E.W.WRIGHT, M.B., Ch.B., D.P.H. London Borough of Waltham Forest REPORT OF THE MEDICAL OFFICER OF HEALTH 1971 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH - 1971 CORRIGENDA p.24 Code B.E 48 Age Groups Males Col.2 should read 1 Col.3 should read 2 p.28 Delete figures shown for 1968 and 1969 under Golden Ostermilk and A.D. & C. Drops CONTENTS MEMBERS OF THE HEALTH COMMITTEE DEPARTMENTAL STAFF INTRODUCTION BY MEDICAL OFFICER OF HEALTH THE WORK OF THE DEPARTMENT DURING 1971:- Control of Communicable Disease - New Horizons Child Health Service - Preparation for Independence Dental Service Environmental Health Services Nursing Services SPECIAL ARTICLE:- The Growth of Environmental Health CONTRIBUTIONS FROM COLLEAGUES:- Rainfall and Sewerage Water Supplies STATISTICAL SECTION PRINTED BY THE LONDON BOROUGH OF WALTHAM FOREST LONDON BOROUGH OF WALTHAM FOREST HEALTH COMMITTEE 1971 - 1972 Chairman: Councillor Mrs.E.Bartram VIce-Chairman: CounciI lor Mrs.L. D.Gurr, J. P. Members: Alderman Mrs.A.Ward Counci I lor J .Col I ins „ Miss H.E.Digby „ J.Kaye „ K. R.Sanders „ Mrs.P.K.Williams Ex-officio: Councillor G.R.Smith - I - STAFF OF THE HEALTH DEPARTMENT (at 31.12.1971) Medical Officer of Health and Principal School Medical Officer - E.Walter Wright, M.B., Ch.B., D.P.H. Deputy Medical Officer of Health - Geoffrey H.G.Poole, M.B., B.S., D.P.H., D.(Obst.) R.C.O.G. Senior Medical Officers - Gwyneth Richards, L.R.C.P., L.R.C.S., L.R.F.P.S., D.C.H., D.(Obst.) R.C.O.G. F.John Goodey, B.A.(Hons.), M.R.C.S., L.R.C.P. Carmel P.Dooley, L.R.C.P. & S.I.. D.P.H. Margaret E.Buckley, M.B., B.Ch., D.P.H. Medical Officers in Department - Margaret J.Caton, M.R.C.S., L.R.C.P. Eileen M.Cameron, M.B., Ch.B. Scott Cameron, M.B., Ch.B. Nandini Chandaria, M.B., B.S. *Margaret Edwards, B.Sc., M.B., B.Ch., C.P.H. Sarah Mclntyre, M.B., Ch.B. *Jocelyn N.Newman, M_B., Ch.B., D.C.H., D.(Obst.) R.C.O.G. Joan Whitaker, L.R.C.P., L.R.C.S., L.R.F.P.S., D.(Obst.) R.C.O.G. Plus sessional Medical Practitioners Psychiatric Adviser *W.R.Little, M.R.C.P., M.B., B.S., D.P.M. *(Part-time) Principal Dental Officer - G.P.L.Taylor, L.D.S., R.C.S. Senior Dental Officer - R.C.Ward, L.D.S., R.C.S. 13 Dental Officers (Whole-time equivalent in post = 3.4); 3 Dental Auxiliaries; 4 Dental Technicians (3 vacant posts) 17 Surgery Assistants (6 vacant posts) Chief Public Health Inspector - W.Richards, D.P.A., M.A.P.H.I. Deputy Chief Public Health Inspector - J.H.Butler, F.R.S.H., M.A.P.H.l. Divisional Public Health Inspectors - D.R.King, M.A.P.H.l. N.Smith, M.A.P.H.l. Senior Inspector Housing - E.Day, M.A.P.H.l. 4 Senior Public Health Inspectors; 9 Public Health Inspectors (4 posts vacant); 4 Technical Assistants; 5 Pest Control Assistants; 3 Pupil Public Health Inspectors (2 posts vacant). Chief Nursing Officer - Gillian Pittom, S.R.N., S.C.M., H.V.Cert. Cert.D.N. Superintendent Nursing Officer - Elizabeth O'Connor, S.R.N., S.C.M., H.V.Cert. M.T.D., Q.N. Principal Nursing Officers - Gladys Thorburn, S.R.N., S.C.M., H.V.Cert. (I vacancy) -2 - Midwifery Tutor - Amy M.Delves, S.R.N., S.C.M., M.T.D., Q.N. Nursing Officers (Health Visiting) - Brenda Buttle, S.R.N., R.S.C.N., H.V.Cert. Christina Egan, S.R.N., S.C.M., H.V.Cert. Evelyn M.Geary, S.R.N., S.C.M., H.V.Cert. Mary Young, S.R.N., S.C.M., H.V.Cert. Nursing Officers (Home Nursing) . - Winifred Clinton, S.R.N., S.C.M., Q.N. F.Griffiths, S.R.N., Q.N. Beatrice Hern, S.R.N., N.D.N. (Q.N.) Bridget Hunt, S.R.N., S.C.M. Nursing Officer (Midwifery) - Post vacant 3 Field Work Instructors 32 Health Visitors (9 vacancies) 4 Tuberculosis Visitors 20 Clinic Nurses 6 Student Health Visitors (1 vacancy) 1 Infectious Disease Nurse 20 Midwives (4 vacancies) 52 District Nurses and 4 Auxiliary Nurses 18 Student Nurses 35 Pupil Midwives Health Education Officer - H.Bradley, M.I .H.E. Chief Chiropodist - R.J .King, M.Ch.S. 15 Chiropodists (4 vacant posts) Speech Therapists - Joan Maharaj, L.C.S.T. Satinig Powell, L.C.S.T., L.R.A.M., L.G.S.M. Mary Tippett, L.C.S.T. Catherine Yorke, L.C.S.T. (part-time) Chief Administrative Officer - F.J.Aylward Senior Admisistrative Assistants - S.Ames A.Thomas A.Wade 6 Administrative Assistants; 37 Clerical Assistants; 14 Clinic Clerks; I M.O.H. Secretary. - 3 - THE MAYOR, ALDERMEN AND COUNCILLORS OF THE LONDON BOROUGH OF WALTHAM FOREST Madam Mayor, Ladies and Gentlemen, I have the honour to present my report for the year 1971, the first since Health was split off from Welfare, a split soon to be consolidated by the removal of Personal Health Services from Local Government. At the end of this report are pages of statistics setting out the work of the department as far as statistics can. The contributions in the earlier pages set out the same subject from a different standpoint. We have in recent years been wooed by a number of "Management" concepts - all of value as far as they go, but nearly all appearing to claim more for themselves than is justified by their results. This is often because management techniques come from industry and commerce where quantifiable results are essential, and so defined objectives have a great appeal. The danger in the Health and Social Services - a danger often avoided because of the obstinate refusal of a democracy to "see sense" - is that these techniques when applied to human affairs can systematically distort thinking and undue priority is given to those developments which are quantifiable, to the detriment of those, often more important, which are not. An emotive example of this is Family Planning. "Contraception is better than abortion" - universally agreed, and how satisfying to state because both are largely quantifiable. "Mature responsibility for oneself and for others is better still". This is also true whether one's opinion is that it is rarely, sometimes or always an alternative in the first statement. My point is that the second statement, being vague and unquantifiable, lacks appeal to those who are attracted to the simplicity of concepts like "management by objectives" and priorities in the distribution of resources are distorted accordingly. The documents about reorganisation of the Health Services lay stress on the high costs incurred by our sophisticated National Service - nothing is so quantifiable as finance!- and conclude that therefore it needs good management. Of course it needs good management; any big enterprise does. But it is a cause for watchful anxiety that this conclusion derives from a preoccupation with finance, with the unfortunate bias to quantification that that implies. Fortunately it would appear that more recent thinking has been much more broadly based. In any service quality is important as well as quantity but in personal services with indefinable objectives like "health" the importance of quality can mean that quantitative figures mean very little. For instance, the number of visits made by Health Visitors or of Health Education talks given are a very secondary consideration compared to what actually happens at the visits or talks. In assessing how good a personal health service is attention should always be directed first to these qualitative aspects. One is morale, another the quality of staff, another the amount and aptness of training, and another the degree of initiative shown by individuals. The feature to which I would draw attention is that of communication which at all levels vitally affects the quality of service. Does the nurse treat her patient within a human relationship or just as an object receiving technical attention? - 4 - Is the intention of the doctor being achieved by the nurse or just an approximation of it? Does the doctor (or patient? or administrator?) make decisions with the benefit of all information, including the influences of and repercussions on related people as well as quantifiable data? Is the whole Health Service system in constant touch with the community it serves, giving leadership where appropriate, but equally receptive of that community's views? The new Community Health Councils proposed for the Health Service are designed to achieve this and the greatest vigilance and care must go into ensuring that they attract into their membership those most able to voice true community views and voice them vigorously. The Councils themselves must be constantly self-aware in representing the "man in the street" rather than unrealistic and noisy sectional interests. It is a challenging and potentially rewarding concept — if it works. In 1971 Waltham Forest made a number of advances concerning communications in the Health system. Undoubtedly the great leap forward the Council has taken in starting work on three major Health Centres is progress indeed. These buildings do not change people, either doctors or patients, and to expect them to do so is misguided. It is sad that the fact that they have not done so is at times given as evidence against their value. What they do do, besides often providing better facilities, is enormously to shorten the lines of communication between all who work there. Experience teaches that sooner or later the new links are used, found to be of great assistance, and used again. So success breeds confidence and confidence between colleagues musters all the skills available in the service of the patients, in a new quality of care. In Waltham Forest we have in respect of the building of further health centres not only an incentive but a goad. Young doctors qualifying now have a new concept of what Family Doctoring is all about, derived from the new techniques advance has made available to us, and there is really no prospect of them coming to some of the practices in the south of the borough in particular, when vacancies are occurring in so many places which are in more attractive areas to live. In these circumstances every effort must be made to get modern health centres built as soon as possible; the Authority should in my view bend to the limit to meet the fears and anxieties of doctors in the area in this respect. Many of the objections they have to taking this step are neither fantasy nor old fashioned reaction to change (though some are!) but honest reasoning based on distances of travel and money spent on their present premises. The danger of family Health Services spiralling downward in quality in these parts of the borough may not be imminent for a few years, but neither can all the Health Centres be built overnight, and action now is necessary to protect the population and doctors of this area from crisis in the foreseeable future. These are other aspects of communication which give satisfaction. The big advance in attachment of Health Visitors and District Nurses to group practices has been an achievement, greatly reducing the number of professional relationships each has to make with consequent increase in quality and use of those remaining. All is not gain, for the good in a Health Visitor feeling responsible for a district is lost, but the gain in quantity of work done is easy to measure while the work is altogether vitalised by the rapport between doctor and nurse and by each with their colleagues. She gains a sense of responsibility for the patients on that doctor's list as well as keeping an eye on some not registered with a doctor locally. The new links with hospitals referred to in Miss Pittom's report and refashioning of the old ones are other evidence of progress and all these things are steps in the process of unifying the Health Services which has been going on for years but which is soon to be accelerated by the administrative reorganisation. - 5 - The tripartite Health Service is only to be unified by creating new divisions where there were none before, and the separation of Health from the Local Authority with its Environmental, Social and Education services means that administrators must start all over again building bridges to minimise the effects of the barriers created, and local Authorities must think very seriously where they are going to get medical services for their own staff. The Council, by its plans to site the Area Teams of Social Workers in the new Health Centres now on the way, has taken a most constructive step-ahead of most - in making links shorter and easier and one would hope that the new Community Physicians will, like some administrative staff, i n respect of Social Services or Education be physically placed to facilitate those informal relationships between the services which are so fruitful. The system whereby school doctors and nurses are related to specific schools in Waltham Forest - not always the case elsewhere - is one which forms strong links with the staff of those schools and is a feature one would like to see preserved. And what of the Environmental Services? The work of the Public Health Inspectorate in respect of the environment, one of the oldest pillars on which local government as we know it has been built, is facing a future still, at the time of writing, quite undecided. Waltham Forest is very seriously under-established on Public Health Inspectors at the present time. The training and qualifications of the Public Health Inspector have only limited application outside local government unlike the training for the great majority of the other local Government specialities. In these circumstances i t is vital nationally, and in Waltham Forest in particular, that the Public Health Inspectorate should emerge from all these changes with a strong corporate identity and good career prospects. If it does not, progress on planning, housing redevelopment and so on will be hampered or even halted while available staff concentrate as they always must on those environmental duties which keep edidemics and pollution from robbing us of any pleasure in our civilisation. My annual report provides an opportunity each year for me to thank my own staff for all their support, and also colleagues in other departments who give of their help and co-operation so freely and this I do again most sincerely. In 1971 there was the traumatic experience for Health Department staff of the setting up of the new Social Services Department and the transfer of Grosvenor House to Education, with all the shifting of responsibilities and relationships that these involved. I should like therefore particularly to thank colleagues in those departments for their tactful help and understanding during that time, and place on record an appreciation of how the whole process was carried out within an unbroken relationship of friendliness and goodwill. I should like also to thank members of the Council - particularly of those Committees with which this department is most involved - for all their help and interest. Special thanks are due to Mrs.E.Bartram, Chairman of the Health Committee and to Mrs.P.K.Williams, Chairman for the first part of the year for their encouragement and support. I have the honour to be, Madam Mayor, Ladies and Gentlemen, Your obedient servant, Walth wirht Medical Officer of Health - 6 - THE WORK OF THE DEPARTMENT CONTROL OF COMMUNICABLE DISEASE - NEW HORIZONS Dr.Geoffrey Poole, Deputy Medical Officer of Health, writes:- The trend in recent years for infectious diseases to play a diminishing role as causes of illness and death continued throughout 1971. Even measles, the only notifiable disease to show a significant increase, with 1,131 cases against (800) last year should, because of the persistence of the biennial epidemic pattern despite vaccination, be compared with the 1,558 cases notified during 1969. Infectious Jaundice was somewhat increased at 80 cases (54) with one death as was Tuberculosis at 86 (79) with six deaths. Two cases of Paratyphoid, one of Typhoid and the discovery of a typhoid carrier in a house in multiple occupation involved this section in some urgent visits and examination of specimens as did the surveillance and screening of 149 Cholera contacts returned from the outbreak in Spain. Visits related to the prevention and control of infectious disease totalled 1,839, including 633 routine visits to newly arrived immigrant families and 621 specimens were examined. The most notable epidemiological event during the year was the abandonment of routine vaccination of infants against Smallpox which dated from the Vaccination Act of 1853 which made smallpox vaccination obligatory for all infants. This forward step has been made possibleby the extensive vaccination campaigns carried out in tropical and sub-tropical countries where smallpox was prevalent. The World Health Organisation now reports only a few areas from which Smallpox has not yet been eradicated so that, while vaccination is still necessary for travellers to such areas, the risk of importing smallpox into the United Kingdom grows less every year and no longer justifies the mass vaccination of infants. It has been said that Medical Officers of Health exist to abolish the need for their own existence and it is forecast that in the coming integration of all branches of the Health Service in April 1974 Medical Officers of Health will indeed disappear - to be replaced by Community Physicians. This is not quite the mixture as before under a new label, the whole emphasis of the work has changed. Pure water supplies, the safe disposal of sewage, industrial wastes and refuse are now the responsibility of other officers who need only occasionally to consult the M.O.H. The Public Health Inspectorate has evolved into a corps of highly trained technical officers over whose professional activities the M.O.H. exercises an advisory rather than a supervisory role. The formation, in April, of the Social Services Department has relieved the M.O.H. of much of his direct responsibility for the welfare of the aged, the mentally and physically handicapped and the homeless. We have, in this country, moved a long way from the cholera, typhoid and smallpox outbreaks which were largely responsible for the appointment of Medical Officers of Health a century ago. Immunisation has replaced isolation in fever hospitals for diseases like diphtheria, polio and smallpox. Modern drugs have brought under close control diseases like meningitis, scarlet fever and tuberculosis. With a first class Public Health Laboratory Service the new style community physician does not need to be a bacteriologist, only a few will be needed as specialists in infectious diseases, chiefly those imported from countries less advanced in public health. What then remains for the Physician to the Community? The answer is a new and wider concept of total community health. Last year I referred to the inversion which had taken place between the mortality from Tuberculosis (Walthamstow and Leyton) and from Cancer of the lung (Waltham Forest) over the last four decades. Year Population Tuberculosis Lung Cancer Deaths Deaths 1930 253,100 189 16 1950 229,300 68 85 1970 235,040 1 183 No more convincing illustration could be given of our hard-won but almost total success in dealing with a disease spread by an infectious germ; or of our dismal failure to contain a disease due to a cancer producing chemical in tobacco smoke spread by habit, example and cigarette advertising. Following our report last year of the epidemic increase in smoker's - 7 - cancer the Members of the Health Committee agreed unanimously to ban smoking at their meetings and several councillors have set a praiseworthy example by giving up cigarette smoking altogether. Much of our Health Education effort this year has been directed towards schools and youth clubs because the best way to stop smoking is not to start. Another target for the Community Physician is the rapid spread of venereal disease. Although caused by transmissible germs these diseases are, for all practical purposes, acquired only by sexual intercourse with an infected person and their control calls for co-ordinated efforts on the part of the Community Physician, Health Education Officers, Health Visitors and the Liaison Officers of V.D. departments at designated hospitals, Because of the need to ensure strict secrecy venereal diseases are not notified individually but the total of new cases among Waltham Forest residents reported positive by hospital clinics serving this region of London during the last two years were:- 1970 1,162 new cases 1971 1,566 new cases This shows an increase of over one third (34.76%) but does not imply the problem is peculiar to Waltham Forest since the total new cases attending these hospitals were: for 1970 — 41,873 cases; increasing by 14,157 to 56,030 in 1971, again a rise of approximately 34%. Control of sexually transmitted disease depends upon successful contact tracing, a task calling for great tact and persuasion to obtain the co-operation of the patient, the source case and all the other contacts of the latter. This is primarily carried out by the liaison officer at the hospital clinic but in Waltham Forest two senior Health Visitors with these qualities and appropriate experience have been nominated to help in establishing contact with persons in the Borough who may be infected. Posters designed by the Health Education Officer and showing times, addresses and telephone numbers of the nearest "special clinics" are appropriately displayed. Anyone who thinks they may have been exposed to sexually transmitted disease but are unwilling to approach their family doctor (as they ought to do) can obtain advice by telephoning 928— 3401 at any time day or night. This special confidential service is provided in conjunction with the Borough of Westminster and callers are not asked to identify themselves. Almost equally dangerous but fortunately on a much smaller scale is the misuse of drugs by young people. Here again is a social disease which is contagious in the sense that it is spread by contact in pubs, youth clubs and coffee bars wherever young people congregate. But unlike the infectious diseases of the past it cannot, any more than could smoker's cancer or venereal disease, be eliminated by inoculation, isolation or sanitary engineering. These modern plagues call for an attack on a broad front enlisting the aid of all the agencies which exist to help young people. Threats and prohibitions just do not work on the emancipated (or could one say undisciplined) youth of today and if they are to be steered away from sexual promiscuity, venereal disease, drug dependence and the fatal habit of cigarette smoking, it is not enough to tell them that life holds better things. We must ensure that it does and that they are freely available to those most in need. Central Government, through projects like the Lee Valley Regional Park, and Local Authorities through their Education, Youth Service, Recreation and Leisure provisions, as well as by their support of voluntary associations, can exert a very great influence on the activities and communal life of young people and consequently upon their behaviour. - 8 - It may appear that a great deal of public money and manpower are already being devoted to a somewhat overprivileged generation but such investment in the future is going to determine the quality of life for all of us in the years to come. One is reminded of the Church Council in Chingford who proposed to close their youth club because of unruly behaviour. The Vicar, with greater wisdom, replied that he would agree to close the clubroom when the boys had stopped breaking the windows. A healthy community should contain the proper assortment of the different age, occupational and social class groups. The escalating costs of houses (and land) in the London area are forcing young couples to move many miles out to new towns and housing estates leaving an imbalance of older citizens who, as they become aged, will inevitably miss the support of their sons and daughters whose own children will be deprived of the influence of effective grandparents. Waltham Forest Council operate a preferential housing scheme for newly-married couples within the Borough and this is a very positive step towards maintaining a healthily balanced community and combating the fragmentation of family units with consequent loss of mutual support and the resulting heavier demands on health and welfare services. The impact of housing policy upon the health of a community cannot be over-emphasised and is a matter of great concern to the Community Physician. One aspect alone, the assessment of priority points for rehousing on medical grounds, calls for the judgment of Solomon and occupies a great part of the time of a senior medical officer. Some people enjoy living in tower blocks, some endure it and some declare it is driving them mad. Certainly there is no easy solution to the problem of providing the total amount and the variety of accommodation suited to the needs of our community within the limited space available but those charged with the responsibility of planning for it will have ready help from all sources of information including those knowledgeable in community health and social welfare needs. Mental health, one of the most commonly advanced pleas for medical priority rehousing, is another field in which the Community Physician will have much to offer. Because he will have a locus in the hospitals and in the home supportive services as well as knowledge and experience of Local Authority provisions he will be ideally placed to advise on projects linking the three services, such as the provision of day hospitals and hostels, as well as ensuring the total continuity of care so facilitating the earlier discharge of patients from hospital, mental or otherwise. Working conditions also exercise a profound effect upon the health, both mental and physical, of a population. Recent legislation, such as the Offices, Shops and Railway Premises Act, introduced new standards of amenities and working conditions for non-factory workers similar to those provided under the various Factories Acts. We are all becoming more aware of the influence of environment upon health but it would seem that these provisions do not go far enough. Automation and mass production tend to reduce the factory worker's interest and his identification with the finished product to an extent where the job - especially for young people - becomes a deadly bore so that they are driven to seek stimulation and excitement elsewhere in perhaps undesirable ways. The ever-increasing cost of labour has given rise to much enthusiasm for methods of boosting productivity, often by bonus schemes which encourage maximum effort throughout the working day. Usually no provision at all is made for workers who, because of age or infirmity, cannot keep up with the pace of the gang to which they become a financial liability. Yet unless people who are not fully fit are kept in employment they must degenerate in idleness at the taxpayers' expense. One hopes that the management experts will find it possible to include some light duty jobs in their improvement schemes or even include a Community Physician in their planning team. - 9 - Just as earlier generations of Medical Officers of Health laboured to reduce the amount of harmful substances and organisms to which their communities were exposed, the Community Physician of tomorrow must employ every effort to reduce mental stress which is one of the most noxious elements in modern life. Diseases known to be induced or exacerbated by stress, hypertension with 56 deaths (66) and coronary thrombosis with 577 (646) were significantly lower than 1970, as was lung cancer with 187 against last year's record of (205). However, deaths from all causes, 2,847 (3,017) were down by 170 or 5.66% while the population fell by only 1,080 to 233,960 (235,040) approximately 0.4%. Allowing for the very slightly smaller population at risk the reduction in the deaths from these three diseases, all of which predominantly affect cigarette smokers, tempts one to hope that all the effort expended in recent years to combat this fatal habit are beginning to take effect. Certainly there has been no major advance in their treatment nor any general lessening of stress. Prospective surveys since 1952 into causes of death among doctors show that over a period of ten years the odds against dying from lung cancer, for those who stop smoking, fall progressively from I in 8 for heavy smokers to approach the non-smokers I in 300. Prospective studies, that is predicting and then recording the fates of a selected group of individuals over a given period, are the most accurate way of proving cause and effect relationships and for diseases of the lungs, heart and arteries cigarettes stand convicted beyond all reasonable doubt. The Community Physician of the future may have more use for a computer than a microscope but the clouds of preventable illness and unnecessary premature deaths are not lacking from his new horizons. CHILD HEALTH SERVICE - PREPARATION FOR INDEPENDENCE Dr.Gwyneth Richards, Senior Medical Officer, writes When the baby is born it has already been developing for some months and although it is a complete and separate person there is still a long way to go before that child becomes an independent individual. All who work with children aim to help the child to develop into a person who is sound in mind and body and able to make full use of his or her abilities. When one reads newspapers, listens to the radio or watches television, one needs to be reminded that the majority of children develop into normal, healthy adults and it is only the minority who cannot cope with life. Our work in the Child Health Service is to help the development of wholeness. Ante-Natal The health of the new-born child is dependent upon the health of the parents and this dates back even to their childhood. Their health has been guarded, defects corrected and they have in many cases been immunised against rubella to prevent the mother getting german measles during pregnancy and perhaps giving birth to a handicapped child. Genetic counselling is also arranged for parents with handicapped children. The future mother is supervised during the pregnancy and at the birth of the child by our colleagues to prevent problems developing which would affect the new life. Despite all this care one cannot attain full perfection. Some babies develop from defective cells and are already imperfect from conception, others develop abnormally and others cannot change from a completely dependent to a separate life successfully. Some of these would die and some would live with handicaps. The miracle remains, however, that after all the hazards the developing baby has negotiated the majority are born healthy. Handicapped children are discussed so much at present one tends to forget that the number of normal children exceeds the number of children who are severely - 10 - handicapped in the ratio of about 160: I , and a larger proportion of handicapped children die during the first year of life. Pre-School Our aim is that every baby living in this borough should be examined thoroughly between 2 — 6 weeks, at 7 months, one year, two years, three years, four years and then in school at five years. Unfortunately we do not have adequate staff to enable such examinations to be carried out on all the children so we still have to confine our examinations to those who come routinely to the clinics, or who are asked to attend because some complication before, during or after the child's birth has made us consider the child to be "At Risk". At these examinations the child is examined to see that vision, hearing, health, motor and mental development are within normal limits. The children enjoy playing with 'Doctor's toys' and do not realise that these toys are used to judge their movements and ability. The doctor finds this work more interesting but more exacting and tiring. The results are important. If a defect such as squint, defective vision, defective hearing, muscular skeletal defect or speech defect are found the child is referred to the appropriate clinic in the borough, for further investigations or treatment. If the child has any more complicated abnormality or suspected abnormality arrangements can be made for them to be seen at the special assessment clinic which was started in 1971 and which provides a combined local authority and hospital service with the backing of both sets of facilities. School There will still be children who will not show their handicap until they have been placed in a more academic learning situation after the age of six but it is anticipated that the majority of chi Idren with a handicap will be diagnosed we 11 before the age of five years and the parents made aware of the special facilities to meet the needs of the child from an early age. Not all children who are handicapped at birth will be handicapped at school age. Surgery, special diets and medicaments have enabled children to take their place in ordinary schools and live a normal life. Others who have had very severe illnesses and would previously have died, or who have defects at birth which were previously fatal, now live on and require special facilities. This therefore causes the number of children with handicaps to be no fewer than previously. Some of the children attending ordinary schools have severe handicaps but if they can cope in an ordinary background without any detriment to their education this is a more advantageous place for them. They, however, require special supervision to see that they are holding their own and are therefore seen more frequently than others who are seen in their first year at school and unless selected for the selective medical, based on the questionnaire completed by the parents, medical records, vision and hearing test results and comments from the head and class teacher, are not seen for a routine medical inspection until they are near school leaving age. The majority of children are therefore only seen for routine medical inspection twice in their school days or when they wish to do "Out-of-school" work, but others are seen frequently for poor attendance or at the request of the school staff or parents. Vision and general hygiene checks are carried out annually and any defects noticed by the nursing staff on these occasions are also referred to the School Medical Officer for further follow-up or treatment. Although the majority of children are able to attend ordinary schools we are fortunate in this borough to have a comprehensive series of special schools. The Senior Medical Officers visit these special schools almost each week, examine the children more frequently and become even more involved in their welfare and future career than is possible in the larger ordinary schools. At present the borough lacks a partially hearing unit and we hope this can soon be remedied. - 11 - The health of the children is good. They are healthier, cleaner, better clad and better nourished than ever before. We risk now going the opposite way. Many children are too fat and until they agree to watch their diet they become fatter and fatter until discomfort, ridicule and unpopularity forces them to accept the advice which previously they would not accept. Then begins the long drudge of slimming. Day Nurseries 1971 has seen changes in health and welfare work with the separation into Health and Social Service Departments. Day nurseries were transferred to the Social Services Department in this borough on 1st November, 1971. We were able to transfer the four nurseries, which had carried out excellent work in the past, and the newly built Morris Road Day Nursery which had been opened recently and which had replaced the much older Ellingham Road Day Nursery. Although the responsibility has changed hands the Health Department will still be responsible for the health and hygiene in the nurseries and regular visits by Medical Officers will continue as in the past. Cervical Cytology These clinics have continued with comparatively short waiting lists but never quite managing to catch up on the number of requests. In 1972, when the first batch of "5 years ago" women are recalled for repeat cytology examinations, it is anticipated that the load will be more than doubled because of the need to repeat not only our own examinations but also those which had previously been done in hospital. The sessions held at Hatch Lane and Granleigh Road Clinics, the examination of slides and the receipt of reports, have run smoothly and efficiently and any abnormality been referred for further treatment. Family Planning Family Planning Clinics have continued to be run by the Family Planning Association in local authority clinics, the local authority being responsible for financial arrangements for those requiring contraception on medico-social grounds, whether they were carried out in the clinic or in the woman's home. Sessions have recently been started in St. James Health Centre (this makes the fifth centre in the borough), with a health visitor speaking three North Indian Languages being present to help the women who require this extra help. In this way we have been able to provide a satisfactory family planning service in which those who cannot afford to pay for the help can receive assistance from the local authority. THE SCHOOL DENTAL SERVICE Mr.G.P.L.Taylor, Principal Dental Officer, retired owing to ill-health in January 1912 after several months illness, and the following report on the work of the Dental Department has been contributed by Mr.R.C.Ward, Senior Dental Officer:- Once again we have suffered from a shortage of dental officers and this has been reflected in the inspections and treatment that have been carried out during the year. Mrs.L.E.Broadbent retired in March after seventeen years devoted service at Marmion Avenue Clinic. We were indeed very sorry to lose such a popular and capable dental surgeon and she has been greatly missed by both patients and staff. This left us with only two fulltime dental officers (Mr.Taylor and myself). We have, therefore, been relying very heavily on our sessional dental officers and three auxiliaries. Despite the staff problems the number of children under five years of age who attended for treatment rose from I 129 in 1970 to 1514 in 1971. Correspondingly the number of fillings - 12 - At birth babies are able to suck, swallow, cry, sneeze, cough and lift the head when lying face downwards - these are self-preserving reflexes. They also have reflexes which were of use in a more primitive development. One of these is the ability to make a stepping movement, a reflex which is normally lost during the first few weeks of life. Vision can be checked by increasingly complex tests from infancy onwards. At this stage the examiner watches the child following a moving object horizontally and vertically. Alertness of child, any abnormal movement of the eyes, or a squint can also be noticed at the time. "Put the cat on the chair". "Now put the dog under the table". A test devised to see if the child knows the meaning of "on", "under", "beside" and "in" - he did not. Although other tests are used to see if the child can see, hear and carry out movements quickly and skilfully, these are also noticed at this time. Pre-writing exercise, indicates preferred hand, method of holding crayon, fine motor control and ability to copy shapes correctly. for this age group rose, whilst the total of teeth extracted was below that for 1970. This is ari encouraging sign which I hope will continue. The dental laboratory has provided an increased number of ear moulds for the deaf children at Hawkswood School. Our technician is also pioneering a technique using denture soft lining material for part of the mould. This has, in some cases, proved far more satisfactory than the all plastic appliance which is normally used. The part of the service which gives most cause for concern is that of school inspections. The number of children inspected at school fell from 13836 in 1970 to 10239 in 1971. This means that only 28% of the school population was inspected. As one of the primary functions of the local authority dental service is the carrying out of yearly school inspections we must make every effort to improve on this in 1972. However, I feel that we can expect little improvement in the service we offer unless more dental officers can be recruited. Staffing must therefore be a high priority for next year and I hope that our programme of improvement in premises and equipment will be of help in this. Clean Air Act I 956. Smoke Control Areas ENVIRONMENTAL HEALTH SERVICES Mr.Richards, Chief Public Health Inspector writes:- During the year the Council decided to re-commence smoke control work, which had been temporarily suspended during the past 2 years due to financial circumstances and shortage of sol id smokeless fuel. The Council authorised that Smoke Control Area No. 16 shall become operative on 1st June next year. During the present year a large number of necessary fireplace conversions were carried out to comply with the Order. When this area comes into operation the whole of the old Borough of Walthamstow will be covered by smoke control areas. The Department continues to co-operate with the Ministry of Technology in a national survey of air pollution, concentrations of smoke are measured by apparatus installed at sites within the Borough. A number of applications for approval in respect of new furnace installations in factories and other premises were received. These were approved with or without modification as necessary. Offices, Shops & Railway Premises Act. 1963 It was found necessary to reduce the number of inspections carried out during the year under this Act, due to the shortage of staff. Despite this a reasonable standard has been maintained in this type of premises. This Act contains no provisions for the service of a notice on the owner or occupier of premises where a contravention is found. The only official remedy where an offence is found is for the Council to prosecute the offender. This is contrary to normal public health practice and would undoubtedly be condemned as high handed. In this Borough where an offence is found, the responsible person is informed in writing and given an opportunity to remedy the offence. This method has been found to work very well and the contraventions are usually quickly remedied, it has also reduced the number of prosecutions in the Courts. - 13 - Several inspections have been carried out under the Hoists and Lifts Regulations made under this Act. These Regulations apply to all types of lifts etc. whether used for passengers or goods. Every lift must be examined by a lift engineer every 6 months in the case of a power operated lift and every 12 months in the case of a hand operated lift. This engineer must give a written report in respect of this examination and this report must be available for inspection by authorised officers of the Council. A number of lifts were found to be defective on these examinations and appropriate repairs were carried out. Investigations were made into a number of accidents which were reported to this Department. Many of these accidents were due to carelessness or lack of attention and sometimes to disregard of rules as to the cause of accidents. It can be stated that most accidents occur from negligence of employees in not following elementary instructions. There were no serious accidents in this Borough. Food Inspection and Sampling The inspection of food and food premises and the taking of samples of food forms an important part of the work of the public health inspectors. Numbers of samples were taken of, all types of food for chemical and bacteriological examination. Bacteriological reports Wi samples of various foods are of great value in assessing standards of hygiene in the manufacture, distribution, storage and handling of food. This type of report may disclose defective refrigeration, inadequate cleansing of utensils equipment and premises and may show defects in the process of pasteurisation or sterilisation. Routine Public Health Work A large number of complaints continue to be received by the Department. These complaints cover all aspects of the work and each one is investigated and appropriate action taken as necessary. Housing Acts Mr.Butter, Deputy Chief Public Health Inspector contributes the following:- In the field of housing, the year was notable at national level for the Government's major re-appraisal of rents and housing finance. Complex changes are proposed to the system of housing subsidies paid by the Exchequer to local authorities, involving an increase in the amount payable to those Authorities with special housing problems. The proposals regarding rents which were introduced in the White Paper 'Fair Deal for Housing' can perhaps largely be summarised by one paragraph from the White Paper itself; "In the Government's view, the right principle is first to determine a rent which is reasonable for the dwelling and then to consider whether the tenant needs help towards that rent". In other words subsidies are to be directed to people rather than bricks and mortar. This underlines the new Government's policy of selectivity and it remains to be seen whether or not this new thinking will prove acceptable to the man in the street be he private tenant, Council tenant or landlord. It is proposed that rent controlled dwellings will become subject to rent regulation by a staged programme of transition, and this principle will also be applied to Council owned dwellings. I feel it is an indisputable fact that Controlled Rents have become so far out of line with the current cost of property maintenance that the present system is actually promoting the deterioration of our privately owned housing stock. The highly emotive question of the inclusion of Council property in the new all embracing scheme is one which I do not propose to deal with here, although it must be acknowledged that there are anomalies between the rents charged for Council dwellings and those applicable to private tenants at the present time. At local authority level, improvement of the housing stock within the Borough has proceeded firstly by replacement of unfit and outworn properties and secondly by improvement - 14 - and repair where houses have a suitable life expectation. The first stage of the Markhouse Road Slum Clearance/Redevelopment Scheme was confirmed by the Minister without modification during the year. This area consisted of clearance areas and adjoining areas where the houses, although not unfit for habitation had, in the opinion of the Council, passed their useful life. The first stage of the Markhouse Road Redevelopment Scheme is the fore-runner of an ambitious programme to update the housing stock in Walthamstow and during the year 11 more clearance areas were declared in the vicinity. It seems that an increasing use of a combination of Parts III and V of the Housing Act, 1957 to effect clearance will be inevitable if housing policy is to deal with the large number of houses which will become obsolescent or socially unacceptable within the next 20 years. The Housing Act, 1969 gave a fillip to the improvement and repair of the existing housing stock by the setting up of procedures combining improvement grants with the machinery for the re-assessment of rents by way of Qualification Certificates. The full effect of this was felt by the middle of the year when over 2000 applications for Qualification or Provisional Qualification Certificates had been received. This placed an additional burden upon the staff which was already seriously below establishment. Although all applications for Qualification Certificates alleged that the prescribed modern amenities existed and that the properties were in a satisfactory state of repair, this was not supported by the facts in respect of over 50% of the applications and one can only conclude that the owners or their representatives had not in fact even visited their properties for some considerable time. Towards the end of the year there was a reduction in the rate of applications received, probably in anticipation of the further legislation which it is expected will reach the Statute Book by 1972. From a practical point of view this enabled the Inspectorate to undertake the accumulated backlog of work so that by the end of the year a total of over 2800 applications had been dealt with. It is surprising that in spite of a steep rise in house prices the Department is frequently involved in complaints concerning vacant and apparently abandoned houses. Such housing units are a loss to the community, a lost revenue to the rating authority, a loss of amenity to the neighbourhood and a constant cause of complaint to the local authority. In a few cases the owners of the properties have been traced but who by an eccentric whim prefer to leave the unoccupied houses to deteriorate. Powers to deal with this situation are limited but I am pleased to report that as a result of pressure from the Department 6 houses were re-occupied during the year after remaining vacant in some instances for as long as ten years. The 1967 national housing survey demonstrated that the extent of unfit housing was much greater than formerly supposed. Now there is a pressing need for an accurate assessment of the condition of the older housing stock within the Borough. Short and long term improvements must be geared to a formulated housing programme and the first step is proposed by detailed surveys to be carried out by the Public Health Inspectorate. It is hoped to commence such surveys early in the New Year and decisions as to further redevelopment will be made having regard to the additional information available. Small but significant progress has been made toward solving the problem of itinerant caravan dwellers. The Caravan Site Act, 1968 required local authorities to provide suitable sites so that gypsies could become assimilated into a settled community if they so desired. During the year the Council authorised a scheme providing basic facilities for sixteen caravans, and by the end of the year site work was in progress. - 15 - NURSING SERVICES Miss Gillian Pittom, Chief Nursing Officer, writes:- During this year the nursing services were reorganised, following the national pattern advised by the Department of Health and Social Security. The appointment of a Chief Nursing Officer was made in the early part of the year and following this appointment a complete review of the structure was carried out. It was necessary to consider the changing needs in community care and the increasing demands upon the nursing service, both from closer working relationships with hospital and general practitioners as well as the imminent changes in the training of student nurses and midwives. It was agreed that the most useful organisation of the nursing service would be through line management with managers responsible for all three services at middle and functional management or first line. These appointments were made during the year with the exception of the middle management level. The important moves in the community nursing services have been made with the integration of the National Health Service in 1974 in the forefront of our minds. The midwifery and district nursing service by attachment in groups, laid the foundation of much closer working with general practitioners and completion of this was made when Health Visitors also became attached to practices during the latter months of 1971. The establishment of Health Visitors was increased by I Health Visitor and I sponsored Student Health Visitor in 1971. The establishment is now 35 with 25 Clinic/School Nurses working in close association with Local Health Authority Medical Officers and Health Visitors. The present establishment is approximatley I:6,800 head of population, or an overall of 60 Health Visitors School/Clinic Nurses I:4,000. The circular considers the norm for Health Visiting (excluding School Nursing) should be I:3,000 — 4,600 according to the type of area concerned. The establishment of District Nursing Sisters has been maintained at full strength with an increase of 4 State Enrolled Nurses each year for three years, from 1971. This makes the total establishment on 1st April, I 972 60 District Nursing Sisters, approximately an establishment of District Nursing Sisters I:5,000. All District Nursing Sisters have District Nurse training as soon after appointment as possible. The circular commends I:2,500 - 4,000 according to the type of area concerned. The midwifery service is remaining an effective domiciliary service with slightly less births, but increasing number of early discharges from hospital. The community nursing team has, during the last year, moved towards complete attachment to general practitioners and is already showing itself to be undertaking an improved service to a greater number of people and more satisfying to the staff concerned. This deployment of the community nursing team enables both Health Visitors and District Nursing Sisters to apply their own skills more effectively. During the past year special in-service training schemes have been arranged so that domiciliary midwives could spend two weeks in Thorpe Coombe Maternity Hospital to refresh their hospital training and at present a reverse scheme is being offered to Thorpe Coombe Sisters in the community. Whipps Cross Ward Sisters are spending a day with Health Visitors and District Nursing Sisters working in Health Centres and visiting with them in the course of their ordinary routine work. Discussions have taken place with the Director of Education at Whipps Cross Hospital about the proposed changes in the student nurse training. - 16 - A programme has been prepared for students undertaking their State registration course to participate in the community care experience as suggested in the last General Nursing Council 1969 syllabus. Plans are proceeding with Thorpe Coombe Maternity Hospital to participate in the new integrated midwifery training scheme after July 1972. Liaison schemes with hospitals in this authority have already been started some years ago. These relationships have been reviewed and in some areas revised. New arrangemements have been made in two hospitals - Chingford and Langthorne. Plans are being made for increasing the amount of time and interaction already spent in Whipps Cross to encompass all the main units there. These new and improved exchanges of understanding and easier methods of communication are showing an improved standard of patient care, both before admission and after discharge from hospital and, in some cases, has enabled an elderly patient to come home at an earlier date, or the time of waiting for admission to hospital to be less. At all times general practitioners and social services have worked closely with hospital and community nursing services- Some members of management in the nursing team have taken special courses in management alongside their hospital colleagues. Arrangements for training have been made for the remainder. Special day courses for appreciation of relationships in Hospitals and Health Centres have been arranged and were much appreciated by the staff. SPECIAL ARTICLE THE GROWTH OF ENVIRONMENTAL HEALTH The first public health inspectors are said to have originated in ancient Rome in 494 B.C. Among the matters for which they were responsible were the city's drainage system, the cleansing and paving of streets, the prevention of nuisances, the supply of good and cheap grain to the market and the destruction of unsound goods. For many centuries the epidemic diseases of cholera, smallpox, plague, yellow fever and typhus ravaged countries in different parts of the world. The only measures countries were able to take against these diseases from the fourteenth century to the beginning of the nineteenth century were quarantine measures. In 1830 cholera appeared in England despite these quarantine measures and during the next 3 years outbreaks occured throughout the United Kingdom. The outbreak disappeared in 1833 but reappeared in 1848. Although some rudimentary public health measures were taken by many societies from earliest times their efforts were hampered by a lack of knowledge of the causes of infectious disease and the absence of proper administrative machinery. In the British Isles in early nineteenth century there was no comprehensive system of local government, the only elected local authorities were the municipal corporations. There was no central government department charged with responsibility for the health of the people. Bacteriology was an unknown science and many quaint theories to explain the transmission of disease were then current. It was at this time that the foundations of the public health service were laid. This was due in part to a growing acceptance of the principle that the state should accept some responsibility for its people. It was due also to some extent to fear of disease - the cholera epidemics, for instance provided a powerful stimulus to action - coupled with a growing belief that much sickness was preventable. - 17 - The one factor above all others which made the Government take an active interest in public health was the Industrial Revolution. Starting in the latter part of the eighteenth century and continuing throughout most of the nineteenth, using iron as its raw material, coal as the source of power, and the steam engine to harness that power for productive purposes, its influences on the life of this country are still evident. Before this period Britain was an agricultural country with a population in 1750 of 6 to 7 millions. The people were spread evenly over the country and no town except London contained more than 30,000 people. The building of these new factories, and mills drew labour to them and people flocked into the industrial towns which grew rapidly in size. Workers had to live near their employment as there was no public transport. The owners of the factories built dwelling houses near their factories to accomodate their workpeople, this resulted in large estates of back to back houses, courts and tenements which are characteristic of our present industrial towns in the Midlands and the North. As the density of population in the towns increased a host of environmental health problems arose. Methods of sanitation which were tolerable under rural conditions were grossly defective in densely packed communities, the water supply was often taken from the same river into which untreated sewage was discharged. In 1838 the Home Secretary commissioned Edwin Chadwick to prepare a report into the health of the working population in England and Wales (later extended to Scotland). This report was entitled "Report on the Sanitary Condition of the Labouring Population of Great Britain", and was pub I i shed in I 842. The conclusions of this report included the fol lowing "That the various forms of epidemic, endemic and other disease caused, or aggravated, or propagated chiefly amongst the labouring classes by atmospheric impurities produced by decomposing animal and vegetable substances, by damp and filth and close and overcrowded dwellings prevail amongst the population in every part of the Kingdom, whether dwelling in separate houses, in rural villages, in the larger towns - as they have been found to prevail in the lowest districts in the metropolis. That such disease wherever its attacks are frequent, is always found in connection with the physical circumstances above specified and that where those circumstances are removed by drainage, proper cleansing better ventilation and other means of diminishing atmospheric impurity, the frequency and intensity of such disease is abated, and where the removal of the noxious agencies appears to be complete such disease almost entirely disappears." This was referred to as Chadwick's "sanitary idea", the principle that the environment had a substantial influence on health, and the principal remedies he advocated were proper drainage, removal of refuse from houses and streets and the improvement of water supplies. He also recommended the appointment of public health officials to initiate public health measures and legislation. His findings were the principles on which sanitary reform was based for the next 50 years and it was on this foundation of sanitation that our modern public health service was buiIt. After Chadwick's report had been published a Royal Commission was appointed which confirmed his findings. The direct result of the Commission's report was the passing of the first public health act in 1848, which among other things established a Board of Health. Later other Boards and Commissions were appointed and as a result of these the Public Health 18 Act, 1875 came into operation and remained in operation until 1936 being amended or added to by other Public Health Acts. Under the provisions of these public health acts and certain local government acts local authorities were formed and given the necessary power to act. These authorities have remained substantially in the same form to the present day. During the past century there has been a vast improvement in the health of the people of the United Kingdom and much of this is due to the elimation of many hazards from our physical environment. So great has been the advance in environmental health that there is sometimes a tendancy to write off this sub ject as no longer of great importance. It is true that there are greater opportunities for dramatic and exciting achievements when the standard of environmental health is low than when a high standard has been attained. A high standard has been reached in the United Kingdom, so that it is difficult to produce striking results from all the work which is done in the field of environmental health. Although environmental health work may now present fewer opportunities, for sensational advances, it is constantly growing in scope and complexity. It is important to realise the changes that are constantly taking place in our environment and the influence they are exercising on the nature of the work and the way it is performed. The stimulus for the creation of the public health service came from public concern about disease which in due course was discovered to be of bacterial origin.As the causative organisms of communicable disease were discovered it became possible to eliminate these microbiological dangers from our environment and disease after disease was brought under control. With these types of disease under control our attention must now be focussed on microchemical hazards with which we are becoming increasingly surrounded. It was found that the post war changes in our environment have one element in common, that is, the vastly increased amounts of chemical substances, many of them new, that reach the food we eat, the water we drink, the air we breath and the soil we cultivate or build upon. Synthetic insecticides are used throughout the world to protect man, animals and food, rodenticides and herbicides are used on a large scale and these may result in pollution of the land and water supplies. It has been estimated that some 400 chemicals are added to food in the form of preservatives, anti-oxidents, emulsifiers, stabilisers, moisteners colouring agents, thickeners and thinners. The waste products of the internal combustion engine and of an increasing number of industrial processes pollute the air to an even greater degree and the greater consumption of fuels adds to this pollution. In the field of housing many changes are taking place, many unfit houses have been cleared, although there are still a large number to deal with. Local Authorities now have powers to require the modernisation of existing houses and may pay grants towards the cost. Up to the present most of this work has been done by owners/occupiers, but local councils are now concentrating on this work and it is anticipated that property owners will now carry out more conversions. Recent legislation has given power to local authorities to deal with Shops, Offices and Railway Premises and most local authorities have implementated this legislation. Factory premises are controlled under the Factories Acts and this type of premises is subject to continual inspection. It is a useful exercise from time to time to look back along the path we have travelled and so remind ourselves of how far we have come and what we have achieved on our journey. Looking back over the years from the middle of the last century, all associated with public 19 health in its widest sense can have a justifiable feeling of pride at the progress we have made and the high standard of health we have now attained throughout the United Kingdom. Environmental health work has played an important part in this progress and although it may lack some of the drama associated with it in bygone days it still has a vital role to play. There are problems still to be overcome and constant vigilance is necessary to guard against the many hazards which could still beset us. There are no grounds for complacency for the time cannot be foreseen when man will be immune from the effects of his environment. W.Richards, D.P.A., M.A.P.H.I., Chief Public Health Inspector. CONTRIBUTIONS BY COLLEAGUES RAINFALL AND SEWERAGE Contributed by D.M.P.Sullivan, C.Eng.,M.l.C.E.,F.l.Mun.E., Borough Engineer and Surveyor Rainfall The rainfall recorded at three rainfall stations in the Borough was an average of 612 millimetres (24 inches). There was heavy rainfall on 4 days during the year causing some flooding in the various parts of the Borough. Exceptional rainfall of 58mm. was recorded on the 4th August when widespread flooding including flooding of many houses occured. Sewerage The Walthamstow Southern Area (Southern Branch) Relief Surface Water Sewer was completed during the year. The Leytonstone Area Relief Surface Water Sewer (Stage I) contract has continued throughout the year, completion being delayed by construction difficulties, and is now about 70 per cent complete. The invitation of tenders for Stage IlA is awaiting the completion of Stage I. Work started on the Hale End South (Stage II) Relief Surface Water Sewer and this is now 95 per cent complete. Tenders for the Beech Hall Road Relief Surface Water Sewer have been obtained and also for the diversion of the surface water sewer in Chingford Cemetery and work is anticipated to commence on these schemes in the near future. Tenders for the civil engineering and building work for the Low Hall Depot Pumping Station have been invited and a tender for the pumps has been accepted. The contract documents for The Avenue E.4., Relief Surface Water Sewer Area (Southern Branch) have been prepared and tenders will be invited shortly. Schemes for relief surface water sewers in the Forest Side/Forest View E.4., and the Chingford Mount Area (Southern Branch) have been approved in the long term capital programme for commencement during 1972-1973 and design work on these schemes is in progress. The Greater London Council have started work on the construction of new enlarged stormwater tanks at Birch Tree Avenue to replace the existing ones serving the Chingford area. 20 Sewage Disposal The Council have no sewage disposal responsibilities. WATER SUPPLIES Contributed by Dr.E.Windle Taylor, C.B.E., M.A., M.D., D.P.H., F.C.Path. Director of Water Examination, Metropolitan Water Board. 1. (a) The supply was satisfactory both as to (i) quality, and (i i) quantity throughout I 971. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after the analytical results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structually separate dwellings supplied in your area, but the population supplied direct according to the Registrar-General's estimates at 30th June, I 971, was 233,960. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride is being added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations:- Lee Bridge works, and Chingford Mill Pumping Station. Between May and September, much of Walthamstow and parts of Chingford received water from Coppermills Works. A small portion of Lower Chingford adjoining Sewardstone Road north of King's Head Hill is supplied with Thames-derived water from Sewardstone Reservoir. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on pages 62 and 63 . (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. 21 STATISTICAL INFORMATION VITAL STATISTICS Area of Borough (in acres) 9,805 Population (Registrar General's Estimate, midyear 1971) 233,960 Number of Rate Assessments at 31st December 1971 96,617 Total Assessable Value £12,51 1,454 Product of a penny rate £120,600 STATISTICAL INFORMATION Live Births: WALTHAM FOREST ENGLAND & WALES[ MALES FEMALES Legitimate 1874 1789 3663 lllegitimate 196 155 351 4014 Live Birth Rate per 1,000 population 17.2 16.0 " as adjusted by comparability factor (1.06) 18.2 Illegitimate live births per cent of total live births 9.0 Stillbirths: Number (26 males: 28 females) 54 Rate per 1 ,000 total live and stillbirths 13 12 Total live and stillbirths 4068 Infant deaths (deaths under one year) 73 Infant Mortality Rates: Total infant deaths per 1 ,000 total live births 18 18 Legitimate infant deaths per 1,000 legitimate live births 18 17 lllegitimate infant deaths per 1,000 illegitimate live births 20 24 Neo-Natal Mortality Rate (deaths under four weeks per 1,000 total live births). 12 12 Early Neo-Natal Mortality Rate (deaths under one week per 1,000 total live births) 11 10 Perinatal Mortality Rate (stillbirths and deaths under one week combined per 1 ,000 total live and stillbirths) 24 22 Maternal Mortality: Number of deaths 1 Rate per 1,000 total live and stillbirths 0.24 Deaths: Total number 2847 Death rate per 1,000 population 12.2 11.6 "as adjusted by comparability factor (0.89) 10.9 23 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE - 1971 I.C.D CAUSE HEADING CAUSE OF DEATH TOTAL (ALL AGES) AGE GROUPS - MALES AGE GROUPS - FEMALES UNDER 1 1 -4 5-14 1 524 2534 3544 45- 54 5564 6574 75+ TOTAL MALES UNDER 1 1 -4 5-14 1 524 2534 3544 4554 5564 6574 75+ TOTAL FEMALES B4 Enteritis and other diarrhoeal diseases 3 - - - - - - - - 1 1 2 - - - - - - - 1 - - 1 B5 Tuberculosis of respiratory system 5 - - - - - - - 1 1 - 2 - - - - - - 1 - - 2 3 B6(1) Late effects of respiratory T.B. 1 - - - - - - - - - 1 1 - - - - - - - - - - - B17 Syphilis and its sequelae 2 - - - - - - - - 1 1 - - - - - - - - _ 1 1 B 18 Other infective and parasitic diseases 4 - - - - - - - 1 - 1 2 1 - - - - - - - 1 - 2 B19(1) Malignant neoplasm, buccal cavity etc. 8 - - - - - - - - 1 1 2 - - - - - - 1 2 - 3 6 B19(2) Malignant neoplasm, Oesophagus 7 - - - - - - - 1 1 1 3 - - - - - - - 1 1 2 4 B19(3) Malignant neoplasm, stomach 66 - - - - - - 1 16 12 12 43 - - - - - - 1 4 4 14 23 B19(4) Malignant neoplasm, intestine 91 - - - - - 1 - 6 19 8 34 - - - - - 2 3 13 11 28 57 B19(5) Malignant neoplasm, larynx 2 - - - - - - - 1 1 - 2 - - - - - - - - - - - B19(6) Malignant neoplasm, lung, bronchus 187 - - - - - 3 12 47 62 28 152 - - - - 1 3 2 10 6 13 35 B19(7) Malignant neoplasm, breast 54 - - - - - - - 1 - - 1 - - - - - 2 4 16 10 21 53 B19(8) Malignant neoplasm, uterus 8 - - - - - - - - - - - - - - - - - 2 5 1 - 8 B19(9) Malignant neoplasm, prostate 30 - - - - - - - 1 10 19 30 - - - - - - - - - - - B19(10) Leukaemia 10 - - - - - - - 1 - 3 4 1 - - - 1 - - 1 1 2 6 B19(11) Other malignant neoplasms 161 - - - 3 3 2 4 26 18 20 76 - - - - - 3 5 21 25 31 85 B20 Benign and unspecified neoplasms 7 - - - - - - - 2 1 1 4 - - - - - - 1 1 1 - 3 B21 Diabetes mellitis 23 - - 1 - - - - 1 2 3 7 - - - - - - - - 5 11 16 B22 Avitaminoses, etc. 1 - - - - - - - - - 1 1 - - - - - - - - - - - B46(1) Other endocrine etc. diseases 11 1 - 1 - - - - 1 - - 3 - - - - - 1 - - 3 4 8 B23 Anaemias 8 - - - - - - - - - 2 2 - - - - - - - - - 6 6 B46(2) Other diseases of blood, etc. 1 - - - - - - - - 1 - 1 - - - - - - - - - - - B46(3) Mental disorders 4 - - - - - - - - - 1 1 - - - - - - - - 1 2 3 B24 Meningitis 1 - - - - - - - - - - . - - - - - - - - _ 1 1 B46(4) Multiple sclerosis 2 - - - - - 1 - - - - 1 - - - - - - 1 - - - 1 B46(5) Other diseases of nervous system 33 1 1 1 - 1 - 2 2 6 4 18 1 1 - - - - - - 6 7 15 B26 Chronic rheumatic heart disease 40 - - - - 1 - 4 - 5 2 12 - - - - - - 2 10 9 7 28 B27 Hypertensive disease 56 - 1 - - - - - 4 6 11 22 - - - - - - 1 3 10 20 34 B28 Ischaemic heart disease 577 - - - - 2 4 24 87 109 104 330 - - - - - - 2 17 66 162 247 B29 Other forms of heart disease 176 - - - - 3 - 1 6 12 43 65 - - - - - - - 1 12 98 111 B30 Cerebrovascular disease 341 - - - 1 - - 6 18 40 51 116 - - - - 1 1 3 6 45 169 225 B46(6) Other diseases of circulatory system 130 - - - - - - 3 9 17 17 46 - - - - - - 2 5 11 66 84 B31 Influenza 3 - - - - - - 1 1 1 3 - - - - - - - - - - - B32 Pneumonia 309 12 1 - - - - 2 18 20 74 127 2 - 1 - - - 3 5 34 137 182 B33(l) Bronchitis and emphysema 151 - - - - - 1 2 12 43 57 115 - - - - - - 1 2 12 21 36 B33(2) Asthma 9 - - - - 1 - 2 2 - - 5 - - - - - - - 2 2 - 4 B46(7) Other diseases of respiratory system 20 - - - - - 2 - 3 1 5 11 1 - - - - - 1 - 1 6 9 B34 Peptic ulcer 18 - - - - - - 1 3 2 4 10 - - - - - - - - 3 5 8 B35 Appendicitis 2 - - - - - - - 1 - - 1 - - - - - - - - 1 - 1 B36 Intestinal obstruction and hernia 19 1 - - - - - - 1 1 2 5 1 - - - - - 1 2 2 8 14 B37 Cirrhosis of liver 4 - - - - - 1 - 2 - - 3 - - - - - - - 1 - - 1 B46(8) Other diseases of digestive system 37 - - - - - - 1 1 4 6 12 - - - - - - 1 1 7 16 25 B38 Nephritis and nephrosis 18 - - - - - 3 1 - 1 5 10 - - - - - 1 - 2 3 1 8 B39 Hyperplasia of prostate 2 - - - - - - - - - 2 2 - - - - - - - - - - - B46(9) Other diseases, genito-urinary system 22 - - - - - - - 1 1 8 11 - - - - - - 1 1 2 7 11 B41 Other complications of pregnancy etc. 1 - - - - - - - - - - - - - - - - 1 - - - - 1 B46(10) Diseases of skin, subcutaneous tissue 2 - - - - - - - - - - - 1 - - - - - - 1 - - 2 B46(11) Diseases of musculo-skeletal system 15 - - - - 1 - - 1 1 - 3 - - - - - - - 4 - 8 12 B42 Congenital anomalies 24 9 - 1 - - - - 1 4 - 15 3 1 - 1 1 - - 2 - 1 9 B43 Birth injury, difficult labour, etc. 16 11 - - - - - - - - - 11 5 - - - - - - - - - 5 B44 Other causes of perinatal mortality 20 18 - - - - - - - - - 18 2 - - - - - - - - - 2 B45 Symptoms and ill defined conditions 16 1 - - - - - - - - 3 4 - 1 - - - - - - - 11 12 BE47 Motor vehicle accidents 10 - - - 2 1 - 1 1 - 2 7 - - 1 - - - - 1 - 1 3 BE48 All other accidents 48 - 2 - - 1 5 2 3 1 4 19 - 1 - 1 1 1 1 - 11 23 29 BE49 Suicide and self inflicted injuries 25 - - - 2 1 3 3 2 3 1 15 - - - 1 - 2 - 5 1 1 10 BE50 All other external causes 6 - - - - 1 1 1 - 1 - 4 1 - - - - - - - 1 - 2 2847 54 4 6 8 16 27 75 286 410 509 1395 19 4 2 3 5 17 40 146 299 917 1452 24 DEATHS FROM CANCER AGE AT DEATH MALES FEMALES TOTAL Under 5 years - 1 1 5 and under 15 years - - - 15 and under 25 years 3 - - 25 and under 45 years 9 12 21 45 and under 65 years 119 91 210 65 years and over. 216 173 389 Total 347 277 624 Previous Years- 1970 367 289 656 1969 351 274 625 BIRTHS During the year a total of 4,068 births were registered. In the same period 4,142 births were notified in accordance with Section 203 of the Public Health Act which were distributed asfollows:- DOMICILIARY INSTIUTIONAL LIVE STILL LIVE STILL Notified births which occurred in the Borough 651 4 1964 25 Birth notifications transferred outwards 3 220 3 Birth notifications transferred inwards. 1 - 1696 27 Adjusted Total 649 4 3440 49 Previous Years - 1970 693 4 3332 66 1969 778 8 3231 57 CARE OF PREMATURE INFANTS (weighing 5½lbs or less) live still born Number born at home 10 - Number born in Hospital or Nursing Home 239 33 25 MIDWIFERY The work of the Council's Midwives was as follows:- 1971 1970 1969 Domiciliary confinements attended under N.H.S. arrangements where: (a) doctor was not booked 3 5 14 (b) a doctor was booked 656 743 785 Cases delivered in hospital and other institutions but discharged and attended before tenth day 825 637 679 Miscarriages attended 1 3 3 New cases booked 857 1,065 958 Cases on the books at the end of the year 337 505 366 Medical aid notices issued 22 - 12 Visits paid (as midwife): (a) Ante-natal 4,315 4,842 5,876 (b) Nursing 16,081 15,741 14,791 (c) Other post-natal 1,134 769 676 Total Visits 21,530 21 ,352 21,343 Administration of Analgesics Cases in which Gas and Air was administered 3 Cases in which Trilene was administered 52 22 24 Cases in which Entonox was administered 313 436 487 Cases in which Pethidine or a related compound was administered 281 261 287 Clinic Sessions Number of sessions attended: (a) General practitioner's clinics 1,369 I ,290 1,441 (b) Midwife's clinics 371 412 444 Number of ante-natal examinations by the midwife: (a) General practitioner's clinics 12,900 10,542 10,587 (b) Midwife's clinics 1,750 2,273 2,601 Number of women attending midwife's clinics who had not previously attended any ante-natal clinic in the current year 810 423 474 26 Child Welfare Clinic Attendances ASSEMBLY HALL DAWLISH ROAD EMMANUEL HALL GRANLEIGH ROAD HATCH LANE HANDSWROTH AVE HURST ROAD LEYTON GREEN ST. JAMES MARMION AVENUE PRIORY COURT ST. FRANCIS HALL YARDLEY LANE WEST AVENUE TOTAL FOR THE YEAR - ALL CLINICS 1971 1970 1969 Children attending for the first time in 1971 who were born in 1966 17 54 - 22 19 12 6 34 21 26 16 13 10 250 265 290 1967 16 134 5 34 10 30 5 108 104 36 20 15 30 547 619 571 1968 17 140 12 73 32 62 9 164 145 119 31 10 58 872 963 941 1969 50 277 45 132 40 134 22 205 198 141 80 28 120 1,472 1,542 1,526 1970 89 382 117 371 69 238 64 372 422 316 213 52 340 3,045 2,616 3,321 1971 128 345 45 405 44 252 268 381 420 291 256 43 296 3,174 3,309 3,506 Total attendances 2,747 6,594 1,368 5,045 1,207 6,120 3,668 4,605 5,920 7,952 3,344 1,494 5,278 55,342 53,646 55,328 Attendance of children seen by Medical Officer 571 2,189 266 1,236 449 1,632 1,100 1,466 1,586 698 1,333 136 1,943 1 4,605 15,022 15,410 No. of children referred elsewhere 25 157 30 171 1 1 5 10 118 37 38 116 2 37 757 858 707 No. of sessions (a) Medical Officers 42 193 20 143 67 133 58 172 82 53 142 10 144 1,259 1,409 1,327 (b) Sessional G.P's 2 3 - 17 1 3 30 - 60 26 - 1 - 143 65 134 (c) Health Visitors 53 14 30 18 9 5 10 21 6 96 5 41 3 311 271 220 27 28 Distribution of Welfare Foods and Nutrients NUTRIENTS WELFARE FOODS ADEXOLINE OPTROSE MARMITE COW & GATE OSTERMILK NO.2 S.M.A. HUMSD. TRU FOOD FAREX GROATS GOLDEN OSTERMILK NAT-DRIED MILK A.D.& C. DROPS A.& D. TABLETS. E JUICE Assembly Hall 585 4,720 1,861 493 878 978 193 146 117 62 127 569 164 5,510 Hurst Road 1,018 2,788 1,034 1,589 1,030 305 83 1 17 111 29 173 336 189 4,144 Dawlish Road 473 2,688 1,003 2,264 1,323 617 - 197 81 4 572 504 188 5,371 Emmanuel Hall 297 1,105 396 486 355 70 - 40 25 2 132 230 42 1,017 Granleigh Road 861 2,251 1,134 2,022 1,346 624 - 181 81 69 812 158 319 5,208 Handsworth Avenue 1,687 7,405 2,441 1,746 1,380 503 70 153 143 166 462 317 246 8,739 Hatch Lane 265 1,607 626 217 366 52 58 16 16 21 163 170 57 2,107 Leyton Green 889 3,995 1,322 2,403 1,385 574 - 21 1 97 48 570 681 182 6,981 Priory Court 1,183 4,710 1,693 1,646 1,216 392 7 108 1 18 49 736 347 314 4,024 St. James 1,006 4,847 1,219 2,803 1,625 787 108 127 139 126 940 626 252 5,960 Marmion Avenue 1,565 8,934 2,950 1,338 1,089 931 - 143 149 36 434 546 248 9,717 Yardley Lane 162 901 471 195 293 129 1 23 17 74 78 95 50 1,341 West Avenue 693 3,746 788 2,336 1,527 754 44 228 66 125 472 583 138 3,888 W.V.S. Chingford - - - - - - - - - - 14 15 17 436 Hospitals and Nurseries 100 48 - 7 4 - - - - 197 180 - 1,212 10,784 49,745 16,938 19,545 13,817 6,716 564 1,690 1,160 81 1 5,882 5,357 2,406 65,655 Previous Years - 1970 13,633 51,128 14,467 18,501 14,126 5,841 346 1,817 1,056 - 7,523 - 2,969 68,725 1969 15,310 39,955 1 1,810 19,288 16,044 5,547 395 1,641 869 923 10,573 4,563 3,025 70,499 1968 14,126 44,567 1 1,582 15,938 12,656 5,557 472 1,509 762 1,125 15,238 4,753 3,057 68,142 Mothercraft and Relaxation Classes New cases 347 Attendances 1,115 No. of classes held 167 Congenital Malformation 139 cases of congenital malformation were notified to the Registrar General's office during the year. Children "At Risk" 1971 1970 1969 Children on register at 1 january 2,625 2,600 3,070 Children added during year 1 ,501 1 ,412 1 ,276 Children removed during year 1 ,604 1 ,387 1 ,746 Children on Register at 31 st December 2,522 2,625 2,600 Cervical Cytology Clinics HATCH LANE GRANLEIGH ROAD No. of smears taken 947 379 No. of sessions 52 26 Dental Treatment of Expectant and Nursing Mothers and Children under five years CHILDREN UNDER 5 YRS. EXPECTANT & NURSUING MOTHERS 197 1 1970 1969 1971 1970 1969 Number of patients given first inspections during year 329 272 312 24 26 19 Number of patients who required treatment 213 171 194 21 22 18 Number of patients who were offered treatment 204 164 194 17 22 18 Attendances for treatment: First visit 682 569 513 30 33 30 Subsequent visits 832 560 644 42 38 52 Total visits 1,514 1,129 1,157 72 71 82 Treatment provided: Number of fillings 877 720 766 39 29 54 Teeth filled 792 666 682 36 23 48 Teeth extracted 183 213 192 9 1 1 29 General anaesthetics given 72 81 79 1 5 7 Emergency visits by patients 36 37 33 - 4 5 Patients X-rayed 12 2 2 6 5 6 Patients treated by scaling and/or removal of stains from the teeth (Prophylaxis) 258 327 221 14 7 23 Teeth otherwise conserved 171 147 163 - - - Teeth root filled - - - 1 - - Inlays - - - - - - Crown - - - - - 1 Number of courses of treatment completed during year 570 374 259 20 16 17 Patients supplied with full upper or full lower _ _ _ _ . Patients supplied with other dentures - - - 2 2 1 Number of dentures supplied - - - 2 2 1 29 Family Planning GRANLEIGH ROAD HATCH LANE HURST ROAD LEYTON GREEN ST. JAMES* Number of new patients 334 344 609 249 51 Number of persons treated 805 1,342 1,671 587 60 Number of attendances 2,021 3,422 4,498 1,672 116 Number of sessions 51 99 99 50 16 * From September 1971 HEALTH VISITING (a) Sessions Worked Number of sessions (half days) devoted to: 1971 1970 1969 (i) Health visiting 7,427 7,892 7,529 (ii) Child welfare centres 3,315 3,674 3,578 (iii) Ante-natal, post-natal, relaxation etc. clinics 391 313 409 (iv) School clinics 764 979 897 (v) Other school nursing 1,647 1,887 1,890 (vi) Health education (including mothercraft) 499 351 551 (vii) Other work (including clerical) 5,514 5,078 5,193 Total sessions 19,557 20,174 20,047 (b) Cases visited for the first time in the year (i) children born in 1966 1,010 1,217 1,090 ” ” ” 1967 1,307 1,621 1 ,409 ” ” ” 1968 1,630 1,828 1 ,857 ” ” ” 1969 1,834 2,263 2,149 ” ” ” 1970 2,1 10 2,464 2,401 ” ” ” 1971 3,957 3,778 3,861 (ii) persons aged 65 or over 2,01 1 2,327 2,443 (iii) others (excluding school nursing cases) 1,322 1,409 1 ,707 Total 15,181 16,907 16,917 (c) Number included in item (b) (i) mentally disordered persons 79 136 157 (ii) persons discharged from hospital (other than mental hospitals) 365 397 406 (iii) tuberculosis households 2 12 5 (iv) households visited on account of other infectious diseases 7 17 20 (d) Number included in item (b) and where appropriate item (c) who were visited at the special request of a G.P. or hospital: (i) persons aged 65 or over 572 567 548 (ii) mentally disordered persons 34 52 64 (iii) persons discharged from hospital (other than mental hospitals) 187 107 222 30 (e) Total number of visits to: EFFECTIVE INEFFECTIVE (i) children under 5 years of age 21,035 5,754 (ii) persons aged 65 or over 5,172 1,308 (iii) other (excluding school nursing cases) 4,367 554 Total visits 1971 30,574 7,616 Total visits 1970 35,448 7,917 Total visits 1 969 36,288 7,864 1971 1970 1969 (f) Sessions attended at G.P's surgeries (included above) 484 388 270 HOME NURSING (a) Cases visited for the first time in the year: CASES TOTALS VISITS 1971 1970 1969 1971 1970 1969 (i) aged under 5 1,336 917 745 3,162 3, 1 14 2,291 (ii) aged 5 and under 65 4,539 2,632 2,109 38,080 32,596 34,691 (iii) aged 65 or over 2,625 2,431 3,084 107,055 105,870 98,443 Total cases 8,500 5,980 5,938 148,297 141,580 135,425 (b) Cases on the books at the end of the year 1971 1,550 1970 1,512 1969 1,405 LOAN OF SICKROOM EQUIPMENT New Issues in 1971 equipment health & welfare dept. chingford red cross equipment health & welfare dept. chingford red cross Commodes 249 64 Urine Bottles 69 27 Wheelchairs 170 163 Bed Boards (sets) - 6 Bed Cradles 98 35 Feeding Cups 7 9 Air Rings 94 27 Crutches (pairs) 7 10 Bed Pans 122 42 Bed Tables - 20 Back Rests 127 52 Walking Sticks _ 20 Draw Sheets 146 27 Others 25 5 Plastic Sheets 255 - - - - 31 CHIROPODY TREATMENT NEW CASES CLINIC ATTENDANCES DOMICILIARY TREATMENTS TREATMENTS AT OLD PERIODS RESIDENTIAL HOMES CASES TREATED DURING THE YEAR Children 934 4,609 - - 1,298 Expectant mothers 3 4 - - 4 Physically Handicapped 7 159 36 - 65 Aged (over 65 years of age) 497 20,565 3,963 1,684 6,820 Others 421 7,175 74 - 2,025 Total for 1971 1,862 32,512 4,073 1,684 10,212 Previous Years - 1970 1,730 34,358 4,214 1,829 1969 2,177 37,750 6,000 1,617 LAUNDRY FOR THE INCONTINENT ARTICLES LAUNDERED DOMICILIARY CASES RESIDENTIAL HOMES 31,193 36,138 REGISTRATION OF PREMISES Public Health Act, 1936 - Nursing Homes NO.OF HOMES BEDS PROVIDED MATERNITY OTHERS Homes registered at 31st December, 1971 1 71 Essex County Council Act, 1933 - Establishments for Massage and Special Treatment Establishments registered at 3 1 st December, 1971 CHIROPODY MASSAGE ETC. 7 6 32 INFECTIOUS DISEASES - NOTIFICATIONS DISEASE 1ST QUARTER 2n d QUARTER 3RD QUARTER 4TH QUARTER TOTAL Scarlet Fever 27 23 7 15 72 Whooping Cough 73 35 10 12 130 Measles 495 431 181 24 1,131 Tuberculosis 16 27 26 17 86 Typhoid - 1 - - 1 Paratyphoid - 1 1 - 2 Acute Meningitis 3 2 3 1 9 Dysentery 3 6 2 6 17 Ophthalmia Neonatorum - 4 - - 4 Food Poisoning 2 2 11 1 16 Infective Jaundice 19 32 26 3 80 Malaria - - - - - Totals 638 564 267 79 1,548 TUBERCULOSIS New Notifications and Deaths during 1971 AGE PERIODS NEW CASES DEATHS PULMONARY NONPULMONARY PULMONARY NONPULMONARY Under 1 year M F M F M F M F - - - - - - - - 1 - 4 years. 1 - - - - - - - 5-9 years - - - - - - - - 10-14 years - 3 1 - - - - - 15-19 years 3 2 2 3 - - - - 20 - 24 years 4 6 2 2 - - - - 25 - 34 years 10 3 4 6 - - - - 35 - 44 years 1 2 5 5 - - - - 45 - 54 years 3 - - 2 - 1 - - 55 - 64 years 6 - 1 - 1 - - - 65 and over 3 5 - 1 2 2 - - 31 21 15 19 3 3 - - Totals 52 34 6 - 86 6 33 Tuberculosis among Immigrants Cases of tuberculosis among immigrants seen at the local Chest Clinic numbered 55 These occured in the following groups:- RESPIRATORY NON-RESPIRATORY Pakistani 17 13 Indian 1 8 Kenyan 3 3 West Indian 2 1 Irish 2 1 Others 3 1 Tuberculosis - Care and Aftercare (a) Work of Tuberculosis Visitors (i) Visits to new cases 255 (ii) Total visits to households 1,659 (iii) Sessions attended at Chest Clinic 847 (b) Contacts Examination of contacts during year (i) first examinations 419 (ii) subsequent examinations 394 MEDICAL EXAMINATIONS OF STAFF Completed during period 1st January to 31st December,1971:- Medical Examinations 489 Medical Assessments 1,001 34 VACCINATION AND IMMUNISATION TYPE OF COURSE OR DOSE YEAR OF BIRTH OTHERS UNDER 16 YEARS TOTALS 1971 1970 1969 1968 1964-67 Diphtheria - Primary 48 1,918 587 87 130 17 2,787 Booster - 24 196 54 2,713 129 3, 1 16 Whooping Cough - Primary 48 1,890 578 79 67 2 2.664 Booster. - 18 188 40 375 32 653 Tetanus - Primary 48 1,918 590 88 134 76 2,854 Booster 26 198 58 2,724 242 3,248 Poliomyelitis - Primary 48 1,937 583 88 183 15 2.854 Booster - 27 1 17 59 2,702 139 3,044 Measles 2 767 775 234 327 55 2,160 Rubella - - - - 1 734 735 VACCINATION AND IMMUNISATION TYPE OF VACCINE USED L PRACTITIONERS IMMUNISATIONS OR VACCINATIONS COMPLETED BY BOROUGH STAFF PRIMARY COURSES REINFORCING DOSES PRIMARY COURSES REINFORCING DOSES Diphtheria, Whooping Cough, Tetanus and Poliomyelitis combined - - - - Diphtheria, Whooping Cough and Tetanus 1,434 615 1,230 38 Diphtheria and Whooping Cough combined - - - - Diphtheria and Tetanus combined 9 817 112 1,540 Diphtheria only - 2 2 16 Whooping Cough only - - - - Tetanus only 91 143 4 7 Poliomyelitis:- (a) Salk - - - - (b) Sabin 1,428 1,690 1,416 1 ,354 Smallpox 907 225 181 5 Measles 1,036 - 940 - Rubella 174 - 566 - 35 B.C.G. Vaccination of Children Results of Heaf Test:- (a) Tubercul in Positive 111 (b) Tuberculin Negative 2,621 Number vaccinated with B.C.G. 2,621 GENERAL DENTAL SERVICE Number of Sessions 210 Number of appointments made 1,255 Number of new patients seen 193 Analysis of Treatments Provided Fillings - Plastic 180 Amalgam 359 Inlays 1 Crowns 3 Scaling and gum treatment 185 Dressings 93 Extractions 57 General Anaesthetic given 2 Local Anaesthetic given 130 X-rays 224 Dentures supplied 100 Dentures repaired 85 Impressions 253 Bites 77 Try-in 128 Minor Oral surgery 6 Other treatment 175 DENTAL LABORATORY DENTURES REPAIRS REMARKS OR RELINE APPLIANCES CROWNS INLAYS STUDY MODEL TRAYS EAR INSERTS General Dental Service 100 63 22 2 3 3 - 102 - School Dental Service 18 6 - 95 28 - 280 13 449 Maternity and Child Welfare 4 - - - - - - 2 - 36 PUBLIC HEALTH INSPECTION 1. Inections, Re-inspections, Action (a) GENERAL STATUTORY PROVISIONS COMPLAINTS RECEIVED INSPECTIONS AND RE-INSPECTIONS INFORMAL NOTICES SERVED FORMAL NOTICES SERVED HOUSES CLASSIFIED Clean Air Act, 1956 130 1,095 1,800 189 - Housing Acts, 1936/69 and Regulations - 5,959 3 19 - Public Health Acts, 1936/64, and Noise Abatement Act, 1960 2,025 15,432 652 299 - Prevention of Damage by pests act, 1949 3,578 17,075 19 6 - Food and Drugs Act, 1955 and Food Hygiene Regulations, 1960/66 267 3, 166 106 - - Factories Act, 1961 43 332 13 - - Pet Animals Act, 1951, Riding Establishments Act, and Animal Boarding Establishments Act, 1963 - 115 - - - Offices, Shops and Railway Premises Act, 1963 - 2,766 101 - - 37 (b) DETAILED (i) Rent Act, 1957 - Para. 4, First Schedule Applications for certificates received 4 Decisions not to issue certificates Nil Decisions to issue certificates 4 Undertakings given by landlords under paragraph 5 of the First Schedule 1 Undertakings refused by local authority under proviso to paragraph 5 of the First Schedule Nil Certificates issued 3 Applications by landlords for cancellation Nil Objection by tenants to cancellation Nil Certificates cancelled by local authority Nil Applications for certificates (Form P) Nil (ii) Housing Acts, 1957/69 (a) Individual Houses - Demolition/Closing Orders Undertakings accepted (Section 16) 3 Closing Orders made 23 Demolition Orders made (Section 17) Nil Closing Orders revoked and Demolition Orders Nil substituted (Section 28) Nil Orders/Undertakings determined 5 (b) Slum Clearance Areas Number of areas represented (Sections 42 & 157 (1) 11 Houses unfit for human habitation 85 Houses included by reason of bad arrangement Nil Houses on land acquired under 43 (2) 49 Numbers of people to be displaced (a) individuals 369 (b) Families 131 (c) Compulsory Purchase Orders confirmed The Waltham Forest Housing Part III (Markhouse Road, E.I7) Compulsory Purchase Order 1970 comprising 5 clearance areas and the Waltham Forest Housing Part V (Markhouse Road, E.I7) Compulsory Purchase Order were confirmed by the Secretary of State for the Environment during the year. The Waltham Forest Housing Part III (Arkley/Camden/Ringwood Roads, E.17) Compulsory Purchase Order 1971 was withdrawn following acquisition of the properties by the Council. 38 The Waltham Forest Housing Part III (Ringwood Road, E.I7) Compulsory Purchase Order 1971 was made and the Minister's decision is awaited. Following Official Representations 8 Clearance Areas were declared by the Council in respect of Arkley Road, Arkley Crescent and South Grove, E.17 in December. (d) Housing Act 1969 - Part III - Qualification Certificates A total of 2,829 applications have been received up to 31 st December 1971 , by this Department in connection with the conversion of Control led Tenancies to Regulated Tenancies for the purposes of recent control. Action has been taken as follows:- Section 44(1) Section 44(2) Section 46(3)(4) Applications Received 2,439 321 69 Certificates Recommended 1,270 255 67 Certificates Not Recommended 870 26 Nil Applications Withdrawn 37 12 Nil Applications Pending 262 28 2 (iii) Food and Drugs Act, 1955 (Inspection and Supervision of Food Premises) The following inspections were carried out at the under-mentioned food premises in accordance with the requirements of the Public Health Act, 1936, Food and Drugs Act, and Food Hygiene (General) Regulations, I960, Ice-Cream (Heat Treatment) Regulations, 1947/52, Factories Act, 1961, Leyton Corporation Act, I 950, Essex County Council Act, 1952, and relevant legislation. TYPE OF PREMISES NUMBER OF INSPECTIONS Retail Food Shops 2,003 Catering establishments (including factory canteens, hospitals, nursing homes, school meals kitchens) 596 Food Hawkers/Street Traders/Fairgrounds 244 Food Manufacturers/Depots, Dairies, Bakehouses 169 Off-Licences 33 Public Houses 121 3,166 39 (iv) The Offices, Shops and Railway Premises Act, 1963 (a) Registrations and General Inspections CLASS OF PREMISES NO. OF PREMISES REGISTERED DURING THE YEAR TOTAL NO. OF REGISTERED PREMISES AT END OF YEAR NO. OF REGISTERED PREMISES RECEIVING A GENERAL INSPECTION DURING THE YEAR Offices 15 547 145 Retail shops 42 1,652 687 Wholesale shops, warehouses 4 98 24 Catering establishments open to the public, canteens 1 1 195 83 Fuel storage depots - 6 5 Totals 72 2,498 944 Number of visits of all kinds by Inspectors to registered premises 2,766 40 (b) Analysis of Contraventions Found SECTION NO. OF CONTRAVENTIONS FOUND SECTION NO. OF CONTRAVENTIONS FOUND 4 Cleanliness 38 12 Clothing Accommodation 4 5 Overcrowding Nil 13/14 Seating Facilities Nil 6 Temperature 27 15 Eating Facilities Nil 7 Ventilation 4 16 Floors, passages and stairs 12 8 Lighting 10 17/18/19 Machinery 15 9 Sanitary Conveniences 98 21 Noise and Vibration 2 10 Washing Facilities 42 24 First Aid General Provisions 30 11 Drinking Water 1 50 Exhibition of Forms 36 Total 319 (c) Analysis of Persons Employed in Registered Premises by Workplace CLASS OF WORKPLACE NUMBER OF PERSONS EMPLOYED   Office 5,447 Retails shops 7,71 1 Wholesale departments, warehouses 1,153 Catering establishments open to the public 1,240 Canteens 80 Fuel storage depots 58 Total 15,689 Total Males 7,349 Total Females 8,340 (d) Reported Accidents WORK PLACE NUMBER REPORTED ACTION RECOMMENDED NO ACTION PROSECUTION FORMAL WARNING IN FORMAL ADVICE Offices 4 - - 4 - Retail shops 32 - - 32 - Wholesale shops, warehouses 9 - - 9 - Catering establishments open to public, canteens 2 - - 2 - Fuel storage depots - - - - - Totals 47 - - 47 - 41 (v) Prevention of Damage by Pests Act, 1949 - Rodent Control Complaints received 2,461 Inspections and Re-inspections 13,575 Premises treated 2,055 2. Nuisances Abated, Defects Remedied, Improvements Effected (i) PUBLIC HEALTH ACTS The total number of repairs and improvements carried out to dwellings and other premises is as follows, compared with the past two years:- 1969 1970 1971 2,796 2,750 2,760 (ii) FOOD AND DRUGS ACTS/FOOD HYGIENE REGULATIONS The total number of repairs and improvements carried out to food establishments and industrial premises is as follows, compared with the past two years:- 1969 1970 1971 1,657 1,704 1,490 3. Registration and/or Licensing of Business Premises (i) Approximate number of business premises in the Borough and functions involved. OFFICES SHOPS AND RAILWAY PREMISES ACT,1963 NO: FOOD PREMISES BUSINESS DESIGNATION SUBSIDIARY FUNCTIONS NO. Registration Baker 94 Local Authority 2,498 Butcher 137 H.M.F. Inspector 872 Canteen/Staff* 51 Exempt 2,037 Total 5,407 Canteen/School* 72 Class of Premises Registered by Local Authority Catering/Public 186 Catering/Misc. 3 Chemist 87 Office 547 Confectionery 284 Retail Shop 1,652 Wholesale 98 Fishmonger 51 Catering/Public. 195 Fish Frier 46 Fuel Store 6 Greengrocer 163 Factories Act, 1961 Grocer/General 334 Off-Licence 99 Power 816 Public House 87 Non-power 56 18 Trade Store/Multiple 14 Non-food 3,744 Depots/Food Storage 63 Food 1,663 Stall/Vehicle 534 42 (ii) Details of Registrations/Licences ACT OR REGULATION ON REGISTER 31.12.1971. Food and Drugs Act, 1955 Ice-Cream Premises 906 Food Preparation, etc. Premises 105 Milk and Dairies (General) Regulations, 1959 Distributors 293 Dairies 8 Milk (Special Designation) Regulations, 1960 Pasteurised 163 Sterilised 150 Untreated 8 Ultra Heat Treated 65 Essex County Council Act, 1952 Hawkers of Food 206 Hawkers' Storage Premises 39 Leyton Corporation Act, 1950 Section 63 - Vendors of Shellfish 19 Section 48 - Hairdressers' Premises. 253 Pet Animals Act, 1951 Annual Licences 29 Animal Boarding Establishments Act, 1963 2 Rag Flock and other Filling Materials Act, 1951 11 Riding Establishments Act, 1964 1 Total 2,258 43 4. Legal Proceedings (i) Public Health Acts, 1936/61, Clean Air Act, 1956 27 applications were made for legal proceedings to enforce the requirements of notices served. 7 cases were subsequently heard by the Court and abatement orders made. The remaining 20 cases were withdrawn before the court hearing, or after adjournment, the work required by the notices having been completed. (ii) Food and Drugs Act, 1955 135 complaints regarding foodstuffs were investigated and reported for consideration of legal proceedings. A wide variety of food was implicated, i.e. milk, bread, cakes, sausages, tinned goods, bacon and confectionery. The reason for the complaint was either the presence of foreign matter or the appearance of mould growth on the food. (iii) Food Hygiene (General) Regulations, 1960 Legal proceedings were authorised in respect of 8 contraventions under Food Hygiene (General) Regulations, 1970. Analysis of Legal Proceedings SEC.ACT/ REG. NATURE OF OFFENCE NUMBER OF OFFENCES FINES IMPOSED £ 6 The food business carried on in insanitary premises 1 5 7 Articles of equipment not kept clean and in good order and condition. 1 5 9 Food so placed as to involve risk of contamination 1 5 16 Failure to maintain sanitary convenience in a clean and/or efficient condition, and failure to exhibit "wash hands" notice 2 10 18 Failure to provide a wash basin and/or hot and cold water supply and/or hand washing requisites 1 5 22 Failure to provide suitable and sufficient means of lighting in a food room 1 5 25 Failure to maintain the walls of a food room so as to prevent the risk of infestation by mice 1 5 Total 8 40 Total Costs awarded to Council 21.50 44 (iv) Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 Hawking of Food and Pleasure Grounds Pleasure fairs operating at Chingford Plain, E.4. and Lea Bridge Road, E.10., were visited by members of the Public Health Inspectorate during the Bank Holiday periods. Food hawkers' stalls, mobile canteens and ice cream vendors etc., were inspected and registrations checked. While the general standard of hygiene practiced by food vendors was reasonable for open air trading, it was necessary to issue a number of verbal warnings and written intimations regarding infringements of the Food Hygiene (General) Regulations, 1960. Legal proceedings were authorised in respect of 18 contraventions under Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966. Analysis of Legal Proceedings SEC.ACT/ REG. NATURE OF OFFENCE NUMBER OF OFFENCES FINES IMPOSED £ 4 Food stall insanitary and food exposed to risk of contamination 2 12 13 The name and address of the person carrying on the food business was not legibly and conspicuously displayed 2 11 16 Failure to supply adequate supply of hot water and failure to provide hand washing requisites 3 25 17 Failure to provide bandages, dressings and antiseptics for first aid treatment 1 10 18 Failure to provide facilities for washing and sorting food and equipment 2 10 21 The stall was not suitably covered and screened at the sides and back thereof in such a manner as to prevent any mud, dust, dirt, filth or other contaminating substance from being deposited upon any open food thereon 7 38 22 Failure to provide sufficient number of covered recepacles for waste trimmings and refuse 1 5 Total 18 111 Total Costs awarded to Council 25 45 5. Sampling - Food and Drugs Act, 1955 Samples Submitted for Chemical and Bacteriological Examination TYPE OF EXAMINATION AND ANALYSIS OF RESULTS MISC. FOODS MILK ICE CREAM ICE LOLLIES COOKED MEATS WATER DRINKING SWIMMING POOLS No. Chemical 99 - - - - - 1 No. Bacteriological 36 30 80 - 102 9 3 No. Satisfactory 99(C) 30(B) 30 52 - 80 9 1(C) 3(B) No. Fairly Satisfactory 4(B) - 15 - 9 - - No. Unsatisfactory 2(B) - 13 - 13 - - 6. Meat and Food Condemned Condemnation certificates were issued in respect of the under-mentioned unsound foodstuffs surrendered by various traders in the Borough as a result of routine inspection of food premises. COMMODITY TINS PACKETS/ BOXES BOTTLES OUANTITY TONS CWT. ST. L.BS. Tinned Goods 547 - - - - - Tinned Meats 86 - - 4 3 22 Tinned Fruits 162 - - 9 3 2 Frozen Foods - 9,728 - - - - Fish - - - 3 - 27 Meat - - 1 10 2 8 Fats Suet - - 8 2 - 14 Lard Poultry - - 1 3 - 6 Fruit - - 3 18 3 12 Dried Goods - 349 pkts. - - - - 368 Gammons 792 jars Pickled Herrings 631 lbs. Dried Milk 301 cases Aubergines 27,802 pkts. cole slaw salad 92,720 Peaches 46 7. Factories Act, 1961 The following are the prescribed particulars required by Section 153 (1) of the Factories Act, 1961,to be included in annual reports. 1. Inspections PREMISES NUMBER OF NUMBER ON REGISTER 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 18 14 1 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 816 279 10 . (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 38 39 2 - Total 872 332 13 - 2. Cases in which defects were found NUMBER OF CASES IN WHICH DEFECTS WERE FOUND NUMBER OF CASES IN WHICH PROSECUTIONS WERE INSTITUTED PARTICULARS FOUND REMEDIED REFE TO H.M. INSPECTOR RRED BY H.M. INSPECTOR (1) (2) (3) (4) (5) (6) Want of cleanliness - - - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) 1 1 - - - Sanitary Conveniences (S.7) - - - - - (a) Insufficient 8 5 - 6 - (b) Unsuitable or defective 29 24 - 25 - (c) Not separate for sexes 4 3 - 1 - Other offences against the Act (Not including offences relating to out-work) 1 1 - 1 - Total 43 34 - 33 - 47 3. Outwork NATURE OF WORK SECTION 133 SECTION 134 NO. OF OUTWORKERS IN AUGUST LIST REQUIRED BY SECTION 133 (1) (C) NO. OF CASES OF DEFAULT IN SENDING LISTS TO THE COUNCIL NO. OF PROSECUTIONS FOR FAILURE TO SUPPLY LISTS NO. OF INSTANCES OF WORK IN UNWHOLESOME PREMISES NOTICES SERVED PROSECUTIONS Wearing apparelMaking 123 - - - - - Footwear 1 - - - - - Umbrellas, etc. - - - - - - Handbags 6 - - - - - Artificial flowers 6 - - - - - Garment hangers 21 - - - - - Boxes, etc. wholly or partly of paper Making 27 - - - - - Gents Neckwear 33 - - - - - Upholstery trimmings 2 - - - - Brushes 3 - * - - - Loose cover specialist - - - - - Toys 9 - - - - - Watch strap - - - - - - Buttons, carding - - - - - - Christmas crackers, etc. 8 - - - " - Belts for power transmissions - - - - - - Lampshades 14 - - - - - Household Linen - - - - - - Curtain and furniture hangings - - - - - - File making 2 - - - - - Furniture and upholstery - - - - - - Caning - - - - - - Hampers and Baskets 14 - - - - - Paint Boxes 8 - - ■ - - Total 277 - - - - - 48 SCHOOL HEALTH SERVICE SCHOOL POPULATION NUMBER OF SCHOOLS NUMBER OF PUPILS ON SCHOOL REGISTERS AT END OF YEAR Nursery 3 256 Primary 77 21,230 Secondary 27 13,705 Special 8 657 Totals - 1971 115 35,848 1970 109 34,196 1969 108 32,799 SCHOOL MEDICAL INSPECTION (a) Periodic Medical Inspections 1971 1970 1969 5 year age group 2,888 2,766 3,172 10-11 year age group 1,277 1,212 1,214 14 years age group 1,925 1,169 1,725 Others 633 704 751 Total 6,723 5,851 6,862 No. of special inspections 1,380 1,409 1,351 No. of re-inspections 5,461 5,019 4,721 6,841 6,428 6,072 (b) Physical Condition of Children Inspected AGE GROUP INSPECTED (BY YEAR OF BIRTH) NO.OF PUPILS INSPECTED PUPILS WHOSE CONDITION WAS CLASSIFIED UNSATISFACTORY 1967 and later 76 - 1966 1,409 - 1965 1,403 - 1964 254 - 1963 52 - 1962 99 - 1961 839 - 1960 438 - 1959 51 - 1958 34 - 1957 143 - 1956 and earlier 1,925 - Total 6,723 - * Selective Medicals - A total of 893 children were found not to warrant a medical examination. 49 (c) Individual Pupils found to require treatment at Periodic Medical Inspections during the year (excluding dental diseases and infestation with vermin) AGE GROUP INSPECTED (BY YEAR OF BIRTH) INDIVIDUAL PUPILS FOUND TO REQUIRE TREATMENT FOR DEFECTIVE VISION (EXCLUDING SQUINT) FOR ANY OTHER CONDITION TOTAL INDIVIDUAL PUPILS 1967 and later 1 5 6 1966 78 123 196 1965 95 201 281 1964 10 37 44 1963 2 7 9 1962 7 8 13 1961 95 124 206 1960 53 83 131 1959 2 5 7 1958 4 4 7 1957 12 5 17 1956 and earlier 218 130 336 Total 577 732 1,253 50 (d) Pupils found to have undergone tonsillectomy AGE GROUP NO. INSPECTED NO. FOUND TO HAVE UNDERGONE TONSILLECTOMY BOYS GIRLS BOYS G1RLS Infant 1,658 1,230 44 9 Junior 664 613 37 31 Leaver 1,103 822 68 87 Other 340 293 27 15 Totals 3,765 2,958 176 142 (e) Pupils found to have defects of colour vision INTERMEDIATE INSPECTIONS LEAVER INSPECTIONS OTHERS Tested for Colour Vision 1,277 1,925 633 Found to have defects of colour vis ion 17 26 4 (f) Parents present at Medical Inspection NO. INSPECTED PARENT PRESENT PERCENT Infant Boys 1,658 1.535 92.6 Girls 1,230 1,107 90.0 Junior Boys 664 492 74.1 Girls 613 481 78.3 Leaver Boys 1,103 137 12.4 Girls 822 246 29.9 Other Boys 340 206 60.6 Girls 293 222 75.7 51 (g) Defects found by Periodic and Special Inspections during the year DEFECT CODE NO. DEFECT OR DISEASE PERIODIC INSPECTIONS SPECIAL INSPECTIONS ENTRANTS LEAVERS OTHERS TOTAL (ALL GROUPS) TREATMENT OBSERVATION TREATMENT OBSERVATION TREATMENT OBSERVATION TREATMENT OBSERVATION TREATMENT OBSERVATION 4 Skin 33 83 25 20 55 47 1 13 150 70 19 5 Eyes (a) Vision 174 105 218 47 185 43 577 195 95 60 (b) Squint 45 30 6 9 9 12 60 51 12 11 (c) Other 12 12 12 9 8 9 32 30 7 8 6 Ears (a) Hearing 41 99 8 19 27 92 76 210 47 44 (b) Otitis Media 15 39 6 19 8 26 29 84 4 11 (c) Other 12 43 7 9 9 21 28 73 8 13 7 Nose and Throat 69 256 8 41 41 146 118 443 33 65 8 Speech 38 103 1 3 17 35 56 141 36 39 9 Lymphatic Glands 10 57 3 12 7 32 20 101 2 19 10 Heart 5 36 1 9 2 12 8 57 3 9 1 1 Lungs 16 73 9 34 12 45 37 152 5 19 12 Developmental (a) Hernia 3 11 2 7 2 6 7 24 13 6 (b) Other 20 145 14 47 24 104 58 296 42 53 13 Orthopaedic (a) Posture 2 13 3 36 4 18 9 67 15 18 (b) Feet 50 73 11 41 38 47 99 161 37 12 (c) Other 17 27 16 65 20 32 53 124 39 26 14 Nervous System (a) Epilepsy 4 2 4 - - 1 8 3 19 3 (b) Other 6 14 1 8 3 17 10 39 8 12 15 Psychological (a) Development 2 65 - 1 2 100 4 166 36 25 (b) Stability 6 168 2 13 13 168 21 349 31 66 16 Abdomen 6 14 3 10 7 40 16 64 6 14 17 Other 3 26 14 25 2 12 19 63 129 38 OTHER MEDICAL INSPECTIONS (a) Employment of children (other than in entertainment) (i) initial examinations 99 (ii) re-examinations - (b) Employment of children in entertainment (i) initial examinations 2 (ii) re-examinations - EXAMINATIONS BY SCHOOL NURSES Head Inspections Number of examinations 25,053 Number of children found to be unclean 234 Vision Testing at School Number of children tested 16,976 Number referred to Eye Clinic 385 Foot Inspections at School Number of children inspected 3,628 Number referred for treatment 80 MINOR AILMENT CLINICS New Cases Boys Girls Ringworm - Head - - Body - - Scabies 2 - Impetigo - 1 Other Skin Diseases 66 44 Defective Vision and Squint 313 297 Other Eye Defects 41 24 Defective Hearing 209 181 Other Ear Diseases 24 48 Nose and Throat Defects 991 97 Speech Defects 77 42 Lymphatic Glands 37 14 Heart and Circulation 8 16 Respiratory Diseases 28 18 Developmental Defects 139 119 Orthopaedic Defects 90 119 Nervous Disorders 32 25 Psychological Disorders 215 146 Other Defects and Diseases 207 216 Total attendances 4,791 1,587 1,407 53 SPECIALIST CLINICS 1971 1970 1969 (a) Aural Sessions 66 66 60 New cases 287 240 286 Total attendances 739 791 818 Referred to hospital for operative treatment 231 202 222 (b) Ophthalmic Sessions 360 377 365 New cases 794 974 889 Attendances 5,103 6,472 5,965 Glasses prescribed 1,285 1 ,366 1,292 Glasses obtained (i) through H.M.C. optician 986 1 ,079 1,011 (ii) privately 299 287 281 (c) Orthoptic Sessions 461 381 261 New cases 236 216 158 Attendances 2,208 1,576 982 (d) Orthopaedic Sessions 49 61 61 New cases 437 430 411 Attendances 1 ,543 1 ,607 1,558 Appliances provided 489 514 348 (e) Physiotherapy Sessions 534 560 527 New cases 176 190 189 Attendances 2,882 2,425 2,679 (f) Paediatric Sessions 19 20 22 New cases 51 53 62 Attendances 129 141 100 (g) Child Guidance Cases referred or re-opened for treatment during year:- (i) Under 5 years Boys 52 40 43 Girls 22 34 24 (i i) Over 5 years Boys 210 234 222 Girls 135 170 133 419 478 422 Cases closed during year 383 315 657 54 DENTAL INSPECTION AND TREATMENT (a) Attendances and Treatment AGES 5 TO 9 AGES 10 TO 14 AGES 16 AND OVER TOTALS 1971 1970 1969 First visit 4.398 2,613 282 7,293 7,763 6,991 Subsequent visits 6,624 4,826 486 11,936 10,704 11,133 Total visits 11,022 7,439 768 19,229 18,467 18,124 Additional courses of treatment commenced 362 174 33 569 427 1,081 Fillings in permanent teeth 2,694 4,824 661 8,179 9,059 8,189 Fillings in deciduous teeth 7,355 831 - 8,186 7,750 7,838 Permanent teeth filled 2,282 4,164 590 7,036 8,417 7,606 Deciduous teeth filled 6,822 794 - 7,616 7,355 7,253 Permanent teeth extracted 183 745 84 1.012 829 1,308 Deciduous teeth extracted 2,966 773 - 3,739 3,242 3,661 General anaesthetics 876 369 22 1.267 1.287 1,394 Emergencies 338 120 21 479 418 253 1971 1970 1969 Pupils X-rayed 425 368 375 Prophylaxis 3,292 3.147 2,033 Teeth otherwise conserved 1,275 1,209 1,305 Teeth root filled 82 37 12 Inlays - 4 4 Crowns 64 27 32 Courses of treatment completed 5,551 6,137 5.266 55 (b) Orthodontics 1971 1970 1989 New cases commenced during year 88 75 76 Cases completed during year 71 60 81 Cases discontinued during year - 4 8 Removable appliances fitted 93 76 100 Fixed appliances fitted 6 5 3 Pupils referred to Hospital Consultant - 9 3 (c) Prosthetics 5 TO 9 10 TO 14 15 & OVER TOTAL Pupils supplied with F.U. or F.L..(first time) - - - - Pupils supplied with other dentures (first time) 1 7 3 11 Numbers of dentures supplied 1 7 3 11 1971 1970 1989 (d) Anaesthetics General Anaesthetics administered by Dental Officers - - - Medical Officers 1,267 1,052 1,358 (e) Inspections (i) First inspection at school:- Number of Pupils 10,239 13,836 14,045 (ii) First inspection at clinic:- Number of Pupils 3,124 3,118 2,835 Number found to require treatment 9,833 10,116 9,459 Number offered treatment 8,746 9,267 8,971 (iii) Pupils re-inspected at school clinic 543 1,290 516 Number found to require treatment 489 664 329 (f) Sessions Sessions devoted to treatment 3,229 3,266 3,175 Sessions devoted to inspection 88 116 111 Sessions devoted to Dental Health Education 37 23 78 56 SPEECH THERAPY (a) Attendances DAWLISH ROAD HATCH LANE HURST ROAD 1. 2. TOTAL Number in attendance at beginning of year 98 69 84 - 251 Number under observation at beginning of year 152 " 19 - 171 New cases 110 56 64 33 263 Re-admitted 1 - 1 75 77 Transfer from other clinics - 1 2 - 3 Discharges - cured 10 49 42 3 104 - improved 4 - 10 13 27 - defaulted . 3 12 57 72 - transferred to other clinics - 3 8 2 13 - left district 4 3 1 5 13 - no progress - - - - - Number in attendance at end of year 111 64 65 11 251 Number under observation at end of year 232 4 32 17 285 (b) Analysis of defects treated DAWLISH ROAD HATCH LANE HURST ROAD 1. 2. TOTAL Stammer 13 9 10 4 36 Dyslalia 123 87 63 7 280 Stammering and dyslalia 8 2 12 2 24 Delayed language development 35 16 41 2 94 Cleft palate speech 1 2 3 - 6 Voice defects 6 3 1 - 10 Speech defect due to deafness 3 4 20 - 27 Defects of neurological origin - 2 17 1 20 Unclassified 5 1 3 - 9 New cases referred 260 Attendances during year 6,343 57 HANDICAPPED PUPILS BLI N D PARTIALLY SIGHTED DEAF PARTI AL HEARING PHYSICALLY HANDI CAPP ED DELI C AT E MAL ADJUST ED E.S.N. EPILEPTIC SPEECH DEFECT TOTAL Children newly assessed as handicapped during year ended 31.12.1971 Boys - - - 1 12 2 5 14 - - 34 Girls 1 - 1 1 7 1 2 19 - - 32 Children who on 20.1.1972 were receiving special educational treatment:- (i) at maintained special schools:- (a) Day 4 10 7 33 60 14 20 336 2 - 486 (b) Boarding - 3 - 1 1 3 9 3 - - 20 (ii) at non-maintained special schools:- (a) Day - - - - - - - - - - . (b) Boarding - - 1 - 4 2 7 - 2 - 16 (iii) at independent schools - - 1 - - - 10 3 - - 14 (iv) special classes or units - - - 2 - - " - - - 2 Children awaiting placement in special schools at 20.1.1972 1 - - 1 2 - 2 1 - - 7 Children who, at 20.1.1972 were being educated:- (i) at hospital - - - - 1 - 4 - - - 5 (i i) at home - - - - - - - - - - - 58 SPECIAL SCHOOLS Brookfield House School for Physically Handicapped Children At the end of 1971 the medical classification of the 86 children on the roll was as follows:- Congenital Deformities 7 Cerebral Palsy 23 Cardiac DisabiIities 6 Muscular Dystrophy 1 Haemophilia 4 Perthes Disease 5 Spina Bifida 2 Asthma 8 Other Physical Handicaps 23 Osteomyelitis 3 Osteogenesis Imperfecta 3 Poliomyelitis 1 Joseph Clarke School for Partially Sighted Children The ophthalmic condition on admission of the 77 children who attended the school during 1971 were as follows:- Albinism 6 Aniridia 7 Cataracts 25 Congenital Day Blindness 1 Detached Retina 1 Dislocation of the Lenses 2 High Myopia 6 Iridocyclitis 3 Microphthalmos 1 Nystagmus 9 Optic Atrophy 6 Retinal Degeneration 2 Retinoblastoma 1 Retrolental Fibroplasia 1 Coloboma 2 Macular degeneration 1 Retinitis pigmentosa 2 Glaucoma 1 William Morris School for the Deaf Of the 97 children on the roll at the end of the year 77 were classified as deaf and 20 as having partial hearing. 59 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 1 ,375 DISCRETIONARY STANDARD Total number of grants approved 362 380 Total amount of grants approved £159,606 £71 ,273 (b) Contributed by H.Thome, Esq., A.I.H.M., Borough Housing Manager. Properties in Management at December 1971. Pre-War houses 1.853 Pre-War flats 130 Post-War houses 1,776 Post-War flats 10,035 Out Borough houses 840 Out Borough flats 59 Prefabricated bungalows 21 Acquired properties 2,977 17,691 Garages 4,060 21,751 Number of properties made available for letting Number of properties 1,522 Families rehoused Number rehoused 1,579 61 HOUSING (a) Contributed by N.P.Astins, Esq.,A.R.I.B.A.,Borough Architect. Dwellings completed during 1971 FLATS HOUSES By the Local Authority 732 5 By Private Enterprise 27 29 By Housing Associations 56 19 815 53 METROPOLITAN WATER BOARD - WATER EXAMINATION DEPARTMENT AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE LONDON BOROUGH OF WALTHAM FOREST DURING 1971 Milligrammes per litre (unless otherwise stated) Description of the Sample Number of Samples Day of the month Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs, from KMn04 4 hrs. at 27°.-C. B.O.D. 5 days at 20°. C. Hardness (total) CaC03 Hardness (non-carbonate) CaC03 Magnesium as Mg Sodium as Na Potassium as K Chloride as CL Phosphate as P04 Silicate as Si02 Sulphate as S04 Natural Fluoride as F Surface-active material as Manoxol OT Turbidity units Colour (Burgess units) PH value Electrical Conductivity (micromhos) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) Thames-derived 364 0.029 0.084 6.1 1.04 - 281 90 5 23.5 5.1 34 2.3 10 64 0.15 0.02 0. 1 13 7.8 580 Lee Bridge 52 0.014 0.096 6.7 1.14 - 297 99 6 31.0 6.4 39 3.2 10 78 0.20 0.03 0.2 15 7.9 620 Chingford Mill 4 0.20 0.021 0.2 0.27 276 64 27 0.45 0.1 6 7.4 560 Coppermills 49 0.020 0.105 6.8 1.16 - 304 109 6 31.0 6.4 43 3.4 10 78 0.20 0.03 0.1 12 7.6 630 BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1971 OF WATER SUPPLIED TO THE LONDON BOROUGH OF WALTHAM FOREST Source of supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Number of samples Agar plate count per ml. Coliform count E. coli count 20-24 hours at 37° C. 3 days at 22° C. Percent, samples negative in 100 ml. Count per 100 ml. Percent, samples negative in 100 ml. Count per 100 ml. 20-24 hours at 37° C. 3 days at 22° C. Percent, samples negative in 100 ml. Percent, samples negative in 100 ml. Lee Bridge 2,698 59.7 35.29 11.3 59.30 2.1 278 27.4 99.64 100.0 Chingford Mill 250 0.1 12 99.20 - 100.00 - 254 0.1 8 100.0 100.0 Thames-derived 8,154 53.9 40.37 12.2 54.91 5.1 3,901 8.4 99.51 99.97 CoppermilIs 693 14.5 34.63 10.4 52.67 2.7 240 9.9 100.0 100.0 INDEX A Pages Analgesics 26 Animal Boarding Establishments Act 1963 43 Ante-Natal Care 10 Aural Clinics 54 B B.C.G. Vaccination 36 23, 25 Births - Congenital abnormalities 29 Brookfield House School for Physically Handicapped children 59 Business premises, registration and licensing of 42 C 7, 25 Caravan Site Act 1968 15 Causes of Death 7, 24 Cervical Cytology 12, 29 Child Guidance Clinics 54 Child Health 10 Child Welfare Clinic Attendances 27 Children "At Risk" 11, 29 Children, dental treatment of 29 Children, handicapped 10, 58 Chingford Red Cross 31 Chiropody Treatment 32 Cigarette Smoking 10 Clean Air Act 1 956 13, 37, 44 Committee 1 Communicable Disease 7 Compulsory Purchase Orders 38 Condemned meat and food 46 Congenital Malformation 29 D Day Nurseries 12 Deaths 23 Deaths - Causes of 24 Deaths - from Cancer 7, 25 Dental Laboratory 36 D (cont.) Pages Dental Service 12,29,36,55,56 District Nurses 16,31 E Environmental Services 13,17 Essex County Council Act 1933 - Establishments for Massage and Special Treatment 32 Examinations by School Nurses 53 Expectant and Nursing mothers, dental treatment 29 F Factories Act 1961 37,47 Families Rehoused 61 Family Planning 12,30 Food Inspection and Sampling 14 Food and Drugs Act 1955 37,39,42,43,44 Food and meat condemned 46 Food Hygiene Regulations 37,39,42,44,45, 46 Food Poisoning 33 H Handicapped Children 11 ,58 Handicapped school pupils 58 Health Committee 1 Health Visiting 16 Health Visiting - attachment to G.Ps 16,30 Health Visiting - liaison with hospitals 16 Home Nursing 31 Housing 14,61 Housing Act 1957 38 Housing Act 1969 38,39 Housing Acts Regulations 37 Housing Associations 61 1 Immigrants, tuberculosis among 34 Immunisation and vaccination 35 Improvement Grants 15,61 Incontinent Laundry Service 32 Infectious Diseases 7,33 1 (cont.) Pages Infant Mortality 23 infants and Toddlers Clinics 27 infants, Premature 25 J Joseph Clarke School for Partially Sighted Children 59 L 32 M Massage and Special Treatment, establishments for 32 Maternal Motality 23 Medical examinations of staff 34 Medical inspections, school 49 Medical inspections, other 53 Midwifery 26 Milk and Dairies (General) Regulations 1959 43 Milk (Special Designation) Regulations I960 43 Minor Ailments Clinics 53 Mortality Rates 23 Mothercraft and Relaxation Classes 29 N Noise Abatement Act 1960 37 Nursing Homes, registration of 32 Nursing Services 16 0 Offices, Shops and Railway Premises Act 1963 13,37,40 Ophthalmic Clinics 54 Orthopaedic Clinics 54 Orthoptic Clinics 54 Outwork 48 P Paediatric Clinics 54 Pet Animals Act 1951 37,43 P (cont.) Pages Physiotherapy Clinics 54 Population 23 Population-School 49 Premature Infants, care of 25 Prevention of Damage by Pests Act 1949 37,42 Public Health Acts 37,42,44 Public Health Act 1936-registration of Nursing Homes 32 Public Health Inspection 37 Q Qualification Certificates 15,39 R Rainfall 20 Red Cross, Chingford 31 Redevelopment and Slum Clearance 15,38 Registration of Premises 42 Rent Act 1957 38 Riding Establishments Act 1963 43 S School Dental Service 12 School Health Service 49 School Medical Inspections 49 School Population 49 Sewerage 20 Sickroom Equipment 31 Slum Clearance and Redevelopment Schemes 15,38 Specialist Clinics 54 Special Schools 59 Speech Therapy 57 Staff 2,3 Staff-Medical Examinations 34 Statistics 23 T Tuberculosis 7,33,34 V Vaccination and Immunisation 35 Venereal Disease 8 Vital Statistics 23 w Pages Water Supplies 21,62,63 Welfare Foods and Nutrients 28 William Morris School for Deaf 59