4411(1) Mr. Paherson York House WAK 55 2. A 702, Elephant 3. Miss Mijouain, York House BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1962 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 1962 MELVILLE WATKINS, M.R.C.S., L.R.C.P., D.P.H. MEDICAL OFFICER OF HEALTH INDEX Page SECTION A - Statistics and Social Conditions of the Area 8 SECTION B - General Provision of Health Services in the Borough 12 SECTION C - Infectious Diseases 28 SECTION D - Sanitary Circumstances of the Area 35 SECTION E - Sanitary Circumstances of the Area - Statistics 40 SECTION P - National Health Service Act, 1946 - Part III Services 53 Page Acreage 8 Adulteration of Food 47 Ambulance Facilities 12 Ante-Natal Clinics 66 Assessments 8 B.C.G. Vaccination 77 Birth Control 66 Birth Notifications 66 Births 8 'Brookscroft' Welfare 72 Bungalows for the Disabled 31 Care of Mothers and Young Children 55,66 Census 1961 8 Chest Clinic 61 Chiropody 59,78 Clearance Areas 37 Clinics 72 Committees 4,53 Comparability Factor 11 Confinements 74 Convalescence 71,79 Cremation 16 Daily Guardian Scheme 71 Day Nurseries 71 Deaths from Accidents in the Home 11 Deaths, Infants 9 Deaths, Causes of 10 Dental Laboratory 65 Dental Treatment 55,68 Diphtheria Immunisation 76 Diseases of Animals Acts 39 Disinfections 16,40 Disinfestation 36 Page Domestic Help Service 59,80 Domiciliary Chiropody 59,78 Employment 11 Factories Act 1961 51 Five Decades of Life and Death 17 Food and Drugs Act 1955 38 Food Hygiene Regulations 1960 39,49 Flooding 17 Food Inspection 43 Pood Poisoning 29 Funeral Arrangements 16 Gas and Air Analgesia 73 General Dental Service 65 General Information 16 Hairdressers 37 Health Education 56,79 Health Centres 54 Health Services Clinics 65,72 Health Visiting 56,74 Home Nursing 57,75 Hospital Accommodation 13 Housing Act 1957 37 Housing, General 33 Housing, Inspection 43 Housing Statistics 32 Ice Cream 38,44 Immunisation 58,75 Improvement Grants 32 Infant Mortality 9.27 Infectious Diseases 13,28 Inquests Laboratory Facilities Page Land Charges 37 Laundry Service for the Incontinent 14 Legal Proceedings 39 Massage and Special Treatment 13 Maternal Mortality 9 Meals on Wheels Service 13 Meat and other Foods 38,45 Medical Examinations 16,81 Medicaments 70 Midwifery 55,73 Milk Supplies 37 Moral Welfare 60 Night Attendance 60,81 Notices, Sanitary 40 Nursing Homes 13 Nutrients 70 Old People's Welfare 13,14 Orthopaedic Treatment 67 Outworkers 52 Paediatric Clinic 67 Pet Animals Act, 1951 40 Poliomyelitis 29 Poliomyelitis Vaccination 77 Population 8,9 Post Mortems 16 Post Natal Clinics 66 Premature Infants 66 Prevention of Damage by Pests Act, 1949 40,49 Page Prevention of Illness 59,78 Public Health Inspection 35,40 Rainfall 17 Rateable Value 8 Rehousing on Medical Grounds 34 Rent Act, 1957 37,42 Rodent Control 49 Sampling of Food 38,47,48 Scabies Treatment 13 Sickroom Equipment 79 Smallpox Vaccination 75 Smoke Abatement 35,42 Social Conditions 8 Special Premises 41 Staff 12 Statistics 8,65 Stillbirths 9 Swimming Baths 36 Tetanus Immunisation 77 Toddlers Clinics 72 Tuberculosis 29,61,63,78 Vaccination 58,75 Verminous Premises 36 Vital Statistics 8 W'stow Assn. of T.B.Care Helpers 63 Water 36 Welfare Centres 69,72 Welfare Foods 70 Welfare Services 64 Whooping Cough Immunisation 76 4 HEALTH COMMITTEE 1962 - 63 Chairman: COUNCILLOR MRS. C.E. STANNARD Vice- Chairman: COUNCILLOR MRS. E.L. BALDWIN Ex- officio THE WORSHIPFUL THE MAYOR - ALDERMAN MISS D. WRIGLEY, J.P., THE DEPUTY MAYOR - ALDERMAN E.C. REDHEAD. J.P., M.P.. CHAIRMAN OP FINANCE COMMITTEE - ALDERMAN ROSS WYLD, O.B.E..J.P.. (Deceased) ALDERMAN G.S. MACE ALDERMAN MRS. W.M. PALETHORPE COUNCILLORS: C.G. ABLEY L. A. BAYLIS R.J.L. CAVE MRS. R. COLIN P. FURBER L.V. GRAHAM COUNCILLORS: J.H. HAMMOND C. A. LYONS J.E. NICHOLLS F.A.J. 0' SHEA MRS. B.M. REYNOLDS D. WEINSTEIN Medical Officer of Health: M. WATKINS, M.R.C.S., L.R.C.P. D.P.H. Deputy Medical Officer of Health: G.H. POOLE. M.B., B.S., D(Obst.) R.C.O.G., D.P.H. 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 beg to present my report upon the health of Walthamstow for the Year 1962. The preliminary report on the census taken in 1961 was published in January. It confirms the trends revealed in the yearly estimations of population. It shows a reduction of 10.2 per cent in the lalthamstow population since the 1951 census. In the same period the number of households decreased by 4.8 per cent, while the number of dwellings increased by 7 per cent. It is tempting to try to evaluate the changing social pattern on the evidence so far obtained but the information is insufficient for any worth while deductions. The only certain facts are that there is a decline of population and an increase in the number of dwellings. We must await the publication of the full report on the census which will give detailed information with regard to household amenities, basic standards, densities, occupation per room, etc. With the coming of the Re-organisation of Local Government in Greater London Walthamstow will merge with neighbouring boroughs to form one independent administrative area. It seems, therefore, an appropriate time to take stock and, for a moment, to glance backwards over the past 50 years of Public Health in Walthamstow. Such an exercise, apart from being of intense historical interest, can teach us many lessons. Dr. Poole has very competently reviewed this period. This follows in the report entitled "Five Decades of Life and Death in Walthamstow" . It reveals a satisfactory reduction in incidence and mortality and in some cases an almost complete disappearance of infectious diseases. Infant mortality has declined over the years and the expectation of life has been prolonged. Local Authorities can rightly congratulate themselves on the significant part that they have played in this process. But let us not be complacent. This very success has produced its own challenges, especially amongst the increasing numbers of the elderly and the greater survival rate among premature infants, in which a great number of defects and handicaps are found. There is also the advance of the venereal diseases. 6 The story of Infectious Diseases over the years is a resounding success for preventive measures. To treat and contain these diseases local authorities spent large sums of money building Isolation Hospitals and sanatoria. At the same time they strove with the utmost energy to make these very buildings unnecessary, so that today only a fraction of this type of hospital provision is needed. Can it be that this pattern will again be repeated in another content; that of the elderly? The great need today is for more hostel accommodation for the frail and enfeebled. But if the same preventive outlook and same philosophies are carried out by future Health and Welfare departments with equal vigour and dedication as in the past the need for merely custodial hostel accommodation should diminish rather than increase. While the march of Medical Progress enables a greater intensification of domiciliary care, both for mental and general medical cases, the multiplicity of specialities and workers tends towards fragmented care of patient and family, thus emphasising the need for co ordination and integrated services. In all this, Health Authorities and their comprehensive domiciliary services will have a vital role to play. December 3rd to 7th saw the arrival of the all too familiar but unwelcome visitor, fog It was almost ten years to the day that the disastrous fog of 1952 descended upon the country and was calculated to have caused 4,000 deaths in London alone. The conditions in both years were almost similar. Sulphur Dioxide concentrations were similar for both periods but smoke pollution was significantly lower in December this year. As far as Walthamstow is concerned the effect on mortality of this year s episode cannot be judged accurately as the numbers involved are too small to be of any statistical significance but the figure for the whole of London shows a striking fall from that of 1952. On the other hand the effect on morbidity or sickness rates is less easy to determine, but judged by the demands for hospital admissions and new claims to sickness benefit this showed a significant drop from that of 1952. although the claims were double that of the previous week. The reasons for the lowered incidence of mortality and morbidity due to this year s fog is difficult to determine. It would be gratifying to be able to say categorically that it was due to the efforts of local authorities in carrying out the provisions of the Clean Air Act. Even so. it is significant that although conditions were similar in almost all respects during the two episodes the one factor that differed was the marked reduction in smoke pollution this year. Another reason postulated was that those people most vulnerable to conditions of fog. on receiving timely press warnings, did not expose themselves unnecessarily. 7 With all the improvement recorded in infectious diseases over the years, more effective immunising materials are being constantly sought. During the year the Minister of Health authorised the introduction of Oral Poliomyelitis Vaccine, which is easily and painlessly administered. It promises to be a most effective weapon not only for the prevention but also for the control of an outbreak. This year also saw the introduction of immunisation against Tetanus and its inclusion in a combined triple vaccine for primary courses. Included in this report is an account by Mr. Southgate of the specially designed bungalows for the handicapped in Warburton Terrace. There is, of course, need for more, but it is gratifying to think that the Council have seen fit to make this provision notwithstanding the welter of demand for ordinary housing. This has a special interest for the Health Department as more and more time and attention is now given to the handicapped by all categories of our staff. I wish to thank Members of the Health and Health Area Subcommittees for their interest and support during the year; also to all members of staff. I am pleased to acknowledge my indebtedness to the many who have contributed to this Report. I have the honour to be, Your obedient Servant, M IATKINS Medical Officer of Health. 8 A STATISTICS & SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar General's Estimate, mid year 1962) 108,190 Number of Assessments (31st December 1962) 40,866 Rateable Value (31st December 1962) £1,804,484 Estimated Product of a penny rate (1962/63) £7,290 Census - 1961 The census of the population of England and Wales was taken on the 23rd April 1961 and from the Preliminary Report I have extracted the following information. The figures are, of course, provisional, and relate to the numbers only, by sex. of the population, and to the numbers of private dwellings and households. Populat ion Area 1961 1951 Intercensal Increase Persons Males Females Persons Males Females Numbers Per cent Walthamstow 108,788 51,884 56,904 121,135 57,068 64,067 12347 10.2 Private Households and Dwellings Private Households Private Dwellings Area 1961 1951 Intercensal 1961 1951 Intercensal Increase Increase Number Per cent Number Per cent Walthamstow 36,972 38,847 1875 4.8 35,537 33,213 2,324 7.0 Population 1931-1961 Population increase per cent per year Area 1931 1939* 1951 1961 1931-39 1939-51 1951 61 Walthamstow 132,972 130,000 121,135 108,788 -0.28 -0.60 1.06 * 1939 figures are mid year estimatip 9 Population:- The Registrar-General's Estimate of the home population at mid-year, 1962, is 108,190, a decrease of 670 on the previous year. The steady decline continues. This figure has been used for the calculation of the following statistics: - Live Births: Number 1566 Rate per 1,000 population 14.4 Illegitimate Live Births per cent of total live births 6.3 Stillbirths: Number 24 Rate per 1,000 total live and stillbirths 15.1 Total Live and Stillbirths 1590 Infants Deaths (deaths under 1 year) 25 Infant Mortality Rates: Total infant deaths per 1,000 total live births 16.0 Legitimate infant deaths per 1,000 legitimate live- births 15.0 Illegitimate infant deaths per 1,000 illegitimate live births 30.0 Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 total live births) 12.7 Early Neo-natal Mortality Rate (death under 1 week per 1,000 total live births) 12.7. Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 27.6 Maternal Mortality (including abortion): Number of deaths 1 Rate per 1,000 total live and stillbirths 0.6 Deaths. The Registrar-General's classification of causes of death by sex totals is given on page 10. 10 Causes of Death as given by the Registrar General for the Year 1962 Causes of Death Males Females Total 1961 1. Tuberculosis, Respiratory 5 5 7 2. Tuberculosis, other - - - 1 3. Syphilitic Disease 4 2 6 2 4. Diphtheria - - 5. Whooping Cough - - - - 6. Meningococcal Infections - - - - 7. Acute Poliomyelitis - - - - 8. Measles - - - - 9. Other Infective and Parasitic Diseases - - - 1 10. Malignant neoplasm, stomach 21 23 44 40 11. Malignant neoplasm, Lung. bronchus 55 20 75 81 12. Malignant neoplasm, breast 1 26 27 23 13. Malignant neoplasm, uterus - 9 9 10 14. Other malignant and lymphatic neoplasms 63 68 131 121 15. Leukaemia, aleukaemia 4 3 7 10 16. Diabetes 5 6 11 10 17. Vascular lesions of nervous system 65 83 148 154 18. Coronary disease, angina 160 81 241 251 19. Hypertension with heart disease 8 6 14 30 20. Other heart disease 54 85 139 165 21. Other circulatory disease 23 32 55 62 22. Influenza 7 3 10 9 23. Pneumonia 38 46 84 86 24. Bronchitis 54 29 83 82 25. Other diseases of respiratory system 6 5 11 10 26. Ulcer of stomach and duodenum 10 3 13 16 27. Gastritis, enteritis and diarrhoea - 4 4 6 28. Nephritis and nephrosis 3 1 4 6 29. Hyperplasia of prostate 8 - 8 8 30. Pregnancy, childbirth, abortion - 1 1 - 31. Congenital malformations 6 3 9 7 32. Other defined and ill defined diseases 25 65 90 95 33. Motor Vehicle Accidents 11 4 15 13 34. All other accidents 10 9 19 13 35. Suicide 4 6 10 4 36. Homicide and operations of war - - - - Totals 1962 650 623 1,273 - Totals 1961 684 639 ~ 1,323 The age distribution of Cancer deaths was as follows: Deaths from Lung Cancer are shown separately but are also included in the total age groups. Under 1 yr 1 4 yrs. 5 14 yrs 15 24 yrs. 25 44 yrs. 45-64 yrs. 65 74 yrs. 75 & over Total deaths 2 2 1 12 124 79 73 Lung Males 1 31 16 7 Females 2 8 4 6 11 The total number of deaths in 1962 (1273) compares with 1323 in 1961, the respective death rates being 11.76 and 12.15 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 1.03 The above factors, when applied to the crude rates, produce the following adjusted rates:- Live births 14.8 Deaths 12.1 Deaths from Accidents in the home Twelve deaths occurred in 1962 from this cause. All except 3 died at home. Ages and sexes were:- Pemale: 65, 65, 72, 73, 73, 75, 76, 86, 86 Male: 10, 70, 76 In order to put these and other deaths in proper perspective, the following comparison is made: - Cause of Death 1962 1961 (a) Suicide 10 4 (b) Motor Vehicle accidents 15 13 (c) All other accidents 19 13 (d) Accidents in the home (included in line (c) 12 6 (e) Tuberculosis 5 7 (f) Poliomyelitis Nil Nil Employment Contributed by Mr. A.J. Dechant, Manager of the Local Employment Exchange. 1. Insured population of the Boroughs of Walthamstow, Leyton, Chingford, Wanstead and Woodford:- Approximately 47,800 men and 37,700 women. 2. Insured population of the borough of Walthamstow:- Approximately 20,700 men and 14,850 women. 3. The number of persons placed in employment in the whole area during 1962:- Approximately 3,000 men and 1,500 women. These figures include approximately:- 219 disabled men and 64 disabled women. 4. The average number of persons unemployed in the whole area during 1962:- 1,000 men 200 women. These figures include approximately 100 disabled men 20 disabled women. 12 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 Mrs. D.L. Wood, S.R.N., Q.D.N., Infectious Diseases Nurse 21.5.62. Mr. I. Smith Pupil Public Health Inspector 10.9.62. Mrs. M. Brain, Clerk 15.10.62. Resignat ions Miss N. M. Tomlinson, S.R.N., S.P.N., Infectious Diseases Nurse 7.4.62. Mrs, G.R. Heath Clerk 24.8.62. Laboratory Facilities Arrangements continued with the Public Health Laboratory Service at Colindale. The number of specimens examined during the year was as follows:- Spec imens Total Faeces and rectal swabs 200 Nose and Throat Swabs 36 Food 2 Miscellaneous 4 Total 242 Ambulance Facilities These are available from a depot situated at Whipps Cross which is administered centrally from Chelmsford, via the Control Centre at Ilford. 13 Treatment of Scabies and Verminous Conditions The arrangement, detailed in the report for 1953. with the Hackney Borough Council, continued, and one case was referred there during 1962 receiving one treatment. Hospital Accommodation (a) Acute Cases - There were no major changes in 1962 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 34 New Cases 32 Brought forward from 1961 2 M.O.H. requests to Langthorne Hospital or Area Welfare Officer 14 Admitted to Hospitals 4 Admitted to Hostels 7 Died before admission 2 Refused Hospital or Hostel accommodation 7 Cancelled or deferred 6 Waiting for Hostel accommodation 4 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 1962. During the year the medical staff paid fourteen visits to the establishments registered for massage and special treatment. Old People's Welfare Association The Town Clerk, as Honorary Secretary of the Walthamstow Old People's Welfare Committee, informs me that the Committee's "Meals on Wheels" Service provided 34.752 meals (including a free Christmas dinner) during 1962. and for the month of January 1963. 3,233 meals, which is a record for any one month since the Service was inaugurated in March 1948. 14 The following table shows the services provided during the past five years: - 1958 1959 1960 1961 1962 Approximate number of meals served weekly 400 460 660 668 689 Number of people receiving meals 21,157 24,415 34,334 34,877 34,752 New Meals on Wheels cases occurring 80 81 112 180 164 Number of vehicles involved 6 6 7 8 8 To whom the vehicles belong Private hire Number of paid assistants 2 2 2 2 2 Number of voluntary assistants (on average) 60 65 60 70 68 Number of Social workers for the elderly 6 5 6 5 4 Number of visits annually 160 150 140 280 250 Laundry Service for the Incontinent This service continues for the assistance of those elderly persons where relatives are unable to cope with soiled linen. 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 1962: - Total number of persons - Walthamstow 28 Total number of persons - Woodford 10 Total number of persons - Chingford 1 Average number of cases per week 17 Total number of articles laundered 12,985 Average number of articles per week 250 Total number of journeys 1,391 Health and Welfare of the Elderly A pilot survey of the elderly in Walthamstow (described in the 1961 Report) disclosed a need for more case finding, informed advice, help and observation than was being provided by the Health Visitors or by voluntary agencies. Accordingly, the Health Committee was asked to approve the employment of the Department's Infectious Diseases Nurse on this work during any periods when she could be spared from her normal duties. This the members were pleased to authorise and when the post became vacant the newly appointed nurse, Mrs. D.L. Wood S.R.N. , Q.D.N,, was directed to visit all cases brought to her notice to assess their needs and procure whatever assistance could be provided. In this she was greatly aided by the Superintendent and District Health Visitors and by the Secretary of the Old People"s Welfare Association. 15 Mrs. Wood commenced duty on 21st May 1962 and during the ensuing seven months made 873 visits. A proportion of these were noneffective for various reasons but 585 effective visits resulted in 419 old people being found in need of help of some kind. In 56 cases the old people lacked sufficient clothing and all were supplied through the W.V.S. Only 8 of them were sufficiently able-bodied to attend the W.V.S. centre unescorted, another 8 were taken by car and in the remaining 40 cases the clothing was brought to their homes. There were 21 old people with inadequate bedding (one old gentleman slept on the bed springs covered only with a ragged blanket). 4 beds, 5 mattresses, and 12 sets of blankets and sheets were supplied. 40 old people previously unknown to the Department were referred to the health visitors and a further 55 assisted as follows:- 15 referred to (and received) National Assistance 8 referred to Housing Department 8 provided with Meals on Wheels 10 provided with Domestic Help 2 provided with Fire Guards 1 provided with Wireless Set 5 referred to the Blind Welfare Officer (3 subsequently registered as blind) 6 provided with Home Nursing The remainder were helped in less tangible ways by advice and encouragement, and it is impossible to gauge the value of this work in preventing breakdown in the physical and mental health of old people, especially those living alone in poor circumstances. Typical of the cases dealt with are the following examples:- 1. Mrs. A., a widow of 78, had begun to get into debt during her husband's last illness' She was wholly dependant on National Assistance and when brought to our notice owed £10 in rent. She was encouraged to try to pay this off but failed to keep up the payments and the debt increased to £15 and she was in danger of being taken to Court. The Glasspool Trust was approached and generously offered to provide a grocery allowance of 10/ d weekly provided Mrs. A. paid the current rent and 7/6d per week off the arrears. This, in conjunction with friendly visits each week, enabled the old lady to meet her commitments and undoubtedly spared her a great deal of anxiety during the closing period of her life, for she died a few months later. 2. Two spinster sisters aged 61 and 59, were found to be suffering from obvious malnutrition and on enquiry it emerged that both were attempting to subsist on the one old-age pension of the elder sister. The younger of the two was incapable of working and had no means whatever, so that they had only £2, 7. Od a week between them to cover, rent, fuel, light, clothing and food. In addition medicines had to be 16 bought for the younger sister who was incapacitated by severe migraine. They refused to apply for National Assistance and repeated visits had to be made before they finally yielded to friendly persuasion and consented to sign the forms. Now in receipt of adequate assistance their health has markedly improved. These cases, which could be duplicated repeatedly from the daily work of the health visitors, serve to illustrate the need to re-orientate the Health and Welfare Services towards greater provision for the elderly in the community. During the past five years the number of visits to old people had almost doubled, from 1,097 in 1958 to 2,152 this year, despite unfilled vacancies in the health visitors' establishment. When and if it becomes possible to raise (and fill) this establishment to the recommended level of one health visitor to each 4,000 population we should have about fifty per cent more staff to undertake this important and increasing task in Preventive Medicine. Meanwhile we are grateful to the Committee for authorising the auxiliary employment of Mrs. Wood on this workwhich she has carried out with such enthusiasm and efficiency. Funeral Arrangements Arrangements continued with regard to burials within the terms of the National Assistance Act, 1948. 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 Contributed by Mr. D.M.P. Sullivan, Borough Engineer and Surveyor. Cremation Facilities for cremation are available at the City of London Crematorium at Manor Park and also the Manor Park Crematorium, Manor Park. Inquests and Post Mortems Walthamstow Others Total Post Mortems Examination only 115 186 301 Post Mortems Examination and Inquests 16 50 66 Inquests only 6 69 75 137 305 442 17 Rainfall The annual rainfall at the Perry Lane Station was 22.37 inches. In 1961 it was 23.82 inches. Flooding Severe flooding occurred in many areas of the Borough on one occasion and in a limited number of areas on two further occasions. Five Decades of Life and Death in Walthamstow Contributed by Dr. Geoffrey H.G. Poole. When Walthamstow's first Medical Officer of Health, Dr. J.J.Clarke, wrote his Annual Report for 1911 he described conditions which, contrasted with those of today, show clearly the progress which has been made in preventive medicine and the public health during the past fifty years. Walthamstow, in those days, was a new town; the population of just over 125,000 had trebled in twenty years (from 46,500 in 1890). There were comparatively few old people and many more children in population (25,000 on the school rolls) but the expectation of life was only just over 50 years. The death-rate remained steady at 11.7 but the birthrate had begun to decline rapidly from 37 per thousand population in 1901 to 25.3 in 1911. Dr. Clarke comments:- "The influences tending to restriction of family seem 1 to be operative alike in town and country, and are probably due to the spread of education amongst the lower strata of the population, who seem less inclined than heretofore thoughtlessly to beget their kind, whose disabilities begin and end with life and death." A certain amount of pomposity was accepted, and even expected, from doctors in those days. Now we express ourselves rather differently about family planning. In the words of the Royal Commission on Population (1949) "Public policy should assume and seek to encourage voluntary parenthood." The comparatively high mortality in a predominantly young population was due, in large measure, to the incidence of infectious diseases which attacked about a thousand of the inhabitants every year. Table I shows the incidence of (then) notifiable infectious diseases contrasted with that of 1961 - TABLE I 1911 1961 Cases Deaths Cases Deaths Diphtheria (including Membraneous Group) 287 30 0 0 Erysipelas 114 8 8 0 Scarlet Pever 387 5 127 0 Enteric Pever 23 3 1 0 Puerperal Pever 4 2 0 0 Tuberculosis 207 167 50 8 1,022 215 186 8 18 Of the then non-notifiable diseases no estimate can be made but there were 130 deaths from diarrhoea and enteritis, 32 from measles and 19 from whooping cough. Over one third (503) of deaths from all causes (1,456) were in children under five years of age. In 1961 only 27 children died under the age of 5 and 16 of these deaths were in the first year of life. Only one death was classified under infantile diarrhoea compared with 116 in 1911 when Dr. Clarke reported: "Deathsfrom summer diarrhoea in infants are largely the result of an unclean food supply and unfortunately there is no standard for cleanliness of milk, although, in this respect, more important in relation to infant feeding in the third quarter of the year than a standard of quality. With the disappearance of the cleanly milkmaid, her place has been taken by the farm hand absolutely ignorant of the most rudimentary methods of scientific cleanliness, with the result that, at its source, a process of defilement of the milk takes place, which is continued right up to its destination. Delivered at the homes of the poor, into dirty or, at best, partially clean vessels, and stored in unsuitable places, the milk undergoes, under the influence of the summer heat, still further pollution, so that by the time baby receives it as food it teams with decomposing bacteria whose products are poisonous." While sharing his regret at the disappearance of "the cleanly milkmaid" one feels that Dr. Clarke would have approved whole-heartedly of the pasteurisation of milk, the supply of pure dried milks at welfare centres, and the enforcement of the Pood Hygiene Regulations, in connection with which the Public Health Inspectorate made over 2,000 inspections of food premises in Walthamstow during 1961. Pood poisoning, which had shown a progressive increase since the last war has, during the past year or two, begun to fall. Moving on ten years, to 1921, we find that little change has taken place in the size of Walthamstow; the population has increased by only 2,000 to 127,441. The birth-rate had fallen to 21.7 and the death-rate was exceptionally low at 9.5 (England and Wales 12.1, London 12.4). Real progress had been shown, however, in reducing the Infant Mortality Rate from 108.4 in 1911 to 61.4 per thousand in 1921. Infectious Disease was still rampant; an outbreak of scarlet fever affected 983 persons, but the death rate from notifiable infectious diseases, other than tuberculosis, had fallen to about one third of the 1911 figure. Dr. Clarke comments:- "Deaths from all these diseases are theoretically preventable, and no-one should die except from senile decay, but we have not yet attained that ideal." It must be admitted that neither have we, but we have made some progress towards it, the expectation of life at birth being now 68.1 years (73.9 for women) instead of 55.6 and 59.6 as it was in 1921. 19 Table II gives the incidence and deaths from notifiable infectious diseases in 1921:- TABLE II Cases Deaths Diphtheria 380 12 Scarlet Pever 983 5 Puerperal Pever 5 3 Pneumonia (number notified) 49 88 (actual) Tuberculosis 256 144 1,673 252 Dr. Clarke commented:- " Thirty per cent of those dying from tuberculosis have not been notified as suffering from the disease during their life-time, and death followed within three months of notification of 11 per cent" 'The Public Health administration as applied to tuberculosis is lame and halting and unsatisfactory" "Some years ago I made an effort to have the homes disinfected when vacated by Phthisical patients Such a procedure was declared by the Local Government Board as ultra vires, and a breach of faith as to the secrecy which was supposed to be attached to every notification." With a case mortality ratio of over 50 per cent for tuberculosis it is easy to appreciate Dr. Clarke's feelings and also why tuberculosis used to be known as " the Captain of the Men of Death". The deaths from all causes in 1921 totalled 1,237 and 231 or under l/5th occurred in children under 5 compared with more than twice this number ten years earlier. Most striking was the fall in the number of deaths from diarrhoea and enteritis, from 130 in 1911 to only 45. This, and the reduction of over 40 per cent in the Infant Mortality Rate emphasises the value of the work carried out at the Council's Infant Welfare Clinic at Truro Hall and at the "Brookscroft Voluntary Centre" in implementing the provisions of the Maternity and Child Welfare Act of 1918. Over 19, 000 attendances were made during the year, divided almost equally between the two centres. Nearly 3,000 domiciliary visits were made by nursing staff from Brookscroft and classes in Mothercraft. Infant Care and Needlework were well attended. Already a more modern picture is emerging, but it was by no means uniform school medical inspections disclosed one school where 6.7 Per cent of the children had active lice and 25 per cent had nits 20 The 1931 Report is made by Dr. Powell. Dr. Clarke having retired in the previous year. The population had increased to 132,965 and Walthamstow was now the largest Municipal Borough (NonCounty) in England. The birth-rate had dropped to 14.5, while the death-rate was steady at 10.4 the expectation of life had increased to about 60 years (Male 58.74, Female 62.88) and the population was beginning to approximate to a modern distribution, i.e., far fewer children and relatively more of the middle-aged and elderly. The Infant Mortality Rate was, however, little improved; from 61.4 in 1921 it had fallen only to 56 per thousand live births though this was still better than England and Wales (66) or London (65). It is said that the Infant Mortality Rate is a good index of the quality of the Health and Welfare services available, and it is gratifying to note that Walthamstow has been consistently in the lead in maintaining a low Infant Death Rate. Notifiable infectious diseases still accounted for much morbidity, Chicken Pox was made notifiable because of the local prevalence of Smallpox. Table III shows the incidence of Infectious Diseases in 1931. TABLE III Cases Deaths Smallpox 67 0 Scarlet Fever 451 2 Diphtheria 324 11 Enteric Fever 38 1 Pneumonia 211 108 Puerperal Fever 11 1 Puerperal Pyrexia 30 0 Ophthalmia Neonatorum 8 0 Erysipelas 61 0 Encepnalitis Lethargica 2 3 Cerebro-spinal Meningitis 1 0 Chicken Pox 1,260 0 Tuberculosis 190 108 Poliomyelitis 1 0 Several more diseases had been added to the list of those notifiable and there had been little improvement in the case incidence compared with previous years, but the case mortality ratio, that is, the number of deaths from diseases divided by the number of cases occuring, showed a dramatic fall, except for tuberculosis. Whooping Cough (14 deaths) and Influenza (20 deaths) were not then notifiable. Deaths in children under five totalled 155, only 11 per cent of the total (1,403). Over one third of these were due to congenital debility and malformation, premature birth, etc., which conditions nowadays account for the majority of infant deaths. Infantile Diarrhoea and Enteritis, the great killers of children in the two earlier decades, accounted for only eight deaths. 21 Tuberculosis, however, still killed 108 Walthamstow people in 1931 Dr. Powell wrote Reviewing the incidence of infectious diseases there was happily a diminished incidence in respect of the three main diseases. Thus smallpox only showed one third of the incidence of 1930 scarlet fever three quarters, and diphtheria some three fifths. Enteric fever, however, accounted for a total of 3 8 cases 33 of which were part of the Epping" outbreak. As a result of this experience I have no hesitation in stressing the necessity for the compulsory pasteurisation of all raw and ungraded milk. At least two important cities in the Country intend to promote the necessary legislation. The position may well be summed up in an extract from a recent article from the Public Health press The Americans, who are ahead of all nations in the hygiene of food handling insist upon pasteurisation of all milk except of what corresponds to our certified milk and be it noted the American drinks five times as much milk as the Englishman. But, be it noted also, in the States pasteurising plants are closely watched by the Health Authorities as distilleries are watched by the revenue officers in England. " I think we can claim that this ideal at least, has been attained. All milk sold in Walthamstow must be either tuberculin tested or heat treated and all dairies, pasteurising plants and distributors are licensed annually by the Corporation only after the Medical Officer of Health is completely satisfied with the standard of cleanliness maintained and the efficiency of the pasteurising process. Two hundred and four inspections were made in 1961 for this purpose while all other premises where food is prepared or sold were also subjected to close inspection. Dr. Powell also drew attention to the statement made by the then Chief Medical Officer to the Ministry of Health no Local Authority responsible for the health of children should be satisfied that it has done its duty until every parent knows that children can be protected against diphtheria with safety and reasonable certainty of complete protection. When these needs were so clearly seen and expressed it is remarkable that pasteurisation of milk was not made compulsory in London until 1951 and diphtheria immunisation was not generally adopted until 1940 Delay in the legislative and administrative machinery imposes such a time lag that, if progress is to be maintained, it is very necessary for the Health Committee and its Medical Officer of Health to be somewhat ahead of their time in recognising trends and anticipating needs. Walthamstow has evidently been fortunate in this respect. 22 1941 was described by Dr. Powell in an abbreviated unprinted report as dictated by the economy standards of the time. The population, due to evacuation and other effects of war. had fallen to 94,170 (it had been 130,000 in 1939). The birthrate was nevertheless maintained at 13.8 with the death-rate 13.3. The infant mortality rate showed only slight improvement over the past decade at 44.8 (56 in 1981) - it actually showed an increase of 1940 as did the Maternal Mortality Rate at 6.7 due no doubt to the inevitable interference of war conditions with the maternity servicss, Infectious Disease still played a major role in diminishing the health of the community; during the year 2,036 cases occurred as shown below, but most of the apparent increase was due to the inclusion of measles, accounting for more than half the total. TABLE IV Cases Deaths Scarlet Fever 117 0 Diphtheria 26 5 Enteric Fever 1 0 Pneumonia 138 83 Puerperal Pyrexia 38 0 Ophthalmia Neonatorum 3 0 Erysipelas 31 0 Cerebro-Spinal Meningitis 20 5 Measles 1,087 4 Whooping Cough 451 1 Poliomyelitis 1 0 Tuberculosis 116 61 In 1951 normal peace-time conditions were reported, the population was 120,900 and both the birth and death rates were very low at 13.5 and 10.8 respectively (National averages were 15.5 and 12.5). Not a single case of diphtheria occurred and Dr. Powell wrote:- "It is now estimated that if a non-immunised child catches diphtheria, the chances of dying from the disease are seven times greater than those of the immunised child. The need still remains to concentrate on the immunisation of as many babies as possible on reaching the age of nine months. At present about 40 per cent of the babies born annually are immunised before reaching the age of one year, but the target still remains at 75 per cent." This is equally true today when rather more than 50 per cent of babies are immunised in their first year. Immunisation had already dramatically reduced the morbidity and mortality from diphtheria but other infectious diseases were still prevalent though the case mortality rate had in all cases been greatly reduced, as shown in Table V. With only 37 deaths the case mortality rate of tuberculosis had fallen from 50 per cent to just over 30 per cent. 23 TABLE V Cases Deaths Scarlet Fever 118 0 Whooping Cough 742 0 Measles 2, 295 1 Pneumonia (notified) 84 100 (actual) Meningoccal Infection 5 0 Poliomyelitis 9 0 Dysentery 159 0 Ophthalmia Neonatorum 2 0 Puerperal Pyrexia 43 2 Typhoid and Paratyphoid Fevers 2 0 Food Poisoning 14 0 Erysipelas 33 0 Malaria 2 0 Tuberculosis 123 37 The Infant Mortality Rate, which had been falling comparatively slowly from 61.4 in 1921 to 44.8 in 1941, dropped almost 50 per cent to 23 in 1951 and the mortality from infectious diseases was greatly reduced although there were 21 deaths from influenza that year. Of the 742 cases of whooping cough none was fatal, and Dr. Powell wrote:- "Although the notifications of whooping cough were nearly twice the national rate, no death from the disease was recorded. The scheme of immunisation inaugurated by your Council (in 1947) and continued by the County Council has no doubt contributed materially to this position." A total of 2,510 children had been immunised against whooping cough, 494 in 1951. The 1961 report was made by Dr. Watkins, Dr. Powell having retired in 1959 after twenty-nine years as Medical Officer of Health, and again there had been striking changes in Walthamstow. The population, due chiefly to emigration to the New Towns, was falling steadily and had dropped to 108,860. Birth and Death rates at 14.4 and 12.6 compared well with national averages and the infant mortality rate was down to 15.7. The movement, predominantly of younger families, to homes outside the Borough and the general increase in the expectation of life were together producing an ageing population: more than 10 per cent of the population were estimated to be over retiring age and health and welfare problems among the elderly, especially those living alone, were making increasing demands on the Department. The 1961 report contains details of a pilot survey of the elderly and a number of papers describing the activities of the Health Department in meeting their needs. 24 Commenting on the survey, Dr. Watkins wrote:- "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 Just as with so many other conditions, prevention is better that cure, so our aim with the elderly should be to maintain them active, interested, and useful members of the community." Considerable progress had been made also in combating infectious disease as shown in the table. TABLE VI Cases Deaths Scarlet Fever 127 0 Whooping Cough 39 0 Measles 1,375 0 Pneumonia 53 0 Meningococcal Infection 1 0 Dysentery 44 0 Ophthalmia Neonatorum 1 0 Puerperal Pyrexia 103 0 Paratyphoid Fever 1 0 Food Poisoning 26 0 Erysipelas 8 0 Tuberculosis 50 8 Only 8 deaths occurred from tuberculosis and there were 50 new cases compared with 37 deaths and 123 new cases in 1951; it was clear that tuberculosis, like all the other infectious diseases, was being brought under control. B.C.G. vaccination against tuberculosis had been available to secondary school children and to contacts of the disease since 1954. and vaccination against poliomyelitis was commenced in 1956. As with diphtheria (no cases) and whooping cough (39 cases only) immunisation was proving its value and through constant vigilance and the prompt application of established methods of control infectious disease had largely ceased to be a problem. However the changes in population structure, increasing numbers of middle aged and elderly, as shown in Tables VII and VIII was producing a new set of problems in Public Health. 25 TABLE VII Expectation of Life at Birth Males Females 1911 51.5 55.35 1921 55.62 59.58 1931 58.74 62.88 1941 Not available 1951 66.42 71.54 1961 68.1 73.9 TABLE VIII Analysis by Age Groups of Total Mortality in Walthamstow Age Group 1911 1921 1931 1941 1951 1961 0 - 1 340 173 110 53 Not Available 24 1 - 5 163 78 45 18 3 5-15 79 50 41 22 4 15 - 25 67 68 66 34 12 25 - 45 196 199 154 125 39 45 - 65 296 283 354 334 316 65+ 317 406 633 667 925 Total 1,456 1,237 1,403 1,253 1,309 1,323 From Table VIII it is clear that three times as many Walthamstow citizens are now living beyond the age of 65 as did so fifty years ago and the relative number of pensioners is increasing quite rapidly. In 1911 infectious disease (pneumonia excluded) caused 407 deaths (28% of the total) and all forms of cancer only 102 (7%). By 1961 the corresponding deaths from Infectious conditions numbered only 12 (less than 1%) but the number of cancer deaths had risen to 285 (21½%). To some extent this increase is linked with the general ageing of the population but the most rapid increase in deaths has occurred in deaths from cancer of the lung, which caused 81 of 285 cancer deaths last year. While the causes of cancer, and of its increasing incidence, remain obscure we do know that air pollution and excessive cigarette smoking tend to produce lung cancer and the Council are whole-heartedly pressing forward a phased programme of Smoke Control Areas (of which a map appeared in the 1961 Report) designed to eliminate air pollution from the town and also supporting a campaign to discourage smoking especially among schoolchildren and young people. It is gratifying to see practical efforts being made to overcome one of the worst scourges of our generation but I can confidently Predict that whoever carries out the next fifty years survey will wonder why, out of a truly astronomical National budget, we spend so little on medical research that the Imperial Cancer Research fund has to raise money by selling flags in the streets. 26 Apart from Cancer (21½%), the chief causes of deaths in Walthamstow were diseases of the heart and blood vessels (566 - 43%) and respiratory diseases, especially chronic bronchitis (187 - 14%), the only other major cause of death being accidents, both home and road, which killed 83 Walthamstow people in 1961. We cannot say, as Dr. Clarke did of infectious diseases in 1921 Deaths from all these diseases are theoretically preventable" although some of them are. Infant mortality has come down from 108.4 per thousand to 15.7 and the majority of such deaths now occur in the first few hours or days after birth because of congenital abnormalities or gross prematurity: Mortality among pre school children in Walthamstow has fallen from 163 to 3 and of school-children from 79 to 4, The general health of children is now so good that the two most frequent causes of death in the 1 - 14 age group are accidents and cancer (Office of Health Economics Report, December 1962). The changing picture of infectious disease and of morbidity and mortality in childhood has been reflected in a gradual re-orientation of the services provided by the Health Department. It is now possible for the Infectious Diseases Nurse to spend some part of her time assisting old people, the health visitors too, find it necessary to spend an increasing proportion of their time seeing to the welfare of the elderly, especially those living alone. Eighty per cent of the Home Helps are provided because of infirmity due to age and approximately the same proportion of the District Nursing Service is devoted to old people. It would be economically impossible, even if it were desirable, to provide sufficient old people's homes to accommodate all those old people who are not being adequately looked after by their relatives, and this growing problem can best be met by providing staff and facilities to enable effective preventive medicine to be practised, to maintain as far as possible the health and independence of the elderly in their own homes. This, with the health and welfare of the mentally and physically handicapped, and the community care of the mentally ill will prove the greatest challenge to the Local Authority Health and Welfare Service now and in the future and it is to be hoped that the members and officers of the new authority will be as successful in dealing with these problems as their predecessors were with infectious diseases. 27 28 C. - INFECTIOUS DISEASES The following table shows the ward incidence of the various infectious diseases which were notified during the year:- Disease St. James Street High Street Hoe Street Wood Street Hale End Higham Hill Total Scarlet Fever 12 4 7 13 22 17 75 Whooping Cough 11 1 4 7 6 11 40 Measles 5 5 11 23 26 24 94 Diphtheria - - - - - - - Pneumonia 11 1 6 7 8 5 38 Meningococcal Infection - - - - - - - Acute Poliomyelitis Paralytic - - - - - - - Non-Paralytic - - - - - - - Acute Infective Encephalitis - - - - - - - Post Infectious Encephalitis - - - - - - - Dysentery - 2 - - 1 2 5 Ophthalmia Neonatorum 11 - - - - - 1 Puerperal Pyrexia 2 2 14 41 1 2 62 Smallpox - - - - - - - Paratyphoid Fever - - - - - - - Typhoid Fever - - - - - - - Food Poisoning 1 2 1 2 2 15 23 Erysipelas 5 1 1 1 5 5 18 Malaria - - - - - - - Tuberculosis Respiratory 9 6 4 3 9 11 42 Meninges and Central Nervous System - - - - - - - Other Forms 1 1 3 - 1 3 9 Totals, 1962 58 25 51 97 81 95 407 Totals, 1961 164 192 275 357 469 371 1,828 29 FOOD POISONING Nineteen cases were notified during 1962 and none was fatal. There was one small familial 'outbreak', in which the infecting agent was Salmonella Kiambi; and two in which the agent was not identified. One of the single cases was due to Salmonella Typhi-murium, and in three cases the infecting agent was Salmonella Kiambi, Staphylococci and C1. botulinum respectively. 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 1962:- Age Periods NEW CASES DEATHS Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F Under 1 year - - - - - - - - 1-4 years - - - - - - - - 5-9 years 1 - 1 1 - - - - 10-14 years 1 - - - - - - 15-19 years 2 - 1 - - - - - 20-24 years 1 4 1 - - - - - 25-34 years 4 2 2 - - - - - 35-44 years 5 1 2 - - - - - 45-54 years 7 - - - - - - - 55-64 years 8 - 1 - - - - - 65 and over 4 2 - - 5 - - - Totals 33 9 8 1 5 - - - 42 9 5 - 51 5 30 TUBERCULOSIS-NOTIFICATION AND DEATH RATES The following graph shows the trend of notification of tuberculosis 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. 31 HOUSING Bungalows for the Disabled - Warburton Terrace Contributed by Mr. F.G. Southgate, A.R.I.B.A.,Borough Architect. The bungalows have been designed for the use of persons who, though disabled, are capable of caring for themselves with a minimum of help. Siting: The bungalows have been sited at the rear of the existing Council properties in Sturge Avenue and form part of a scheme comprising 20 bungalows and 62 lock-up garages. Those for the disabled persons have been interspersed with those for normal persons so as to avoid the feeling of a 'colony'. The living rooms have a southwesterly aspect and overlook the playing fields of the Monoux School. Each bungalow has been provided with a 'car-port' . Planning Generally: The circulation space between rooms has been kept to straight corridors for the easy manipulation of invalid chairs and the halls are sufficiently large to allow for the storage of an invalid chair. Doors to the living rooms are of the double swing type that can be pushed open by the foot of the chair; other doors are of the light sliding type on overhead tracks. Entrance doors are reached by means of an 'easy' ramp with special thresholds for draught exclusion. Bathrooms have been enlarged over the normal size to allow for easy manoeuvring of invalid chairs with sufficient space at the side of W.C. pans for an invalid chair to be wheeled alongside. W.C. pans will be raised if required. Grab-rails will be provided to suit the needs of individual tenants. Shallow type baths have been used with a special pulley type bath plug so that the invalid will not have to reach down to remove the plug and side mounted valves. An additional W.C. and lavatory basin have been provided for the use of able persons who may be visiting or living in the bungalows. Kitchens: Working top levels have been lowered to 2'6" from the floor. Living Rooms and Bedrooms: Windows throughout have been designed to open from a sitting position with opening sublights instead of fanlights. Floor finishes throughout are in mastic asphalt. Heating: The heating is by warm air from a self-igniting gas unit; this provides background heating to the living room, hall and kitchen and by overspill to the outer rooms in the bungalows. In addition, electric fires are provided in the living room and main bedroom. Electrica1 Installations: Switches and plugs for electric apparatus are fixed at waist level and rewirable fuses are dispensed with and circuit breakers used. 32 Statistics Houses completed by the Local Authority 1962 Hoe Street Ward 32 Flats St. James Street Ward 2 Flats Higham Hill Ward - - High Street Ward 42 Flats Hale End Ward 20 Houses Wood Street Ward 2 Flats 12 Houses 78 Flats 32 Houses Houses completed by Private Enterprise Hoe Street Ward 8 Flats St. James Street Ward - - Higham Hill Ward - - High Street Ward 23 Flats Hale End Ward 12 Flats 1 House Wood Street Ward 9 Flats 1 House 52 Flats 2 Houses Note: All were permanent houses and flats In addition to the main building programme, improvements and conversions were carried out at a number of Council owned properties. Improvement Grants Applications received from owner/occupiers:- Discretionary 103 Standard 106 Total number of grants and amounts approved by Council to owner/occupiers:- Discretionary 81 £20,937 Standard 60 £8,120 Applications received from Warner Estate Ltd. Discretionary 48 Total number of grants and amounts approved by Council to Warner Estate Ltd. Discretionary 56 £11,378 Summary Total number of applications Discretionary 151 Standard 106 33 Total number of grants Discretionary 137 Standard 60 Total amount of grants Discretionary £32,315 Standard £8,120 Families rehoused:- 1-bedroom group 97 2-bedroom group 192 3-bedroom group 203 4-bedroom group 17 Total 509 Property under management at December 1962:- Pre-1939 houses and flats 1,614 New houses and flats 3,080 Properties at Canvey Island 206 Properties at Billericay 441 Prefabricated bungalows 64 Properties converted into flats 306 Properties acquired for housing purposes 901 Properties for Clearance and Demolition 328 Requisitioned dwellings - Halfway houses 2 General Properties 32 Commercial Properties 74 Garages 1,112 Total 8,160 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 1962:- No. of new properties made available for letting 111 Acquired 93 Normal vacancies 99 Nominations to private landlords 24 New properties at Canvey 49 New properties at Billericay 133 Total 509 The number of families rehoused in New Towns during 1962 was 92. 34 The following extracts are taken from the Annual Report of the Housing Management Committee:- Rehousing During 1962 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 43 'D' Families living apart 5 'E' Irregular overcrowding 76 'G' Two refusals of alternative accommodation 1 'K' Three or more families (relatives) in House - 'H' Transfer of priority housing - 'J' Special cases 54 'J' Rehousing subject to nomination 12 M.O.H. Medical recommendations (T.B.) 3 M.O.H. Cases for consideration 6 Special requests for emergency accommodation 36 Total 236 MEDICAL CASES During 1962, eleven cases claiming rehousing priority for tuberculosis were investigated and reported upon. Of these eleven cases were added to the list. The position at the end of 1962 was as follows:- Class 1 Class 2 Class 3 Class 4 Total On list at end of 1961 2 3 9 - 14 Added to list during 1962 2 1 3 5 11 4 4 12 5 25 Rehoused or removed from list during 1962 2 - 1 - 3 On list at end of 1962 2 4 11 5 22 In addition to the tuberculosis cases, twelve other cases were recorded as needing special consideration on medical grounds and seventy-six on general grounds. 35 D. SANITARY CIRCUMSTANCES OF THE AREA Contributed by Mr. W. Richards, Chief Public Health Inspector. Public Health Inspection of the Area During the year 531 Intimation Notices were served; 91 were in respect of business premises and 440 related to defects in private houses. Of the latter figure, 367 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 of property for non-compliance with these notices in 4 cases. Orders were made as follows - 28 days with £2.2.0. costs, 28 days with £1.1.0. costs, 21 days with £2.2.0. costs and 28 days without costs. 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 142. 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 surveys in respect of Smoke Control Areas Nos. 4 and 5 were completed during the year and Orders were confirmed by the Minister of Housing and Local Government. These Orders will come into operation next year. By the end of the year a number of fireplaces in these areas had been converted to burn smokeless fuels. There were two objections lodged with the Minister of Housing and Local Government in respect of Smoke Control Area No. 3. A Public Inquiry in respect of these objections was held by the Minister during the year. As a result of this Inquiry a large factory was excluded from the operation of the Order. This Order was confirmed (as amended by the Minister) later in the year and will come into operation next year. 36 The inspections of premises in Smoke Control Areas Nos 6, 7 and 8 were commenced and were still proceeding at the end of the year. Water Supply The whole of the area is supplied by the Metropolitan Water Board and the standard has been satisfactory both in quality and quantity. Bacteriological and chemical examinations of supplies are carried out by the Metropolitan Water Board. The water supplied is not plumbo solvent in action; no cases of lead contamination or other forms of contamination have been found. All the dwelling houses and the population in the area are supplied direct from the water mains, by means of piped supplies to the houses. Verminous Premises The number of dwelling houses reported to be infested with vermin remains comparatively small. Fifty five rooms were disinfected and insecticides were issued, free of charge to eight 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. Contributed by Mr. B.M.F. Dixon, manager of Walthamstow Baths. "From January 1st to December 31st the Baths were open on 3 00 days. The number of Swimming Bath bathers was 14,297 whilst 85,078 hot baths were provided. 8,257 Pensioners took advantage of the free bathing facilities. 1,267 Steam Baths were taken from July when the service started. Sampling was carried out with very good results. Sewerage Arrangements for sewerage and sewage disposal in the district are reasonably adequate. 37 Hairdressers Eighty eight premises are registered under the Walthamstow Corporation Act 1956. Inspections of these premises were carried out under the Bye Law requirements and most were found to be in a reasonable condition. Rent Act, 1957 This Act empowers the landlords of dwelling houses to increase rent provided the property is in good repair. On receipt of a notice of increased rent from the landlord, the tenant, if he considers that the property is not in good repair, must serve a notice on the landlord specifying the works he considers should be carried out. If the landlord does not carry out the works specified or does not give an undertaking to carry out the work, within six weeks, the tenant may apply to the Council for a Certificate of Disrepair. This Certificate, if issued, will enable the tenant to deduct any increase already paid from the date of 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, 1957. Section 81 Applications for "permitted number" were received from landlords and certificates issued during the year respecting 24 lettings. Local Land Charges Enquiries relating to outstanding sanitary notices were dealt with in 1,882 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 74 samples of milk were taken and submitted to the Counties Laboratories for bacteriological examination, including Phosphatase, Methylene Blue and Turbidity tests. 38 These samples of milk were mainly taken from roundsmen during the course of delivery, or on arrival at schools. They include monthly 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. 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 were 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 unsatisfactory, 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 Food There is no slaughterhouse 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 consumption. 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 106 samples were submitted to the Public Analysts for chemical 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.C., of 20 Eastcheap, London, E.C.3. and bacteriological examinations by the Counties Public Health Laboratories, Thresh House. Verulam Street, Gray's Inn Road, London, W.C.1. 39 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 maintained throughout the district. 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 1962:- Food Hygiene (General Regulations, 1960, Sections 9(e), 33(i), 34. Smoking whilst serving open food (one case). Court awarded Penalty of £5 and £2.2.0. Costs. Food and Drugs Act, 1955, Sections 2, 8 and 106. Foreign matter in bread (one case). Court awarded £5.5.0. Costs. Rodent excreta in bread (one case). Court awarded Penalty of £5 and Costs £5.7.0. Blackcurrants affected with mould. Case dismissed. Common Lodging Houses There are no common lodging houses in the area. Rag Flock and other filling materials Act, 1951 No applications for approval were received during the year and all premises registered or licensed under the Act were inspected. Diseases of Animals Acts Swine Fever (Infected Areas) Order, 1953. No licences were issued during the year. Fowl Pest Order, 1936. No Orders were issued during the year. Foot and Mouth Disease Orders. No Order was issued during the year. 40 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 inspections made No. of nuisances remedied No. of complaints received No. of Intimation Notices No. of Statutory Notices Total Visits Served Complied with Served Complied with 17,862 2,706 1,618 531 519* 73 87* 23,882 * Includes notices outstanding from previous year. The following table shows the nature of work executed and improvements effected during the year: Drains tested, 402, drains reconstructed or repaired, 237; drain obstructions removed, 119; drains, means of access provided, 44; drains, ventilations provided or improved, 14; soil pipes renewed or repaired, 80; rainwater pipes repaired or renewed, 50; roofs repaired or renewed, 158; gutterings repaired or renewed, 116; W.C. pans and traps provided, 100; W.Cs repaired or cleansed, 78; W.Cs' lights and ventilation improved, 3; gully traps provided, 59; waste pipes repaired or renewed, 49; new sinks provided, 6; stoves and firegrates repaired or renewed, 24; water supply re instated, 10; yard and forecourt pavings repaired, 37; dirty houses cleansed, 7; dirty rooms cleansed, 19; floors repaired, 69; ventilation under floors provided or improved, 16; dampness remedied, 244; offensive accumulations removed, 24; manholes repaired or resealed, 68; miscellaneous repairs, 640; animals improperly kept, removed, 4. Infectious Diseases Visits to premises, 65. Disinfections Rooms disinfected, 10; articles disinfected, 4,298; articles destroyed, 22. 41 Special Premises Number Visits paid Factories (a) Non-power 31 35 (b) Power 476 190 (c) Other premises 18 7 Outworkers 250 250 Butchers 85 187 Bakers and shops 42 73 Fishmongers, Fryers and Curers 33 85 Cafes and Caterers 91 219 Grocers 219 406 Greengrocers 75 76 Ice Cream Manufacturers 5 22 Ice Cream Vendors 413 224 Dairies 2 16 Milksellers 135 142 Ladies' Hairdressers 42 51 Gentlemen's Hairdressers 31 53 Rag Dealers 1 1 School kitchens 24 69 Street Stalls 150 411 Schools 61 32 Public Houses 38 47 As a result of the regular periodical visiting of the above premises, the following works were carried out: Butchers Cleansings, 12; accumulations removed, 8; new bins provided, 6; W.Cs repaired and cleansed, 2; other improvements, 10; floors repaired and ventilated, 1. Bakers Cleansings, 6; floors repaired, 3; other improvements, 5. Fishmongers Cleansings, 3; drains cleared, 1; accumulations removed, 5; other improvements, 4. Cafes and Caterers Cleansings, 20; floors repaired, 6; kitchen light and ventilation improved, 3; other improvements, 40. Grocers Store rooms cleansed, 8; washing accommodation improved, 1; other improvements, 11. Greengrocers Store rooms cleansed, 2; other improvements, 4. Ice Cream Manufacturers and Vendors Cleansings, 1. Hairdressers Improvements, 5. Public Houses Cleansings, 3. Schools W.Cs repaired and cleansed, 1; flush cisterns repaired, 1. 42 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 3.0 2.1 2.2 1.3 1.1 0.60 Willow Walk site 2.4 1.7 1.9 1.2 0.86 0.65 Woodford County High School 1.7 1.4 1.4 0.73 0.62 0.82 Blackhorse Lane site 3.2 1.9 1.9 0.76 0.96 0.65 July Aug: Sept: Oct: Nov: Dec: Sir George Monoux Grammar School 0.72 0.76 1.3 1.9 3.1 3.0 Willow Walk site 0.88 0.65 0.88 1.6 2.7 2.9 Woodford County High School 0.60 0.52 0.65 1.1 2.1 2.3 Blackhorse Lane site 0.89 0.71 1.3 2.1 3.1 2.9 The above figures are similar to those obtained by adjacent authorities and are lower than those given for Central London, the highest figure for Central London being 6.5. Rent Act, 1957 The following action was taken under the Act during 1962: Part I Applications for Certificates of Disrepair (1) Number of applications for certificates 11 (2) Number of decisions not to issue certificates - (3) Number of decisions to issue certificates (a) in respect of some but not all defects 6 (b) in respect of all defects 5 (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 1 (6) Number of certificates issued 4 Part II Applications for cancellation of Certificates (7) Number of applications by landlords to Local Authority for cancellation of certificates 2 (8) Number of objections by tenants to cancellation of certificates 2 (9) Number of decisions by Local Authority to cancel in spite of tenant's objection - (10) Number of certificates cancelled by Local Authority 1 In addition to the above, 13 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 13 applications, 10 certificates were issued and the remainder (3) were not granted. 43 Housing Inspections 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) 1,294 (b) Number of inspections made for the purpose 3,769 (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 7 (b) Number of inspections made for the purpose 10 (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) 16 (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 440 II. Unfit houses closed:- (1) Under Sections 16(4), 17(1) and 35(1), Housing Act, 1957 16 (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 367* (2) After formal notice under (a) Public Health Acts 87* (b) Sections 9 and 16, Housing Act, 1957 3* (3) Under Section 24, Housing Act, 1957 - * Including those notices outstanding from previous years. Inspection and Supervision of Food Details of Milk Samples taken: Grade No. of Samples Satisfactory Result Pasteurised 30 30 Sterilised 4 4 Tuberculin Tested Pasteurised 40 40 Totals 74 74 44 Milk (Special Designations) Regulations 1960. As from the 1st January, 1961, these Regulations brought into force new forms of licences and periods 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 127 Pasteurised 85 Tuberculin Tested 29 There are no cow-keepers in the district. The number of Retail Milk Distributors is 135. One hundred and forty-two visits were paid to registered premises and a satisfactory standard of cleanliness was maintained. Ice Cream Thirty applications for registration were received and were dealt with as follows:- Vendors, New 8 Vendors, Transfers 18 Applications refused 4 Number on Register at end of year 413 Number of premises used for manufacturing 5 Food Standards (Ice Cream) Order, 1951 Six samples of ice cream were taken and submitted to the Public Analysts who reported the following satisfactory results:- Fat Content 6.9 12.7 12.5 9.8 12.0 9.4 Bacteriological Examination of Ice Cream Sixty-three 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 35 Grade II 18 Grade III 6 Grade IV 4 45 Lollies (Various ) Nine water ice samples were examined for bacterial purity and all were satisfactory. 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. 199 tins Evaporated Milk 238 tins Peaches 1 tin Condensed Milk 94 tins Pears 21 tins Pull Cream Milk 5 tins Rhubarb 33 tins Cream 1 tin Gooseberries 52 tins Coffee 44 tins Grapefruit 11 tins Malt Beverage 38 tins Apricots 647 tins Soup 214 tins Pineapple 6 tins Strained Food 38 tins Prunes 224 tins Baby Poods 3 tins Blackberries 65 tins Junior Poods 16 tins Plums 222 tins Creamed Rice 25 tins Grapefruit Juice 1 tin Chocolate Pudding 1 tin Apple and Apricot Juice 3 tins Treacle Puddings 1 tin Apple and Pineapple Juice 7 tins Jam 11 tins Pineapple Juice 15 tins Syrup 44 tins Orange Juice 9 tins Macaroni 1 tin Ginger Beer 4 tins Beetroot 21 tins Tomato Juice 60 tins Beans 11 tins Vienna Sausages 1 tin Broad Beans 91 tins Steak 18 tins Butter Beans 3 tins Meat Pudding 306 tins Baked Beans 1 tin Veal and Ham 4 tins Beans & Sausages 1 tin Irish Stew 31 tins Beans/Pork 2 tins Ravioli 6 tins Curried Beans 2 tins Tongue 363 tins Peas 3 tins Beef Loaf 53 tins Spaghetti 1 tin Minced Beef 3 tins Asparagus 1 tin Sweet Corn 39 tins Carrots 2 tins Pease Pudding 13 tins Vegetable Salad 90 tins Salmon 248 tins Tomatoes 2 tins Crab 55 tins Mixed Vegetables 25 tins Pilchards 5 tins Potato Salad 15 tins Sild 2 tins Sauerkraut 94 tins Kippers 3 tins Tomato Puree 31 tins Roes 54 tins Fruit Salad 6 tins Cheese Flaps 32 tins Cherries 34 tins Confectionery 107 tins Mandarin Oranges 41 tins Drink Crystals 1 tin Mandarins & Peaches 33 tins Baking Powder 46 5 tins Custard Powder 5½ lb Cereals 12 jars Herrings 3½ lb Sultanas 1 jar Cucumber 23½ lb Currants 2 jars Onions 3¼ lb Raisins 8 jars Lemon Cheese 15 lb Margarine 6 jars Marmalade 5 lb Cheese 63 jars Jam 101 pckts Peas 5 jars Potted Meat 12 pckts Mixed Vegetables 3 jars Pickles 12 pckts Spinach 1 jar Meat Extract 28 pckts Beans 2 stone Haddock 6 pckts Broad Beans 9 stone Skate 8 pckts Brussel Sprouts 111 botts Sauce 18 pckts Chips 16 botts Horseradish 7 pckts Pie Fillings 2 botts Nut Oil 12 pckts Pastry 2 botts Lemon juice 28 pckts Cake Mix 14 botts Essence of Rennet 72 pckts Sponge Mix 435 lb Meat (various) 1487 pckts Custard Powder 270 lb Steak and Kidney 95 pckts Jelly 21½ lb Steak 397 pckts Blanc Mange 631½ lb Corned Beef 12 pckts Fruit Drink 12 lb Corned Mutton 8 pckts Chocolate Eclairs 209¼ lb Luncheon Meat 3 pckts Nuts 240¼ lb Chopped Pork 19 pckts Chocolate 18 lb Tongue (tinned) 351 pckts Pudding Sauce 306½ lb Ham (tinned) 3 pckts Pigs' Livers 66½ lb Ham 1 pckt Pork Chops 65¼ lb Pork (tinned) 5 pckts Lamb Chops 221¼ lb Pork 6 pckts Stewing Steak 99¾ lb Bacon 4 pckts Minced Meat 193½ lb Beef 29 pckts Steaklets 1½ lb Beef Sausages 30 pckts Beefburgers 12 lb Beef Suet 4 pckts Chicken Joints 243 lb Lamb 7 pckts Chicken Pies 40 lb Lambs' Livers 12 pckts Steak and Kidney Pies 24 lb Jellied Veal 25 pckts Sausages 8 lb Veal 6 pckts Smoked Haddock 23½ lb Chicken 35 pckts Fish Fingers 40 lb Rabbits 70 pckts Kippers 40 lb Potatoes 2 pckts Herring Roes 1 lb Onions 14 pckts Plaice Fillets 15 lb Flour 12 pckts Cod Fillets 3 lb Salt 11 pckts Cereal 17 lb Sugar 1 pckt Porridge 6 lb Pudding Mix 1 pckt Haricot Beans 37½ lb Dried Mixed Fruit 1 pckt Tapioca 45 lb Blackcurrants 1 pckt Rusks 22¼ lb Apricot Pulp (tinned) 1 pckt Sago 13 lb Plums (tinned) 7 pckts Macaroni 47 2 pckts Rice 5 Chickens 3 pckts Biscuits 288 Cucumbers 16 Steak and Kidney Pies 94 Ice Cream Bricks 5 Dairy Cream Sponges 134 Iced Lollies Cooked Meats Sampling of these products continued during 1962, seventy-five samples being taken. Twenty were classified as unsatisfactory because of bacteriological contamination which occurred during storage and exposure for sale. Miscellaneous Samples Eighteen samples were submitted for bacteriological examination, with the following results:- No. Satisfactory Unsatisfactory Frozen Veal 1 1 - Blanc Mange 1 1 - Sausage Meat Pie 1 1 - Creamed Confectionery 9 6 3 Pish Cakes 6 5 1 Adulteration, etc. - Food and Drugs Act, 1955 During the year, one hundred and six samples of food and drugs were submitted to the Public Analysts. Thirteen samples were reported as being unsatisfactory, details respecting same are given below:- Description of Articles Result of Analysis Action taken Solution of Acetic Acid Contained 3.1% excess of Acetic Acid. The word 'concentrated' did not appear on the label. Warning letter Cough Linctus Contained anionic detergent equivalent to 2.4% Manoxol O.T. Warning letter Camomile Tisane Contained excessive proportion of sand. Warning letter Pork Sausages (2) Deficient in meat. No declaration of preservative given. Warning letters Beef steak with gravy Contained 65% meat - is poor for an article described as 'Beef Steak with gravy'. No action Garden Peas No name or address of packer or list of ingredients given on the label. Warning letter 48 Description of Articles Result of Analysis Action taken Cream Cheese Pat content low No action Currant Bun Contained foreign matter in the form of pulped fruit and starchy matter. Warning letter Bread-foreign bodies in Consisted of rodent excreta. Prosecution. Penalty £5 Costs £5.7.0. Dairy Ice Cream Deficient milk solids by 61%. Warning letter Milk Ice Cream Deficient milk solids by 50%. Warning letter Ice Cream Lolly Alternative list of ingredients unsatisfactory. Warning letter The following summary gives details of food sampled and results of analyses:- No. Satisfactory No. Unsatisfactory Formal Informal Total Formal Informal Total Milk 8 2 10 - - - Cream, Double - 2 2 - - - Butter - 1 1 - - - Buttered Rolls 4 - 4 - - - Brandy Butter - 1 1 - - - Currant Bun - - - - 1 1 Coffee (Instant) - 2 2 - - - Evaporated Milk - 1 1 - - - Grapefruit Drink - 1 1 - - - Blackcurrant Health Drink - 2 2 - - - Tea - 1 1 - - - Whisky 10 - 10 - - - Orange Squash - 1 1 - - - Orange Drink - 2 2 - - - Still Lemon - 1 1 - - - Cidakin - 1 1 - - - Vinegar flavoured with Tarrogon - 1 1 - - - Beef Steak with Gravy - - - - 1 1 Beef Dripping - 2 2 - - - Sausages, Beef 1 - 1 - - - Sausages, Pork 3 - 3 2 - 2 Sausage Rolls - 1 1 - - - Steak Pie - 1 1 - - - Pickled Meat, Cooked - 1 1 - - - Pickled Meat, Uncooked - 2 2 - - - Cream Cheese - - - - 1 1 Ice Cream - 3 3 1 1 2 Ice Lolly - 1 1 - - - Push Up (Ice Cream or Lolly) - - - - 1 1 Biscuits - 1 1 - - - Peas, Garden - - - - 1 1 Pickled Gherkins - 1 1 - - - Smoked Salmon Mayonnaise - 1 1 - - - Chicken Spread - 1 1 - - - Minced Chicken in Jelly - 1 1 - - - Blackberries in Syrup - 1 1 - - - Jam - 4 4 - - - Jelly - 1 1 - - - Rice - 1 1 - - - 49  No. Sat is factory No. Unsat is factory Formal In formal Total Formal Informal Total Flour. Self Raising - 1 1 - - - Flour. Plain - 1 1 - - - Custard Powder - 1 1 - - - Vanilla Flavouring - 1 1 - - - Coffee Colour - 1 1 - - - Rose Pink Colour - 1 1 - - - Strawberry Extract - 1 1 - - - Gelatine - 1 1 - - - Crunchy Peanut Spread - 1 1 - - - Buttercrisp - 1 1 - - - Sweets - 7 7 - - - Marzipan - 1 1 - - - Mixed Cut Peel - 1 1 - - - Glace Cherries - 1 1 - - - Honeyjel - 1 1 - - - Honeygar - 1 1 - - - Dandelion Coffee Essence - 1 1 - - - Cayenne Pepper - 1 1 - - - Camomile Tisane - - - - 1 1 Cough Linctus - 1 1 1 - 1 Bread foreign bodies in - - - - 1 1 Solution of Acetic Acid - - - - 1 1 Totals 26 67 93 4 9 13 Food Hygiene (General) Regulations, 1960 The following food premises are established in the Borough:- Butchers, 85; Bakers, 42, Fishmongers, 33, Cafes and Caterers, 91; Grocers, 219; Greengrocers, 75; Dairies, 2; Milksellers, 135; Ice Cream Manufacturers, 5; Ice Cream Vendors, 413. The following inspections were carried out in respect of food premises:- Butchers, 187; Bakers, 73; Fishmongers, 85; Cafes and Caterers, 219; Grocers, 406; Greengrocers, 76; Dairies, 16; Milksellers, 142; Ice Cream Manufacturers, 22; Ice Cream Vendors, 224. Prevention of Damage by Pests Act.,1949 Type of Property Non-Agricultural Local Authority Dwel1ing houses(inc. Counci1 houses) All other (including business premises) Total Agricultural I. Number of properties in Local Authority's District 11 34,613 5,565 40,189 4 II. Total N9. of properties inspected as a result of notification 11 380 83 474 - 50  Type of Property Non-Agricultural Agricultural Local Authority Dwelling houses (inc. council houses) All other (including business premises) Total No. of such properties found to be infested by: Common rat Major 1 - - 1 - Minor 7 275 75 357 - Ship rat Major - - - - - Minor - - - - - House mouse Major - - - - - Minor 3 45 5 53 - III. Total No. of properties inspected in the course of survey under the Act - 157 96 264 4 No. of such properties found to be infested by:- Common rat Major - - - - - Minor - 121 89 210 1 Ship rat Major - - - - - Minor - - - - - House mouse Major - - - - - Minor - 30 3 33 - IV. Total No. of properties otherwise inspected (e.g. when visited primarily for some other purpose) - 22 12 34 - No, of such properties found to be infested by:- Common rat Major - - - - - Minor - 11 8 19 - Ship rat Major - - - - - Minor - - - - - House mouse Major - - - - - Minor - 6 2 8 - V. Total inspections carried out, incl. reinspections 44 2,733 392 3,169 - VI. No. of infested properties (in Sees II,III & IV) treated by the L. A. 11 488 182 681 - VII. Total treatments carried out, incl. retreatments 36 2,403 304 2,743 VIII. No. of notices served under Sec. 4 of the Act; (a) Treatment - - - - - (b) Structural Work (i.e. Proofing) - - - - - IX. No. of cases in which default action was taken following the issue of a notice under Sec. 4 of the Act - - - - - 51  Type of Property Non-Agricultural Agricultura1 Local Authority Dwel1ing houses(inc. Council houses) . All other (including business premises) Total X. Legal Proceedings - - - - - XI. No. of Block' control schemes carried out - - - - - Factories Act, 1961 The following tables show the work carried out under this Act:- 1.- INSPECTION OF FACTORIES ETC. (Including Inspections made by Public Health Inspectors) Premises (1) No. on Register (2) 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 31 2 - Factories not included above in which Section 7 is enforced by the Local Authority 476 162 3 - Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers premises) 18 7 - - Totals 525 200 5 - 2 DEFECTS FOUND IN FACTORIES ETC, Particulars No. of cases in which defects were found Pound Remedied Referred to H.M, Inspector Referred by H.M. Inspector Legal Proceedings Instituted (1) (2) (3) (4) (5) (6) Want of Cleanliness (Sec.l) 5 3 - - - Overcrowding (Sec.2) - - - - - Unreasonable Temp. (Sec. 3) - - - - Inadequate Ventilation (Sec.4) - - - - - Ineffective drainage of floors (Sec.6) 1 1 - - - Sanitary Conveniences (a) Insufficient - 1 - - - (b) Unsuitable or Defective 19 22 - - - (c) Not separate for Sexes - - - - - Other offences (not including offences relating to Outwork) 3 4 - - - Totals 28 31 - - - 52 NUMBER AND TRADES OF OUTWORKERS NOTIFIED Wearing Apparel (making of)204 Household Linen 1 Chocolates and Sweetmeats 1 Umbrellas etc. 1 Boxes 4 Brush Making 6 Stuffed Toys 17 Artificial Flowers 4 Cosaques, Christmas Crackers etc. 11 Lampshades 1 Total 250 53 SECTION F NATIONAL HEALTH SERVICE ACT, 1946 PART III SERVICES WALTHAMSTOW HEALTH AREA SUB COMMITTEE 1962/63. Chairman: Councillor Mrs. C.E. STANNARD (Walthamstow Borough Council). Vice'Chairman: Councillor Mrs. E.L. BALDWIN (Walthamstow Borough Council). MEMBERS: Representing:- Essex County Council Alderman K.E.B. GLENNY, O.B.E., J.P. (Chairman, County Health Committee) Alderman H.J.E. PALETHORPE Councillor W.J. BOWSTEAD, J.P. Councillor Mrs. M.J. HARVEY Councillor Mrs. S.M. BOVILL (Vice-Chairman, County Health Committee) Councillor Mrs. J.L. LOCK Councillor Mrs. A.E. WELSH Walthamstow Borough Council Alderman Mrs, W.M. PALETHORPE Councillor C.G. ABLEY Councillor L.A. BAYLIS Councillor R.J.L. CAVE Councillor Mrs. R. COLIN Councillor P. FURBER, J.P. Councillor L.V. GRAHAM Councillor J.H. HAMMOND Councillor C.A, LYONS Councillor J.E. NICHOLLS Councillor F.A.J. 0'SHEA Councillor Mrs. B.M. REYNOLDS Councillor D. WEINSTEIN Executive Council for Essex Mr. F.A. WORTLEY (Subsequently replaced by Mr. J.W.R. NATION) Forest Group Hospital Management Committee Mrs. B.E. BOTTOMLEY, J.P. Local Medical Committee for Essex Dr. W.R. John Voluntary Organisations Mrs. M. BROWN Mr. E.P. MARR Miss A. Woolgar (One vacancy) 54 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 SubCommittee on behalf of the County Health Committee (Essex County Council). Details are given in statistical form on pages 64 to 81. Section 21 HEALTH CENTRES I referred in my Report for 1961 to the recommendation of the Health Area Sub-Committee concerning the establishment of six Health Services Clinics in Walthamstow. In January 1962 the Minister of Health requested Local Health and Welfare Authorities to provide him with details of their plans for the development of their services over a ten year period in order that these could be interlocked with his Hospital Plan for England and Wales. Local Health Authorities were asked to include in their plans schemes for the provision of new buildings and the replacement of unsatisfactory premises. The Health Area Sub-Committee, when sub mitting their recommendations to the County Council in regard to this aspect of the plan re-affirmed their desire for the erection of six Health Services Clinics in the Area and specified the years or periods during which they considered these projects should be commenced. This schedule of projects as amended by the County Council and included in the County Plan is set out below. Project Approximate Cost Capital Programme (Year or Period) £ 1. Hurst Road Health Services Clinic, Site 10,000 1963/64 Building 80, 000 Furniture and Equipment 5,000 Professional Fees 3,000 £98,000 2. Highams Park Health Services Clinic and Ambulance Station (one vehicle). Site 10,000 1964/65 Building 34,000 Equipment 3,500 Professional Fees 1,500 £49,000 3. west Avenue Health Centre (to include General Practitioners' accommodation) Site 10,000 1966/67 Building 50,000 Equipment 5,000 Professional Pees 3, 000 £68.000 55 Project Approximate Cost Capital Programme (Year or Period) £ 4. Priory Court Health Services Clinic (Extension) Building 5,000 1966/67 Equipment 1, 000 Professional Pees 500 £6, 500 5. St. James' St.Health Services Clinic Site 8,500 1967/72 Building 30,000 Equipment 3,000 Pees 1, 500 £43,000 6, Wood Street Health Services Clinic Site 5,000 1967/72 Building 20, 000 Equipment 2, 500 Professional Pees 1,000 £28,500 56 Section 24. HEALTH VISITING Health Education Programme At each clinic every opportunity is given to parents to discuss matters concerning the health and welfare of their families with the health visitor. Talks have been given either individually or collectively by discussion group. Much emphasis is laid on the necessity for protection against infectious illness by vaccination and immunisation, otherwise many apathetic parents would not avail themselves of this service for their children. Classes of instruction in mothercraft and relaxation were held weekly at the clinics. Attendance figures however appear to have fallen recently, which is rather surprising in view of the continued high birth rate. Similar classes were given weekly to expectant mothers in residence at 'Carville' , which is the local home for mothers and babies administered by the Walthamstow Branch of the Chelmsford Diocesan Moral Welfare Association. Thorpe Coombe Maternity Hospital include the health visitor as a speaker each month in their ante natal class health education programme to explain the professional services which she can offer. In the secondary modern schools, senior girls continue to enjoy the parentcraft courses arranged for them. Unfortunately, owing to staff shortages, we are unable to meet the demand for health education to the younger age groups Several health talks have been given to outside organisations e.g. young wives clubs, church groups and voluntary organisations. Lectures on the social aspects of disease and the Public Health Service were again given to student nurses in their final year of training at the Connaught Hospital. Occasional films have been shown in the evenings to adult groups giving parents the opportunity to put forward their views and join together in discussion. Home Visiting Programme - in recent times, the changing trend has been toward more selective visiting, enabling the health visitor to offer her services where the need is greatest. Apart from the routine work connected with mothers and young children, this type of visiting has included an increasing number of problems connected with early mental ill health and to those of the elderly. These naturally are of a time consuming nature, but have proved to be far more effective and satisfying to the recipient and health visitor alike. Many students of various nationalities from universities, colleges, hospitals and other training centres nave accompanied the health visitor in her work in order to gain knowledge concerning the Public Health and Welfare Services. 57 school Health Programme - Apart from the routine duties connected with medical examinations, other services performed by the health visitors and school nurses for each child have included annual foot surveys, simple vision testing and hygiene inspections. Regarding the latter group, owing to a slight increase in the number of verminous conditions in some areas, more frequent examinations have been carried out. Follow up visits to the home which provide opportunities for more personal consultation continueto be of great value. Medical and Social Liaison - Regular contact is maintained with the local geriatric and general hospitals which the health visitor visits weekly for the purpose of exchanging information and knowledge concerning both in-patient and out-patient, thus forming a beneficial link between home and hospital services. As a medico social worker, some of the health visitors work together with general practitioners for one session per week, providing a team highly trained in practical and social medicine. We are much indebted to the Women's Voluntary Service and other social bodies for their valuable assistance afforded to us in many diverse ways. There still remains a great need for the extension of voluntary services to augment those already provided. Section 25. HOME NURSING Training and Educational Activities - Three Candidates Undertook district training in 1962 and two passed the Queen's Roll Examination. Four Queen's Nurses attended Refresher Courses arranged by the Queen's institute of District Nursing. Two nurses attended a Joint Study Day last October arranged by the Royal College of Nursing. Ten Queen's Nurses attended special lectures at the Lady Raleigh Training Home. Two nurses paid visits of observation to a Radiotherapy unit and to a Mental Hospital. Four Health Education Students accompanied the district nurses on their morning round. Two film shows were arranged for the benefit of the district nurses and midwives. Equipment supplied for the service Disposable syringes were made available for use and proved very satisfactory. An additional mechanical hoist was provided for the use of heavy helpless patients, to assist relatives and nurses with necessary lifting, Social Activities - Thirty parcels were provided by the Nurses' Social Fund, and sent out to old people at Christmas. A Jumble Sale was organised and the proceeds allocated towards a Proposed summer outing for the elderly patients in 1963. 58 Section 26 VACCINATION AND IMMUNISATION Vaccination and Immunisation Arrangements - In September 1961 the Minister of Health issued a memorandum to Local Health Authorities summarising certain advice he had received from the Standing Medical Advisory Committee regarding the timing of various immunisation procedures in childhood - and setting forth two alternative schedules of immunisation. Both schedules provided for the use of combined antigens, i.e. an admixture of vaccines to confer simultaneous immunity against Diphtheria, Whooping Cough and Tetanus, thereby reducing the number of injections a child would need to receive in order to be given protection against these three diseases. The Minister's recommendations were considered by the Health Committee of the Essex County Council and authority given for the provision, in future, of supplies of combined antigens, in addition to the usual single antigens. The Council stipulated that immunisation against Tetanus was, for the time being, to be restricted to school children and preschool children. These arrangements provided a suitable opportunity for revision of the various types of record card in use in the County and for the introduction of a 'Master ' Record Card, retained in Health Area Offices, on which details of all protective innoculations given to individuals are recorded. In addition a 'Personal' Record Card giving similar information for retention by the patient was devised. Combined antigens and the new types of Record Cards were introduced in the Walthamstow Health Area from the beginning of 1962. Sab in Vaccine - A major development in the arrangements for routine vaccination against Poliomyelitis occurred during 1962. In February the Minister of Health notified Local Health Authorities that he had decided, after receiving advice as to its safety and reliability, to make Oral Vaccine available for the vaccination of persons eligible under the scheme. The recommended course of primary vaccination with this material consists of three doses, each of these drops, given at intervals of four to eight weeks. It can be administered in a spoonful of glucose syrup to babies or on a lump of sugar in the case of older children or adults. Oral Vaccine can also be used to give reinforcing doses to children who have had three previous injections of Salk Vaccine. Supplies of the new type of Vaccine were received in Walthamstow in March and were quickly brought into use by General Practitioners and at the various County Council Clinics in the Health Area. 59 Section 28 PREVENTION OF ILLNESS CARE AND AFTER CARE Chiropody - The arrangements for providing chiropody treatment which is not restricted to any special categories of persons, continued during the year. We were fortunate in maintaining a full establishment of chiropodists, although at the end of October one member of the staff, who had been with us 15 years, decided to accept an appointment nearer to his home to avoid travelling difficulties. A replacement was appointed on the 31st December thus avoiding a long period of closure at the West Avenue Health Services Clinic. During the two months when West Avenue was without a full time chiropodist the children's sessions were undertaken by part-time relief staff. In the course of the year the Chiropody Service gave 21,636 treatments, details of which are given in the table on page 78 At the end of November the Chiropody Department assumed responsibility for treating some sixty patients of pensionable age now living in 'Alliston House', Shernhall Street. Regular visits are made at two weekly intervals to this newly opened Old People's Home, where a temporary surgery has been equipped. The domiciliary service is provided for incapacitated patients who are unable to attend for treatment at one of the regular Clinics. A total of six sessions per week are devoted to this work, two by members of the regular whole time staff, and four by part-time chiropodists who were recruited primarily for this purpose. The domiciliary service creates difficulties for the chiropodists as treatment in the home without the use of normal clinic equipment places them under a strain. Thus it is not easy to obtain staff who are willing to accept the professional responsibility of working under these conditions. However the service is greatly appreciated by housebound patients who look forward to their visits from the chiropodist. Section 29 DOMESTIC HELP SERVICE The particularly severe winter created difficulties for both patients and staff. Many patients were made house-bound, and often relied completely on the Domestic Help Service for almost all day to day needs. Some patients suffered the inconvenience of burst pipes, lack of water, and Yery often no fuel, and in these circumstances normal household duties became a strain upon the individuals concerned. Even in the worst weather most domestic helps continued to attend patients, often having to travel on foot, and during this trying period relatively few were absent on account of sickness. The high standard of service set by the domestic help staff has generally been maintained. It is of interest to note however, that although the number of applications for appointment continues to be satisfactory, not all candidates are willing to undertake the work when the nature of the duties are fully appreciated, namely, attention to the personal needs of patients and sometimes the cleaning of not so clean homes. 60 The Night Attendant Service continues to be available, and a small number of attendants are on the register. Fewer calls have been made on this service and often patients were admitted to hospital within a short period. No applicant has had to be refused. CHELMSFORD DIOCESAN MORAL WELFARE ASSOCIATION The 'Carville Home', at 43, West Avenue Road. E. 17, is a home for unmarried mothers and their babies, and 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, previously Superintendent of the home, retired at the end of 1962 after 17 years in Walthamstow, and has contributed the following notes:- "Looking back over 17 years one is conscious of many changes in social work. Carville Moral Welfare Shelter, as it was then called, took care of girls on remand, children in need of care and protection and also whose mothers were in hospital. Much of this vork is now done by the Children's Department of the County Council. The night bell was kept busy in those days. Many thought that with the coming of the Children's Act, 1948, the day of voluntary work carried out by the church and others was over, but events proved this not to be the case. The problem of the unmarried mother and her child became apparent on a much larger scale. The local authorities have a statutory obligation to care for unmarried mothers and their babies, but because our homes were already in existence and because of our vocation and special training we were in a position to help, and the County Council delegated their statutory responsibility to the Diocesan Moral Welfare Association by making an annual grant towards the maintenance of the homes. I look back before the centralising of local government to working in my early days with the Health Department of Walthamstow Borough Council: this was team work at its best. Dr. A.T.W. Powell, who was then Medical Officer of Health, put me in touch with those who were in a position to be of assistance in the days immediately following the war. Miss A.C. Keenan, who was at that time Super intendent Health Visitor, gave me all the help and advice at her disposal, finding foster mothers and homes. The Health Visitor was always welcome, and this good will and kindness has continued until my retirement. During my 35 years in moral welfare work some thousands of adults and babies have passed through my care, either in the home or through outdoor case work. Many of these babies have now grown up and married and have been in touch with me, and I do know their reaction to the status of illegitimacy. Is society not making too light of this problem? My experience has made me realise how important it is to educate girls to think for themselves as we did at Carville. How much wiser it would be to do this earlier and prevent so much unhappiness." 61 Miss M.H. Ward, who succeeded Hiss Williams as Superintendent of the home, contributes the following details in respect of 1962. During the year we had one mother aged 13½ years, two aged 14 years and five aged 15 years. The majority of the remainder were in their late teens with a few in theit late twenties. The ages of the residents tends to become lower and the time spent in the home after the birth of the baby is a little longer. This is due in sane cases to adoption taking longer, another reason is the lack of foster mothers. On the whole the majority of the mothers make a clean break with the home on leaving. Although all say " V 11 write " , very few do. Quite a number of the old' girls do keep in touch, one in particular comes and sells flags for us on Princess Elizabeth Day. The relaxation classes arranged at the home by the health visitors continue to be a great help to the expectant mothers. The table below summarises the indoor work for 1962 ". Amitied Adults Babies Total From Walthamstow 19 13 32 Prom rest of County 70 53 123 From outside County 2 2 4 Totals 91 68 159 WALTHAMSTOW CHEST CLINIC Dr, H. Ramsay Consultant Chest Physician, has contributed the following: The number of cases of tuberculosis remaining on the Clinic Register at 31.12.1962 was. Respiratory 1934 ) Non Respiratory 157 ) 2091 The clinic figures of main interest are set out below. They refer of course to the combined attendances of Walthamstow, Chingford and Leyton patients. Total Attendances 16.078 Total New Cases 6,504 Total X rays 14,943 Miniature Camera 3,059 New Notifications 96 do (Walthamstow only) 45 62 "The total number of new cases of tuberculosis arising in the Clinic area was 96 of which 78 were cases of respiratory disease and 18 were non-respiratory. Of the total number remaining on the Clinic register at December 31st, 1962, 54 produced broncho-pulmonary secretions positive for tubercle bacilli during the year. The new Clinic building provides up-to-date accommodation in excellent surroundings and the association with a large general hospital is a great advantage, Close contact must be maintained with the Local Authority Health Departmentsas this remains an essential part of the continuing effort to control tuberculosis completely. The total notifications of new cases of tuberculosis refers to the combined area, with the Walthamstow figure separately." Dr. H. Ramsay, Chest Physician has supplied the following information regarding the numbers of people X rayed during the recent Mass Radiography survey carried out in Walthamstow. It is of interest to note that very few cases of 'significant' tuberculosis were discovered, a total of four only out of just over 6,000 examinations. Groups Attending Male Female Total General Public 1,711 2,282 3,993 Organised Groups 983 576 1,559 Schoolchildren 469 - 469 Total 3, 163 2,858 6,021 TOTAL number requiring further investigation 51 33 84 Groups in which Pulmonary Tuberculosis was discovered Male Female Total Requiring immediate treatment Organised Groups 1 - 1 Requiring close clinic General Public - 1 1 supervision Organised Groups 2 - 2 Requiring occasional clinic General Public 4 4 8 supervision Organised Groups 4 - 4 Schoolchildren 1 - 1 Presumed healed.no further General Public 7 8 15 action required Organised Groups 2 - 2 Among other abnormalities discovered were: Male Female Total Bronchial Carcinoma 1 - 1 Congenital abnormalities of heart and vessels 2 1 3 Acquired abnormalities of heart and vessels 4 3 7 Pneumonia 1 1 2 Emphysema 3 2 5 Pulmonary fibrosis non T. B. 3 1 4 Pleural thickening or calcification 3 - 3 Abnormalities of the diaphragm - 1 1 Congenital abnormalities of the bony thorax and soft tissues 8 6 14 Acquired abnormalities of the bony thorax and soft tissues 1 - 1 63 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:- Since the decision of the Annual Meeting of 1961 to extend the scope of the Association's work in order to cover all patients under the care of the Chest Physicians, the help given to non-tuberculous patients has increased steadily. This has been made easier by the County Council's removal of the restrictions on the use of funds derived from their grants,. We are now able to give assistance to patients suffering from bronchitis, bronchiectasis, asthma and other lung diseases on lines very similar to those long applied to the tuberculous. It is still necessary to approach these cases with caution until the long term financial effect of our present policy can be more clearly assessed, but we are convinced that the action taken has already been proved to be justified, and look forward to further extension of these activities. In undertaking this additional work we have not allowed the interests of the tuberculous to be adversely affected; the fact that the period of hospital treatment is now much reduced, and that patients frequently return to earning capacity within a comparatively short time after discharge from hospital, has led to the release of some expenditure previously required for these patients. Never theless, expenditure during the past year was the highest ever, amounting to over £1,200. During the year covered by the report, 125 individual cases were dealt with, and help arranged as follows: Tuberculous Patients Non Tuberculous Patients Grocery Vouchers 32 Fuel 9 Holiday expenses 3 Clothing & Bedding 7 House repairs 2 Rent, debts, etc. 5 Clothing & bedding 29 Grocery vouchers 4 Pares to visit 3 Holiday expenses 3 Rent, debts, etc. 8 Christmas grants 30 Fuel 33 Christmas grants 88 Many other small grants and items of assistance were given from time to time throughout the year as occasion arose, and in cases where expenditure proved too great for us to meet alone, welcome help was contributed from other sources such as the Glasspool Trust. We have appreciated the co-operation given by all departments of the local authority, and in particular the close liaison we enjoy with the staff of the Health Department, without whose help our work would be much more difficult. 64 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 1962. Number of Walthamstow Residents in accommodation provided under Section 21 (1)(a) National Assistance Act, 1948. Number admitted to Residential Accommodation during 1962. Number admitted to Temporary Accommodation under Section 21 (1) (b) National Assistance Act, 1948. Blind Persons, etc. Other Classes of Handicapped Persons Registered Registered Number employed in: Blind Partially Sighted Defective Sighted Workshops Home Workers Scheme Open Industry Male Female Total Male Female Women Children 52 104 156 21 32 8 20 228 54 8 1 5 31 255 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 1962 to persons having residence in the Borough of Walthamstow. The County Council continues to develop the provision of residential accommodation for aged persons there are 2 aged persons' homes accommodating 104 residents in Walthamstow. and further homes are planned to meet the increasing demand. 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. There is also a local occupational centre for physically handicapped persons and. on average, 60 persons attend daily. 65 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 530 Appointments made 3,193 kept 2,741 Plastic fillings 287 Amalgam fillings 1,368 1,655 Inlays 5 Crowns 16 Scalings and gum treatments 379 Dressings 332 Extractions 370 General anaesthetics 33 Local anaesthetis 27 X-rays 369 Impressions 663 Bites 149 Try-ins 199 Full upper dentures 102 Pull lower dentures 80 Partial upper dentures 54 Partial lower dentures 32 268 total dentures Repairs 249 Minor Oral Surgery 18 Other Operations 347 Dental Laboratory Dentures Repairs Reline Remakes ances Crowns Inlays General Dental Service 234 132 17 12 1 5 - Walthamstow Committee for Education 28 23 - - 129 19 1 Leyton Committee for Education 46 12 1 - 41 13 - Forest Divisional Executive Committee for Education 4 - - - 49 - - Maternity and Child Welfare Patients 8 - - - - - - 66 Section 22. CARE OF MOTHERS AND YOUNG CHILDREN Notification of Births Domici1iary Institutional Live Still Live Still Notified births which occurred in the Area 502 4 1,760 27 Birth notifications transferred out to places outside the Area - - 1,003 13 Birth notifications transferred in from places outside the Area 2 - 349 9 Care of premature infants (Weighing 5½lb. or under) Born at Home 21 Born in Hospital or Nursing Home 79 Ante Natal and Post Natal attendances (Local Authority Clinics) New Patients- Ante Natal Natal Low Hall Lane Clinic 24 1 Silverdale Road Clinic 12 2 West Avenue Clinic 3 - District Nurses Training Home and Midwives' sessions held at Ante -Natal Clinics 376 _ TOTALS 415 3 Total Attendances Low Hall Lane clinic 108 4 Silverdale Road Clinic 65 8 West Avenue Clinic 19 - District Nurses Training Home and Midwives' sessions held at Ante-Natal Clinics 2,340 - TOTALS 2,532 12 Birth Control (Medical Grounds) New cases 4 Total attendances 18 67 Orthopaedic and physiotherapy Clinic (Children under School Age) New cases seen by Orthopaedic Surgeon 32 Re attendances 43 Children treated 7 Children attending for aftercare 12 Children attending for U.V.L. Paediatric Clinic (Children under School Age) New cases:- Heart Disease 3 Enuresis 1 Hernia 1 Hydrocele 1 Vomiting 1 Jaundice 1 Tight foreskin 1 Haemoptys is 1 Retarded Development 2 Torticollis 1 Speech 1 Total 14 Total attendances 25 68 Dental Clinics Patients inspected and treated during the year. Expectant Mothers Nursing Mothers Children under school age Patients examined 14 10 51 Patients found to require treatment 14 10 46 Patients who have commenced treatment 13 10 45 Patients who have completed treatment 7 - 13 Patients awaiting treatment - - - Attendance for treatment 24 19 56 Types of Treatment Given Extractions (a) Permanent teeth 21 15 - (b) Temporary teeth - - 40 Fillings (a) Permanent teeth - 11 - (b) Temporary teeth - - 32 Inlays provided - - - Crowns provided - - - Anaesthetics administered (a) Local - - - (b) General (i) by Medical Offrs. - 3 29 (ii)by Dental Offrs. - - - Scaling 1 1 - Prolonged scaling and gum treatment - - - Silver nitrate treatment - - 1 Dressings 2 1 1 X-ray examinations 2 1 Dentures provided- a) Full - 2 2 (b) Partial - - - Dentures repaired - - - Dentures remade (a) Full - - - (b) Partial - - - Orthodontic appliances (a) Fixed - - - (b) Movable - - - Prophylactic treatment and other operations - 10 - 69 Child Welfare Brookscroft (Voluntary Scheme) Low Hal1 Lane Higham Hill and Priory Court Si1verdale Road West Avenue Winchester Road Total UNDER X YEAR First attendances 261 334 282 107 230 138 1,352 Subsequent attendances 4,223 4,855 4, 083 1,808 2,495 1,559 19,023 Total attendances 4,484 5,189 4,365 1,915 2,725 1,697 20,375 1 YEAR OF AGE First attendances 17 7 20 10 24 17 95 Subsequent attendances 931 997 1,055 498 872 357 4,710 Total attendances 948 1,004 1,075 508 896 374 4,805 2-5 YEARS First attendances 13 21 17 47 5 103 Subsequent attendances 401 877 728 309 417 351 3,083 Total attendances 414 898 745 309 464 356 3,186 Total attendances (all age groups) 5,846 7,091 6,185 2,732 4,085 2,427 28,366 Number examined by Clinic Doctor 661 1,756 1,303 491 1,074 483 5,768 Sessions held 102 151 124 122 130 52 681 70 Welfare Foods DISTRIBUTION CENTRE National Dried Milk (Tins) Cod Liver Oil (Bottles) Vitamin Tablets (Packets) Orange Juice (Bottles) Brookscroft Welfare Centre 1,554 411 312 2,643 Low Hall Lane Health Services Clinic 1,782 1,203 197 2,044 Northcott House Distribution Centre 5,959 284 676 6,541 Higham Hill and Priory Court Health Services Clinic 2,394 234 297 2,661 Silverdale Road Health Services Clinic 738 254 305 3,348 West Avenue Health Services Clinic 1,991 219 249 2,772 Winchester Road Infant Welfare Centre 683 166 191 2,150 General Practitioner's Surgery 68 34 35 253 TOTAL issues at Distribution Centres 15,169 1,805 2,262 22,412 In addition the following were issued to; Hospitals (National Health Service) 705 - - - Day Nurseries - 180 - 216 GRAND TOTAL OP ISSUES 15,874 1,985 2,262 22,628 Nutrients and Medicaments Sales Free Issue lbs. ozs. lbs. ozs. Adexolin - - 34 1 Bemax 73 1½ - - Cow and Gate 5,834 - - - Farex 842 8 - - Glucodin 90 - - - Lactagol 18 8 - - Maltoline with Iron - - 115 8 Marmite 704 12 - - Milk of Magnesia - - 13 - Mist Ferri et Amnion. Cit. Pro. Infantibus - - 4 8 Ostermilk 6,149 - - - Robinson's Ready Cook Groats 375 - - - Scott's 'Twin Pack' 434 - - - Virol 575 13 - - Trufood 290 - - - S. M. A. 577 - - - Rose Hip Syrup 2,745 bottles (8oz) Iron Tablets 29,040 tablets. Value of Cash Sales £2,901 2.1d, 71 Convalescence Applications were received during the year from 2 mothers with 3 children, but were eventually withdrawn. 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 15 46 19 45 34 91 Total attendances during year 3,440 9,696 3,764 7,984 7,204 17,680 Average attendances 13.5 38.2 14.8 31.4 28.3 69.6 51.7 46.2 97.9 Number of days open 254 254 Training Number of Students who gained certificate of National Nursery Examination Board 6 Future Careers (on leaving): General Nursing Training 3 Teaching at a School for the Deaf 1 Housemother at a Boarding School 1 Nursery School 1 Daily Guardian Scheme No of Guardians on Register at end of year 6 No. of applications for services of Daily Guardian 67 Referred to Day Nurseries 47 Referred to Daily Guardian but nothing further heard 14 Placed with Daily Guardian 6 Continued in care of Daily Guardian from previous years 2 72 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 (Schoolchildren) Optician Dental Foot Clinic Ophthalmic (1st, 3rd & 5th Orthoptic Minor Ailment Dental Foot Clinic Paediatric (1st & 3rd) Dental Foot Clinic Orthoptic Orthodontic Minor Ailment Dental Ophthalmic (2nd & 4th Optician (2nd & 4th Minor Ailment P.M. Dental Foot Clinic Ear, Nose & Throat Ophthalmic (2nd & 4th) Orthoptic Dental Foot Clinic Ophthalmic Optician Dental Foot Clinic Immunisation & Vaccination Dental Foot Clinic Ophthalmic Orthoptic Optician Dental Foot Clinic Ophthalmic Orthodontic Optician Evening Foot Clinic General Dental Service Foot Clinic Foot Clinic General Dental Service Foot Clinic Orthodontic Silverdale Road A.M. Foot Clinic Minor Ailment Foot Clinic (School children) Foot Clinic Dental Foot Clinic Foot Clinic P.M. Infant Welfare Ante Natal/ Post Natal (twice monthly) Toddlers Clinic (twice monthly) Foot Clinic Midwives Ante Natal Clinic Foot Clinic Infant Welfare Relaxation & Mothercraft Class Dental Foot Clinic Evening Foot Clinic Foot Clinic Higham Hill and Priory Court A.M. Foot Clinic Dental Foot Clinic (School children) Dental Foot Clinic Foot Clinic Dental Foot Clinic Dental 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 Dental Relaxation and Mothercraft Class Dental Evening Foot Clinic Foot Clinic Low Hall Lane A.M. Minor Ailment Foot Clinic Foot Clinic (Schoolchildren) 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 Welfare 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 and Child Guidance Consultations daily (morning and afternoon) from Monday to Friday Orthopaedic Clinic, Wingfield House School, Hale End Road Speech Therapy and Massage and 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 Massage Remedial Exercises and Sunlight Treatment Diphtheria & Whooping Cough Immunisation (Alternate weeks) 73 Section 23 MIDWIFERY Cases attended by Council Midwives MIDWIVES Total DomiciIiary Midwives Home Nurse Midwives 1. Cases attended:- (a) No doctor booked or present at delivery – – – (b) No doctor booked but one present – – – (c) Doctor booked but not present 294 37 331 (d) Doctor booked and present 148 25 173 442 62 504 2. Cases delivered in institution but attended by Council Midwives on discharge 62 22 84 3. Ante Natal Examination:- (a) paties Home 2,154 186 2,340 (b) Local Health Authority Clinics 2,356 111 2,467 (c) General Practitioners Clinics 1,630 460 2,090 4. Lying-in visits 6‚140 757 6,897 5,390 611 6,001 Administrat ion of Trilene, and Gas and Air Analgesia Number of patients who received analgesia 454 Percentage of district confinements 90 Medical Aid Number of medical aid notices received 4 74 Place of confinement During the year Walthamstow Mothers were confined as follows:- Forest Gate Hospital Mother s (salvation Army) Hospital,Clapton 192 North Middlesex Hospital, Edmonton 22 Thorpe Coombe Maternity Hospital Wanstead Hospital 46 Other Hospitals or Nursing Homes Total 1,114 At Home: Council Midwife present 504 Family doctor but not Council Midwife present 3 Total Confined 1,621 Section 24, HEALTH VISITING During the Jear the Health Visitors made 17,505 visits to homes:- To expectant mothers:- First visits 640 Subsequent visits 137 To children under 1 year of age:- First visits 1,659 Subsequent 2,825 To children between the ages of 1 and t years 2,485 To children between the ages and 2 and 5 years 3,771 Other visits:- To the aged 2,152 Tuberculous households 19 Special visits 1,315 Unsuccessful visits 2,502 Number of attendances by Health Visitors at Local Health Authority Clinic sessions 1,171 Number of Health Education talks given in schools 242 75 Section 25 HOME NURSING New Cases Total visits Medical 984 50,264 Surgical 119 6,636 Tuberculosis 1 77 Infectious diseases - - Maternal Complications - 58 Others - 43 Totals 1,104 57,078 Number of visits (included above) to persons over 65 years of age 32,148 Section 26 VACCINATION AND IMMUNISATION Vaccination against Smallpox Age at date of vaccination Persons vacc inated Persons Re-vaccinated Under 1 year 1,114 1 year 275 2 2-4 years 513 138 5-14 years 2,104 1,360 15 years and over 3, 855 6,102 Total 7,861 7,602 Total vaccinated by local authority staff (included above) 1,437 1,316 76 Immunisation against Diphtheria Age at date of final injection (primary) 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 894 15 1-4 years 176 142 5-9 years 20 261 10-14 years 14 15 Total 1,104 433 Total immunised by Local authority staff (included above 379 211 Immunisation against Whooping Cough Age at time of the final injections Children who completed a full course of immunisation during the year Under 1 year 779 1-4 years 92 5-9 years 10 10 years and over 4 TOTAL (primary courses) 885 Total immunised by local authority staff (included above) 249 Re-inforcing injections 119 77 Immunisation against Tetanus Age at date of final injection (primary) Children who comple ted a full course of primary immunisat ion during the year. Children who were given a re-in forcing injection during the year. Under 1 year 781 15 1-4 years 221 96 5™9 years 32 67 10-14 years 26 3 Total 1,060 181 Total immunised by local authority staff (included aoove) 398 62 Poliomyelitis Vaccination Category Number of Persons Vaccinated Salk Vaccine (2 doses) Sahin Vaccine (3 doses) Children born in 1962 46 160 " " " 1961 360 451 " in years 1943/60 291 197 Persons born in years 1933/42 153 65 " before 1933 who Were under 40 years and 'special' groups 219 73 Totals 1,069 946 Third doses of Salk or Sabin vaccines (all groups) 3,564 Fourth " " " " " 1,060 B C G. Vaccination Category Number Skin Tested Result of Hea f Test Vaccinated wi th B.C. G. Tuberculin Positive Tuberculin Negative School Children 1,196 205 931 931 Students attending further education establishments – – – – Totals 1,196 205 931 931 78 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 3 2 5 - School children 482 523 2,346 - Expectant Mothers 1 - 1 - Physically handicapped 2 3 7 - Aged (over 65 years of age) 292 1,885 6,883 765 Others 694 3,551 11,629 - Total 1,474 5,964 20,871 765 Tuberculosis Home Visits and Clinics attended Tuberculosis Visitors Heal th Vi si tors Total of tuberculous households at end of year 1,026 - Visits to tuberculous households during the year (excluding non-access visits) 1,010 19 Attendance at Chest Clinic sessions during the year 767 - Extra Nourishment Number of new cases during year supplied with free milk 33 Total number being supplied free milk at end of year 76 Rehabi1 it at ion Number of cases receiving rehabilitation treatment for whom financial responsibility accepted Nil 79 Loan of Sick Room Equipment Number of issues made to patients during year 256 Number of articles on loan at end of year which had been on loan for.- (a) under 1 year 161 (b) 1 and under 2 years 77 (c) 2 and under 5 years 70 (d) 5 years and over 12 Convalescence for Adults Number of applications during year 76 Length of stay: One week 1 Two weeks 54 Three weeks 1 Pour weeks Health Education reaching to groups by Departmental Staff Ato .of Sessions Total At tendances (a) Clinic,Welfare Centres, Relaxation classes 153 913 (b) School 241 2,715 (c) Professional Organisations - - (d) Parent/Youtn/General Adult Group 3 430 (e) Others - - Total 397 4,058 Number of film shows given at sessions referred to above 164 Exhibitions in which department has participated Of the 76 applications received, 38 were in respect of perons aged 65 years and over. Recuperative holidays were arranged and accepted by 29 of these patients. 80 Section 29. DOMESTIC HELP Visits by Domestic Help Organisers Domestic Help Service Night At tendance Service First visits to homes: 696 15 Re - visits to homes: (a) Domestic help present 412 _ (b) Night attendant present - - (c) Help/Attendant not present 3,081 46 Other visits 192 2 Help provided Maternity Acute sick Tuberculo sis Chronic Sick Aged not sick Others Total Aged Others Requests for help from new cases during the year 99 43 5 365 50 6 7 575 Cases not eligible for assistance or not requiring service 14 4 1 46 9 3 4 81 New cases helped during the year 85 39 4 319 41 3 4 496 Total cases completed during the year (a) 83 39 10 365 52 4 7 560 Cases being helped at end of year who have received help for: Under 3 months 2 2 1 65 4 1 - 75 3-5 months (incl.) - 2 2 50 5 - - 59 6-11 months (incl.) - 3 2 89 7 2 - 103 12 months & over - 12 623 69 3 - 707 Total (b) 2 7 17 827 85 6 - 944 Total cases helped during the year (i e. total of (a) and (b)) 85 46 27 1,192 137 10 7 1.504 Hours of help provided during the year. 2,972 1,250% 2,932 154,334 16. 069 568 707 178.833¼ 81 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 2 10 over 4 weeks - - 6 Total (a) 1 2 16 Cases being helped at end of year who received help for. Under 3 months - - - Over 3 months - - - Total (b) - - Total cases helped during the year (i.e. total of (a) and (b) 1 2 16 Hours of attendance provided during year 18 37 1,601 MEDICAL EXAMINATION OF STAFF Category No. of medical examinations County Council employees; (a) Entrants to County Council's service 150 (b) Retirement on Superannuation 3 Walthamstow Borough Council employees 277 Entrants to teaching profession and training colleges 118 Others 2 Total 550