WAL 57 BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1963 MELVILLE WATKINS, M.R.C.S., L.R.C.P., D.P.H. MEDICAL OFFICER OF HEALTH Borough of Walthamstow HEALTH DEPARTMENT TOWN HALL, FOREST ROAD, WALTHAMSTOW, E.I7 Telephone: LARkswood 5544 With the Compliments of the Medical Officer of Health BOROUGH OF WALTHAMSTOW REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1963 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 11 SECTION C - Infectious Diseases 15 SECTION D - Sanitary Circumstances of the Area 24 SECTION E - Sanitary Circumstances of the Area - Statistics 29 SECTION F - National Health Service Act, 1946 - Part III Services 41 Page Acreage 8 Adulteration of Food 35 Ambulance Facilities 12 Ante-Natal Clinics 57 Assessments 8 B, C.G, Vaccination 68 Birth Control 57 Birth Notifications 57 Births 8 'Brookscroft' Welfare 63 Care of Mothers and Young Children 43,57 Chest Clinic 53 Children 'At Risk' 44 Chiropody, 49,68 Clearance Areas 26 Clinics 63 Committees 4,41 Comparability Factor 10 Confinements 65 Convalescence 62.69 Cremation 14 Daily Guardian Scheme 62 Day Nurseries 62 Deaths from Accidents in the Home 10 Deaths, Infants 8 Deaths, Causes of 9 Dental Laboratory 56 Dental Treatment 43,59 Diphtheria Immunisation 67 Diseases of Animals Acts 28 Disinfections 13, 29 Disinfestation 25 Page Domestic Help Service 51,70 Domiciliary Chiropody 49,68 Employment 10 Factories Act 1961 39 Food and Drugs Act 1955 27 Food Hygiene Regulations 1960 28, 37 Flooding 14 Food Inspection 32 Food Poisoning 16 Funeral Arrangements 13 Gas and Air Analgesia 64 General Dental Service 56 General Information 13 Hairdressers 26 Health Education 70 Health Centres 42 Health Services Clinics 56 Health Visiting 45,65 Home Nursing 46 66 Hospital Accommodation 12 Housing Act 1957 26 Housing. General 19 Housing, Inspection 32 Housing Statistics 18 Ice Cream 27,33 Immunisation 49 67 Improvement Grants 18 Infant Mortality 8 Infectious Diseases 5 15.29 Inquests14 Laboratory Facilities 11 Page Land Charges 26 Laundry Service for the Incontinent 13 Legal Proceedings 28 Massage and Special Treatment 12 Maternal Mortality 8 Meals on Wheels Service 13 Meat and other Poods 27,34 Medical Examinations 13 72 Medicaments 61 Midwifery 44 64 Milk Supplies 26,33 Moral Welfare 52 Night Attendance 72 Notices, Sanitary 29 Nursing Homes 12 Nutrients 61 Old People's Welfare 13 Orthopaedic Treatment 58 Outworkers 40 Paediatric Clinic 58 Pet Animals Act, 1951 28 Poliomyelitis 16 Poliomyelitis Vaccination 68 Population 8.21 Post Mortens 14 Post Natal Clinics 57 Premature Infants 57 Prevention of Damage by Pests Act. 1949 29 37 Page Prevention of Illness 49,63 Public Health Inspection 24 29 Rainfall 14 Rateable Value 8 Rehousing on Medical Grounds 20 Rent Act, 1957 26.31 Rodent Control 37 Sampling of Food 27,36 Scabies Treatment 12 Sickroom Equipment 69 Smallpox Vaccination 67 Smoke Abatement 24 .31 Social Conditions 8 Special Premises 30 Staff 6,11 Statistics 29,56 Stillbirths 8 Swimming Baths 25 Tetanus Immunisation 67 Toddlers Clinics 63 Tuberculosis 16,69 Vaccination 49 67 Verminous Premises 25 Vital Statistics 5,8 W'stow Assn. of T. B. Care Helpers 53 Water 25 Welfare Centres 60 63 Welfare Foods 61 Welfare Services 55 Whooping Cough Immunisation 67 4 HEALTH COMMITTEE 1963 - 64 Chairman COUNCILLOR MRS. E.L. BALDWIN Vi ce-Chairman: COUNCILLOR P. FURBER Ex-officio THE WORSHIPFUL THE MAYOR - ALDERMAN MRS. W.M. PALETHORPE. J.P., TOE DEPUTY MAYOR - ALDERMAN MISS D. WRIGLEY, B.A., CHAIRMAN OF FINANCE COMMITTEE - ALDERMAN T.W. SMITH. ALDERMAN E.C. REDHEAD ALDERMAN C.B. REYNOLDS COUNCILLORS: C„ G. ABLEY R.J.L. CAVE MRS. R. COLIN L.V. GRAHAM MRS. L.D. GURR J.H. HAMMOND COUNCILLORS; J,E. NICHOLLS A.M. O'REILLY F.A.J. 0' SHEA MRS. B.M. REYNOLDS F.S. WATTS 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.G. POOLE, M.B., B.S.., D(0bst. ) 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 submit my report upon the health of the Borough for 1963. VITAL STATISTICS The steady decline in the population of the Borough continues. (There was an overall reduction of 930 in the mid. year estimates) but this is mainly due to migration, especially to the New Towns, and not to a natural decrease in the population In fact the birth rate continues to rise with a practically static death rate. There has been a small increase in the infant mortality rate. With future developments in the Health and Welfare services in mind we have indulged in some crystal gazing into predicted populations for ten and twenty years hence but have been forced to the conclusion that the policy of the Local Authority, especially in regard to the provision of housing, will be the greatest single factor in determining the size and age structure of the local population. Diseases of the circulatory system and malignant diseases main tain their position as the main killers. Of the malignant diseases carcinoma of the lung is the one condition that is steadily increasing. It is extraordinary that notwithstanding all the weight of medical opinion, how indifferent the public seem to be towards this appalling yet preventable loss of life. INFECTIOUS DISEASES This was a Measles year, 1690 cases being notified as opposed to 94 last year. Fatality from this disease was nil. Yet we cannot ignore the fact that measles still exacts its toll of complications. So much so that vaccine for its prevention is being actively sought. Whooping cough notifications were also up from last year. It is gratifying to record a nil return for poliomyelitis. We would like to think that our immunizing programme is paying off. The mild nature of most infectious diseases these days tends to engender complacency but we must always be on the alert for the occasional explosive outbreak of such diseases as smallpox or typhoid which can disrupt the lives of whole communities. 6 Tuberculosis has come to be regarded as being fairly well contained but it is disturbing to record a comparatively sharp rise in cases this year. From the Consultant Chest Physician s report it will be seen that half the increase is attributed to immigrants. We are often presented with difficulties in persuading and explaining the need for immigrant contacts of tuberculosis to present themselves for investigation and surveillance. STAFFING Except for Public Health Inspectors and Health Visitors we have been most fortunate in maintaining a very high level of staffing. We are more than pleased with the situation in the domiciliary midwifery field, where there is an ever-increasing case load due to the higher birthrate and the early discharges from the maternity hospitals FUTURE PROSPECTS When the long awaited Comprehensive Clinic in Hurst Road is finally built it will enable us to put into effect many of the schemes which a forward looking local authority health service seeks to attain. The Audiology Unit will offer a complete assessment of the child s hearing at the earliest possible age together with opportun ities to combine this with the essential counselling and instruction of the parents in their part in assisting the child to overcome its handicap. Facilities will also be more readily available to bring together a team of varying disciplines to make an early and comprehensive assessment of all handicapped children. The increasing number of infants who survive with serious congenital and multiple defects demands such early and expert evaluation and management and all assistant medical officers should be given the opportunity of train ing in this field of child health and development. General Practitioner participation in the Clinic opens up exciting fields of co-operation between them and our staff. There could be mutual efforts in establishing preventive clinics in the field of geriatrics and mental health. Of great interest and urgency at the present isthe cytology clinic, i.e., the examination of women in vulnerable age groups for precancerous lesions of the womb. The Clinic will also provide much needed facilities for a Health Education Centre and could be used for the instruction of both pre and post graduate medical students in practical public health and preventive medicine with benefit to the future general practitioner as well as stimulating recruitment of suitable candidates to careers in the Service 7 The acquisition of property in Bisterne Avenue for the purpose of giving the elderly a short stay in delightful surroundings is a unique venture. It will fill an essential gap in our services for the aged and will encourage and enable many more families to maintain their elderly parents in their own homes. The care of the elderly and the prevention of developmental deformities and neo-natal death are two of the great and growing problems of this decade. Much has already been done in both these fields; our services for the elderly were generally reviewed in the 1961 report and as an instance of the improved ante-natal care available to expectant mothers it is notable that this year only three medical aid notices were issued by midwives attending a confinement compared with 200 annually twenty years ago. It is rare nowadays for an expectant mother not to be adequately supervised throughout her pregnancy and confined either by her own doctor or by a general practitioner obstetrician nominated by him, hence the diminished use made of the scheme whereby the Local Authority were empowered (in 1946) to pay a fee to any doctor summoned by one of their midwives in an emergency. I wish to record my thanks to the Chairman, Vice-chairman and Members of the Health and Area Health Committees for their continued understanding, also to my Chief Officer colleagues and my staff for their ever ready co-operation and help. I have the honour to be, Your obedient Servant, M. WATKINS Medical Officer of Health. 8 A. - STATISTICS & SOCIAL CONDITIONS OF THE AREA Area (in acres) 4,343 Population (Registrar General's Estimate, mid year 1963) 107 260 Number of Assessments (31st December 1963) 41 028 Rateable Value (31st December 1963) £5 , 604,601 Estimated Product of a penny rate (1963/64) £22,750 Population - The Registrar General's Estimate of the home population at mid-year. 1963 is 107,260, a decrease of 930 on the previous year. The steady decline continues. This figure has been used for the calculation of the following statistics: Live Births: Number 1665 Rate per 1,000 population 15.5 Illegitimate Live Births per cent of total live births 6.2 Stillbirths. Number 30 Rate per 1,000 total live and stillbirths 17.7 Total Live and Stillbirths 1695 Infants Deaths (deaths under 1 year) 37 Infant Mortality Rates: Total infant deaths per 1,000 total live births 22.2 Legitimate infant deaths per 1,000 legitimate live births 21,1 Illegitimate infant deaths per 1,000 illegitimate live births 38.4 Neonatal Mortality Rate (deaths under 4 weeks per 1, 000 total live births) 14.4 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 total live births) 12.0 Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 29.5 Maternal Mortality (including abortion): Number of deaths NIL Rate per 1,000 total live and stillbirths NIL Deaths The Registrar General s classification of causes of death by sex totals is given on page 9, 9 Causes of Death as given by the Registrar General for the Year 1963 Causes of Death Males Females Total 1962 1 Tuberculosis Respiratory 4 2 6 5 2 Tuberculosis other - - - - 3 Syphilitic Disease 1 - 1 6 4 Diphtheria - - - - 5 Whooping Cough - - - - 6 Meningococcal Infections - - - - 7 Acute Poliomyelitis - - - - 8 Measles - - - - 9 Other Infective and Parasitic Diseases 1 - 1 - 10 Malignant neoplasm stomach 19 17 36 44 11 Malignant neoplasm Lung bronchus 74 9 83 75 12 Malignant neoplasm breast - 19 19 27 13 Malignant neoplasm uterus - 8 8 9 14 Other malignant and lymphatic neoplasms 52 62 114 131 15 Leukaemia aleukaemia 6 2 8 7 16 Diabetes 6 10 16 11 17 Vascular lesions of nervous system 65 96 161 148 18 Coronary disease angina 147 106 253 241 19 Hypertension with heart disease 5 9 14 14 20 Other heart disease 59 81 140 139 21 Other circulatory disease 35 39 74 55 22 Influenza 3 4 7 10 23 Pneumonia 55 55 110 84 24 Bronchitis 63 24 87 83 25 Other diseases of respiratory system 7 4 11 11 26 Ulcer of stomach and duodenum 11 5 16 13 27 Gastritis enteritis and diarrhoea 3 5 8 4 28 Nephritis and nephrosis 4 2 6 4 29 Hyperplasia of prostate 3 - 3 8 30 Pregnancy childbirth abortion - - - 1 31 Congenita] malformations 6 4 10 9 32 Other defined and ill defined diseases 38 49 87 90 33 Motor Vehicle Accidents 5 4 9 15 34 All other accidents 9 8 17 19 35 Suicide 3 4 7 10 36 Homicide and operations of war - - - - Totals 1963 684 628 1,312 - Totals 1962 650 623 - 1 273 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 yrs. & over Total deaths 2 2 12 86 90 76 Lung Males 1 29 28 16 Females 1 4 4 - 10 The total number of deaths in 1963 (1312) compares with 1273 in 1962. the respective death rates being 12.2 and 11.76 per 1.000 population, The comparability factors for Walthamstow are given by the Registrar General as follows:- Comparability factor for births 1.06 Comparability factor for deaths 1.01 The above factors, when applied to the crude rates, produce the following adjusted rates;- Live births 16.4 Deaths 12.3 Deaths from Accidents in the home Ten deaths occurred in 1963 from this cause. All died at home, Ages and sexes were Female: 89,86,82,76,9. Male 87,78.62,57,27. In order to put these and other deaths in proper perspective the following comparison is made: Cause of Death 1963 1962 (a) Suicide 7 10 (b) Motor Vehicle accidents 9 15 (c) All other accidents 17 19 (d) Accidents in the home (included in line (c) 10 12 (e) Tuberculosis 6 5 (f) Poliomyelitis Nil Nil Employment Contributed by Miss G. Cordell, Manager of the Local Employment Exchange. 1. Insured population of the Boroughs of Walthamstow, Leyton. Chingford, Wanstead and Woodford:- Approximately 48,526 men and 36,831 women. 2. Insured population of the borough of Walthamstow: Approximately 21,286 men and 14.513 women. 3. The number of persons placed in employment in the whole area during 1963:- Approximately 3,584 men and 1,411 women. These figures include approximately:- 267 disabled men and 84 disabled women. 4. The average number of persons unemployed in the whole area during 1963;- 1,132 men 228 women. These figures include approximately:- 117 disabled men and 22 disabled women. 11 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: Appointment s From Miss K. Smith Junior Clerk 30.7.1963 Mrs. P. Murray Part-tune uaundress 4.3.1963 Mrs. I. Thompson Part-time Laundress 4.3.1963 Resignations Mr. D.J. Cross Public Health Inspector 9.4.1963 Mr. L. P. Joyce Public Health Inspector 16.6,1963 Mr, w. Potter Inspecting Assistant 7.4.1963 Mrs. D. Puleston Part-time Laundress 1.3.1963 Mrs. D. Sedger Clerk 30.6.1963 Laboratory Facilities Arrangements continued with the Public Health Laboratory Service at Colindale. The number of specimens examined during the year was as follows: - Specimens Total Faeces and rectal swabs 863 Nose and Throat swabs 24 Pood 4 Miscellaneous 10 Total 901 12 Ambulance Facilities These are available from a depot situated at Whipps Cross which is administered centrally from Chelmsford, via the Control Centre at Ilford. Treatment of Scabies and Verminous Conditions The arrangement with Hackney Borough Council, detailed in the report for 1953, continued. Seventeen treatments were given at the cost of £14. 0. 6d. Hospital Accommodation (a) Acute Cases. - There were no major changes in 1963 in regard to the hospital accommodation available for the inhabitants of the Borough. (b) Chronic Cases. Regional Hospital Boards have asked that Medical Officers of Health shall support when necessary on 'social grounds the recommendations of medical practitioners for the admission of the chronic sick to hospital. All possible help was given when requested. The following table shows the position in regard to hospital and hostel admissions considered and/or supported on 'social' grounds. Total number of cases 32 New Cases 28 Brought forward from 1962 4 M.O.H. requests to Langthorne Hospital or Area Welfare Officer 6 Admitted to Hospitals 7 Admitted to Hostels 6 Died before admission 3 Refused Hospital or Hostel accommodation 3 Cancelled or deferred 10 Waiting for Hostel accommodation 2 It is a pleasure again to record the unfailing help and consideration experienced from Dr. DeLargy at Langthorne Hospital, from Mr. P.J. Meacock, 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 1963. During the year the medical staff paid fifteen visits to the establishments registered for massage and special treatment. 13 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 35,328 meals (including 110 free Christmas dinners) during 1963. The following table is a summary of the Meals-on-Wheels provided during the year. Number of Meals served weekly (approximate) 710 Number of people receiving meals (approximate) 725 Number of new cases, for the year 169 Number of vehicles involved 7 Number of voluntary Helpers 60 Number of visits annually 245 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 1963: - Total number of persons - Walthamstow 29 Total number of persons - Woodford 13 Total number of persons - Chingford 1 Average number of cases per week 25 Total number of articles laundered 17,633 Average number of articles per week 346 Total number of journeys 2,064 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 156 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. 14 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 125 155 280 Post Mortems Examination and Inquests 10 23 33 Inquests only 4 63 67 139 241 380 Rainfa11 The annual rainfall at the Ferry Lane Station was 23.38 inches, In 1962 it was 22.37 inches. Flooding Widespread flooding occurred on three occasions during the year and severe flooding on one occasion. 15 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 9 3 6 13 25 11 67 Whooping Cough 53 13 24 41 40 36 207 Measles 319 186 213 229 407 343 1,697 Diphtheria - - - - - - - Pneumonia 6 3 4 6 16 5 40 Meningococcal Infection . - - - 1 - 1 Acute Poliomyelitis Paralytic - - - - - - - Non Paralytic - - - - - - - Acute Infective Encephalitis - - - - - - - Post Infectious Encephalitis - - 1 - - - 1 Dysentery 29 11 119 31 5 21 216 Ophthalmia Neonatorum 1 1 - - - - 2 Puerperal Pyrexia 2 2 2 10 3 - 19 Smallpox - - - - - - - Paratyphoid Fever - - - - - - - typhoid Fever - - - - - - - Food Poisoning - - - 1 3 5 9 Erysipelas 1 - 2 - 1 3 7 Malaria - - - - - - - Tuberculosis Respiratory 5 6 9 9 9 17 55 Meninges and Central Nervous System - - - - - - - Other Forms - 1 2 4 1 2 10 Totals, 1963 425 226 382 344 511 443 2,331 Totals, 1962 58 25 51 97 81 95 407 16 Food Poisoning Nine cases were notified during 1963 and none was fatal. There was one familial 'outbreak', in which the infecting agent was Salmonella Typhi murium. 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 durin 1963: Age Periods NEW CASES DEATHS Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F Under 1 year - - - - - - - - 1-4 years 1 - - - - - - - 5-9 years 1 1 - - - - - - 10-14 years - - - - - - - - 15 19 years 1 3 1 - - - - - 20 24 years 2 2 - 3 - - - - 25-34 years 8 2 1 2 - - - - 35-44 years 5 4 1 1 - - - - 45-54 years 4 5 - 1 1 1 - • 55- 64 years 6 1 - - - - - - 65 and over 8 1 - - 3 1 - • 36 19 3 7 4 2 - - Totals 55 10 6 - 65 6 17 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., and 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. 18 HOUSING Contributed by Mr. P.G. Southgate, A.R.I.B.A., Borough Architect. Statistics Houses completed by the Local Authority 1963 Flats Houses Hoe Street Ward 15 - St. James Street Ward - - Higham Hill Ward - - High Street Ward 75 - Hale End Ward - 27 Wood Street Ward 119 14 Totals 209 41 Houses completed by Private Enterprise Flats Houses Hoe Street Ward - 1 St. James Street Ward - - Higham Hill Ward - - High Street Ward - - Hale End Ward 4 - Wood Street Ward 9 2 Totals 13 3 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 208 Standard 140 Total number of grants and amounts approved by Council to owner/occupiers:- Discretionary 74 £21,118 Standard 123 £15,395 Applications received from Warner Estate Ltd. Discretionary 37 Total number of grants and amounts approved by Council to Warner Estate Ltd, Discretionary 43 £8,963 19 Summary Total number of applications Discretionary 245 Standard 140 Total number of grants Discretionary 117 Standard 123 Total amount of grants Discretionary £30,081 Standard £15,395 General Mr. R. Park, the Council's Acting Housing Manager has kindly contributed the following details of rehousing carried out by the Housing Department in 1963:- No. of new properties made available for letting 249 Acquired 78 Normal vacancies 144 Nominations to private landlords 9 New properties at Canvey New properties at Billericay Total 480 Families rehoused:- 1-bedroom group 144 2 bedroom group 181 3-bedroom group 140 4-bedroom group 15 Total 480 Property under management at December 1963:- Pre-1939 houses and flats 1,614 New houses and flats 3,329 Properties at Canvey Island 206 Properties at Billericay 441 Prefabricated bungalows 30 Properties converted into flats 314 Properties acquired for housing purposes 885 Properties for Clearance and Demolition 418 Halfway houses 2 General Properties 39 Commercial Properties 74 Garages 1,687 Total 9,039 The number of families rehoused in New Towns during 1963 was 55. 20 The following extracts are taken from the Annual Report of the Housing Management Committee:- Rehousing During 1963 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 29 'D' Families living apart 6 'E' Irregular overcrowding 120 'G' Two refusals of alternative accommodation 3 'K' Three or more families (relatives) in House 1 'H' Transfer of priority housing - 'J' Special cases 57 'J' Rehousing subject to nomination 5 M.O.H. Medical recommendations (T.B.) 2 M.0.H. Cases for consideration 8 Special requests for emergency accommodation 55 Total 286 A review of the register carried out in the latter half of 1963 revealed a considerable improvement in the overall housing position since the previous review. There are now only 507 families in the hardcore of the register, compared with 741 shown two years previously including 241 cases which have been registered for less than twelve months. It would seem that the urgent housing need caused by over crowding which has persisted over many years has lessened considerably and we have now passed to a phase where the emphasis must be placed upon providing improved standards. The housing register includes 318 old age pensioners requiring one bedroom premises but this is considered to be only a part of the total need among elderly persons in the town and methods of discovering other necessitous cases must be followed wherever practicable. There is need for the building of flats specially designed for elderly persons with a warden in charge for those applicants who would benefit from this type of accommodation but other elderly persons much prefer to live in schemes of mixed development and care in the proper selection of tenants for various types of vacancies is necessary, MEDICAL CASES During 1963 nine cases claiming rehousing priority for tuberculosis were investigated and reported upon. They were all added to the list. 21 The position at the end of 1963 was as follows:- Class 1 Class 2 Class 3 Class 4 Total On list at end of 1962 2 4 11 5 22 Added to list during 1963 2 1 6 9 4 5 11 11 31 Rehoused or removed from list during 1963 1 1 1 1 4 On list at end of 1963 3 4 10 10 27 In addition to the tuberculosis cases, thirteen other cases were recorded as needing special consideration on medical grounds and ninety three on general grounds. POPULATION PREDICTION AS RELATED TO HOUSING PROVISION The Registrar General has produced estimates (which are likely to be very accurate) of the population structure of England and Wales during the next twenty years but it is not possible to predict with any degree of accuracy the populations of local areas. In Walthamstow, for example, the opening of the Victoria line will tend to attract white-collar commutors, while the transfer of industrial concerns to satellite towns, e.g., Taylor Controls to Stevenage, may lead to some industrial workers moving out of the district. By altering the proportion of various classes within the community large differences might arise in the housing need even if the total population remains numerically the same. The Local Authorities, through their own town planning and redevelopment schemes, may themselves profoundly affect the structure of the population by encouraging or discouraging industrial development or providing particular types of housing. Therefore no local estimate can pretend to be accurate but it is reasonable, as a first approximation, to apply the National trends to local statistics and then introduce such corrective factors as can be foreseen. Projected Populations for England and Wales by Age Groups Age Groups 1962 1972 1982 Thousands % Thousands % Thousands % 0-14 years 10, 559 22.6 12,351 24.4 13,214 24.4 15-44 years 18,720 40.1 19, 535 38.6 21,864 40.4 M 45/65 years ) 10.504 22.5 10,510 20.8 10,130 18.7 W 45/60 years ) M 65+ years ) 6.985 14.9 8,125 16.0 8, 878 16.4 W 60+ years ) TOTAL 46,768 100.1 50,521 99.8 54,086 99.9 22 The increase (1,792 000 in 1972 and 2,655,000 in 1982) in the number of children in the population, represents percentage increases of about 17 per cent and 25 per cent on the 1962 figures. For pensioners the corresponding figures are 1 140, 000 more in 1972 and 1,893,000 more in 1982. percentage increases of over 16 per cent and 27 per cent respectively. These groups together now comprise 37.5 per cent of the whole population; in 1972 the percentage will be 40.4 and in 1982 40.8 per cent. The Birth and Death Rates are the two most important factors governing these population trends and the difference between these rates for Walthamstow and the National average both reflects and determines the local population structure, i.e., its distribution into age groups. Death Rates YEAR 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 England and Wales 12.5 11.3 11.4 11.3 11.7 11.7 11.5 11.7 11.6 11.5 12.0 11.9 Walthamstow 10.8 10.8 9.9 9.5 10.0 10.2 11.4 10.2 10.8 10.1 12.1 11.7 Birth Rates YEAR 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 England and Wales 15.5 15.3 15.5 15.2 15.0 15.6 16.1 16.4 16.5 17.1 17.4 18.0 Walthamstow 13.5 12.6 12.2 12.3 11.3 11.8 11.4 11.3 12.7 12.79 14 14.4 Death Rates in Walthamstow have been almost consistently lower than the National average and have played some part in producing a higher proportion in the older age groups though migration of young families to out borough housing estates is probably a more important factor. Because of the smaller proportion of young adults the birthrate is considerably below that for England and Wales but has risen parallel with the National average since 1955 when it was 3,7 per thousand below (15 11.3) now it is 3.6 points down (18 14.4) so that though there may be relatively fewer child producing families the same trends are operating here as elsewhere and it is therefore reasonable to predict the future population structure of Walthamstow by extrapolating from the 1961 census figures for distribution of population using the same percentage changes as the Registrar General has computed for the National average so long as migration is ignored. 23 Population of Walthamstow Age Group Distribution Age Groups 1951 Actual 1961 Actual 1972 Projected 1982 Projected No. % No. % No. % No % 0-14 years 25,707 21.2 21,263 19.55 24,877 21.2 26,579 21.2 15-44 years 52,198 43.0 41,230 37.85 45-59 years 24,382 20.3 26,078 23.85 Males only 60 64 years 2,599 2.1 2,820 2.58 M 65+years) 16,249 13.4 17,454 16.00 20,247 17.24 22,166 17.15 W 60+ ” ) TOTALS 121,135 100 108,845 99.83 117,553 125,313 These projections are based on the assumption that Walthamstow follows the National trend with an increase of total population of 8% between 1962 and 1972 and by 15.13 per cent between 1962 and 1982 but they may be completely vitiated by the effects of migration whose profound influence on population structure is shown by the loss of nearly eleven thousand young adults and four and a half thousand children between 1951 and 1961 death rates in these groups being negligible. During the last 10 years while all these young people had left the town the numbers over 45 have increased by 3,122. This age group is less likely to be affected by migration, so that the prediction of the number of the pensioners is probably fairly accurate. While it is impossible to give a realistic forecast for the number of children there is every indication that both number and proportion will increase in Walthamstow as elsewhere. The proportion marrying at all ages is increasing, especially among women between 20 and 24 years and 25 to 29 years, and the expected number of children per couple has increased from 1.99 for those married in 1940 to 2.5 for those married in 1956. Irrespective of the total population, therefore, a large increase in the number of pensioners is certain and a moderate increase in the number of children, and in family size, is probable, and it would seem prudent to consider housing schemes which envisage providing room for children and their grandparents. 24 D. SANITARY CIRCUMSTANCES OF THE AREA Contributed by Mr, W. Richards. Chief Public Health Inspector, Public Health Inspection of the Area During the year 543 Intimation Notices were served, 48 were in respect of business premises and 495 related to defects in private houses. Of the latter figure, 399 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 notices in five cases. The hearings were adjourned sine die in three cases; in another, costs of £2.2.0. were awarded and an Order of twenty-eight days was made and costs of £3.3.0. was given in the other case. Proceedings were taken against an owner who failed to provide the required information as to ownership of a property, and the Court awarded costs of £2.2.0. and penalty of £5.5.0. 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 301.. 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 Smoke Control Areas Nos. 3,4 and 5 came into operation during the year. The detailed surveys in respect 6f smoke Control Areas Nos, 6, 7 and 8 were completed during the year, and areas Nos. 6 and 7 were confirmed by the Minister of Housing and Local Government and will come into operation next year. An objection was lodged in respect of area No. 8 and a public inquiry was held by the Minister. The decision of the Minister had not been received by the end of the year. 25 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. Sixteen rooms were disinfected and insecticides were issued. free of charge, to nine 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. Steam baths and old age pensioner's free baths reached new records in 1963 with 1510 steam bathers and 8320 old age pension bathers - the highest ever. After dropping to 84,024 in 1961 the number of slipper bath bathers increased to 89,845. The swimming pool water was sampled by the M.O.H. with excellent results in clarity and bacteriological purity. 1963 shows only a slight percentage decrease on the peak swimming year of 1961. Fitness and health through swimming remain a challenge to motor and T.V. Age flabbiness for thinking Walthamstow people.' Sewerage Arrangements for sewerage and sewage disposal in the district are reasonably adequate. 26 Hairdressers Ninety three premises are registered under the Walthamstow Corporation Act 1956. Inspections of these premises were carried out under the Bye Law requirements and most were found to be in a reasonable condition. Rent Act, 1957 This Act empowers the landlords of dwelling houses to increase rent provided the property is in good repair. On receipt of a notice of increased rent from the landlord, the tenant, if he considers that the property is not in good repair, must serve a notice on the landlord specifying the works he considers should be carried out. If the landlord does not carry out the works specified or does not give an undertaking to carry out the work, within six weeks, the tenant may apply to the Council for a Certificate of Disrepair, This Certificate, if issued, will enable the tenant to deduct any increase already paid from the date of the application to the Council and he need not pay the increased rent demanded. 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 39 lettings. Local Land Charges Enquiries relating to outstanding sanitary notices were dealt with in 2,299 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 66 samples of milk were taken and submitted to the Counties Laboratories for bacteriological examination, including Phosphatase, Methylene Blue and Turbidity Tests. 27 These samples of milk were mainly taken from roundsmen during the course of delivery, or on arrival at schools. They include monthly sampling from one dairy. 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 are taken for both chemical and bacteriological examination. Those taken for chemical examination complied with the legal requirements for fat content etc. and samples taken for bacteriological examination were mostly of a high standard. Two water ice samples were taken for bacteriological examination and were satisfactory. 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 Foods There are no slaughterhouses in operation in the Borough. A considerable amount of various types of food was inspected, a certain quantity of which was condemned as unfit for human consumption. Sampling of Food for Bacteriological Examination Various types of food were sampled including 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, 102 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. 28 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. One dairy in the area is registered under the Milk and Dairies Regulations. Condemned food was 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 1963 Food and Drugs Act 1955 String in loaf of bread. Court awarded Costs of £5.5.0. Maggot in loaf of bread. Court awarded Penalty of £10.0.0. and Costs £1.1.0. Black substance in loaf of bread, Court awarded Costs of £2.2.0. Food Hygiene (General) Regulations 1960 Smoking whilst delivering bread. Court awarded Penalty of £5 and Costs £1.1.0. Common Lodging Houses There is no common lodging house in the area. Rag Flock and other filling materials Act, 1951 No application for approval was 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 Orders were issued during the year. Pet Animals Act. 1951 Fourteen premises are licensed in the Borough for the sale of pet animals. All licenses are renewed annually and all premises were inspected during the year. 29 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 15,655 1,715 2,118 543 393* 102 75* 20,952 * Includes notices outstanding from previous year. The following table shows the nature of work executed and improvements effected during the year:- Drains tested, 208; drains reconstructed or repaired. 107; drain obstructions removed, 75; drains, means of access provided, 46; drains, ventilations provided or improved, 4; soil pipes renewed or repaired, 41; rainwater pipes repaired or renewed, 42; roofs repaired or renewed, 114; gutterings repaired or renewed, 122; W.C. pans and traps provided. 74; W.C.s repaired or cleansed, 55; gully traps provided, 37; waste pipes repaired or renewed, 38; new sinks provided, 3; stoves and firegrates repaired or renewed, 9; water supply re instated, 27; yard and forecourt pavings repaired, 30; dirty houses cleansed, 1; dirty rooms cleansed. 27; floors repaired, 29; ventilation under floors provided or improved, 12; dampness remedied. 133; offensive accumulations removed. 14; manholes repaired or resealed, 37; miscellaneous repairs, 429. Infectious Diseases Visits to premises, 12. Disinfections Rooms disinfected. 7; articles disinfected, 4,440; articles destroyed, 24. 30 Special Premises Number Visits paid Factories (a) Non-power 30 6 (b) Power 459 88 (c) Other premises 23 11 Outworkers 151 65 Butchers 82 78 Bakers and Shops 42 33 Fishmongers, Fryers and Curers 35 41 Cafes and Caterers 88 72 Grocers 227 186 Greengrocers 78 42 Ice Cream Manufacturers 5 15 Ice Cream Vendors 420 63 Dairies 1 9 Milksellers 141 32 Ladies' Hairdressers 64 18 Gentlemen's Hairdressers 50 16 School Kitchens 26 43 Schools 59 25 Street stalls 120 357 Public Houses 38 40 Rag Dealers 1 1 Caravans 3 8 As a result of the regular periodical visiting of the above premises, the following works were carried out:- Butchers Cleansings, 3; accumulations removed, 2; W.C.s repaired and cleansed, 1; other improvements, 1. Bakers Cleansings, 1; other improvements, 1. F ishmongers Cleansings, 2; drains cleared. 3; yards repaved, 3; accumulations removed, 4; other improvements, 2. Cafes and Caterers Cleansings, 5; floors repaired, 2; kitchen light and ventilation improved, 1; other improvements, 15. Grocers Store rooms cleansed, 1; other improvements, 4. Greengrocer s Store rooms cleansed, 1. School kitchens Cleansings, 1; other improvements, 2. Public Houses Cleansings, 2. 31 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. Mar. April May June Sir George Monoux Grammar School 3.9 3.1 2.6 1.7 1.2 0.77 Willow Walk site 3.1 2.2 1.6 1.3 1.1 0.63 Woodford County High School 2.2 1.7 1.4 0.84 0.70 0.44 Blackhorse Lane site 3.4 2.5 3.3 1.5 1.4 1.1 July Aug Sept. Oct. Nov. Dec. Sir George Monoux Grammar School 0.93 0.70 0.88 1.6 1.9 2.8 Willow Walk site 0.66 0.65 0.72 1.2 1.7 2.2 Woodford County High School 0.47 0.42 0.54 0.86 1.1 1.4 Blackhorse Lane site 0.92 0.76 0.88 1.6 2.4 2.6 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 9.8 milligrams. Rent Act, 1957 The following action was taken under the Act during 1963:- Part I- Applications for Certificates of Disrepair (1) Number of applications for certificates 7 (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 1 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 4 (5) Number of undertakings refused by local authority under proviso to paragraph 5 of the First Schedule - (6) Number of certificates issued 2 Part II - Applications for cancellation of Certificates (7) Number of applications by landlords to Local Authority for cancellation of certificates 10 (8) Number of objections by tenants to cancellation of certificates 9 (9) Number of decisions by Local Authority to cancel in spite of tenant's objection 1 (10) Number of certificates cancelled by Local Authority 2 In addition to the above, 7 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, and all applications were granted. 32 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) 1,137 (b) Number of inspections made for the purpose 3,374 (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 5 (b) Number of inspections made for the purpose 7 (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) 1 (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 495 II. Unfit houses closed:- (1) Under Sections 16(4), 17(1) and 35(1), Housing Act, 1957 1 (2) Under Sections 17(3) and 26, Housing Act, 1957 - (3) Parts of buildings closed under Section 18, Housing Act, 1957 1 III. Unfit houses made fit and houses in which defects were remedied:- (1) After informal action by Local Authority 399* (2) After formal notice under (a) Public Health Acts 73* (b) Sections 9 and 16, Housing Act, 1957 - (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 Results Satisfty. Unsatisfty. Pasteurised 25 24 1 Sterilised 5 5 - Tuberculin Tested Pasteurised 36 34 2 Totals 66 63 3 33 Milk (Special Designations) Regulations, 1960. As from the 1st January, 1961, these Regulations brought into force new forms of licences and period of duration The following licences are in operation to 31st December, 1965. Pasteurisers' Licences 1 Dealers' Licences: Tuberculin Tested 1 Dealers' Pre-packed Milk Licences: Sterilised 128 Pasteurised 88 Tuberculin Tested 29 There are no cow keepers in the district. The number of Retail Milk Distributors is 141. Forty-one visits were paid to registered premises and a satisfactory standard of cleanliness was maintained. Ice Cream Seven applications for registration were received and dealt with as follows:- Vendors, New 1 Vendors, Transfers 6 Number on Register at end of year 420 Number of premises used for manufacturing 5 Food Standards (Ice Cream) Order, 1951. Four samples of ice cream were taken and submitted to the Public Analysts who reported the following satisfactory results: Fat Content 12.7 12.2 16.3 10.1 Bacteriological Examination of Ice Cream Forty four samples were submitted for examination and for grading in accordance with the provisional test of the Ministry of Health, with the following results:- Grade 1-26 Grade II-10 Grade III-3 Grade IV-5 Lollies (Various) Two water ice samples were examined for bacterial purity and both were satisfactory. 34 Meat and Other Foods There is no slaughterhouse 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. 255 tins Evaporated Milk 14 pkts. Chicken Quarters 13 tins Pull Cream Milk 18 pkts. Chicken 3 tins Skimmed Milk 84 pkts. Steak & Kidney Pie 50 tins Cream 6 pkts. Cheeseburgers 818 tins Soup 12 pkts. Dinners 392 tins Strained Foods 107 pkts. Plaice 5 tins Veal 17 pkts. Scampi 55 tins Steak 25 pkts. Fish Cakes 3 tins Steak & Kidney Pie 166 pkts. Fish Fingers 7 tins Chicken Snacks 1 pkt. Roe 3 tins Irish Stew 28 pkts. Haddocks 20 tins Sweet Puddings 26 pkts. Kippers 242 tins Creamed Rice 56 pkts. Cod Steaks 11 tins Macaroni 5 pkts. Lemon Sole 11 tins Pie Pilling 5 pkts. Herrings 273 tins Prunes 31 pkts. Broad Beans 99 tins Pineapple 51 pkts. Spinach 154 tins Peaches 103 pkts. Sliced Beans 118 tins Pears 7 pkts. Sweet Corn 89 tins Mandarin Oranges 358 pkts. Peas 24 tins Grapefruit 9 pkts. Brocolli 75 tins Fruit Salad 19 pkts. Mixed Vegetable 9 tins Plums 41 pkts. Brussel Sprouts 1 tin Raspberries 47 pkts. Chips 111 tins Cherries 14 pkts. Raspberries 1 tin Blackcurrants 1 pkt. Strawberries 2 tins Gooseberries 10 pkts. Cream Sponge 174 tins Loganberries 41 pkts. Pastry 8 tins Grapefruit Juice 11 pkts. Sausage Rolls 166 tins Orange Juice 21 pkts. Eclairs 10 tins Pineapple Juice 36 pkts. Lemon Mousse 9 tins Beans/Sausage 332¾ lb. Luncheon Meat 12 tins Beans/Pork 318¾ lb. Chopped Pork 569 tins Baked Beans 2¼ lb. Minced Beef Loaf 1 tin Curried Beans 655¼ lb. Corned Beef 18 tins Butter Beans 6 lb. Corned Mutton 123 tins Spaghetti 57 lb. Pork (tinned) 309 tins Peas 92¼ lb. Pork 8 tins Broad Beans 42 lb. Lamb 15 tins Carrots 77¼ lb. Ham (tinned) 3 tins Potato Salad 77½ lb. Ham 3 tins Vegetable Salad 56½ lb. Jellied Veal 13 tins Macedoine 279½ lb. Beef 2 tins Beetroot 3 3¾ lb. Chicken 35 104 tins Tomatoes 53 pkts. Beefburgers 7 tins Tomato ) Juice 25 pkts. Chicken Pie 4 tins Tomato ) 4 pkts. Chicken & Mushroom 6 tins Syrup 6½ lb. Plums 52 tins Salmon 7½ lb. Currants 2 tins Prawns 72 lb. Jam (tinned) 20 tins Pilchards 1¾ lb. Butter 6 tins Herrings 20¾ lb. Plums (tinned) 42 jars Pickles 1760 lb. Apples 3 pkts.Mixed Grill 3¾ cwt. Potatoes 66 pkts. Steaklets 2 stone Plaice 54 pkts.Braised Steaks 7 boxes Ices Cooked Meats Sampling of these products continued during 1963, seventy samples being taken, Eighteen were classified as unsatisfactory because of bacteriological contamination which occurred during storage and exposure for sale. Miscellaneous Samples Nine samples of various foods were taken for bacteriological examination, seven of which were satisfactory. Appropriate action was taken in respect of the unsatisfactory samples, one being a cream eclair and the other a beef croquette. Adulteration, etc.- Food and Drugs Act, 1955 During the year, one hundred and two samples of food and drugs nere submitted to the Public Analysts. Ten samples were reported as being unsatisfactory, details respecting same are given below:- Description of Articles Result of Analysis Action taken Camomile Tisanes (3 samples) Proportion of sand and earthy matters excessive. Warning letter Garden Peas Dehydrated with preservative - incorrectly labelled as 'Garden Peas'. Warning letter "Squeeze Up" (Ice Confection) Labelling of ingredients not in accordance with Labelling of Pood Order. Warning letter Tindas No statement of ingredients appeared on label as required by Labelling of Pood Order. Warning letter Cream Cheese Pat content was low for article described as 'Cream Cheese' . Warning letter 36 Description of Articles Result of Analysis Action taken Bread and Butter Fat on bread consisted of margarine containing approx. 10% butter. Warning letter Diabisc Biscuits Excessive carbohydrates to justify description 'Starch reduced'. Warning letter Blackcurrant Sweets with liquid Glucose and Vitamin C. No declaration of proportion of Vitamin C per oz. was given as required by Labelling of Food Order. Warning letter The following summary gives details of food samples and results of analyses:- No.Satisfactory No.Unsatisfactory Formal Informal Total Formal Informal Total Milk 6 - 6 - - - Ice Cream - 4 4 - - - 'Squeeze Up (Ice Confection) - - - - 1 1 Fruit Lolly - 1 1 - - - Cream, Cultured - 1 1 - - - Cream, Double - 1 1 - - - Cream, Sterilised - 2 2 - - - Butter - 1 1 - - - Dripping 1 1 2 - - - Cheese, Cream - 2 2 - 1 - Bread and Butter - - - 1 - 1 Hamburger - 1 1 - - - Sausages,Pork 2 2 4 - - - Beef, Minced 2 - 2 - - - Beef Steak, with Gravy - 1 1 - - - Steak & Kidney Pudding - 1 1 - - - Chicken Croquettes - 1 1 - - - Chicken Roll - 1 1 - - - Chicken Fritters - 1 1 - - - Irish Stew - 1 1 - - - Chili Con Carne - 1 1 - - - Fish Cakes - 1 1 - - - Fish Sticks - 1 1 ~ - - Crab. Dressed - 1 1 - - - Cheese Spread with Lobster - 1 1 - - - Spaghetti in Tomato Sauce - 1 1 - - - Paste - 2 2 - - - Jam - 1 1 - - - Soup - 3 3 - - - Yoghurt - 1 1 - - - High Protein Cereal - 1 1 - - - Peas, Garden - - - - 1 1 Cole Slaw - 1 1 - - - French Beans, Quick Dried - 1 1 - - - Horseradish,, Creamed - 2 2 - - - Apple Flakes - 1 1 - - - Apples - 2 2 - - - Tindas - - - - 1 1 Peaches - 1 1 - - - Peanut Kernels - 1 1 - - - Vegetable Juices - 1 1 - - - Camomile Tisanes - - - 2 1 3 Peppermint Tisanes 1 - 1 - - - Rose Hip & Hibiscus Tisanes 1 - 1 - - - Cider, Vinegar - 1 1 - - - Tea - 1 1 - - - 37 No.Sat isfactory No .Unsat isfactory Formal Informal Total Formal Informal Total Shandy _ 2 2 - - - Whisky 6 - 6 - - - Lemon Juice - 1 1 • - - Jelly - 2 2 - - - Jelly Crystals - 1 1 - - - Sweets - 7 7 - 1 1 Marzipan - 2 2 - - - Peel Cut - 1 1 - - - Gelatine, Edible 1 - 1 - - - Pickle 2 2 - - - Curry Powder - 1 1 - • - Yeast - 2 2 - - - White Pepper Ground - 1 1 - - - Bicarbonate of Soda - 1 1 - - - Biscuits, Diabisc - - - - 1 1 Biscuits, Medicinal Charcoal - 1 1 - - - 20 72 92 3 7 10 Food Hygiene (General) Regulations, 1960 The following food premises are established in the Borough: Butchers, 82 Bakers, 42; Fishmongers, 35: Cafes and Caterers, 88; Grocers. 227 Greengrocers, 78; Dairies. 1; Milksellers, 141; Ice Cream Manufacturers. 5, Ice Cream Vendors, 420. The following inspections were carried out in respect of food premises. Butchers, 78 Bakers, 33; Fishmongers, 41, Cafes and Caterers, 72; Grocers, 186 Greengrocers, 42; Dairies, 9; Milksellers. 32; Ice Cream Manufacturers, 15: Ice Cream Vendors. 63. Prevention of Damage by Pests Act 1949 [ Type of Property Non^Agr icultural (1) (2) (3) (4) (5) Local Authority Dwelling houses(inc. Council houses) All other (including business premises) Total of Cols (1) (2) & (3) Agricultural I. Number of properties in Local Authority's District 12 34.609 6,407 41 028 3 II, Total number of properties in spected as a result of notification 240 59 299 Number of such properties found to be infested by:- Coramon rat Major - • - - - Minor - 204 51 255 - Ship rat Major - ~ -• - Minor - - House mouse Major - . - - - Minor 22 5 27 - 38  Type of Property Non Agricultural (5) Agricultural (1) Local Authority (2) Dwel1ing Houses(inc• Council Houses) (3) All other (including Business Premises) (4) Total of Cols.(1), (2) & (3) III Total number of properties in spected in the course of survey under the Act 12 137 49 198 3 Number of such properties found to be infested by Common rat Major - - •• - Minor 2 112 27 141 Ship rat Major — - Minor - - - - House mouse Major _ _ - • Minor 18 4 22 IV Total number of properties otherwise inspected (e g when visited primarily for some other purpose) Number of such properties found to be infested by 31 14 45 • Common rat Major - Minor - 16 9 25 Ship rat Major - - - Minor - - - - House mouse Major - - - - Minor 6 2 8 V. Total inspections carried out including re inspections 104 3. 268 281 3,653 8 VI. Number of infested properties (in Sections II, III & IV) treated by the L, A. 2 360 92 454 VII. Total treatments carried out including re treatments. 23 1,800 460 2.283 VIII. Number of notices served under Section 4 of the Act: (a) Treatment (b) Structural Work (i, e.Proofing) _ _ - IX, Number of cases in which default action was taken following the issue of a notice under Section 4 of the Act. X. Legal Proceedings - - - XI. Number of Block control schemes carried out - - - - - 39 Factories Act, 1961 The following tables show the work carried out under the above Act. 1. - INSPECTIONS Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1,2,3,4 and 6 are to be enforced by Local Authorities 30 6 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 459 88 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 23 11 Totals 512 105 - 2. Cases in which DEFECTS were found Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Refei To H.M. Inspector •red By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S, 1) _ _ _ . Overcrowding (S- 2) . . - - Unreasonable temperature (S3) _ Inadequate ventilation (S 4) _ - - - Ineffective drainage of floors (S 6) . . Sanitary Conveniences (S 7) (a) Insufficient 1 - - - (b) Unsuitable or defective 6 8 . (c) Not separate for sexes Other offences against the Act (not including offences relating to Outwork) 3 3 Totals 10 11 - 40 NUMBER AND TRADES OF OUTWORKERS NOTIFIED Wearing Apparel (making of) 121 Boxes 3 Brush Making 4 Artificial Flowers 9 Cosaques, Christmas Crackers etc. 11 Lampshades 1 Furniture and Upholstery 2 Total 151 41 SECTION F NATIONAL HEALTH SERVICE ACT, 1946 PART III SERVICES WALTHAMSTOW HEALTH AREA SUB COMMITTEE 1963/1964. Chairman: Councillor Mrs. E.L. BALDWIN (Walthamstow Borough Council). Vice-ChaIrman: Councillor P. FURBER (Walthamstow Borough Council). MEMBERS: Representing:- Essex County Council Alderman K.E.B. GLENNY, O.B.E., Alderman Mrs. S.M. BOVILL, J,P., (Chairman County Health (Vice-Chairman, County Health Committee) Committee) Alderman H.J.E. PALETHORPE Councillor W.J. BOWSTEAD, J.P., Councillor Mrs. M.J. HARVEY Councillor Mrs. A.E. WELSH Councillor Mrs. J.L. LOCK Walthamstow Borough Council Alderman Mrs. W.M. PALETHORPE Councillor C.G. ABLEY Councillor R.J.L. CAVE Councillor Mrs. R. COLIN Councillor L.V. GRAHAM Councillor Mrs. L.D. GURR Councillor J.H. HAMMOND Councillor J.E. NICHOLLS Councillor A.M. O'REILLY Councillor F.A.J. 0'SHEA Councillor Mrs. B.M. REYNOLDS Councillor F.S. WATTS Councillor D. WEINSTEIN Executive Council for Essex 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) 42 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 pages55 to 72. Section 21 HEALTH CENTRES In my Report for 1962 I referred to the six Health Services Clinics to be provided in Walthamstow in accordance with the Development Plan for Local Health and Welfare Services. The first of these to be erected willbe the one in Hurst" Road; for which a revised sum of £139,500 has been allocated. Work on the project should commence during the autumn of 1964. The building will be of 3 storey construction with the Clinic services accommodation on the ground and first floors and a flat for a resident caretaker on the second floor. All the Specialist and School Health Services such as Ear, Nose and Throat, Paediatric, Ophthalmic and Dental Clinics at present accommodated in the Town Hall will be transferred to the new premises together with others, such as the Child Guidance Service, Speech Therapy and Orthopaedic Clinics which are now operating in buildings situated in various parts of the Borough. A new service available at the Clinic will be the Audiology Unit which will undertake the scientific testing of children's hearing, particularly young children who by reason of congenital disabilities or other factors may be subject to defective hearing. Specially designed soundproof rooms together with up to-date equipment will be provided and the Unit will be staffed by a Consultant with particular skills in this field, aided by trained assistants. It is also intended to provide an opportunity for three local medical practitioners to operate their practices from the new Clinic. These doctors will not be provided with special separate accommodation but will make use of certain rooms during periods when these are not required for use by the Local Authority Services. It is hoped by this means that the general practitioners will be able to make greater use of the specialised facilities provided by the Local Authority and it will be possible to build up an integrated service to the community based on improved relationships and a cooperative spirit among all personnel employed in the Clinic. 43 Redecoration and Improvements to Premises Day Nurseri es The Area Surveyor for Building Maintenance prepared a scheme for transfer of the laundry equipment installed at the Higham Hill Nursery to the Annexe, and for the provision in the latter of a sink and new water heater. The vacated laundry was then converted for use as a baby bathroom. At the Handsworth Avenue Nursery an additional "Drugasar" gas heater was installed in the corridor serving the sanitary area and bathroom to overcome problems of cold and condensation. At both Nurseries coloured linoleum tiles were laid in the Hall, Office, Isolation Room and Staff Room which considerably improved the appearance of these rooms. General Internal and external redecorations in accordance with the phased programme of annual improvements were carried out in various premises under the control of the Health Area Sub-Committee. General Dental Service The General Dental Service figures included in the statistical summary on page 56 of this report unfortunately indicate a further reduction in the volume of work. This is due to staff losses which so far we have been unable to make good. Discussion are taking place with the Essex Executive Council to try and recruit a parttime dental surgeon for the General Dental Service, and it is hoped that these will be fruitful before long. One interesting point is the reduction of General Anaesthetic cases. This is due, not only to the fact that there are fewer new cases coming for treatment because it takes us all our time to care for those patients we already have, but it is also due to the tendency for cases requiring multiple extractions to be referred to the Oral Surgery Unit at Honey Lane Hospital. Section 22, CARE OF MOTHERS AND YOUNG CHILDREN Priority Dental Service There has been a slight increase in the number of mothers requesting treatment for themselves or for their children under school age. It would appear that many mothers who seek treatment outside the local Health Authority Service do not take full advantage of the facilities offered for their children. Some of them seem unaware that dental service is provided in conjunction with other child welfare services. 44 There is little doubt that if very young children are brought to the dental clinic at an early age, they are likely to be much happier about dental inspection and treatment during their school life and afterwards. The statistical details of patients inspected and treated during the year are given on page 59 of this report. Children "At Risk"' The Chief Medical Officer to the Ministry of Health in his Reports for 1959 and 1960 drew attention to the importance of ensuring that a child's deviation from normal should be recognised as early as possible and the nature of his handicap fully assessed in order that the necessary specialised treatment can be given, together with advice in the day to day management of the child as well as counselling the possibly distressed and bewildered parents. Subsequently the Minister of Health recommended local health authorities to set up registers of young children who are considered to be at risk of handicapping conditions arising from adverse circumstances in their parental, perinatal or postnatal life, or who have unfavourable family histories or whose developmental progress is in some way retarded or abnormal. It is a comparatively simple matter to compile and maintain an "At Risk register but exceedingly difficult to cope successfully with the problems of thorough investigation and assessment of each child on the register. A considerable knowledge of normal as well as handicapped children is necessary and careful investigation is required of the child's level of functioning in locomotion, manipulation, vision, hearing, speech, general understanding and social behaviour. Work of this nature can only be undertaken by a trained and experienced medical officer able to devote time not only to the detailed work of assessment but able to follow up cases and keep in personal touch with parents, consultants, family doctors and other personnel concerned with the child s progress and development. At the present time insufficient medical staff are available to deal effectively with this aspect of the scheme and the problem can only be solved by increasing the medical man power of the Department. Section 23 MIDWIFERY During the year one full time midwife was appointed, bringing the total employed to 7 whole-time Midwives and 3 District Nurse/Midwives not including supervisory staff. In view of the continuing National shortage of practising midwives the local situation may be regarded as satisfactory, although some of the staff are near retiring age. 45 The number of home deliveries was 508. In 301 of these cases a General Practitioner/Obstetrician was booked but was not present at the delivery. There was an increase in the number of cases discharged from Maternity Hospital after 48 hours into the care of domiciliary midwives, i.e. 276 cases in 1963 compared with 84 in 1962. The report for 1956 gave details of the steps taken in regard to co operation with general practitioners and these arrangements, amended and improved in the light of experience, continued during the year under review. In 1963, 8 Midwives and Nurse/Midwives assisted at Antenatal Clinics held in the surgeries of 14 General Practitioners. Sixteen pupil Midwives from Thorpe Coombe Maternity Hospital undertook their district midwifery training at the Nurses Home and 15 passed the examination. Two Midwives attended refresher courses arranged by the Royal College of Midwives. For some time past it has been a regular practice for local Maternity Hospitals to request through the Department reports on the home conditions of certain expectant mothers who have applied to have their confinement in Hospital. Hitherto these reports have been completed by Health Visitors, but in view of the fact that in the event of a hospital booking being refused, or the case being accepted for a 48 hour admission only, a district Midwife would be concerned with the confinement or the lying in period, arrangements have now been made for the district Midwives to take over this reponsibility and report upon the suitability or otherwise of the home circumstances of individual cases. Section 24 HEALTH VISITING Since the implementation of the National Health Service Act the Health Visitor has acquired a miscellaneous collection of duties to meet the changing social and environmental conditions of the community. We hear much of selective and discretionary visiting and of Quality rather than quantity. Being confronted daily with a variety of medical and social problems, it is not surprising that the Health Visitor may have some doubt as to her own function and finds it difficult to decide the order of priorities in her visiting. In Walthamstow. we do not specialize in any one particular field of the Health Visitor's variety of work. As a family visitor the range is wide and is in fact often described to cover from Womb to Tomb i.e. expectant mothers, children under five years of age, school children, the elderly and handicapped. Visits in these categories are carried out as and when the need arises. 46 A little more emphasis is placed on follow-up visits to the elderly, in particular those recently discharged from hospital. Numbers in this category might be expected to increase with the forecast rise in life expectancy. I should like to mention here the very commendable efforts made by many school-children from several of the Senior Schools in Walthamstow, who assist the Health Visitors by visiting elderly people in their homes on a "social basis" . Monetary and material needs provided on a statutory basis can never hope to provide or cover the small everyday personal requirements so important to the individual. One frequently reads of the irresponsible behaviour of young people. It is, therefore, very rewarding and also reassuring, to know of our young citizens who are prepared to give their time to undertake these visits which are greatly appreciated. Local British Red Cross Groups have also contributed greatly in providing whenever asked special services to the elderly and handicapped, in particular to those who live in Warburton Terrace which is a group of bungalows specially designed for those with some degree of disability. The main aim of Public Health is the prevention of ill-health. For this service to be carried out efficiently adequate staff must of necessity be provided. This often is easier said than done when there is a general shortage of Health Visitors. For many years, we, like other local authorities have employed State Registered Nurses to assist existing staff in clinic and school work, thus relieving the Health Visitor from duties which do not require such specialized training. These nurses play an important part in the public health team, performing duties connected with school medical examinations, surveys and immunisation programmes. Section 25. HOME NURSING The outstanding training and educational activity of the year was a joint study project for ward sisters and district nurses sponsored by the County Borough of West Ham with the backing of the Royal College of Nursing. The theme was the continuous patient care in hospital and community and most of the hospitals and home nursing services in East London were invited to participate. Ward Sisters from Whipps Cross Hospital visited Walthamstow and accompanied district nurses on their rounds. They were able to see patients under treatment who had been discharged from hospital, and others who would need to be admitted to hospital were it not for the effectiveness of the home nursing service. Exchange visits were arranged and a number of the district nursing staff visited Whipps Cross and Langthorne Hospitals in order to see the institutional aspects of the problem, and in particular patients who would 47 be discharged to the care of the home nursing service, and patients who had recently been admitted to hospital having previously been under the care of the home nurses. These arrangements had the advantage of bringing together the hospital and domiciliary nursing staff and provided an opportunity for discussing mutual problems. The project ended with an afternoon conference held in April at the West Ham College of Technology to which general practitioners, senior Medical and Nursing Officers from both hospital and Local Health Authorities were invited together with participating nursing staff, as well as other staff concerned such as Almoners and Home Help Organizers. Useful information was exchanged and valuable discussion took place. It was agreed there is an urgent need to promote better liaison between the separate branches of the Health Services for the benefit of the community. As a result of contacts made during the joint study project, where difficulties have arisen regarding the discharge of patients from hospital to unsatisfactory home conditions, it has sometimes been possible to find a solution by a direct approach to the Almoner or Ward Sister concerned. The provision of the various supportive services is essential in many of these difficult cases, e.g. Home Help Service, Meals on Wheels, the loan of sick room equipment, etc. The extension of the Home Help Service to give more effective cover at weekends and Bank Holidays for old people living alone would remove many difficulties for both patient and nurse. This problem is almost impossible to solve, since most domestic helps are prepared to work from Monday to Friday only because of their family commitments. A handful of volunteer domestic helps is available to provide help at weekends for a few selected cases where the need is very great and when no alternative arrangements can be made for the necessary care to be given by families, neighbours or friends. The provision of domiciliary physiotherapy for home bound patients would also improve patient care to a greater degree and the domiciliary chiropody service is also valuable although somewhat limited owing to the shortage of qualified staff. The pattern of patient care is changing; whereas nowadays there are fewer Mersalyl and Insulin injections there is a corresponding increase in the number of iron injections and steroids. More children are being nursed at home, more post-operative cases are discharged earlier and prediagnostic investigation is now part of domiciliary work. In order to make further improvement in the standard of equipment Provided, various types of disposable catheters, syringes, needles and sterile dressings have been tried out and some approved for general use. 48 A Jumble Sale was organized during the year by the staff attached to the District Nurses Home and the proceeds allocated to a summer outing for old people, and during the Christmas period 32 parcels were distributed to deserving old people in the area. The following case study prepared by a member of the district nursing staff illustrates the part played by a district nurse in the rehabilitation of a domiciliary patient after a cerebral haemorrhage, and the importance of simple exercises prior to the referral of the case to a hospital outpatient physiotherapy clinic if this should be indicated. Male patient: Aged 62 years. Occupation Carpenter. Referred to District Nursing Service as Cerebral haemorrhage for daily general care. information obtained at first visit All routine facts necessary for nursing association records. Number in family: one, his wife. Condition at first visit. Fully conscious. Marked left hemiplegia speech slurred, movements of normal respiration difficult. Pale tearful and despondent showed no reaction to normal conversation. This condition was in no way helped by his wife who sobbed wildly by his bedside. Routine nursing care Bed position moved to allow view from window. His wife accompanied me to another room. Her image of a 'stroke was one of utter helplessness. She was consoled, informed and instructed. As a great part of the nursing, physical and psychological, would depend upon her she reacted well to this and liked the idea of working together . This all important first visit is the basis on which to build the good relationship professionally, which should exist at all future visits. Second and consecutive visits Taught simple exercises of affected limbs. Asked to make vowel sounds. All this in the presence of his wife, to enable her to continue same. During the day this she did with enthusiasm and by the seventh day there was some improvement. The doctor visited three times weekly and prescribed mild sedation. Two small dishes were given to the patient, one containing small pins. He was taught to transfer them one at a time to the other dish using thumb and fingers of the affected hand. This he did continually and was soon able to use soap and face cloth, and so wash himself. Breathing exercises were carried out two hourly. This increased the patient s morale and he would tell me daily of some returning movement and go through his programme of exercises for his visitors. He sat up twice daily, placed both feet flat on the floor and rose to a standing position with the help of his wife who was assisting his recovery. The room furniture was now adjusted to enable him to have plenty of leverage for walking. This he did morning and evening 49 guided by myself and his wife. He was seen by doctor and told he could walk a short way to the dining room for meals. The only thing he could not do was hold a razor firmly enough to shave himself. I approached a neighbour who did this for him. Summary: (a) Rehabilitation should begin as soon as possible (b) A set programme of exercises should be given. (c) The importance of these should be explained to all the family. Section 26 VACCINATION AND IMMUNISATION The arrangements for protection of children against Diphtheria, Whooping Cough and Tetanus continued on the lines referred to in my Annual Report for 1962. So too, did the scheme for Vaccination against Poliomyelitis but the Ministry of Health recommended during the year that all young children previously immunised should be offered a reinforcing dose of vaccine on joining school. Reinforcing doses were also recommended for persons at special risk of contracting poliomyelitis such as general medical practition ers, Hospital and Health Department staffs, etc. Section 28 PREVENTION OF ILLNESS CARE AND AFTER CARE Chiropody I am pleased to be able to report once again that a full staff of chiropodists was maintained throughout the year. The establishment which is the whole time equivalent of 7 posts is filled by 6 whole time and 6 part time staff. There have been some minor changes of part time personnel but the fact that most of the whole time chiropodists have been with us for a number of years is indicative of the satisfactory personal relationships which exist within the Department. For many years it was the practice to appoint locum tenens staff to cover annual holidays and sickness and this appreciably increased the number of patients who could be treated. There were always chiropodists, for example those who were building up their own practices, who were pleased to be able to assist in this way. Recently the general expansion of the Local Authority Chiropody Service in neighbouring boroughs and districts appears to have absorbed surplus labour and more often than not it now proves impossible to recruit relief staff. Unfortunately this tends to extend the period between treatments. However, bearing in mind that Walthamstow is one of the few areas to provide a full chiropody service to all age groups as well as the priority categories, the Present position may be regarded as very satisfactory. 50 The Domiciliary Service is provided for incapacitated patients who are unable to attend for treatment at one of the regular clinics. The number of patients referred increases as the existence of the service becomes more widely known. The time is approaching when an increase in the establishment of chiropodists will become inevitable if we are to expand this extremely useful service for housebound patients in addition to meeting our other commitments. Nevertheless the recruitment of additional staff for domiciliary work might well prove extremely difficult for the reasons mentioned in my report for 1962. The statistical details of new cases and attendances are given on page 68 . Of a total of 20,701 treatments given 8,013 were for the priority categories (expectant mothers, physically handicapped and persons over 65 years of age), and a balance of 12.688 for non priority patients. It can be estimated from these figures that the introduction of a restricted priority service involving the exclusion of other patients, would reduce the average period between treatments from 13 weeks to less than 6 weeks. Such a policy, while probably receiving a satisfactory reception from the priority classes, would be unlikely to find favour among the non priority group since an un restricted service has been operated in this Borough since 1930. The following brief case history refers to an unusual foot condition recognised by a member of the chiropody staff, and illustrates the diagnostic function of the Chiropody Service which is less well known than the facilities for treatment Mrs. H. Aged 68. Housewife. Patient attended Low Hall Lane Chiropody Clinic complaining of chillblains. On examination extensive scar tissue was seen on sole of foot.Patient said it was the result of treatment for a wart.By the extent of the scar tissue it was suspected that a melanoma (malignant cancer) had been removed. Further examination revealed a small lump, indicating that the growth had become active again.Patient stated that she was under six months surveillance at Hospital but was not due to return for two months.It was explained to her that she should report back to Hospital but this she was reluctant to do as she was about to go on holiday.The Chiropodist emphasized the extreme urgency of the matter and she agreed to attend Hospital that day and was thereupon admitted for an operation on the following day. This simple observation made at the Foot Clinic in all probability saved her life. 51 Section 29 DOMESTIC HELP SERVICE This Service has continued to run smoothly during the year and despite the many varied causes for providing help, the number of cases throughout the year has remained about the same. Often the Service is requested for care of children and specially selected domestic helps are called for; older women are invaluable in these homes to give the motherly touch, especially where a mother is absent. Out of the total of patients helped 80% have been over 65 years of age and service given to these has mostly been of a repetitive nature. Of this percentage regularly receiving help, many are completely bed ridden,needing daily attention for shopping, food and general comforts,apart from keeping the home clean. Many have regained their former pride in their home simply by being encouraged by a suitable domestic help. Sometimes week end help is required by bed-ridden patients, with out relatives who are willing to help. This can provide a difficulty as Staff for week end work are always volunteers. Most domestic helps are married women,who have home commitments and cannot give time at week ends.However,no really deserving case is left without help,should the need be urgent. The Night Attendant Service has had a number of calls made upon it;a proportion of these has been short term owing to patients being admitted to hospital. We have been fortunate in recruiting a further two Night Attendants making a total of four. Each has been ready to attend patients at very short notice and their work has been greatly appreciated by relatives. During the year there have been a number of domestic helps whose enthusiasm for the work has been very evident at the start but who unfortunately have left after only a very short period of service. This has meant that some patients have had several changes of helps, which needs to be explained personally to them, involving more visits to the same patients. Routine check visits have been maintained regularly, thus ensuring that the amount of help is adequate. Following a trial period of 12 months commencing in May 1961, the County Council authorised the continuance of the provision of free domestic help for expectant mothers certified by a doctor to be suffering from toxaemia of pregnancy and needing such assistance. Help is given according to the needs of each individual case and in practice varies from full time to 4 hours daily. Medical certificates are required at 28 day intervals. During the year there were 5 beneficiaries of this service all referred by general practitioners. 52 CHELMSFORD DIOCESAN MORAL WELFARE ASSOCIATION The Carville Home at 43 West Avenue Road, Walthamstow, 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 M.H.Ward,Superintendent of the Home,contributes the following details "The ages of residents has not been quite so low during the past year. There were 26 in their 20 s and 2 in their 30 s. In 1963 we has only 1 fourteen year old and 1 fifteen year old mother. This is accounted for by the fact that the Diocesan Maternity Home in Brentwood is now fully staffed and able to take most of the young expectant mothers. "More mothers kept their babies, in a number of cases going home direct from hospital. Quite a number of Old Girls'continued to keep in touch although I expected there would be a falling off after Miss Williams' retirement at the end of 1962. A successful Old Girls party was held early in the New Year, the ages of the children ranging from six months to 7 years. " The relaxation classes continue to be most successful and are greatly appreciated by the expectant mothers. We are indebted to the Health Visitors who run these classes, and in fact to all the Town Hall staff. It is with the greatest regret that 'Carville severed its connection with Dr. Helen Watson on her retirement. She has been the Medical Officer of the Home for a great number of years and has always been most helpful and willing to assist at any time if we have been worried over the health of one of the babies. "The table attached summarises the Indoor Work for 1963. It will be noted that there is a decrease in the number of admissions compared with the previous year and this was owing to some last minute cancellations by girls who found themselves able to remain at home or stay with relatives. Of the total admitted 10 were unable to settle down and did not stay very long. Admitted. Adults Babies Total From Walthamstow • • • 5 3 8 Prom rest of County • • • 54 33 87 Prom outside County • • • 12 5 17 Totals 71 41 112 53 WALTHAMSTOW CHEST CLINIC Dr. H. Ramsay, Consultant Chest Physician, has contributed the following - " The Chest Clinic at Whipps Cross now serves the territory of Walthamstow, Chingford and Leyton. The work of the Clinic continues to develop but the main point of interest so far as this report is concerned is the situation as regards tuberculosis. The following are the figures for the area of the Borough of Walthamstow; - * New Notifications. Respiratory 55(37) Non Respiratory 10(8) * Notifications in the Pakistani group. Respiratory 9 Non-Respiratory 1 (The figures in brackets indicate the new notifications for the previous year 1962) " It will be seen that there has been an increase in the number of cases notified. There is no immediate explanation for this, though the continued intensity of the search for new cases by Mass Radiography and other methods may have something to do with it. In any case it is an indication that efforts to control the disease should in no way be slackened. " The work of the Chest Clinic and the Local Health Authority must continue at the highest possible level of efficiency for some time to come." WALTHAMSTOW AND CHINGFORD ASSOCIATION OF TUBERCULOSIS CARE HELPERS Miss A. Woolgar, Honorary Case Secretary of the Walthamstow arid Chingford Association of Tuberculosis Care Helpers reports as follows:- "the year 1963, being the first full year during which we were free to use our County Council grants for the benefit of non tuberculous Patients, has given us a clearer picture of the ways in which our funds may be applied in this respect. 'Cases of lung cancer have been given immediate assistance while waiting grants from the Society for Cancer Relief. Bronchitics have been provided with extra nourishment and fuel during the winter months, or assistance with holiday expenses in the summer, and many small items of help have been given on lines similar to those available to the tuberculous , as shown in the figures given below, help for the tuberculous still being the larger proportion. 54 Tuberculous Patients Non-Tuberculous Patients Grocery vouchers 25 Fuel 12 Holiday expenses 3 Clothing & bedding 8 House repairs 1 Rent, debts etc. 8 Clothing & bedding 28 Grocery vouchers 3 Pares to visit 5 Holiday expenses 3 Rent, debts etc. 9 Pares to visit 2 Fuel 33 Holiday expenses 3 Christmas grants 80 "During the year we were represented at the bi-annual meetings of Essex Tuberculosis Care Associations and our member spoke on behalf of these Associations at the Conference of Voluntary Bodies held in October. The Chairman and the Hon. Case Secretary also attended a Conference on Bronchitis arranged in London by the Chest and Heart Association. Throughout the year we have enjoyed a very happy relationship with the local authority and with those voluntary and statutory bodies which also are concerned with the welfare of the patients and their families and we are grateful for their co-operation. "In the autumn, serious consideration was given to the advisability of amalgamation with the Leyton Tuberculosis Association. The local Chest Clinic, now established in a new building within Whipps Cross Hospital now serves the three boroughs, Walthamstow Chingford and Leyton which will merge into Borough 13 under the Greater London Plan and it was felt that the establishment of a singe Care Association would be beneficial from the patients' point of view and would, in some respects, simplify the handling of their personal problems within the Chest Clinic. 'General agreement on this matter was reached before the end of the year and it is expected that by the time this Report is published amalgamation will already have taken place. "It may be of interest to note that the Walthamstow Association came into being in 1926. Chingford joining us during the war years, and that the present Chairman. Mrs. A. Cordell in the only founder member still serving. "There seems to be no doubt that an Association such as this still has a useful part to play in the total care of ther chest Clinic patient and should be able to continue to fulfil its function within the new Borough.'' Ol m COUNTY COUNCIL OF ESSEX WELFARE COMMITTEE RESIDENTAL AND WELFARE SERVICES Mr. W. E„ Boyce, County Welfare Officer has kindly prepared the following table and explanatory notes:- Extent Number of to which Walthamstow services residents in provided accomodation in 1963. provided under Section 21 (1) (a) National Assistance Act, 1948. Number admitted to residential accommodation during 1963, 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 208 53 24 2 4 30 279 48 103 152 20 32 12 31 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 1963 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 another home is in course of erection. 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 56 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 455 Appointments made 2,670 kept 2,307 Plastic fillings 202 ) 1 504 Amalgam fillings 1,302 ) Inlays 2 Crowns 9 Scalings and gum treatments 322 Dressings 253 Extractions 279 General anaesthetics 25 Local anaesthetics 313 X-rays 408 Impressions 442 Bites 113 Try-ins 190 Pull upper dentures50)132 Full lower dentures44)total Partial upper dentures 38)dentures Partial lower dentures 30) Repairs 115 Relines 20 Minor Oral Surgery 18 Other Operations 346 Dental Laboratory Dentures Re pairs Re I ines Re makes Appl i ances Crowns Inlays General Dental Service 167 119 20 7 - 6 Waltharastow Committee 1 for Education 16 20 107 19 Leyton Committee for 1 Education 36 5 - - 39 13 Forest Divisional Executive Committee 1 for Education 5 5 - - 53 2 Maternity and Child Welfare Patients 4 " • - ~ — 57 Section 22 CARE OF MOTHERS AND YOUNG CHILDREN Notification of Births Domici1iary Inst1tutional Live Still L i ve Still Notified births which occurred in the Area 511 3 1,908 29 Birth notifications transferred out to places outside the Area 1 - 1,052 10 Birth notifications transferred in from places outside the Area 4 - 329 6 Care of premature infants (Weighing 5½lb. or under) Born at Home 18 Born in Hospital or Nursing Home 95 Ante Natal and Post Natal attendances (Local Authority Clinics) Ante Natal Post Natal New Patients- Low Hall Lane Clinic 10 2 Silverdale Road Clinic 3 - West Avenue Clinic 10 - District Nurses Training Home and Midwives' sessions held at Ante-Natal Clinics 288 TOTALS 311 2 Total Attendances Low Hall Lane Clinic 57 2 Silverdale Road Clinic 4 - West Avenue Clinic 22 - District Nurses Training Home and Midwives' sessions held at Ante Natal Clinics 2,537 TOTALS 2,620 2 Birth Control (Medical Grounds) New cases 4 Total Attendances 4 58 Orthopaedic and Physiotherapy Clinic (Children under School Age) New cases seen by Orthopaedic Surgeon 19 Re-attendances 52 Children treated 7 Children attending for aftercare 14 Paediatric Clinic (Children under School Age) New cases- Heart Disease 1 Undeveloped genitals 2 Labia minora adhesion 1 Hypothroidism 1 Vomiting 1 Epilepsy 2 Asthma 1 Mongolism 1 Retarded Development 5 Torticollis 1 Total 16 Total attendances 30 59 Dental Clinics Patients inspected and treated during the year. Expectant and Nursing Mothers Children under school age Patients examined 22 85 Patients found to require treatment 20 69 Patients who have commenced treatment 18 64 Patients who have completed treatment 15 27 Patients awaiting treatment - Attendance for treatment 56 89 Types of Treatment Given Extractions (a) Permanent teeth 7 - (b) Temporary teeth 90 Fillings- (a) Permanent teeth 49 - (b) Temporary teeth - 11 Crowns and Inlays provided Anaesthetics administered- (a) Local - - (b) General (i) by Medical Offrs. 1 12 (ii) by Dental Offrs. 1 39 Scalings and gum treatment 12 2 Silver nitrate treatment 5 24 Dressings 8 3 Radiographs 6 2 Dentures provided- (a) Full - - (b) Partial 2 - Dentures repaired 2 - Dentures remade- (a) Pull - - (b) Partial - - Orthodontic appliances- (a) Fixed - - (b) Movable - - Prophylactic treatment and other operations 21 8 60 MATERNITY AND CHILD WELFARE CLINIC ATTENDANCES Hicham Hill & Priory Cour t Low Hall Lane Silverdale Road West Avenue Winchester Road "Brookscroft" (voluntary Scheme) TOTALS CHILD WELFARE CENTRES No. of sessions held by (a) Medical Officers 111 150 59 107 51 63 541 (b) Health Visitors 3 3 53 5 2 66 132 Children attending for the first time 1963 220 244 124 228 112 225 1 153 in the year who were born in: - 1962 265 164 105 187 87 76 884 1961 90 122 33 109 49 19 422 1960 41 65 33 55 25 16 235 1959 23 30 4 22 6 11 96 1958 11 11 7 3 5 3 40 TOTALS. 650 636 306 604 284 350 2,830 Total attendances 5.719 5, 244 2.084 4.243 2,931 6, 212 26,433 No. of children seen by Medical Officer 1,277 1,893 486 1 420 753 674 6, 503 ANTE-NATAL AND POST NATAL CLINICS NO. of sessions held - 16 9 8 - - 33 Patients attending for the first time in the year (a) Ante Natal - 10 3 10 - - 23 (b) Post Natal - 2 - - - - 2 Total Attendances (a) For ante natal examination - 57 4 22 - - 83 (b) For post natal examination - 2 - - - - 2 ANTE NATAL MOTHERCRAFT AND RELAXATION CLASSESNo. of classes held 8 28 32 23 7 - 98 Patients attending for the first time in the year 4 25 53 21 3 - 106 Total Attendances 27 106 176 68 46 - 423 61 WELFARE FOODS DISTRIBUTION CENTRE National Dried Milk (Tins) Cod Liver Oil (Bottles) Vitamin Tablets (Packets) Orange Juice (Bottles) Brookscroft Welfare Centre 1, 481 422 344 2.733 Low Hall Lane Health Services Clinic 1,593 265 194 2,129 Northcott House Distribution Centre 5,849 348 686 6,044 Higham Hill and Priory Court Health Services Clinic 2,373 285 375 3.070 Silverdale Road Health Services Clinic 963 238 234 3,066 West Avenue Health Services Clinic 1,834 243 268 3, 186 linchester Road Infant Welfare Centre 937 174 168 2,037 General Practitioner s Surgery 393 39 40 450 TOTAL issues at Distribution Centres 15,423 2,014 2, 309 22,715 In addition the following were issued to:- Hospitals (National Health Service) 1,006 _ _ 12 Day Nurseries - 180 - 216 GRAND TOTAL OF ISSUES 16,429 2,194 2,309 22,943 Nutrients and Medicaments Sales Free Issue lbs. ozs. lbs. ozs. Adexolin - - - - Bemax 50 12 - - Cow and Gate 7,553 - - - Parex 937 10 - - Glucodin 90 4 - - Lactagol 18 8 - - Maltoline with Iron _ _ 82 8 Marmite 647 8 - - Milk of Magnesia 15 8 Mist Perri et Ammon. Cit. Pro. Infantibus - - 6 - Ostermiik 5,874 - - - Robinson's Ready Cook Groats 446 - - - Scott's Twin Pack 474 - - - Virol 625 5 - - Trufood 115 - - - S.M.A. 1,022 - - - Rose Hip Syrup 10,656 Bottles - - Iron Tablets - - 15,032 tablets Value of Cash Sales £3,740. 9s. 5d. 62 Convalescence No applications were received during the year in respect of mothers and young children. Day Nurseries There are two day nurseries in the Borough approved for train ing purposes each having accommodation for 60 children aged 0-5 years. HIGH AM 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 17 48 15 50 32 98 Total attendances during year 3,503 8,621 3,059 9,108 6,562 17,729 Average attendances 13.8 33.9 12.0 35.9 25.8 69.8 47.7 47.9 95.6 Number of days open 254 254 Training Number of Students who gained certificate of National Nursery Examination Board , 9 Future Careers (on leaving) General Nursing Training „. Teaching at a School for the Deaf „. ... ,. Housemother at a Boarding School .. s. .. .» .. Staff Nursery Nurses Remained in Nursery as Staff Nursery Nurse , . Nursery Nurse with family abroad . „„ „ „ . . 5 Dally Guardian Scheme No. of Guardians on Register at end of year 7 No., of applications for services of Daily Guardian .« o. 53 Referred to Day Nurseries .. .. .. .. 39 Referred to Daily Guardian but nothing further heard 10 Placed with Daily Guardian .. 4 Continued in care of Daily Guardian from previous years 2 63 PROGRAMME OF CLINICS HELD AT DATE OF PUBLICATION MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY Town Hall A.M. Dental Chiropody Orthoptic Minor Ailment Ophthalmic (1st, 3rd & 5th) Dental Chiropody (Schoolchildren) Optician Dental Chiropody Ophthalmic (1st, 3rd & 5th) Orthoptic Minor Ailment Dental Chiropody Paediatric (1st & 3rd Dental Chiropody Orthoptic Orthodontic Minor Ailment Dental Ophthalmic (2nd & 4th Optician (2nd & 4th Minor Ailment P.M. Dental Chiropody Ear. Nose & Throat Ophthalmic (2nd & 4th) Orthoptic Dental Chiropody Ophthalmic Optician Dental Chiropody Immunisation & Vaccination Dental Chiropody Ophthalmic Orthoptic Optician Dental Chiropody Ophthalmic Orthodontic Optician Evening Chiropody General Dental Service Chiropody Chiropody General Dental Service Chiropody Orthodontic Silverdale Road A.M. Chiropody Minor Ailment Chiropody (Schoolchildren) Dental Chiropody Chiropody Chiropody Dental P M. Infant Welfare Ante Natal/ Post Natal (twice monthly) Toddlers Clinic (twice monthly) Chiropody Dental Midwives Ante Natal Clinic Chiropody Dental Infant Welfare Dental Relaxation & Mothercraft Class Dental Chiropody Dental Evening Chiropody Chiropody Higham Hill and Priory Court A.M. Chiropody Dental Dental Chiropody (Schoolchildren) Dental Chiropody Chiropody Dental Chiropody Dental Dental P. M. Dental Chiropody Infant V/elfare Dental Chiropody Toddlers Clinic (alternate weeks) Dental Midwives Ante Natal Clinic Chiropody Infant Welfare Chiropody Dental Relaxation & Mothercraft Class Dental Evening Chiropody Chiropody Low Hall Lane A.M. Minor Ailment Chiropody Chiropody (School children) Chiropody Minor Ailment Chiropody Chiropody P.M.. Infant Welfare Chiropody Relaxation & Mothercraft class Infant Welfare Chiropody Ante Natal/ Post Natal Chiropody Infant Welfare Chiropody Evening Chiropody Chiropody Chiropody Chiropody West Avenue A. M Chiropody Dental Dental Chiropody (School children) Dental Chiropody Dental Chiropody Dental Chiropody P M Chiropody Dental Infant Welfare Dental Relaxation & Mothercraft Class Chiropody Dental Ante Natal/ Post Natal (twice monthly) Infant Welfare Dental Toddlers Clinic (alternate weeks) Dental Evening Chiropody Chiropody Winchester Road P.M Infant Welfare District Nurses Training Home Carisbrooke Road P.M. Midwives Ante Natal Clinic Midwives Ante Natal Clinic Midwives Ante Natal Clinic Old Monoux School High Street Speech Therapy and Child Guidance Consultations daily (morning and afternoon) Prom 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 & Immunisation Infant Welfare Massage Remedial Exercises and Sunlight Treatment 64 Section 23 MIDWIFERY Cases attended by Council Midwives MIDWIFERY Domiciliary confinements attended under N.H.S. arrangements where (a) a doctor was not booked 2 (b) a doctor was booked 506 Cases delivered in hospital and other institutions but 276 discharged and attended before tenth day Miscarriages attended 21 New cases booked 611 Cases on the books at the end of the period 1,427 Medical aid notices issued 3 Visits paid (as midwife) (a) Ante-natal 2,779 (b) Nursing 6,762 (c) Other post-natal 206 Total visits 9,747 ADMINISTRATION OF ANALGESICS Cases in which Gas and Air was administered 425 Cases in which Trilene was administered 29 Cases in which Pethidine or a related compound was administered 272 CLINIC SESSIONS Number of sessions attended (a) Medical Officer's clinics 12 (b) General practitioner's clinics 299 (c) Midwife's clinics 288 Number of ante-natal examinations by the midwife (a) Medical Officer's clinics 12 (b) General practitioner's clinics 2,078 (c) Midwife's clinics 2,537 Number of women attending midwife's clinics who had not previously attended any ante-natal clinic in the current year 612 65 Place of Confinement During the year, Walthamstow Mothers were confined as follows Forest Gate Hospital 24 Mother s (Salvation Army) Hospital,Clapton 170 North Middlesex Hospital, Edmonton 18 Thorpe Coombe Maternity Hospital 855 Wanstead Hospital 36 Other Hospitals or Nursing Homes 82 Total 1,185 At Home; Council Midwife present 508 Family doctor but not Council Midwife present - Total Confined 1,693 Section 24. HEALTH VISITING During the year the Health Visitors made 17,883 visits to homes - HEALTH VISITING Cases visited for the first time in the current year (a) children born in 1958 899 " " " 1959 1,059 " " " 1960 1,181 " " " 1961 1,606 " " " 1962 1,810 " " " 1963 1,899 (b) persons aged 65 or over 1,533 (c) others (excluding school nursing cases) 1,025 Number included in item (2) (a) mentally disordered persons 75 (b) persons discharged from hospital (other than mental hospitals) 158 (c) tuberculous households 14 (d) households visited on account of other infectious diseases 13 Number included in item (2) and where appropriate item (3) who were visited at the special request of a G.P. or hospital (a) persons aged 65 or over 307 (b) mentally disordered persons 20 (c) persons discharged from hospital (other than mental hospitals) 60 66 Total number of effective visits to (a) children under 5 years of age 11,245 (b) persons aged 65 or over 2,199 (c) others (excluding school nursing cases) 1,493 Total effective visits 14,937 Total number of ineffective visits to (a) children under 5 years of age 2,288 (b) persons aged 65 or over 479 (c) others (excluding school nursing cases) 179 Total ineffective visits 2,946 Sessions attended at G.P.'s surgeries(included above) 293 Visits of inspection to tuberculosis shelters 4 SESSIONS WORKED Number of sessions (half days) devoted to (a) Health visiting 2,498 (b) Child welfare centres 953 (c) Ante natal, post-natal, relaxation 23¼ (d) School clinics 2 (e) Other school nursing 158¾ (f) Health education (including mothercraft) 371¾ (g) Other work (including clerical) 1,30114 Total sessions 5,520 Section 25. HOME NURSING Cases visited for the first time in the year (a) Aged under 5 at 1st visit in year 87 (b) Aged 5 and under 65 at 1st visit in year 419 (c) Aged 65 or over at 1st visit in year 934 Total cases 1,440 Visits made to cases (a) Aged under 5 at 1st visit in year 262 (b) Aged 5 and under 65 at 1st visit in year 11,894 (c) Aged 65 or over at 1st visit in year 43,314 Total visits 55,470 Cases on the books at the end of the year 1,200 67 Section 26. VACCINATION AND IMMUNISATION The following tables give details of prophylactic treatme carried out during the year by General Practitioners and Loc Health Authority Staff. Disease. Protective Course. Age at date of Immunisation or Vaccination Under 1 yr 1-4 yrs 5-9 yrs 10-15 yrs 15 yrs & over Diphtheria Primary 1,095 369 235 11 - Reinforcing 22 554 814 21 - Whooping Cough Primary 1,080 335 28 6 - Reinforcing 20 336 54 3 - Tetanus Primary 1,087 568 888 69 - Reinforcing 22 452 228 8 - Smallpox Primary 92 151 24 122 Reinforcing - 9 37 362 Type of Vaccine used Immunisations or Vaccinations completed by General Practitioners. Inmiunisations or Vaccinations completed by County Staff. Primary Course Reinforcing doses Primary Course Reinforcing doses Diphtheria, Whooping Cough and Tetanus combined 880 161 543 250 Diphtheria and Tetanus combined 11 23 234 250 Diphtheria only 32 167 10 560 Whooping Cough only 23 2 3 _ Tetanus only 171 12 773 14 Poliomyelitis:- (a) Salk 289 1, 057 17 297 (b) Sabin 601 579 809 209 Smallpox 344 361 45 47 68 Poliomyelitis Vaccination Category Number of persons vaccinated Salk Vaccine (2 doses) Sabin Vaccine (3 doses) Children born in 1963 36 160 " " " 1962 136 710 " " " 1961 39 200 " " in years 1943/60 36 231 Persons born in years 1933/42 42 49 Persons born before 1933 who were under 40 years and 'special groups 17 60 Totals 306 1,410 Reinforcing doses 2,142 B.C.G. Vaccination Category Number skin tested. Result of Heaf Test. Vaccinated with B.C.G. Tuberculin Positive Tuberculin Negative School children 363 57 306 306 Students attending further education establishments - - - - Totals 363 57 306 306 Section 28. PREVENTION OF ILLNESS, CARE AND AFTER CARE Chiropody New cases during year Cas es being treated at end of year Clinic attendance s during year Domici1iary treatments during year Pre school children 5 2 13 - School children 424 471 1,955 - Expectant Mothers - - - - Physically handicapped 3 - 23 - Aged (over 65 years of age) 378 1,735 7,109 881 Others 626 3,405 10,720 - Total 1,436 5,613 19,820 881 69 Tuberculosis Home Visits and Clinics attended Tuberculosis Visitors Health Visitors Total of tuberculous households at end of year 1,026 - Visits to tuberculous households during the year (excluding non access visits) 1,205 14 Attendance at Chest Clinic sessions during the year 677 - Extra Nourishment Number of cases during year supplied with free milk 89 Total number being supplied free milk at end of year 68 Rehabilitation Number of cases receiving rehabilitation treatment for whom financial responsibility accepted Nil Loan of Sick Room Equipment Number of articles on loan at end of year which had been on loan for. (a) under 1 year 96 (b) 1 and under 2 years 75 (c) 2 and under 3 years 77 (d) 5 years and over 11 Total 259 Convalescence for Adults Number of applications during year 68 Length of stay: Two days 1 One week 3 Two weeks 35 Three weeks 4 Of the 68 applications received, recuperative holidays were arranged and accepted by 43 of the patients. 70 The reasons for the cancellations are given in the following summary:- Patient made private arrangements 3 Patient not fit at date of admission 3 Patient moved to another Area 1 Assessment forms not returned 12 Case subsequently found to be not eligible 1 Patient refused arrangements made 4 Bereavement 1 Health Education Teaching to groups by Departmental Staff No.of Sessions Total Attendances (a) Clinic, Welfare Centres, Relaxation Classes 98 423 (b) School 145½ 2,274 (c) Professional Organisations 6 22 (d) Parent/Youth/General Adult Group 5 178 (e) Others 236¾ 899 Total 491¼ 3,796 Number of film shows given at sessions referred to above 52 Exhibits Staged 52 Section 29. DOMESTIC HELP Visits by Domestic Help Organisers Domestic Help Service Night Attendance Service First visits to homes: 686 13 Re - Visits to homes: (a) Help/Attendant present 364 1 (b) Help/Attendant not present 2,666 8 Miscellaneous visits: (a) Help/Attendant seen 146 - (b) Others 86 1 71 Help provided Category TOTAL 'A' 'B' 'C' 'D' Aged 65 and over Maternity Chronic Sick under 65 Others under 65 Requests for help from new cases during the year 424 99 60 54 637 Cases not eligible, or not requiring Assistance 67 15 14 6 102 New cases helped during the year 357 84 46 48 535 Total cases completed during the year 464 85 61 46 656 Cases being helped at end of the year 903 2 83 8 996 Total cases helped during the year 1, 367 87 144 54 1,652 Hours of help provided during the year 159,155½ 2,895½ 12,355½ 1.224¼ 175,630¾ Notes (1) All cases 65 years of age or over are included in category A. (2) Expectant mothers and those debilitated or incapacitated as a direct result of confinement are included in category B. (3) Tuberculosis cases under 65 years are included in category C. Analysis of cases of mental disorder, and other cases included under Category D in previous table New cases helped Cases completed Cases being helped at end of year Mental disorder 65 years and over (see note) - - - Mental disorder under 65 years (see note) 2 3 - Help for harassed mothers 4 4 - Problem family (see note) - - - Absence of mother 3 3 - Acute Illness 36 33 8 Others 3 3 - Notes (1) Mental disorder includes all cases where help is given as a direct result of mental illness or mental subnormality in a family. Cases 65 years of age or over are included in category A and those under 65 years in category D Hours of help (included above) provided for cases of mental disorder (i) 65 years or over nil (ii) under 65 years 99 72 Night Attendance Service Seriously ill patients residing alone Inabi1ity 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 TOTAL Requests for help from new cases during year 2 2 9 13 New cases helped during year 1 1 8 10 Cases helped earlier in present year re-opened during year - - - - Total cases completed during year (a) 1 1 8 10 Cases being helped at end of year (b) - _ _ _ Total cases helped during year i.e. total of (a) and (b) 1 1 8 10 Hours of attendance provided during year 9 20 347¾ 376¾ MEDICAL EXAMINATION OF STAFF Category No. of medical examinations County Council employees: (a) Entrants to County Council's service 175 (b) Retirement on Superannuation 4 Walthamstow Borough Council employees 298 Entrants to teaching profession and training colleges 103 Others 3 Total 583