 - - - Beef, Potted with Butter - 1 1 - - - Paste, Chicken Meat - 1 1 - Pate de Foie - 1 1 - - - Paste, Fish - 1 1 - - - Fish Cakes, Salmon - 1 1 - - - Jam - 1 1 - - - Jelly - 3 3 - - - Honey - 1 1 - - - Gelantine - 1 1 - - - Nutmeg Ground - 1 1 - - - Ginger Ground - 1 1 - - - Almonds Ground - 2 2 - - - Dried Fruit - 2 2 - - - Caraway Seed - 1 1 - - Pepper - 2 2 - - - Flour - 2 2 - - Powder, Baking - 1 1 - - - Powder, Curry - 2 2 - « - Cherries - 1 1 - - - Pears 2 2 - - - Apples - 1 1 - - - Rhubarb - 1 1 - - _ Rhubarb in Syrup - 1 1 _ - - Tomatoes - 1 1 - - - Peas, frozen 1 - 1 - - - Peas, split - 1 1 - - - Pickle, Mustard - 1 1 - - - Tapioca - - - - 1 1 Butterscotch - 1 1 - - Fruit Drops - 1 1 - - - Buttered Brazils - 1 1 - - - Bubble Gum - 1 1 - - - Toffee Apple 1 - 1 - - - Cough Twi st - 1 1 - - - Chlorodyne - 1 1 - - - Saccharin Tablets - 1 1 - - - Yeast Tablets - 1 1 - - - Wincarnis Jelly - 1 1 - - - Totals 32 68 100 3 1 4 Food Hygiene (General) Regulations,, 1960 The following food premises are established in the Borough:- Butchers, 86; Bakers. 43; Fishmongers, 34; Cafes and Caterers.93; Grocers, 231; Greengrocers, 79; Milksellers, 132,; Ice Cream Manufacturers, 5; Ice Cream Vendors, 384. The following inspections were carried out in respect of food premises: Butcherss 231; Bakers. 82; Fishmongers, 100; Cafes and Caterers, 355; Grocers, 580; Greengrocers, 165; Dairies, 25 Milksellers, 204; Ice Cream Manufacturers, 65; Ice Cream Vendors, 258. 36 PREVENTION OF DAMAGE BY PESTS ACT, 1949 Type of Property Non-Agricultural Agricultaral Local Authority Dwelling houses All other (including business premises) Total I. No. of properties in Local Authority's District .. 18 34,557 5, 572 40,147 4 II. No. of properties inspected as a result of:- (a) Notification 11 482 91 584 1 (b) Survey under the Act - 275 57 332 - (c) A visit primarily for some other purpose - - - - - III. Total inspections carried out including re-inspections 113 1,886 430 2,429 1 IV. No. of properties inspected (in Sec. II) which were found to be infested by:- (a) Rats Major 1 - 13 14 - Minor 5 479 81 565 - (b) Mice Major - - - - - Minor 5 34 17 56 - V. No. of infested properties (in. Sec.IV) treated by the Local Authority .. 11 513 111 635 - VI. Total treatments carried out including retreatments - - - - - VII. No. of notices served under Sec. 4 of the Act (a) Treatment - - - - - (b) Structural Work (i.e. Proofing). - - - - - VIII. No. of cases in which default action was taken following the issue of a notice under Sec. 4 of the Act - - - - - IX. Legal Proceedings - - - - - X. No. of Slock' control schemes carried out 1 - - - - 37 Factories Acts, 1937 & 1959 The following tables show the work carried out under these Acts:- 1. - INSPECTION OF FACTORIES, ETC. (Including Inspections made by Public Health Inspectors) Premises (1) No. on Register (2) In- Inspections (3) Written Notices (4) Occupiers prosecuted (5) Factories in which Sections 1,2, 3,4 and 6 are to be enforced by Local Authorities 31 21 2 - Factories not included above in which Section 7 is enforced by the Local Authority- 481 215 6 - Other premises in which Section 7 is enforced by the Local Authority 25 2 - Totals 537 238 8 - 2. - DEFECTS FOUND IN FACTORIES, ETC- Particulars No. of cases in which defects were found. Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Legal Proceedings Instituted (1) (2) (3) (4) (5) (6) Want of Cleanliness (Sec. 1) 11 8 - - - Overcrowding (Sec. 2) - - - - - Unreasonable Temp. (Sec. 3) .. - - - - - Inadequate Ventilation (Sec. 4) - - - - - Ineffective drainage of floors (Sec.6) - - - - - Sanitary Conveniences: (a) Insufficient 3 - - - - (b) Unsuitable or Defective 19 28 1 1 - (c) Not separate for Sexes - - - - - Other offences (not including offences relating to Outwork) 1 1 - - - Totals 34 37 1 1 - 38 NUMBER AND TRADES OF OUTWORKERS NOTIFIED Wearing Apparel (making of) 418 Basket making 1 Paper Bags 6 Furniture and Upholstery 3 Umbrellas etc. 3 Boxes 14 Brush Making 11 Stuffed Toys 3 Artificial Flowers 9 Cosaques Christmas Crackers etc. 2 Lampshades 1 Total 471 39 CARE OF THE ELDERLY The following are contributions from the various members of the Staff dealing with the services provided for old persons, commencing with details of the Pilot Survey of the elderly in Walthamstow. pilot survey of the elderly in walthamstow In order to form an estimate of the total number of elderly people in Walthamstow, especially those living alone, and to determine the proportion needing help from the Health and Welfare Services a survey has been carried out by the Health Visiting staff. All houses in streets whose names commence with the letter 'E' were visited representing a random sample of approximately 3 1/3 % of the total inhabited dwellings. Assuming that this sample, drawn from all districts in the town, is fairly representative, the ascertained numbers when multiplied.by a factor of 30 gives an approximation of the total population in the various groups. The survey, although much more time-consuming than was at first expected, has proved most illuminating. Not only will the data obtained be very valuable in planning any extensions to existing services but it has disclosed a number of cases where practical help, needed now, has been provided and a much large number where the need for assistance will almost certainly arise in the near future. All these cases are being kept under observation by means of follow-up visits. The number of people of pensionable age found by the survey was 368. Of these 252 were women and 116 men. The estimate for the total number of pensioners is therefore 368 x 30 = 11,040, representing almost 10 per cent of the population of the town, with a percentage distribution of sex and age groups as follows:- 60-64 65-70 71-80 81-90 90+ yrs. yrs. yrs. yrs. yrs. Women 11.4 21.4 25 9 1.63 - 67.43 Men - 13.6 13.6 4.1 0.27 - 31.57 99% Of the 368 interviewed 97 women (26%) and 16 men (14%) were living alone but an encouraging factor was that in only two cases (both ladies 71-80) were they without effective relatives or friends, Less satisfactory is the fact that only 39 of the 368 were previously known to the health visitors with another 7 who were receiving help from other agencies. 62 (17%) needed help of some kind and 52 were already receiving it, in 33 cases from the Health Department and in 19 from other agencies. As a result of the survey new or additional help was provided for 45 cases, in 34 of them direct by the Department and in 11 through other agencies. (NOTE - Because of this duplication the figures for help provided do not agree with the other totals in the attached table). 40 After some initial suspicion in a few cases the Health Visitors' enquiries were well received by the old people, many of whom were obviously very pleased indeed to find some one really concerned about their welfare even when, as often happened, they refused help. An example of this was an old couple living with their bachelor son. Both were over 80 and crippled (wearing calipers) as the result of a street accident. Domestic Help was clearly needed here but so far hast been refused. Some cases are managing only precariously like a lady of 64 whose husband, prematurely retired because of ill health, is often confined to his bed. She then has to nurse him as well as look after her aged mother (96) who lives alone next door. If she herself is taken ill we shall be faced with a triple problem. The majority of the old people, however, are hale and hearty and managing their affairs without assistance. An example of sturdy independence and self help is the old lady of 86 who has purchased a typewriter in order to correspond with her married children because she can no longer hold a pen. In our opinion this kind of survey and the resulting follow up of cases like those quoted above can make a substantial contribution to the health and welfare of the elderly. 41 SUMMARY SURVEY OP THE ELDERLY CONDITIONS WOMEN MEN 60-64 65-70 71-80 81-90 90 + Total 65-70 71-80 81-90 90 + Total LIVING Alone 13 25 42 16 1 97 7 5 4 - 16 With Spouse 12 34 24 6 - 76 29 34 7 - 70 Relative 15 19 25 11 5 75 13 11 4 - 28 Companion 2 1 1 - - 4 1 - - 1 2 TOTALS 42 79 92 33 6 252 50 50 15 1 116 KNOWN to Health Visitor 6 6 10 5 2 29 5 3 2 - 10 to other agency 1 2 4 7 - - Previously unknown 35 73 80 28 6 222 45 47 13 1 106 IN CONTACT WITH Relatives (or friends) 42 79 90 33 6 250 50 50 15 1 116 NEED OP HELP Present 5 3 20 11 1 40 2 12 7 21 None at present 37 76 82 22 5 222 48 38 8 1 95 HELP PROVIDED 'By Health Dept. 2 2 10 3 2 19 2 6 6 - 14 Already By other agency 2 2 5 3 12 1 4 2 - 7 As result of Survey By Health Dept. 1 1 14 6 _ 22 - 9 3 _ 12 By other agency 1 - 8 - - 9 - 2 - - 2 TOTAL HELPED 6 5 37 12 2 62 3 21 11 - 35 42 Aged and/or Chronic Sick Section 47 of the National Assistance Act 1948 gives local authorities power for securing the necessary care and attention for persons who:- (a) are suffering from grave chronic disease or, being aged infirm or physically incapacitated, are living in insanitary conditions, and (b) are unable to devote to themselves, and are not receiving from other persons, proper care and attention. If the Medical Officer of Health reports to the local authority after investigation and consideration that he is satisfied that, in the interest of any such person residing in the area, removal from the premises would alleviate suffering or injury to health, or serious nuisance to other persons, the appropriate authority may make application to a court of summary jurisdiction for the area for an order for the removal of such person subject to certain other conditions. Such an order if granted, remains in force for a period of three months. This is rather a complicated procedure, but in 1951 the National Assistance (Amendment) Act was introduced to enable local authorities to deal with such cases expeditiously. This enables the Medical Officer of Health or local authority to apply direct to the Court or J.P. for an order for removal which can be put in operation immediately but in this case the order remains in force for a period of three weeks only. Experience has proved that it is far better to persuade the person to accept the social services available, or to be admitted to welfare accommodation voluntarily. During the year, six cases required consideration. One case died at home, one was persuaded to enter an institution for the blind and one was admitted voluntarily to welfare accommodation. The remaining three cases remain at home under close supervision. An increase of visits to the elderly is partially due to the 'Pilot' survey undertaken by health visitors. Close liasion with hospitals continue, 214 written reports were submitted by the health visitors at the request of different hospitals, relating to elderly people, either before admission to or following discharge from hospital. The care of the elderly is essentially a human problem and whether home or institutional care is better for any individual person is a matter for consideration and discussion amongst all concerned. Acute distress can be caused to old people when removed from their own homes and near relatives. If they are to have the latter part of their lives without suffering and distress, the care of the elderly must always be a matter of human relationship with their families, their relatives or friends. Whether the relatives 43 choose to leave it to 'someone else' or face up to the moral responsibility of a frequently exacting nature is a matter of individual choice. Fortunately a great majority of relatives do accept their responsibilities but are not always aware of the help they can be given in the form of equipment, which helps to lighten the burden. Varying standards of hygiene and habits are frequently a matter of concern to relatives and visitors especially amongst the elderly living alone. Little success will be achieved in trying to enforce personal standards, especially where facilities are limited. Any improvement that may be possible must of necessity be of a gradual and persuasive process. The elderly living alone can quite successfully be allowed to remain happily in their own homes, particularly if they can be persuaded to take advantage of the available services. Very few elderly people accept institutional care readily, even for a temporary period, in order that their relatives or friends can have a holiday. Once they have accepted such an arrangement, it is usually reasonably easy to persuade them to accept again when the occasion arises. The following are details of two of many similar cases which were dealt with during the year. Miss D. Aged 90 years - Lives alone. A niece had been very attentive until severe ill health prevented her from giving further assistance, and an elderly brother although visiting regularly, is unable to give any material help because of his age. Because of her confused state at times, and in spite of all the social services provided, it is doubtful that she could have been allowed to remain in her own home, but for the continual supervision of her neighbour. It was possible after much persuasion, to get her consent for temporary admission to Langthorne Hospital for one month during the neighbour's absence. This acceptance was only made possible on the promise that she would return home. Mr. S. Aged 70 years - Brought to the notice of the Health Department by his brother's general practitioner who had arranged admission to hospital for Mr. S's brother. The two brothers had lived together for many years and both were unmarried. Mr. S. had chronic suppurating ulcers of both legs, for which he had been discharged from the army during 1914/18. Apparently he had not worked since, his income being derived from investments made by a relative. Possibly he was supported by his brother who, it was understood, was a retired schoolmaster. This brother died a few days after admission to hospital. Mr. S. had had no medical treatment for many years and was not registered with a general practitioner. He was ultimately persuaded to enter hospital and after five months treatment and rehabilitation was able to return to his own home. 44 Chiropody in relation to old age Mr. R.J. King, M.H.Ch,S.„ Chief Chiropodist, reports as follows The Walthamstow Chiropody Clinic has been serving the Borough since September, 1931. It was the first Municipal Clinic in Essex and the second in the Country. Municipal Chiropody started in Bermondsey in 1930, having been introduced by the late Mr. A.J.R.Bride B.Sc.F.C. Ch.S., who was at that time the Head of the Chelsea School of Chiropody. Mr. Bride was also consulted by the Walthamstow Health Committee when the Chiropody service was started in this Borough. Prom its inception the Chiropody service in Walthamstow has provided treatment for all age groups and until 1948 all persons of pensionable age were treated free, without an assessment of means. Later, domiciliary treatment was provided by the Old People" s Welfare Committee of the Borough Council and the work undertaken by a private Chiropodist. Two years ago the County Council assumed respon sibility for the Domiciliary Service, which, together with the Clinic Service, is administered by the Walthamstow Health Area Sub Committee. In Walthamstow we now provide five domiciliary sessions per week and during 1961, 707 treatments were given to patients in their own homes. The population over 65 years of age forms a large proportion of our patients, (of a total of 22,784 treatments given during the year 6,992 were for patients in this age group) and in this field professional attention of a specialised nature is called for. Elderly patients are often troubled with poor circulation and a condition which causes loss of sensation, (Peripheral Neuropathies) thus minor abrasions in treatment, or from trauma, can very quickly lead to ulceration. The degeneration of elastic and muscular tissue, coupled with the disappearance of subcutaneous fat, and atrophy of the fibro fatty pads, plus the fine tissue paper skin, calls for very careful handling and often lengthy treatment time because the ary fine skin is usually coupled with very hard corny conditions and deformed nails. These conditions are worsened by the inability of the patients to reach their feet, and quite often shoes are discarded because of pain, which restricts normal social and domestic activity. Deterioration can be rapid resulting in the patients becoming bed ridden. With chiropody attention however these patients can in many cases be kept ambulant, thus saving hospital beds, or daily visits by the home nurse. Elderly people who live on their own often bring their problems to the chiropodist, simply because they have no one to talk to at home and the chiropodist, because of his knowledge of the Health Services generally, is in a position to put them in touch with the appropriate officials. As well as hearing about the problems of our elderly patients, we also hear of their joys, and the chiropodist needs to be a good listener. 45 The Chiropody Service in Walthamstow is fortunate in having six full time and three part time Chiropodists, and is the only Clinic in Essex with a full staff. This situation has not been brought about by higher salaries or elaborate surgeries, but I think, by the happy relations which exist between the Chiropodists and the other members of the Health Department Staff. District nursing of the elderly The primary aim and object of the district nursing service is to provide total nursing care to patients in their own homes, especially the chronic sick and aged, in order to cater for their physical, mental, emotional and social needs; to assist in rehabilitation and to play an important part in health teaching and prevention of disease. The 'home nurse' or district nurse has had special training to equip her for these highly skilled duties, and has the privilege of right of entry into all homes she visits. She works as right hand to the doctor and the family whenever skilled nursing care is needed in the home. Any responsible person may summon her, in fact she is a public servant, but she may not continue to visit without the family doctor's consent. In a busy district her day's work may entail twenty calls, giving injections to patients suffering from diabetes, cardiac failure, cerebral degeneration, cancer, respiratory infections, doing dressings for a variety of cases, varicose ulcer, leg ulcers, burns, scalds or any post-operative wounds, to carrying out general nursing care for a variety of conditions from a terminal case of carcinoma, where she may spend two hours daily in the house, to a young child with whooping cough. Daily reporting of all patients under her care to the family doctor and the Nursing Superintendent is necessary, as well as writing accurate concise reports on the appropriate message form left at the house. Occasionally she will meet the family doctor in order to discuss the progress of the patient and to see if anything more can be done to help him. General nursing care consists of attending to the daily toilet, including care of the skin, hair, teeth and nails, as well as blanket bathing. This is very important to the comfort of the patient if there is any question of bedsores. Where long term illness exists, i.e. an advanced stage of carcinoma, the condition calls for all the skill, patience, ingenuity, cheerfulness and moral support which a nurse can give to the patient and his family and this is nursing of the highest order. It may be necessary for sick room equipment to be borrowed i.e. special bedstead with hoist, mackintosh sheet, urinal bed cradle back rest air cushion, commode etc. The relatives are requested to call for these at the District Nurses Home, or the local authority or 46 Red Cross. The district nurse has knowledge also of the many services, voluntary and statutory in the area, which can help her patient. These services are especially useful where a home nurse is visiting an elderly blind person living alone and who must be given constant supervision and total nursing care. Requests are also made through the district nurse for home helps, night sitters-in, chiropody service, meals on wheels etc. When nursing the heavy, helpless patient it is necessary for the home nurse to know the art of lifting without incurring the occupational hazard of a slipped disc. In these cases a mechanical hoist may be provided and the relatives taught how to operate this single hand ed. The home nurse plays a vital part in the attempt to rehabilitate a patient under her care recovering from a stroke, aiming to bring the muscles back into working condition. This can only be achieved by a gentle approach on her part giving helpful suggestions as well as listening to the patient with a sympathetic ear, at the same time encouraging him to talk freely. For his part, the patient realises he is an active participant and that joint efforts are being made for a real purpose. Quite often the opinion and advice of the home nurse may be sought on modern treatment of mental illness, and may tip the scales in order to encourage a patient to enter a mental hospital as a voluntary patient. Certain other responsibilities in relation to nursing patients in their own homes compels a district nurse to become competent in the art of improvisation, i.e. where there is strictly limited domestic equipment. She has already learned the art of caring for the tools of her trade e.g.. district bag, but even this requires considerable resourcefulness on her part, and although the patient runs less risk of infection at home, the methods of sterilising equipment and dress ings must approximate to hospital standards. Certain essential records of all patients, as well as report making to the family doctor, must be kept by the nurse as this is necessary for her own and the patients good, as well as provoding useful information for the Medical Officer of Health in compiling of statistics, and the great aim of all is prevention of disease. Constant health teaching and giving of advice to relatives on how to manage in between visits is an important part of the respons ibilities of the home nurse she may be asked for advice on prevent ion of accidents in the home, especially in the case of elderly persons also for the healthy members of the household. In this respect she will bear out and complement the work of the Health Visitor who may also be attending the home. 47 At all times the good relationship which exists between the patient, relatives and nurse is of infinite value and something to be guarded. Co-operation with the three legs of the National Health Services is also essential to the success of district nursing. Finally, the district nurse (as a person) should always be approachable, friendly yet professional to all people who wish to confide in her. She is before the eye of the community and the public set store by her principles, general behaviour, appearance and standard of work. In this respect she serves patient, family and community. The position at the end of December 1961, was as follows:- Cases Attended Visits Paid Persons of 65 years and over at first visit during year 1239 39,724 Persons who received more than 24 visits during year 499 43,765 Of these the largest proportion were suffering from cardiac failure, cerebral degeneration, arthritis and carcinoma and the remainder mainly from respiratory infections and post operative conditions. Domestic Help Service Over the years the Domestic Help Service has brought great relief and comfort to hundreds of old people especially those living alone, who very often are heard to remark that "they don t know how they would have got on without it Regular attendances from 'their own' domestic help means so much to them, apart from the value of often helping to keep good standards in the home and very often in the person. Throughout the Winter months this Service had proved very valuable where it has been necessary for fires to be lighted daily, this very often being one of the few comforts that is left to aged people, since in most cases they are home bound. In both areas there are a number of bed ridden cases where but for service given by Domestic Helps together with Meals on Wheels Incontinent Laundry Service and District Nurse, working in conjunction with each other, they would not be able to remain in their own homes. Some of the typical problems facing old people are namely inability to get out in severe weather conditions, (very often to collect pensions), climbing stairs to bring in coals etc. There is also the problem of loneliness and difficulty in enlisting help from neighbours who all too often look upon old people as a nuisance. All the difficulties are very often ironed out by the attendance of a domestic help together with check visits by domestic help organisers. 48 Here we illustrate two typical examples of patients covered by these services; Mrs. A. aged 74 years suffering from disseminated sclerosis with incontinency, is confined to wheelchair, spends six weeks in Langthorne and six weeks at home. Domestic Help attends daily, lighting fire, giving breakfast,(meals on wheels are delivered mid day.) sandwiches and flask of tea are left for tea, does personal washing and ironing and in fact makes this patient generally comfortable. Mrs. B. aged 70 years suffering from a fibrous growth on lung cardiac and severe arthritis, is entirely helpless, relies upon this service seven days a week to perform such tasks as emptying toilet bucket, making bed and putting everything at hand for patients needs through out the day. together with keeping her home clean shopping and personal washing etc. An hour is given on Saturdays and Sundays to give patient immediate comforts, Laundry service for the incontinent In 1953 the Borough Council held a Conference on the problems and progress of Old Peoples' Welfare and reference was made to the need for a Laundry Service for the Incontinent. Subsequently it was reported that such a Service could be carried out within the terms of Section 84 of the Public Health Act 1936, which gives power ' to cleanse at the Authority s expense upon a certificate signed by the Medical Officer of Health or the Public Health Inspector any article that requires to be cleansed in order to prevent injury or danger of injury to the health of any person in the premises. A pilot scheme was authorised and arrangements were made with a local laundry for the laundering of the articles after preliminary cleansing and disinfection at the Council s Disinfecting Station. The articles dealt with are mainly bed linen, night clothing or underclothing and the service is free to the patient. The Service is only carried out where the Medical Officer of Health or Public Health Inspector gives a certificate and where it is impossible for the washing to be done at home by a relative or Domestic Help. The necessary equipment was installed at the Disinfecting Station and the collection preliminary cleansing, rinsing and disinfecting carried out by the Disinfecting Staff. The Service was commenced on 1st March 1954 and collection was made weekly and the articles returned completely laundered within approximately 24 hours. Experience conclusively proved the need of this Service and authority was given for additional equipnent i.e. a steam washing machine and a hydro extractor to be provided and this was installed in 1955. Later in the year further improvements were authorised with a view to the extension of the Service to enable some of the worst 49 cases to be dealt with twice weekly, and in 1956 a part-time laundress was appointed so that the whole of the Service could be carried out at the Disinfecting Station, and arrangements with the local contractor were cancelled. There is no doubt that the success of this scheme has proved beneficial to those old persons where relatives are unable to cope with soiled linen,, because during the whole period of this Service there has been not one single complaint. During the first year a total of 12 esses (average of four per week) were dealt with. Up to the end of 1961 the total number of cases dealt with had reached 114. Of these 30 were still using the Service. In addition, in December 1961 the Borough Council agreed to undertake the service for two neighbouring authorities on a financial cost basis. The following table shows the number of cases dealt with during 1961 and how the Service has increased since its inauguration in 1954. 1961 1954 Total number of persons 30 12 Average number of cases per week 15 4 Total number of articles laundered 11,872 1,287 Average number of articles per week 233 29 Total number of journeys 1,128 336 Old people and the Work of the Public Health inspector Contact between the Public Health Inspectors and Old People arises mainly in connection with visits concerning domestic accomm odation or associated matters. In this respect, the old people them selves are not necessarily a problem, but more the unfortunate victims of circumstances associated with their stage of life, and the problems hinge more on economical factors than on direct public health matters. The main reasons for calls in connection with old people arise in much the same manner as calls generally for all walks of life repair of property, unsatisfactory housing, and visits in connection with alterations to fireplaces by virture of the operation of the Clean Air Act. The fact that the majority of old people have retired from work removes them from the sphere of duties which involve factories, shops, food premises and other non-domestic premises. The special problem of old people living in dirty conditions and in need of care and attention is in effect an exceptional state of affairs, rather than a generality, and the Public Health Inspector is only one officer of the many people involved in the event of one of this category of person being discovered. This type of person the recluse or the invalid requiring the resources of the Council's 50 incontinent laundry service, whilst needing attention - frequently almost immediately - does not present a normal picture of conditions associated with old people, but should rather be considered as a pathological case requiring remedial treatment; this is beyond the scope of the Public Health Inspectors. The cleaning up and clearing of accumulations usually associated with such a case is in no way different from that which would be required in a similar case of a person of younger years. The main problem, which could be generalised (although with specific exceptions) arises from shortage of money. There are broadly three categories of circumstances: 1) the owner/occupier. 2) the controlled tenant 3) the owner of tenanted property In all three cases, the shortage of money results in the maintenance of the property being neglected. The money shortage inevitably arises from the limited income of fixed pensions and the income is insufficient to cover the costs of repair and redecoration of the living accommodation. The effect is also aggravated by the physical inability to render 'do-it-yourself' services in similar manner to the efforts of younger generations. Each of the three categories has similar results on the properties. The dilapidation becomes more intense, and the resultant deterioration requires greater eventual expense to rectify. The retired person who is an owner-occupier does not normally come to the attention of the Public Health Inspector as a result of his own initiative (apart from enquiries for grants under the Clean Air Act); indeed, in the majority of cases there would be little purpose as there are few occasions on which the Council can provide much assistance through the Public Health Inspector to an owner occupier. Contact with such a person may arise, possible, only after the accommodation may have deteriorated to an extent that adjoining property is affected. A typical example would be where a leaky gutter causes dampness in the neighbouring house, and the occupier affected complains to the Health Department. Upon inspection of the offending property, a typical picture may emerge. The elderly occupants may use only two rooms of the house, the other rooms being in disuse and becoming damp and dilapidated. The whole premises may be badly in need of redecoration, and the room nearest the offending gutter may be virtually uninhabitable. The only action that the Public Health Inspector can take is to require the repair of the offending gutter in order to prevent nuisance to the neighbouring house. Whilst it is not strictly the Public Health Inspector's problem as to how the house owner is going to afford the repair required, it will, nevertheless, be asked of him. It is this real difficulty of finding a practical solution which can be considered as the basic problem underlying the work of the Public Health Inspector in relation to old people. 51 The Public Health Inspector can only make suggestions. The decisions rest with the people concerned. The result is in a sacrifice of some form or another and this may or may not have an effect on their existing standard of living or a subsequent (although not readily connected) effect on their general well-being, or health. In addition, it is normally only the minimum essentials that receive attention, and the property remains in much the same basic state of neglect and subject to additional troubles arising. The general living conditions of old people who are controlled tenants show similar characteristics. Only part of the house is in regular use; the internal decorations are dirty with age, and the exterior decorations badly weather worn and exposing the fabric of the building underneath. Often, the last major attention the property received was during the immediate post-war period as a result of war damage repair. Here, speaking generally, the owners budget for repair work within the confined limits of the return from the controlled rent and the effect on the property is one of apparent neglect. Usually, the essential repairs are attended to by the owners, and as such there is no immediate problem, but the Public Health Inspector is often asked in such cases whether assistance can be given to obtain redecoration of the rooms in use. Typically, the walls and ceiling of the living room may be almost black, and give a very depressing atmosphere to the old people who spend a large proportion of their time in the room. It poses a difficulty to convince the old people concerned that under the existing provisions of the Rent Act the terms of the tenancy are such that it falls upon themselves to bear the cost of the redecoration and that the owner no longer has the responsibility. The Public Health Inspector does not often come into direct contact with the old person who is an owner of tenanted property, as the property is normally in the hands of agents. However, the effect on the property is much the same, with expenditure at a minimum and the property on the border-line of repair. Depending upon the actual tenure, the state of the premises may be improved by the activity of the tenant, particularly if there is a young tenant who exerts himself to redecorate the rooms to his liking. The effect of limited fixed incomes of old people also shows in connection with work required under the Clean Air Act, in that the elderly persons will often indicate that the alterations cannot be afforded, or that the cost of the smokeless fuel will be beyond their means. Most of thern have a strong sensQ of independence, and it is only a few who actually apply for extensions of the 70% grant available. In general, the benefit of conversion to smokeless fuel is not appreciated by the old people, and there remains a rooted preference for the coal fire which they have been accustomed to for the past sixty or seventy years or more. It often seems that the Public Health Inspector's conversations with old people on this subject has little lasting effect, and they are reluctant to convert to smokeless fuel. 52 To summarise the problem in connection with old people is not a direct one but the aggregation of circumstances which results in a long term deterioration of property with a consequential greater financial outlay at some future time in order to bring the premises up to a reasonable standard and whilst the solution to the problem is not the affair of the Public Health Inspector nevertheless various aspects of the problem are thrown at him. The Housing Manager says With regard to problems associated with old age. I would say that whilst the Council do not make a lot of fuss in building blocks of flats specifically for elderly people the needs of these people do receive more attention by the Council as regards rehousing than any othei sections All vacancies of bedsitting room flats and ground floor one bedroom flats are allocated to elderly people and of this type of accommodation on first and second floors at least two thirds go to elderly people, who feel sufficiently active to climb the stairs. I think it is true to say that as far as Walthamstow is concerned the elderly people like to be provided with accommodation that is not specially designed for elderly people. They like to feel that they are a real part of the community. We experience certain complaints for example, in connection with the block of flats on the Hylands Estate, which was specially designed for the elderly people but I am of the opinion that the majority of the complaints are to the fact that there are 40 elderly people all in one group. " 53 SECTION G NATIONAL HEALTH SERVICE ACT, 1946 PART III SERVICES WALTHAMSTOW HEALTH AREA SUB-COMMITTEE (1961/62) Chairman Councillor Mrs. W.M. PALETHORPE (Walthamstow Borough Council) Vice Chairman: Councillor Mrs. C.E. STANNARD (Walthamstow Borough Council) Members: Representing: - Essex County Council Alderman K.E.B. GLENNY, O.B.E.. Councillor W.J. BOWSTEAD, J.P. (Chairman, County Health J.P. Committee) Councillor Mrs. M.J. HARVEY. Councillor Mrs. S.M. BOVILL Councillor Mrs. A.E. WELSH (Vice-Chairman, County Health (One Vacancy) Committee) Alderman H J. E. PALETTHORPE Walthamstow Borough Council Alderman The Lady McENTEE O.B.E. J.P. (deceased) Alderman C.B. REYNOLDS. Councillor Mrs. E.L. BALDWIN. Councillor L.A. BAYLIS. Councillor J.J. BRACKEN. Councillor Mrs. R. COLIN. .Councillor W.G. FREWIN. Councillor P. FURBER, J. P. Councillor J.H. HAMMOND. Councillor Mrs. B.M. REYNOLDS Councillor E. ROSOMAN. Councillor D. WEINSTEIN. Councillor Mrs. J.C. OAKMAN. Executive Council for Essex Mr. F.A. WORTLEY. Forest Group Hospital Management Committee: Mrs. B.E. BOTTOMLEY, J. P. Local Medical Committee for Essex: Dr. W.R. JOHN. Voluntary Organisations Mrs. L A. BRAZIER. Mrs. M. BROWN. Mrs. A. CORDELL. Mr. E.P. MARR. 54 F. 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 63 to 78. Section 21 HEALTH CENTRES During 1960 the Health Area Sub-Committee recommended the establishment in Walthamstow of four main Health Services Clinics to serve the following neighbourhoods: (a) Highams Park (b) Higham Hill (c) West Avenue (d) St. James' Street (e) Hurst Road. In addition a subsidiary clinic in the Wood Street area was proposed. The clinics at Highams Park, West Avenue, and St. James' Street are intended as replacements of the existing inadequate or unsuitable premises. The Hurst Road Clinic will absorb the clinics and sessions at present accommodated in the Town Hall in order to release more rooms for use by the Walthamstow Borough Council's staff. In the case of Higham Hill an extension of the existing Clinic built in 1959 is recommended in order to provide more adequate accommodation for the Health Services operated there. The County Health Committee subsequently approved the provision of clinics in Hurst Road and at Highams Park and these were included in the provisional programmes for 1963/4 and 1964/5 respectively. It was at one stage proposed that the Hurst Road Clinic should be built partly on land owned by the Walthamstow Borough Council and partly on adjoining land owned by the Walthamstow Child Welfare Society. Unfortunately certain difficulties arose which necessitated a decision to build the Clinic on the Borough Council's land only. Negotiations in regard to the acquisition of the land were proceeding at the date of preparation of this Report General Dental Service The work of the General Dental Service continues to contract owing to the shortage of dental staff. However an additional surgeon was recruited towards the end of the year which should improve the situation. 55 Section 22. CARE OF MOTHERS AND YOUNG CHILDREN Welfare Foods Service Prom the 1st June, 1961, under the directions of the Minister of Health, orange juice, cod liver oil and vitamin tablets distributed through the Welfare Poods Service have been sold at prices which cover the cost, i.e. orange juice l/6d. per bottle instead of 5d., and in place of free supplies of cod liver oil and vitamin tablets these have been sold at 1/Od. per bottle and 6d. a packet respectively, tokens not being required for these purchases. From this date orange juice has been obtainable for children up to the age of 5 years instead of 2 years as previously. The only tokens now in use for orange juice, cod liver oil and vitamin tablets as distinct from those for liquid or dried milk, are those issued for free supplies by the National Assistance Board or the Ministry of Labour. Details of issues are given in the table on page 68, Section 23 MIDWIFERY During the year 23 pupil midwives from Thorpe Coombe Maternity Hospital undertook their district midwifery training at the Nurses' Homes, and all passed the examination. The retirement of two teaching midwives towards the end of the year brought about a serious situation in the District Midwifery Service. The two midwives with their pupils ha.d been undertaking 180 cases annually and the remaining midwives were all working to capacity. Thus, taking into account the increasing number of home confinements, unless replacements could be recruited there would be a minimum of 200 babies born in Walthamstow during the following year without the aid of a midwife. Unfortunately repeated advert isements had failed to attract applicants. Against this background of approaching emergency, consultations were held with hospital and general practitioner representatives in order to try and solve the immediate problem. Meantime letters were sent to some 200 non-practising qualified midwives resident in Walthamstow and district inviting application for thevacantposts. As a result of these letters, and the efforts of our associates in hospital and elsewhere, we were able to recruit four midwives. This was made possible by the co-operation of the Walthamstow Borough Council who made housing accommodation available for two of the midwives. The third midwife occupied a house owned by the County Council and made vacant by one of the retirements. The fourth midwife already had her own home just outside the Borough. She had not practised midwifery for a good many years and was given a comprehensive refresher course at Thorpe Coombe Maternity Hospital 56 before taking over her own district. In view of the national shortage of practising midwives we must count ourselves singularly fortunate at the outcome. However, several of our present midwifery staff are also nearing retiring age, and we shall not be permanently out of difficulty in Walthamstow until the wider problem is solved. Section 24. HEALTH VISITING Expectant Mothers - First and subsequent visits to expectant mothers again shows a considerable increase. We are greatly indebted to the Thorpe Coombe Maternity Hospital for their continued co-operat ion in respect of the expectant or nursing mother and her baby. Requests for reports on social conditions gives the health visitor an early and necessary opportunity of making contact with the expectant mother. Relaxation and Mothercraft Regular sessions continue to be held at the four main clinics and 'Carville' Home, one health visitor giving a series of talks over several weeks, which ensures continuity of instruction. The value of this type of instruction and demonstrat ion is now accepted and appreciated. Many mothers attending are referred by their general practitioner and hospitals. infant Welfare clinics - The mothers who bring their babies regularly can be given guidance in management and feeding problems. A careful check can be kept on those babies who do not make mental or physical satisfactory progress. The doctors sessions are kept within reasonable numbers so that an unharassed atmosphere can be created. This is necessary to allow time to penetrate into medical problems and give suitable advice. The health visitor whilst of necessity, copes with large numbers, can make arrangements, where there are special difficulties, to pay a home visit and by listening, interpreting, encouraging and counselling seek to help. As the baby grows older, the mothers attend the clinics less frequently. The toddler sessions seek to obtain more regular supervision of the 2 5 age group, and mental defects and behaviour problems can be found before they become serious. Higher standards of health and physique among young babies over recent years is obvious, and there is an increased urge by parents to do their best This necessitates deep understanding, sympathy and tact on the part of health visitors and doctors. Health Education in Schools The programme of health education in secondary modern schools has continued and young mothers attending the child welfare clinics renew their acquaintance with health visitors from whom they have had guidance as adolescents. During the year talks were given and in the form of exp.eriinents, simple instruct ion was given to a group of educationally sub normal girls. Shortage of staff and other demands made on the health visitor prevented continuation and possible evaluation of the experiment. 57 School Nursing Service - The work undertaken by the school nurse has included preparation and attendances at routine medical and hygiene inspections, certain home visits to parents including those required for the follow up of defaulters from clinics. The discovering of minor defects and verminous conditions before these develop into natters of serious concern are the primary duties of the school nurse and are intended to fill the gap in between the routine medical inspections. Close contact between head teacher, class teacher and school nurse is maintained at all times. A new commonsense attitude of parents seeking the help and advice of the school nurse before conditions have a chance to affect others, replaces the old antagonism and feeling of parental guilt associated with infestation. In general the trend of the school nurses work is more preventive in character with opportunities for the school child to regard the school nurse as a friend. The duties of the full time school nurse at the School for the Physically Handicapped can be regarded as an integral part of the life of the school. She deals with minor ailments, attends medical inspections, carries out treatment prescribed by the school medical officer. She also visits the homes of the pupils where necessary and takes part in out of school activities. Section 25. HOME NURSING During 1961 one Queen's student undertook her three months district training. Four district nurses attended Refresher Courses, and six public health students accompanied nurses on observation visits. A total of 62,536 visits were made during the year. This is a decrease from the number made in the previous year owing to the admission of elderly sick patients to hospital at an earlier stage in the illness than formerly. Fewer visits to surgical patients were required owing to advanced treatment by doctors, therefore more time was spent by nurses in giving advice and help on social and domestic problems to the aged sick. During the year mechanical hoists were provided for four heavy, helpless patients and these enabled relatives to operate necessary lifting single handed. Section 36. VACCINATION AND IMMUNISATION Arrangements for vaccination against Poliomyelitis continued, as in the previous year, to be available to all persons between the ages of 6 months to 39 years plus certain groups who are at special risk because of their occupation, together with their families. Some interference with the programme of vaccination was experienced because of shortages of Salk vaccine but on the whole a fairly satisfactory number of primary vaccinations and reinforcing doses were administered. 58 Section 28. PREVENTION OF ILLNESS, CARE AND AFTER CARE Chiropody The re organisation of the Chiropody Service in the Health Area reported fully in my Report for 1960 operated very successfully during 1961 but the Area Sub Committee became concerned at the rather lengthy waiting periods between treatments at certain peripheral clinics In order to reduce these periods it was decided to transfer all patients under 45 years of age who had no special disability or whose circumstances did not merit special consideration, to the Town Hall Clinic where, because of the number of chiropodists employed they could be absorbed without unduly extending the waiting list there This arrangement was introduced in September and achieved a reduction of 2 to 3 weeks in the waiting periods at the Clinics concerned to the benefit of the more elderly and necessitous patients attending. Section 29. DOMESTIC HELP SERVICE The demand for home help continues to increase and assistance was given for 184,794 hours compared with 181,602 hours the previous year. The Night Attendance Service has continued to serve a small number of patients strictly on recommendation from doctor and has included many aged cases, affording great relief and appreciation from relatives often in desparate circumstances. This Service has become more widely known in recent months and a small staff of regular night attendants working an average of three nights a week has met all demands to date 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 E. 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 1960 cases. The ages of the mothers were 14 years (2); 15 years (3) 16 years (10) Most of the remainder were 17 or 18 years with one or two over 20 The relaxation classes arranged at the home by the health 59 visitors are of considerable help to the girls.' Admitted Adults Babies Total From Walthamstow 19 13 32 From rest of County 70 53 123 From outside County 2 2 4 Totals 91 68 159 Outdoor work: Walthamstow (Mothers and babies) 30 15 45 Other County cases 22 10 32 From outside County 4 4 8 Totals 56 29 85 In addition to the nineteen Walthamstow mothers admitted to the Home, Miss Williams made arrangements for ten others to enter homes elsewhere in the County, supervising further care on return to the Borough. WALTHAMSTOW CHEST CLINIC Dr. H. Ramsay, Consultant Chest Physician at the Walthamstow Chest Clinic, has contributed the following: - 'The number of cases of tuberculosis remaining on the Clinic Register at 31.12.1961 was:- Respiratory 1313 Non-Respiratory 105 1418 The clinic figures of main interest are set out below. They refer, of course, to the combined attendances of Walthamstow and Chingford patients. 1961 1960 Total Attendances 14,572 13,370 Total New Cases 5,408 5,249 Total X-rays 13,166 12,175 Total Screening 34 67 Miniature Camera 3,371 3,640 New Notifications 51 55 (W' stow only) Cancer of the lung steadily increases,and 71 cases were diagnosed at the Clinic during the year The total number of new cases of tuberculosis arising in the Clinic Area, i.e. Walthamstow and Chingford, was 69 of which 57 60 were cases of respiratory disease and 12 were non-respiratory, this is only three less than the previous year. Of the total number remaining on the Clinic register at December 31st 1961, 50 produced broncho pulmonary secretions positive for tubercle bacilli during the year. 'In addition to the work at the Clinic centre in Walthamstow there is a session each week at Chingford Hospital, where the total attendances in 1961 were 300 (new cases 281). 'On March 17th 1962, the Clinic finally moved to a new building at Whipps Cross Hospital where the service provided in the old premises in the High Street will be maintained in full.' 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 At the Annual Meeting of the Association in May 1961, we amended our Constitution to enable us to give help to patients suffering from chest conditions other than tuberculosis. The decision to do this was not reached without serious thought, particularly as the County Council were not prepared to agree to our using for these patients any monies derived from County Council grants. It was therefore necessary for us to establish a separate fund, and assistance to non-tuberculous patients was, of necessity, limited by the money available in that fund. We decided that, in general, we should give help with warm clothing bedding and fuel during the winter months and if possible, with holidays where these were recommended by the Chest Physician. Long-term help of the kind given to tuberculous patients by means of grocery vouchers etc., would not be possible without the certainty of a substantial income to this fund. A beginning has been made and it is hoped that in the not too distant future it may be possible to offer these other patients the full range of help now given to the tuberculous. During the year covered by this Report, a total of 100 individual cases was dealt with and help arranged as follows:- Milk 2 Grocery 30 Fuel 39 Pares to visit patients 2 Clothing and Bedding 25 Holidays 5 Christmas Grants 75 61 In addition to those listed above, special help was given to a patient disabled by arthritis. With the advice and co-operation of the Head Occupational Therapist at Whipps Cross Hospital where the patient was treated for tuberculosis, we were able to provide equipment to facilitate bathing following discharge and also to obtain attachments for knife and fork to enable him to deal more easily with his meals - a benefit not only to the patient but also to his wife who was relieved of considerable strain. 62 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 1961. Number of Walthamstow residents in accommodation provided under Section 21(1) (a) National Assistance Act, 1948. Number admitted to Residential Accommodation during 1961. Number admitted to Temporary Accommodation under Section 21 (l)(b) National Assistance Act, 1948. Blind Persons etc. Other Classes of Handicapped Persons Registered Registered Number employed in: Blind Partially Sighted Defective Sighted Home Workers Scheme Workshops Open Industry Male 59 Female 118 Total 177 Male 20 Female 43 Women 3 Children 9 226 59 26 6 36 200 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 1961 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 in 1962 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. An occupational centre for physically handicapped persons will be operating in the Borough in 1962. 63 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 415 Number of patients treated 325 Appointments made 3003 kept 2739 Plastic fillings 258 1167 Amalgam fillings 909 Inlays 6 Crowns 8 Scalings and gum treatments 320 Dressings 320 Extractions 314 General anaesthetics 55 Local anaesthetics 255 X rays 356 Impressions 545 Bites 135 Try ins 214 Pull upper dentures 67 176 total dentures Full lower dentures 42 Partial upper dentures 23 Partial lower dentures 44 Repairs 158 Minor Oral Surgery 16 Other Operations 376 Dental Laboratory [ Dentures Re pairs Re line Remakes Appliances Crowns Inlays General Dental Service 173 155 6 4 - 7 1 Walthamstow Committee for Education 42 34 - - 146 15 - Leyton Committee for Education 30 16 - - 83 4 1 Forest Divisional Executive Committee for Education 1 2 - - 20 - - Maternity and Child Welfare Patients 6 - - - - - - 64 Section 22. CARE OF MOTHERS AND YOUNG CHILDREN Notification of Births Domiciliary Institutional Live Still Live Still Notified births which occurred in the Area 474 5 1,691 32 Birth notifications transferred out to places outside the Area - 1 901 18 Birth notifications transferred in from places outside the Area 1 - 369 10 Care of premature infants (Weighing 5½lb or under) Born at Home 17 Born in Hospital or Nursing Home 85 Ante Natal and Post Natal attendances (Local Authority Clinics) New Patients - Ante Natal Post Natal Low Hall Lane Clinic 48 7 Silverdale Road Clinic 11 - West Avenue Clinic 2 - District Nurses Training Home and Midwives sessions held at Ante-Natal Clinics 395 TOTALS 456 7 Total Attendances Low Hall Lane Clinic 177 20 Silverdale Road Clinic 77 - West Avenue Clinic 8 - District Nurses Training Home and Midwives' sessions held at Ante Natal Clinics 2,196 - TOTALS 2, 458 20 Birth Control (Medical Grounds) New cases - Total attendances 21 65 Orthopaedic and Physiotherapy Clinic (Children under School Age) New cases seen by Orthopaedic Surgeon 18 Re-attendances 41 Children treated 10 Children attending for aftercare 15 Children attending for U.V.L 1 Paediatric Clinic (Children under school age) New cases:- Heart disease 2 Enuresis 2 Migraine 1 Hernia 2 Persistent vomiting 1 Coelic disease 1 Epilepsy 1 Development 6 Shortened fraenum 1 Eczema 1 Swelling in Chest 1 Total 19 Total attendances 36 66 Dental Clinics Patients inspected and treated during the year. Expectant Mothers Nursing Mothers Children under school age Patients examined 9 12 61 Patients found to require treatment 9 12 58 Patients who have commenced treatment 9 12 52 Patients who have completed treatment 4 9 19 Patients awaiting treatment - - - Attendance for treatment 16 33 72 Types of Treatment Given Extractions (a) Permanent teeth 3 6 (b) Temporary teeth - 78 Fillings - (a) Permanent teeth 6 17 _ (b) Temporary teeth - - 21 Inlays provided - - - Crowns provided - - - Anaesthetics administered - (a) Local 1 6 (b) General (i) by Medical Offrs. 2 5 - (ii) by Dental Officers - - 51 Scaling 1 1 - Prolonged scaling and gum treatment 2 - - Silver nitrate treatment - - - Dressings - 3 2 X-ray examinations - 2 1 Dentures provided - (a) Pull - - - (b) Partial - 2 - Dentures repaired - - - Dentures remade (a) Pull - - - (b) Partial - - Orthodontic appliances (a) Fixed - - _ (b) Movable - - - Prophylactic treatment and other operations 6 10 - 67 Child Welfare Brookscroft (Voluntary Scheme) Low Hall Lane Higham Hi 11 and Priory Court Silverdale Road West Avenue Winchester Road Total UNDER 1 YEAR First attendances 289 356 307 156 258 107 1,473 Subsequent attendances 4,106 4,541 4,537 2,348 3,881 1,603 21,016 Total attendances 4,395 4.897 4,844 2,504 4,139 1,710 22,489 1 YEAR OF AGE First attendances 12 19 8 13 11 1 64 Subsequent attendances 986 1,042 879 562 648 294 4,411 Total attendances 998 1, 061 887 575 659 295 4,475 2 5 YEARS First attendances 16 27 8 10 19 1 81 Subsequent attendances 559 1,355 739 478 614 235 3,980 Total attendances 575 1 382 747 488 633 236 4,061 Total attendances (all age groups) 5,968 7,340 6,478 3,567 5,431 2,241 31,025 Number examined by Clinic Doctor 794 1,732 1,253 504 742 390 5,415 Sessions held 103 122 150 127 119 51 672 68 Welfare Foods DISTRIBUTION CENTRE National Drier] Milk (Tins) Cod Liver Oil (Bottles) Vitamin Tablets (Packets) Orange Juice (Bottles) Brookscroft Welfare Centre 1 638 665 507 3,912 Low Hall Lane Health Services Clinic 1,774 521 435 3,745 Northcott House Distribution Centre 7,201 889 1,273 9,825 Higham Hill and Priory Court Health Services Clinic 2,465 479 514 4,191 Silverdale Road Health Services Clinic 850 503 411 4,206 Thorpe Coombe Maternity Hospital - 62 499 1,728 West Avenue Health Services Clinic 2,393 555 407 4,359 Winchester Road Infant Welfare Centre 484 333 249 3,126 TOTAL issues at Distribution Centres 16,805 4,007 4,295 35,092 In addition the following were issued to Hospitals (National Health Service) 714 _ 54 Day Nurseries 180 204 GRAND TOTAL OP ISSUES 17,519 4,187 4,295 35,350 Nutrients and Medicaments Sales Free Issue lbs. ozs. lbs. ozs. Adexolin - - 30 3 Bemax 107 61/2 - - Cow and Gate 5,202 - - - Parex 839 8 - - Glucodin 102 4 - - Lactagol 24 4 - - Maltoline with Iron - - 99 - Marmite 683 12 - - Milk of Magnesia - - 17 - Mist Perri et Ammon. Cit.Pro. Infantibus - - 3 14 Ostermilk 3.958 - - Robinson's Ready Cooked Groats 332 8 - - Scott's 'Twin Pack' 436 8 - - Virol 717 2 - - Trufood 298 - - - S.M.A 640 - - - Value of Cash Sales £2,286. 2. 5d. 69 Convalescence Mothers sent to Convalescent Home Children 2 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. HIGHAM 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 13 50 18 43 31 93 Total attendances during year 2,921 9,817 3,119 8,718 6, 040 18,535 Average attendances 11.5 38.6 12.3 34.3 23.8 72.9 50.1 46.6 96.7 Number of days open 254 254 Training Number of Students who gained certificate of National Nursery Examination Board 8 Future Careers (on leaving): In Dav Nurseries of other Authorities 2 Staff Nursery Nurse Special School 1 Staff Nursery Nurse Nursery School 1 Staff Nursery Nurse in U.S.A. 1 Teaching 1 Banking 1 Marriage 1 Daily Guardian Scheme No. of Guardians on Register at end of year 16 No of applications for services of Daily Guardians 57 Referred to Day Nurseries 48 Referred to Daily Guardian but nothing further heard 4 Placed with Daily Guardian 5 Continued in care of Daily Guardian from previous years 4 70 PROGRAMME OF CLINICS HELD AT DATE OF PUBLICATION MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY Town Hall A.M. Dental Foot Clinic Orthoptic Minor Ailment Ophthalmic (1st, 3rd & 5th) Dental Foot Clinic (School children) Orthoptic Optician Dental Foot Clinic Ophthalmic (1st,3rd & 5tl) Orthoptic Isiinor 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 Ophthalmic (2nd & 4th) 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 General Dental Service 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 Foot Clinic Infant Welfare Dental Foot Clinic Toddlers Clinic (alternate weeks) 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 Mother craft class Infant Welfare Foot Clinic Ante Natal/ Post Natal Foot Clinic Infant Welfarf Foot Clinic Evening Foot Clinic Foot Clinic Foot Clinic Foot Clinic West Avenue A.M. Foot Clinic Dental Foot Clinic (school children) Dental Foot Clinic Dental Foot Clinic Dental Foot Clinic P.M. Foot Clinic Dental Infant Welfare Dental Relaxation and Mothercraft Class Foot Clinic Dental Ante Natal/ Post Natal (twice monthly) Infant Welfare Dental Toddlers Clinic (alternate weeks) Foot Clinic Dental 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 (morning 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 Welfere Massage, Remedial Exercises and Sunlight Treatment Diphtheria & Whooping Cough Immunisation (Alternate weeks) 71 Section 23. MIDWIFERY Cases attended by Council Midwives MIDWIVES Domiciliary Midwives Home Nurse Midwives Total 1. Cases attended:- (a) No doctor booked or present at delivery 3 2 5 (b) No doctor booked but one present – – – (c) Doctor booked but not present 309 28 337 (d) Doctor booked and present 111 22 133 423 52 475* 2. Cases delivered in institution but attended by Council Midwives on discharge 53 12 65 3. Ante Natal Examination: (a) Patients' Homes 1,637 75 1,712 (b) Local Health Authority Clinics 2,201 95 2,296 (c) General Practitioners' Clinics 1,647 338 1,985 5,485 508 5,993 4. Lying-in visits 4,661 375 5,036 * Including three cases attended outside the Borough by arrangement, and one case confined in the Borough but normally resident outside the County of Essex. Administration of Trilene, and Gas and Air Analgesia Number of patients who received analgesia 434 Percentage of district confinements 91.37 Medical Aid Number of medical aid notices received .. 15 72 Place of Confinement During the year Walthamstow Mothers were confined as follows Forest Gate Hospital 30 Hackney Hospital 7 Mother's (Salvation Army) Hospital, Clapton 190 North Middlesex Hospital Edmonton 23 Queen Mary s Hospital E. 15 12 Thorpe Coombe Maternity Hospital 798 Wanstead Hospital 47 Other Hospitals or Nursing Homes 68 Total 1,175 At Home: Council Midwife present 471 Family doctor but not Council Midwife present 4 Total Confined 1,650 Section 24 HEALTH VISITING During the year the Health Visitors made 17,511 visits to homes. To expectant mothers:- First visits 595 Subsequent visits 121 To children under 1 year of age:- First visits 1,504 Subsequent visits 3,179 To children between the ages of 1 and 2 years - First visits 209 Subsequent visits 2,176 To children between the ages of 2 and 5 years 4;376 Other visits:- To the aged 1,776 Tuber colous households 1 After stillbirths 16 Special visits 1,235 Unsuccessful visits 2,323 Number of attendances by Health Visitors at Local Health Authority clinic sessions 688 Number of Health Education talks given in Schools 224 73 Section 25. HOME NURSING New Cases Total visits Medical 889 51,930 Surgical 126 7,040 Tuberculosis 5 468 Infectious diseases - - Maternal Complications - 25 Others 138 3,073 Totals 1,158 62,536 Number of visits (included above) to persons over 65 years of age 39,724 Section 26. VACCINATION AND IMMUNISATION Vaccination against Smallpox Age at date of vaccination Persons Vaccinated Persons Re-vaccinated Under 1 year 751 – 1 year 100 - 2-4 years 64 11 5-14 years 55 39 15 years and over 107 204 Total 1,077 254 Total vaccinated by local authority staff (included above) 506 52 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 1,038 - 1-4 years 322 160 5-9 years 172 963 10-14 years 28 183 Total 1,560 1,306 Total immunised by local authority staff (included above) 787 781 74 The 1,560 children who completed a full course of immunisation during the year received their injections at the following places - Schools 167 Welfare Centres 446 Town Hall Clinic 96 Brookscroft 78 General Practitioners' Surgeries 773 Total number of children under 15 years immunised at 31st December 1961 18,532 Immunisation against Whooping Cough Age at time of the final injections ChiIdren who completed a full course of immunisation during the year Records of combined diphtheria -pertussis immunisation received Under 6 months 6-12 months 1-4 years 5 years and over 803 400 144 42 185 182 72 29 TOTAL (primary courses) 1,389 468 Total immunised by local authoritv staff (included above) 667 Reinforcing injections 101 110 Poliomyelitis Vaccination Category Number of persons vaccinated (2 inject ions) During 1961 Total since scheme commenced (including vaccinations completed in 1961) Children born in years 1943/61 1,842 22,573 Persons born in years 1933/42 712 6,323 Persons born before 1933 who were under 40 years of age 1,637 3,997 Others (Special Groups) 23 277 Expectant Mothers 67 1,159 Totals 4,281 34,329 Third doses (all groups) 4,711 29,410 Fourth doses (School children only ) 5,219 5,219 75 B.C.G. Vaccination Category Number Skin Tested Result of Heat Test Vaccinated with B.C.G. Tuberculin Positive Tuberculin Negative School Children Students attending further education establishments 1,586 220 1,291 1,291 Totals 1,586 220 1,291 1,291 Section 28. PREVENTION OF ILLNESS, CARE AND AFTER CARE Chiropody New cases during year Cases being treated at end of year Clinic attendances during year Domiciliary treatments during year Pre school children 7 1 23 – School children 550 498 2,660 - Expectant Mothers 1 4 10 - Physically handicapped 1 2 24 - Aged (over 65 years of age) 571 1,860 6,285 707 Others 687 2,931 13,075 - Total 1,817 5,296 22,077 707 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) 1,273 1 Attendance at Chest Clinic sessions during the year 711 - Extra Nourishment Number of new cases during year supplied with free milk 41 Total number being supplied free milk at end of year 110 Rehabilitation Number of cases receiving rehabilitation treatment for whom financial responsibility accepted NIL 76 Loan of Sick Boom Equipment Number of issues made to patients during year 225 Number of articles on loan at end of year which had been on loan for:- (a) under 1 year 166 (b) 1 and under 2 years 76 (c) 2 and under 5 years 82 (d) 5 years and over 11 Convalescence for Adults Number of applications during year 67 Length of stay - One week 3 Two weeks 47 Three weeks 1 Pour weeks Of the 57 applications received, 32 were in respect of patients aged 65 years and over. Recuperative holidays were arranged and accepted by 24 of these patients whose ages ranged from 65 to 84 years. Health Education Teaching to groups by Departmental Staff No. o f Sessions Total At tendances (a) Clinic, Welfare Centres, Relaxation Classes 158 1,008 (b) School 224 6,341 (c) Professional Organisations - - (d) Parent/Youth/General Adult Group - - (e) Others 4 132 Total 386 7,481 Number of film shows given at sessions referred to above 17 Exhibitions in which department has participated - Section 29. DOMESTIC HELP Visits by Domestic Help Organisers Domestic Help Service Night Attendance Service First visits to homes 700 9 Re - visits to homes (a) Domestic help present 352 1 (b) Night attendant present - 2 (c) Help/Attendant not present 2,770 7 Other visits 360 13 77 Help provided Mater nity Acute Sick Tuber culosis Chronic Sick Aged not sick Others Total Aged Others Requests for help from new cases during the year 107 57 6 318 68 4 10 633 Cases not eligible for assistance or not requiring service 26 8 42 10 2 4 92 New cases helped during the year 81 49 6 339 58 2 6 541 Total cases completed during the year (a) 87 51 5 326 62 4 4 539 Cases being helped at end of year who have received help for Under 3 months 4 2 62 10 1 – 79 3-5 months Cincl.) 1 1 52 7 1 1 63 6 11 months find.) - 1 3 119 14 2 139 12 months & over - 13 561 54 4 635 Total (b) - 6 19 797 85 6 3 916 Total cases helped during the year (i.e. total of (a) and (b)} 87 57 24 1,123 147 10 7 1,455 Hours of help provided during the year 3,613½ 1,901½ 3,344½ 156,275¾ 17,700 1.11114 687 184793¾ Night Attendance Service Seriously ill patients residing alone Inability of aged husband or wife to care for seriously ill patients at night Relief of relatives who have to give routine night attention to sick people Cases completed during the year and helped for: 4 weeks & under – 1 8 Over 4 weeks – – 2 Total (a) – 1 10 Cases being helped at end of year who received help for: Under 3 months – – 3 Over 3 months – – 1 Total (b) – – 4 Total cases helped during the year (i.e. total of (a) and (b) – 1 14 Hours of attendance Provided during year – 10 1,149% 78 MEDICAL EXAMINATION OF STAFF Category No. of medical examinations County Council employees (a) Entrants to County Council's service 153 (b) Retirement on Superannuation 1 Walthamstow Borough Council employees 327 Entrants to teaching profession and training colleges 112 Others 6 Total 599 Printed in the Borough Treasurer's Department