Ac44113 EAS 39 COUNTY BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report ON THE Health and Sanitary Condition of the Borough, AND THE REPORT TO THE EDUCATION COMMITTEE. BY W. BENTON, M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health. Medical Superintendent of the Borough Hospital. Medical Ofiicer to the Education Committee. Medical Officer Maternity and Child Welfare Centre. Medical Officer to Committee for Care of the Mentally Defective. Chief Tuberculosis Officer. TOGETHER WITH THE REPORT OF THE CHIEF SANITARY & FOOD INSPECTOR. For the Year ended 31st December, 1920. RECORDERS, EAST HAM. COUNTY BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report ON THE Health and Sanitary Condition of the Borough, AND THE REPORT TO THE EDUCATION COMMITTEE. BY W. BENTON, M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health. Medical Superintendent of the Borough Hospital. Medical Officer to the Education Committee. Medical Officer Maternity and Child Welfare Centre. Medical Officer to Committee for Care of the Mentally Defective. Chief Tuberculosis Officer. TOGETHER WITH THE REPORT OF THE CHIEF SANITARY & FOOD INSPECTOR. For the Year ended 3ht December, 1920. RECORDERS, EAST HAM. 1921. To His Worship the Mayor, the Aldermen, and Councillors of the County Borough of East Ham. Ladies and Gentlemen, I beg to submit the Annual Report of the work carried out by the Public Health and School Medical Department for the year 1920. I am pleased to note that although there is still much overcrowding in the Borough, which accounts for the large number oj infectious diseases through insufficient isolation, the health of the district is good. The following is an extract from the Registrar General's Report for 1919 :— "As might be expected the highest places in both tables (xxxiii. and xxxiv.) are occupied for the most part by residential towns, but the position of East Ham, eighth for the mortality of the first twelve months and fifth for that of the first four weeks out of the whole 82 County Boroughs, shows what results may be obtained in a working class community. The conditions here, of course, differ materially from those of the more common case where the areas of industry and, of residence coincide; and the habitually low rates returned by this and neighbouring residential working class suburbs of London are of good omen for the success which may be achieved elsewhere by improvements in town planning and transport. " The position of East Ham in 1918 was also similar." East Ham might well, with such conditions of low death and Infantile Mortality rates, be classified as a " Health Resort." The ever-increasing duties caused by legislation during the past years have greatly increased the duties of the present Staff, and although it has been a big task they have been successfully carried out. During the war the report was diminished at the request of the Local Government Board, but the Ministry of Health now require more detail to be inserted. In connection with Maternity and Child Welfare excellent work has been carried out, but it is an urgent necessity that beds should be provided for maternity cases, and I trust that if the suggested purchase of the Cottage Hospital should not mature, other accommodation will be provided. There has been delay in the completion of " Harts " as a Sanatorium, hut I hope this year will bring better results, and we shall then be able to deal more efficiently with Tuberculosis. We were seriously threatened with an epidemic of Small-pox, introduced from abroad, but owing to energetic action on the part of the Department the cases were limited to the three families directly infected. I regret the Council did not proceed with the proposed Cleansing and Disinfecting Station for dealing with verminous children and sufferers from Scabies, as this would have been a great asset to the Borough, and loss of attendance at school and much suffering would have been obviated. It was stated that it was degrading to the parents, but if it is not considered degrading to the parents in the West End of London, it surely coidd not be considered to be such in this district. In a report to the Education Committee in September, 1911, I pointed out the necessity of providing a suitable, Cleansing Station for dealing with such cases. Further, the present method of disinfection of clothes of persons who have been suffering from Infectious Diseases, Tuberculosis, etc., is unsatisfactory. 1 wish to thank the Chairman and Members of the Committee for their sympathy and support in the past, and to point out that I fully appreciate that with the present high rates strict economy must be practised even in the Public Hecdth Department, but not to the detriment of the health of the Borough. 1 also beg to thank all the members of my Staff for their continued loyal support. I am, Ladies and Gentlemen, Your obedient Servant, W. BENTON, Medical Officer of Health. Town Hall, East Ham, E. 6. April, 1921. EAST HAM CORPORATION. PUBLIC HEALTH COMMITTEE. The Mayor (Councillor G. P. Dean, J.P.)* ‡ The Deputy-Mayor (Councillor A. Stokes).*‡ Alderman O. R. Anstead, J.P.‡ (Chairman M.D. Committee). Alderman J. Brooks, J. P. (Chairman, Public Health Committee). Alderman E. Edwards, J.P.* Alderman C. Northfield, J.P. Alderman H. Osborn, J.P.‡ Councillor A. Ali.wright.* + Councillor R. Banks-Martin, J.P. Councillor A. Cot.es* (Chairman, M4 and C.W. Committee). Councillor W. G. Davie* Councillor J. Evans. Councillor \V. K. Fennell.* Councillor W. C. Ford, J.P. Councillor G. Mitchell. Councillor V. R. Oliver. Councillor F. Smith. Councillor J. A. Williams, J.P. Councillor A. H. Wiseman, J.P.*+ MATERNITY AND CHILD WELFARE COMMITTEE Miss Davibs. Mrs. Locke. Mrs. Dean. Mrs. Norman Mrs. Grout. Mrs. Papworth. Mrs. Wright. COMMITTEE FOR THE CARE OF THE MENTALLY DEFECTIVE. Mrs. R. Banks-Martin. Mrs. W. C. Ford. Councillor T. M. McGiff. Also members of the M. and C.W. Committee.* Also members of the M.D. Committee.‡ STAFF OF THE PUBLIC HEALTH DEPARTMENT. Clerks: Miss G. Bone, W. Lank, H. G. Luckett, G. W. Friend. F. J. Kendall, A.R.San.I., Chief Clerk. Tuberculosis Nurses: Miss L. E. Mallon and Miss E. E. Cook. Dispensary Clerk: Miss V. Reid. Health Visitors: Miss K. Bower, Mrs. A. Woodman, M.R.San.I., Miss Alderman, Miss L. Baiuiett, Miss C. Cox and Miss A. E. O'Leary. Child Welfare Clerk: Miss M. A.McCall. Inspector uf Mid wives: Miss K. Bower. Assistant Inspectors: R. A. Baskett, W. S. C. Tooby, W. J. Worley. Sanitary and Food Control Inspectors: M. J. J. Hillyard, M.S.I.A., J. G. Anderson, M.S.I.A., G. D. Lill, M.S.I.A. Matron uf Isolation Hosjntal: Miss M. E. Wij.kins. Assistant Matron : Miss A. F. Hindle. Veterinary Inspector: H. J. Parkin, M.R.C.V.S. Chief Sanitary a.- Food Inspector and Inspector Contagious Diseases (Animals) Act: Joseph G. Banks, A.R.San.I., M.S.I.A. Assistant Medical Officer, Maternity and Child Welfare: S. Eleanor Hill, M.D.Lond. Deputy Medical Officer of Health and Senior Assistant School Medical Officer: D. S. Bkouch, M.C., M.B., Ch.B., D.P.H. Medical Officer of Health, School Medical Officer, Medical Superintendent Isolation Hospital, Chief Tuberculosis Officer, Medical Officer Maternity and Child Welfare Centre and Medical Officei to Committee for Care of Mentally Defective: W. Benton, M.R.C.S., L.R.C.P., D.P.H. 6 Summary of Report for 1920. Population, Census 1911, 133,487. Estimated Population for death-rates, mid 1920 (Registrar- General), 150,207. Estimated Population for birth-rates (Registrar-General), 150,363. Acreage, 3,326. Persons per acre, 45. Inhabited Houses, Census 1911, 24,263. Births, 3,489. Birth-rate per 1,000 of the estimated population, 23.2. Deaths, 1,479. Death-rate per 1,000 of the estimated population, 9'8. Excess of births over deaths, 2,010. Zymotic death-rate, 0.57. Infantile Mortality per 1,000 births, 64. Water Supply—Metropolitan Water Board. COMPARATIVE STATISTICS. Annual Rate per 1,000 Living. Rate per 1,000 registered Births. Births. Deaths. Diarrhoea & Enteritis. (under 2 years.) Infant mortality. England & Wales 25.4 12.4 8.3 80 96 Great Towns 26.2 12.5 10.4 85 London 26.5 12.4 9.5 75 EAST HAM 23.2 9.8 6 .3 64 7 COUNTY BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. REPORT OF THE MEDICAL OFFICER OF HEALTH For the year 1920. NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. Population. The population of the Borough at the Census of 1911 was 133,187, and the present estimated population 150,207. Social Conditions. East Ham is chiefly a residential district. A large part of the population consisting chiefly of clerks, warehousemen, mechanics, postal officials anri others, travel to London for their daily work. Transport. East Ham is we'll supplied with transport by means of the District, Midland and Great Eastern Railways, also by a through service of trams and motor omnibuses. Industries. The local industries are the Beckton works of the Gas Light and Coke Company, Royal Albert Docks of the Port of London Authority, a firm of wholesale druggists, manufacturers of ladies' wearing apparel, artificial flower workshops, and laundries, but none of these appear to have any influence on the public health of the Borough. Offensive Trades. Several attempts have been made to establish offensive trades but I am pleased to note that the Council have refused permission. No licence has been granted for any of these trades to be carried on in the Borough. 8 Poor Law Relief. Poor Law relief is undertaken by the West Ham Board of Guardians. The Clerk of the Guardians gives the following information :— Amount of Out-door Relief granted to persons resident in the Borough of East Ham during the year ended 31st December, 1920, was ^16,034. Hospitals. At the Passmore Edwards Hospital in Shrewsbury Road casualties are treated, but a scheme is proposed to build a large General Hospital close to the present site. Local medical practitioners send a number of their patients to various London Hospitals for special treatment. PHYSICAL FEATURES AND GENERAL CHARACTER OF THE DISTRICT. Boundaries. East Ham is classified as one of the 96 great towns of England and Wales. It is bounded on the north by Wanstead, south by the River Thames, adjoins West Ham on the west, llford and Barking on the east. Acreage. The acreage is 3,326. Subsoil. t The subsoil is sand and gravel, with the exception of a portion in the south of the Borough, where it consists of alluvium overlying London clay. Altitude. The altitude is low, the highest point being about 50 feet above ordnance datum. Climate. The climate' is mild. 9 SANITARY CIRCUMSTANCES OF THE DISTRICT. Water Supply. Water is supplied by the Metropolitan Water Board, and is of excellent purity. Most of the houses now have a supply from the main, and of sufficient quantity. Rivers and Streams. Apart from the Thames there are few watercourses in the Borough, and the only trouble experienced is in connection with the ditches in the southern end of the Borough in the region of the Docks. Drainage and Sewerage. The? drainage of the Borough is on the separate system, the surface water flowing to the water course and the sewage to the Council's own Works and Pumping Station. The sewage at first passes through a screening chamber into a pump-well beneath the engine house, from which it is pumped into precipitation tanks, where it is treated with lime (9 grains to each gallon of se'wage). There are two continuous-flow precipitation tallies. Only one tank is in use at a time during dry weather. The effluent from these tanks is treated with Ferric sulphate in liquid form (4. 7 grains per gallon of sewage). It then flows into one of the three quiescent tanks and is allowed to rest for two or three hours, and afterwards pumped on to the bacteria beds. The effluent from the bacteria beds flows through a humus basin to allow suspended matter to settle, and is finally discharged into the River Roding, a tidal tributary of the Thames. The effluent is frequently analysed, and no complaints have been made during the year as to its character. It contains very little trade effluent. Closet Accommodation. This consists of water closets- Scavenging. The collection of House Refuse is carried out weekly and is carted partly by Electric Motor Vans, and otherwise by contract with Horse Carts, to the Destructor which adjoins the Sewage Disposal Works. The heat of combustion arising therefrom is applied to the generation of steam required for the Works. Where a dustbin is not provided a notice is served upon the owner of the property to supply one. 10 Sanitary Inspection of District. The general inspection of the district, especially house-tohouse inspection, was lessened during the period of the war, and a large amount of property was very much neglected, but with an increase of Staff much progress has been made during the past year, although there is still much difficulty owing to lack and cost of material, in obtaining the desired results. The details of this Department's work are given on pages 86—90. Other Conditions -Public Baths. The covered-in Public Swimming Bath is much appreciated. The swimming pond is 120 ft. by 40 ft. For a distance of 30 ft. from the shallow end it has a uniform depth of 3 ft., the remainder ranging from 3 ft. to 6 ft. 9 in. at the deep end, the deepest portion being 8 ft. 6 in. over the outlet. There are three shower baths and two foot baths, with urinal and w.c. accommodation. The slipper baths and vapour baths are also well patronised. There is no doubt that besides serving the purpose of instruction in swimming, the bath will promote cleanliness and good health. Public Urinals. There are 16 public urinals in the Borough, which arc inspected periodically and found to be satisfactory. Destruction of Rats. Every effort has been made during the year in this direction, but the close proximity of the docks makes it difficult to keep them under control. A Rat-catcher has been employed to wage war on the rats which infest the sewage works, Isolation Hospital, and a few houses. Smoke Nuisance. Fortunately for the health of the Borough we have few factories, so that few complaints are made of this nuisance. SANITARY CONDITION OF THE SCHOOLS. The Medical Officer of Health is also the School Medical Officer, thus close co-operation between the Public Health Department and School Medical Service. 11 There is still room for improvement in some of the older schools of the Borough, but am afraid that with the high education rate and high cost of work further improvement will have to be postponed. The sanitary accommodation in most cases is satisfactory, and the water supply is good, but the lighting, ventilation and heating is in some schools unsatisfactory. When a number of infectious diseases is noted to have occurred at a certain school, visits of inspection are made to ascertain if a " carrier " is present spreading the infection, and " swabs " taken from suspicious throats and noses, or in cases of Scarlet Fever any children who may have been away from school on account of illness examined for any signs of desquamation. It is often that a child may have a slight illness and no medical man called in, and the child returning to school shortly after found to have had a mild attack of Scarlet Fever. The teachers have rendered assistance by the notification of any suspicious cases. It has not been found necessary to close any of the schools for infectious diseases being prevalent, but a number of class rooms have been disinfected when cases have occurred. I have, in my previous reports, drawn attention to the danger of the common drinking cup in the schools, and advised the installation of a drinking spray. VITAL STATISTICS. BIRTHS. During the year 3,489 births were registered (males 1,827, females 1,662), as against 2,449 in 1919, giving a birth-rate of 23.2 per 1,000 population. The rate for England and Wales was 25.4, for the 96 great towns 26.2; and for London 26.5. 12 illegitimate Births. Forty-three of these were registered. DEATHS. ' The number of deaths during the year was 1,479, of which 421 were of persons of 65 years and upwards, giving a rate of 9.8. 576 deaths were! reported of persons belonging to the Borough which had taken place in Institutions outside the district. The death-rate for England and Wales was 12.4, for the 96 great towns 12.5, and for London 12.4. INQUESTS. 120 inquests were held, 49 deaths being attributed to violence. INFANTILE MORTALITY. 224 deaths of infants under 1 year of age occurred in the Borough, giving a rate of 64 per 1,000 births registered as compared with 73 per 1,000 in 1919. Rate for Legitimate Children, 62 per 1,000 births registered. Rate for Illegitimate Children, 186 per 1,000 births registered. The number of infant deaths and the rate per 1,000 birth for the past five years were as follows :— Year. Number of Infant Deaths. Rate per 1,000 Births Registered. 1916 245 77 1917 221 85 1918 154 69 1919 179 73 1920 224 64 The infant mortality rate in the 96 large towns of England and Wales was 85 per 1,000 births. 13 STATEMENT SHOWING THE WORK NOW BEING CARRIED OUT IN CONNECTION WITH THE SCHEME FOR MATERNITY AND CHILD WELFARE. Number of notified births 3,154 Number of un notified births 447 Number of deaths under one month of age 101 Number of deaths under one year of age 224 Number of still-births notified 60 Number of first visits to houses where births had been registered 4,005 Number of re-visits to houses where births had been registered 8,797 Number of first visits to ante-natal cases 237 Number of re-visits to ante-natal cases 200 Special visits 289 Number of attendances at Infants' Clinics l5,789 During this year owing to the increase in the number of mothers and babies attending the Infant Consultations, and the consequent overcrowding of rooms at the White House, it was found necessary to limit, to a certain extent, the number of visits of healthy infants, until suitable premises could be found for opening a branch centre in the northern part of the Borough. Rooms being available for one afternoon a week at St. Michael's Institute, Manor Park, it was decided to start holding Infant Consultations there on Tuesdays from 2 to 4 p.m., and since September there has been a large number of attendances at this centre. There is also a small branch centre at North Woolwich, for which more comfortable quarters have recently been secured in St. John's Church Schools. The number of expectant Mothers attending the Ante-natal Clinic has increased, the total being 187, of which 108 were new cases. A large proportion of these wished to go into a Maternity Home, and had to be referred to West Ham Hospital, or the Plaistow Maternity Charity Lying-in Home at West Ham. The Council having decided to purchase the Cottage Hospital in Shrewsbury Road, it is proposed to open it as a permanent 14 nity and Child Welfare Centre, with a Maternity Home of 12 beds, accommodation for the latter being in the northern wing of the building. The resignation in June of Miss Buckton, who had been a most energetic and successful Health Visitor for the past 5 years, was felt to be a serious loss to the work. The appointment of Miss O'Leary in July brought the number of the Health Visitors again to six, but this number is hardly sufficient to cope with the work, and will need to be increased in the near future. The Matron of the Day Nursery resigned on account of illhealth in July, and an entirely new Staff has been appointed. The unsuitability and inadequacy of the house in which the Day Nursery is at present lodged, make it impossible to maintain a proper standard of hygiene, and a better building is urgently needed for the purpose. Milk (Mothers and Children) Order, 1918. Dried Milk has been supplied at cost price for children attending the Maternity and Child Welfare Centre, and fresh milk to expectant and nursing mothers, and for infants free of charge in necessitous cases. £1,800 were provided in the estimates for this purpose, but it is estimated that this amount will be exceeded in the coming year owing to increasing unemployment. The following scale of economic circumstances was adopted by the Council :— Mothers and infants receive meals or milk when the net income per head of the family per week comes within the following scale :— Net income per head of the family per week, Mat. and No. in family. Child Welfare Scale s. a. Two 10 0 Three 8 0 Four 7 6 Five 6 6 Six or over 6 0 Method of Calculation. The net income per head of a family is defined as the income less outgoings divided by the number in family. 15 Income. income as calculated under the following heads :— (a) Wages—(1) Parents' or guardians' weekly wage, the average for four weeks being taken. the earnings of children under 14 years. (b) Lodgers—Children over 14 years of age working are reckoned as lodgers. Income from lodgers is reckoned on the following basis :— Payment received per Proportion reckoned w«-ek from Lodgers. as income. Up to 12s. Nil. Over 12s. 50 per cent, of surplus over 12s. (c) Letting—The whole amount received is taken as income. Outgoings. Outgoings include : (a) rent; (b) insurance ; (c) fares to and from work ; and (d) care of children away from home. Number in Family. The number in family is taken to be the parents or guardians or older sisters looking after the home and not working, and children under 14 years. Where the income is below the scale, milk is supplied free. Where the income is not more than 2s. per head above the scale, half the necessary quantity of milk is supplied free. Applications are made on the form given below, and if any doubt arises as to the income being correct, information is obtained from the Employers. Note.— The application and the statements therein must be signed as correct by the Husband and Wage-earner, as well as the Mother herself, and particular attention is drawn to the warning clause. Proceedings will be taken in fraudulent cases. Surname Address Occupation of Husband (Wage-earner) Name and Address of Employer Rent Insurances (amounts) Income from ALL sources (total) (Casual workers to give details of earnings during past month.) 16 Amount allowed to Wife for housekeeping expenses simply Special circumstances:—Loss of work, or illness of parents or children (state if expectant mother) Number of Children Give ages We have EACH read over this statement, declare same to be correct, and, in witness thereof, have EACH signed same. (Signed) (Husband, or Wage-earner) (Signed) (Mother) Date Milk provided under this arrangement must not be used for any other purpose, or Police Court proceedings will be taken in the matter. WARNING.— As instances have occurred of understatement of means, it is imperative that the above be read over carefully and no false statement made, as this signed document will be produced as evidence. Changed circumstances to be intimated. Milkman's Name and Address CERTIFIED to be required and case to be necessitous, Medical Officer oj Health. MIDW IVES' ACT. Fifty-nine midwives notified their intention to practise in the Borough during the year 1920. Forty of these were attached to the Plaistow Maternity Charity and its branches at East Ham and North Woolwich, and eight to Sir Henry Tate's Nurses' Home, Silvertown, the remain ing eleven practised independently. Of these latter, three left the neighbourhood, two withou having practised as midwives. One case of puerperal fever was reported among the case: attended by midwives. Forty-three visits were paid for the inspection of bags an( records. 17 297 records of sending for medical help were sent in. For the Mother :— Ruptured Perineum. Prolonged Labour. Malpresentations. Retained Placenta and Membranes. Fits. A. P. H. P. P. H. Rise of Temperature. Inflammation of Breasts. Puerperal Fever Other Causes. 80 48 14 10 3 9 4 17 s l 19 For the Infant :— Dangerous Feebleness. Deformities. Dis. from Eyes. Ophthalmia Neonatorum. Injuries. Artificial Feeding. Deaths. Chief Causes. 42 8 14 4 1 6 4 10 NOTIFIABLE INFECTIOUS DISEASES. 1,281 cases of Infectious Disease were notified during the year. Small Pox. Ten cases of this disease occurred, with 3 deaths. Scarlet Fever. 718 cases of this disease were notified during the year as against 530 in 1919. One death occurred from the disease. 365 cases were removed to the Isolation Hospital. Diphtheria. 426 cases of this disease were notified with 18 deaths. 451 cases were notified in 1919 with 29 deaths. 380 cases were removed to the' Isolation Hospital. Enteric Fever. Ten cases of Enteric (Typhoid) Fever were notified, with 4 deaths, 18 Erysipelas. 72 case's of Erysipelas were notified, the same number as the previous year. There were six deaths. Ophthalmia Neonatorum. During the year 30 cases were notified. Puerperal Fever. Six cases of this dise'ase were notified, the same number as the previous year. Epidemic Cerebro-Spinal Meningitis. Three cases of this disease (commonly known as Spotted Fever) were notified, with 2 deaths. Acute Polio-Myelitis. One case was notified, which proved fatal. Acute Encephalitis Lethargica. Five cases notified, with two deaths. Typhus Fever. No case was notified. Tuberculosis. The number of deaths from Tuberculosis was 158, as compared with 129 in 1919. The following table shows the number of deaths from Pulmonary and other forms of Tuberculosis :— Pulmonary Tuberculosis (Phthisis) 131deaths Tuberculosis of the Brain (Meningitis) 8deaths Other forms of 'Iiberculosis 19 deaths 19 Under the Public Health (Tuberculosis) Regulations the total number of notifications received was Tuberculosis (Pulmonary) 242 as against 258 in 1919 Tuberculosis (Other Forms) 68 as against 74 in 1919 310 332 The overcrowding in the Borough gives rise to difficulties in the isolation of cases of Tuberculosis at home as in other infectious diseases, and, in my opinion, will certainly increase the number of cases in the future; but with the shortage of houses, suitable accommodation cannot be obtained. I was recently informed of a case where a father who had advanced Tuberculosis, actually had to sleep in the same room as his wife, with other children, and, further, the wife was expecting to be confined in the same room, as no other room was available. THE HARTS SANATORIUM, WOODFORD GREEN. The provision of beds at " Hart's," opened in October, completes the scheme for treatment of Tuberculosis of the Lungs. Fifty beds have been provided—20 being reserved in the Administration Block for advanced or bed cases, a converted Army hut for 24, and 6 revolving shelters for 6 early cases of the disease. A further 24 beds will be provided in the permanent pavilion which is about to be erected. A few children have been admitted suffering from nonpulmonary tuberculosis, viz., glands, spine, and joints—but to complete the scheme for all cases of Tuberculosis, I should advise an open-air residential school to be erected in the grounds, where such cases could be treated and educated at the same time. We have a large number of pre-tubercular children attending the Tuberculosis Dispensary who would receive much benefit by such treatment and eventually reduce the number of cases of Tuberculosis. The lesident Medical Officer is also the Tuberculosis Officer in charge of the Tuberculosis Dispensary. He is, therefore, able to admit tho'se he thinks will benefit by Sanatorium treatment and to keep in contact with the patients after discharge, which is most satisfactory from every point of view. 20 TUBERCULOSIS DISPENSARY. The work of the Tuberculosis Dispensary is becoming more important each year. Its primary object is to get into touch with all cases of Tuberculosis arising in the Borough—to investigate the home conditions and arrange for the examination of relatives and friends residing in close contact with the sufferers. In this way early cases of the disease may be detected and other individuals presenting suspicious signs kept under careful observation. The Dispensary should not be entirely for the general treatment of the disease, but a consultative centre, where advice is given, arrangements made for the future welfare, treatment and observation of the patient. With Harts Sanatorium a combined scheme is possible, the: results of which appear most favourable. The advantage to the patient is that after observation at the Dispensary he can be sent to the Sanatorium, where he is under the supervision of the same medical officer. Upon discharge he again attends the Dispensary and thus there is no break in the continuity of his treatment. This ideal arrangement presents great advantages over those of other Boroughs where there is no direct connection between the Dispensary and Sanatorium. A large number of the younger patients at present can be classified as pre-tubercular; these are seen at the Dispensary on a separate day at stated intervals. Recently, owing to the more stringent requirements of the Ministry of Pensions the work dealing with ex-service men has been greatly increased. Also, possibly on account of the medical inspection of school children and the greater interest in Tuberculosis generally, the attendances at the Dispensary have been considerably greater. The real value to' the community at large lies in the extent to which the Dispensary deals with those suspicious cases, the majority of which have been in contact with persons diagnosed as suffering from the complaint. Its object would, therefore, be defeated should the early and suspected case of disease be ignored owing to stress of other work. 21 REPORT ON THE WORK OF THE TUBERCULOSIS DISPENSARY FOR THE YEAR 1920. N umber of patients on treatment, December 31st, 1919, 680:- Insured. Un-insured. Children. Males. Females. Males. Females. Males. Females. 276 74 27 137 83 83 Number removed during the year ending December 31st, 1920, 262 Insured. Un-insured. Children. Males. Females. Males. Females. Males. Females. 126 31 14 69 9 13 97 of these have died, 26 left the district, 139 have been removed from the Register for other causes. Number added during the year 1920, 308 (228*):— Insured. Un-insured. Children. Males. Females. Males. Females. Males. Females. 124 39 10 62 34 39 * 13 of these were ex-service men notified to, but not diagnosed at the Dispensary. 67 were re-admissions. Number remaining on treatment December 31st, 1919 :— Pulmonary, 643. Non-Pulmonary, 83. Total, 726. Insured. Un-insured. Children. Males. Females. Males. Females. Males. Females. 274 82 23 130 108 109 The following tables show treatment being received by the patients on Register, December 31st, 1920. Number of patients attending Dispensary for treatment, 399 :— Insured. Un-insured. Children. Males. Females. Males. Females. Males. Females. 142 43 17 87 58 52 Number of patients receiving Domiciliary treatment, 88 :— Insured. Un-insured. Children. Males. Females Males. Females. Males. Females. 58 17 6 6 3 4 Number of patients receiving Sanatorium treatment, 65 :— Insured. Un-insured. Children. Males. Females. Males. Females. Males. Females. 32 5 2 11 9 6 Number of patients attending for Observation, 174 :— Insured. Un-insured. Children. Males. Females. Males. Females. Males. Females 42 17 4 28 38 47 Number of deaths from Pulmonary Tuberculosis on Register of Dispensary during 1919, 49 :— Insured 41. Un-insured 7. Children Males, T. B. .+ 27 Males, T. B. + 0 Males, T. B. + 0 Males, T. B. — 4 Males, T. B. — 0 Males, T. B. — 0 Females, T. B. + 0 Females, T. B. + 6 Females, T. B. + 0 Females, T. B. — 10 Females, T. B. — 1 Females, T. B. — 1 Number of these who have attended for the first time and died during the same year, 23 :— Insured 15. Un-insured 7. Children 1. Males, T. B. + 5 Males, T. B. + 0 Males, T. B. + 0 Males, T. B. — 0 Males, T. B. 0 Males, T. B. — 0 Females, T. B. + 9 Females, T. B. + 6 Females, T. B. + 0 Females, T. B. — 1 Females, T. B. — 1 Females, T. B. — 1 Number of deaths from Pulmonary Tuberculosis on Register of Dispensary during 1920, 92 :— Insured 74. Un-insured 17. Children 1. Males, T. B. + 49 Males, T. B. + 1 Males, T. B. + 0 Males, T. B. 13 Males, T. B. 2 Males, T. B. 0 Females, T. B. + 9 Females, T. B. + 8 Females, T. B. + 1 Females, T. B. — 3 Females, T. B. — 6 Females, T. B. — 0 Number of these who have attended for the first time and died during the same year, 14 Insured 13. Un-insured 1. Children 0. Males, T. B. + 11 Males, T. B. + 0 Males, T. B. + 0 Males, T. B. - 1 Males, T. B. — 0 Males, T. B. — 0 Females, T. B. + 1 Females, T. B. + 1 Females, T. B. + 0 Females, T. B. — 0 Females, T. B. — 0 Females, T. B. — 0 Number of deaths from Non-pulmonary Tuberculosis on Register of Dispensary during 1920, 5 :— Insured 4. Un-insured 0. Children 1. Males 3 Males 0 Males 0 Females 1 Females 0 Females 1 Number of these who have attended for the first time and died during the same year, 3 :— Insured 2. Un-insured 0. Children 1. Males 2 Males 0 Males 0 Females 0 Females 0 Females 1 22 23 Number of patients who left the district during 19-19, 2l : — Insured 17. Un-insured 3. Children 1. Males, T. B. + 7 Males, T. B. + 4 0 Males, T. B. + 0 Males, T. B. — 2 Males, T. B. 0 Males, T. B. 0 Females, T. B. + 8 Females, T. B. + 0 Females, T. B. + 0 Females, T. B. — 5 Females, T. B. — 3 Females, T. B. — 1 Number of these who have attended for the first time and left the district during the same year, 2 :— Insured 2. Un-insured 0. Children 0. Males, T. B. + 0 Males, T. B. — 0 Males, T. B. + 0 Males, T. B. — 1 Males, T. B. — 0 Males, T. B. — 0 Females, T. B. + 0 Females, t. B. + 0 Females, T. B. + 0 Females, T. B. — 1 Females, T. B. — 0 Females, T. B. — 0 Number of patients who left the district during 1920, 26 : — Insured 19. Un-insured 7. Children 0. Males, T. B. + 7 Males, T. B. + 1 Males, T. B. + 0 Males, T. B. — 8 Males, T. B. — 0 Males, T. B. — 0 Females, T. B. + 2 Females, T. B. + 2 Females, T. B.+ 0 Females, T, B. — 2 Females, T. B — 4 Females, T. B. — 0 Number of these who have attended for the first time and left during the same year, 5 :— Insured 5. Un-insured 0. Children 0. Males, T. B. + 0 Males, T. B. + 0 Males, T. B. + 0 Males, T. B. — 3 Males, T. B. — 0 Males, T. B. — 0 Females, T. B. + 0 Females, T. B. + 0 Females, T. B. + 0 Females, T. B. — 2 Females, T. B. — 0 Females, T. B. — 0 Number of patients who have been removed from the Register for other causes during 1919, 65:— Insured 25. Un-insured 14. Children 26. Males, T. B. + 3 Males, T. B. + 0 Males, T. B. + 5 Males, T. B. — 14 Males, T. B. — 0 Males, T. B. — 10 Females, T. B. + 2 Females, T. B. + 8 Females, T. B. + 5 Females, T. B. — 6 Females, T. B. — 6 Females, T. B. — 6 Number of these who were admitted and discharged during the same year, 7 :— Insured 4 Un-insured 2. Children 1. Males, T. B. + 0 Males, T. B. + 0 Males, T. B. + 0 Males, T. B. — 4 Males, T. B. — 0 Males, T. B. — 0 Females, T. B. + 0 Females, T. B. + 2 Females, T. B. + 0 Females, T. B. — 0 Females, T. B. — 0 Females, T. B. — 1 Number of patients who have been removed from the Register for other causes during 1920, 139 :— Insured 60. Un-insured 59. Children 20. Males, T. B. + 6 Males, T. B. + 1 Males, T. B. + 0 Males, T. B. 40 Males, T. B. — 9 Males, T. B. — 11 Females, T. B. +4 Females, T. B. + 8 Females, T. B. + 0 Females, T. B. — 10 Females, T. B. —41 Females, T. B. — 9 24 Number of these who were admitted and discharged during the same year, 19:— Insured 6. Un-insured 2. Children 11. Males, T. B. + 0 Males, T. B. + 0 Males, T. B. + 0 Males, T. B. - 4 Males, T. B. — 0 Males, T. B. - 6 Females, T. B. + 0 Females, T. B. + 0 Females, T. B. + 0 Females, T. B. — 2 Females, T. B. — 2 Females, T. B. — 5 305 Sputum examinations were made—109 were found to contain Tubercle Bacilli and 196 were negative. 531 patients were examined for diagnosis—228 were found to be suffering from some form of Tuberculosis and attended for treatment; of these, 194 were found to have Pulmonary Tuberculosis, 35 were contacts; and 34 were found to have NonPulmonary Tuberculosis, 5 of these were contacts. 123 were of doubtful diagnosis, so allowed to attend for observation. Number of pre- Tuberculrs attending for treatment, 346. Number of school children who have attended as specials for medicine, 78. Nurses' Visits—Soldiers 733 Nurses' Visits—Civilians 1,189 1,922 Number of attendances at Dispensary 6.746 COMMUNICABLE DISEASES—NON-NOTIFIABLE. Whooping Cough. Fifteen deaths were registered as due to Whooping Cough, as against 12 in 1919. Measles. Seven deaths, as against 12 in 1919. MENTAL DEFICIENCY. Work for Mental Defectives in the Borough. At the close of the year there were in their own homes : — 23 defectives under statutory supervision, 55 defectives under friendly care, on whom a report is forthcoming from a voluntary visitor once a quarter. 25 There were in addition:— 21 in certified institutions (of whom 8 were sent under order [or under S. 15] during; the year, including 1 received at the State Institution for violent defectives) 9 in residential special schools, paid for by Education Committee. 12 in poor law institutions, maintained by the Guardians. 4 in lunatic asylums (figure not inclusive), maintained by the Guardians. 1 defective removed from the district. 1 reputed defective is stated to be doing well outside the area. During the year 26 fresh cases were referred to the Committee. Training Centre. The Training Centre has been held on three afternoons a week, throughout the year. The attendance has fallen to an average of five, which is small, and unless more cases are found suitable for admission, i.e., unless further imbecile children are so certified and notified to the local authority it is doubtful whether the Centre can be continued. The Training Centre and supervision is undertaken by the Essex Voluntary Association. VENEREAL DISEASE. The joint scheme with the London County Council and neighbouring Authorities, in which East Ham forms a part, continues to wo k successfully. It will be noted from the table given that the number of cases treated from this Borough at the various London hospitals have increased slightly from 334 in 1919 to 361 in 1920. The largely increased number of pathological examinations made for medical practitioners is a gratifying feature of the returns. Only one medical practitioner in this Borough has qualified to receive free supplies of salvarsan substitutes. 26 The following table refers to this scheme :— VENEREAL DISEASES. Summary of work done by the Hospitals during the Year 1920. London Middlesex Essex Surrey Kent Herts Bucks E. Ham W. Ham Croydon Total New Patients:— Syphilis 7,917 704 392 285 206 89 58 121 324 80 10,176 Soft Chancre 570 26 19 12 21 — 2 4 26 3 683 Gonorrhoea 10,127 872 443 293 182 87 53 164 363 71 12,655 Not Venereal 4,998 534 237 165 113 39 32 72 229 58 6,477 Total 23,612 2,136 1,091 755 522 215 145 361 942 212 29,991 Total Attendances 365,478 34,011 12,386 12,190 7,282 2,436 1,946 3,434 10,278 2,480 451,921 No. of " In-patient" days 54,529 1,846 2,924 1,900 3,505 1,324 1,209 332 963 405 68,937 Salvarsan Substitutes, doses given 51,266 4,635 2,164 2,666 1,565 643 603 603 1,662 552 66,359 Pathological Examinations. For or at Centre Spirochaetes 1,384 191 31 63 14 14 19 13 90 8 1,827 Gonococci 17,745 1,694 1,231 639 375 188 73 497 1,143 204 23,789 Wassermann 24,768 1,657 989 934 541 202 129 241 696 199 30,356 Others 809 42 12 6 24 2 4 4 5 1 909 Total 44,706 3,584 2,263 1,642 954 406 225 755 1,934 412 56,881 For Practitioners Spirochaetes 26 — 1 2 — — — — — — 29 Gonococci 1,611 149 113 57 3 12 — 16 11 55 2,027 Wassermann 9,513 537 750 411 67 32 22 136 268 138 11,874 Others 84 — — — — — — — — — 84 Total 11,234 686 864 470 70 44 22 152 279 193 14,014 27 REPORT ON THE BOROUGH BACTERIOLOGICAL LABORATORY. During the year 1920 there were 1,263 specimens examined for Medical Practitioners. The following is a summary of the number of specimens examined, with results :— Specimens. Positive. Negative. Suspected Diphtheria 1263 248 1015 Results were communicated per telephone or sent by special messenger to the medical practitioners concerned. DISINFECTION. 1,566 premises were disinfected. The steam disinfector at the Isolation Hospital is used for bedding and other articles requiring disinfection. PUBLIC HEALTH (Milk & Cream) REGULATIONS, 1912 & 1917. 1. Milk and Cream not sold as Preserved Cream. Milk 154 *One sample contained 8 grains of Boric Acid per pint. Cream 3 * Vendor of Milk fined £1 10s. and costs 10s. 6d. 2. Cream sold as Preserved Cream. (i) Correct statements made 4 (ii) Statements incorrect 0 4 (iii) Percentage of Preservative Percentage stated found in each sample. on statutory label. 0.3 0.3 0.3 0.3 0.37 0.4 0.4 0.4 Determinations made of Milk Fat in Cream sold as Preserved Cream. Above 35 per cent. 4 Below 35 per cent. 0 4 28 FACTORY AND WORKSHOP ACT. Annual Report of the Medical Officer of Health for the year 1920, for the County Borough of East Ham, on the administration of the Factory & Workshop Act, 1901, in connection with Factories, Workshops, Workplaces & Homework. 1—INSPECTION. Including Inspections made by Sanitary Inspectors. PREMISES. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 7 l — Workshops (Including Workshop Laundries) 79 4 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) — — — Total 86 5 — 3.—DEFECTS FOUND IN FACTORIES, WORKSHOPS, AND WORKPLACES. PARTICULARS. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts :— Want of cleanliness 1 1 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other Nuisances 9 9 — — Sanitary accommodation (i w.c. required for 25 persons) insufficient 2 2 — — unsuitable or defective — — — — not separate for sexes 2 2 — — Offences under the Factory and Workshop Act Illegal occupation of underground bakehouses(s.lOl) — — — — Breach of Special sanitary requirements for bakehouses (ss. 97 to 100). — — — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) — — — — Total 14 14 — — 29 NATURE OF WORK. OUTWORKERS' LIST, SECTION 107. WHOLESOME PREMISES, SECTION 108. INFECTED PREMISES, SECTIONS 109 & 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions Sending twice in the Year. Sending once in the Year. Failing to keep or permit inspection of lists. Failing to send lists. Instances. Notices Served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109 110) Lists. Outworkers. Lists. Outworkers. Contractors Workmen. Contractors. Workmen. Wearing Apparel— (1) making, etc. — — — 5 — 26 — — — — — — — — — (2) cleaning & washing Household Linen Lace, Lace Curtains and Nets Curtains and Furniture Hangings Furniture & Upholstery Electroplate File making Brass & Brass Articles Fur pulling Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches & Keys Umbrellas, &c. Artificial Flowers Nets, other than wire nets (sieves) Tents & Sacks Racquet & Tennis Balls Paper&c.Boxes PaperBags Brush Making 2 — 2 — — — — — — — — — — — — Pea Picking Feather Sorting 2 — 10 — — — — — — — — — — — — Carding&c. of Buttons,&c. Stuffed Toys Basket Making Chocolates & Sweets Cosaques, Xmas Crackers & Xmas Stockings Flag Making Total 4 — 12 5 26 — — — — — — — 30 4.—REGISTERED WORKSHOPS. 5 OTHER MATTERS. Workshops on the Register (s. 131) at the end of the Year. Number. Class. Number Wearing Apparel Manufacturers 117 Matters notified to H.M. Inspector of Factories:— Bakehouses 49 Failure to affix Abstract of the Factory and Workshop Act (s. 133) Laundries 41 Printers 11 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector Reports (of action taken) sent to H.M. Inspector 12 Other Workshops 124 12 Other — Underground Bakehouses (s. 101):— Certificates granted during the year — Total number of Workshops on Register 342 In use at the end of the year 10 31 METEOROLOGICAL RECORD—YEAR 1920. Rain Gauge 5-in. in diameter, placed 1-foot above ground, 15 feet above sea level. Temperature taken in the shade of a Stevenson's Screen, 5 feet from the ground. Months. Temperature of Air during the Month. Mean Temperature of Air. Rainfall. Highest Maximum. Lowest Minimum. Mean of No. of Days on which Rain fell, 0.01 inches and over. Amount collected in inches. Mean rate of fall for Rainy Days. Greatest fall in 34 hours, Date of greatest fall. All Highest. All Lowest. January 57o 22o 48°.3 35°.6 41°.9 16 2.37 015 0.61 10th February 64° 26° 50°.5 35°. 5 43°. 0 10 0 .54 0 .05 0.30 20th March 67° •28° 55°.2 37°. 5 46°.3 14 1.44 0.10 0.30 6th April 60° 33° 55°.2 33°.0 48°.5 22 2.70 0.12 0.40 lst May 84° 35° 65°.4 46°.4 55°.9 10 0.48 0.05 0.12 6th June 79° 38° 69°.6 50°.4 60°.0 9 1.28 0.14 0.47 20th July 75° 45° 68°.0 52° .1 60°.0 17 3.46 0.20 0.61 21st August 77° 43° 66°.6 49°.8 58° 2 7 207 0.29 0.96 18th September 80° 39° 66°.0 49°.2 57°.6 11 2.78 0.25 0.77 15th October 71° 28° 60°.0 42°.5 51°.5 10 0.95 0.09 0.26 1st & 16th November 60° 22° 50°.6 34°.8 42°.7 9 0.85 0.09 0.33 27th December 56° 10° 45°.5 35°. 5 40°. 5 23 2.09 0.09 0.34 23rd Means and Totals for the Year. 84° 10° 58°.4 41°.8 50°.5 158 21.03 0.13 0.96 Aug. 18th The Rainfall for the Year was 3 ins. below, and the number of days on which rain fell one below the year 1919, at East Ham. 32 CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1920. Notifiable Disease. Number of Cases Notified. Total Casks Notified in Each Ward. Total Cases Removed to Hospital. At all Ages. Under 1 year. 1 and under 5. years. 5 and under 15 years. 15 and tinder 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. Beckton and North Woolwich Ward. Central Ward East. Central Ward West. Manor Park Ward. Plashet Ward East. Plashet Ward West. Small Pox 10 ... ... 1 2 5 2 ... 4 1 4 1 ... ... 10 Diphtheria (including Membranous Croup). 426 2 104 288 16 13 3 ... 67 65 111 97 50 36 380 Erysipelas 72 1 1 3 5 25 29 8 9 10 22 14 8 9 10 Scarlet Fever 718 1 92 521 71 30 3 ... 78 145 142 148 98 107 365 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 10 ... 1 5 1 2 1 ... 4 ... 2 1 1 2 8 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 6 ... ... ... 1 5 ... ... ... ... ... 5 1 ... 4 Cerebro- Spinal Meningitis 3 2 ... ... 1 ... ... ... ... 1 1 ... ... 1 2 Poliomyelitis 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... Ophthalmia Neonatorum 30 30 ... ... ... ... ... ... 4 4 6 10 4 2 3 Encephalitis Lethargica 5 ... ... ... ... 4 1 ... 2 ... 2 ... ... 1 2 Pulmonary Tuberculosis 242 2 1 10 60 131 38 ... 32 56 40 52 31 31 192 Other forms of Tuberculosis 68 4 11 28 9 12 4 ... 4 14 16 17 7 10 21 Totals 1591 42 211 856 166 227 81 8 204 296 347 345 200 199 997 33 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN EAST HAM, 1920. CAUSES OF DEATH. Net Deaths at the subjoined ages of "Residents" whether occurring within or without the Borough. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 15 and under 65 years. 65 and upwards. All Causes M 765 122 17 22 30 49 125 220 180 F 714 102 15 20 28 34 109 165 241 1. Enteric Fever M 3 ... ... ... 1 1 ... 1 ... F 1 ... ... ... 1 ... ... ... ... 2. Small-pox M 1 ... ... ... 1 ... ... ... ... F 2 ... ... ... ... 1 1 ... ... 3. Measles M 8 1 3 3 .. 1 ... ... ... F 9 1 4 2 2 ... ... ... ... 4. Scarlet Fever M 1 ... ... ... 1 ... ... ... ... F ... ... ... ... ... ... ... ... ... 5. Whooping Cough M 7 2 3 2 ... ... ... ... ... F 8 7 1 ... ... ... ... ... ... 6. Diphtheria and Croup M 11 1 1 3 6 ... ... ... ... F 7 ... 1 3 3 .. ... ... ... 7. Influenza M 17 1 ... 1 1 1 4 6 3 F 26 ... ... ... ... 1 15 6 4 8. Erysipela M 3 1 ... ... ... ... 2 ... ... F 3 ... 1 ... ... ... ... 2 ... 9. Pulmonary Tuberculosis M 79 2 ... 1 ... 18 38 19 1 F 52 ... 1 1 ... 15 26 8 1 10. Tuberculous Meningitis M 6 3 ... 1 1 ... 1 ... ... F 2 1 ... 1 ... ... ... ... ... 11. Other Tuberculous Diseases M 8 ... ... ... ... 3 3 1 1 F 11 ... ... 4 1 2 2 2 ... 12. Cancer, Malignant Disease M 65 ... ... ... ... 1 5 39 20 F 71 ... ... ... ... ... 7 38 26 13. Rheumatic Fever M 8 ... ... ... 4 2 ... 1 1 F 5 ... ... ... 3 1 1 ... ... 14. Meningitis M 2 ... ... ... ... ... ... 2 ... F 5 2 ... 1 ... 2 ... ... ... 15. Organic Heart Disease m 78 ... ... ... 1 6 15 30 26 F 68 ... ... ... 2 1 5 19 41 16. Bronchitis M 47 9 1 ... 1 1 3 10 22 F 60 11 1 ... 1 1 2 10 34 17. Pneumonia (all forms) M 77 15 7 1 2 2 14 18 15 F 5 16 4 6 4 3 6 9 17 18 Other Respiratory Diseases M 6 ... ... ... ... ... 1 4 1 F 8 ... ... ... 2 1 5 19. Diarrhtœ, &c. M 21 15 ... ... ... 1 2 3 ... F 8 6 1 ... ... ... ... 1 ... 20. Appendicitis ?nd Typhlitis M 3 ... ... ... 1 1 1 ... ... F 4 ... ... ... ... ... 2 2 ... 21. Cirrhosis of Liver M 3 ... ... ... ... ... ... 3 ... F 8 ... ... ... 1 ... 1 3 3 21a. Alcoholism M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 22. Nephritis and Bright's Disease M 23 ... ... 1 ... 1 2 13 6 F 20 ... ... ... 4 1 4 4 7 23. Puerperal Fever M ... ... ... ... ... ... ... ... ... F 4 ... ... ... ... ... 4 ... ... 24. Parturition, apart from Puerperal Fever M ... ... ... ... ... ... ... ... ... F 4 ... ... ... ... ... 4 ... ... 25. Congenital Debility, &c. M 59 57 1 ... ... ... 1 ... ... F 41 41 ... ... ... ... ... ... ... 26. Violence, apart from Suicide M 33 ... ... 4 5 3 6 15 ... F 16 6 1 ... 1 ... 2 2 4 27. Suicide M 6 ... ... ... ... 2 2 2 ... F 1 ... ... ... ... ... ... 1 ... 28. Other Defined Diseases m 190 15 1 2 5 5 25 53 84 F 205 11 .. 2 5 6 25 57 99 29. Causes ill-defined or unknown m ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 34 ISOLATION HOSPITAL. From 1st April, 1919, to 31st March, 1920. Days. 381 Patients treated in Scarlet Fever Wards 18,521 515 Patients treated in Diphtheria Wards 24,578 14 Patients treated in Cubicles 606 Number of patients—days 43,705 ESTABLISHMENT CHARGES. '£ Provisions 3,785 Linen, Bedding, and Furniture 455 Chandlery and Sundries 957 Lighting, Heating and Water 2,020 Repairs to Hospital and Maintenance of Grounds 741 Rates, Taxes, and Insurance 184 Office Expenses 124 Salaries and Wages 4,299 12,565 PATIENTS' EXPENSES. '£ Medicines and Medical Appliances, Antitoxin and Disinfectants 1,009 Stimulants 21 Maintenance of Ambulances 714 £ 1,744 Average cost per patient per day, 6s. 6½d. COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Annual Report OF THE School medical officer FOR THE YEAR 1920. 37 EAST HAM EDUCATION COMMITTEE. Councillor J. A. Williams, J.P. (Chairman). Councillor A. H. Wiseman, J.P. (Vice-Chairman). Councillor G. P. Dean, J.P. (Mayor). Councillor A. Stokes (Deputy-Mayor). Mrs. W. c. Ford. Miss A. Pockney. Alderman O. R. Anstead, J.P. Alderman J. Buookb, J.P. Alderman E. Edwards, J.P. Alderman C. Northfield, J.P. Alderman M. Oakes, J.P. Alderman H. Osborn, J.P. Councillor A. Allw right. Councillor R. Banks-Martin, J.P Councillor A. Coles. Councillor W. G. Davie. Rev. Idris Evans. Councillor W. K. Fennell. Councillor W. C. Ford, J.P. Councillor T. M. McGiff. Councillor V. R. Oliver. Councillor N. A. Papworth. Mr. J. E. Pooley. Mr. E. J. Sullivan. Councillor F. Webster. School Nurses: Mrs. Nears, Miss Kekwick, Mrs. Sorrell, Miss Davy, Miss Case, Miss Smith and Miss Rigby. School Medical Clerks: Miss I. L. Hollingsworth, Miss A. M. Dean and Miss M. I. Barker. Dentist: F. E. Bendix, L.D.S., R.C.S., M.R.C.S., L.R.C.P. Ophthalmic Surgeon: A. Henry Thompson, M.D. Aural Surgeon: Gilbert C. Chubb, F.R.C.S.,Eng., D.Sc., Etc. Assistant Medical Officers: D. S Brough, M.C., M.B., Ch.B., D.P.H. Miss M. M. Thomson, Ij.R.C.P., L.R.C.S. and D.P.H. Medical Officer: W. Benton, M.R.C.S., L.R.C.P., D.P.H. 38 County Borough of East Ham Education Committee. Mr. Chairman, Ladies and Gentlemen,— I beg to submit my Annual Report as School Medical Officer for the year ending 31st December, 1020. I wish to express my thanks to the Committee for their kind consideration of my recommendations and to express my indebtedness to the Head Teachers for help and courtesy extended to the School Nurses, and to my Staff for the excellent work they have accomplished under present difficulties. Your obedient Servant, WILLIAM BENTON, Medical Officer to Education Committee. STATISTICAL DATA. School Places:— Provided Schools 26,881 Non-Provided Schools 1,090 Total 27,971 Number on Registers :— Provided Schools 24,530 Non-Provided Schools 1,029 Total 25,569 Teaching Staff: Head Assistant Certificated Assistant Uncertificate Supplementary Student & Pupil Cookery 622 61 496 42 4 13 6 39 I. STAFF. In addition to the Chief School Medical Officer, the Staff of the School Medical Department is made up as follows :— (a) Two full time Medical Officers, one of whom is also Deputy Medical Officer of Health. (b) One full time dentist—who devotes part of his time to Child Welfare Work. (c) Seven School Nurses, one of whom is allocated to the dental department. (d) Three women clerks. (e) Opthalmic Surgeon (part time). (f) Aural Surgeon (part time). 2. CO-ORDINATION. Infant and Child Welfare. (a) The School Medical Officer is also Medical Superintendent of the Infant and Child Welfare work. In this way there is an intimate association between the two services—School and Child Welfare Medical Work. This arrangement also enables the school nurses and the health visitors to exchange views and cooperate with one another when otherwise their work might overlap or clash. There is, however, still scope for closer working between the two above-named departments, and it is hoped that as time goes on a more complete scheme of co-operation may be evolved. Nursery Schools. (b) There are no nursery schools in the Borough at present, though the matter has been under consideration. The Care of Debilitated Children under School Age. (c) Clinics are held daily at the Child Welfare Centre, where any child under school age who requires medical advice may be seen. The School Nursing Staff and the School Attendance Officers assist in bringing these clinics to the notice of parents, where they meet suitable cases in the course of their work. As children who are attending the Child Welfare Centre mature and reach school age, they are handed over to the School Medical Authorities, who continue to exercise the necessary supervision. 40 3. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene. (a) With a few exceptions the schools in the Borough are of comparatively recent construction, and on the whole satisfactory. The most recently built schools are admirably placed, combining ease of access with quiet and open surroundings and spacious playgrounds. The ventilation, lighting, warming, equipment and sanitation are up-to-date, practical and efficient, and the Borough is fortunate in having many schools of which it may be justly proud. No detailed inspection of the various school premises has been undertaken this year, but the Medical Officers have considered and given advice upon any special points brought to their notice by the teachers. On the whole the schools may be regarded as satisfactory, though certain of them are overcrowded. Most of them are wellbuilt on sites adjacent to, but not on, the main thoroughfares. The playgrounds are large and provided with good surfaces, while the general surroundings are as attractive as may be in an eastern suburb of London. 4. MEDICAL INSPECTION. The following is a synopsis of School Medical Work for the year :— Routine and Special Inspection 7,392 Re-inspections 2,950 Consultations at Inspection Clinic 6,961 Number of Treatments at Clinic 11,017 General Cleanliness Visits to Schools 277 Nurses' Visits to Homes 2,925 Children Examined for Cleanliness 60,394 Number of Cleansings 5 Prosecutions 1 There are two Assistant School Medical Officers, one of whom 5 also Deputy Medical Officer of Health and devotes a certain mount of his time to Public Health duties. (a) During the year an endeavour was made to examine the three age groups specified by the Board of Education, viz., 41 Entrants, Intermediates and Leavers, and also to work off various arrears of work that remained as a legacy of the disturbed conditions that existed during the war. (b) It was found impossible however to overtake the whole of the work so planned, and at the end of the year three schools remained at which no routine medical inspection had been done. These schools will accordingly be visited by the School Medical Officer in the early part of 1921, when double groups will be examined with a view to bringing the work up-to-date. This will, of course, throw the routine examinations for 1921 still further behind, and to meet the difficulty I have applied for the assistance of a third medical officer which will allow of a more systematic distribution and a more thorough performance of the various branches of school medical service. (c) Each time the School Medical Officer visits a school to examine children he includes all abnormal children as " specials," in addition to his routine cases. In this way not only is every new cripple child in a school immediately seen, but an annual survey is made of all known cripples with a view to noting their progress. Cases in which the crippling defect is too severe to allow the child to attend school' are investigated by the School Attendance Officers, and if necessary the School Medical Officer visits the child at its home. (d) The disturbance of school routine caused by Medical Inspection is minimised by the doctor using the teachers' rooms for his examinations and having the children from their classes in small batches of six at a time. This arrangement, for which we are indebted to the courtesy of the teachers, has been found to work very well. 5. FINDINGS OF MEDICAL INSPECTIONS. Uncleanliness. (a) A considerable part of the School Nurses' work consists in maintaining a standard of cleanliness amongst school children. For this purpose a school nurse visits each school thrice yearly and examines each scholar, paying special attention to the presence of vermin or nits, and to the state of the hair. These repeated examinations over a course of years have had the result of raising the standard of personal hygiene very considerably, whilst this constant supervision leads to the discovery and early 42 TABLE VII. TABLE OF VERMINOUS CONDITIONS FOUND AT EXAMINATIONS FOR GENERAL CLEANLINESS. SCHOOLS Dept. Number Exam'd. few Nits. Many Nits and Vermin. Body and Clothing Verminous. SCHOOLS. Dept. Number Exam'd. Few Nits. Many Nits and Vermin. Body and Clothing Verminous. Brampton Road Girls 356 12 4 ... Napier Road Girls 1159 93 28 2 Boys 368 2 ... 1 Boys 1336 18 12 ... Jr. Mixed 299 11 5 ... Infants 1438 126 87 9 Infants 293 7 2 ... New Beckton Girls 580 75 11 ... Castle Street R.C. Mixed 485 32 24 2 Boys 779 8 2 2 Infants 361 29 12 6 Infants 708 63 ■ 5 ... Central Park Road Girls 1345 117 10 ... Plashet Lane Girls 1417 141 26 ... Boys 1417 6 1 ... Boys 1562 26 5 ... Infants 1490 97 15 ... Infants 1357 115 40 ... Essex Road Girls 1130 37 31 1 Storey Street Mixed 849 28 13 ... Boys 1121 14 4 3 Infants 797 51 29 ... Infants 1112 12 13 ... Silvertown R.C. Mixed 880 36 12 ... Fourth Avenue Girls 1130 237 51 3 Infants 604 29 11 ... Boys 1171 37 ... 4 St. Winefride's R.C. Mixed 688 13 53 7 Infants 840 94 12 3 Sandringham Road Girls 916 97 14 ... Hartley Avenue Girls 1104 109 13 ... Boys 1154 10 ... ... Boys 1289 6 5 ... Infants 913 79 6 ... Infants 1264 94 19 ... Shaftesbury Road Girls 1153 49 9 1 High Street Mixed 567 27 10 ... Boys 1140 2 ... ... Infants 466 40 40 ... Infants 758 57 5 2 Kensington Avenue Girls 1269 74 4 ... Shrewsbury Road Mixed 420 17 6 2 Boys 1357 2 ... ... Infants 486 32 5 3 Infants 1251 44 ... ... Technical College Girls 394 15 ... ... Lathom Road Girls 1464 123 37 2 Vicarage Lane Girls 831 48 31 ... Boys 1399 10 2 ... Boys 872 15 13 ... Infants 1460 118 9 ... Infants 1263 69 30 1 Manor Park Girls 882 79 19 ... Walton Road Girls 1482 28 81 1 Boys 754 32 ... ... Bovs 1463 14 30 ... Infants 671 98 10 2 Infants 2136 24 66 1 Monega Road Girls 694 93 4 ... Boys 911 4 2 ... Total 60394 3123 994 58 Infants 1139 48 6 ... Percent. 5 .2 1.6 0 .09 43 treatment of most of the minor ailments. During the year the school nurses made 60,394 examinations, exclusive of those made whilst accompanying the Medical Officer. In this number 58 children were found who harboured body vermin, 994 children showed vermin and many nits in the hair, whilst 3,123 children showed only a few nits. Only moderate satisfaction can be derived from these figures, for whilst the great majority of school children excel in the care of their person there remains a certain number who are always more or less unsatisfactory—a shame to themselves and a menace to others. It must be clearly understood—and this is a point the School Medical Staff must ever bear in mind—that the fault does not lie with the children themselves. They are the victims of circumstances, and their unhappy condition is due to lack of parental care and to the squalor and filth of their homes. Thus the problem extends outside the scope of school work, for it is quite impossible to expect children to be free of vermin if other members of the household are infested. The responsibility undoubtedly lies with the parents. I am not convinced, however, that wholesale prosecution is the remedy, especially in these times when houses are overcrowded or tenanted by more than one family, when unemployment is rife and actual want not unknown. I do feel, however, that a Cleansing Station should be available for use when necessary where assistance could be rendered to parents who were striving to do better and which would enable disciplinary action to be taken where persuasion had finally failed. Minor Ailments. (b) With a comprehensive scheme of clinics in operation within easy access of the various schools in the Borough, it is not surprising that few minor ailments were discovered at routine medical inspection. Most of these ailments were detected by the school teachers or nurses at an early stage, and speedily remedied at one of the clinics. The part played by the clinics in keeping school children free from minor ailments may best be realised by an examination of the following table, which shows that while many minor ailments did 44 exist amongst the scholars during the year, they were constantly treated and cured, so that few were allowed to persist until discovered at routine medical inspection. Chief Minor Ailments. Discovered at Routine Medical Inspection. Discovered by Teachers and Nurses and sent to Clinic. Scabies 8 185 Impetigo 12 422 Conjunctivitis 6 133 Blepharitis 11 55 Ear Disease 43 339 Ringworm (Scalp) 3 88 Ringworm (Body) 2 81 Tonsils and Adenoids. (c) Definite enlargement of Tonsils and Adenoids demanding operation is found mostly among the entrants, at which stage it is usually remedied. Amongst the older children where enlargement still persists it is usually found to be of moderate degree where no disability is apparent to the parents and where operative steps have consequently been postponed and palliative treatment tried. During the year 226 routine cases of much enlarged tonsils were discovered, with 731 cases where the tonsils were moderately enlarged. Amongst " specials " the numbers were 47 and 8 respectively. Definite adenoids were present in 65 routine cases and suspected in 143 routine cases, whilst among " specials " the numbers were 138 and 6. The combination of enlarged tonsils and adenoids was found in 81 routine cases and 88 "specials," whilst 33 routine cases and 16 " specials " showed both enlarged tonsils and adenoids present in a moderate degree. Tuberculosis. (d) Definite pulmonary tuberculosis was diagnosed in two of the routine cases and 1 special case, whilst it was suspected in 20 routine cases and 3 special cases. All these were referred to the Tuberculosis Dispensary for treatment. In addition 6 routine cases and 15 special cases were under periodical supervision of the School Medical Officer pending a diagnosis. A further number of children in whom no lesion could be found but who were judged to be pre-tubercular attend the Tuberculosis Dispensary to receive 45 supplies of cod liver oil and malt. These are seen periodically by the School Medical Officer. Tubercular glands were found in 2 cases and suspected in 1 case. Other forms of tubercular infection were discovered in 2 cases and suspected in 5 cases. Skin Disease. (e) The chief Skin Diseases found during Medical Inspection were Impetigo, Scabies and Ringworm of scalp and body. Only 12 cases of Impetigo were discovered at routine inspection, while 422 were seen at the clinics. 8 cases of Scabies were found during routine inspection, while 185 were seen as "specials." Ringworm of the scalp was diagnosed in 91 cases, only 3 being found during routine inspection, while 83 cases of Ringworm of the body were seen, 81 of them being " specials." Thus it will be seen that just as in minor ailments very few skin cases are allowed to persist until found by the doctor during his routine examination. They are in nearly all cases detected byparent or teacher and sent to the clinic for treatment. (See also 8 (d), page 51.) External Eye Disease. (f) Here again most of the cases were seen as " specials " at one of the clinics. Only 11 cases of Blepharitis and 6 cases of Conjunctivitis were found at routine medical inspection, whilst 55 cases of the former disease and 133 cases of the latter disease were seen at the clinics. There were 8 cases of Corneal Ulcer and 4 of Corneal Opacity, all of which were first seen as clinic cases. Vision. (g) During the year 806 cases were found to be suffering from defective vision suspected to be due to errors of refraction. Of these 526 were examined under atropine by the Eye Specialist at the Town Hall, while 14 were treated elsewhere. Of the 526 cases submitted to refraction 359 were prescribed glasses, and these were obtained in every case; 43 received treatment other than by glasses, while in 122 cases no treatment was considered necessary. (See Ophthalmic Surgeon's report, page 68.) 46 Ear Disease and Hearing. (h) As noted elsewhere, 8 (g), ear disease and defective hearing are very prevalent amongst school children, and form a large proportion of the treatment cases at the clinics. During routine inspection 43 cases of Otitis Media were found, while no fewer than 339 were seen at the clinics. Defective hearing was present in 187 cases seen at routine inspection, while 114 cases of similar defect were seen at the clinics. Dental Defects. (i) See report of Dental Surgeon, page 72. Crippling Defects. (j) During the year a census of school children suffering from crippling defects was taken, when it was found that 107 school children were so affected. Full details are given under paragraph 22, page 65. 6. INFECTIOUS DISEASE. A comprehensive scheme is in force in the Borough whereby there is active co-operation between the Medical Officers and the school teachers, school nurses and attendance officers, with view to preventing the spread of infectious disease. In this scheme are included the notifiable and non-notifiable infectious diseases, together with the contagious skin and eye affections. Each case of notified disease is regarded as possibly connected with other cases of the same disease which, owing to their mildness or the absence of some of the characteristic symptoms, have been overlooked by the parent or teacher, or both. Inquiries are therefore made at the patient's home and into the condition of the children who have been in contact at school with the scholar who has fallen ill. Teachers are instructed in the symptoms of onset of the chief infectious diseases and are directed temporarily to exclude children showing any symptoms suggestive of any of these diseases until medical assurance can be had that they may attend school without harm to themselves or danger to others. 47 The head teachers are at once informed of cases of notifiable diseases occurring in children attending their departments, and contacts can therefore be forthwith excluded. The attendance officers inform the school medical officer of any children who have recently been kept at home with illness of a suspicious character or concerning whom circumstances suggest vhe possibility of infection. A register of the non-notifiable diseases, Measles, Chickenpox, Whooping Cough, and Mumps is kept in the school medical officer's department. The entries in this register are made from notification forms sent by the school teachers. The accuracy of these notifications is verified by the attendance officers, who consult the Medical Officer in all cases of doubt. During the year 1920 both Scarlet Fever and Diphtheria were very prevalent in the London area, and East Ham was affected in common with other districts. As the occurrence of a case of either of the above-named diseases in a house leads to the automatic exclusion from school for a time of any scholars in that house the effect of this epidemic is certain to be reflected in the average school attendance for the year. In addition to the recognised infectious diseases there are a number of contagious diseases for which scholars are also excluded. During the year 1,060 exclusion forms were issued to children for the following complaints :— Ringworm of Scalp 165 Ringworm of Body 104 Impetigo Contagiosa 100 Infective Eye Inflammations 66 Eczematous Diseases 33 Acute Throat Conditions 160 Scabies 297 Miscellaneous Affections 135 Total 1,060 48 7. FOLLOWING UP. After medical inspection and the notification to parents and teachers of discovered defects, a certain time, except in cases of urgency, is allowed parents in which to procure hospital, private or other treatment for their children. Where suitable treatment can be given at one of the school clinics as in aural, eye or dental defects, this is offered and an acceptance paper is forwarded to the parent for him to sign and return. When an acceptance of treatment is received it is filed and the children are summoned to attend for specified treatment in rotation. In other cases, e.g., in ringworm of scalp or enlarged tonsils and adenoids, hospital letters are available. After a certain period, usually a month, the school nurse visits the homes of the children to find whether treatment has been obtained and to urge the necessity of obtaining remedial measures where nothing has been done. This process is a considerable part of the nurses' work, for while many parents are only too glad to carry out the doctor's suggestions, others either through indifference or through private difficulties defer doing so, and in some cases the nurse has to visit as many as six times before the desired result is attained. In this work the Medical Officer is greatly dependent on his school nurse for his results, for coercive measures have little to commend them and are fraught with difficulties. In fact, prosecution except in isolated cases of defiance may do infinite harm— it may be rankly unjust in the case selected, it fosters a hostile attitude on the part of parents towards school medical work generally, and tends to make parents regard the nurse as an official rather than a friend. Thus the results of following-up reflect to a large extent the suitability of a nurse for her special work. A tactless nurse who hopes to drive will accomplish nothing and he received with open hostility, whereas one with ready sympathy and ample patience will achieve much—the most hostile will unbend, the most truculent will yield, and she will be greeted with cordiality where formerly suspicion and distrust held sway. The path of the school nurse has not been an easy one to tread, but gradually she is asserting her individuality and is becoming more and more a valued friend to whom parents are ever ready to resort for advice not only in medical matters but on all subjects affecting their social welfare. This is indeed a triumph; it is a harvest all school nurses may reap. 49 Another part of the machinery of following-up falls to the school medical officer who re-visits each school later in the year and personally examines all children previously found defective to see what treatment has been carried out and to further urge treatment both personally and through the school nurse where none has been obtained. During 1920, 2,299 children were reinspected by the medical officers, when it was found that 2,080, or 90.4 per cent., had obtained some form of treatment. Even this does not accurately represent the full numbers treated, as there is a long waiting list of eye cases who will eventually be treated, but who could not be so recorded at the time of reinspection. While not ideal these results are distinctly encouraging when compared with previous years and should be a source of satisfaction to the Borough and the school medical staff alike. In the course of their following-up work the school nurses paid 2,925 visits to the homes of children with defects, urging that treatment should be carried out and advising how best such treatment could be obtained. 8. MEDICAL TREATMENT The following clinics are held weekly for the treatment of defects in school children:— (1) General Clinic, Town Hall—Mondays, Wednesdays and Fridays, 9 a.m. (2) General Clinic, St. Michael's Institute, Manor Park— Tuesdays and Thursdays at 9 a.m. (3) General Clinic, North Woolwich, Mondays and Fridays at 2 p.m. (4) General Ear Clinic, Town Hall, Thursdays at 2 p.m. (5) Eye Specialist Clinic, Town Hall, Tuesdays at 1.30 p.m. (6) Ear Specialist Clinic, Town Hall, Tuesdays at 3 p.m. Any school child for whom medical advice is required or who demands a special examination may be sent to one of the general clinics. When treatment can be suitably given this is done. In other cases the child is referred to one of the special clinics, to a private practitioner, or to a hospital, according to circumstances. Should a child require to make repeated attendances at the clinic an appointment card is given him on which is noted 50 the hour and date of his next attendance. To enable chronic cases to have uninterrupted treatment a nurse is on duty at the various clinics throughout the school holidays. Minor Ailments. (a) Chiefly those of the skin, eye, ear, throat and nose, and injuries are seen and treated daily at the general clinics. The skin cases consist chiefly of Septic Sores, Impetigo, Scabies and Ringworm. All these, with the exception of ringworm of the scalp, are treated at the clinic, repeated attendances being made wherever necessary. A limited supply of dressings or ointment is given for home use in necessitous cases. Of the eye cases only the simpler external conditions, such as Conjunctivitis, Blepharitis and Corneal Ulcer are treated, the others being referred to the Eye Specialist. The possibility of defective vision being a causal factor in external eye diseases is always borne in mind and the vision tested in all doubtful cases. Acute throat cases are not encouraged to attend the clinics owing to the possibility of infecting other children. Teachers are asked to send such cases to a private practitioner as far as possible. All the same, many infective sore throats do appear for examination, and when necessary swabs are taken with a view to examining for diphtheria bacilli. The same course is followed in nose conditions showing crusting or ulceration. Only external ear conditions are dealt with at the general clinic, all others which necessarily demand detailed examination by speculum being sent to one of the special aural clinics. Tonsils and Adenoids. (b) Arrangements have been made with St. Mary's Hospital, Plaistow, whereby children suffering from enlarged tonsils and adenoids may have them removed 'by operation. A fixed charge per case is made by the Hospital Authorities, which charge is defrayed by the Education Authority. Tuberculosis. (c) Any school child found to be suffering from tuberculosis or judged to be pre-tubercular is sent to the Tuberculosis Dispensary. It remains with the Tuberculosis Officer whether a 51 child is permitted to attend school. Doubtful cases are kept under supervision by the School Medical Officer and examined from time to time. Surgical cases are referred to one of the London General Hospitals for advice, and where special appliances are advocated the Education Committee may contribute towards the cost. Skin Cases. (d) These are treated at the general clinic and in most cases the results are highly satisfactory, as the children attend several times a week until cured. It is found that this repeated attendance at the clinic is a great improvement on giving advice for home treatment, and while it throws a heavy strain on the school nursing staff, the results justify the extra labour. There are, however, two skin diseases, namely, Ringworm of the Scalp and Scabies, which demand more exhaustive notice. Ringworm of the Scalp. This is a disease which has long been a source of trouble and worry to all engaged in school medical work, and despite every effort there is little decrease in its incidence among school children. Most of the cases are first noticed by the school teacher, by the parent, or by one of the school nurses during her cleanliness survey. When a suspected case is first discovered it is sent to the clinic for examination by the Medical Officer. Definite cases can be at once diagnosed by the aid of a magnifying glass, but where doubt exists hairs are examined microscopically. In the event of a case being confirmed as ringworm the parents are straightway advised to have X-ray treatment carried out at the London Hospital. Should the parent agree to this course he is given a letter to the hospital, and the cost of the operation is defrayed by the Education Committee. In some instances the parents object to X-ray treatment as it entails the temporary loss of hair—a serious matter amongst the older girls. In these cases other forms of treatment are tried, but the loss of school attendance is always serious, as there is no remedy which can be considered as even moderately efficient in the treatment of this disease except that of epilation by X-rays. 52 Scabies. This is a skin disease which has been all too prevalent amongst school children during the last few years, and one which has been the cause of the loss of much school time and incidentally of educational grant. It is a disease that is easily cured provided that the proper treatment is given and thoroughly carried out. At present, however, when every second house is overcrowded, when adequate bathing facilities are absent in the affected homes, and when disinfection is neglected it is practically impossible to stamp out the disease. Added to this is the fact that in many houses not only is the bedding and furniture infected, but many adults harbour the complaint, so that even if children are cured they are speedily re-infected. The problem requires to be tackled as a whole, and the first step is the erection of a Cleansing Station where cases—not only the school children —may be suitably treated. In such a station adequate supplies of hot water would be available, the treatment would be supervised and thoroughly carried out, automatic disinfection of homes would be secured, and a rational scheme with definite hope of success established. At present no such station is available and the cost of erecting one has hitherto been insuperable, though there is a satisfactory disinfecting apparatus awaiting installation. Meantime, all cases have to be treated at home, and as the details of the treatment are seldom understood and still more rarely carried out, the results are highly discouraging. Sufferers from Scabies are told to use sulphur ointment after a hot bath on two or at most three successive nights, and then to have a complete change of clean clothing, the old garments being disinfected. What actually happens is that the hot bath—the key to the treatment—is seldom available, fresh outer garments are not supplied, and the infected clothes are not properly disinfected. As for the ointment, it is used in excessive quantities and over extended periods with a view to making up for the other defects in the treatment, with the result that a sulphur dermatitis, most difficult to cure, develops. I have in the past and I do again urge the Education Authorities to consider the erection of a Cleansing Station, as I consider school medical work suffers appreciably from the lack of it. For some years the tendency was, as it ought to be, for 53 the schools to become progressively more free of verminous and Scabies cases. Recently, however, the schools are not so satisfactory as they were in former years, and this I attribute largely to the want of a Cleansing Depot, without which cases cannot be satisfactorily treated, nor can statutory action be taken against parents who wilfully and habitually offend. External Eye Disease. (e) Cases of external eye disease, consisting mainly of Conjunctivitis, Blepharitis, and Corneal Ulcer, are treated at the general clinics, where scholars may attend daily. Cases requiring special examination or treatment are referred to the Eye Specialist. Vision. (f) All cases of suspected defective vision are in the first instance examined by the School Medical Officer, who decides whether they shall be sent to the Eye Specialist for further examination. For further details see special Eye Report, page 68.) Ear Disease. (g) In common with other districts, East Ham has had to face the problem of treating a vast amount of ear disease—mostly of the chronic type—amongst school children. With a view to securing the best results possible, the Education Committee appointed, in September, Dr. Chubb as Aural Surgeon to attend for one session weekly. This is a distinct step forward, and though the beneficial results of his work will not show immediately owing to the extremely chronic and intractable nature of the disease in question, there can be no doubt that the institution of this specialist service will be an immense boon to the children of the Borough. In order to make the most of Dr. Chubb's services only the more serious cases are referred to him. All cases of ear disease or deafness are first examined by the Assistant School Medical Officer, who at once treats the simpler cases and sends the more serious ones to the specialist. In this way it is possible to keep abreast of the work to avoid a waiting list and to give every case immediate attention. In many of the cases seen owing to their chronicity nothing more than some amelioration of the diseased condition can be hoped for, but even this is of prime 54 importance. As time goes on such cases will be treated at a much earlier stage in the disease, when the results will be correspondingly better. Some idea of the scope of the Ear Clinic may be gathered from the following figures:— Number of Ear Cases examined 388 Number of Treatments for Ear Disease 2,363 Dental Defects. (h) There is a full-time Dentist, who devotes four-fifths of his time to the treatment of school children. Anaesthetics are administered to certain selected cases during one session per week, when the Assistant School Medical Officer attends for this purpose. As will be seen from a perusal of the Dental Report, this work is very far behind, and in future years its scope will have to be considerably curtailed. The report of the Dental Officer is appended. (See Dental Surgeon's Report, page 72.) Crippling Defects and Orthopaedics, (i) All cripple children are seen by the School Medical Officer as "specials" during his visit to the school. Enquiries are made regarding these cripple children, and where necessary they are advised to seek treatment at one of the large general or orthopaedic hospitals. In necessitous cases the Education Committee may make a grant to defray the cost of special appliances for the use of such cripple children provided these appliances are approved by the School Medical Officer. There is no special provision for the education of cripple children in the Borough, with the exception of those able to attend an ordinary school. The provision of a Physically Defective Centre has recently been under consideration, and premises have been secured, but a large outlay of money would be necessary to adapt and equip the building, and this has not yet been sanctioned. (See also page 65, Census of Cripples.) 9. OPEN-AIR EDUCATION. Playground Classes. (a) Classes are occasionally held in the playgrounds at some of the schools, but there is no definite scheme in connection with this. During fine weather the playgrounds are very largely occupied with physical drill classes. 55 School Camps. (b) Camps were held in connection with three schools—New Beckton, Lathom Road and Walton Road—during the summer. In the case of New Beckton School the camp was held at Great Bookham, Surrey, from 3rd to 17th July. Fifty boys between the ages of 12 and 14 years attended. The cost of the camp was £91 9s. 8d., of which the Education Committee contributed £2 15s. 7d. The Lathom Road School camp was held at Hazlemere, Bucks, for five weeks—27th July till 3rd September. The number of scholars who attended was as follows:— 1st week 50 2nd week 46 3rd week 64 4th week 47 5th week 18 The age limits for the boys were 10 to 14 years. In all 82 boys attended the camp, 60 for three weeks and 22 for two weeks. The total cost was £135, of which the Education Committee contributed £35. Walton Road School boys were in camp at Sunninghill, near Ascot, from 1st to 15th July. The number of boys who attended was 50, the ages ranging from 12 to 14 years. The total cost was .£100, of which the Education Committee contributed £30. School Journeys. (c) The boys' department of Brampton Road School organised a School Journey to Tun bridge Wells from 6th to 13th May. Twenty boys, whose average age was 13¼ years, attended. The total cost was £30, of which £15 was contributed by the Education Committee. The girls' department at Brampton Road School arranged a School Journey to Chichester from 9th to 16th June. The girls, who numbered 30, were housed in the Y.W.C.A. hostel. The average age of the girls attending was 13½ years. The total cost was £42, of which £17 were defrayed by the Education Committee. 56 Kensington Avenue Girls' School arranged a School Journey to Folkestone from 1st to 8th October. The girls, who were housed in a boarding house, numbered 45, and their average age was 13 years. The total cost was £78, the Education Committee making a grant of £32. Open-Air Classrooms in Public Elementary Schools. (d) There are no open-air classrooms in any of the schools in the Borough. Day Open-Air Schools. (e) There are no open-air schools in the Borough. Such a school is under consideration at present for the use of certain physically defective children, but no definite decision regarding it has yet been made. Residential Open-Air Schools. (f) There are no such schools in East Ham. 10. PHYSICAL TRAINING. Physical training is conducted in all schools on the lines laid down by the Board of Education. Beyond deciding which children shall be excused physical exercises the Medical Officer takes no part in the direction of the physical training. This is left entirely to the school teachers, many of whom possess special qualifications for the work. There is no Area Organiser of Physical Training in East Ham, though a strong plea was put forward in last year's Annual Report for the appointment of one. In addition to the ordinary physical exercises carried out during school hours, most of the schools run football and baskethall teams for the benefit of the boys and girls respectively. Instruction in Swimming. Facilities for learning to swim are provided for both boys and girls attending schools in the Borough. Bathing accommodation is now available for 1,000 boys and 500 girls each week. The baths are open to boys on Monday, Tuesday and Thursday forenoons, and the boys attend from the separate schools 60 at a time each half-hour. For girls the baths are available on Monday 57 afternoons and Wednesday forenoon and afternoon. One teacher accompanies every 30 scholars. A Swimming Instructress has been appointed for the girls. Special arrangements are made to convey the scholars to and from school by tramcar, and a programme of periods allotted to each school is issued so as to prevent any unnecessary loss of school time. 11. PROVISION OF MEALS. During the year meals have been provided for necessitous children as required. In one school (Plashet Lane) a feeding centre has been opened to supply the children in that district. Children in other districts have been supplied by private caterers. The School Medical Officer suggests a suitable menu for the children's dinners and periodically visits the various centres to satisfy himself regarding the quality of the food and the general arrangements for distribution, but takes no part in the selection of the children to be fed. This selection is left in the hands of the school teachers through the Ward Committee. Dealing with this matter in their Annual Report for 1912, the Board of Education points out that an effective co-ordination should exist between the work of the provision of meals and that of the school medical service, and they consider no scheme as wholly satisfactory unless the School Medical Officer (a) has the right to nominate for school feeding any children found at the routine medical inspection or on special examination to be suffering from malnutrition due to insufficiency or unsuitability of food. (b) is consulted as to the dietary provided. (c) has the right and duty of inspecting the actual arrangements made in regard to the preparation, distribution and service of meals. (d) is consulted in all cases of doubt as to the necessity for retaining a child on the feeding list owing to its physical condition. During the year 1920, 77,352 meals were provided for 800 children, compared with 35,711 meals for 210 children in 1919, 58 12. SCHOOL BATHS. There are no baths used at the schools for the bathing of school children. 13. CO-OPERATION OF PARENTS. Before the Medical Officer commences the examination of children at any school a notice is sent to the parents intimating the day and hour of the proposed inspection. This notice is of such a nature that while it invites the parents to be present at the examination of their children, it gives them opportunity for stating objections to examination. Ten years ago such objections were fairly common—during 1912, 217 parents objected— but a great improvement in this respect has now set in, and only very occasionally is the School Medical Officer refused permission to examine a scholar. Indeed, the advice of the School Medical Officer is now sought to an embarrassing extent, with the result that during the present year the clinics grew to dimensions which seriously affected the performance of the routine medical inspections at school. In 1920 the percentage of parents who were present at the inspections was considerably greater than in any previous year. This is most gratifying, for without the active interest of the parents the best results cannot be hoped for. A good deal of prejudice against school medical inspection has had to be overcome, but during the last year there have been sessions when every child was accompanied by one or other parent. This, however, is not always the case, and it is rather unfortunate that the parents w ho do attend are chiefly those who take the greatest care of their children, and therefore the majority of these are usually in good health and condition. One would infinitely prefer an interview with the parents of the weakly and neglected child. Every parent who does attend, however, lessens the work of the school nurse in the matter of visiting and allows her to concentrate her energies on the children whose parents have not been present at the inspection. 59 14. CO-OPERATION OF TEACHERS. We are fortunate in East Ham in possessing a staff of teachers nearly all of whom are alive to the advantage of and in complete sympathy with the work of the School Medical Officer. This attitude is at once gratifying to the doctor and beneficial to the scholars. In all matters pertaining to school medical work the teaching staff are ever ready to assist; they prepare the cards complete with multiple details, arrange for parents to attend at specified session, supply the best available accommodation for the doctor, and give cheerful assistance in management of the children —all factors which facilitate and expedite the Medical Officer's work. Indeed, the assistance given by school teachers is never adequately recognised, and 1 wish to express on behalf of myself and my assistants our appreciation of all the work they do for us so willingly. Without the co-operation and goodwill of the teaching staff our work loses half its efficacy, and we are greatly indebted to the teachers not only for their generous assistance, but also for necessary information regarding children's past health and for many practical suggestions in connection with school medical work generally. Following-up work is for the most part done by the school nurses, but the teachers often have an opportunity of interviewing parents and are ever ready to advocate the necessity of having the doctor's recommendations carried out. In certain schools, too, the teachers are able to obtain hospital letters, which they distribute judiciously among the most deserving and needy parents. Every morning a certain number of children arrive at school suffering from some illness or other, and it is here that the observation powers of the school teacher are of such assistance in keeping the schools free of epidemic disease and in having any illness treated in its early stages. Most of the teachers have a fair and many of them a comprehensive knowledge of the symptoms of the commoner ailments, and should any child arrive at school feeling or looking ill the teacher is quick to seek the advice of the clinic or the private practitioner as he things best. It is, however, in detecting incipient infectious and infective diseases that the aid of the school teacher is most valuable, and here naturally the individuality of any one teacher displays itself, 60 Many children suffering from chronic complaints have to make regular attendances at the clinic over a period of time, and the supervision of this comes within the teachers' activities. It is necessary that the child should attend regularly and also that as little time as possible be lost by the scholar at the clinic. With a view to assisting the teacher in this work each child so attending the clinic receives a special appointment card (vide below). This card shows the next date when the child is due to come to the clinic for treatment and also the time of the scholar's arrival at and departure from the clinic. In this way the teacher knows exactly when the child should be sent for treatment and whether any time is wasted in the journey. CLINIC APPOINTMENT CARD. Name School Date. Duration of Attendance. Arrival. Departure. Date of next Attendance. Date. Duration of Attendance. Arrival. Departure. Date of next Attendance. Keep this card clean. 15. CO-OPERATION OF SCHOOL ATTENDANCE OFFICERS. Any child absent from school is visited by a school attendance officer. If the latter is satisfied that the child is ill and having proper attention he does not interfere. If, however, the officer is not satisfied that the child has good cause for being absent the parents are asked to bring the child to one of the clinics, where the doctor decides whether the child is fit for school or not, 61 16. CO-OPERATION OF VOLUNTARY BODIES. There is little of this type of work in East Ham. In certain cases a child may be sent for a holiday through the agency of the Invalid Children's Aid Association, in others the aid of the Society for the Prevention of Cruelty to Children may be invoked, but there is ample scope for more voluntary work. A certain amount of training of mentally defective children is done voluntarily in the district, but this feature is still in its infancy. 17. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Physically Defective Children. It is very regrettable to again have to report that no school for physically defective children, as well as no open-air school, have yet been provided in this area. The need for both such schools is still very great, and though extra expenditure would be entailed an ultimate saving would, I am sure, result, i.e., lessening of loss of grant for non-attendance at the ordinary schools, decrease in clinic cases and in cases at present being sent to the country. Blind and Deaf Children. A special examination and investigation has been possible for the first time since the war of all such exceptional children in the Borough, and full details are contained in Table 3 of this Report. At the termination of routine medical inspection in each school these exceptional children are brought forward as specials and each case separately investigated. As a result 7 boys and 1 girl are attending special schools for the blind and 9 boys and 8 girls are being educated at deaf centres. One girl has been sent to a deaf and dumb school. Mentally Defective Children. As in previous reports, I regret to report the continued nonprovision for education of the feeble-minded within the Borough. The need for such a school is most urgent. Residential schools are practically all full, and great difficulty is found in securing a vacancy, and in many cases even if a vacancy be found parents are unwilling to part with a child completely when they would gladly send it for daily education. 62 A reference to Table 3 will show that out of 63 children who have been certified as mentally defective but educable in a special school, 45 are having no education, 6 are attending backward classes which is most unsuitable, 1 an ordinary elementary school, and only 11 have been satisfactorily placed. Surely in a large and flourishing district such as East Ham such a state of affairs should not be allowed to continue. 18. NURSERY SCHOOLS. There are at present no Nursery Schools in East Ham. 19. SECONDARY SCHOOLS. There is only one secondary school in East Ham, and up till now only the entrants, together with certain special cases, have been examined. During this and future years, however, it is hoped that it will be possible to examine the scholars in each year group so that each student will be examined annually during his course. Dr. Mary M. Thomson, one of the Assistant School Medical Officers, examines the girls. Scholars enter the secondary school at various ages, but usually between 12 and 13 years, and it is found that just as the parents have shown an interest in their children's educational welfare by securing for them the advantage of secondary education, so they exhibit an interest in the physical well-being of their boys and girls. As will be seen from the following table, medical inspection of scholars entering the secondary school reveals few of the ordinary defects, as naturally these have been remedied while the pupil was attending an elementary school. Defects of teeth and eyesight are the conditions mostly found requiring treatment, and hitherto facilities for having such treatment have been provided at the school clinic and have been widely taken advantage of. Unfortunately, in future it will be impossible to offer dental treatment to secondary school scholars, as it has been found necessary owing to pressure of work to limit dental treatment strictly to the age-groups suggested by the Board of Education. This is a matter for regret, as the secondary scholars were most appreciative of the work of the school dentist. 63 The comparative absence of defects amongst the secondary school students allows of more attention being paid to incipient disease conditions and pathological tendencies. Amongst boys chest and heart conditions and any tendency to rupture are carefully noted, whilst amongst girls, in addition to the foregoing, special attention is given to such points as carriage, posture, anaemia, and the establishment of menstrual functions, in all of which a little timely correction or advice is of the utmost value. TABLES SHOWING NUMBERS OF STUDENTS EXAMINED IN THE SECONDARY SCHOOL DURING THE YEAR, 1920. 12 yrs. 13 yrs. 14 yrs. Other Ages Total. Boys 9 26 20 3 58 Girls 36 13 3 12 64 "SPECIAL CASES." Boys — Girls 7 TABLE OF DEFECTS FOUND IN STUDENTS ENTERING THE SECONDARY SCHOOL DURING THE YEAR, 1920. Boys. Defect. Referred for Treatment. Under Observation. Anaemia 1 2 Teeth 19 — Defective Vision 6 — T. B. Chest 1 1 Heart Weakness 1 — Enlarged Glands — 1 Enlarged Tonsils — 16 Bronchial Catarrh — 2 Other Defects — 8 No. of Individual Children with defects 26 27 64 Girls. Defects. Referred for Treatment. Under Observation. Special Cases. Teeth 21 — — — Heart Flabby 1 — — — Defective Vision 18 — 4 — Deafness 1 — — — Nervous Condition — 2 — — Enlarged Tonsils — 7 — — Nits — 2 — 1 Adenoids — 2 — — Enlarged Glands — 1 — — Other Defects 2 5 — — No. of Individual Children with Defects 31 16 4 1 20 CONTINUATION SCHOOLS There are no Continuation Schools in East Ham at present. 21. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. All children in their final medical examination prior to leaving school have a note placed on their medical card if there is any special point in their medical history likely to affect the choice of employment. These medical cards are then forwarded to the Junior Labour Bureau so that the special notes contained thereon may be used to advantage. In cases of definite disability steps are also taken to interview the parent and advise as to the choice of suitable employment. During school medical inspection no children were discovered whose health was considered to be adversely affected through employment outside school hours. 22. SPECIAL INQUIRIES. (a) In September an outbreak of Diphtheria occurred in one of the elementary schools. As the cases could not be definitely related to any special classes an examination of the nose and throat of every child in the school was made, all suspicious cases being "swabbed." This resulted in the discovery of several nasal carriers. These were excluded and treated when the incidence of the disease in the school speedily returned to normal. 65 Census of Cripple Children of School Age in the Borough. In March the Board of Education asked for a return showing particulars of all cripple children of school age. Many of these were able to be brought to the school clinic for examination, but others had to be visited in their homes by the school medical officers. These cases were further analysed and grouped according to their fitness for education in (a) Ordinary School. (b) Special School. (c) Institution. The result of the analysis is shown in the following table:— TABLE SHOWING GROUPING OF CRIPPLE CHILDREN ACCORDING TO FITNESS FOR EDUCATION. Causa of Crippling. Suitable for Education in Ordinary School. Physically Defective School. Residential Institution. Tubercular Cases 4 19 6 Poliomyelitis Cases 7 14 1 Rickets Cases — 1 — Congenital Deformity, etc., Cases 15 14 9 Severe Heart Cases 1 10 6 No special provision has been made for any of the above children, with the exception of those fit to attend an ordinary school, In all 107 cripple children were examined, divided into the following classes:— (1) Crippling due to Tuberculosis 29 (2) Crippling due to Poliomyelitis Anterior Acuta 22 (3) Crippling due to Rickets 1 (4) Crippling to Congenital Deformities, Trauma, etc. 38 (5) Crippling due to Severe Defects of the Heart 17 Total 107 66 23. MISCELLANEOUS. During the year 67 candidates for scholarships were examined. None of these was rejected, but treatment of certain defects were suggested where necessary. Fifty teachers were medically examined by the School Medical Officer during the year. W. BENTON, Medical Officer of Health and Medical Officer to Education Committee. COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Report OF THE Opbthalmic Surgeon FOR THE YEAR 1920. 68 REPORT OF OPHTHALMIC SURGEON. The selection of cases for Ophthalmic examination is made partly on the results of the preliminary test of vision carried out at routine medical inspection and partly from special cases seen at the clinics. Children with eye symptoms or visual defects are asked to attend the Town Hall Clinic, where a further test under more perfect conditions of light is made. Where there is found to be defect sufficient to suggest the necessity for glasses, atropine ointment is put into the eyes and a small box of this ointment with instructions for home use is given to the parent, who is told to bring the child on the following Tuesday to see the Eye Specialist. On Tuesdays these cases undergo ophthalmoscopic examination. Toward the end of the session the Optician attends and takes measurements of the children requiring glasses and also distributes glasses ordered to those children who were seen and whom he measured the previous week. By this arrangement the Surgeon is enabled to make a final inspection and the suitability of the spectacles is ensured. Further, the dual attendance of the Surgeon and Optician is a distinct advantage in cases where questions arise as to special points in spectacles. Provision of Spectacles. The cost of spectacles varies according to the lenses and quality of frame. The average cost, however, is 6s. to 7s. Parents are expected to pay the Optician for glasses supplied, and in most cases they do so. In certain cases it is found parents cannot afford to pay for the spectacles, and in such cases they are supplied free. During the year spectacles were supplied free to about 80 children, £21 being so expended. In all 526 cases were submitted to refraction during the year. Of these 359 cases were prescribed spectacles; 43 received treatment other than by glasses, whilst in 122 cases no treatment was considered necessary. 69 I wish to point out that the work of the Eye Specialist is gradually extending until now it is impossible to keep abreast of it working one session per week. The result is that the work has fallen behind considerably and there is an extensive waiting list. Cases have now to wait about six months before their turn to see the Eye Specialist comes round. Not only is this bad for the child's vision, but it is construed by the parents as indifference or carelessness on the part of the School Medical Officer and his staff, and incidentally it vitiates statistics which have to be made up and submitted to the Board of Education within two months of the child being examined. B.—Treatment of Visual Defect. Number of Childlen. Referred for Refrac tion. Submitted to Refraction. For whom Glasses were Prescribed. For whom Glasses were Provided. Recommended for Treatment other than by Glasses. Received other Forms of Treatment. I'" or whom no Treatment was considered necessary. Under Local Education Authority's Scheme Clinic or Hospi tal. By Private Practitioner or Hospital. Otherwise. Total. 806 526 14 — 540 350 359 43 43 122 A. HENRY THOMPSON, M.D., Ophthalmic Surgeon. COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Annual Report ON THE WORK DONE IN The School Dental Clinic FOR THE YEAR 1920. 72 To the School Medical Officer, County Borough of East Ham Education Committee. Sir, I have much pleasure in submitting to you my first Annual Report upon the work done in the School Dental Clinic during the year 1920. Every school has been visited and treatment offered, whenever necessary, to all children from 6 to 8 years of age; 5,731 children were examined, and 4,593 were referred for treatment, i.e., 80 per cent. had teeth requiring attention, only 20 per cent. having teeth sound and free from decay. In addition 1,084 children under 5 and over 8 years of age, recommended for treatment by the School Medical Officers, Nurses and Teachers, have received treatment; these latter cases are included under the heading "Specials" as well as in their respective age group columns in the following statistical tables:— D.—Treatment of Dehtai. Defects. 1. Number of Children dealt with (totals). Age Groups. (Routine Inspection Also included under age group columns 5 & 9 to 14. "Specials." Totals. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. (a) Inspected by dentist 106 2135 2317 1279 297 162 130 145 178 95 (1113) 8446 (b) Referred for treatment 101 1090 1845 1058 292 162 130 145 178 95 (1103) 5696 (c) Actually treated 97 845 807 509 277 162 130 145 178 95 (1084) 3245 (d) Re treated (result of periodical examination) — — — — — — — — — — — — 2. Particulars of Time given and of Operations undertaken. No. of Half Days devoted to Inspec tion. No. of Half Days devoted to Treatment. Total No. of Attendances made by the Children at the Clinic. No. of Permanent Teeth. No. of Temporary Teeth. Total No. of Fillings. Total No. of Extractions. No. of Adminis trations of General Anaesthetics. No. of other Operations. Permanent Teeth. Temporary Teeth. Extracted Filled Extracted. Filled 49 341 4041 396 856 6334 589 1445 6730 338 451 120 73 The number of special cases is large, and, since the aim of the systematic routine inspection, treatment and re-inspection is to gradually reduce dental defects to a minimum and to finally bring under dental supervision the whole of the scholars of all ages, it will be necessary to give primary consideration to this routine work, except in urgent cases, where teeth and mouths are in such a condition as to interfere with education or attendance at school. Of the 5,696 children referred for treatment, only 3,245, or 57 per cent., availed themselves of the opportunity afforded at the Dental Clinic, but the percentage of "consents" is steadily rising. An increase in the work of following up cases and advising parents, together with the education of the children in oral hygiene, would undoubtedly lead to a further reduction in the number who fail to attend for treatment, and the appointment of a second School Nurse, and also a Clerk, in the dental department would make this possible. The services of the School Nurse have been invaluable, and much time and trouble have been saved as a result of her assistance in the management of the children, both at the Dental Clinic and at the Schools, in the making of appointments and other clerical work, and in assisting during the carrying out of treatment, but she has no time for visiting even urgent cases. Inspection has shown the extreme urgency for commencing treatment at as early an age as possible. Many children of six years of age, who were examined during the past year, had decayed permanent teeth which were unsavable, while it was not at all uncommon to meet with children of this age whose temporary teeth were all hopelessly decayed and septic. An instance of the early occurrence of dental decay was afforded by a case sent to the Dental Clinic from the Maternity and Child Welfare Centre—an infant, age 14 months, with four septic temporary incisor roots in the upper jaw; these had ulcerated through the gum and were causing acute inflammation and great pain; the roots were extracted and the inflammatory condition subsided. Several other children under school age, and sent from the Maternity and Child Welfare Centre, have been treated. The excellent advice with regard to infant diet and oral hygiene, which is given 74 at the Welfare Centre to nursing and expectant mothers, is bound to have a very marked effect in reducing the number of cases of school children showing dental defects, but at present it is advisable to commence dental inspection at the Schools at the age of entrance. The routine work for 1921 should therefore include the primary inspection and treatment of all children in the age-group 5 to 7, together with the re-examination of all children between the ages of 7 and 9 (i.e., the age-groups 6 to 8, which were previously inspected in 1920). • The number of children included in the routine inspections will increase year by year, until the children of all ages are under dental supervision, and as the percentage of those availing themselves of treatment is increasing, the amount of work to be undertaken will be great, and if this work is to be carried out as it should be, the advisability of appointing a second School Dentist should be considered. The dental treatment has been of very great benefit to those children whom it has been found possible to treat, and it is therefore only reasonable that the present scheme should be increased to such an extent and in such a manner that efficient dental treatment may be provided, as soon as possible, for all the children in the schools. The question of carrying out orthodontic treatment at the Dental Clinic might also be considered; many cases of irregularity of the teeth have been met with, and the majority of these could be corrected by the fitting of a simple vulcanite appliance; the outlay for the necessary apparatus would not be great, and the cost of the individual appliances might be defrayed by the parents of the children concerned. The accommodation at the School Dental Clinic is by no means ideal; the surgery is well equipped with up-to-date appliances, but the admission of more daylight would result in the saving of much time and strain. A larger and more comfortable waiting room, and a third room, with a separate exit, for use after gas cases, etc., are also very necessary. 75 The dental work undertaken in connection with the Maternity and Child Welfare Centre is shown in the following table:— No. of Half Days devoted to Treatment. No. of Attendances. No. of Permanent Teeth. No. of Temporary Teeth. Total No. of Fillings. Total No. of Extractions. No. of Adminis trations of General Anaesthetics. No. of other Operations. Adults. Children. Extrac ted. Filled. Extrac ted. Filled. Permanent Teeth. Temporary Teeth. 41 166 47 203 45 85 7 52 288 32 98 18 The increasing number of mothers who are bringing- young children for advice and treatment is encouraging, but great difficulty has been experienced in persuading the adults to have septic and unsavable teeth or roots extracted, owing to our inability to supply artificial teeth. It has been my aim throughout to carry out all treatment in as painless a manner as possible, and for this purpose either a general or a local anaesthetic has been used for all extraction cases, nitrous oxide gas being administered where it has been necessary to extract permanent teeth in the case of older children and adults. Dr. Brough has kindly devoted 35 sessions to the administration of this general anaesthetic in the Dental Clinic, and 349 children and 21 adults have thus been spared much pain and anxiety. In conclusion I should like to express my gratitude and thanks to the School Medical Officers, Nurses and Teachers, for the very valuable advice and help which they have given, and for the kindness which has been shown to me during my first year of office. I have the honour to be, Sir, Your obedient Servant, FREDERICK E. BENDIX. 76 TABLES GIVING SUMMARY OF WORK OF SCHOOL MEDICAL SERVICE from 1st JANUARY, 1920 to 31st DECEMBER, 1920. Table I.—Number of Children Inspected 1st January 1920 to 31st December 1920. A.—Routine Medical Inspection.* Age. Entrants. 3. 4. 5. 6. Other Ages. Total. Boys 4 3 767 175 58 1007 Girls 7 9 752 187 50 1005 Totals 11 12 1519 362 108 2012 Age. Intermediate Group. Leavers. Other Ages. Total. Grand Total. 8. 12. 13. 14. Boys 966 170 903 138 146 2323 3330 Girls 981 144 805 96 159 2185 3190 Totals 1947 314 1708 234 305 4508 6520 B.—Special Inspections. Special Cases *Re-Examinations (i.e., No. of Children Re-examined). Boys 2147 1348 Girls 2017 1602 Totals 4164 2250 C.—Total Number of Individual Children inspected by the Medical Officer, whether as Routine or Special Cases (no Child being counted more than once in one Year). No. of Individual Children Inspected. 10684 *The figures in this column refer only to re-examinations of children seen as routine or special cases at school 77 Table II.—Return of Defects found in the Course of Medical Inspection in 1920. This table is intended, except as regards the final line, to be a record of defects and not of individual children who are defective. For the sake of convenience cases of Squint should not be recorded also under the heading of "Defective Vision," and cases of defect of Nose and Throat should be included in one only of the sub-headings. As regards "Teeth," particulars should be given in the statements of the working of schemes of (1) dental inspection, (2) findings including oral sepsis, and (3) treatment where a scheme is in operation. (See also Table IVd.) Defect or Disease. Routine Inspections. Specials. Number referred for Treatment. Number requiring to be kept under observation, but not referred for Treatment. Number referred for Treatment. Number requiring to be kept under observation, but not referred for Treatment. (1) (2) (3) (4) (5) Malnutrition 66 3 8 4 Uncleanliness: Head 33 545 8 - Body 19 70 — — Ringworm Head 3 1 88 1 Skin Body 2 — 81 5 Scabies 8 — 185 — Impetigo 12 3 422 — Other Diseases(non- Tubercular) 13 13 224 9 Blepharitis 11 2 55 — Conjunctivitis 6 — 133 — Keratitis - - - - Corneal Ulcer - - 8 - bye Corneal Opacities — — 4 — Defective Vision 396 1 286 6 Squint 24 - 35 — Other Conditions 2 9 6 1 Defective Hearing 187 9 114 3 Ear Otitis Media 43 5 339 4 Other Ear Diseases 4 9 6 1 Enlarged Tonsils 226 731 47 8 Nose and Adenoids 65 143 138 3 Throat Enlarged Tonsils and Adenoids 81 33 88 16 .Other Conditions 9 19 45 38 Enlarged Cervical Glands (Non-Tubercular) 23 430 87 22 78 Table II.—(continued). (1) (2) (3) (4) (5) Defective Speech 4 41 3 7 Teeth—Dental Diseases (see above) See Special Dental Report. Heart and Circulation. Heart Disease: Organic 13 3 4 11 Functional 20 9 6 3 Anæmia 59 37 39 6 Lungs Bronchitis 28 21 8 5 Other Non-Tubercular Diseases 33 15 19 33 Tuberculosis Pulmonary : Definite 2 - 1 1 Suspected 20 6 3 15 Non-Pulmonary: Glands 2 1 - — Spine — — - — Hip — — - — Other Bones and Joints - - - — Skin — — - — Other Forms 1 — 1 5 Nervous System Epilepsy 2 3 5 7 Chorea 4 3 6 9 Other Conditions 1 38 23 83 Deformities Rickets 1 1 - - Spinal Curvature 1 6 3 1 Other Forms 3 10 — 3 Other Defects and Diseases 105 334 711 315 Number of Individual Children having Defects which required Treatment or to be kept under observation. 2351 1847 2204 921 79 Table III.—Numerical Return of all Exceptional Children in the Area in 1920. Boys. Girls. Total. Blind (including partially blind), within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893. Attending Public Elementary Schools 2 - 2 Attending Certified Schools for the Blind 7 1 8 Not at School 3 3 6 At Private School — 1 1 Deaf and Dumb (including partially deaf), within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893. Attending Public ElementarySchools 1 1 2 Attending Certified Schools for the Deaf 9 8 17 Not at School - - - Mentally Deficient. Feeble Minded. Attending Public Elementary Schools - 1 1 Attending Special Classes for Backward Children 5 1 6 Attending Certified Schools for Mentally Defective Children 7 4 11 Notified to the Local Control Authority by Local Education Authority during the year 6 2 8 Not at School 22 23 45 Imbeciles. At School - 1 1 Not at School 5 2 7 Notified to Board of Control — — — Idiots. Notified to Board of Control — — — Epileptics. Attending Public Elementary Schools 7 7 14 Attending Certified Schools for Epileptics 1 1 2 In Institutions other than Certified Schools 1 1 Not at School 1 5 6 Physically Defective. Pulmonary T uberculosis. Attending Public Elementary Schools 7 4 11 Attending Certified Schools for Physically Defective Children - - - In Institutions other than Certified Schools 11 5 16 Not At School — — — 80 Table III.—(continued). Boys. Girls. Total. Physically Defective, continued. Crippling due to Tuberculosis. Attending Public Elementary Schools 7 0 13 Attending Certified Schools for Physically Defective Children - - - In Institutions other than Certified Schools 2 4 6 Not at School 16 8 24 Crippling due to causes other than Tuberculosis, i.e., Paralysis, Rickets, Traumatism. Attending Public Elementary Schools 28 21 49 Attending Certified Schools for Physicallv Defective Children - - - In Institutions other than Certified Schools - - - Not at School 14 27 41 Other Physical Defectives, e.g., delicate, and other children suitable for admission to Open-air Schools ; children suffering from severe heart disease. Attending Public Elementary Schools 101 59 160 Attending Open-Air Schools — — — Attending Certified Schools for Physically Defective Children, other than Open-Air Schools - - - Not at School 11 10 21 Dull or Backward* Retarded 2 years 208 192 450 Retarded 3 years 136 78 214 *Judged according to age and standard. No case retarded more than 3 years is included in this category unless it has been decided after examination by the Medical Officer that the child is not mentally defective. 81 Table IV.—Treatment of Defects of Children during 1920. A.—Treatment of Minor Ailments. Disease or Defect. Number of Children. Referred for Treatment. Treated. Under Local Education Authority's Scheme. Otherwise. Total. Skin— Ringworm— Head 125 123 — 123 Ringworm—Body 99 81 12 93 Scabies 217 133 71 204 Impetigo 541 515 9 524 Minor Injuries 41 33 8 41 Other skin disease 283 198 70 268 Ear Disease 388 271 51 322 Eye Disease (external and other) 295 268 19 287 Miscellaneous 1400 1014 299 1313 B.—'Treatment of Visual Defect. Number of Children. Referred for Refrac tion. Submitted to Refraction. For whom Glasses were Prescribed. For whom Glasses were Provided. Recommended for Treatment other than by Glasser. Received other Forms of Treatment. For whom no Treatment was considered necessary. Under Local Education Authority's Scheme Clinic or Hospital. By Private Practitioner or Hospital. Other- wise. Total. 806 526 14 - 540 359 359 43 43 122 82 Table IV. (continued). C.-Treatment of Defects of Nose and Throat. Referred for Treatment. Number of Children. Received Operative Treatment. Received other Forms of Treatment. Under Local Education Authority's Scheme—Clinic or Hospital. By Private Practitioner or Hospital. Total. 634 382 70 452 68 D.—Treatment of Dental Defects. 1. Number of children dealt with (totals). Age Groups. (Routine Inspection) Also included under age group columns 5 & 9 to 14. "Specials." Totals. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. (a) Inspected by dentist 106 2135 2317 1279 297 162 130 145 178 95 (1113) 6814 (b) Referred for treatment 101 1690 1845 1058 292 162 130 145 178 95 (1103) 5696 (c) Actually treated 97 845 807 509 277 162 130 145 178 95 (1084) 3245 (d) Re-treated (result of periodical examination) - - - - - - - - - - — - 83 Table IV. (continued). 2. Particulars of Time given and of Operations undertaken. No. of Half Hays devoted to Inspec tion. No. of Half Days devoted to Treatment. Total No. of Attendances made by the Children at the Clinic. No. of Permanent Teeth. No. of Permanent Teeth. Total No. of Fillings. Total No. of Extractions. No. of Adminis trations of General Anaesthetics. No. of other Operations. Permanent Teeth. Temporary Teeth. Extracted Filled Extracted Filled 49 341 4041 390 856 6334 589 1445 6730 338 451 120 Table V.—Summary of Treatment of Defects as shown in Table IV. (A, B, C, D and F, but excluding E). Disease or Defect. Number of Children. Referred for Treatment. Treated. Under Local Education Authority's Scheme. Otherwise. Total. Minor Ailments 1989 1521 340 1861 Visual Defects 806 526 14 540 Defects of Nose and Throat 634 382 138 520 Dental Defects 2134 1551 8 1559 Other Defects 1400 1014 299 1313 Totals 6963 4994 799 5793 84 Table VI.—Summary relating to Children Medically Inspected at the Routine Inspections during the Year 1920. (1) The total number of children medically inspected at the routine inspections * 6520 (2) The number of children in (!) suffering from defects (other than uncleanliness or defective clothing or footgear) who require to be kept under observation (but not referred for treatment) 1232 (3) The number of children in (1) suffering from- Malnutrition 60 Skin Disease 38 Defective Vision (including squint) 420 Eye Disease 43 Defective Hearing 187 Ear Disease 47 Nose and Throat Disease 381 Enlarged Cervical Glands (non-tubercular) 23 Defective Speech 4 Dental Disease See Special Heart Disease— Dental report Organic 13 Functional 20 Anæmia 59 Lung Diseases (non-tubercular) 61 Tuberculosis— Pulmonary definite 2 suspected 20 Non-pulmonary 3 Disease of the Nervous System 7 Deformities 5 Other defects and diseases 105 (4) The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, &c.) 2299 (5) The number of children in (4) who received treatment for one or more defects (excluding uncleanliness, defective clothing, &c.) 2080 * "Specials" are not included in this Table. ROUTINE DENTAL INSPECTION AND TREATMENT. 1.—NUMBER OF CHILDREN DEALT WITH, (in each school). School. Age Groups. Also included under AgeGroups 5 and 9 to 14. 'Specials' Total. Routine Inspection. 5 6 7 8 9 10 11 12 13 14 (a) Inspected by Dentist. New Beckton 12 67 84 63 8 4 2 3 4 3 36 250 Kensington Avenue 2 74 160 88 11 8 5 2 7 7 42 364 Manor Park 4 34 89 132 6 4 7 2 7 3 33 288 Castle Street 4 3 30 27 30 3 — 2 2 — 41 101 Shaftesbury Road 3 186 116 14 5 11 6 7 6 5 43 359 High Street 5 72 67 11 16 4 3 — 1 2 31 181 Technical Institute — — — — — — 3 19 13 2 37 37 Higher Elementary — — — — — — 2 8 4 — 14 14 Storey Street 2 54 66 31 6 4 5 6 1 — 24 175 St. Winefrides 1 31 58 12 2 1 2 3 — 3 12 113 Sandringham Road 4 84 92 99 8 — 1 — — 4 17 292 Fourth Avenue 2 89 81 14 8 6 4 5 7 7 39 223 Brampton Road 14 194 48 19 26 10 8 9 7 2 76 337 Monega Road 1 125 104 29 7 8 3 4 11 10 44 302 Shrewsbury Road 5 27 78 61 8 7 — 4 1 1 26 192 Central Park 6 85 178 94 25 11 9 6 8 6 71 428 Walton Road 2 181 188 16 25 10 18 8 19 6 88 473 Lathom Road 9 155 156 77 28 21 11 7 20 14 110 498 Napier Road 3 125 133 98 13 9 2 9 3 — 39 395 Hartley Avenue 4 130 174 81 19 18 14 13 21 3 92 477 Silvertown 4 15 52 57 8 — 3 2 3 3 23 147 Plashet Lane 4 51 154 174 21 15 14 23 22 9 108 487 Vicarage Lane 10 152 113 65 11 3 1 — 8 2 35 365 Essex Road 5 201 96 17 6 5 7 3 3 3 32 346 TOTALS. 106 2135 2317 1279 297 162 130 145 178 95 1113 6844 (b) Referred for Treatment. New Beckton 12 60 68 58 8 4 2 3 4 3 36 222 Kensington Avenne 2 56 101 64 11 8 5 2 7 7 42 263 Manor Park 4 32 64 100 6 4 7 2 7 3 33 229 Castle Street 4 3 20 21 25 3 — 2 2 — 36 80 Shaftesbury Road 3 150 94 14 5 11 6 7 6 5 43 301 High Street 5 69 61 11 16 4 3 — 1 2 31 172 Technical Institute — — — — — — 3 19 13 2 37 37 Higher Elementary — — — — — — 2 8 4 — 14 14 Storey Street 1 54 64 25 6 4 5 6 1 — 23 166 St. Winefrides 1 24 50 9 2 1 2 3 — 3 12 95 Sandringham Road 4 69 74 88 8 — 1 — — 4 17 248 Fourth Avenue 2 71 69 14 8 6 4 5 7 7 39 193 Brampton Road 12 132 40 19 26 10 8 9 7 2 74 265 Monega Road 1 91 87 24 7 8 3 4 11 10 44 246 Shrewsbury Road 5 25 61 55 8 7 — 4 1 1 26 167 Central Park 6 72 131 77 25 11 9 6 8 6 71 351 Walton Road 2 128 149 14 25 10 18 8 19 6 88 379 Lathom Road 9 126 130 57 28 21 11 7 20 14 110 423 Napier Road 3 104 108 75 13 9 2 9 3 — 39 326 Hartley Avenue 4 105 144 75 19 18 14 13 21 3 92 416 Silvertown 4 12 43 46 8 — 3 2 3 3 23 124 Plashet Lane 4 47 126 145 21 15 14 23 22 9 108 426 Vicarage Lane 8 114 91 54 11 3 1 — 8 2 33 292 Essex Road 5 146 70 13 6 5 7 3 3 3 32 261 TOTALS. 101 1690 1845 1058 292 162 130 145 178 95 1103 5696 (c) Actually Treated. New Beckton 12 29 27 17 6 4 2 3 4 3 34 107 Kensington Avenue 2 35 37 28 11 8 5 2 7 7 42 142 Manor Park 4 27 23 42 6 4 7 2 7 3 33 125 Castle Street 4 3 11 9 12 3 — 2 2 — 23 46 Shaftsbury Road 3 50 44 8 5 11 6 7 6 5 43 145 High Street 5 40 29 10 16 4 3 — 1 2 31 110 Technical Institute — — — — 3 19 13 2 37 37 Higher Elementary — — — — — — 2 8 4 — 14 14 Storey Street 1 26 31 11 6 4 5 6 1 — 23 91 St. Winefrides 1 16 30 5 2 1 2 3 — 3 12 63 Sandringham Road 4 26 30 33 8 — 1 — — 4 17 106 Fourth Avenue 2 44 29 14 8 6 4 5 7 7 39 126 Brampton Road 12 72 27 17 26 10 8 9 7 2 74 190 Monega Road 1 44 41 18 7 8 3 4 11 10 44 147 Shrewsbury Road 5 18 26 25 8 7 — 4 1 1 26 95 Central Park 6 50 54 41 25 11 9 6 8 6 71 216 Walton Road 2 23 45 9 25 10 18 8 19 6 88 165 Lathom Road 9 76 62 34 28 21 11 7 20 14 110 282 Napier Road 3 51 54 36 13 9 2 9 3 — 39 180 Hartley Avenue 4 77 91 41 19 18 14 13 21 3 92 301 Silvertown 4 11 9 12 8 — 3 2 3 3 23 55 Plashet Lane 4 40 43 59 21 15 14 23 22 9 108 250 Vicarage Lane 5 42 38 35 11 3 1 — 8 2 30 145 Essex Road 4 45 26 5 6 5 7 3 3 3 31 107 TOTALS. 97 845 807 509 277 162 130 145 178 95 1084 3245 Report OF THE Chief Sanitary & Foob Inspector FOR THE YEAR 1920. 66 Annual Report of the Chief Sanitary and Food Inspector. To His Worship the Mayor, the Aldermen and Councillors of the County Borough of East Ham. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit to you my twenty-fifth Annual Report on the work done by the Sanitary Inspectors during the year ended 31st December, 1920. The total number of inspections made during the year under consideration was 8,041. These include visits to premises upon complaints of nuisance, inspections of markets, workshops, slaughterhouses, bakehouses, cowsheds, dairies, etc. There have been 24,675 nuisances discovered, comprising choked and defective drains, leaky roofs, defective sanitary appliances, animals improperly kept, etc. In obtaining abatement of the aforesaid nuisances, the following Notices were served :— Preliminary 6,531 Statutory 1,062 Dust Bin 953 Water 15 making a total of 8,561 Notices. During the year 2,561 complaints were received, as follows:— Beckton and North Woolwich Ward 327 Central Ward—East 437 Central Ward—West 506 Manor Park Ward 653 Plashet Ward—East 326 Plashet Ward—West 312 The complaints referred principally to defective drainage and appurtenances to the drains proper. 87 Complaints Received. Beckton and North Woolwich Ward. Central East Ward. Central West Ward. Manor Park Ward. Plashet East Ward. Plashet West Ward. Total. January 19 27 51 42 18 14 171 February 7 44 46 49 19 27 192 March 56 40 61 57 27 21 262 April 26 31 42 52 20 26 197 May 54 31 43 46 21 15 210 June 25 32 38 45 29 29 198 July 23 38 39 53 21 23 197 August 24 43 25 52 20 26 190 September 23 41 52 57 40 24 237 October 10 27 38 70 30 26 201 November 30 42 39 70 42 46 289 December 30 41 32 60 39 35 237 Total 327 437 506 653 326 312 2581 Written—1716. Verbal—845. Complaints.—They referred to the following Nuisances:— Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov Dec. Total Drains Choked 79 66 128 63 100 70 49 93 87 65 66 95 961 Accumulations 11 7 11 3 3 4 1 1 1 4 4 10 60 Water cut off 1 ... 2 ... ... 1 ... ... 2 ... 2 1 9 Offensive smells 4 3 6 6 4 11 3 4 3 4 ... 1 49 No dust bins 10 11 12 10 10 14 14 9 16 13 15 10 144 Dilapidations 15 36 30 44 39 21 15 17 40 23 48 21 349 Overcrowding ... 1 3 ... ... 1 3 ... 1 4 2 ... 15 Insanitary condition. 7 9 8 5 9 15 18 9 5 3 13 1 104 Dampness 17 18 9 9 5 2 22 14 21 16 24 14 171 Others (various) 27 41 53 57 40 59 72 43 61 67 95 84 699 Total 171 172 262 197 210 198 197 190 237 201 269 237 2561 HOUSE TO HOUSE INSPECTION. Special attention has been devoted to this important branch of Public Health service. The inspectorial staff have laboured incessantly to overtake arrears occasioned by the war, and during the year 4,393 primary visits were made, arising from which it was discovered that at 3,678 houses, being 83 per cent., work of sanitary amendment, comprising 17,252 defects, had to be dealt with by the service of sanitary notices to render the dwellings in such a condition which could be considered a reasonable state of 88 repair. It is only by house-to-house inspection that an intimate knowledge of the condition of property is ascertained, for there are many persons who are " long suffering " and do not complain. Inspections were made in the Wards as follows:— Inspections. Fair condition. Beckton and North Woolwich 628 18.4 per cent. Central—East 1,275 25.1 per cent. Central—West 1,267 12.7 per cent. Manor Park 606 5.6 per cent. Plashet—East 236 12.3 per cent. Plashet—West 382 13.3 per cent. Beckton and North Woolwich Ward— Name of Road. No. of premises inspected. No. of premises where nuisances existed. No. of premises found in fair condition. Albert Road 117 124 23 Boundary Road 4 4 — Cameron Street 17 16 1 Church Street 14 8 6 Claremont Street 69 56 13 Cyprus Place 8 7 1 Elizabeth Street 79 66 13 Fabian Street 30 21 9 Francis Street 21 20 1 Glenister Street 34 34 — High Street 22 13 9 Manor Way 1 1 — Milk Street 8 8 — Muir Street 15 14 1 Newland Street 6 1 5 Robert Street 25 23 2 Roman Road 102 75 27 Storey Street 26 21 5 628 512 116 Central—East Ward— Alexandra Road 77 35 42 Arthur Road 8 8 — Barking Road 4 4 — Becket Avenue 53 28 25 89 Name of Road. No. of premises inspected. No. of premises where nuisances existed. No. of premises found in fair condition. Bonny Downs Road 49 46 3 Brighton Road 59 54 5 Eastbourne Road 61 60 1 Folkestone Road 23 23 — High Street South 16 16 — Langdon Road 14 12 2 Langton Avenue 18 7 11 Market Street 37 28 9 Melbourne Road 112 83 29 Napier Road 82 70 12 Nelson Street 66 59 7 Park Avenue 34 22 12 Poulett Road 51 38 13 Ranelagh Road 85 57 28 St. Alban's Avenue 78 36 42 Sussex Road 5 4 1 Talbot Road 77 55 22 Telham Road 85 69 16 Vicarage Lane 6 6 — Wellington Road 81 61 20 Welstead Road 94 74 20 1,275 955 320 Central—West Ward— Abbotts Road 67 61 6 Barking Road 6 6 — Bartle Avenue 39 35 4 Benson Avenue 2 2 — Boleyn Road 40 39 1 Boundary Road 6 6 — Castle Street 41 41 — Central Park Road 10 5 5 Cleves Road 31 31 — Dickens Road 76 42 34 Ernald Avenue 118 110 8 Florence Road 38 38 — Greenleaf Road 16 16 — Harrow Road 39 35 4 Heigham Road 25 21 4 Hockley Avenue 50 46 4 Name of Road. No. of premises inspected. No. of premises where nuisances existed, No. of premises found in fair condition. King's Road 37 35 2 Loxford Avenue 64 45 19 Macaulay Road 117 102 15 Parr Road 96 91 5 Priory Road 36 36 — Redclyffe Road 49 43 6 Seymour Road 67 63 4 Stamford Road 104 92 12 Thackeray Road 93 67 26 1,267 1,108 159 Manor Park Ward— Alverstone Road 183 180 3 Grantham Road 140 131 9 Herbert Road 3 2 1 Parkhurst Road 70 55 15 Selborne Avenue 30 28 2 Sixth Avenue 3 3 — Walton Road 177 173 4 606 572 34 Plashet—East Ward— Colston Road 26 23 3 Halley Road 18 18 — Rixsen Road 31 26 5 Sherrard Road 120 110 10 Stanley Road 41 30 11 236 207 29 Plashet—West Ward— Bristol Road 7 6 1 Crescent Road 46 38 8 Green Street (Ann's Passage) 11 11 - Lansdowne Road 67 58 9 Park Road 64 57 7 Prestbury Road 70 57 13 Rosedale Road 70 66 4 Sandringham Road 33 26 7 Stafford Road 14 12 2 382 331 51 4,394 3,678 716 90 91 DRAINS UNSTOPPED, CLEANSED AND REPAIRED. The important work of unstopping and cleansing drains has been carried out by the Council's men free of charge. This policy of the Corporation, which has been in operation for many ears, continues to work with success. 966 house drains were tested, 42 were found defective, 288 soil pans and traps were renewed, while 361 drain ventilating pipes, 624 (lushing apparatuses and 591 waste pipes were either repaired or renewed. ROOFS, RAINWATER PIPES AND EAVES-GUTTERS. At 3,874 houses Notices were served to abate nuisances caused by leaky roofs, defective eaves gutters or rainwater pipes. It is essential to the health and comfort of the inmates of a dwelling house that the roof shall be kept at all times watertight and that the eaves gutters and rainwater pipes shall carry off the water to the drains. DIRTY PREMISES. This term includes walls and ceilings being dirty and dilapidated or in such a condition as to be a nuisance. Notices have been served in respect of 5,046 premises. The figures as a result of house-to-house inspection show a great increase. LAVATORIES AND URINALS. There are 40 urinals in the Borough (excluding those in the Public Parks). 28 are attached to licensed premises and to which the public have access. Special attention has been given by the District Inspectors to cleansing and lighting, and 176 inspections have been made. There are 4 public underground conveniences where Attendants are in charge and a standard of efficiency maintained. There are also 12 semi-public urinals attached to licensed premises, where the urinals serve a public purpose as well as a private obligation. In these circumstances the Council and the licensees have entered into an agreement as to responsibility for maintenance, etc. Some of these agreements have been working satisfactorily for over 20 years. My experience urges me to suggest that if our streets are to be kept decent and clean more public conveniences should be erected. 92 MORTUARIES. There are two mortuaries, one on the Town Hall site and the other at North Woolwich. They have been periodically inspected and found in an excellent condition. Both buildings are now under the control of a Mortuary Keeper, assisted by his wife who attends to female bodies. There have been 90 bodies admitted and 51 post-mortem examinations held during the, year. VAN DWELLERS AND SQUATTERS. 31 visits have been made to the van dwellers and squatters' settlements in Langdon Crescent, where water closets connected to the sewer have been erected, and a water supply for drinking purposes provided. By making these provisions the Bye-laws are complied with, but complaints are frequently made by persons who live in the near neighbourhood of the habits and manners of the van dweller and squatter. TEMPORARY BUILDINGS. The erection of temporary structures at rear of premises contrary to Bye-laws is a common practice. Many of these buildings impede light and ventilation, and sometimes encase the drain. All breaches of Byelaws are reported to the Borough Engineer and the buildings inspected by a Sub-Committee, and where proved to be a nuisance their removal ordered. SCHOOLS. The Public and Elementary Schools have been inspected by the District Inspectors. Special attention is given to drains, gullies, urinals, latrines, etc. In most of the schools the work of cleansing the sanitary conveniences is satisfactorily done. COMMON LODGING HOUSES. There is only one common lodging house in the Borough, with accommodation for 42 beds, situated in Albert Road, North Woolwich. It is regularly visited and on no occasion has it been necessary to serve any Notice or complain of nuisance. BAKEHOUSES, FACTORIES AND WORKSHOPS. There are 342 factories and workshops, excluding outworkers. These factories include bakehouses, laundries, blousemakers, tailors, boot-repairers, shirtmakers, artificial flower maker, etc. 93 During the year 150 inspections have been made, including 100 factories50 bakehouses, and 124 out-workers. The Inspectors' attention is chiefly devoted to the ventilation of workrooms and workshops, also to sanitary appliances and accommodation. The Chief Factory Inspector has on 19 occasions informed us of irregularities in factories or workshops discovered by the Home Office Inspectors when discharging their duties and the Chief Factory Inspector has been informed of anything discovered by our Inspectors that came within his province to deal with. DAIRIES, COWSHEDS AND SLAUGHTERHOUSES. There are 11 registered cowsheds, 198 registered dairies, and 13 slaughterhouses in the Borough. During the year, 214 inspections have been made. The premises are usually found in a satisfactory condition. The provisions of the dairies and cowsheds regulations have been complied with. In dairies the principal cause of trouble is dirty utensils, whilst in cowsheds it is the dirty surroundings, which frequently include the milker; but in reviewing past years it is gratifying to note that there has been a decided improvement in cleanliness and purity of the milk supplied, but there yet remains much to be done. The markets have been regularly inspected and on 17 occasions the Inspectors have discovered food exposed for sale in such a condition as to justify them calling upon the responsible person to have it removed and not used for the food of man. Consignments of unsound food have been surrendered for condemnation as follows:— Fish 27 trunks. Winkles 1½ cwts. Meat 48 stones. Bacon 95 lbs. Corned Beef 28 tins. Rabbits 237 Chickens 26 Ox Tongue 1 tin. Sardines 10 tins. Condensed Milk 393 tins. Pears 4 barrels. Plums 17 pkts. Bread 1 loaf. UNSOUND FOOD. 127 certificates have been given indicating the condition of the food when submitted for examination. Care is exercised when issuing a certificate to ascertain essential facts, 94 SALE OF FOOD AND DRUGS ACT. Under the provisions of this Act 223 samples were taken for the twelve months ending 31st December, as compared with 330 for the previous year. Out of the 223 samples 10 proved upon analysis to be adulterated. This is equal to an adulteration rate of 4.48 per cent., as compared with 8.5 per cent. for the year 1919. It will be seen from the table that 53 samples of milk have been taken, of which 3 were adulterated, which is equal to 5.6 per cent., as compared with 5.0 per cent. for the previous year. This shows a slight increase in the adulteration rate. Article Sampled. No. of Samples taken. No. of Adulterated Samples. Milk 53 3 Butter 28 — Whiskey 21 — Condensed Milk 18 1 Vinegar 9 1 Beer 8 — Margarine 8 — Baking Powder 7 — Cream 7 3 Lard 7 — Lime Water 6 1 Epsom Salts 4 — Gin 3 — Pepper 3 — Suet 3 — Bread 2 — Brown Sugar 2 — Coffee 2 — Cream of Tartar 2 — Honey 2 — Milk—Separated 2 — Spirits of Nitre 2 1 Ammoniated Tincture of Quinine 1 — Aspirin 1 — Citrate of Magnesia 1 — Cocoa 1 — Cod Liver Oil 1 — Custard Powder 1 — Demerara Sugar 1 — Dripping 1 — Evaporated Milk 1 — Fruit Pudding Powder 1 — Golden Syrup 1 — Jam 1 — Lemonade Powder 1 — Malt Extract 1 — Mincemeat 1 — Mixed Sweets 1 — Parrish's Food 1 — Refined Borax 1 — Saccharin 1 — Table Jelly 1 — Viota Sponge 1 — Wholemeal Flour 1 — Yorkshire Pudding Powder 1 - 95 PROSECUTIONS UNDER THE SALE OF FOOD AND DRUGS ACT FOR THE YEAR 1920. Date. Article. Offence. Fines. Costs. April Margarine Selling Margarine in plain wrapper £ s. d. £ s. d. 3 0 0 1 5 0 May Lime Water Selling Lime only half Strength 2 0 0 0 10 6 June Condensed Milk Deficient in Milk Fat 2 0 0 0 10 6 June Malt Vinegar 100 per cent. other than Malt 10 0 0 10 6 Ootober Milk Added water 5 per cent 1 0 0 0 10 6 October Milk 8 grains Boric Acid per pint 1 10 0 0 10 6 December Margarine Selling Margarine in an improper wrapper ... Withdrawn 0 10 a December Butter 50 per cent. Margarine Withdrawn 0 10 6 December Butter 50 per cent. Margarine 3 0 0 0 10 6 December Margarine Selling Margarine in an improper wrapper 1 0 0 - PROSECUTIONS UNDER THE CONTAGIOUS DISEASES (ANIMALS) ACT, FOR THE YEAR 1920. Date. Offence. Fines. Costs. October Moving into the Borough 3 pigs not accompanied by a Licence £ s. d. £ s. d. 4 0 0 December Removing from premises outside Scheduled area 16 pigs without a 25 0 0 Licence or 61 days — 96 PROSECUTIONS UNDER THE FOOD CONTROL ORDERS FOR THE YEAR, 1920. Date. Order Infringed. Offence. Fines. Costs. January Spirits (Prices and Description) Order 1919. Selling whiskey above maximum price £ s. d. £ s. d. Dismissed. ... January do. do. Adjourned sine die February Meat (Retail Prices) Order, Selling Sausages above maximum price 5 0 0 ... March Spirits (Prices and Description) Order. Serving Spirits in an improper measure 15 0 0 ... March Jam (Prices) Order 1919, Selling Jam above maximum price 4 0 0 ... April Meat (Retail Prices) Order. Selling Mutton above Maximum price 5 0 0 ... April do. do. 5 0 0 ... April I.ive Stock (Sales) Order. Slaughtering sheep that had not been bought and sold in a market 5 0 0 ... June Spirits (Prices and Description) Order. Selling whiskey above maximum price ... Dismissed 10 0 0 June do. do. do. 10 0 0 June do. do. 5 0 0 3 3 0 June do. do. 5 0 0 3 3 0 97 PROSECUTIONS UNDER THE PUBLIC HEALTH ACT FOR THE YEAR, 1920. Date. Situation of Premises. Offence. Result. January Alverstone Road Non-compliance with sanitary notice. Work carried out in agreed time. Payment of costs. January Telham Road (2 houses). do. Withdrawn. February Hallev Road (8 houses). do. Withdrawn. Payment of costs. March Market Street (18 houses). do. Magistrate's Order made. Payment of costs. May Shoebury Road do. Magistrate's Order made. Fined 5-. Costs 6/-. May Manor Way do. Withdrawn. Work completed. June Ernald Avenue do. do. September High Street, North Woolwich (2 houses). do. Withdrawn. Payment of costs. September Storey Street (5 houses). do. do. September Walton Road (3 houses). do. do. September Macaulay Road (12 houses). do. do. October Elizabeth Street (2 houses). do. Withdrawn. Work completed. November Ernald Avenue (2 houses). do. Withdrawn. Payment of costs. November Market Street (3 houses). do. do. November Lichfield Road do. do. November Washington Avenue (2 houses). do. do. December Halley Road (18 houses). do. do. December Shrewsbury Road do. do. December Victoria Avenue do. do. December Katherine Road do. do. 98 Prosecutions—continued. Date. Situation of Premises. Offence. Result. December Market Street (11 houses). Non-compliance with sanitary notice. Withdrawn. Payment of costs. December Cleves Road (2 houses). do. do. December Central Park Road do. do. December Kempton Road do. do. December Lloyd Road do. do. December Alverstone Road do. do. December Malvern Road do. do. December Sheridan Road do. do. 99 INFECTIOUS DISEASES. The District Inspectors visit all cases of infectious disease notified. The sanitary arrangements of the house arc examined, and where any defect is discovered or amendment required, Notice is served upon the person responsible and the work carried out under the Inspector's supervision. Directions are given as to isolation and disinfection. A report of the case containing all the necessary particulars required by the Medical Officer of Health is prepared, and every precaution is taken to prevent spread of disease. DISINFECTANTS. There are 4 depots in the Borough conveniently situated for distributing disinfectants to ratepayers requiring same. They are open daily, and during the year 12 tons of powder and 880 gallons of disinfecting fluid have been distributed. TRADE REFUSE. There have been 1,297 loads of trade refuse removed from business premises during the year. The Council remove free of charge, providing it is placed in a suitable receptacle and deposited in a convenient position ready for collection on the day appointed. The refuse is conveyed to the Destructor Works and destroyed. HOUSE REFUSE. There have been 11,719 loads, representing 19,267 tons, of house refuse collected during the year, as compared with 10,860 loads for the previous year—an increase of 889. This is due to the increase in the number of families, the poor quality of the fuel, together with badly constructed and defective stoves. The method of collection is the weekly pail system, and from inception it has worked successfully. The Council have a fleet of electric motors, which have displaced horse-drawn vans and effect a considerable saving in money. 100 Dust Collection. Beckton and North Woolwich Ward. Central East Ward. Central West Ward. Manor Park Ward. Plashet East Ward. Plashet West Ward. Total number of Loads Collected. January 190 250 198 234 144 175 1191 February 141 177 169 218 127 147 979 March 138 166 179 277 192 177 1129 April 141 203 138 213 148 171 1014 May 154 182 128 246 133 138 981 June 113 141 116 219 154 152 895 July 161 180 152 210 125 143 971 August 91 120 90 180 100 87 668 September 128 143 126 196 131 149 873 October 166 175 154 199 128 134 956 November 142 189 135 263 160 145 1034 December 139 187 180 190 166 196 1058 Totals 1704 2113 1765 2645 1708 1814 11749 TRADE REFUSE. January 138 February 95 March 112 April 109 May 101 June 109 July 113 August 108 September 107 October 98 November 100 December 107 Total 1,297 loads. DUST BINS. During the year reports have been made to the Committee that 953 houses were without suitable dust bins. On every occasion the Committee authorised enforcement of the provisions of the Fast Ham Improvement Act, 1903, and Statutory Notices have been served on responsible persons to provide for the 101 mises a suitable galvanised iron dust bin, 18 inches deep and 16 inches in diameter. These sizes may appear small, but when the bins are full they are quite heavy enough for a man to lift from the ground and throw the contents into the van. There is a further advantage of a small bin ; it can be made of good material and cost the same to produce as a large cheap bin. Further, a large bin encourages some folks to place refuse into it that should be burned. The Council contract to be supplied with a quantity of bins (not less than 250) made to a carefully prepared specification, and these are sold to owners of property at cost price and in most cases are appreciated. PETROLEUM AND EXPLOSIVES ACTS. Licences are issued annually in respect of premises where petroleum is stored for sale and where upwards of 60 gallons are kept for private purposes. In every case the premises are inspected and the provisions of the Act insisted upon. Very few infringements are discovered. Licence holders are informed of the requirements when they apply and invariably comply with them. There are some 29 licensed premises for petroleum and 50 for the storage of explosives, which comprise mixed fireworks. RAT EXTERMINATION. The passing of the Rats and Mice Act, 1919, imposes a duty upon the local authority to see that the provisions are carried out. As far back as 1917 the Council entered into a contract with a professional firm of rat-catchers to carry out the work of rat destruction in certain rat-infected areas in the Borough. During the last twelve months' contract this firm destroyed 2,584 rats. The contract was renewed for a further year. In addition, the Council have men who are adept rat catchers, and they devote considerable time to the work. Rat traps and poisons are sold to persons desiring such, and advice is always given to any enquirer. The Chief Inspector is the Rat Officer for the Borough. CINEMAS AND MUSIC HALLS. The premises licensed for music, dancing and cinema performances have been regularly inspected and special attention given to overcrowding and to the prevention of standing in 102 passages, gangways, and staircases, and further, that the requirements of the Council's byelaws regarding doors and lights are observed. Slight infringements are usually practised at cinemas, to which the attention of the managers has been directed on a few occasions. No prosecutions have been instituted for breaches of byelaws during the year. SANITARY INSPECTORS' ANNUAL CONFERENCF. The Council appointed the Chairman of the Public Health Committee and the Chief Sanitary Inspector to attend the Annual Conference held at Margate in September. The Conference was presided over by Sir James Crichton-Browne, M.D., L.L.D., F.R.S., and was addressed by his Worship the Mayor of Margate. Subjects of importance having an immediate bearing on Public Health were considered, discussed and resolutions carried. The Conference lasted several days, and it was generally agreed to have been time profitably spent. I am, Ladies and Gentlemen, Your obedient Servant, (Signed) JOSEPH G. BANKS, Chief Sanitary Inspector. The Following is a Record in Detail of the Inspections made during the Year 1920:— Beckton & North Woolwich Ward. Central East Ward. Central West Ward. Manor Park Ward. Plashet East Ward. Plashet West Ward. Total. 1920 1920 1920 1920 1920 1920 1920 Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Premises found in fair condition 96 123 126 323 103 155 134 43 73 21 88 51 620 716 Factory and workshop premises 3 ... 9 ... 7 ... 41 ... 8 ... 32 ... 100 ... Outworkers' premises ... ... ... ... 2 ... 37 ... 2 ... 22 ... 61 ... 124 ... Bakehouses 1 ... 4 ... 7 ... 21 ... 2 ... 15 ... 50 ... Slaughter-houses 2 ... 18 ... 1 ... 63 ... ... ... 6 ... 90 ... Dairies ... 15 ... 13 ... 15 ... 67 ... 3 ... 11 ... 124 ... Urinals inspected 62 ... 44 ... 34 ... 18 ... 5 ... 13 ... 176 ... Walls and ceilings dirty and dilapidated ... 97 476 231 833 390 1099 312 607 229 181 243 348 1502 3544 Yards improperly paved and dilapidated ... 20 79 41 169 65 227 65 274 30 64 33 58 254 871 No forecourt paving ... 1 12 3 54 37 87 13 61 16 19 19 27 89 260 Drains unstopped and cleansed 381 ... 363 ... 382 ... 471 ... 190 ... 150 ... 1937 ... Defective drains ... ... 4 ... 2 1 9 ... 8 ... 5 ... 28 1 Defective w.c. connections ... 2 1 1 ... 1 ... 4 1 3 ... ... ... 11 2 Defective w.c. traps ... 2 3 2 2 4 1 5 ... 3 1 2 ... 18 7 Soil pipes and drains insufficiently ventilated 1 ... ... 2 1 1 ... ... ... ... ... ... 2 3 Defective flushing apparatus... 10 38 36 71 69 114 68 80 37 17 49 35 269 355 Soil pans foul and broken 4 10 12 34 26 52 21 37 10 11 24 22 97 166 Defective vent pipes ... 8 10 23 38 25 73 30 70 23 21 21 19 130 231 R.W. pipes and eaves gutters defective 36 101 91 295 135 450 157 515 82 95 95 137 596 1593 Do. connected to drain 1 1 ... ... 4 15 ... ... ... 1 4 6 9 23 Roofs leaky ... ... 37 124 84 313 121 329 110 225 70 48 123 101 545 1140 Defective sink waste pipes ... 12 36 27 76 43 99 53 136 34 19 27 29 196 395 Houses without water (M.W.Bd.) ... ... ... ... ... 2 ... 5 ... 2 ... 3 ... 12 ... Cisterns without covers 2 1 3 ... 8 14 ... ... 4 2 9 25 26 42 Drinking water improperly stored ... 3 5 13 11 11 3 25 2 11 3 1 2 64 26 Dilapidated floors 10 81 26 103 31 118 62 286 20 30 26 42 175 660 Insufficient underfloor ventilation ... 3 10 8 32 18 77 33 224 12 29 14 35 88 407 Dampness 37 114 78 294 132 322 168 349 99 54 101 81 615 1214 Accumulations .. ... 4 13 1 21 4 20 19 13 ... 11 ... 78 28 Inundations ... ... ... ... 1 ... 1 ... 3 ... 1 ... 6 ... Overcrowding ... ... ... ... 1 1 1 2 ... 2 ... 5 ... 10 2 Unsound food ... 2 ... 8 ... 3 ... 1 ... 1 ... 2 ... 17 ... No dust bins ... 11 5 21 19 40 217 74 207 35 49 44 113 225 610 No manure bins ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Animals improperly kept 1 ... ... ... ... ... 2 2 1 ... ... ... 4 2 Temporary buildings found ... ... ... 2 ... 2 ... 2 ... ... ... ... ... 6 ... Smoke nuisances 6 2 30 6 15 21 7 ... 12 4 6 9 76 42 Rear passages unpaved or undrained ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gipsies ... ... ... ... ... ... 31 ... ... ... ... ... ... ... ... ... 31 ... Breaches of Bve-Laws and Regulations ... ... 7 ... 1 ... 3 ... 1 ... 1 ... 13 ... Other nuisances 179 583 356 1212 503 1559 558 1284 325 317 309 673 2230 5628 Drains tested ... 115 166 ... 191 239 122 ... 133 ... 966 ... Inspections 322 628 636 1275 763 1267 818 606 521 236 587 382 3647 4394 Total Inspections 950 1911 2080 1424 757 969 8041 103 INDEX. A. Abatement of Nuisances 86 Abattoirs 93 Acreage 6, 8 Acute Encephalitis Lethargica 18 Acute Polio-myelitis 18 Adenoids 50 Air Temperature 31 Altitude 8 B. Bacteriological Laboratory 27 Bakehouses 30,92 ,, Underground 30 Bathe 10 Births 6, 11, 13 Still 13 Birth-rate 6,11 Births, Illegitimate 12 Blind Children 79 Boundaries 8 C. Cancer 33 Cerebro-Spinal Meningitis 18 Children, Medical Inspection of 40 Cinemas and Music Halls 101 Cleanliness of School Children 41, 42 Cleansing Station 3 Climate 8 Clinic, Ante-Natal 13 Clinic, School 49, 60 Communicable Diseases (non- notifiable 24 Complaints of Nuisances 87 Contagious Diseases (Animals) Act 95 Cowsheds 93 Creche 14 D. Dairies 93 Day Nursery 14 Deafness 61 Deaths, Causes of 33 Deaths, No. of 6, 12, 33 Death-rate, General 6,12 Death-rate, Infantile 12 Deaths, Institutional 12 Deaths in Large Towns 6 Death-rate, Zymotic 6 Density of Population 6 Dentistry 72 Diphtheria 17 Dirty Premises 91 Disinfection 27 Drainage Work 9, 91 E. Education Statistics_38 Encephalitis Lethargica 18 Enteric Fever 17 Epileptic Children 79 Erysipelas 18 Explosives Act 101 Eve Diseases of School Children 68 Eye, External Inflammation of 45 F. Factory and Workshop Act 28, 29, 92 Following-up 48 Food Control (Enforcement of Orders) 96 Food and Drugs Act 94, 96 Food Inspection 93 Food, Unsound and Diseased 93 H. Health Visitors' Visits 13 Hearing of School Children 46, 49, 61 Heart Diseases of Sohool Children 64, 66, 78 Home Work, out workers 29, 93 Hospital, Admissions to 8, 32 Hospital Cost, per patient 34 Maternity 3 House Refuse, Removal 99 House to House Inspection 87 I. Imbecile Children 79 Impetigo 50, 77, 81 Industries 7 Infant Consultation 13 Infantile Mortality 12 Infectious Diseases 17, 32, 46 Infectious Diseases non-notifiable 24 Influenza 33 Inhabited Houses, Number of 6 Inquests 12 Inspection of Borough 10, 86 L. Laboratory Work 27 Legal Proceedings 95 Licences, Petroleum 101 Lung Diseases of School Children 44, 78, 84 M. Market Places 93 Maternity and Child Welfare 13, 39 Maternity Home 3, 14. Measles 24, 47 Mental Defects of School Cihildren 24,61,79 Mental Deficiency 24, 61, 79 Meteorology 31 Midwives Act 16 Milk and Cream Regulations 27 Milk, Free 14 Mortuaries 92 N. Notices Served 80 Notification of Births 13 Notification of Infectious Diseases 17, 32 Nuisances Abatement 86 Nuisances Discovered 86 Nutrition of School Children 57 O. Offensive Trades 7 Open-air Education 54, 56 Ophthalmia Neonatorum 18, 32 Ophthalmic Report 68 Orthopaedics 54 Out-relief 8 Outworkers 29, 93 Overcrowding 2 104 INDEX—continued. P. Petroleum Licences 101 Physical Training 56 Polio Myelitis 18 Poor Law Relief 8 Population 6, 7 ,, for Birth-rate 6 ,, for Death-rate 6 Prosecutions (Food Control) 96 Public Health Act 97 (Sale of Food and Drugs Act) 95 Puerperal Fever 17, 18, 32 R. Rainfall 31 Rat Extermination 10, 101 Refuse 'Removal 9, 99, 100 Ringworm 50, 51 Roofs Leaky 91 S. Sanatorium 19 Scabies 3, 44, 45, 52 Searlet Fever 17 School Camps 55 ., Children, Blind 61 Cripples 46, 54, 65 Children Excluded 47 Children, Heart Diseases of 64, 65, 78 Hearing 46, 53, 61 Children. Lung Diseases of 44, 78, 84 Medical Treatment 49 Children, Nutrition of 57 Children, Physical Training 56 Children, Skin Diseases of 51, 84 „ Children, Teeth 46, 72, 78 ,, 'Children, Verminous conditions 41, 42 ,, Dentistry 46, 72, 78 Disease of Nose and Throat 46, 50, 53 ,, Open-air 19, 54, 56 ,, Journeys 55 ,, Meals 57 ,, Baths 58 ,, Secondary 63 Schools Sanitary condition 10, 40 ,, Nursery 39, 62 ,, Continuation 64 Slaughter Houses 93 Social Conditions 7 Small Pox 3, 17 Smoke Nuisances 10 Sputum Examination 24 Staff 5, 37, 39 Subsoil 8 Summary of Report 6 T. Table—Air Temperature 31 ,, Bacteriological Examinations 27 ,, Births Registered 6 ,, Birth-rate 6 ,, Birth Visiting 13 ,, Cancer 33 ,, Causes of Death 33 ,, Cleansing of School Children 42 ,, Clinic, Treatment at 81, 82 ,, Comparative Statistics 6 ,, Complaints—Nuisances 87 Table—Complaints Received 87 ,, Deaths 33 ,, Dental Treatment 72, 82 ,, Dust Collection 100 „ Eye Examinations 69, 81, 83, 84 ,, Exclusion Forms Issued 47 ,, Factories and Workshops 28,30 „ Food and Drugs Act, Legal Proceedings 27, 94, 95 ,, House Refuse Collection 100 ,, Infantile Mortality 12 ,, Infectious Cases Removed to Hospital 32 „ Infectious Cases Notified 32 ,, Hospital Expenses 34 ,, Hospital Establishment Charges 34 „ Meteorological Record 31 ,, Notifications 32 ,, Outworkers 29 ,, Rainfall 31 ,, Record of Inspections 76 ,, School Children Excluded 47 ,, School Children Crippled 65 ,, School Children Defects 77 ,, Secondary School Examinations 63 ,, Statistical Data (Education) 38 „ Tuberculosis 21, 22, 23, 24 ,, Tuberculosis Hospital Patients 32 ,, Tuberculosis Notifications 32 ,, Typhoid Fever 32 ,, Typhoid Fever Hospital Patients 32 „ Venereal Diseases 26 ,, Verminous Condition of School Children 42 ,, Vision of School Children 69, 81 Teaching Staff 38 Teeth Decayed 72, 82, 83 Teeth for School Children 72, 82, 83 Temperature 31 Throat Affections 47, 77, 83, 84 Tonsils 50 Trade Refuse, Removal of 100 Transport 7 Tuberculosis 18 ,, Treatment of 19 ,, Visits 24 Tuberculous Diseases 18 Tuberculous Diseases of School Children 50 Tuberculosis Dispensary 20 Typhoid Fever 17 Typhus Fever 18 U. Unsound Food 93 Urinal Accommodation 10, 91 V. Venereal Disease 25, 26 Verminous Condition of School Children 42, 77 Vision of School Children 45, 53, 68 W. Watercourses 9 Water Supply 9 Whooping Cough 24 Workshops 28, 30, 92 Z. Zymotic Death-rate 6