III London Borough of Waltham Forest REPORT OF THE MEDICAL OFFICER OF HEALTH E.W.WRIGHT, M.B., Ch.B., D.P.H. 1972 WAL 68 CONTENTS MEMBERS OF THE HEALTH COMMITTEE DEPARTMENTAL STAFF INTRODUCTION BY MEDICAL OFFICER OF HEALTH THE WORK OF THE DEPARTMENT DURING 1972:- Control of Community Diseases Child Health Service Dental Service Environmental Health Services Community Nursing Service 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 1972-1973 Chairman: Councillor Mrs.E.Bartram Vice-Chairman: Councillor Mrs.L.D.Gurr, J.P. Members: Councillor H.M.Cohen ” Miss H.E.Digby ” D.Eberst ” Mrs.E.L.Gordon ” Mrs.M.I.Little ” Mrs.P.K.Williams Ex-officio: Councillor Mrs.E.M.Dare, J.P. STAFF OF THE HEALTH DEPARTMENT (at 31.12.1972) 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. Principal Medical Officer - Gwyneth Richards, L.R.C.P., L.R.C.S., L.R.F.P.S., D.C.H., D.(Obst.) R.C.O.G. Senior Medical Officers - 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. *Margaret Edwards, B.Sc., M.B., B.Ch., D.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 - R.C.Ward, B.D.S., L.D.S., R.C.S. Senior Dental Officer - Vacant 13 Dental Officers (Whole-time equivalent in post= 5.2); 2 Dental Auxiliaries; 4 Dental Technicians (2 vacant posts) 17 Surgery Assistants (7 vacant posts) Chief Public Health Inspector - J.H.Butler, F.R.S.H., M.A.P.H.I. Deputy Chief Public Health Inspector - D.R.King, M.A.P.H.I. Divisional Public Health Inspectors - J.Coldwell, M.A.P.H.I. N.Smith, M.A.P.H.I. Senior Inspector Housing - E.Day, M.A.P.H.I. 4 Senior Public Health Inspectors; 14 Public Health Inspectors (6 posts vacant); 5 Technical Assistants (I vacancy); 6 Pest Control Assistants; 4 Pupil Public Health Inspectors (I post vacant). Chief Nursing Officer - Gillian Pittom, S.R.N., S.C.M., H.V.Cert. Cert.D.N. Principal Nursing Officers - Gladys Thorburn, S.R.N., S.C.M., H.V.Cert. Kathleen McManus, S.R.N., R.H.P.A., Q.I.D.N.S. - 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) - Patricia Giles, S.R.N., S.C.M., Q.D.N. 3 Field Work Instructors 32 Health Visitors (6 vacancies) 3 Tuberculosis Visitors 32 Clinic Nurses (5 vacancies) 6 Student Health Visitors (1 vacancy) 1 Infectious Disease Nurse 17 Midwives (1 vacancy) 63 District Nurses (4 vacancies) and 16 Pupil Midwives 12 Auxiliary Nurses Health Education Officers - A.Brooks, B.Sc., S.R.N. H.Bradley, M.I.H.E. Chief Chiropodist - R.J .King, M.Ch.S. 15 Chiropodists (6 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 Administrative Assistants - S.Ames A.Thomas A.Wade 6 Administrative Assistants; 43 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 eighth Annual Report being that for the year 1972. As Annual Reports are not in practice finalised until after the Registrar General's figures for the previous year become available in April, this is the last which I shall write while still your Medical Officer of Health. It is a title one has felt honoured to hold and one whose passing I, like many of my colleagues, view with some nostalgia. It has after all for over a century been an integral part of the fabric of local government, attracting the jokes, the occasional fame, but predominantly the unromantic treadmill routine by which a nation has steadily lifted itself from the unhygienic horror and squalor it produced as the pioneer of industrial revolution. Now, with the wealth that revolution produced, in social circumstances unknown to our forbears, the health professions set out to pioneer a new sort of Health Service. It cannot succeed unless it too is part of the fabric of local government though circumstances have produced a structure which will bring it outside the control of the local municipality. The future relationships between Health Services and Local Government are crucial. There has already been deep consideration by the Working Party on Collaboration, some of whose proposals are incorporated in the new structure, but that does not relieve one from working it out locally. There must be mutual respect if the partnership is to work. The structures are quite different, one having in essence a single Council with a hierarchical structure of officers, while the other has teams of officers as equals, with a hierarchical structure of committees. Clearly there must be mutual respect amongst officers for the professional skill of others. There is nothing new about this, though it is only in recent years that it has been explicitly defined as a goal. Domination of one by the other works and can be successful to a degree but it is not as fruitful from the patient or client's point of view, and is an extravagant use of resources the ultimate crime these days. At the same time at member level there are great opportunities for the right people to give direction and inspiration to the intricate tangle which the officers will be operating. The Community Health Councils, if their members can demonstrate that they are statesmanlike, responsible, constructive and above all really an expression of local opinion, could be a most powerful force for good. They must however earn respect first, or all the misgivings expressed about them will be tragically justified. One would hope therefore that every effort will be made to persuade the bright lights of local communities, those who are the enlightened, progressive, and always extremely busy people, to find time for this work. The local authority representatives on the Area and Regional Health Authorities also have a very constructive role to play and will require a skill at handling divided loyalties of a high order, for if their loyalties are demonstrably more one way than the other their colleagues on the deprived side will cease to listen to them. Their contribution can only then deteriorate. For members of committees of different kinds and for officers the prospects are challenging and the way untried. I believe that the ultimate position will be much improved services to patients, and greater achievements by staff in their attack on the ills of people, but it is a long road and we - 4 - shall need to keep our eye very firmly on the goal while we weather the storms caused by the mistakes we make on the way. Let us not, however, get bemused by structure. It is not an end in itself. All sorts of bad structures work quite well if the human relationships are right while good ones can easily founder if someone determines they shall. Ironically some of the doctors one would seek out to treat oneself are the very ones who can be an administrator's nightmare. They will fight anyone on behalf of their patients - including the administration! At the same time while efficient tidy management is a good and constructive thing it is not the highest aim, and must not become a sacred cow to which all else is sacrificed. This report contains contributions from the various senior officers of the department setting out different areas of the work and I hope that they will be widely read. The problem of shortage of public health inspectors not only stays with us but gets worse. I must repeat my comments in my last Annual Report on this subject for at the time of writing the situation is critical. The whole of the Council's programme of redevelopment of its outworn areas could at any moment founder on this one problem, for priority must always be given to those duties which protect us from the diseases of environmental origin. It is absolutely essential that the Council should convey to our Inspectors and to any who might seek employment with us how much they are valued as a section of the Council's work. This is done already by personal expressions of thanks and consideration of conditions of service (though there is always scope for improvement there!) In addition there is an opportunity, as the Council reviews its departmental structures, to ensure that the Public Health Inspectorate after reorganisation is on a stable footing with a strong corporate identity and good career prospects without the necessity of moving to another authority to find them. The nursing services have expanded and completed the conversion to working in attachment with general practitioners and have made strides in tidying up the various problems which arose in the wake of this advance. Miss Pittom sets out other advances achieved during the year. Certainly the generous increase in establishment which the Council approved in the latter part of the year gives room for the first class School Health Service which members have now every right to expect, at least on the nursing side. The recruitment of public health doctors for infant welfare and the school health service is now back with us as a problem though we have some answers. After several months of excellent progress when we enjoyed the position of having all the posts in our increased establishment full we have since 1972 in quick succession had the resignation of three doctors-all reluctantly and because of personal circumstances. On Chiropody we have had a year where the wonderfully good work which as always is done by this service has for some areas been overshadowed by the shortage of staff. We have had difficulties before but they have always been overcome. This time they have not and we are feeling the pinch as a national shortage shows itself in a failure to recruit locally. The answer is the national one of training more chiropodists but that will take years and the prospects in the short term are bleak. Dentistry, Speech Therapy, Physiotherapy have all had their staffing problems also. In Administration the fact that the clerical services we share with the Social Services Department have been in difficulties of recruitment has meant that we have also shared in the problems created; the great goodwill between the two departments which is such a feature of Waltham - 5 - Forest has stood us in good stead in the circumstances. However, taking the swings with the roundabouts, it has been a good year. I extend my thanks to all the staff of the department who have made such headway with the problems of the day at a time when the future is so uncertain, and would also like to thank colleagues in other departments who have, as always, been so helpful. I would also like to thank the Chairman and Members of all the committees which officers of the department serve but particularly Councillor Mrs.E.Bartram, Chairman of the Health Committee, for the help and support received during the year. I have the honour to be, Madam Mayor, ladies and gentlemen, Your obedient servant, Waltn wi Medical Officer of Health - 6 - THE WORK OF THE DEPARTMENT CONTROL OF COMMUNITY DISEASES Dr.Geoffrey Poole, Deputy Medical Officer of Health, writes:- This has been a fortunate year without any serious episode of infectious disease. Measles, thanks to vaccination, had the lowest incidence recorded here with only 297 cases (I,131) and whooping cough, no doubt due to improved vaccines-, produced only 20 notified cases (130). For the third year in succession we have escaped a dysentery outbreak with its troublesome sequel of children excluded from school and mothers losing work. Much credit for this must go to our colleagues in the Education Department for continued improvement of lavatory facilities in schools and to the teachers (and our own staff) for inducing improved personal hygiene among the children. Of exotic diseases we had nine cases of malaria, only two of typhoid fever and one of paratyphoid. Approximately 1,200 visits were made by the DMOH and/or Control of Infection Sister to cases of infectious diseases and 568 specimens taken for laboratory examination. In addition visits to newly arrived immigrants (including those in connection with infectious diseases) amounted to 1,173 including special visits to 300 Asians expelled from Uganda, a total of 2,357 visits in all. After citing the abandonment of routine vaccination against smallpox (after 120 years) as the outstanding epidemiological event of 1971 it is ironic that 1972 should see one of the most explosive outbreaks in Europe of recent times when the entry of a single infected person produced in Yugoslavia 174 cases, 34 of which were fatal. It is exactly 100 years since the last major smallpox epidemic in England when in 1871 /72 there were 42,000 deaths, almost 10,000 occurring in London alone, and the Yugoslav episode, while it warns us to keep alert, must be seen against the background of the history of the disease. Maps published by the World Health Organisation show progressive shrinkage of the areas in which quarantinable diseases still exist and there is no doubt that mass vaccination campaigns in developing countries will soon eradicate smallpox altogether since man is the only known reservoir for the virus. The elimination of tuberculosis will be more difficult. It was the only infectious disease apart from VD to show a significant increase in 1972 to 105 (86) new cases but of these no less than 64(61%) occurred among the comparatively small immigrant population. An increasing number of chemotherapy-resistant strains of the tubercle bacillus are being found-often because patients default and disappear before completing their treatment-so that it is still necessary for all schoolchildren to be given BCG vaccination if tests show they have insufficient resistance to protect them from these particularly dangerous strains of bacteria. During 1972 2,032 schoolchildren were found with insufficient antibody and all were vaccinated. Venereal disease, or as it is now called sexually transmitted disease, showed an increase of 14% to 1,785 new cases (1,566). This was not unexpected after the 35% increase 1970/71. It is doubtful if there is any reduction in the extension of indiscriminate intercourse but there may be a wider appreciation of the added risk of dispensing with the mechanical protectives formerly used in casual intercourse before the "Pill" became widely available. Cancer deaths were slightly increased at 627 (624) of which 188 (187) were primary cancers of the lung due mainly to cigarette smoking, as some other cancers are now known to be. Total deaths from diseases associated with smoking were as follows: TABLE 1 MALE FEMALE TOTAL % INCREASE Lung Cancer 157 (152) 31 (35) 188 (187) - Ischaemic Heart Disease 400 (330) 278 (247) 678 (577) 17.5% Bronchitis and Emphysema 124 (115) 56 (36) 180 (151) 19.2% 7 By the time statistics for next year's report are available the office of Medical Officer of Health will have ceased to exist. Since the mid 1800s when decimating outbreaks of infectious disease were by far the most important causes of death and demonstrated the need for a medically qualified official to control infection, to advise his Local Authority on improvement of the sanitary circumstances of the area and on "the exclusion of all noxious influences", the MOH can show a record of 125 years solid achievement. In 1834 Dr.John Snow was able to stop a London cholera outbreak which had, in 10 days, caused 500 deaths within a 250 yard radius of the polluted well in Broad Street, by the simple expedient of taking away the handle of the pump. Today's community health problems are less acute but very much more difficult to solve. Indeed there is little the MOH or his Local Authority can do alone to check the increase in VD, the toll of smoker's cancer, the premature deaths from coronary thrombosis, the high incidence of mental illness and the shortage of hospital beds, especially for the elderly. So complex are the major health problems of today that an integrated approach at national level is clearly necessary to encompass them. Almost half of all the hospital beds in Britain are occupied by mental patients and half the remainder are geriatric. The era of the MOH added 25 years to our life expectancy. During the period of sanitary reform diseases due to contagion and environmental factors were controlled largely by sanitary engineering, pure water, safe drains, cleaner food, etc., and prompt isolation when every considerable town had its own fever hospital. This was followed by the period of communal responsibility for personal health with the establishment of free health clinics for mothers and young children, the provision of health visitors, district nurses and midwives as well as a free School Health Service. Malnutrition between the wars was combated by welfare foods and vitamins. Since 1948 prevention by immunisation has virtually eliminated infectious disease; neglected medical conditions should never occur with a free National Health Service while Social Security provides protection from the malnutrition of poverty. Most of us (especially if we are non-smokers) can expect far to exceed the scriptural three score years and ten but it is the quality of life rather than its duration with which we should now be concerned. Elimination of infectious disease, improved health care and nutrition throughout the world has led to a population explosion, especially in the under-developed countries, which threatens by sheer overcrowding of our planet to make life extremely difficult if not insupportable. A rational family planning policy and the early abortion of unwanted pregnancies may hold this progress in check for a time but the continuing survival of more and more people to great age and infirmity inevitably increases the burdens upon those of working age who must support and care for them. Despite the influx of many hundreds of Commonwealth immigrants who are predominantly of the younger age groups and have (compared with the home population) an unusually high proportion of children, the number and proportion of elderly people in our local population continues to rise: TABLE II POPULATION OF WALTHAM FOREST YEAR TOTAL UNDER 1 1 -4 5-14 15-64 65+ 1968 236,900 3,910 14,690 27,700 157,800 32,800 1969 235,880 4,090 14,710 28,700 155,580 32,880 1970 235,040 3,690 14,910 29,900 153,940 32,600 1971 233,960 4,100 13,700 31,100 151,060 34,000 - 8 - Making a crude assumption that everyone from 15 to 64 is at work and everyone over 65 retired, it is plain that the numbers of pensionable age are steadily rising while there is a corresponding fall in the numbers of working age people available to support or care for their needs. Expressing this ratio in terms of percentage we have:- TABLE III 1968 32,800 = 20.78% 1969 32,880 = 21.13% 157,800 155,580 1970 32,600 = 21.19% 1971 34,000 = 22.50% 153,940 151 ,060 To these figures for dependents must be added those under 15,48,900 in 1971. The effect of raising the school leaving age with increased opportunities for further education is to increase this figure to between 33% and 36% of the working population, and there is no reason to suppose it will not go on rising. Meanwhile the prospects of increasing survival among the elderly continued to improve. Cancer is an important cause of death among this age group; of the total of 627 cancer deaths in Waltham Forest during 1972 almost 69%, 429, occurred at ages over 65,217 of them at 75 or over. Progress in cancer research is advancing rapidly, already animals have been successfully immunised so as to reject implanted cancer which would certainly kill the unprotected animal and it cannot be long before means are found of arousing or stimulating the ability to destroy malignant cells in man - a great boon which nevertheless will bring problems. As the percentage of workers in a population falls it becomes increasingly important to protect them from illness and premature death. Many large firms find it sound economics to engage a staff doctor who saves much more than his salary by reducing absenteeism. Already the Offices, Shops and Railway Premises Act prescribes satisfactory working conditions for all employees similar to those imposed by the Factories Acts upon industry. In January 1973 the "appointed factory doctor" is to be replaced by the Employment Medical Advisory Service which will extend the supervision of the health of factory workers to all employed young people. Increased facilities for healthy exercise and, it is hoped, a greatly expanded Health Education Service can make positive contributions to preserving the health of this most valuable group of people. Despite our best efforts, and the increasing use of automated machinery in reducing manpower needs, the problems posed by the inexorable increase of pensioners continue to grow. Already the original raison d'etre for the health visitor - maternal and child welfare - has been over-shadowed by the need to oversee the health of the elderly and this despite the parallel activity of the social workers. The whole system of retirement at 65 (60 for women) should be reviewed. To demand maximum output from all workers, be they dustman on productivity bonus or directors working a 14 hour day until their 65th birthday, and then disrupting their whole life style by suddenly withdrawing all work may be sound economically (though I doubt it) but physiologically and psychologically it equates with stopping your car by driving it at full speed into a brick wall. Far better to work half time from 64 to 66 or to work at reduced pressure dropping half or one day a week each year from 60 or even 55. Retired people should be given opportunities and encouragement to prepare for this radical change by developing interests and activities outside the work scene. At the same time those who are fit enough should take up light work part time. The financial implications of such a scheme would be formidable but the benefit to the individual and to the community would be enormous. Already the Council runs a pre-retirement course for their own employees - other large employers should do the same. Age is a bad yardstick by which to gauge a person's ability to work; some are active and mentally alert at 80, others fossilised at 40. - 9 - It may be felt that the MOH has finally achieved his aim-to make his own office redundant. His successor, the Community Physician, will be concerned with these more complex ecological and social problems, with influencing mental attitudes as well as monitoring the total health care available to individuals and groups within the community. The Community Physicians will be members of the Health Management Teams from District (equivalent in size to existing London Boroughs) through Area to Region and the Department of Health and Social Security. The concepts of critical management and cost/benefit analysis are at first sight repugnant to most doctors, but if tomorrow's problems are to be contained radical change is necessary. Only a few years ago, when the statutory lying-in periods after childbirth was 14 days, we were desperately short of beds in maternity hospitals. Co-ordination and the provision of an efficient home care maternity service enables most mothers and babies to be discharged after only 48 hours, theoretically increasing the bed usage by a factor of 7. Of course, in practice, not all are fit for early discharge, nor are all homes suitable for maternity and neo-natal nursing but, without putting up a single extra bed, 3,079 or 85% of our total 3,629 live births this year took place in hospital and still there were beds available. Some similar radical approach is needed to contain the growing demand for mental and geriatric beds. Since the Community Physician will have a locus in the hospitals as well as in the community he is better placed to deal with problems of this nature. Hopefully he will continue a close collaboration with the members and officers of the former Local Health Authorities especially the Public Health Inspectorate, in the field of Social Services and that of housing policy where a background of local authority health and welfare work is invaluable. He is not really a new medical animal - there have been Community Physicians since the priest physicians of Ancient Egypt - Moses wrote the first textbook on Public Health with food and personal hygiene regulations (Leviticus Old Testament) over 4,000 years ago. CHILD HEALTH SERVICE Dr.Gwyneth Richards, Principal Medical Officer, writes:- With the advent of re-organisation of the National Health Service and the formation of new Health Authorities in 1974, I cannot resist the temptation to look back and see what progress has been made under the present National Health Service, especially in the field of Child Health. This has been considerable and children have never been so healthy, well fed, well clothed, and given such good facilities for equipping them for the future than at present. Yet still there are discussions and reports concerning the "disadvantaged child", showing how children are affected physically, mentally and educationally by an adverse background - an adverse background which is still a great improvement on the slum conditions where we worked in pre-National Health Service days. Then, much of the medical and social help provided was in the hands of charitable organisations and their supervised students, and a more rudimentary school health and clinic services provided locally. Memories of work in a slum in student days - filth and smells; gross overcrowding; poor lighting; inadequate heating; inadequate water supply; lack of cleanliness and ventilation; poor quality of clothing and food; large families with children with heads and faces covered with impetigo and the rest of the body covered with scabies; lice of various types on body and head; fleas and bugs in flats where the well-kept was the unexpected and not the rule; confinements at home in grossly unsuitable conditions with the mother an equally unsuitable patient for a birth at home or even in hospital; a drawer used for the baby instead of a cot and none of the sterile packs used nowadays. Increasing pay packets, increasing standards, and help available for the poor and handicapped has made such a difference that deprivation has taken on a different aspect and is seen now more as an emotional rather than a physical deprivation - inadequate income and inadequate accommodation not necessarily the important factors. - 10 - VISION AND HEARING Routine screening of hearing is carried out from infancy onwards, methods varying according to age and ability. Those who have failed hearing screening tests are referred for skilled examination in a sound reduced room. Here an older child is seen indicating that she hears the special pure tones in the headphones. In this way degree and type of deafness can be assessed. Hospital staff attend at two clinics in the Borough to see children with various defects of the Ear, Nose and Throat who have been referred for specialist opinion. All children with a hearing loss are seen (together with comprehensive details of their loss) so that arrangements can be made for correct treatment of the defect. This boy is being examined with a new type of machine which gives additional information regarding the condition of the drum and middle ear. The Senior Dental Technician has specialised in making ear moulds for children in Waltham Forest who require an aid to improve their hearing. These must fit comfortably and firmly and require to be replaced frequently because of growth. He has found that by tipping the inner part with a special soft material they fit more satisfactory. Recently he has made artificial ears incorporating the receiver for a child without ears. Routine screening of vision is carried out in Pre-school and school age groups, methods varying according to age and ability. This new aparatus eliminates the need for a 6 metre room, good lifting and a second adult (to prevent cheating!!) Distant, near, binocular and colour vision can be checked in a few minutes. Hospital staff attend at 3 clinics in the Borough. They examine and follow up children referred from screening sessions, prescribe glasses and refer those requiring special treatment. Here prescribed lenses are being checked by reflection of light to see that they are still the correct ones. Children with squints or suspected squints are seen by Orthoptists in the 3 Eye Clinics. Using this aparatus, while the child sees colourful pictures and indicates when he sees the lion in his den or the canary in its cage the orthoptist is able to measure the angle of the squint, and by other pictures, if both eyes are functioning. Depending on the cause, squints are treated by occlusion, surgery or glasses or some by following with the eyes the pictures while they are moved. With the changing of standards of health and diet and the decrease of and improved treatment of acute illness, we have been able to devote more time and skill to the smaller imperfections in physical conditions in order to help children become a more perfect wholestraight legs, mobile joints, well shaped teeth and good posture, speech, hearing and vision and, we hope, able to cope better with the mad rush of life in the I970's. We have been fortunate in Waltham Forest Health Department, not only in having good facilities with good staff, good clinics and health centres and schools which are able to cater for children with varied abilities and handicaps, but also in having a good relationship with the local General Practitioners and the local hospitals. Specialists in the Orthopaedic, Ear, Nose and Throat, Ophthalmic, Paediatricand Mental Subnormality fields hold clinics in the borough and see children in the pre-school and school age groups, paying attention to minor as well as major defects and providing hospital facilities when necessary for further diagnosis and treatment. This has been a happy relationship which should not be lost in re-organisation, but we hope will even increase further - perhaps with consultants seeing older people in Health Centres as well. During 1972 there has been improvement in the service. In the pre-school clinics we have continued to examine children with a more developmental bias and in 1973 will be examining at 4½ years for the routine infant-school medical inspection. We have examined many of the children in this group in the past but from now on will aim to see all at this age. Some children will still be seen in the Infant School, those who have failed to attend or have been unco-operative and those who have been found to have a defect either at a previous medical or as a result of discussion with the Head and Class Teacher. We are glad that the earlier substitution for the Ministry vitamin A. & D drops to replace the fishy, smelly cod liver oil (often not given to the children ) has now been further improved by the addition of vitamin C, so enabling the mothers to give A, D & C in one dosage. This has been of great advantage, especially to non-English speaking mothers and we have been very pleased at the excellent take-up rate. It seems strange that cod liver oil and orange juice, both a war time supplement, have only recently been superseded by the Department of Health, whereas other multi-vitamin preparations have been on the market for years-the result has been worthwhile but I wonder how many grandmothers wish that they too could have managed without the orange staining and fishy smell of baby clothes in the past. Two Keystone Vision testing machines have been in use in the latter part of this year; this has enabled visions to be checked more adequately in schools where inadequate distances and lighting have made examination extremely difficult in the past. Owing, however, to shortage of staff, Doctors, Clinic Nurses, Physio-therapists, Speech Therapists, and administrative staff, as well as increasing demands, we have not been able to give the perfect service we would wish. One such demand has been the need for more hygiene inspections because of the increased incidence (nationally) of nits and lice in heads. Fortunately the increase has been controlled by additional supervision and treatment. We are glad that the end of the year saw an increasing establishment of Doctors and Nurses and administrative staff with the potential of improvement this brings. But the continued shortage of physio-therapists and speech therapists made too great a demand on the therapists in post. This has meant non-referral of less handicapped children and sometimes referral to hospital for a service which could be provided locally. The equipment in the audiology unit has been improved and more investigations into children's hearing loss have already been started. In 1973 with the completion of the new school for maladjusted children and, in September, a partially hearing unit, new schools will have been provided for all handicapped children during the past eight years - a great achievement in one borough. -II- We look forward now to a continuing increase in nursery places and replacing all old schools for the non-handicapped children, realising some of these children are the disadvantaged ones where adequate early facilities help to minimise the effects of adverse background. We have excellent co-operation from Head Teachers and Social Services in priority admissions of children who need the extra help to nursery schools and day nurseries and the Development Sessions in the clinics still provide excellent but limited places for observation and treatment of those who require help of a more specialised nature than ordinary play groups and for whom other facilities are not available. Progress continues. One has doubts about future changes. There were these 25 years ago; there were these 8 years ago. Both times the changes have been successful. We hope that with the changes in 1974 the Child Health Service in Waltham Forest will again be able to continue its increasing work of preparing babies through childhood for a satisfactory adult life. THE DENTAL SERVICE Mr.R.C.Ward, Principal Dental Officer, writes:- Mr.G.P.L.Taylor, the Principal School Dental Officer, retired in January after several months illness. Geoffrey, with over thirty years service, first to Walthamstow and then to Waltham Forest had been principal Dental Officer since 1965. He was, perhaps, at his best treating handicapped children and could communicate with, and handle even the most difficult patients. For this alone, we have missed him a great deal. Looking back over previous annual reports the problems of staff shortage is a recurrent topic and 1972 was no exception. Although we managed to recruit two full-time dental officers during the year, we were still below an ideal establishment. We were particularly fortunate to obtain the services of an extra dental technician, despite their national shortage. This has allowed extra time to be spent on the provision of ear moulds for Hawkswood School. It was disappointing to note that the number of visits in this service had fallen from the previous year, and that such a high proportion of children inspected required treatment. Our target must be to encourage as many parents as possible to bring their children for an inspection long before they are of school age. In this way the problem of having to deal with a fractious child suffering from toothache could be avoided. If the first visit to the dentist can be purely an inspection, or the carrying out of a minor procedure, a child's confidence is soon gained and any future treatment can be carried out far more easily, and with much less distress to the patient. Despite our staffing problems the number of children inspected at school rose from 10,239 in 1971 to 14,635 in 1972. Taking into account those children inspected at the clinic, 51% of the school population received a dental inspection during the year compared with 41% - 12 - Recruitment Child Welfare Service School ServiceInspections in I 971. Although this is an improvement it is still below the national average of 58%. Our aim is to concentrate initially on as many primary schools as can be included on an annual basis. We hope that it will then be possible to increase the number of schools included from year to year until an annual inspection of all school children is achieved. Extractions We have endeavoured to follow a policy of restoration rather than extraction, and it can be seen from the table below that the ratio of filled to extracted teeth has risen in both services from 1971 to 1972. Ratio of Filled/Extracted Teeth Deciduous Permanent School Welfare 1971 2.0 4.3 8.4 1972 2.5 8.0 20.6 General Anaesthetics It is probably true to say that more children are "put off" dentistry by having a general anaesthetic than by any other dental technique. In fact, this is often the only procedure that can be remembered from a previous course of treatment. We have tried, therefore, to carry out as many extractions as possible under local anaesthesia and the figures quoted below reflect a promising degree of success in this. The number of General Anaesthetics as a percentage of total visits by all patients School Welfare 1971 7 5 1972 4.5 2 During 1972 a simple test for sickle cell anaemia was instigated for certain ethnic groups prior to general anaesthesia. This test was carried out by the dental nurse. St. James Health Centre The decision by the Health Committee to approve the provision of a dental suite at this Health Centre was particularly welcome, as this area of the borough is in need of such faci lities. Special Groups These include the physically handicapped, maladjusted and E.S.N, children. As with difficult normal children, the problem here is normally one of time and dentists in the general service can only reasonably care for a small number of these patients. Because local anaesthesia or simple general anaesthesia in the dental chair is not applicable to the majority of these patients, comprehensive dental treatment on a "day care" basis is the only solution. This would have to be carried out in a specially equipped unit and with the services of a fully trained staff. Perhaps the provision of such facilities will become possible within the new Area Health Authority. Prevention The ever increasing demand for dental treatment associated with the persistent - 13 - shortage of dentists leads inevitably to the question of prevention of dental disease. It is generally accepted that dental decay can be prevented to a considerable extent by the use of fluorides and dietary control, and periodontal disease by oral hygiene. As it is unlikely that the sugar intake by children will fall to any significant extent fluorides provide the only answer. Apart from water fluoridation several methods are available but they require a degree of enthusiasm on the part of the parent and/or child and are relatively more expensive and less effective than water fluoridation. Considerable evidence is available to show that a fluoride level of I p.p.m. in drinking water will reduce dental decay by 50% and that its effect persists throughout life. Furthermore, it is completely safe, and it is the only way prevention can reach those who are most in need of it. ENVIRONMENTAL HEALTH SERVICE Mr.Butler, Chief Public Health Inspector writes:- The year was characterised by the marked shortage of qualified Public Health Inspectors. However, valiant efforts by the remaining staff ensured that adequate attention was given to the day to day business of the Inspectorate, although this necessitated some cut back in routine work, for example the inspection of food premises, even on the figures for I 971 . Most District Public Health Inspectors were, in fact, required to cover at least two districts during the year. This capacity for adaptability by the Public Health Inspectorate is a unique asset to local government, and the advantages are to be seen best during times of staff shortage. The Public Health Inspectors' wide field of training in all aspects of environmental health facilitates the ready redeployment of manpower to meet changing and new problems facing the Section. It is to be hoped that these thoughts will be borne in mind when restructuring of local authorities is considered in preparation for 1974. I am unable to detail all of the aspects of work carried out during the year, but the following notes are indication of matters which have required particular attention:- Housing Surveys Accurate and up-to-date information as to conditions within its boundaries is essential to a Local Authority. Indeed it might be said that in the absence of such data balanced judgment as to future schools building, redevelopment, transport, shopping and many other facilities would be impossible. As was foreshadowed in the report for 1971, during the year the Public Health Inspectorate were instructed by the Council to undertake surveys of certain areas of older housing. The areas selected for survey were those not affected by the Council's current Long Term Capital Programme and in which it was thought poor housing was most likely to be found. - 14 - The aim of the survey was to - (a) assess housing conditions in some detail. To achieve this objective, dwellings of the same age, layout and construction were numbered into groups of 4 or 5. An external inspection was made of every dwelling and access was gained to at least one dwelling in each group and an internal inspection was carried out and information gained as to tenure, general condition and to the extent of facilities provided. (b) to assess the feasibility and justification for including any area in a redevelopment programme. (c) to provide a basis for making specific recommendations as to future action within the framework of future housing policies. The results of the surveys provide a basis for reviewing the Council's overall strategy for dealing with the Borough's older housing stock and to determine not only the extent and rate of its programme of replacement of the poorest housing, but also whether any additional areas justify treatment as general improvement areas. Such was the importance attached to the commencement of these surveys that staff had to be temporarily seconded from the general duties division of the Inspectorate, despite the already severe shortage of qua lified staff avai I able. Some 2,156 dwel I ings in six areas were surveyed during the year. The results of two such surveys were reported to the responsible Committee during the year when it was decided that the information available justified phased redevelopment in one area and general improvement in the other. Offices, Shops & Railway Premises Act, 1963 As could be expected during the 8th year of the operation of the Act compliance by employers and enforcement by the Public Health Inspectorate are now integrated within the framework of all similarly inter-related statutes etc., concerned with environmental health, welfare, hygiene and public protection. The specialised attention given to registration and initial inspections during the formative years of the new Act is not now necessary but a constant review of the changing pattern of business use and occupancy of premises is essential and has been maintained so far as other staff duties could permit. Probably the most important change which has occurred is the availability of records from other departments of the Council. The Inspectorate have taken full advantage of the Land Use Survey Register which has recently been compiled and computerised print-outs now form the basis of the Offices, Shops & Railway Premises Act records classified according to business use. The advantages of using this system are two-fold since there is a continual up-dating of records as revisits are carried out and a feed-back channel of information has been established to update the computer. Many employers are now aware of the legislation and it is interesting to note that in a number of cases during the year, advice was sought by intending employers prior to the setting up of new businesses and that co-operation between the various departments of the Council has resulted in mutual consultation before plans are finally agreed. It is also a surprising feature that employers (in spite of the fact that an Abstract of the Act is required by law to be permanently and prominently displayed on business premises) often telephone this Department for advice on details which are literally at their own elbow. - 15 - Routine Public Health Work The large number of complaints concerning living accommodation received by the Section continued during the year. Despite the Council's continued slum clearance programme, this is a reflection of the ever higher environmental standards demanded year by year by the public, a demand nurtured both by increased personal incomes and by the educational effects of the media and others. However, we have only to look about us, especially in the southern half of our Borough to realise the vast amount of work remaining to be done. While it has been said the Public Health Inspector exists to work himself out of a job, there appears no likelihood of this happening in our lifetime. Food Sampling The satisfactory level of routine sampling was maintained throughout the year, few examples of adulteration, pesticide residues or bacterial infection were encountered. The number of food complaints received from consumers remains at a high level. It is right that the standard demanded by the housewives is rising and there is certainly no room for complacency. Members of the public often do not appreciate that whilst inspections, investigations and representations are always made concerning each item of food which is the subject of complaint, it is not usually possible to prosecute the offender for the particular incident unless the complainant is prepared to attend the Magistrates Court as witness for the Council. Complaints generally fall into two categories - the suspected presence of foreign bodies in food and allegations of mould or staleness. In spite of the installation of increasingly sophisticated equipment for the detection of foreign substances and metal by most large food processers, there still remains a problem which is not completely solved. Allegations of mould and staleness frequently occur in pre-packed products particularly in bread, meat pies, sausages and cheese and where substantiated have usually arisen due to lack of proper stock rotation. The proposed introduction of date coding may well result in a reduction of complaints of this type. Gypsies The problems associated with some itinerant caravan dwellers are too obvious to require much amplification. Stories of vandalism; old car dumping; bonfires; lack of proper water supplies and sewerage, along with almost non-existent education for their children are legion throughout many areas of North-East Londonl Unfortunately, many of these tales are true, as the Inspectorate are only too well aware. In consultation with the Gypsy Council, the Borough provided a small site in the north west of the Borough for 16 caravans to comply with the Caravan Sites Act, 1968 and occupation commenced in July 1972. A warden has been appointed who lives on the site and the occupiers pay a rent for the services provided. It is the Government's view that if all Local Authorities make some provision for the estimated 15,000 itinerants in the country it will go far towards offering these people a more settled mode of life if it is their desire. Unfortunately, not all Local Authorities are anxious to shoulder their responsibility in this manner and it would be manifestly unfair if the ratepayers of this Borough were to be expected to play host to an ever increasing number of non-paying guests occupying unauthorised sites. The costs in expensive public service manpower alone are sufficient to deter even the most liberal minded Authority, and the physical dangers to which the Public Health Inspectors in this Borough have been exposed in the course of their duties concerning unauthorised caravan sites have necessitated Police attendance on several occasions. When the Secretary of State agrees to declare the Borough a designated area under Section 12 of the Caravan Sites Act, 1968 unauthorised encampments by itinerants can be adequately controlled within the Borough. Finally I record my thanks for the loyal support of the Public Health Inspectorate who, - 16 - due to the extreme shortage of staff and the varying needs of the service, have been subjected to changes in duties and responsibilities during the year. COMMUNITY NURSING SERVICE Miss Gillian Pittom, Chief Nursing Officer, writes:- The Community Nursing Service has extended the range of work throughout the year. The staff have increased in number thus an increasing amount of in-service and specialised training has been made available in order to enable the staff to improve and keep abreast of the many changes and the demands made upon them by their patients. For the first time in this Authority ancillary help has been available for assisting the district sisters' routine visits to the severely handicapped and elderly. The 3 nursing services working with the general practitioner, forming the primary care teams in the community, have begun to be more fully extended in areas other than health centres. A new emphasis is being placed on age groups needing regular surveillance within the community in the preventive field as well as screening of vulnerable groups such as those with obesity or chest conditionsThis group-work links all members of the team. Health Visitors and Clinic Nurses are continuing to play an important part in child school health and have shown an increasing interest in developmental screening. In certain areas where children are considered at risk due to home pressures all members of the primary care team meet with their colleagues in hospital and in the Social Services Department for care of this group and discussion of individual families. Midwifery This year has been notable for the institution of a different type of midwifery training during the latter part of the year. This will provide a more comprehensive years' training in midwifery with an added emphasis on community experience at an early stage for every student midwife. One hostel for student midwives has been considered sufficient for the numbers of students requiring residential accommodation so Clifton House was closed in June. Carisbrooke continues to serve 10 student midwives. One nursing officer responsible for midwifery and the midwifery tutor have office accommodation and one room is used for district midwives to meet students for training purposes. Domiciliary deliveries have shown a continuing slow decline as in accordance with the national pattern. Early transfers have increased and more general practitioners have delivered their own midwifery patients in Thorpe Coombe with their appropriate midwife.the mother and child shortly being returned home in the continuing care of this partnership. It is hoped that this excellent integration of the services will increase as it is more widely known and appreciated. General practitioners have an increasing awareness of ante-natal patients and domiciliary midwives support them at all their clinics assisting with domiciliary and hospital booked cases. District Nursing This service is spreading rapidly in the domiciliary field and in general practitioner premises as well as health centres. The breadth of work has increased and a wider variety of nursing care has been available for sick and severely handicapped. This improved service has been greatly assisted since May, when 9 nursing auxiliaries were recruited for routine care of elderly and handicapped. These assistants have been allocated to small groups of nurses mostly as part-time morning help and have proved a happy and successful addition. Some of the nursing sisters volunteered to assist the nursing officers with suitable training - 17 - for theseauxiliaries. The state enrolled nurses have been increased by 4. It is hoped to be able to place one state enrolled practical nurse in each of the larger group practices. Unfortunately the more recently trained S.E.N, is difficult to recruit for as yet many of them remain in the hospital field. We have been able to offer district training to 3 state enrolled nurses this year. Following the closer links by nursing officers with Langthorne Hospital district nursing sisters have been encouraged to contain the elderly sick patients in their own homes for longer periods and in some cases have accepted an earlier transfer home due in some part to the increased awareness and understanding in the hospital. Health Visitors As in other areas throughout the country this service has become increasingly difficult to maintain at full strength but those health visitors who are on our staff have worked hard to cover the gaps caused by unfilled posts. All areas of health visiting have been successfully maintained and in some areas new responsibilities have been accepted. There has been participation in a variety of health education group work with some emphasis on the more unusual. For example - Health education alongside keep-fit has been a very popular evening group. Other centres have nutrition groups as well as parentcraft including a small following of fathers, groups for deprived mothers, mothers of handicapped children - the latter being joined by a social service colleague. Some school health education continues but is likely to be increasingly the responsibility of clinic school nurses. Health Visitors continue to play an important part in specialised and routine care of children during their early years as well as assisting with pre-entry school Medical inspections in clinics. They continue to work with children in clinics and take full responsibility for home visiting. The mobility and varied nationalities living in some parts of the borough does require some intensive and in some families prolonged home visiting. Close liaison with Whipps Cross Hospital in the paediatric unit and in the midwifery field at Thorpe Coombe has been expanded. One health visitor now visits special groups one afternoon each week for discussion of problems and to assist in overcoming of language problems. Again a health visitor attends a family planning clinic one evening a week in order to assist where there are language problems. As the demands of the school health services have increased so the need for an increase in the establishment of school nurses became obvious. We had insufficient staff available to carry out the heavy programme of annual screening for visual and hearing defects as well as continue to carry out a total health programme for each child. In order to do this the school clinic nurse establishment was increased by I I to 36 in the latter part of the year. This enables the schools for handicapped to have a more realistic school nursing establishment. Clinic/School nurses are now able to take an active part in school health in every school and are becoming increasingly aware of the need for health education amongst the younger children. More time has been allocated to improving and maintaining good relationships with hospital and social service colleagues. Discussions and talks of interest to all members of the team have been organised successfully. Regular meetings of nurses and social service colleagues are encouraged at all levels. - 18 - WATER SUPPLIES Contributed by Dr.E.Windle Taylor, C.B.E., M.A., M.D., D.P.H., F.C.Path. Director of Water Exami nation, Metropolitan Water Board. 1. (a) The supply was satisfactory both as to (i) quality, arid (ii) quantity throughout 1972. (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 structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1972, was 233,200. (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:- Coppermill works, and well water from Chingford Mill Pumping Station. 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 60 and 61 . (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. - 19 - CONTRIBUTIONS BY COLLEAGUES RAINFALL AND SEWERAGE Contributed by D.M.P.Sullivan, C.Eng.,M.I-C.E.,F.I.Mun.E., Borough Engineer and Surveyor Rainfall The rainfall recorded in the Borough was an average of 462 mm (18.2 inches). This was a dry year, the average annual rainfall being about 600 mm. There was heavy fainfall on 2 days during the year causing some flooding in various parts of the Borough. Sewerage The Leytonstone Area Stage I and the Hale End South Stage II Relief Surface Water Sewer Schemes were completed. The following relief surface water sewerage schemes were carried out during the year- Beech Hall Road, Chingford Cemetery Diversion, The Avenue, E.4. Work was started on the following Contracts: - Low Hall Depot Pumping Station Highams Sewer Area Flood Relief Scheme Leytonstone Area Stage II A The Greater London Council completed the construction of enlarged stormwater tanks at Birch Tree Avenue to serve the Chingford area. Sewerage Disposal Sewerage disposal is carried out by the Greater London Council. STATISTICAL INFORMATION VITAL STATISTICS Area of Borough (in acres) 9,805 Population (Registrar General's Estimate, midyear 1972) 233,200 Number of Rate Assessments at 3 1 st March, 1973 97,132 Total Assessable Value £12,700,587 Product of a penny rate £121.500 Live Births: WALTHAM FOREST ENGLAND & WALES MALES FEMALES Legitimate 1670 1583 3253 11 legitimate 177 147 324 14.8 3577 Live Birth Rate per 1 ,000 population 15.3 " as adjusted by comparability factor (0.99) 15.1 Illegitimate live births per cent of total live births 9.0 Sti 1 Ibirths: Number (24 males: 30 females) 54 12 Rate per 1 ,000 total live and stillbirths 15 Total live and stillbirths 3631 Infant deaths (deaths under one year) 61 Infant Mortality Rates: Total infant deaths per 1 ,000 total live births 17 17 Legitimate infant deaths per 1 ,000 legitimate live births 17 17 Illegitimate infant deaths per 1 ,000 illegitimate live births 15 21 Neo-Natal Mortality Rate (deaths unde; 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) 9 10 Perinatal Mortality Rate (stillbirths and deaths under one week combined per 1 ,000 total live and stillbirths) 23 22 Maternal Mortality: Number of deaths 1 Rate per 1 ,000 total live and stillbirths 0.27 Deaths: Total numbe 3056 Death rate per 1,000 population 13.1 12.1 "as adjusted by comparability factor (0.86) 1 1.3 -21 - - 22 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE -1972 . CAUSE HEADING CAUSE OF DEATH TOTA L (ALL AGES) AGE GROUPS - MALES 1 AGE GROUPS - FEMALES TOTA L FEMALES UNDER 1 1 -4 5-1 4 1 5- 25- 35- 45- 55- 65- 75 + TOTAL MA LES UN DER 1 1 -4 5-1 4 1 5- 25- 35- 45- 55- 65- 75 + 24 34 44 54 64 74 24 34 44 54 64 74 B4 Enteritis and other diarrhoeal diseases 7 4 1 - - - - - - - - 5 2 - - - - - - - - - 2 B5 Tuberculosis of respiratory system 3 - - - - - - - 1 1 1 3 - - - - - - - - - - - B6(l) Late effects of respiratory T.B. 1 - - - . - - - - - 1 1 - - _ - - - - - - - . B 1 1 Meningococcal infection 1 - . . - - - - - - - - - - - 1 _ - - . - - 1 BI4 Measles 1 . - - . - - - . - _ _ _ 1 _ | B1 7 Syphilis and its sequelae 4 - - - - - - - 1 - 1 2 - _ . . - - - 2 - 2 B18 Other infective and parasitic diseases 2 - - - - - - - - - - - 1 - - - - - - - - 1 2 B19( 1) Malignant neoplasm, buccal cavity etc. 6 - - - - - - - 1 - 1 2 . . . . _ - - 2 . 2 4 B 19( 2) Malignant neoplasm, oesophagus 9 - - - - 1 - - - 2 1 4 1 4 5 B19( 3) Malignant neoplasm, stomach 69 - - - - 1 - - 9 20 12 42 - . . . . - 1 3 4 19 27 B19(4) Malignant neoplasm, intestine 84 - - - - - 1 2 10 12 1 | 36 . _ . . 1 1 2 6 13 25 48 B19(5) Malignant neoplasm, larynx 2 - - - - - - - - 1 - 1 - - - - . - - - 1 - 1 B19(6) Malignant neoplasm, lung, bronchus 188 - - - - - 2 6 43 63 43 157 - - . - . . 5 6 6 14 31 B19(7) Malignant neoplasm, breast 62 - - - - - - - - - - - _ - - _ _ 2 7 14 20 19 62 B 1 9(8) Malignant neoplasm, uterus 18 - - - . - - - - - - - - - - - - - 1 5 5 7 18 B19(9) Malignant neoplasm, prostate 23 - - - - - - - 3 7 13 23 - - - - - - - - - - - BI9( 10) Leukaemia 13 - - - 1 - - - . 2 1 4 - - - - - - 2 1 1 5 9 BI9( 1 1) Other malignant neoplasms 153 - 1 - 1 1 2 6 15 25 16 67 - 1 - - - 3 8 25 27 22 86 B20 Benign and unspecified neoplasms 9 - - - - - - 1 1 1 2 5 - - - - - 1 1 1 1 4 B2I Diabetes mellitis 28 - - - - 1 - - 1 4 5 11 - - - - - - - 2 8 7 17 B46( 1) Other endocrine etc. diseases 7 - - - - - - 1 1 1 1 4 - - - - - - - - 1 2 3 B23 Anaemias 1 1 - 1 - - - - - - 1 1 3 . _ - 2 - - - - 1 5 8 B46(2) Other diseases of blood etc. 1 - - - - - - - 1 - . 1 - - - - - - - - - - - B46(3) Mental disorders 5 - - - - 1 - - - - 1 2 - - - - - - - - - 3 3 B24 Meningitis 2 - - - - - - - 1 1 - 2 - - - - - - - - - - - B46(4) Mjltiple sclerosis 3 - - - - - - - - 1 - 1 - - - . 1 - - 1 - - 2 B46( 5) B26 Other diseases of nervous system 24 1 - - 1 - 1 - . 2 1 6 - 1 I - . _ . - 5 1 1 18 Chronic rheumatic heart d'sease 26 - - - - - - 4 2 3 2 1 1 - . _ - _ - - 2 7 6 15 B27 Hypertensive disease 65 - - - - - 1 - 4 8 10 23 - - . - - - - 7 10 25 42 B28 Ischaemic heart disease 678 - - - - 1 7 37 86 152 1 17 400 - - - - - 2 8 24 71 173 278 B29 Other forms of heart disease 189 - - - - - - 2 11 16 33 62 - - - - - 1 2 2 20 102 127 B30 Cerebrovascular disease 298 - - 1 - 1 1 3 19 36 49 1 10 - - - - - 1 2 15 47 123 188 B46(6) Other diseases of circulatory system 107 - - - - 1 - 1 9 16 14 41 - - - - - - . 3 1 4 49 66 B3I Influenza 13 1 - - 1 - - 1 - 2 2 7 1 5 6 B32 Pneumon ia 427 1 - - - - 4 - 1 40 104 166 5 2 - - - 1 3 12 31 207 261 B 3 3( 1) Bronchitis and emphysema 180 - - - - - - 1 20 40 63 124 - - - - - - 2 5 14 35 56 B33(2) Asthma 6 - - - 1 - - 1 1 1 - 4 - - - - - . 2 - . . 2 B46(7) Other diseases of respiratory system 37 - 1 - - - - - 2 3 8 14 2 - 1 - - - - 2 3 15 23 B34 Peptic ulcer 14 - - - - - - - 2 4 2 8 - - - - - - - - - 6 6 B35 Appendiciti s 4 - - - - - - - - 1 1 2 - - - - - . . 1 . 1 2 B36 Intestinal obstruction and hernia 13 - - - - - - - - 1 3 4 - - - - 1 . . . 4 4 9 B37 Cirrhosis of 1 iver 4 - - - - - - - - - . . - - - - . . 1 1 2 . 4 B46(8) Other diseases of digestive system 25 - - - - - - 1 - 3 4 8 - - - - - 1 - 4 8 4 17 B38 Nephritis and nephrosis 14 - - - - 1 1 1 3 4 1 1 | - - - - - - - 2 1 - 3 B39 Hyperplasia of prostate 7 - - - - - - - - 2 5 7 - - - - - - - - - - - B6(9) Other diseases, genito-urinary system 29 - - - - - - - 2 3 5 10 1 - - - - - 1 2 3 12 19 B4I Other complications of pregnancy etc. 1 - - - - - - - . - - - - - . - 1 - . . . 1 B46( 1 1) Diseases of Musculo-skeletal system 1 1 - - - - - - - - - - - - - - - - . . . 4 7 1 1 B42 Congenital anomalies 21 6 - - - 1 - - 2 1 1 | | 5 . 2 . 1 - 1 1 . . 10 B43 Birth injury, difficult labour etc. 12 6 - - - - - - - - - 6 6 6 B44 Other causes of perinatal mortality 16 10 - - - - - - - - - 10 6 - - - - - - - - - 6 B45 Symptoms and ill defined conditions 14 1 - - - - - - - - 4 5 I - - - - - - - 1 7 9 BE 47 Motor vehicle accidents 41 - - 4 3 3 3 2 3 2 2 22 . - 1 1 - 3 2 1 2 9 19 BE 48 All other accidents 37 1 1 1 1 - 2 1 2 3 2 14 I 1 - - - 1 . 2 4 14 23 BE49 Suicide and self-inflicted injuries 24 - - - 2 3 2 3 3 1 2 16 . - - 1 _ 2 1 1 1 2 8 BE50 All other external causes 7 - - - - - 2 1 1 1 - 5 * 1 - - 1 - - - •- - 2 3056 31 5 6 11 16 29 75 277 487 546 \ 483 30 7 5 5 6 19 52 153 344 952 1573 DEATHS FROM CANCER AGE AT DEATH MALES FEMALES TOTA L Under 5 years 1 - 1 5 and under 15 years - 1 1 15 and under 25 years 2 - 2 25 and under 45 years 8 7 15 45 and under 65 years 95 88 183 65 years and over 230 195 425 T otal 336 291 627 Previous years - 1971 347 277 624 1970 367 289 656 BIRTHS During the year a total of 3,631 births were registered. In the same period 3,931 births were notified in accordance with Section 203 of the Public Health Act which were distributed as fol lows:- DOMICILIARY INSTITUTION A L LIVE STILL LIVE STILL Notified births which occurred in the Borough 550 1 1920 38 Birth notifications transferred outwards - - 239 8 Birth notifications transferred inwards - - 1398 24 Adjusted Total 550 1 3079 54 1971 649 4 3440 49 1970 693 4 3332 66 CARE OF PREMATURE INFANTS (weighing 5½lbs or less) LIVE STILLBORN Number born at home 7 I Number born in Hospital or Nursing Home 246 37 - 23 - MIDWIFERY The work of the Council's Midwives was as follows:- Domiciliary confinements attended under N.H.S. arrangements 1972 1971 1970 543 659 748 Hospital confinements conducted by domiciliary midwives 40 - - Cases delivered in hospital and other institutions but discharged and attended before tenth day 1,157 825 637 Miscarriages attended 7 1 3 New cases booked 1 ,317 857 1 ,065 Cases on the books at the end of the year 483 337 505 Medical aid notices issued 41 22 - Visits paid (as midwife): (a) Ante-natal 4,012 4,315 4,842 (b) Nursing 15,348 16,081 15,741 (c) Other post-nata 1 ,098 1 ,134 769 Total Visits 20,458 21 ,530 21 ,352 Clinic Sessions Number of sessions attended: (a) General practitioner's clinics 1,31 1 1 ,369 1 ,290 (b) Midwife's clinics 324 371 412 Number of ante-natal examinations by the midwife: (a) General practitioner's clinics 12,267 12,900 10,542 (b) Midwife's clinics 1 ,438 1 .750 2,273 Number of women attending midwife's clinics who had not previously attended any ante-natal clinic in the current year 868 810 423 - 24 - - 25 - Child Welfare Clinic Attendances ASSEMBLY HALL DAWLISH ROAD EMMANUEL HALL GRANLEIGH ROAD HATCH LANE HANDSWORTH AVE HURST ROAD LEYTON GREEN ST. J AMES MARMION AVENUE PRIORY COURT Y ARDL EY L AN E WEST AVENUE TOTAL FOR THE YEAR - ALL CLINICS 1972 197 1 1970 Children attending for the first time in 1972 who were born in 1967 24 31 . ii 16 18 2 10 14 6 4 8 31 175 250 265 1968 21 131 4 24 1 1 1 10 9 36 75 18 16 5 44 504 547 619 1969 20 181 1 34 60 149 4 125 101 72 31 18 78 874 872 963 1970 60 258 27 111 36 170 7 206 201 43 65 31 84 1,299 1,472 1,542 1971 1 10 446 63 304 68 266 43 3 35 356 194 179 71 243 2.678 3.045 2,616 1972 74 404 45 359 50 194 225 338 352 577 235 49 233 3,135 3.174 3.309 Total attendances 2.427 5.808 839 4,666 1.133 4,885 3,359 3,722 4,766 4,791 3,000 1,364 4,0 18 44,778 55.342 53.646 Attendance of children seen by Medical Officer 559 1,840 163 1,104 429 1,279 875 1,100 1,348 798 1,137 162 1,710 12,504 14,605 15,022 No. of children referred elsewhere 10 151 9 170 9 40 15 64 53 47 106 2 43 719 757 858 No. of sessions (a) Medical Officers 48 154 21 1 19 66 132 84 146 100 55 125 15 134 1, 199 1,259 1,409 (b) Sessional G.P's - 26 - 4 5 - 2 - 40 61 - - - 138 143 65 (c) Health Visitors 49 1 3 30 23 5 1 1 14 11 3 1 1 1 18 39 6 333 31 1 271 - 26 - N U TRI EN TS WELFARE FOODS ADEXOLINE O PTROSE MARMITE COW & GATE OSTERMILK NO.2 S.M. A. H UMSD. TRU FOO D F AREX GRO ATS GOL DEN OSTERMILK N AT-DRI ED MILK A. D. & C. DROP S A. D. & C. TABLETS Assembly Hall 154 3,695 1,662 469 392 600 137 81 65 105 83 850 123 Hurst Road 668 2,680 1, 129 1,981 451 251 32 103 129 127 197 348 104 Dawlish Road 29 1 ,676 963 1,878 466 882 139 71 - 444 1 ,651 141 Emmanuel Hall 58 728 179 432 1 13 53 10 21 13 - 8 314 16 Granleigh Road 159 2,633 1,323 1 ,354 1,165 596 150 70 250 736 979 173 Handsworth Avenue 943 6,541 2,637 1,402 713 387 164 1 15 171 606 209 1,087 102 Hatch Lane 34 1,206 738 229 3 18 383 9 25 29 83 30 302 30 Leyton Green 276 2,930 806 2,525 592 625 235 134 35 339 469 1.148 159 Priory Court 539 3,057 1,620 1,962 663 521 161 III 1 1 1 180 570 1.015 324 St.James 23 3 4,565 1,286 3,090 724 744 203 109 129 259 839 1,577 187 Marmion Avenue 708 6,395 2,282 1 ,768 416 952 200 1 15 106 191 232 1.027 131 Yardley Lane 41 824 544 363 1 51 103 88 17 36 127 90 216 13 West Avenue 270 2,939 715 2.632 641 597 57 136 75 109 402 923 1 12 Hospitals and Nurseries - - - 2 - - - - - - 48 540 - 4.162 39,869 15,884 20,087 6,805 6,694 1 ,296 1,256 1 ,040 2,376 4,507 12.477 1,615 1 97 1 10.784 49,745 16,938 19,545 13.817 6,716 564 1,690 1, 160 8 1 1 5,382 5,357 2,406 1970 1 3,633 51,128 14,467 18,501 14, 126 5,841 346 1 ,817 1 ,056 - 7,523 - 2,969 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 Distribution of Welfare Foods and Nutrients Mothercraft and Relaxation Classes New cases 443 Attendances 1,182 No. of classes held 183 Congenital Malformation 137 cases of congenital malformation were notified to the Registrar General's office during the year. Children "At Risk" 1972 1971 1970 Children on Register at 1 st January 2,522 2,625 2,600 Children added during year 1 ,210 1 ,501 1 ,412 Children removed during yea 1 ,301 1 ,604 1 ,387 Children on Register at 31st December 2,431 2,522 2,625 Cervical Cytology Clinics HATCH LANE GRANLEIGH ROAD No. of smears taken 784 380 No. of sessions 44 26 Dental Treatment of Expectant and Nursing Mothers and Children under five years CHILDREN UNDER S V R S. EXPECTANT & NURSING MOTHERS 1972 197 1 1970 1972 1 971 1970 Number of patients given first inspections during year 594 329 272 30 24 26 Number of patients who required treatment 582 213 17 1 28 21 22 Number of patients who were offered treatment 580 204 164 28 17 22 Attendances for treatment: First visit 565 682 569 33 30 33 Subsequent visits 376 832 560 35 42 38 Total visits 941 1,514 1, 129 68 72 71 Treatment provided: Number of fillings 561 877 720 25 39 29 Teeth filled 514 792 666 24 36 23 Teeth extracted 64 183 213 16 9 1 1 General anaesthetics given 20 72 81 - 1 5 Emergency visits by patients 42 36 37 1 4 Patients X-rayed 6 12 2 6 6 5 Patients treated by scaling and/or removal of stains from the teeth (Prophylaxis) 246 258 327 21 14 7 Teeth otherwise conserved 128 17 1 147 - - - Teeth root filled - - 2 1 - Inlays - - - - - Crowns - - - - Number of courses of treatment completed during year Patients supplied with full upper or full lower 419 570 374 23 20 16 dentures - - - - - - Patients supplied with other dentures - - 2 2 Number of dentures supplied - - - - 2 2 - 27 - FAMILY PLANNING GR ANL El GH ROAD HATCH LANE HURST ROAD LEY TON GREEN ST.J AMES Number of new patients 456 448 705 330 339 Number of persons treated 1 ,080 1 ,491 1 ,918 700 479 Number of attendances 2,473 3,705 4.927 1 ,141 1 ,819 Number of sessions 61 99 99 57 51 HEALTH VISITING (a) Sessions Worked Number of sessions (half days) devoted to: 1972 1971 1970 (i) Health visiting 6,743 7,427 7,892 (ii) Child welfare centres 3,468 3,315 3,674 (iii) Ante-natal, post-natal, relaxation etc. clinics 185 391 313 (iv) School clinics 767 764 979 (v) Other school nursing 2,140 1 ,647 1 ,887 (vi) Health education (including mothercraft) 188 499 351 (vii) Chest clinic sessions 716 (viii) G.P. surgeries 735 (ix) Other work (including clerical) 4,658 5,514 5,078 (b) Total sessions 19,600 19,557 20,174 (b) Cases visited for the first time in the year (i) children under 5 years 12,381 1 1 ,848 13,171 (ii) persons aged 65 or over 2,632 2,01 1 2,327 (iii) others (excluding school nursing cases) 3,485 1 ,322 1 ,409 T otal 18,498 15,181 16,907 (c) Number included in item (b) who were visited at the special request of a G.P. or hospital: (i) persons aged 65 or over 829 572 567 (ii) mentally disordered persons 82 34 52 (iii) others 1 ,915 187 107 - 28 - EFFECTIVE INEFFECTIVE (d) Total number of visits to: (i) children under 5 years of age 19,531 5,126 (ii) persons aged 65 or over 4,110 (iii) other (excluding school nursing cases) 4,916 1 ,588 Total visits 1972 28,565 6,714 Total visits 1971 30,574 7,616 Total visits 1970 35,448 7,917 HOME NURSING (a) Cases visited for the first time in the year: C ASES TOTAL VISITS 1972 1971 1970 1972 1971 1970 (i) aged under 5 1,898 1,336 917 3,546 3, 162 3,114 (ii) aged 5 and under 65 7,282 4,539 2,632 39.525 38,080 32,596 (iii) aged 65 or over Total cases 4,701 2,625 2,431 1 12,140 107,055 105,870 13,881 8,500 5,980 155,21.1 148,297 141,580 (b) Cases on the books at the end of the year: 1972 1 ,660 1 971 1 ,550 1970 1 .512 LOAN OF SICK ROOM EQUIPMENT EQUIPMENT HEALTH & WEL FARE DEPTS. New Issues in 1 972 HEALTH 8, WELFARE DEPTS. CHIN G FORD RED C ROSS CHINGFORD RED CROSS E QUI PM EN T Commodes 356 71 Urine Bottles 134 31 Wheelchairs 241 92 Bed Boards (sets) - 4 Bed Cradles 104 30 16 1 3 Air Rings 151 24 Crutches (pairs) 12 19 Bed Pans 203 26 - 1 4 Back Rests 184 35 Walking Aids 56 35 Draw Sheets 197 21 Others 32 2 Plastic Sheets 304 - - 29 - CHIROPODY TREATMENT N EW CASES CLINI C ATTENDANCES DOMIC i LI ARY TREATMENTS TREATMENTS AT OLD PEOPLES R ESI DENTI AL HOMES C ASES T REATED DURING THE YEAR Children 712 3,597 - - 1, 107 Expectant mothers - 1 - - 1 Physically Handicapped 5 1 17 67 - 57 Aged (over 65 years of age) 712 18,821 3,653 1 ,968 6,849 Others 342 5,686 24 - 1,925 Total for 1972 1,77 1 28,222 3,744 1 ,968 9,939 Previous Years - 1971 1,862 32,512 3,744 1 ,684 1970 1,730 34,358 4,214 1 ,829 LAUNDRY FOR THE INCONTINENT j ARTICLES LAUNDERED DOMICILIARY RESIDENTIAL CASES HOMES 25,070 43,947 REGISTRATION OF PREMISES Public Health Act, 1936 - Nursing Homes BEDS P RO VI PEP NO.OF HOMES MATERNITY OTHERS Homes registered at 31 st December, 1972 71 Essex County Council Act, 1933 - Establishments for Massage and Special Treatment CHI ROPO DY MASSAGE ETC. Establishments registered at 3 I st December, 1972 7 6 INFECTIOUS DISEASES - NOTIFICATIONS Dl SE ASE 1ST QUARTER 2ND QU A R T ER 3RD QU ART ER 4 T H QU ARTER TOTAL Scarlet Fever 16 10 6 5 37 Whooping Cough 3 1 12 4 20 Measles 62 62 70 103 297 Tuberculosis - Pulmonary 17 13 16 17 68 Tuberculosis - Non-pulmonary 14 6 7 10 37 Typhoid 2 - - - 2 Paratyphoid - - 1 - 1 Acute Meningitis 5 2 2 4 13 Dysentery 2 7 1 1 4 24 Ophthalmia Neonatorum - 1 1 - 2 Food Poisoning 1 3 3 4 11 Infective Jaundice 4 20 7 10 41 Malaria (contracted naturally abroad) 1 4 3 1 9 Mumps encephalitis 1 - - 1 T otals 127 135 139 162 563 TUBERCULOSIS New Notifications and Deaths during 1972 AGE PERIODS NEW CASES DE ATH S P U LMON ARY NONPULMON ARY PULMONARY NONPULMONARY Under 1 year M F M F M F M F 1-4 years 2 I 2 5-9year 2 10-14 year 2 2 15-19 year 3 2 2 3 20-24 years 7 3 | I 25-34year 8 1 | 10 I 5 34-44 year 2 3 3 45-54year 5 3 3 65 and over 4 3 2 I | 5 2 I 3 38 30 18 19 4 - . - Totals 6 8 3 7 105 4 - 31 - Tuberculosis among Immigrants Cases of tuberculosis among immigrants seen at the local Chest Clinic numbered 55. These occured in the following groups:- RESPIRATORY N ON - R ES PI R A T O R Y Pakistan 19 16 Indian 12 6 Kenyan I West Indian - I Irish 5 Others 2 2 Tuberculosis - Care and Aftercare (a) Work of Tuberculosis Visitors (i) Visits to new cases 271 (ii) Total visits to households 1,702 (iii) Sessions attended at Chest Clinic 852 (b) Contacts Examination of contacts during year (i) first examinations 464 (ii) subsequent examinations 407 MEDICAL EXAMINATIONS OF STAFF Completed during period I st January to 31 st December, 1972:- Medical Examinations 449 Medical Assessments 1,463 - 32 - VACCINATION AND IMMUNISATION TYPE OF COURSE OR DOSE YEAR OF BIRTH OTH ERS UNDER 16 YEARS TOTAL 1972 1971 1970 1969 1965-68 Diphtheria - Primary 31 2,085 778 99 96 18 3,107 Booster - 26 42 21 2,235 57 2,381 Whooping Cough - Primary 30 2,051 765 90 58 8 3,002 Booster - 24 39 14 43 1 15 523 Tetanus - Primary 32 2,086 779 98 104 67 3,166 Booster - 28 43 28 2,31 3 177 2,589 Poliomyelitis - Primary 34 2,1 12 784 92 1 1 1 18 3, 151 Booster - 25 40 22 2, 185 68 2,340 Measles 3 946 942 160 169 18 2,238 Rubella - - - - - 1,179 1,179 TYPE OF VACCINE USED IMMUNISATIONS OR VACCINATIONS COMPLETED BY GENERAL PRACTITIONERS IMMUNISATIONS OR VACCINATIONS COMPLETED BY BOROUGH STAFF PRIMARY COURSES R EINFORCING DOSES PRIM ARY COURSES REINFORCING DOSES Diphtheria, Whooping Cough, Tetanus and Poliomyelitis combined - - - - Diphtheria, Whooping Cough and Tetanus combined 1,622 425 1 ,380 98 Diphtheria and Whooping Cough combined - - - - Diphtheria and Tetanus combined 8 713 89 1, 139 Diphtheria only 7 - 1 6 Whooping Cough only - - - - Tetanus only 63 152 4 62 Poliomyelitis:- (a) Salk - - - - (b) Sabin 1,643 1,103 1,508 1,237 Smallpox 310 246 - - Measles 1,078 - 1, 160 - Rubella 86 - 1,093 - -33- B.C.G. Vaccination of Children Results of Heaf Test:- (a) Tuberculin Positive 131 (b) Tuberculin Negative 2,032 Number vaccinated with B.C.G 2.032 GENERAL DENTAL SERVICE Number of Sessions 203 Number of appointments made 1,089 Number of new patients seen 200 Analysis of Treatments Provided Fillings - Plastic I 78 Amalgam 352 Inlays 1 Crowns 2 Scaling and gum treatment 152 Dressings 102 Extractions 53 General Anaesthetic given 2 Local Anaesthetic given 160 X-rays 290 Dentures supplied 59 Dentures repaired 7 Impressions 189 Bites 52 Try-in 74 Minor Oral surgery 6 Other treatment 112 DENTAL LABORATORY DENTURES REPAIRS REMAKES OR RELINE APPLIANCES CROWNS INLAYS STUDY MODEL TRAYS EAR INSERTS General Dental Service 59 44 4 1 1 - - 66 - School Dental Service 13 3 - 73 12 2 340 2 613 Maternity and ChiId Welfare - - - - - - - - - -34- PUBLIC HEALTH INSPECTION I. Inspections, 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 150 1,594 55 19 - Housing Acts, 1936/69 and Regulations - 8,673 34 6 - Public Health Acts, 1936/64, and Noise Abatement Act, 1960 1,915 13,653 613 203 - Prevention of Damage by Pests Act, 1949 3,515 17,582 11 3 - Food and Drugs Act, 1955 and Food Hygiene Regulations, 1960/66 265 2,945 207 - - Factories Act, 1961 - 217 7 - - Pet Animals Act, 1951, Riding Establishments Act, and Animal Boarding Establishments Act, 1963 - 116 1 - - Offices, Shops and Railway Premises Act, 1963 - 1,737 122 - - -35- (b) DETAILED (i) Housing Acts, 1957/72 (a) Individual Houses - Demolition/Closing Orders Undertakings accepted (Section 16) 1 Closing Orders made Nil Demolition Orders made (Section 17) 1 Closing Orders revoked and Demolition Orders substituted (Section 28) Nil Orders/Undertakings determined Nil (b) Slum Clearance Areas Number of areas represented (Sections 42 & I 57 (I) 26 Houses unfit for human habitation 240 Houses included by reason of bad arrangement Nil Houses on land acquired under 43 (2) 207 Numbers of people to be displaced (a) individuals 1,258 (b) Families 426 (c) Compulsory Purchase Orders confirmed The Waltham Forest Housing Part III (Ringwood Road, E.I 7) Compulsory Purchase Order 1971 , was confirmed by the Secretary of State for the Environment without amendment. Following Official Representations 8 Clearance Areas were declared by the Council in December, I 971, in respect of houses in Arkley Road, Arkley Crescent and South Grove, E.I7. A Public Inquiry was held in October, 1972, and the decision of the Secretary of State for the Environment is awaited. Following Official Representations the Council took the following action during the year:- (a) 10 Clearance Areas were declared in March, in respect of houses in Boundary Road, Gamuel Road, Beaconsfield Road, Colchester Road, Boston Road, Chelmsford Road and Lennox Road, E.I7; (b) 4 Clearance Areas were declared in June, in respect of houses in Apsley Road, E.I7; (c) 7 Clearance Areas were declared in July, in respect of houses in Lennox Road, Lennox Avenue, Gordon Road, Queens Road and Richmond Road, E.I7; (d) 5 Clearance Areas were declared in October, in respect of houses in Union Road and Queens Road, E.I7. -36- (d) Housing Finance Act, I 972 - Qualification Certificates A total of 3,419 applications have been received up to 31st December 1972, by this Department in connection with the conversion of Controlled Tenancies to Regulated Tenancies for the purposes of recent control. Action has been taken as follows:- Section 28(1) Section 29(1) Section 29(5) Applications Received 2,861 409 149 Certificates Recommended 1 ,565 346 142 Certificates Not Recommended 1,114 40 1 Applications Withdrawn 45 20 Nil Applications Pending 137 3 6 (ii) 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, 1960/70, Ice-Cream (Heat Treatment) Regulations, 1947/52, Factories Act, 1961, Leyton Corporation Act, 1950, Essex County Council Act, 1952, and relevant legislation. TYPE OF PREMISES NUMBER OF INSPECTIONS Retail Food Shops 1,854 Catering establishments (including factory canteens, hospitals, nursing homes, school meals kitchens) 501 Food Hawkers/Street Traders/Fairgrounds 209 Food Manufacturers/Depots, Dairies, Bakehouses ... 233 Off-Licences 47 Public Houses 101 2,945 -37- (iii) 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 13 558 53 Retail shops 70 1,689 692 Wholesale shops, warehouses 3 101 34 Catering establishments open to the public, canteens 6 197 51 Fuel storage depots 1 7 - Totals 93 2,552 835 Number of visits of all kinds by Inspectors to registered premises 1,737 (b) Analysis of Contraventions Found SECTION NO. OF CONTRAVENTIONS FOUND SECTION NO. OF CONTRAVENTIONS FOUND 4 Cleanliness 48 12 Clothing Accommodation 1 5 Overcrowding Nil 13/14 Seating Facilities Nil 6 Temperature 35 15 Eating Facilities Nil 7 Ventilation 3 16 Floors, passages and stairs 19 8 Lighting 10 17/18/19 Machinery 13 9 Sanitary Conveniences 136 21 Noise and Vibration Nil 10 Washing Facilities 68 24 First Aid General Provisions 28 11 Drinking Water 2 50 Exhibition of Forms 46 Total 409 -38- (c) Analysis of Persons Employed in Registered Premises by Workplace CLASS OF WORKPLACE NUMBER OF PERSONS EMPLOYED 5,545 Retail shops 7,755 Wholesale departments, warehouses 1,274 Catering establishments open to the public 1,298 Canteens 80 Fuel storage depots 63 Total 16,015 Total Males 7,499 Total Females 8,516 (d) Reported Accidents WORK PLACE NUMBER REPORTED ACTION RECOMMENDED NO ACTION PROSECUTION FORMAL WARNING 1N FORM AL ADVIC E Offices 3 - - 3 - Retail shops 22 " - 22 - Wholesale shops, warehouses 2 - - 2 - Catering establishments open to public, canteens 2 - - 2 - Fuel storage depots - - * - - Totals 29 - - 29 - -39- (iv) Prevention of Damage by Pests Act, 1949 - Rodent Control Complaints received 2,663 Inspections and Re-inspections 16,571 Premises treated 2,442 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:- 1970 1971 1972 2,750 2,760 2,404 (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:- 1970 1971 1972 1,704 1,490 1,982 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 69 Local Authority 2,552 Butcher 130 H.M.F. Inspector 785 Exempt 1,944 Canteen/Staff* 51 Total 5,281 Canteen/School* 72 Catering/Public 201 Class of Premises Registered by Local Authority Catering/Misc.* 3 Office 558 Chemist 63 Retail Shop 1,689 Confectionery 314 Wholesale 101 Fishmonger/Fish Frier 37 Catering/Public 197 Fuel Store 7 Greengrocer 123 Grocer/General 235 Factories Act, 1961 Off-Licence 86 Power 775 Public house 85 Non -power 10 Clubs 18 14 Trade Store/Multile Non-food 3,843 Depots/Food Storage 63 Food 1,438 Stall/Vehicle 490 -40- (ii) Details of Registrations/Licences ACT OR REGULATION ON REGISTER 31 12.1972 Food and Drugs Act, 1955 Ice-Cream Premises 938 Food Preparation, etc. Premises 108 Milk and Dairies (General) Regulations, 1959 Distributors 318 Dairies 8 Milk (Special Designation) Regulations, 1963 Pasteurised 179 Sterilised 157 Untreated 10 Ultra Heat Treated 81 Essex County Council Act, 1952 Hawkers of Food 213 Hawkers' Storage Premises 40 Leyton Corporation Act, 1950 Section 63 - Vendors of Shellfish 20 Section 48 - Hairdressers' Premises. 177 Pet Animals Act, 1950 Annual Licences 28 Animal Boarding Establishments Act, 1963 3 11 Riding Establishments Act, 1970 1 Total 2,292 -41 - 4. Legal Proceedings (i) Public Health Acts, 1936/61; Clean Air Act, 1956 32 applications were made for legal proceedings to enforce the requirements of notices served. 6 cases were subsequently heard by the Court and abatement orders made. The remaining 26 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 152 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 (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.I 0., 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, I960. Legal proceedings were authorised in respect of 2 contraventions under Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 and these resulted in a fine of £40, with £5 costs. -42- 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 100 - - - - 6 - No. Bacteriological 27 35 74 - 80 10 2 No. Satisfactory 100(C) 22(B) 35 47 - 71 13 2 No. Fairly Satisfactory 3(B) - 1 1 - 4 - - No. Unsatisfactory 2(B) - 16 - 5 3(B) - 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 QUANTITY TONS CWT. ST. LBS. Tinned Goods 1,814 - - - - - Tinned Meats 34 - - 2 - 3 Tinned Fruits 69 - - 3 4 12 Frozen Foods - 10,326 - - - - Fish - - - 17 1 12 Meat/Bacon - - 1 1 1 7 13 Poultry - - - 2 1 - Fruit - - 1 7 6 7 Dried Goods - 1,137 pkts. - - - - -43- 7. Factories Act, I 961 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 ON REGISTER NUMBER OF INSPECTIONS WRI TT EN NOTI CES 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 10 5 2 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 775 172 13 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 34 31 1 - Total 819 208 16 - 2. Cases in which defects were found PARTICULARS NUMBER OF CASES IN WHICH DEFECTS WERE FOUND NUM BER OF C ASES IN WHICH PROSECUTIONS WERE INSTITUTED FOUND REMEDIED REFERRED TO H.M. INSPECTOR BY H.M. INSPECTOR (1) (2) (3) (41 (5) (6) Want of cleanliness 1 1 - 1 - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) - - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient 5 5 - 3 - (b) Unsuitable or defective 7 6 - 6 - (c) Not separate for sexes— 3 3 - 2 - Other offences against the Act (Not including offences relating to out-work) - - - - - Total 16 15 - 12 - -44- 3. Outwork NATURE OF WORK SECTION 133 SECTION 134 NO. OF OUTWORKERS IN AUGUST LIST REQUIRED BY SECTION 133 11) (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 UN WHOLE- SOME PREMISES NOTICES SERVED PROSECUTIONS Wearing apparel Making 156 - - - - - Footwear - - - - - - Umbrellas, etc. - - - - - - Handbags 4 - - - - Artificial flowers 6 - - - - - Garment hangers 18 - - - - - Boxes, etc. wholly or partly of paper Making 22 _ _ _ - - Gents Neckwear 40 - - - - - Upholstery trimmings 3 . - - - - - Brushes - - - - - - Loose cover specialist - - - - - - Toys 12 - - - - Watch strap - - - - - - Buttons, carding - - - - - - Christmas crackers, etc. 6 - - - - Belts for power transmissions - - " - - - Lampshades 10 - - - - Household Linen - - - - - - Curtain and furniture hangings - - - - - - File making - - - - - - Furniture and upholstery - - - - - - Caning - - - - - - Hampers and Baskets 10 - - - - - Paint Boxes 6 - - - - - Total 293 - - - - - -45- SCHOOL HEALTH SERVICE SCHOOL POPULATION NUMBER OF SCHOOLS NUMBER OF PUPILS ON SCHOOL REGISTERS AT END OF YEAR Nursery 3 271 Primary 78 21,748 Secondary 27 14,115 Special 8 736 Totals - 1972 116 36,870 1971 115 35,848 1970 109 34,196 SCHOOL MEDICAL INSPECTION (a) Periodic Medical Inspections 1972 1971 1970 5 year age group 3,111 2,888 2,766 10-11 year age group 1,346 1,277 1,212 14 years age group 1,529 1,925 1,169 Others 799 633 704 Total 6,785 6,723 5,851 No. of special inspections 1,062 1,380 1,409 No. of re-inspections 5,660 5,461 5,019 6,722 6,841 6,428 (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 171 - 1966 1,334 - 1965 1,606 - 1964 380 - 1963 64 1 1962 128 - 1961 905 - 1960 441 - 1959 73 - 1958 19 - 1957 134 - 1956 and earlier 1,529 - Total 6,784 1 ** Selective Medicals - A total of 571 children were found not to warrant a medical examination. -47- (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 1968 and later 12 24 35 1967 99 115 207 1966 90 167 243 1965 31 30 57 1964 5 7 12 1963 19 27 42 1962 76 119 175 1961 33 52 82 1960 6 6 11 1959 - 2 2 1958 27 19 41 1957 and earlier 254 146 373 Total 652 714 1,280 -48- (d) Pupils found to have undergone tonsillectomy AGE GROUP NO. INSPECTED NO. FOUND TO HAVE UNDERGONE TONSILLECTOMY BOYS GIRLS BOYS GIRLS Infant 1,629 1,482 30 22 Junior 704 642 45 42 Leaver 628 901 35 94 Other 405 394 23 25 Totals 3,366 3,419 133 183 (e) Pupils found to have defects of colour vision INTERMEDIATE INSPECTIONS LEAVER INSPECTIONS OTHERS Tested for Colour Vision 1,346 1,529 799 Found to have defects of colour vision 20 17 4 (f) Parents present at Medical Inspection NO. INSPECTED PARENT PRESENT PER CENT. Infant Boys 1,629 1,444 88.6 Girls 1,482 1,312 88.1 Junior Boys 704 564 80.1 Girls 642 499 77.7 Leaver Boys 628 69 10.9 Girls 901 153 16.9 Other Boys 405 281 69.4 Girls 394 236 59.9 -49- - 50 - (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 TION TREATMENT OBSERVATION TREAT- MEN T OBSERVATION TREATMENT TION 4 Skin 9 44 32 18 57 95 98 157 20 3 5 Eyes (a) Vision 111 137 254 22 287 176 652 335 56 32 (b) Squint 23 19 2 6 17 30 42 55 4 3 (c) Other 1 5 14 3 7 20 22 28 1 1 6 Ears (a) Hearing 22 98 24 20 32 180 78 298 39 38 f (b) Otitis Media 6 23 5 9 13 63 24 95 1 2 (c) Other 10 16 3 3 9 39 22 58 5 3 7 Nose and Throat 11 158 11 17 82 248 104 423 32 29 8 Speech 17 107 1 5 38 82 56 194 10 14 9 Lymphatic Glands 4 39 1 1 4 70 6 110 - 5 10 Heart 3 23 7 9 3 38 13 70 3 3 11 Lungs 9 29 8 4 15 70 32 103 1 12 12 Developmental (a) Hernia 4 8 - 1 10 23 14 32 1 - (b) Other 10 55 12 26 41 141 63 222 32 21 13 Orthopaedic (a) Posture 2 13 7 17 1 1 46 20 76 2 2 (b) Feet 25 63 1 1 17 64 108 100 188 19 11 (c) Other 6 15 1 1 16 16 45 33 76 20 1 3 14 Nervous System (a) Epilepsy 1 4 1 1 2 4 4 9 - 1 (b) Other - 34 3 3 4 22 7 59 6 16 15 Psychological (a) Development 3 40 4 4 2 131 9 175 10 33 (b) Stability 1 119 14 14 4 254 19 387 21 73 16 Abdomen - 22 4 4 4 26 8 52 1 5 17 Other 5 25 1 1 18 20 73 36 1 16 91 16 OTHER MEDICAL INSPECTIONS (a) Employment of children (other than in entertainment) (i) initial examinations 83 (ii) re-examinations 1 (b) Employment of children in entertainment (i) initial examinations 11 (ii) re-examinations 1 EXAMINATIONS BY SCHOOL NURSES Head Inspections Number of examinations 29,482 Number of children found to be unclean 620 Vision Testing at School Number of children tested 20,881 Number referred to Eye Clinic 610 Foot Inspections at School Number of children inspected 921 Number referred for treatment 19 MINOR AILMENT CLINICS New Cases Boys Girls Ringworm - Head - - Body - - Scabies - - Impetigo 1 1 Other Skin Diseases 30 17 Defective Vision and Squint 246 169 Other Eye Defects 8 2 Defective Hearing 252 228 Other Ear Diseases 24 25 Nose and Throat Defects 97 74 Speech Defects 59 31 Lymphatic Giands 24 5 Heart and Circulation 10 18 Respiratory Diseases 21 12 Developmental Defects 123 57 Orthopaedic Defects 73 82 Nervous Disorders 23 27 Psychological Disorders 204 143 Other Defects and Diseases 162 178 1,377 1,069 Total attendances 4,616 -51- SPECIALIST CLINICS 1972 1971 1970 (a) Audiology New cases 226 - - Total attendances 431 - - (b) Aural Sessions 73 66 66 New cases 201 287 240 Total attendances 658 739 791 Referred to hospital for operative treatment 195 231 202 (c) Ophthalmic Sessions 363 360 377 New cases 934 794 974 Attendances 5,060 5,103 6,472 Glasses prescribed 1,220 1,285 1,366 Glasses obtained (i) through H.M.C. optician 864 986 1 ,079 (ii) privately 356 299 287 (d) Orthoptic Sessions 492 461 381 New cases 275 236 216 Attendances 2,134 2,208 1,576 (e) Orthopaedic 76 49 61 New cases 467 437 430 Attendances 1,653 1,543 1,607 Appliances provided 411 489 514 (f) Physiotherapy Sessions 391 534 560 New cases 120 176 190 Attendances 2,141 2,882 2,425 (g) Paediatric Sessions 14 19 20 New cases 66 51 53 Attendances 142 129 141 (h) Child Guidance Cases referred or re-opened for treatment during year:- 602 419 478 Cases closed during year 318 383 315 -52- DENTAL INSPECTION AND TREATMENT (a) Attendances and Treatment AGES 5 TO 9 AGES 10 TO 14 AGES IS AN D OVER TOTALS 1972 1971 1970 First visit 3,919 2,431 393 6,743 7,293 7,763 Subsequent visits 5,91 1 4,823 1 ,002 11,736 11,936 10,704 Total visits 9,830 7,254 1,395 18,479 19,229 18,467 Additional courses of treatment commenced 678 507 86 1,271 569 427 Fillings in permanent teeth 2,527 4,967 1,559 9,053 8,179 9,059 Fillings in deciduous teeth 6,71 1 980 - 7,691 8.186 7,750 Permanent teeth filled 2,046 4,264 1 ,441 7,751 7,036 8,417 Deciduous teeth filled 6,205 930 - 7, 135 7,616 7,355 Permanent teeth extracted 116 505 70 691 1,012 829 Deciduous teeth extracted 2,111 662 - 2,773 3,739 3,242 General anaesthetics 602 231 13 846 1,267 1,287 Emergencies 312 109 22 443 479 418 - 53 -  1972 1971 1970 Pupils X-rayed 623 425 368 Prophy lax is 2,860 3,292 3,1 47 Teeth otherwise conserved 1,061 1,275 1,209 Teeth root filled 42 82 37 Inlays 1 - 4 Crowns 24 64 27 Courses of treatment completed 6,016 5,551 6,137 (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 4 3 8 Numbers of dentures supplied 1 4 1 972 3 1971 8 1970 - 54 - (b) Orthodontics 1972 1971 1970 New cases commenced during year 94 88 75 Cases completed during year 55 71 60 Cases discontinued during year 1 - 4 Removable appliances fitted 104 93 76 Fixed appliances fitted 4 6 5 Pupils referred to Hospital Consultant 28 - 9 (d) Anaesthetics General Anaesthetics administered by:- Dental Officers - . . Medical Officers 846 1,267 1,052 (e) Inspections (i) First inspection at school:- Number of PupiIs 14,635 10,239 13,836 (ii) First inspection at clinic:- Number of pupils 3,493 3,124 3,118 Number found to require treatment 10,269 9,833 10,116 Number offered treatment 9,789 8,746 9,267 (iii) Pupils re-inspected at school clinic 1,065 543 1,290 Number found to require treatment 682 489 664 (f) Sessions Sessions devoted to treatment 3,079 3,229 3,266 Sessions devoted to inspection 92 88 116 Sessions devoted to Dental Health Education 12 37 23 SPEECH THERAPY (a) Attendances HATCH LANE HURST ROAD TOTAL Number in attendance at beginning of year 69 65 11 145 Number under observation at beginning of year 4 32 17 53 New cases 86 58 55 199 Re-admitted - 1 - 1 Transfer from other clinics 1 3 - 4 Discharges - cured 54 34 10 98 - improved 2 3 1 6 - defaulted 14 1 10 25 - transferred to other clinics 1 10 3 14 - left district - 3 - 3 - no progress - - - - Number in attendance at end of year 85 77 10 172 Number under observation at end of year - 31 49 80 (b) Analysis of defects treated HATCH LANE HURST RO A D 1. 2. TOTAL Stammer 9 11 3 23 Dyslalia 1 18 59 20 197 Stammering and dyslalia 4 4 2 10 Delayed language development 17 40 - 57 Cleft palate speech 1 - - 1 Voice defects - 2 1 3 Speech defect due to deafness 4 21 1 26 Defects of neurological origin 3 17 - 20 Unclassified - 5 - 5 New cases referred 266 Attendances during year 5,871 - 55 - HANDICAPPED PUPILS BLIND PARTIALLY SIGHTED DEAF PARTIAL HEARING PHY SI C ALL Y HAN DIC APPED DELICATE MAL ADJUSTED E.S.N. EPI L EPTI C SPEECH DEFECT TOTAL Children newly assessed as capped during year ended 31.12.1972:- Boys - - - 1 5 1 3 30 2 - 42 Girls - - 1 3 1 1 1 23 - - 30 Children who on 25.1.73 were receiving special education treatment:- (i) at maintained special schools:- (a) Day - 10 23 22 37 8 22 371 - - 493 (b) Boarding - 3 - - 1 - 7 2 - - 13 (ii) at non-maintained special schools:- (a) Day - - - - - - - - - - - (b) Boarding - - 1 - 5 2 4 2 2 - 16 (iii) at independent schools - - 1 - - - 7 3 - - 11 (iv) special classes or units - - - - - - - - - - - Children awaiting placement in special schools at 25.1.1973 - - - - 2 - 1 - - - 3 Children who, at 25.1.1973 were being educated:- (i) at hospital - - - - - - - - - - - (ii) at home - - - - - - - 1 - - 1 - 56 - SPECIAL SCHOOLS Brookfield House School for Physically Handicapped Children At the end of I 972 the medical classification of the 76 children on the roll was as follows: Congenital Deformities 6 Cerebral Palsy 25 Cardiac Disabilities 7 Muscular Dystrophy I Haemophilia 2 Perthes Disease 4 Spina Bifida 3 Asthma 6 Fragilitas Ossium 4 Osteomyelitis 2 Still's disease 2 Poliomyelitis 2 Epilepsy 2 Amytonia congenita 2 Miscellaneous 8 Jospeh Clarke School for Partially Sighted Children The ophthalmic condition on admission of the 88 children who attended the school during 1972 were as follows:- Albinism 8 Aniridia 8 Cataracts 22 Anterior Synechia 1 Detached Retina 1 Dislocation of the Lenses 2 High Myopia 8 Iridocyclitis 3 Microphthalmos 2 Nystagmus 12 Optic Atrophy 10 Retinal Degeneration 1 Retinoblastoma 1 Damage to visual cortex 1 Coloboma 2 Macular degeneration 1 Optic nerve glioma 1 Glaucoma 1 Retinitis pigmentosa 2 Retrolental fibroplasia 1 William Morris School for the Deaf Of the 87 children on the roll at the end of the year 72 were classified as deaf and 15 as having partial hearing. - 57 - HOUSING (a) Contributed by N.P.Astins, Esq., A.R.I.B.A., Borough Architect. 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. (b) Contributed by H.Thorne, Esq., A.I.H.M., Borough Housing Manager. Properties under management at 31.12.72 18,361 Properties made available for letting during 1972 I ,856 Number of families rehoused during 1972 1,822 - 59 - Dwellings completed during 1972 FLATS HOUSES By the Local Authority 513 17 By Private Enterprise 80 38 By Housing Associations 60 - 653 55 IMPROVEMENT GRANTS Applications received 2,122 DISCRETIONARY STAN DA RD Total number of grants approved 498 248 Total amount of grants approved £263,002 £46,895 - 60 - METROPOLITAN WATER BOARD - WATER EXAMINATION DEPARTMENT AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE LONDON BOROUGH OF WALTHAM FOREST DURING 1972 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) (M) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) Thames-derived 364 0.031 0.069 6.9 1.06 - 274 82 5 24.5 5.5 35 2.8 10 58 0.15 0.02 0.1 13 7.9 570 Chingford MiII 4 0.23 0.030 0.8 0.30 - 288 72 17.0 27 0.45 0.1 6 7.3 550 CoppermilIs 52 0.019 0.100 8.9 1.36 - 309 96 6 34.6 7.3 50 4.0 10 72 0.17 0.02 0.1 14 7.9 680 - 61 - BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1972 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 Eschericia coli count Agar plate count per ml. Col iform count E. coli count 20-24 hours at 37° C. 3 days at 22• C. Per cent, samples negative in 100 ml. Count per 100 ml. Per cent, samples negative in 100 ml. Count per 100 ml. Number of samples 20-24 hours at 37° C. 3 days at 22° C. Per cent, samples negative in 100 ml. Per cent, samples negative in 100 ml. Chingford Mill 251 0.2 12 99.60 - 100.0 - 251 0.1 13 100.0 100.0 Thames-derived 8,087 42.3 41.94 10.2 56.76 4.0 3,891 10.0 99.85 99.97 Coppermills 994 82.2 41.65 17.2 61.89 2.6 255 9.4 100.0 100.0 INDEX A Pages Animal Boarding Establishments Act 1963 35, 41 Ante-Natal Clinics 24 Audiology 52 Aural Clinics 52 B B.C.G. Vaccination 34 Births 21, 23 Births - Congenital abnormalities 27 Brookfield House School for Physically Handicapped children 57 Business premises, registration and licensing of 40 C Cancer 7, 23 Caravan Site Act 1968 16 Causes of Death 22 Cervical Cytology 27 Child Guidance Clinics 52 Child Health 10 Child Welfare Clinic Attendances 25 Children "At Risk' 27 Children, dental treatment of 12, 27 Children, handicapped 56 Chingford Red Cross 29 Chiropody Treatment 30 Cigarette Smoking 7 Clean Air Act I 956 35 Committee 1 Community Disease 7 Compulsory Purchase Orders 36 Condemned meat and food 43 Congenital Malformation 27 D Deaths 21, 22 Deaths - Causes of 22 Deaths - from Cancer 7, 23 Dental Laboratory 34 D (cont.) Pages Dental Service 12,27,34,53,54 District Nurses 16,29 E Environmental Services 14 Essex County Council Act 1933 - Establishments for Massage and Special Treatment 30 Examinations by School Nurses 51 Expectant and Nursing mothers, dental treatment 27 F Factories Act 1961 35,44 Families Rehoused 59 Family Planning 28 Food Inspection and Sampling 16,43 Food and Drugs Act 1955 35,37,41,42,43 Food and meat condemned 43 Food Hygiene Regulations 35,37,40,41,42, 43 Food Poisoning 31 G Gypsies 16 H Handicapped Children 56 Health Committee 1 Health Visiting 18,28 Home Nursing 29 Housing 14,59 Housing Acts 1957/72 36 Housing Associations 59 Housing Surveys 14 i Immigrants, tuberculosis among 32 Immunisation and vaccination 33 Improvement Grants 59 Incontinent Laundry Service 30 I (cont.) Pages Infectious Diseases 7,31 Infant Mortality 21 Infants and Toddlers Clinics 25 Infants, premature 23 J Joseph Clarke School for Partially Sighted Children 57 L Laundry for the Incontinent 30 M Massage and Special Treatment, establishments for 30 Maternal Mortality 21 Medical examinations of staff 32 Medical inspections, school 47 Medical inspections, other 51 Midwifery 17, 24 Milk and Dairies (General) Regulations 1959 41 Milk (Special Designation) Regulations I960 41 Minor Ailments Clinics 51 Mortality Rates 21 Mothercraft and Relaxation Classes 27 N Noise Abatement Act I960 35 Nursing Homes, registration of 30 Nursing Services 17 0 Offices, Shops and Railway Premises Act 1963 15,35,38 Ophthalmic Clinics 52 Orthopaedic Clinics 52 Orthoptic Clinics 52 Outwork 45 P Paediatric Clinics 52 P (cont.) Pages Pet Animals Act 1951 35,41 Physiotherapy Clinics 52 Population 8,21 Population - School 47 Premature Infants, care of 23 Prevention of Damage by Pests Act 1949 35,40 Public Health Acts 35,40,42 Public Health Act I 936 - registration of Nursing Homes 30 Public Health Inspection 35 Q Qualification Certificates37 R Rainfall 20 Red Cross, Chingford 29 Redevelopment and Slum Clearance 36 Registration of Premises 40 Riding Establishments Act 1970 41 S School Dental Service 12,53 School Health Service 47 School Medical Inspections 47 School Population 47 Sewerage 20 Sickroom Equipment 29 Slum Clearance and Redevelopment Schemes 36 Specialist Clinics 52 Special Schools 57 Speech Therapy 55 Staff 2,3 Staff - Medical Examinations 32 Statistics 21 T Tuberculosis 7,31,32 V Vaccination and Immunisation 33 V (cont.) Pages Venereal Disease 7 Vital Statistics 21 W Water Supplies 19, 60, 61 Welfare Foods and Nutrients I 1, 26 William Morris School for Deaf 57