EAS055 COUNTY BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report on the Health and Sanitary Condition of the Borough, and THE SCHOOL MEDICAL SERVICE, by W. BENTON, M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health. School Medical Officer. General Medical Superintendent and Chief Administrative Officer to the Borough Hospital and Sanatorium. Chief Tuberculosis Officer. Chief Medical Officer Maternity and Child Welfare Centre. Medical Officer to Committee for Care of the Mentally Defective. Medical Officer, Blind Persons Act. together with the report of the CHIEF SANITARY & FOOD INSPECTOR. For the Year ended 31st December, 1923. recorders, east ham. 1924. EAST HAM CORPORATION. PUBLIC HEALTH COMMITTEE. The Mayor (Councillor W. G. Davie, J.P.). The Deputy-Mayor (Councillor H. I. Rolf) Alderman C. Northfield, J.P. Alderman H. Osborn, J.P. Councillor Mrs. H. Allwright. Councillor C. W. Brading. Councillor J. Brooks, J.P. Councillor F. P. Cross. Councillor P. Y. Gerrard. Councillor H. B. Harper (Chairman). Councillor Mrs. E. J. Jacobs. Councillor T. I. Lethaby. Councillor G. Manser. Councillor C. L. E. Masset (Vice-Chairman). Councillor W. T. Newling. Councillor A. Rhodes. Councillor A. Stokes, J.P. MATERNITY AND CHILD WELFARE COMMITTEE. The Mayor (Councillor \V. CI. Davie, J.P.). The Deputy-Mayor (Councillor H. 1. Rolf). Alderman E. Edwards, J.P. Alderman T. McGiff. Councillor Mrs. H. Allwright. Councillor J. Brooks, J.P. Councillor P. Y. Gerrard (Vice-Chairman) Councillor Mrs. E. J. Jacobs (Chairman). Councillor C. L. E. Masset. Councillor E. Shanahan. Councillor W. C. Thirkettle. Miss E. H. Davies. Mrs. A. A. Dean. Mrs. E. Locke. Mrs. L. H. Wright. Mrs. F. Norman. COMMITTEE FOR THE CARE OF THE MENTALLY DEFECTIVE. The Mayor (Councillor W. G. Davie, J.P.). The Deputy-Mayor (Councillor H. I. Rolf). Alderman W. C. Ford, J.P. Alderman C. Northfield, J.P. Alderman A. H. Wiseman, J.P. (Chairman). Councillor C. W. Brading. Councillor J. Milton. Councillor (j. Mitchell. Councillor (J. Montford (Vice-Chairman). Mrs. R. Banks-Martin. Mrs. C. J. Cross. Mrs. A. McGiff. Mr. A. Halls. Mrs. T. M. Twitchett. 6 Summary of Report for 1923. 1. GENERAL STATISTICS. Area in statute acres (land and inland water), 3,324. Population Census 1921, 143,246 (males 69,342, females 73,904). Population adjusted to mid 1923, 146,200. Ward Population. Manor Park 14,866 Little Ilford 17,502 Woodgrange 13,854 Plashet 14,600 Kensington 12,868 Castle 15,320 Central 15,416 Wall End 14,972 Greatfield 11,594 South 15,208 Rateable Value:— Borough Rate £584,000 Assessable Value:— General District Rate £552,000 Sum represented by a Penny Rate:— Borough Rate £2,409 net General District Rate £,2,777 net 2. EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total number of births, 2,838 (males 1,436, females 1,402). Total number of Illegitimate births, 57. Birth-rate, 194. Deaths, 1,319 (males 693, females 626). Death-rate, 9.0. Number of women dying in, or in consequence of, childbirth from sepsis, 5; other causes, 5. 7 Deaths of Infants under one year of age per 1,000 births registered: legitimate, 50; illegitimate, 123; total, 51. Deaths from Measles (all ages), 8. Deaths from Whooping Cough (all ages), 7. Deaths from Diarrhœa (under 2 years of age), 19. Zymotic Death-rate, 0.3. COMPARATIVE STATISTICS. Annual Rate per 1,000 Living. Rate per 1,000 registered Births. Births. Deaths. Diarrhœa & Enteritis (under 2 years). Infant mortality. England & Wales 19.7 11.6 7.7 6.9 105 Great Towns 20.4 11.6 9.9 7.2 London 20.2 11.2 10.2 6.0 EAST HAM 19.4 9.0 6.7 5.1 8 COUNTY BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. REPORT OF THE MEDICAL OFFICER OF HEALTH For the year 1923. SUMMARY OF NURSING ARRANGEMENTS, HOSPITAL AND OTHER INSTITUTIONS AVAILABLE FOR THE DISTRICT. Professional Nursing in the Home. (a) General.—Excellent work is carried out by the Nurses attached to the branch Home in Katherine Road of the Plaistow Maternity Charity to which the Local Authority make no grant. (b) For Infectious Diseases, e.g., Measles, etc., no provision is made. Midwives. No Midwives are subsidised by the Authority, but a large amount of the Midwifery work is undertaken by Nurses of the Burges Road branch of the Plaistow Maternity Charity, in addition to eleven Midwives who have private practice in the Borough, and six practising in the North Woolwich area attached to Sir Henry Tate's Home. Clinics and Treatment Centres. The Maternity and Child Welfare Department at the "White House" provided by the Council is in charge of a Lady Assistant Medical Officer, who also supervises the work of the Health Visitors. For report see pp. 16-19. Infant Consultations and Ante-Natal Clinics are conducted daily. Branch Clinics are also held once a week at St. Michael's Institute, Manor Park, and St. John's School, North Woolwich At the present time there is no Day Nursery in the Borough The School Clinics are referred to in the report on the School Medical Service. 9 Tuberculosis Dispensary, Wakefield Street. Tuberculosis Officer in attendance three afternoons and one evening session each week. For summary, see pages 20—23. Venereal Diseases. East Ham forms a part of the joint scheme with the London County Council. For summary, see page 24. HOSPITALS PROVIDED OR SUBSIDISED BY THE LOCAL AUTHORITY. 1. Tuberculosis. Harts Sanatorium, Woodford Green, has accommodation for fifty beds (for report see page 19). Arrangements have been made for children to be sent to Sanatoria outside the Borough as occasion arises. Ex-service men who require training and treatment are admitted either to Papworth or Preston Hall Tuberculosis Colonies. 2. Maternity. Arrangements have been made for cases to be admitted to Plaistow Maternity Hospital or Queen Mary's Hospital, West Ham. 3. Fever. (For report see page 14.) 4. Small-Pox. An agreement has been concluded with West Ham Corporation for dealing with cases of this disease arising in the Borough. AMBULANCE FACILITIES. (a) For Infectious Diseases.—Two motor ambulances are kept at the Isolation Hospital. (b) For non-infectious and accident cases.—A motor ambulance is kept at the Fire Station. 10 LABORATORY WORK. 356 Bacteriological examinations of "swabs" for suspected Diphtheria were undertaken in our own Laboratory. 195 "swabs" were examined at the Isolation Hospital. Other pathological and bacteriological specimens are sent to London laboratories for examination. Diphtheria and other sera and vaccines are supplied free of charge to Medical Practitioners when required. SPECIAL ACTS OF PARLIAMENT. The following Special Acts of Parliament have been obtained by the Council:— The East Ham Improvement Act, 1898. The East Ham Improvement Act, 1903. The East Ham Corporation Act, 1914. The East Ham Corporation Act, 1919. Special Provisional Orders. The Tramways Orders Confirmation (No. 2) Act, 1898. The Electric Lighting Orders Confirmation (No. 2) Act, 1898. The Tramways Orders Confirmation (No. 3) Act, 1900. The Tramways Orders Confirmation (No. 2) Act, 1904. The Local Government Board's Provisional Orders Confirmation (No. 10) Act, 1904. The Local Government Board's Provisional Orders Confirmation (No. 12) Act, 1907. The Local Government Board's Provisional Orders Confirmation (No. 6) Act, 1908. Acts of Parliament applied to the Borough by order of Ministry of Health. Public Henlth Acts Amendment Act, 1907, Part 10, Sec. 95. 10th October, 1923. 11 Acts of Parliament Adopted. Name of Act adopted. Date of adoption. Date of coming into operation. Infectious Disease (Notification) Act, 1889 12th Nov., 1889 1st Jan., 1890 Infectious Diseases (Prevention) Act, 1890 14th Oct., 1890 18th Nov., 1890 Public Health Acts Amendment Act, 1890, Parts 2, 3 and 5 13th Jan., 1891 18th Feb., 1891 Public Baths and Washhouses Acts 16th Mar., 1897 16th Mar., 1897 Housing of the Working Classes Act, 1890, Part 3 16th Feb., 1897 16th Feb., 1897 Public Libraries Act, 1892 18th June, 1895 1st Aug., 1895 Infectious Disease (Notification) Act, 1889 (Extension) Education (Provision of Meals) Act, 1906 24th Nov., 1908 24th Nov., 1908 Local Government and other Officers' Superannuation Act, 1922 17th July, 1923 1st Oct., 1923 Bye-Laws, Regulations, etc. The following Bye-laws, Regulations, etc., are in force in the Borough of East Ham:— Cleansing of Footways and Pavements. The Removal of House Refuse. The Cleansing of Water Closets, Privies, etc. New Streets and Buildings. Alteration of Buildings. Nuisances. Common Lodging Houses. Slaughter Houses. Public Pleasure Grounds. 12 Bye-Laws, Regulations, &c.—continued. Houses let in Lodgings or occupied by members of more than one family. Allotments. Isolation Hospital. Employment of Children. Dairies, Cowsheds and Milk Shops. Good Rule and Government. Bakehouses. Tramways. Closing Order for Barbers and Hairdressers. Closing Order for Butchers. Closing Order for Chemists. Closing Order for Corn or Forage Dealers. Closing Order for Grocers and Provision Dealers. Tents, Vans, Sheds and similar structures used for Human Habitation. Standing Orders, Rules of Debate for regulating the Meeting and Business of the Council. Standing Orders re Licences for Cinematograph Exhibitions. Standing Orders re Licences for Public Performance of Stage Plays. Standing Orders re Licences for Music, Dancing and other Public Entertainments of the like kind, and Racecourses. Table of Fees to be taken by the Clerk to the Justices of the Peace. Unauthorised Persons on Elementary School Premises. Sale of Coal. Cleansing and Disinfection, Essex (Parasitic Mange) Order, 1909. Lamps Marking Roads Obstructions. Provision of Means of Escape from Fire in case of certain Factories and Workshops. 13 MENTAL DEFECTIVES. Work of the Voluntary Association 1. The Voluntary Association has continued to carry out for the Council (a) the supervision of such defectives in the Borough as are subject to be dealt with under the Mental Deficiency Act, 1913; (b) the ascertainment of new cases requiring statutory action; and (c) special investigations and reports required by the Council for the Board of Control in respect of defectives in institutions to be examined by visiting justices, defectives discharged from Institutional care or on leave of absence therefrom, etc. 2. The training centre, for "ineducable" young defectives and those over school age (i.e., 16 years) was held regularly throughout the year on three afternoons a week. The average attendance was 9. The boys had grown so big that it was thought best to draft those over 14 years of age to a separate handicraft class. The Association put forward a scheme and the Council made a grant. The Board of Control also approved the scheme and allocated a small sum direct towards its support, in addition to reimbursing the Council to the extent of one-half their expenditure. The boys' centre was started in January, 1924. A great deal of spade work had been done for several previous months. The centre is held every morning except Saturday at St. Barnabas' Church Room, which is most kindly put at the disposal of the Association for a nominal sum. Raffia work of various kinds is taught, in addition to cobbling, rug making, basket work, etc. In June, 1923, the Board of Control issued a circular (No. 619) to all local authorities encouraging occupation centres in urban districts and promising support. It is thus evident that these centres for defectives are now to take permanent place in the organisation of work for defectives. Case Work. On 31st December, 1923, there were:— (1) Under statutory supervision 43 (2) Under voluntary care 52 14 Case Work—continued. During the year 1923:— 28 new cases were referred to the Association. 2 defectives had removed to another district. 5 were placed by the Council in institutions under Order. 2 were placed under the guardianship of parents with payment for maintenance. 15 were referred to the Council for action. 2 were admitted to the workhouse under Poor Law. 1 was referred to the Rescue Worker. REPORT UPON THE WORK OF THE BOROUGH HOSPITAL. The following table gives the number of patients admitted for each disease and the number discharged, or who have died, in the year 1923:— Disease. Remaining at end of 1922. Admitted during 1923. Discharged during 1923. Died during 1923. Remaining at end of 1923. Scarlet Fever 50 138 166 2 20 Diphtheria 29 148 155 6 16 Measles — 2 1 — 1 Enteric Fever — 3 0 1 — Erysipelas — 1 1 — — Broncho-pneumonia — 1 1 — — Total 79 293 326 9 37 The case mortality in respect of Scarlet Fever was 1.2 and that for Diphtheria 3.7, whilst the case mortality for all cases was 2.7. Laboratory Work. 195 bacteriological examinations of "swabs" for the identification of the diphtheria bacillus were carried out at the Hospital. During the year 1923, advantage has been taken of the exceptionally low number of cases under treatment, and much headway has been made in the direction of improving and modernising the Hospital premises. 15 In this respect the Public Health Committee and the Hospital have been fortunate in possessing the services of a chairman who has a wide knowledge of Hospital administration. Among the many improvements and additions to the Hospital which have been effected during his period of office are the erection of a large and modern administrative kitchen, the relaying of the Hospital roadways, the installation of new machinery in the laundry, the rebuilding of a portion of the laundry and the allocation of a recreation room for members of the domestic staff. In addition the difficulties, which the medical and nursing staff are compelled to encounter and surmount in order to ensure efficiency, have been recognised and a large number of essential schemes have been introduced, discussed and forwarded; these include the installation of a complete central heating system to overcome the present woefully inadequate supply, and the provision of more suitable and more adequate accommodation for the nursing and domestic staff. The following urgent matters, to which attention has been drawn in previous reports, demand early and favourable consideration:— 1. The provision for increased accommodation for patients in order to prevent overcrowding during epidemic times. At the present time the area of the hospital wards is insufficient to provide for the accommodation of one patient per thousand of the population (146), unless the standards laid down by the Ministry of Health be ignored. (See Ministry of Health Report on Public Health and Medical Subjects, No. 16.) The area of the temporary and permanent buildings combined is only sufficient to provide for 110 beds. Furthermore, the temporary wards should be replaced by permanent buildings; the army huts, which were erected as an emergency expedient during an epidemic, are unsuitable for the nursing of cases of acute infectious disease and are certainly not the type of accommodation that would have been provided had there been time for forethought and deliberation. 16 2. The erection of a Discharge Block. The absence of such a block renders it extremely difficult to ensure that discharged patients are free from infection. 3. The repair and resurfacing of the roads which form the approaches to the Hospital. The very uneven travelling of the ambulances, to which every patient is, of necessity, subjected, must have a detrimental effect. The inter-epidemic period being a favourable opportunity for the advancement of these schemes it is hoped that the year 1924 will witness their rapid progress. MATERNITY AND CHILD WELFARE CENTRE REPORT. Home Visiting. Number of visits made in homes by Health Visitors, included:— Births 2,950 Births, re-visits 4,924 Over 1 year 1,548 Ante-natal 258 Ophthalmia Neonatorum 15 Special Visits 256 Total 9,951 Infant Consultations. Number of attendances, including Manor Park and North Woolwich 13,517 Ante-Natal Clinics. First attendances 181 Second attendances 119 Total 300 Number of births registered (including transfers) 2,838 Males 1,436 Females 1,402 Illegitimate 57 Still-births 46 17 Number of births notified 2,440 Number of births un-notified 398 Number of deaths under 1 month of age 71 Number of deaths under 1 year of age 146 The staff at the Centre now consists of a permanent Medical Officer, five Health Visitors and a Clerk. Owing to the need for economy urged by the Ministry during this year a sixth Health Visitor has not been appointed, and the work has been somewhat hampered; it is to be hoped that this will be rectified during the coming year. In spite of the small staff the standard of work is very high and the number of visits well maintained, though it is impossible to re-visit and follow up cases in a satisfactory manner. Applications for free milk for expectant mothers and children under three years of age increase rather than decrease—£2,000 worth was supplied to necessitous cases—and dealing with these takes up a good deal of valuable time. Attendances at the clinics have increased, and the statistics are very encouraging. Four Infant Consultations, an Ante-Natal Clinic arc held at the White House, a clinic at North Woolwich and one at Manor Park every week. No fresh accommodation has yet been found at Manor Park, and the condition of the rooms there leaves much to be desired. Another branch clinic near the south-west boundary of the Borough is becoming more and more necessary for mothers living in that neighbourhood. The Medical Officer is in attendance at the White House every morning, from 9 to 12 noon, to see special cases, e.g., test feeds, babies with acute digestive troubles requiring special attention, with discharging eyes or infectious skin diseases, and an average of six cases a morning is maintained. Maternity Accommodation. The County Borough of East Ham has no Maternity Home of its own at present. Arrangements have been made for the accommodation of cases at the Howards Road Maternity Home, Plaistow, whose management reserve five beds for the use of East Ham patients, and at Queen Mary's Hospital, West Ham. 18 The Council agree to pay 7s. a day to the authorities of both Hospitals for the maintenance of really necessitous cases, upon written order from the Medical Officer. During the year 6 cases were accommodated. Tonsils and Adenoid Cases. 46 cases of enlarged tonsils and adenoids in children under five years of age have been operated on at St. Mary's Hospital, Plaistow, the Council bearing the cost of treatment when necessary. The results on the whole have been satisfactory and the health of the children in question has benefited greatly. Ringworm Cases. The London Hospital gave X-ray treatment to seven children under five years of age, suffering from Ringworm. By the courtesy of the School Medical Service arrangements have now been made for the treatment of such children by Mr. Golledge, the School Radiographer. Dental Treatment, Owing to the kindly co-operation of Mr. Neame, the School Dentist, Wednesday afternoons have been set apart for the treatment of Ante-Natal cases, and children attending the Infant Clinics. During the year 89 mothers and 121 children have been treated, the improvement in health in all cases being most marked. It is hoped that in the near future facilities for the making or procuring of artificial dentures will be acquired by the Dental Clinic, so that mothers may obtain them at a reasonable cost and not have to injure their health by being without teeth. Midwives Act, 1902. Forty-two midwives notified their intention to practise in the Borough during 1923. Twenty-six of these worked in connection with the Plaistov Maternity Charity and its branches and five for the Sir Henry Tate Nurses' Home at Silvertown. Twenty-five visits of inspection and enquiry were made 19 The standard of work among midwives was very good on the whole, and an increasing number of cases was sent by them to the Ante-Natal Clinic during the year. Medical help was sent for in 190 cases. For the Mothers:— Ruptured Perineum. Prolonged Labour. Retained Placenta A. P. H. P. P. H. Temperature. Inflamed Breasts. Fits. Other Causes. Malpresentations. 51 32 8 9 4 7 l 2 15 10 For the Infants:— Dangerous Feebleness. Deformities. Discharging Eye s Prematurity Other Causes. 22 2 10 7 10 Five cases of artificial feeding were notified, 18 stillbirths, 3 deaths of babies under 10 days, 4 maternal deaths, and 2 cases of puerperal fever. HARTS SANATORIUM REPORT. Patients admitted for treatment classified according to stages of disease:— Early 49 Intermediate (mod. advanced) 60 Advanced 25 Observation 8 148 Patients discharged, 144 (including 2 operation cases and excluding 5 deaths). Result of treatment:— Arrested 19 Much improved 32 Improved 62 Not improved 29 20 Of 142 patients, 106 gained weight; average gain in weight, 10 lbs. 36 patients lost weight or unable to be weighed; average loss of weight, 4 1bs. Average duration of stay, excluding observation cases, 17.5 weeks. Number of patient days 17,981 Total number of beds 50 Average number of beds occupied 49.3 The result of the year's work shows a fair measure of benefit to patients admitted for treatment. The percentage of moderately advanced cases is somewhat high and improvement is often only temporary in character, but many patients have been able to resume their occupations and continue well. Further accommodation is required for female children, as these cases need treatment over a long period and can only be admitted at the expense of adults. The suggested additional buildings would provide more beds and permit of a satisfactory arrangement with regard to the classification of the various stages of disease and give accommodation for those patients in an advanced state, for whom it is impossible to carry out efficient nursing and attention in their own homes. The arrangement for obtaining Radiographs, etc., at Forest Hospital has been extremely helpful, but as many doubtful cases attending the Dispensary are unable to obtain this advantage it follows that an X-ray apparatus suitable for this purpose is urgently required in the Tuberculosis Department. TUBERCULOSIS DISPENSARY REPORT. The work of the Tuberculosis Dispensary has greatly increased. A comparison of the figures shows a far larger number of New cases examined, Nurses' visits, Dispensary attendances, and Medical examinations. This is, in part, brought about by a more efficient system of examination of contacts and by the more frequent use made of the Dispensary for consultation and opinion by General Practitioners. 21 The number of deaths occurring amongst patients attending the Dispensary (Dispensary deaths) is reduced by one-fifth, which is partly owing to the fact that more cases are sent for diagnosis, and treatment recommended at an earlier stage; also that contact cases are under better supervision, rendered possible by the addition to the Medical Staff. The regulations imposed by the Ministry of Pensions and the reference of ex-service men for opinion and report, has greatly added to the work. The system recently initiated by the Ministry of Health for closer collaboration between the General Practitioner and Tuberculosis Officer, although eventually likely to reduce the Dispensary attendances, will for some considerable time augment the duties of this department. Number of patients on treatment, 31st December, 1922:— Pulmonary, 586. Non-Pulmonary, 127. Total, 713. Adults. Children. Males. Females. Males. Females. 329 197 101 86 Number removed during the year ending 31st December, 1923, 161:— Adults. Children. Males. Females. Males. Females. 76 60 10 15 87 of these have died, 49 left the district, and 25 have been removed (discharged) from the register. Number added during the year ending 31st December, 1923, 267:— Adults. Children. Males. Females. Males. Females. 119 105 24 19 256 of these were new cases and 11 were re-admissions. Number remaining on treatment, 31st December, 1923:— Pulmonary, 625. Non-Pulmonary, 194. Total, 819. Adults. Children. Males. Females. Males. Females. 372 242 115 90 Number of deaths from Tuberculosis on register of Dispensary during 1922:—Pulmonary, 105. Non-pulmonary, 6. Total, 111. Adults. Children. Males. Females. Males. Females. 60 41 7 3 22 Number of deaths from Tuberculosis on register of Dispensary during 1923:—Pulmonary, 85. Non-Pulmonary, 2. Total, 87. Adults. Children. Males. Females. Males. Females. 46 38 3 — Number of patients who left the district during 1922:—Pulmonary, 55. Non-Pulmonary, 6. Total, 61. Adults. Children. Males. Females. Males. Females. 25 26 6 4 Number of patients who left the district during 1923:—Pulmonary, 44. Non-Pulmonary, 5. Total, 49. Adults. Children. Males. Females. Males. Females. 23 17 2 7 Number of patients who were removed (discharged) from the register during 1922:—Pulmonary, 43. Non-Pulmonary, 13. Total, 56. Adults. Children. Males. Females. Males. Females. 11 18 12 15 Number of patients who were removed (discharged) from the register during 1923:—Pulmonary, 19. Non-Pulmonary, 6. Total, 25. Adults. Children. Males. Females. Males. Females. 7 5 5 8 470 sputum examinations were made—135 were found to contain Tubercle Bacilli; 335 were negative. 668 patients were examined for diagnosis; 257 were found to be suffering from some form of Tuberculosis and attended for treatment; of these, 180 were found to have Pulmonary Tuberculosis, 26 were contacts; and 77 were found to have NonPulmonary Tuberculosis, 17 of these were contacts. 50 were of doubtful diagnosis so were allowed to attend for observation. Number of pre-Tuberculars and cases attending for observation, 415. Number of school children who have attended as Specials for medicine during 1923 (from 1st January to 26th November, end of scheme), 280. 23 Nurses' Visits—Ex-service men 595 Nurses' Visits—Others 2,747 3,342 Number of attendances at Dispensary during 1923 7,118 Number of Medical Examinations during 1923 1,791 Number of transfers from East Ham to other Boroughs 31 Number of transfers to East Ham from other Boroughs 10 24 VENEREAL DISEASES. Summary of work done by the Hospitals during the Year 1923. London Middlesex Essex Surrey Kent Herts. Bucks. E. Ham W. Ham Croydon Total Other Places Grand Total New Patients:— Syphilis 5,198 429 232 153 135 73 38 46 208 53 6,565 563 7,128 Soft Chancre 223 15 11 33 4 4 — 4 18 — 312 3 315 Gonorrhœa 8,033 732 356 246 184 82 49 135 281 64 10,762 801 11,563 Not Venereal 4,904 458 226 191 109 54 23 75 348 58 6,446 198 6,644 Total 18,958 1,634 825 623 432 213 110 260 855 175 24,085 1,565 25,650 Total Attendances 453,856 33,534 12,228 12,133 7,550 2,443 1,336 3,727 9,744 2,816 539,373 16,136 555,509 No. of "In-patient" days 67,680 3,662 2,890 4,531 2,360 866 1,247 469 1,396 280 85,381 21,281 106,662 Salvarsan Substitutes doses given 40,732 3,534 1,545 1,425 1,011 463 190 367 1,179 406 50,852 1,140 51,992 Pathological Examinations. For or at centre:— Spirochaetes 616 61 10 10 3 5 — 5 17 2 729 33 762 Gonococci 22,795 1,627 857 ooo 329 128 56 369 727 119 27,607 420 28,027 Wassermann 24,673 1,711 837 873 470 239 131 202 729 264 30,129 808 30,937 Others 8,490 281 211 601 151 38 49 23 20 47 9,911 147 10,058 Total 56,574 3,680 1,915 2,084 953 410 236 599 1,493 432 68,376 1,408 69,784 For Practitioners:— Spirochaetes 54 4 — 11 1 - - - - - 70 - 70 Gonococci 3 300 160 100 512 184 24 4 58 203 341 4,886 98 4,984 Wassermann 15,810 466 716 541 166 58 71 133 228 270 18,459 210 18,669 Others 531 28 22 17 15 7 2 1 1 1 625 55 680 Total 19,695 658 838 1,081 366 89 77 192 432 612 24,040 363 24,403 25 TOTAL CASKS NOTIFIED DURING 1923. Disease. Under 1 1—2 2—3 3-4 4-5 5-10 10—15 15—20 20-35 35—45 45-65 65 and over Total all ages Cases admitted to Hosp. Total Deaths Scarlet Fever 1 7 11 12 10 77 26 15 8 3 ... ... 170 143 2 Diphtheria 1 9 12 16 14 56 27 13 9 3 … … 160 152 4 Enteric Fever (Typhoid & Paratyphoid) … … … … … … … … 1 1 1 … 3 3 1 Erysipelas 1 … 1 … … … … … 1 13 12 4 32 10 3 Puerperal Fever … … … … … … … 1 2 2 … … 5 3 5 Cerebro-spinal Meningitis … … … … … … … … 1 … … … 1 … 1 * Ophthalmia Neonatorum 11 … … … … … … … … … … … 11 5 … Pneumonia 1 1 3 1 2 6 1 6 13 4 15 1 54 21 100 Dysentery … … … … … … … … … … … … … … … Malaria … … … … … … … … 1 … … … 1 … … Acute Poliomyelitis … 1 … 1 … … … 1 … … … … 3 3 … Total 15 18 27 30 26 139 54 36 36 26 28 5 440 340 116 Tuberculosis:— (a) Pulmonary M … … … … 2 5 2 14 51 27 20 3 124 148 76 F … … … … 1 5 4 16 44 17 9 … 96 91 53 Total … … … … 3 10 6 30 95 44 29 3 220 239 129 (6) Non-Pulmonary M … 3 3 2 2 8 10 6 8 2 … … 44 26 17 F … … … 2 1 12 8 2 4 1 2 … 32 12 15 Total … 3 3 4 3 20 18 8 12 3 2 … 76 38 32 * The eleven cases of Ophthalmia Neonatorum were visited and treated with no impairment of vision. Notification of Tuberculosis is not completely satisfactory inasmuch that cases are frequently un-notified until the disease is well advanced. In cases where death occurs in a non-notified case the attention of the Medical Practitioner is drawn to the fact and the explanation is usually satisfactory. The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was 1 to 5. 26 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN EAST HAM, 1923. 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. 45 and under 65 years. 65 and under 75 years. 75 and upward. All Causes M 693 85 14 9 23 38 105 210 119 90 F 626 61 8 9 23 41 87 159 94 144 1. Enteric Fever M 1 … … … … … 1 … … … F … … … … … … … … … … 2. Small-pox M … … … … … … … … … … F … … … … … … … … … … 3. Measles M 5 … 4 1 … … … … … … F 3 1 … 2 … … … … … … 4. Scarlet Fever M … … … … … … … … … … F 2 … … … 2 … … … … … 5. Whooping Cough M 5 4 … 1 … … … … … … F 2 1 1 … … … … … … … 6. Diphtheria M 3 … 1 1 1 … … … … … F 1 … … 1 … … … … … … 7. Influenza M 13 … … … … … … 7 1 1 F 9 … … … … 2 1 1 3 2 8. Encephalitis Lethargica M … … … … … … … … … … F … … … … … … … … … … 9. Meningococcal Meningitis M … … … … … … … … … … F 2 1 … … … 1 … … … … 10. Tuberculosis of Respiratory System M 76 … 1 1 2 10 41 17 4 … F 53 … … … 1 18 25 8 … 1 11. Other Tuberculous Diseases M 17 3 2 1 7 2 2 … … … F J5 1 2 1 5 1 3 1 1 … 12. Cancer, Malignant Disease M 73 … … … … … 5 48 14 6 F 78 … … … … … 7 48 13 10 13. Rheumatic Fever M 2 … … … 1 1 … … … … F 5 … … … 1 2 1 1 … … 14. Diabetes M 7 … … … … … 1 6 … … F 7 … … … … 1 2 … 1 3 15. Cerebral Haemorrhage, &c. M 27 … … … …… … 1 7 11 8 F 38 … … … … … 3 10 15 10 16. Heart Disease M 76 … … … 1 3 4 33 20 15 F 87 … … … 1 5 6 32 21 22 17. Arterio-sclerosis M 17 … … … … … … 5 8 4 F 6 … … … … … … 2 2 2 18. Bronchitis M 43 7 … … … … 3 11 10 12 F 56 1 1 1 … … … 10 11 32 19. Pneumonia (all forms) M 61 15 3 1 4 3 11 16 7 1 F 39 11 2 2 3 2 1 6 4 8 20. Other Respiratory Diseases M 14 … … … … … 3 5 3 3 F 5 … … … 1 … 2 … 2 … 21. Ulcer of Stomach or Duodenum M 13 … … … … 1 7 4 1 … F 6 … … … … … 4 2 … … 22. Diarrhoea, &c. M 11 10 1 … … … … … … … F 11 7 1 1 … … … 1 1 … 23. Appendicitis and Typhlitis M 4 … … … … 1 … 3 … … F 5 … … … 3 2 … … … … 24. Cirrhosis of Liver M 6 … … … … … 1 3 2 … F … … … … … … … … … … 25. Acute and chronic nephritis M 28 1 … 1 … 3 2 14 5 2 F 17 … … … 3 … 3 8 2 2 26. Puerperal Sepsis M … … … … … … … … … … F 5 … … … … 2 3 … … … 27. Other Accidents and Diseases of Pregnancy and Parturition M … … … … … … … … … … F 5 … … … … … 5 … … … 28. Congenital debility and malformation, premature birth M 27 26 … l … … … … … … F 30 30 … … … … … … … … 29. Suicide M 11 … … … … 2 3 5 1 … F 5 … … … … … 1 3 1 … 30. Other deaths from violence M 23 … … 1 4 6 3 4 2 … F 6 … … … … 1 1 1 … 3 31. Other defined diseases M 127 19 2 … 3 6 12 21 … 35 F 129 8 1 1 3 4 19 26 18 49 32. Causes ill-defined or unknown M 2 ... … … … … 1 … 1 … F … … … … … … … … … … 27 METEOROLOGICAL RECORD—YEAR 1923. 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 24 hours. Date of greatest fall. All Highest. All Lowest. January 54° 26° 47°.7 31°.9 41°.3 15 0.92 0.06 0.21 6th February 56° 26° 44°.4 37°.4 40°.9 22 2.61 0.12 0.53 7th Match 69° 25° 50°.9 37°.2 44°.0 18 2.14 0.12 0.65 12th April 66° 29° 54°.5 39°.0 51°.7 13 1.43 0.11 0.31 11th May 80° 35° 59°.8 43°.6 51°.7 14 1.61 0.12 0.35 23rd June 77° 36° 63°.5 47°.6 55°.5 8 0.53 0 .06 0.11 12th July 92° 50° 76°.3 56°.6 66°.4 10 2.69 0 .26 1.83 9th August 87° 45° 71°.7 53°.1 62°.4 9 1.99 0.22 0.52 23rd September 76° 40° 66°.3 44°.4 55°.3 12 0.93 0.08 0.21 20th October 66° 34° 57° .7 45°.3 5l°.5 20 4.66 0 .23 0.80 3rd November 58° 21° 44°.6 32°.2 38° .4 10 1.69 0.16 0.65 8th December 56° 26° 45°.1 32°.8 38°.9 17 1.91 0.11 0.42 25th Means and Totals for the Year. 92° 21° 56°.8 42°.0 49°.8 168 2.11 0.14 1.83 July 9th The Rainfall for the Year was 1.05 ins. above, and the number of days on which rain fell 11 above the year 1922, at East Ham. COUNTY BOROUGH OF EAST HAM EDUCATION COMMITTEE. Annual Report of the School Medical Officer FOR THE YEAR 1923. 30 EAST HAM EDUCATION COMMITTEE Councillor N. A. Papworth, J.P. (Chairman). Councillor F. P. Cross (Vice-Chairman). Councillor W. G. Davie, J.P. (Mayor). Councillor H I. Rolf (Deputy-Mayor). Miss A. Pockney. Alderman G. P. Dean, J.P. Councillor G. Montford. Alderman M. Oakes, J.P. Councillor W. T. Newling. Alderman H. Osborn, J.P. Councillor A. H. Owen. Alderman F. Webster. Councillor J.J. Pope. Alderman A. H. Wiseman, J.P. Councillor J. Robertson. Councillor (Mrs.) H. Allwright. Councillor N. Ridler. Councillor (Mrs.) E. J. Jacobs. Councillor A. Rhodes. Councillor A. E. Dennington. Councillor E. Shanahan. Councillor D. Gordon. Councillor A. Stokes, J.P. Councillor H. B. Harper. Councillor E. H. Thompson. Councillor T. I. Lethaby. Dr. J. W. Grice, D.Sc. Councillor G. H. Manser. E. J. Sullivan, Esq. R. Whitfield, Esq. School Nurses: Mrs. Nears, Miss Kekwick, A.R.San.1., Mrs. Sorhell, A.R.San.I, Miss Case, Mrs. Childs, C.M.B., Miss Olifent and Miss Hayward, C.M.B. School Medical Clerks: F. Read, M.S.M. (Administrative Clerk). Miss A. M. Dean, Miss M. I. Barker and Miss F. E. Hales. Dentist (full time): C. S. Neame, L.D.S., R.C.S. Ophthalmic Surgeon: C. L. Gimbi.ett, M.D., M.R.C.P., F.R.C.S. (Three sessions per fortnight.) Aural Surgeon: Gilbert C. Chubb, F.R.C.S..Eng., D.Sc., Etc. (One session per week.) Assistant Medical Officers: Miss M. M. Thomson, L.R.C.P., L.R.C.S., D.P.H. (full time). G. W. Cheater, M.B., B.S., D.P.H. Deputy and Senior Assistant Medical Officer. F. E. Bendix, L.R.C.P., M.R.C.S., L.D.S. Medical Officer: W. Benton, M.R.C.S., L.R.C.P., D.P.H. 31 County Borough of East Ham Education Committee. Mr. Chairman, Ladies and Gentlemen,— I beg to submit my Annual Report, as School Medical Officer, for 1923. The number of routine and special cases examined of elementary school children totalled 11,119, as compared with 9,441 in 1922. A complete medical inspection of all the children in the Secondary School has also been carried out. I have to report that Dr. F. L. Keith, Assistant School Medical Officer, left the service on May 4th, 1923. Dr. G. W. Cheater was appointed as Assistant Medical Officer in June, 1923. Dr. C. L. Gimblett was appointed as Ophthalmic Surgeon on 19th February, 1923, in place of Dr. H. Thompson who resigned the appointment in December, 1922. The past year has witnessed considerable progress in the Work of the School Medical Service, and the barrier, erected upon a pseudo-economic foundation, which so seriously hindered the advancement of preventive measures, is gradually disappearing. The sympathetic attitude of the Chairman of the Education Committee towards the proposals put forward from time to time has greatly assisted in determining the commencement of fresh activities directed to the improvement in the general health and physical development of the children in the Elementary and Secondary Schools. Further rapid progress is anticipated in the coming year in view of the fact that the advantages of preventive and early curative treatment are becoming more generally recognised by the Education Committee. The directions in which advance has been made are set forth in the body of the report (2, 3, 4, 7, 8a, 8c, 8/, 9e, 16,17). 32 I wish to express my indebtedness to the Committee for their kind consideration of my recommendations, also to the teachers for their help and courtesy, the whole of my staff for the excellent work carried out, and to Mr. Thompson and his itaff for their co-operation. I am, Your obedient Servant, WILLIAM BENTON, 33 1. STAFF. A list of the Staff of the School Medical Department will be found on page 30 of this Report. 2. CO-ORDINATION. In my report for the year 1922 I expressed the opinion that great benefit would accrue from the development of closer coordination in administration of the various sections, under the Local Authority, whose primary functions are directed towards maintaining a high standard of Public Health. On many occasions I have pointed out that, owing to the lack of sufficient clerical staff, the highly important administrative side of the services has suffered considerably, and members of the Professional Staff have of necessity been called upon to perform clerical duties to the detriment of those specialised duties, for which they are qualified and which they were appointed to perform. The setting up of a Special Committee, for the purpose of determining the possibility of co-ordinating the Medical Services of the Borough, afforded an excellent opportunity of putting forward the following scheme as a basis from which complete co-ordination could be evolved. 34 OUTLINE OF SCHEME FOR CO ORDINATING THE ADMINISTRATION OF THE MEDICAL SERVICES. A.—Professional Administrative Officers. 35 Each Administrative Officer shall he responsible to the Chief Medical Officer for the internal administration of his Section, and shall submit to the Otfi.ce of the Chief Medical Officer, full reports on the work performed in such Section. The Chief Medical Officer will be solely responsible for furnishing the various Committees with ALL necessary reports and information, but the Responsible Officer of each Section shall attend the meetings of the Committee of the Council which is directly concerned with that Section, in order that the Chief Medical Officer may refer to him, in regard to detail of internal administration should the necessity arise Co-ordination would be materially advanced if Committees of the Council and Chief Officials of Departments referred AI.I. matters, arising in connection with the Medical Services, to the Chief Medical Officer. B.—Clerical Staff. * One Shorthand Typist will fulfil both offices. Each Administrative Clerk shall perform his duties under the direction of the Administrative Officer of the Section concerned. The Clerk to the Chief Medical Officer shall be responsible for all official correspondence, for summarising and indexing the reports and information obtained from the various Sections, for the preparation of Reports to Committees, for the general management of the Office of the Chief Medical Officer, and he shall act in the capacity of Confidential Secretary to the Chief Medical Officer. 36 From the outset it was obvious that the most important foundation for evolving a satisfactory scheme turned upon the organisation of efficient administrative machinery in order that the professional work performed in the various sections should not be rendered less valuable owing to an impossibility of recording, correlating and co-ordinating the important facts elicited thereby, Furthermore, in such a scheme of administration, the most important part, in so far as co-ordination is concerned, will be played by the Central Office, where information and reports, submitted by the various branches of the service, would be filed and analysed, and where any relevant matter could be extracted and forwarded to the sections concerned. It is very encouraging to be able to report that the Council have decided to adopt the scheme with the proviso that the Chief Sanitary Inspector shall retain his present title and status, including any right, privilege, obligation or liability acquired, accrued or incurred by him heretofore, the whole position, however, to be reviewed by the Council upon the vacation of the position of Chief Sanitary Inspector by the present holder of the office. The adoption of the scheme was largely due to the enthusiastic support given to it by His Worship the Mayor, by the Chairman of the Education Committee and bv the Chairman of the Public Health Committee, and the most satisfactory results will follow upon a policy which aims at encouraging each member of the professional staff to specialise, as far as possible, in one particular branch of preventive medicine rather than to perform general duties in several directions. Infant and Child Welfare. (a) This has been fully reported upon in previous years. Nursery Schools. (b) There are no nursery schools under the Authority. The Care of Debilitated Children under School Age. (c) This work is carried out under the Authority's Maternity and Child Welfare Scheme. 37 3. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene. During the year 1923, a complete survey of the sanitary and and hygienic conditions pertaining to all the schools of the Authority has been carried out. Reports upon matters requiring attention have been submitted month by month to the Committee. In most instances my recommendations have received careful consideration, and an endeavour has been made to remedy defects where possible. The patiently awaited action of the Local Authority in regard to the purchase and introduction of modern furniture in the Elementary Schools has, at last, materialised. The detrimental effect of the obsolete type of desk upon the physical, and subsequently upon the mental, condition of the scholars was emphasized in my report for the year 1912, and the decision recently arrived at by the Committee is certain to promote further improvement in the physique of the school children. The attention of the Committee has been directed towards the inadequate heating systems in several of the Elementary Schools. This question is receiving consideration and a satisfactory solution is anticipated. 4. MEDICAL INSPECTION. Following the appointment of a male administrative clerk to the School Medical Section it was considered expedient that he should have full control of the clerical staff and clerical work of the Section, since the practice, previously obtaining, whereby the clerical work was distributed over three departments and much of it was performed by the medical and nursing staff, did not appear to be productive of the best results. Any work in connection with the School Medical Service which was carried out in other departments naturally took second place to the work proper of such departments, with the inevitable result that difficulties and delay frequently arose. 38 At the commencement of the year the Committee decided to adopt a scheme for the complete reorganisation of the work of the School Medical Service, especially in regard to the office routine. The scheme included:— 1. The introduction of a scheme of record-keeping on the lines suggested by the Board of Education. 2. The transference of all work in connection with the School Medical Service, previously carried out in the general office of the Public Health Department, to the office of the School Medical Section. 3. The purchase of a typewriter and the necessary cabinets and files. The process of re-organisation, which has involved very considerable increased pressure of work upon the staff of the Section, has clearly demonstrated the shortcomings and inefficiencies of the methods formerly employed, and an augmentation in the clerical staff will require consideration if complete efficiency is to be maintained. The following is a synopsis of School Medical Work for the year 1923. The figures for the year 1922 are also given for comparison:— COMPARATIVE STATEMENT OF WORK. 1922. 1923. Routine and Special Inspection 7,146 8,341 Re-inspections 2,201 2,956 Consultations at Inspection Clinic 6,113 10,982 Number of Treatments at Clinic 8,036 16,616 General Cleanliness Visits to Schools 251 315 Nurses' Visits to Homes 2,912 2,919 Children examined for Cleanliness 65,464 62,207 (a) At the commencement of the year arrangements were made for the Medical Inspection of all children admitted to the schools during the year, of all children between 8 and 9 years of age, and of all children between 12 and 13 years of age, together with children over 13 years of age who had not already been examined after reaching the age of 12. 39 In addition, provision was made for the inspection of double groups in the two schools which had not been visited in the year 1922, and for the Medical Inspection of all children in the Secondary School. This is the first occasion for many years that I have been able to report that the full programme of Medical Inspection has been carried out. The code requirements have been fulfilled in all the schools, and although re-inspection of children found in be defective has not been completed in nine schools, this work will be carried out early in the year 1924. (6) Towards the termination of routine medical inspection in each school, teachers are requested to bring before the School Medical Officer any special cases who may require examination, and to include amongst these all cases falling within the category of "exceptional children" (Table III). In this way an annual census of all cripples is rendered possible, whilst particulars may be obtained and advice given as to their progress and treatment. (c) The work of medical inspection is carried out during school hours and on school premises in every case, and disturbance of school arrangements is reduced to a minimum. 5. FINDINGS OF MEDICAL INSPECTIONS. (a) Uncleanliness. The School Nurses have carried out three cleanliness surveys of all the children in the elementary schools during the year. During the year the School Nurses made 62,207 examinations, as compared with 65,464 in 1922. Of this number 46 children were found who harboured body vermin (62 in 1922), 1,313 children showed vermin and many nits in the hair (1,071 in 1922), whilst 2,722 children showed only a few nits (3,333 in 1922). Comparative table:— Year. Number Examined. Number with Nits. Number with Head Vermin. Number No- of with Body Exclusion Vermin. Certificates. 1920 60,394 3,123 994 58 85 1921 49,452 2,677 950 102 78 1922 65,464 3,333 1,071 62 95 1923 62,207 2,722 1,313 46 62 40 TABLE VII. TABLE OF VERMINOUS CONDITIONS FOUND AT EXAMINATIONS FOR GENERAL CLEANLINESS. SCHOOLS Dept. Number Examd. Few Nits. Many Nits and Vermin. Body and nothing Verminous. SCHOOLS. Dept. Number Exam'd. Few Nits. Many Nits and Vermin. Body and Clothing Verminous. Brampton Road Girls 923 17 8 Napier Road Girls 1187 128 44 1 Boys 1085 5 11 2 Boys 1268 22 45 2 Jr. Mixed 023 13 1 Infants. 1210 127 46 ... Infants. 941 28 11 New Beckton Girls 617 55 4 ... Castle Street R.C. Mixed 457 20 3 Boys 734 8 1 1 Infants 406 26 2 Infants 614 3 ... ... Central Park Road Girls 1400 50 Plashet Lane Girls 1330 39 30 ... Boys 1404 8 2 Boys 1460 15 7 ... Infants 1877 44 12 Infants 1105 45 27 2 Dersingham Avenue Mixed 476 25 46 o Storey Street Mixed 788 57 27 ... Essex Road Girls 1128 46 47 4 Infants 783 57 39 1 Boys 1097 33 Silvertown R.C. Mixed 759 47 35 5 Infants 1119 46 45 2 Infants 501 38 21 3 Fourth Avenue Ciirls 1124 110 40 St. Winefride's R.C. Mixed 808 31 64 2 Boys 1131 52 17 1 Sandringbam Road Mixed 1087 62 8 ... Infants 740 03 21 Infants 1296 72 38 ... Hartley Avenue Girls 987 65 4 Shaftesbury Road Girls 1627 76 9 ... Boys 1160 5 2 Boys 1566 2 1 1 Infants 1184 59 6 Infants 1313 66 15 1 High Street S. Mixed 862 28 15 Shrewsbury Road Mixed | 413 26 ... ... J. Mixed 747 36 31 Infants ... ... ... ... Kensington Avenue Girls 1161 65 15 Special Class Mixed 74 8 1 ... Boys 1281 27 9 Vicarage Lane Girls 1148 88 46 4 Infants 1047 56 13 Boys 1219 8 20 1 Lathom Road Girls 1800 70 6 Infants 1033 81 44 1 Boys 1396 8 Walton Road Girls 1244 21 106 6 Infants 1198 64 2 Boys 1467 13 42 4 Manor Park Girls 762 144 15 Infants 1684 47 106 ... Bovs 791 41 25 ... Infants 670 128 36 Total 62207 2722 1313 46 Monega Road Girls 1209 78 8 Bovs 1293 1 1 Per cent 437 ! 21 07 Infants 1173 41 Per cent in 1922 5.1 1.6 0 1 vigilance displayed by teachers and nurses. Such cases, frequently recognised in the early stages, have been immediately referred to one of the School Clinics. Chief Minor Ailments. Discovered at Routine Medical Inspection. Discovered by Teachers and Nurses and sent to Clinic 1922 1923 1922 1923 Scabies 2 6 94 42 Impetigo ... 15 37 452 611 Conjunctivitis 9 8 103 147 Blepharitis 26 3 86 116 Ear Disease 55 69 255 312 Ringworm (Scalp) 3 1 65 88 Ringworm (Body) 3 4 197 78 (c) Tonsils and Adenoids. 3'5 per cent, of the children examined during the year Were referred for treatment for " tonsils and adenoids," either separate or combined, as compared with G per cent, in the year 1922. Of these, much enlarged tonsils accounted for 0'68 per 41 It is a matter for grave concern that children are still foum whose bodies and clothing are verminous, and the fact that ther are an increasing number of children who harbour head vermi; deserves very careful consideration. The serious conditions ani results which may arise from the occurrence of pediculosis do no appear to be generally appreciated until they become manifest Sir George Newman, in his report for the year 1922, ascribes th reduction in the number of children infested with vermin in th London area to :— (a) The systematic surveys. (b) The establishment of cleansing stations. (c) The progressive application of the cleansing scheme t< every school. (d) The promotion of school bathing facilities. (e) The steady development of educational methods. (/) The pressure of public opinion. (6) Minor Ailments. As has been the case in former years few minor ailments were discovered at routine medical inspection, owing to the 42 cent. ; definite adenoids were present in 0'88 per cent., and the combined defect was diagnosed in 1 *94 per cent. ; the figures for 1922 were 1 per cent., 3 per cent, and 2 per cent, respectively. The percentage of children moderately affected and requiring to be kept under observation was 5'8, the corresponding percentage in 1922 being 13. In this case 4'46 per cent, had moderately enlarged tonsils, 0'94 per cent, exhibited signs of the presence of adenoids, whilst 0'41 per pent, showed enlarged tonsils and adenoids of moderate degree, as compared with 10"7 per cent. 1'6 per cent, and 0:7 per cent, respectively in the year 1922. (d) Tuberculosis. The total number of cases of tuberculosis, occurring in children of school age, notified to the Medical Officer of Health during the year, was as follows :—• Boys. Girls. Total. Pulmonary Tuberculosis 7 9 16 Other forms of Tuberculosis... 18 20 38 Totals ... 25 29 64 (e) Skin Disease. The number of cases of skin disease still remains high, and the long periods over which treatment must be extended, under present circumstances, is of serious moment. (See Table II.) (/) External Eye Disease. Cases of blepharitis and conjunctivitis continue to increase, and a large percentage of these cases was associated with uncleanliness or occurred in debilitated and delicate children. (Vide report of School Ophthalmic Surgeon.) (g) Vision. Reference to Tables II and IV reveals the fact that less than half the children referred for refraction received treatment. (Vide 8/ and the report of the School Ophthalmic Surgeon, p. 64.) 43 (It) Ear Disease and Hearing. The number of these cases again shows a fall. 0'29 per cent, of the children examined were found to be suffering from otitis media, as compared with 1 per cent, in 1922. The percentage of deaf children was 1'28, the corresponding number for last year being 2'5. (See report of the Aural Surgeon, p. G2.) (i) Dental Defects. See report of Dental Surgeon, p.p 68—71). 0 ) Crippling Defects. Reference to Table 111, on p. 78, will furnish information with regard to the incidence of crippling defects in the area. 54 cases of crippling due to tuberculosis and 247 cases due to other causes were discovered at routine medical inspection during the year. 6. INFECTIOUS DISEASES. A detailed account of the scheme adopted for the detection and prevention of infectious diseases was submitted in my report for 1920. The number of children of school age notified during the year 1923 as suffering from scarlet fever and diphtheria was 103 and 83 respectively. It has long been recognised that the spread of infectious disease depends largely upon the personal conveyance of infection by those who have been in contact therewith, and although the disinfection of fomites and infected houses is possibly important, the rigid isolation and quarantine of contacts is the only means by which we can hope to bring about a marked diminution in the number of cases of acute infectious disease. With this end in view the following scheme has been elaborated whereby not only is the School Medical Service provided with valuable records as to the medical history of the school children and with important statistical information, but the early exclusion from school of actual and contact cases is assured and the prevention of the spread of infection greatly assisted. Furthermore, fewer loopholes exist for contact, or mild cases of the disease, to attend school for several days without the 44 teachers being- cognizant of the fact that these children are inhabitants of " infected houses," whilst the School Medical Service is able to follow closely the movements and progress of actual cases of infectious disease. 1. (i) Information is supplied daily, or as cases arise, to the School Medical Section, in regard to :— (a) School children suffering from notifiable infectious disease. (b) School children who are definite contacts or inhabitants of " infected houses." (ii) Exclusion certificates embracing the full quarantine period are issued from the School Medical Section in respect of these cases, and copies are forwarded to the Secretary and to the Teachers. 2. Information is supplied to the School Medical Section as soon as it becomes available in the General Office in regard to :— (i) Children suffering from tuberculosis, admitted to institutions or discharged therefrom, together with a summary of the physical condition of the children and the recommendations as to future lines of treatment. (ii) Children suffering from tuberculosis attending the Tuberculosis Dispensary, and— (a) Certified by the Tuberculosis Officer as unfit to attend school. (b) Certified by the Tuberculosis Officer as fit to attend school after a period of exclusion. (iii) The progress of children suffering from tuberculosis— three monthly interim reports upon the progress of such children who are inmates of institutions or who attend the Tuberculosis Dispensary. (iv) Children admitted to, or discharged from, the Isolation Hospital. 3. Teachers supply daily reports as to cases of notifiable and non-notifiable infectious disease occurring in children who attend their schools, together with information as to immediate contact cases. Definite rules are laid down for the guidance of teachers in arriving at a decision as to the exclusion of contact cases, and, where doubt exists, rapid reference to the School Medical Service is available. The success of this scheme will depend largely upon the constant vigilance and prompt report of Teachers, Sanitary Inspectors and Attendance Officers, The co-ordination in administration of the various services engaged upon the maintenance of public health should greatly facilitate the working of the scheme. 45 Exclusion forms were issued to children for the following complaints :— Nature of Complaint. Number Excluded. Number of Sessions involved. Ringworm of Scalp 98 2362 Ringworm of Body ... 93 1150 Impetigo Contagiosa... 1L'4 1009 Infective Eye Inflammation ... 119 1635 Septic conditions 71 617 Verminous conditions 62 590 Scabies 66 737 Other Skin conditions 139 1495 Acute Throat conditions 68 1128 Miscellaneous affections 378 11007 1218 21730 The comparative totals for the year 1922 were 1,153 and 19,215. 7. FOLLOWING UP. The arrangements for following up defects found at medical inspection were set out fully in the report for 1920, and these have been continued throughout. The School Nurses have paid 2,919 visits to the homes of children in whom defects were found at routine medical inspection. Of the 1,503 children referred for treatment 1,246, or 78'8 per cent., have obtained treatment. The corresponding percentage for the year 1922 was 89, and the marked falling off was due undoubtedly to the elaborate system in force for the purpose of securing payment from parents for the cost of treatment. Under the amended system (see 8a) it is probable that more satisfactory results will be obtained and that the School Nurses will encounter less difficulty in their work of following up. 8. MEDICAL TREATMENT. The following clinics are held weekly for the treatment of defects in school children :— (1) General Clinic (Minor Ailments and Observation Cases), Town Hall—Mondays, Wednesdays and Fridays, 9 a.m. 46 (2) General Clinic (Minor Ailments and Observation Cases), St. Michael's Institute, Manor Park—Tuesdays and Thursdays at 9 a.m. (3) General Clinic (Minor Ailments and Observation Cases), Nortli Woolwich—Mondays and Fridays at 2 p.m. (4) General Ear Clinic, Town Hall, Fridays at 2 p.m. (5) Eye Specialist Clinic, Town Hall, Thursdavs at 9 a.m. and alternate Mondays at 2 p.m. (6) Ear Specialist Clinic, Town Hall, Tuesdays at 3'p.m. A full account of these clinics was set forth in my report for 1922. (a) Minor Ailments. Nearly 3,000 children attended the clinics for the treatment of minor ailments. Table IV, Group 1, gives an analysis of the.se cases. With regard to the scheme for the payment bv parents of the cost of treatment obtained through the School Medical Service, it became evident that a simpler method of procedure would facilitate our efforts to improve the physical condition of the school children. It was felt that primary consideration should be given to providing the necessary treatment and that the financial question should be dealt with subsequently and should form no part of the duties of members of the School Medical Service. The following amended scheme was adopted by the Committee in July, 1923, and more satisfactory results are anticipated. (1) That no child be deprived of treatment on account of the inability of the parent to meet the cost, and that the income scale be not applied rigidly so as to necessitate meticulous investigation in every case. (2) Scale of Charges.— (a) That free medical treatment be given to the children of parents whose weekly income, after deduction of rent, does not exceed 50s. in the case of a family of two parents and three children, suitable adjustments being made in cases where the family is larger or smaller. 47 (b) That the following' charges be made to parents who have an income in excess of the scale :— (1) Minor ailments—free. (2) Dentistry—for complete treatment, Is. (3) Spectacles—cost price. (4) Operative treatment for tonsils and adenoids—5s. In this connection the School Medical Officer suggested that the following administrative arrangements be made :— (1) That when a parent intimates that he is unable to meet the cost of treatment, a form asking for particulars of income, etc., be supplied, this form to be returned, on completion, to the Borough Treasurer for investigation and the calculation of the amount of the parent's contribution, if any. (2) That arrangements for recovering the amounts due from parents in respect of the cost of treatment of their children to be carried out by the Borough Treasurer's Department. (3) That treatment be not deferred until payment of the cost has been made by the parent. (6) Tonsils and Adenoids. In the case of children moderately affected and requiring to be kept under observation advice has been given as to general hygiene, diet, the necessity for dental treatment and for breathing exercises, etc. Of the children referred for treatment 257 have received operative treatment with marked beneficial results to their general health. (c) Tuberculosis. Diagnosed and suspected cases of pulmonary and non-pulmonary forms of tuberculosis, occurring in school children, are directed to attend the Tuberculosis Dispensary. The observations of the Assistant School Medical Officers in connection with each of the cases thus sent are forwarded to the Tuberculosis Officer, who in turn furnishes a report together with his recommendations to the School Medical Section. 48 Three monthly interim reports upon the progress of children suffering' from tuberculosis, who are inmates of institutions or who attend the Tuberculosis Dispensary, are also furnished to the School Medical Section, through the General Office of the Public Health Department. In this way it is possible to ensure that the medical records of these children are kept up to date and that the cases are not lost sight of. The system by which school children obtain treatment when they are found to be suffering from definite tuberculosis requires little further comment. The decision of the Committee in regard to making arrangements for the admission of delicate and pre-tubercular children to Schools of Recovery is bound to assist greatly in the prevention of this disease. (Vide 9e.) (</) Skin Diseases. For the most part these are treated at the General Clinic, but some cases of chronic and of the rarer skin diseases are referred to hospital. An arrangement exists whereby cases of ringworm of the scalp receive X-ray treatment at a cost to the Authority of £'2 2s. per case. The erection and equipment of a Treatment Centre, containing suitable baths and a steam disinfector, would be of great value in the treatment of impetigo, septic dermatitis, scabies, verminous conditions and other contagious skin affections, and prove a valuable asset in our campaign of prevention. (e) External Eye Disease. 275 cases (278 in 1922) of external eye disease were treated at the School Clinics. The observations of the School Ophthalmic Surgeon, with regard to the best means of dealing with these cases, will be found in his report on p. 64). (J) Vision. On the appointment of Mr. Gimblett as School Ophthalmic Surgeon it was decided, with the consent of the Board of Education, to hold the Ophthalmic Clinic on one additional session per fortnight. 49 Unfortunately the services of a School Oculist were not available during the first two months of the year, and therefore it has been impossible to deal with all the children requiring' treatment. Of the 1,343 cases referred for treatment 573 have been treated. It will be appreciated that a further additional session per week, set aside for the treatment of these cases, would enable the Authority to overcome arrears of work in this direction. (g) Ear Disease 375 consultations were given and 292 children were treated at the General Ear Clinic. See report of Aural Surgeon, p. G2. (h) Dental Defects. I again earnestly approach the Committee to provide more satisfactory accommodation for the School Dental Clinic. It is extremely unfortunate that, with the1 staff available at present, the dental needs of children, above the age of 10 years, cannot be systematically dealt with. See repont of Dental Surgeon, pp. G8—71. («') Crippling Defects. The furnishing of satisfactory treatment in the case of children suffering from crippling defects is a matter of great difficulty, whilst a very large number of them (see Table 111) cannot attend the elementary schools and no Physically Defective Centre has been provided in the Borough. The provision of such a centre has been the subject of deliberation on many former occasions, and the Committee are again giving favourable consideration to the matter. It is hoped that the Board of Education will give it equally favourable consideration. Until a year ago greater difficulty was experienced in obtaining adequate treatment for cases coming under the above heading. Even where parents were willing and anxious to visit a London Centre, the expenditure of time and money was found to be prohibitive, and in most cases treatment was dropped long before the twisted spine could be straightened or the deformed limb brought back to normal. During the year, however, the Balaam Street Children's Hospital, a small and efficient institution of 24 beds, with a remedial clinic attached, has been opened 50 within a short 'bus ride of East Ham, and, with the greatest courtesy and kindness (up till the present date no case has been refused treatment, and I regret that the Local Education Authority have not considered favourably a request for financial assistance from the Hospital Authorities), over 20 children, suffering- from various forms of spinal curvature, infantile paralysis and deformities of the lower limbs, and referred from the School Medical Service, have been, and are being-, treated ; such treatment involving, in many cases, tri-weekly visits and, in other cases, operations and in-patient treatment. I, and my medical staff, are glad of this opportunity of recording our gratitude and thanks to the Hospital management. During the year the Education Committee made grants towards the cost of 13 appliances for the use of cripple children, the total cost being ;£33 3s. fid., of which the Committee contributed /.T4 16s. 6d. 9. OPEN-AIR EDUCATION. (<i) Playground Classes. In a few cases playground classes continue to be held occasionally. (6) School Camps. No School Camps were held during the year 1923 (c) Open-Air Classrooms In Public Elementary Schools. None of the classrooms in the schools of the Borough have been constructed on the open-air principle. (d) Day Open-Air Schools. There are unfortunately no open-air schools in the Borough. The provision of a day open-air school, erected on a suitable site within the Borough, would tend markedly towards reducing the number of definitely physically defective children, with the result that, at no distant date, the present serious need for a large number of places in a Physically Defective Centre and a Residential Open-air School would be less urgent. 51 (e) Residential Open-Air Schools. There are no such schools under the direct control of the Local Education Authority ; the Committee, however, have deemed it desirable to send a certain number of children, for whom such treatment would be beneficial, to the Ogilvie School of Recovery at Clacton-on-Sea. This is a distinctly progressive movement. I am confident that the results will more than compensate an authority, with broad outlook to provision against possible and certain physical infirmity, for their outlay, and I strongly advise that this form of preventive treatment should be extended and elaborated. There are in the Borough of East Ham to-day a more than sufficient number of pre-tubercular, delicate and debilitated children to populate a Residential Open-air School with accommodation for 100. The following figures furnish statistics in regard to such children discovered, during the course of our activities, in the year 192.1 :— Number of children on a waiting list for admission to a School of Recovery ... ... ... ... 110 Number of children referred to the Committee for their consideration ... ... ... ... ... 122 Number of children actually at a School of Recovery at the end of the year 1923 ... ... ... 1 Number of children who have had a period of treatment at a School of Recovery during the vear 192.1 ... * ... 2fi 10. PHYSICAL TRAINING. Physical training has been continued on similar lines to thost quoted in previous reports, and instruction in swimming has been conducted as heretofore. 11. PROVISION OF MEALS. During the year 150,057 meals were provided for 7Pi9 children, as compared with 17.3,043 meals for 047 children in 1922. Tlie School Medical Officer suggests a suitable menu for the children's meals, and the Medical Officers and School Nurses visit the various feeding centres periodically. On these occasions the quality of the food and the preparation, distribution and service of the meals have been satisfactory. The selection of the children to be fed is left in the hands of the School Teachers, through 52 the appropriate Educational Assistance Committee, and although this arrangement is satisfactory, seeing that the Teachers by their constant association with the children are usually well enough acquainted with the home conditions to be able to arrive at a decision, yet it must be remembered that malnutrition may depend upon other causes than want of food. In this connection it is noteworthy that no special cases have been notified to the School Medical Officer by the Teachers or by the Secretary of the Education Committee. More frequent reference to the advice and opinion of the Medical Officers would tend to ensure that the physical condition and need of the child were the important factors in settling the question as to whether meals should be provided in individual cases or not. 12. SCHOOL BATHS. There are no baths used at the schools for the bathing ol school children. 13. CO-OPERATION OF PARENTS. During the year 1923, the number of parents who were present at the routine medical inspections was 3,636 (2,650 in 1922), that is, in 47*3 per cent, of the cases examined (40*3 per cent, in 1922). The increasing interest which parents take in the work of the School Medical Service demonstrates the value which they place upon this work, and assists greatly in ensuring that our advice and directions are carefully carried out. 14. CO-OPE RATION OF TEACHERS. The Teachers render most valuable assistance to the Schftol Medical Service, and the great interest which they exhibit in regard to all matters affecting the physical and mental condition of the scholars is extremely stimulating and encouraging to the School Medical Officers and Nurses. IS. CO-OPERATION OF SCHOOL ATTENDANCE OFFICERS. The co-operation of School Attendance Officers and the coordination of the School Medical Service with that of the School Attendance Department has been fully discussed in previous reports. 53 16. CO-OPERATION OF VOLUNTARY BODIES. There has been little of this type of work in East Ham recently, hut with the establishment of a local branch of the Invalid Children's Aid Association it is probable that the excellent work, carried out by this Association in the past, will be resumed. 17. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Physically Defective Children. Table III reveals the very regrettable fact that 247 children (118 in 1922) suffering from physical defects are receiving no education owing to their being totally unfit to attend public elementary schools. In addition it will be seen that 305 children (322 in 1922), who are considered suitable for admission to open-air schools or certified schools for physically defective children, are attending public elementary schools, and since suitable treatment is not available for these cases it is highly probable that many of them will ultimately join the ranks of the unfit. There are, then, at present, 552 children (440 in 1922) for whom no adequate treatment, either in the form of an open-air school or physically defective centre, has been carried out, with the exception of the 20 children admitted to the Ogilvie School of Recovery. Mentally Defective Children. During the year 1923, the number of cases examined, for purposes of the Mental Deficiency Act of 1913, was 67 (55 in 1922). Of these 40 were classified as mentally deficient, and 21 as dull and backward, recommendations being made as shown in the following table :— Number examined 67 Classified as imbeciles 5 Classified as morally deficient 1 46 Classified as mentally deficient 40 Classified as dull and backward 21 Recommended for Special School 58 Recommended for Special Class 17 54 A reference to Table III will show that out of 119 children who have been certified as mentally defective but educable in a special school, 39 (39 in 1922) are having no education, 24 are attending an ordinary elementary school (14 in 1922), and 56 have been satisfactorily placed. The certification, as a special school, under Part V of the Education Act, 1921, of the classes held at Shrewsbury Road School, carries us a step towards increasing the facilities for educating the feeble-minded within the Borough, but the fact that 63 children are not receiving suitable instruction clearly indicates the necessity for the further expansion of these facilities. 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 tables relating to the work carried out in connection with this school are appended. 55 MEDICAL INSPECTION RETURNS. SECONDARY SCHOOL. TABLE I. RETURN OF MEDICAL INSPECTIONS (see note a). For the Year ended 31st December, 1923. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections— (see note b). Boys. Girls. Entrants — — Intermediates — — Leavers 158 126 Total 158 126 Number of other Routine Inspections (see note c). 77 68 B.—OTHER INSPECTIONS. Number of Special Inspections (see note d). 5 3 Number of Re-Inspections (see note e). 12 10 Total 17 13 56 TABLE II. SECONDARY SCHOOL. A.—Return of Defects found by Medical Inspection in the Year Ended 31st December, 1923. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation,but not requiring Treatment. (1) (2) (3) (4) (5) B. G. B. G. B. G. B. G. Malnutrition — — — — — — — — Uncleanliness: See Table IV., Group V. — — — — — — — — Skin Ringworm: Scalp — — — — — 1 — — Body — 1 — — — — — — Scabies — — — — 1 — — — Impetigo — — 1 — — — — — Other Diseases non-Tuberculous — 1 — 1 — 1 — — Eye Blepharitis — — — — — — — — Conjunctivitis — 1 — — — — — — Keratitis — — — — — — — — Corneal Opacities — — — — — — — — Defective Vision (excluding Squint) 21 31 6 9 7 2 — — Squint — — — — — — — — Other Conditions — — — — — - — — Ear Defective Hearing — — — — — — — — Otitis Media — — — — — — — — Other Ear Diseases — — 1 — — 2 — — Nose and Throat 'Enlarged Tonsils only — — 10 14 — — — — Adenoids only 1 — — — — — — — Enlarged Tonsils and Adenoids — — — 1 — — — — Other Conditions — — 1 — — — — — Enlarged Cervical Glands (Non-Tuberculous) — — 2 10 — — — — Defective Speech — — — — — — — — 57 Table II.-(continued.) (1) (2) (3) (4) (5) B. G. B. G. B. G. B. G. Teeth -Dental Diseases (sec note a) 7 19 3 - - 2 - - See Table IV., Group IV. Heart and Circulation Heart Disease: Organic - - - - - - - - Functional - - - 1 - - - - Anaemia 1 - 3 2 - - - - Lungs Bronchitis - - - - - - - - Other Non-Tuberculous Diseases - - - 1 - - - 1 Tuber- culosis Pulmonary: Definite - - - - - - - - Suspected - - - - - - - - Non-Pulmonary: Glands - - - - - - - - Spine - - - - - - - - Hip - - - - - - - - Other Bones and Joints - - - - - - - - Skin - - - - - - - - Other Forms - - - - - - - - Nervous System Epilepsy - - - - - - - - Chorea - - - - - - - - Other Conditions - - - - - - - - Deformities Rickets - - - - - - - - Spinal Curvature - 1 1 2 - 2 - - Other Forms - - - - - - - - Other Defects and Diseases 1 - 1 3 1 1 - 1 B.-Number of individual children (see note b) found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). GROUP. Number of Children. Percentage of Children found to require. Treatment. (see note d). Inspected (see note c) Found to require Treatment. (1) (2) (3) (4) Code Groups :- Entrants - - - - - - Intermediates - - - - - - Leavers 158 126 14 26 8.8 20.6 Total (Code Groups) 158 126 14 26 8.8 20.6 Other Routine Inspections 77 68 7 9 9.09 13.2 58 20. CONTINUATION SCHOOLS. I here are no Continuation Schools in East Ham. 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. 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 boys have been specially examined, in accordance with the Bye-Laws, and all of these were found to be fit for employment. The following suggestions, which were put forward in my report for the year 1922, have been discussed at a meeting of the Local Insurance Committee, when a resolution was passed to the effect that no useful purpose was likely to be served by the adoption of these suggestions:— "It would appear desirable that, when cases no longer come within the province of the Juvenile Employment Bureau, the medical records should be forwarded to the Local Insurance Committee and thence to the Practitioner on whose panel list the persons concerned are placed. In addition, in order to increase the scope of preventive medicine, it would be a valuable innovation were all insured persons to be subjected to a thorough medical examination by the Panel Practitioner within a month from the date of being included on the panel. In this way, and with the medical records available, treatment could be commenced in the earliest stages of disease, and it would not be necessary to await the occurrence of more or less severe symptoms, which in many cases would denote advanced physical defect, before medical treatment was commenced." I am still of the opinion that a scheme of this type, which aims at securing the co-operation of the General Practitioner in the interest of preventive medicine, would result in the promotion of public health. 59 22. SPECIAL ENQUIRIES. Again the amount of work undertaken by the staff of the School Medical Service during the year has been so great that no time was available for satisfactorily carrying out any of the special inquiries suggested by the Chief Medical Officer of the Board of Education. It is to be hoped, however, that in the coming year there will be adequate staff to make this very important branch of the work possible. 23. MISCELLANEOUS. During the year 1923 the following special medical examinations were made :— Teachers Officers 22 24 Student Teachers 29 Bursars 16 Scholarship Candidates 69 W. BENTON, Medical Officer of Health and Medical Officer to Education Committee. COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Report OF THE Aural Surgeon FOR THE YEAR 1923. 62 ' To the School Medical Officer, County Borough of East Ham, Education Committee. REPORT OF THE AURAL SURGEON FOR THE YEAR 1923. During the year 318 cases have been seen, 164 Boys and 154 Girls. They made 805 visits to me and 3,011 visits to the treatment Clinic. 107 cases were recommended for removal of Tonsils and Adenoids. Rather more than half the cases appear on the cards under the diagnosis of "Deafness." The remainder appear as "Discharging Ears." The latter, however, are also deaf, and many of the former owe their deafness to a previous ear discharge. Once an ear discharge has become chronic, treatment is of importance chiefly from the point of view of lessening or abolishing the discharge and preventing serious complications. Some 25 of these cases are recorded as showing " Marked improvement in Hearing." Rarely, however, can treatment restore anything like normal hearing. In practically every child with deafness or ear discharge, the trouble has started in the nose and throat as nasal obstruction, whether due to Adenoids or to obstructed nasal passages, with its resulting mouth breathing and nasal catarrh. It is at this stage that efficient treatment has the best chance of yielding satisfactory results. In other words, as far as the ear is concerned, prevention is easier than cure, and consists in maintaining clear nasal passages, free from obstruction, free from catarrh, free mom infected Adenoids and Tonsils. It is comparatively rare to find a child with a discharging ear who does not show sufficient cause for this in the condition of the nose and throat. It is not, however, the ear alone that is affected by the presence of nasal catarrh and obstruction. The child's whole growth and development, mental and physical, is adversely affected even in cases where the ear escapes. In conclusion, I wish to record my appreciation of the work of the Sisters in charge of the Clinic and of the Clerk of the Clinic and of the loyal and efficient way in which they have carried out their duties. GILBERT C. CHUBB, F.R.C.S. Eng., D.Sc., etc. COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Annual Report of the Ophthalmic Surgeon FOR THE YEAR 1923. 64 To the School Medical Officer, County Borough of East Ham, Education Committee. Sir, I have to report that during my period of office as Ophthalmic Surgeon to the Education Committee, I have examined 656 eve cases—Cases for refraction 517, Cases of Eye Disease 139. Of these, 133 cases are being re-examined at intervals of six months. These latter are usually cases of short sight, in which the prescribing of glasses is a secondary, though important, consideration, the real point being the prevention of increase in the degree of the defect. This can be best effected by' attending to the general hygiene of the child, with special reference to teeth, tonsils and adenoids, the general conditions under which children live, both at home and at School. There are many cases of myopia in East Ham attending ordinary Schools, for whom special treatment would be useful, not in "myopic" or "blind" Schools, but in a special School where delicate children of all types—myopics, deaf children, and those suffering from the effects of Inf Intile Paralysis or Chorea, and so on, could receive their education. These children, who suffer in the "rough and tumble" of an ordinary School, could in this way be trained as efficient citizens, instead of, for instance, leaving school with such a degree of myopia as to give them a definite handicap when they come to earn their own livings. The ideal consists in shorter hours, and smaller classes than is the rule in the ordinary School, and, as is already recognised, special feeding and good lighting. Added to this should be the proviso that efforts to push the child's education and make him or her "a credit to their teachers" is definitely harmful in many of these cases. I should like to put another point to the Education Committee, in connection with the cases of Eye Disease. The association of septic teeth, tonsils and adenoids, and eye conditions is well recognised and treated in the Clinics at East Ham, especially as being the cause of such conditions as Phlyctenular Conjunctivitis, Chronic Blepharitis, and recurrent Corneal Ulcers. Such conditions lead to much pain, and result in 65 much loss of time at school. They disfigure the child, often seriously; and usually also result in some permanent impairment of sight. One very important cause is, however, at present, very difficult to deal with. Infectious conditions of the skin, especially of the scalp and hair, and of the clothing, are, unfortunately, apt to be common where children congregate in Schools and playgrounds, and when once started are dealt with with difficulty by parents and visiting nurses. I would earnestly recommend the establishment of a central clinic, efficiently equipped to deal with these infectious conditions. This would materially diminish the number of eye cases coming up for treatment. Yours faithfully, CHARLES LEONARD GIMBLETT. COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Annual Report ON THE WORK DONE IN The School Dental Clinic FOR THE YEAR 1923. 68 To the School Medical Officer, County Borough of East Ham Education Committee. Sir, I have much pleasure in submitting to you my Report on the work done in the Dental Clinic for the year 1923. The age groups inspected have been those from 5 to 9 years inclusive. All the children in these groups have been inspected and treatment offered when necessary. The number inspected was 9,367, and the number referred for treatment was 7,216. In addition, 297 cases of toothache or oral sepsis referred by the School Medical Officers have been seen and treated; all these cases being over ten years of age. Details will be found in the following statistical table :— TABLE IV. Group IV.—Dental Defects. (1) Number of Children who were : — Age. Total. Grand Total. Routine Age Groups. Total Specials. 5 6 7 8 9 10 11 12 13 14 (a) Inspected by Dentist 1330 1991 2166 2295 1583 9367 95 56 82 55 9 297 9664 (b) Found to require treatment 7513. (c) Actually Treated 2191. (d) Re-treated as the result of periodical inspection Nil. (2) Half-days devoted to .— 'Inspection 74 Total 372 Treatment 298 (3) Attendances made by children for treatment 3991. (4) Fillings :— Permanent Teeth 685 Temporary Teeth 975 Total 1660 (5 Extractions:— Permanent Teeth 4171 Temporary Teeth 4266) Total (6) Administrations of general anaesthetics for extraction 181. (7) Other operations:— Permanent Teeth 4141 Temporary Teeth 199 Total 613 69 Although the number of parents who realise the benefit of the Dental Clinic is increasing, there is still an appalling number of parents who, either through apathy or ignorance, do not seek dental treatment for their children, and also fail to take the trouble to see that they carry out the elementary principles of oral hygiene. Ultimately the child comes to the Dental Clinic suffering from oral sepsis or badly abscessed teeth, and the result is premature extraction of temporary and permanent teeth. This leads to mal-occlusion, mal-mastication, and loss of the full development of the jaws. Thus the child is handicapped for the rest of its life and its future health is impaired. This ignorance and apathy can be fought by educating the parents and children in the importance of dental hygiene. During the year it was felt to be a necessity to inspect all the children whose parents stated that they had received treatment, other than under the Authority's Scheme, either at their own dentist or at hospital. This inspection was carried out early in September, and it was found that only 12.1 per cent. of the mouths of these children were free from dental caries. Free from Dental Disease 103 One Tooth decayed 126 Two Teeth decayed 161 Three Teeth decayed 150 Four Teeth decayed 82 Five Teeth decayed 47 Six Teeth decayed 22 Seven Teeth decayed 6 Eight Teeth decayed 11 Absent from Re-inspection 139 Total 847 Unfortunately, it is our experience that, apart from the School Dental Clinic, treatment is seldom obtained elsewhere. The following letter is typical of the attitude of local dentists and parents in regard to the School Dental Clinic:— " Dear Sir, My son has a very badly decayed tooth, which the dentist refuses to take out. It is causing him a great deal of pain, and for several nights he has had very little sleep because of it. I should like him to go to the Clinic Dentist. Could you kindly give him a permit to do so? My dentist has told me he does not like to meddle with children's teeth. He seems to think the Clinic Dentist has more experience with children." The adoption of the revised scheme of payment by parents of the cost of dental treatment has had very encouraging results, insomuch that the acceptances for treatment have greatly increased. 70 The number of children who required and accepted treatment, and could not be seen in 1923, was 700. Thus these cases have to be treated in 1924, before the work proper for the year can be commenced, and this work will occupy at least three or four months. This is one important reason for the appointment of at least one more dental surgeon, which has been urged in all former reports. The backbone of school dental work is preventive dentistry, the education of the parents and children in dental hygiene and the importance of mastication and suitable diet. The parents often mistake the first permanent molars for temporary teeth, and in their ignorance give them the corresponding amount of attention. It is a great loss for a child to be deprived of its first permanent molars, as its full power of mastication is lessened for the rest of its life. This preventive work cannot be accomplished to the full, until another dental surgeon is added to the staff. The accommodation of the Dental Clinic is still restricted to two small rooms in the basement of the Town Hall, which are badly lighted, badly ventilated, and very unhealthy to work in the whole day through. It is very unsatisfactory that children should wait in an unhealthy waiting room and then come into a badly ventilated surgery, where it is quite a common thing for them to faint. It is also discouraging that the Dental Nurse and myself should work by artificial light and in these unhealthy conditions, more especially as work is occasionally hampered and interrupted by floods in the surgery. In this connection I beg to draw your attention to the following extracts from Sir George Newman's Report, having reference to the conditions of a satisfactory dental scheme. "The accommodation proposed for a dental clinic should include as a minimum (a) a play-room or waiting-room, (b) an operating room (with good north light), (c) a small rinsing room, which can be used also for recovery after the administration of an anaesthetic." "With the development of the scheme it will, of course, be necessary for Local Education Authorities to review their provision in order to secure that the dental staff is adequate to meet the extension of their duties. The aim of the School Dental Service should be to secure that as many children as possible shall leave school free from dental disease, and trained in the care of the teeth." The work has been accomplished in such a manner as to reduce pain to a minimum, local anaesthetics being employed for all extractions, except in those cases where it is not advisable when a general anaesthetic has been administered. Whenever possible, teeth, both temporary and permament, have been filled in order to preserve them for their maximum service. The fact that the Clinic is expeditiously and smoothly run in spite of serious handicaps, is in no small measure due to the patience, tact and perseverance of Miss Olifent, the Dental Nurse 71 Details of treatment given to mothers and children who are sent by the Maternity and Child Welfare Centre, are 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 Extractions. Total No. of Fillings No. of Adminis trations of General Anaesthetics. No. of other Operations. Adults Children. Eaxtrac ted. Filled. Extrac ted. Filled. Permanent Teeth. Temporary Teeth 39 89 121 110 28 169 43 279 71 50 20 28 The mothers attending the Maternity and Child Welfare Centre apparently realise the importance of dental treatment, both for themselves and their children, as the number of attendances at the Clinic for 1923 are greater than 1922. It is very important for the expectant and nursing mother to have a clean and healthy mouth. Great relief has been afforded to many mothers and children under 5 years, by extractions and fillings. It is no uncommon thing for mothers to bring along babies of 18 months, who have septic mouths, and require three or four extractions. In conclusion, I should like to thank the Medical Officers, Nurses, and Teachers for their co-operation during the year 1923 I have the honour to be, Sir, Your obedient Servant, CYRIL S. NEAME. 72 TABLES GIVING SUMMARY OF WORK OF SCHOOL MEDICAL SERVICE from 1st JANUARY, 1923 to 31st DECEMBER, 1923. NOTES ON TABLE I. (a) The return refers to a complete calendar year. (b) This heading relates solely to the routine medical inspection of the three ordinary age groups, i.e., to medical inspection carried out:— (i) in compliance with Article 7 of the Consolidated Regulations relating to Special Services—Grant Regulations No. 19; (ii) on the school premises (or at a place specially tioned by the Board under Article 44 (h) of the Code); (iii) for the purpose of making a report on each child on the lines of the approved Schedule set out in Circular 582. TABLE I. RETURN OF MEDICAL INSPECTIONS (see note a). For the Year ended 31st December, 1923. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections— (see note b). Entrants 1,459 Intermediates 2,131 Leavers 3,717 Total 7,307 Number of other Routine Inspections (see note c). 380 B.—OTHER INSPECTIONS. Number of Special Inspections (see note d). 3,869 Number of Re-Inspections (see note e). 2,956 Total 6,825 73 (c) Under this heading may be recorded routine inspections, if any, of children who do not fall under the three code agegroups, e.g., routine inspections of a fourth age-group or of other groups of children, as distinct from those who are individually selected on account of some suspected ill-health for "Special" Inspection. (d) A Special Inspection is a medical inspection by the School Medical Officer himself or by one of the Medical Officers on his staff of a child specially selected or referred for such inspection, i.e., not inspected at a routine medical inspection as defined above. Such children may be selected by the Medical Officer during a visit to the School or may be referred to him by the Teachers, School Nurses, Attendance Officers, Parents, or otherwise. It is immaterial for the purpose of this heading whether the children arc inspected at the School or the Inspection Clinic or elsewhere. If a child happens to come before the School Medical Officer for special inspection during a year in which it falls into one of the routine groups, its routine inspection should be entered in Part A. of Table I. and its special inspection in Part B. The inspection to be recorded under the heading of special inspection should be only the first inspection of the child so referred for a particular defect. If a child who has been specially inspected for one defect is subsequently specially inspected for another defect, such subsequent inspection should be recorded as a Special Inspection and not as a Re-inspection. (e) Under this heading should bp entered the medical inspections of children who as the result of a routine or special inspection come up later on for subsequent re-inspection, whether at the School or at the Inspection Clinic. The first inspection in every case will be entered as a routine or special inspection as the case may be. Every subsequent inspection of the same defect will be entered as a re-inspection. Care should be taken to see that nothing is included under the head of special inspections or re-inspections except such inspections as are defined above. Attendances for treatment by a Nurse, or for examinations by anyone other than a Doctor on the staff of the School Medical Service, should not be recorded as medical inspections. If, however, at any such attendance a child is also examined by one of the Authority's Medical Officers, this should be recorded as a special inspection or re-inspection as the case may be, even if treatment is also given ; but such attendance may also of course be recorded as an attendance for treatment. 74 TABLE II. A.—A Return of Defects found by Medical Inspection in the Year ended 31st December, 1923. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Malnutrition 31 17 15 3 Uncleanliness: (See Table IV., Group V.) - - - - Ringworm: Skin Scalp 1 - 88 - Body 4 - 78 2 Scabies 6 - 42 - Impetigo 37 8 611 2 Other Diseases(non- Tuberculous) 33 10 735 5 Eye Blepharitis 3 12 116 Conjunctivitis 8 2 147 2 Keratitis 1 - - 1 Corneal Opacities - 1 4 - Defective vision (excluding Squint) 871 318 397 16 Squint 51 14 24 1 Other conditions 7 5 103 1 Ear Defective Hearing 52 16 77 3 Otitis Media 6 - 28 - Other Ear Diseases 63 21 284 2 Nose and Throat Enlarged Tonsils only 46 514 33 2 Adenoids only 59 106 43 3 Enlarged Tonsils and Adenoids 135 48 89 - Other conditions 15 77 96 4 Enlarged Cervical Glands (Non- Tuberculous) 12 305 34 2 75 Table II.—(continued). (1) (2) (3) 4) (5) Defective Speech 4 22 3 4 Teeth—Dental Diseases (see note a) (see Table IV., Group IV. 634 122 383 1 Heart and Circulation. Heart Disease: Organic 5 9 6 2 Functional 4 30 14 8 Anaemia 51 57 74 7 Lungs Bronchitis 7 24 20 1 Other Non-Tuberculous Diseases 21 31 39 8 Tuberculosis Pulmonary: Definite 3 6 4 3 Suspected 7 4 16 9 Non-Pulmonary: Glands 7 12 9 1 Spine 1 1 — — Hip 2 — — 1 Other Bones and Joints 1 — — — Skin — — — — Other Forms — 1 1 — Nervous System Epilepsy 3 - 10 6 Chorea 6 8 36 1 Other conditions 8 27 31 7 Deformities Rickets 3 6 4 - Spinal Curvature 17 14 4 - Other Forms 14 16 15 14 Other Defects and Diseases 119 298 756 201 B.—Number of Individual Children (see note b) found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). GROUP. Number of Children. Percentage of Children found to require Treatment (see note d). Inspected (see note c). Found to require Treatment. (1) (2) (3) (4) Code Groups :— Entrants 1459 215 14.7 Intermediates 2131 550 25.8 Leavers 3717 681 18.3 Total (Code Groups) 7307 1446 19.7 Other Routine Inspections 380 57 15 76 NOTES ON TABLE II. (a) The figures to be included in this space should refer to the findings of the Medical Officer and not those resulting from dental inspection in the schools by the School Dentist. The findings of the School Dentist should be recorded in Table IV., Group IV. (b) No individual child should be counted more than once in this part of Table II., i.e., under B, even if it is found to be suffering from more than one defect. (c) The figures in this column will of course be the same as those given in Table I. A. (d) The figure in this column will be the percentage of the figure in column (3) of that in column (2). 77 TABLE III. Return of all Exceptional Children in the Area (see note a). Boys. Girls. Total Blind (including partially blind)(see note b). (i.) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 5 3 8 Attending Public Elementary Schools (see note c) At other Institutions — — — At no School or Institution 3 4 7 (ii.) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind 1 1 2 Attending Public Elementary Schools (see note c), - - - At other Institutions — — — At no School or Institution - - - Deaf(including deaf and dumb and partiallydeaf) (see note d). (i.) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf 5 9 14 Attending Public Elementary Schools (see note c) - - - At other Institutions - - - At no School or Institution - - - (ii.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf - - - Attending Public Elementary Schools (see note c) - - - At other Institutions - - - At no School or Institution Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority). (See note e.) Attending Certified Schools for Mentally Defective Children 29 26 55 Attending Public Elementary Schools (see note c) 12 12 24 At other Institutions 1 — 1 At no School or Institution 22 17 39 Notified to the Local Control Authority during the year. Feebleminded 4 2 6 Imbeciles 4 — 4 Idiots — — — Epileptics Suffering from severe epilepsy. (See note f.) Attending Certified Special Schools for Epileptics 1 3 4 In Institutions other than Certified Special Schools 1 - 1 Attending Public Elementary Schools (see note c) - - - At no School or Institution 2 4 6 78 TABLE III.—continued. Boys. Girls. Total. Epileptics (continued). Suffering from epilepsy which is not severe. (See note g.) Attending Public Elementary — — — Schools (see note c) — — — At no School or Institution — — — Infectious pulmonary and glandular tuberculosis. (See note h.) At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 4 3 7 At other Institutions 1 2 3 At no School or Institution 16 12 29 Non-infectious but active pulmonary and glandular tuberculosis. (See note h.) At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools (See note c) 58 44 102 At other Institutions — — — At no School or Institution — — — Physically Defective. Delicate children (e.g., pre- or latent tuberculosis, malnutrition, debility, anæmia, etc). (See note h.) At Certified Residential Open Air Schools 10 19 29 At Certified Day Open Air Schools — — — At Public Elementary Schools (see note c) 71 78 149 At other Institutions 16 14 30 At no School or Institution — — — Active non-pulmonary tuberculosis. (See note h,) At Sanatoriaor Hospital Schools approved by the Ministry of Health or the Board 9 10 19 At Public Elementary Schools (see note c) 34 20 54 At other Institutions 4 1 5 At no School or Institution 15 16 31 Crippled Children (other than those with active tuberculous disease) e.g., children suffering from paralysis, etc, and including those with severe heart disease. (See note h.) At Certified Hospital Schools — — — At Certified Residential Cripple Schools 4 5 9 At Certified Day Cripple Schools — — — At Public Elementary Schools (see note c) 138 109 247 At other Institutions 3 1 4 At no School or Institution 33 29 62 79 NOTES ON TABLE III. (a) This Table is a return of all children in the area for whom the Local Education Authority are responsible, and who (except in the case of children suffering from epilepsy which is not severe) have been ascertained to be blind, deaf, defective or epileptic within the meaning of Part V. of the Education Act, 1921. It is the statutory duty of every Local Education Authority formally to ascertain all defective children in their area irrespective of the actual provision now made for their instruction in Special Schools. It is assumed that every Authority will have a complete list of such children compiled from returns made continuously during the year and kept constantly up to date. In order to secure uniformity, Authorities are requested to make up this Table from their list of defective children as it stands on the last day of each calendar year. Children who are living in residential schools in the area out who come from other areas, should not be included in this Table; but children should be included who are living in residential schools outside the area and who are being maintained there by the Authority. For the purpose of this Table, no child should be included whose defect has not been ascertained by the School Medical Officer or a medical member of the Authority's staff. The definitions of defective children as given in the Act are as follows and must be very carefully borne in mind. A blind child is a child who is too blind to be able to read the ordinary school books used by children. A deaf child is a child who is too deaf to be taught in a class of hearing children in an elementary school. Mentally and physically defective children are children who, not being imbecile and not being merely dull and backward, are defective, that is to say, children who bv reason of mental or physical defect are incapable of receiving proper benefit from the instruction in the ordinary public elementary schools, but are not incapable by reason of that defect of receiving benefit from instruction in such special classes or schools as under Part V. of the Act may be provided for defective children. Epileptic children are children who, not being idiots or imbeciles, are unfit by reason of severe epilepsy to attend the ordinarypublic elementary schools. (b) For the purpose of this return the Board require that children who are blind within the meaning of the Act should be divided into two categories, i.e., (1) those who are totally blind or so blind that they can only be appropriately taught in a school or class for totally blind children, and (2) those who though they cannot read ordinary school books, or cannot read them without injury to their eyesight, have such power of vision that they can appropriately be taught in a school or class for the partially blind. It should be understood that children who are able by means of suitable glasses to read the ordinary school books used by children without fatigue or injury to their vision, should not be included in this Table. 80 (c) It should be understood that none of the children in this Table (except children suffering from epilepsy which is not severe) should in fact be attending public elementary schools. When the heading is retained, it is merely because at present the insufficiency of Special School accommodation makes it impossible to do better for some defective children than to allow them to attend the ordinary school. No space is left for the entry of children with infectious pulmonary tuberculosis attending public elementary schools, as these children should of course be promptly excluded from such schools. (d) Children who are deaf within the meaning of the Act should be classified for the purpose of this Table as (1) totally deaf or so deaf that they can only be appropriately taught in a school or class for the totally deaf, and (2) partially deaf, i.e., those who can appropriately be taught in a school or class for the partially deaf. (e) This category includes only those children for whose education and maintenance the Local Education Authority are responsible, and who are not eligible for notification to the Local Control Authority under the Mental Deficiency Act. (f) In this part of the Table only those children should be included who are epileptic within the meaning of the Act. For practical purposes the Board are of opinion that children who are subject to attacks of major epilepsy in school should be recorded as "severe" cases and excluded from ordinary public elementary schools. (g) In this part of the Table should be entered the remainder of the epileptic children in the area, i.e., children whose diseass is of such a kind as not to unfit them for attendance at an ordinary public elementary school. (h) The exact classification of physically defective is admittedly a matter of difficulty. Valuable information, however, will be obtained if School Medical Officers will record these defective children as accurately as possible under the selected sub-headings, taking care that no child is entered under more than one subheading. 81 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1923 (see note a) TREATMENT TABLE. Group I.-—Minor Ailments (excluding Uncleanliness, for which see Group V.). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme, (see note b). Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm—Scalp 67 3 70 Ringworm—Body Scabies 70 40 1 2 71 42 Impetigo 509 3 512 Other skin disease 347 10 303 Minor Eye Defects (External and other, but excluding cases falling in Group 11.) 275 8 283 Minor Ear Defects (See note c.) 353 8 301 Miscellaneous (e g..minor injuries,bruises,sores, chilblains, etc.) 899 142 1041 Total 2560 183 2743 82 TABLE IV.—continued. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). Defect or Disease. No. of Defects dealt with. Under the Authority's Scheme (see note b). Submitted to refraction by private practitioner or at hospital, apart from the Authority s Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) (Operations for squint should be recorded separately in the body of the Report.) 517 48 8 573 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 5 1 — 6 Total 522 49 8 579 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme 406 (b) Otherwise 50 Total number of children who obtained or received spectacles— (a) Under the Authority's Scheme 406 (b) Otherwise 50 Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of Treatment. Total number Treated. Under the Authority's Scheme in Clinic or Hospital. (see note 6.) By Private Practitioner or Hospital apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 197 60 257 27 284 83 Group IV.—Dentai Defects. (1) Number of Children who were:— Routine Age Groups. Age. Total. Specials. (see note d) Total. Grand Total. (a) Inspected by the dentist 5 6 7 8 9 10 11 12 13 14 1330 1993 2166 2295 1583 9367 95 50 82 55 9 297 9664 (b) Found to require treatment 7513. (c) Actually treated 2191. (d) Re treated during the year as the result of periodical examination noire) Nil (2) Half-davs devoted to:— Inspection 74 Treatment 298 Total 372 (3) Attendances made by children for treatment 3991. (4) Fillings:— Permanent teeth 686 Temporary teeth 975 Total 1660 (5) Extractions:— Permanent teeth 417 Temporary teeth 4226 Total 4643 (6) Administrations of general anaesthetics for extractions 181. (7) Other operations:— Permanent teeth 414 Temporary teeth 199 Total 013 Group V.—Uncleanliness and Verminous Conditions (see note f). (i.) Average number of visits per school made during the year by the School Nurses 5 (ii.) Total number of examinations of children in the Schools by School Nurses 02,207 (iii.) Number of individual children found unclean 2,187 (iv.) Number of children cleansed under arrangements made by the Local Education Authority Nil. (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 Nil. (b) Under School Attendance Byelaws Nil. NOTES ON TABLE IV. (a) The Table should deal with all defects treated during the year, however they were brought to the Authority's notice, i.e., whether by routine inspection, special inspection, or otherwise, during the year in question or previously. (b) This heading should include all cases that received treatment under definite arrangements or agreements for treatment made by the Local Education Authority and sanctioned by the Board of Education under Sections 16 and 80 of the Education Act, 1921. Cases which, after being recommended for 84 ment or advised to obtain it, actually received treatment by private practitioners, or by means of direct application to Hospitals, or by the use of hospital tickets supplied by private persons, etc., should be entered under other headings. (c) If any treatment is given for more serious diseases of the ear (e.g., operative treatment in hospital) it should not be recorded here but in the body of the School Medical Officer's Annual Report. (d) The heading "Specials" in this Table relates to all children inspected by the School Dentist otherwise than in the course of the routine inspection of children in one of the age groups covered by the Authority's approved scheme, namely, to children specially selected by him, or referred by Medical Officers, Parents, Teachers, etc., on account of urgency. The number inspected in each age group should be separately shown, as well as the total, but under "Specials" only the total number should be given. (e) It should be understood that all the cases entered under this head are also entered under head c. (f) A statement as to the arrangements made by the Local Education Authority for cleansing verminous children and a record of the cases in which legal proceedings were taken, should be included in the body of the School Medical Officer's Report. N.B.—Groups I.—V. above cover all the defects for which treatment is normally provided as part of the School Medical Service. Particulars as to the measures adopted by the Authority for providing treatment for other types of defect (e.g., for orthopaedic treatment) or for securing improvement in types of defect which do not fall to be treated under the Authority's own scheme and for which the Authority neither incur expenditure nor accept any responsibility, together with a statement of the effect of the measures taken, should be included in the body of the School Medical Officer's Report. It is convenient for such particulars to follow the headings of Table II. Report of the Chief Sanitary & Food Inspector FOR THE YEAR 1923. 86 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-eighth Annual Report of the work of the Sanitary Inspectors during the year ended 31st December, 1923. The total number of primary inspections made was 7,334. These included 2,869 house-to-house inspections, visits to premises upon complaint of nuisance, inspection of markets, slaughterhouses, cowsheds, workshops, etc. There were 14,463 nuisances, caused principally by sanitary defects, discovered and dealt with by the Inspectors. (These are fully detailed on inset page 98.) Of. these nuisances 6,632 were detected in routine work, actual complaints, and 7,831 by houseto-house inspection. To secure the abatement of nuisances Notices were served as follows:— Preliminary 3,592 Statutory 958 Dust Bin 531 Water 6 5,087 2,718 complaints were received, 1,334 written and 1,384 verbal. Many matters complained of were irrelevant and outside the province of a Sanitary Inspector. In such cases, whenever possible, information is given to complainants—where to apply, etc. 87 HOUSE-TO-HOUSE INSPECTION. Much of the Inspectors' time has been devoted to this very important branch of Public Health service. During the year 2,869 houses have been inspected, and when it is realised that at 75 per cent. of these houses defects are discovered, the value of this work cannot be over-estimated. In fact, it is only by houseto-house inspection that the prevailing conditions existent at the rear of premises are revealed. The number of instances at which no defects have been found was 25 per cent., while routine work was 36 per cent. It is the following-up of this work by the service of Notices and the institution of legal proceedings for enforcement which occupies much time. In many instances, when cases came before the Court reasons were given why Notices had not been complied with, and applications made for extension of time were invariably granted. INCREASE OF RENT (RESTRICTION) ACTS, 1920-23. 153 applications were made by tenants for certificates under Section 2 of the above-named Act certifying that the premises were not reasonably fit for human habitation or in a reasonable state of repair—this certificate enables the tenant to apply to the County Court for a rebate of that portion of the increase of rent sanctioned by the Act for repairs. 114 certificates were issued, and in cases where the condition of the houses did not justify the granting of a certificate the owners were communicated with either by letter or Notice calling their attention to any defects which required remedying. The provisions of Section 2 has advantages, for there are often defects for which it is difficult to obtain a remedy in the ordinary way, i.e., defective coppers, window frames, stoves, etc., but they contribute largely to the comfort of occupiers, and a house is not in a reasonable state of repair where these exist; it is in getting such defects remedied that the Rents Act has a distinct advantage. 88 There is perhaps a disadvantage in cases of very poor property where tenants are in arrears with the payment of rent and applications for certificates are made and granted; the result has been a reduction of the rent previously paid, and owners who could not keep the property in a satisfactory state of repair owing to the non-payment of rent allowed for that purpose are put to greater financial disadvantage; the property has consequently had to be dealt with under the Public Health Act. SANITARY ADMINISTRATION. For the purposes of sanitary inspection the Borough is divided into three districts, with a Senior and Junior Inspector appointed to each division. Including the Chief Inspector there are seven on the inspectorial staff, i.e., one Inspector to every 20,000 inhabitants and about 4,000 houses. It will be seen upon reference to the inspections made that they average over 1,000 primary inspections per Inspector per annum. In addition there has been the work of sampling under the Sale of Food and Drugs Act, and inspections made of cinemas, music halls, etc. A great deal of the Inspectors' time is occupied by following up and superintending the carrying out of the work necessary to comply with Notices served for the abatement of nuisances. The tabular summary of the work of the Sanitary Inspectors is set out on inset opposite page 98, and results of legal proceedings on pages 98 to 98. Disinfection. 919 premises were disinfected, 509 for infectious diseases, 372 for tuberculosis, 2 for scabies, 19 for vermin, 17 other causes. The steam disinfectors at the Isolation Hospital and Sewage Works are used for bedding and other articles as required. Slaughterhouses. There are 14 licensed slaughterhouses in the Borough, and 78 visits have been made during the year. The premises were generally well-conducted, lime-washed and cleansed regularly in accordance with the bye-laws. Bakehouses and Workshops. There are 50 bakehouses and 255 workshops in the Borough, and during the year 351 inspections have been made. The condition of the bakehouses is good. Most of them are of modern construction and well-maintained. 89 Dairies and Cowsheds. There are 2 registered cowsheds and 167 dairies in the Borough. The provisions of the regulations made under the Dairies, Cowsheds and Milkshops Order have been complied with, and in no instance has it been necessary to institute legal proceedings. Food Supply. The markets and shops have been systematically inspected. Two Inspectors are on special duty every Saturday evening, and the reports show that the character of the food may generally be considered good, although there are occasional exceptions, especially when the wet fruit is in season. The practice of surrendering unsound and doubtful food is an important factor in preventing its being exposed for sale, and explains the decrease in the number of seizures. Number of Unsound Food Certificates issued during the year:— Fish 11 Meat 7 Vegetables 4 Fruit 2 Poultry 1 Total 25 Offensive Trades. The only offensive trade in the Borough is one of gut scraping. No complaints were received during the year. Many inspections were made, and the premises generally found in a satisfactory condition. Sale of Food and Drugs Acts. There have been 423 samples purchased for analysis by the Public Analyst, of which 9, equal to 2.1 per cent., were adulterated, as compared with 3.5 per cent. for the previous year. 256 were samples of milk, 2 of which were adulterated, equal to 0.8 per cent. 26 samples of butter were taken, all genuine. In 7 instances legal proceedings were instituted, for results see p. 97. 90 The following articles have been sampled1 and submitted for analysis:— Milk (including 14 bacteriological examinations) 256 Milk (separated) 1 Milk (dried) 1 Milk (condensed) 1 Cream 6 Butter 26 Margarine 6 Margarine Mixture 2 Lard 7 Dripping 4 Frying Oil 1 Olive Oil 1 Tea 5 Coffee Essence 3 Cocoa 3 Cocoa Essence 1 Coffee 1 Orangeade 1 Ginger Wine 2 Fruit Cordial 1 Porter 1 Ale 2 Stout 1 Cheese 3 Lemon Cheese 1 Honey 2 Jam 4 Fish Pastes 4 Meat Paste 1 Brawn 1 Sausages 3 Bread 1 Flour 2 Xmas Pudding 1 Mincemeat 2 Mince pies 2 Jam Sandwich 3 91 Sponge Cakes 6 Cake Mixture 1 Biscuits 1 Tinned Fruit 2 Fruit Salad 2 Apple Rings 1 Cream Custard 1 Custard Powder 2 Pickles 1 Chutney 1 Ketchup 1 Vinegar 1 Pepper 1 Pork and Beans and Tomato Sauce 1 Beef Suet (Shredded) 1 Peas 16 Dried Eggs 1 Liquid Egg 1 Sugar 2 Rice 1 Chocolates 1 Cream Nougat 1 Prescriptions 10 Aspirin 1 Bisurated Magnesia 1 Citrate of Magnesia 1 Cream of Tartar 1 Informal Samples. Milk 1 Butter 1 Lard 2 Tea 2 Cocoa 2 Coffee 1 Honey 1 Jam 2 Cheese 1 Apple Rings 1 Bread 1 92 Fish Paste 1 Flour 2 Pepper 1 Sugar 1 Rice 1 Adulterated Samples. Milk 2 Cream 1 Margarine 1 Sponge Cakes 4 Green Peas 1 Milk and Cream Regulations. The samples submitted coming within the purview of these Regulations were free from preservatives. Milk & Cream not sold as Preserved Cream. (a) Number of samples examined for the presence of a preservative. (b) Number in which preservative was reported to be present, and percentage of preservative found in each sample. Milk 242 — Cream 4 — Cream sold as Preserved Cream. Correct statement made 1 Statement incorrect 1 Total 2 Percentage of preservative found in each sample. Percentage stated on statutory label. 0.32 0.40 0.50 0.40 (Vendor Cautioned) Determination made of Milk Fat in Cream sold as Preserved Cream. (1) above 35% 2 (2) below 35% — Total 2 93 Prosecutions. A tabulated list of prosecutions for the year will be found on pages 95—98. House Refuse Collection. There are 27,600 houses from which house refuse is collected weekly. The Council have a fleet of nine electric dust vans engaged for this purpose; about 22,000 tons of refuse (equivalent to 16 cw.t. per house per annum) have been collected and conveyed to the destructor. The total cost, including £1,325 capital charges, was ,£10,279, which works out at 9s. 4d. per ton, or 7s. 5¼d. per house per annum. During the past three years the cost for Dust Collection has been slowly decreasing. Dust Bins. In order to work successfully and economically, houses must be furnished with portable dust bins for the weekly collection of refuse. The Council have power under the East Ham Improvement Act, 1903, to provide that houses are so supplied. 531 Notices were served for this purpose. In cases where Notices to provide dust bins were not complied with the Council provided them and recovered the cost from the owners of the premises. Trade Refuse. The refuse from tradesmen's premises is collected twice weekly and the system works: satisfactorily. The conditions are that the refuse is kept in suitable receptacles and placed in a convenient position for the collector. Contagious Diseases of Animals Acts. No cases of Parasitic Mange or Swine Fever were reported. Foot and Mouth Disease. The continuance of Foot and Mouth Disease in various parts of the country necessitated much time being devoted to issuing licences and seeing that the provisions of the Orders made by the Ministry were complied with. Rat Extermination The work of exterminating rats has been continued. A professional catcher engaged by the Council has caught 2,456 rats, and combined action has resulted in a large number of these detestable and destructive vermin being destroyed. 94 Petroleum and Explosives Acts. The licensed premises have been inspected, and with on exception the provisions of the statute complied with. The contravention under the Explosives Act is reported on page 98. Music Halls and Cinemas. These premises have been examined and attention given to staircases and passage-ways in order to see that they were lighted and free from obstruction. Housing. New houses erected during the year, 66. J. G. BANKS, Chief Sanitary Inspector. 95 PROSECUTIONS UNDER THE PUBLIC HEALTH ACT FOR THE YEAR 1923. Date. Situation of Premises. Offence. Result. January Park Road Non-compliance with sanitary notice Withdrawn. Payment of costs 3/6 January Blenheim Road do. do. 3/6 January Dorset Road (2 houses) do. do. 7/- January Cleves Road (5 houses) do. do. 17/6 January Telham Road do. do. 3/6 January Romford Road do. do. 3/6 January Shelley Avenue do. do. 3 6 January Malvern Road do. do. 3 6 January Wakefield Street do. do. 3 6 February Cleves Road do. do. 3/6 February Monega Road do. do. 3/6 February St. Dunstans Road (3 houses) do. do. 3/6 March Anns Cottages, Green Street (8 houses) do. do. 3/6 March Stamford Road (4 houses) do. do. 3/6 March Heigham Road do. do. 3/6 March Greenleaf Road (2 houses) do. do. 7/- March Ashley Road do. do. 3/6 April Market Street (4 houses) do. do. 6/- April Walton Road (7 houses) do. do. 14/- April The Warren do. do. 3/6 April Barking Road do. do. 3/6 May Central Park Road do. do. 3/6 May Milton Avenue do. do. 3/6 June Barking Road do. do. 3/6 June Ernald Avenue (2 houses) do. do. /- July Cleves Road do. do. 3/6 July Plashet Grove do. do. 3/6 July Mountfield Road (2 houses) do. do. 3/6 96 Date. Situation of Premises. Offence. Result. July Telham Road (5 houses) Non-compliance with sanitary notice Withdrawn. Payment of costs 3/6 July Alverstone Road Dismissed. July Alverstone Rood (5 houses) do. do. 71- September Frinton Road do. do. 3/6 September Clacton Road (2 houses) do. do. 2 6 September Frinton Road (2 houses) do. do. 3/6 October Shoebury Road do. do. 3/6 October South Esk Road do. do. 3 6 November High Street South do. do. 3/6 November Dersingham Avenue do. do. 3/6 November Melbourne Road (3 houses) do. do. 3/6 November Alverstone Road (2 houses) do. do. 7/- November Alverstone Road (2 houses) do. do. 7/- November Alverstone Road do. do. 3/6 November Melbourne Road (4 houses) do. do. 3/6 December Nigel Road do. do. 3/6 December Nigel Road (2 houses) do. do. 8/6 December Nigel Road (3 houses) do. do. 9/- December Outram Road do. do. 8/6 December Claremont Street (2 houses) do. do. 3/6 December Robert Street (5 houses) do. do. 14/- 97 PROSECUTIONS UNDER THE SALE OF FOOD AND DRUGS ACT FOR THE YEAR 1923. Date. Article. Offence. Fines. Costs. July Milk 8 per cent. deficient in milk fat £ s. d. £ s d. 1 0 0 0 10 6 August Margarine In an improper wrapper 2 0 0 0 10 6 December Sponge Cake (4) Excess of preservative Withdrawn 3 1 0 December Milk 9 per cent. added water 50 0 0 0 10 6 GYPSY BYELAWS. Date. Situation of Premises. Offence. Result. April Langdon Crescent Non-compliance with sanitary notice Withdrawn. Payment of costs 3/6 April Nelson Street do. Fined £Z April Langdon Crescent (7 caravans) do. „ £8 April Nelson Street do. „ £2 May Langdon Crescent(14 caravans do. „ £14 May Langdon Crescent (4 caravans) do. „ £4 May Langdon Crescent (3 Scaravans) do. Withdrawn. No costs May Brookwood Road do. do. Costs 3/6 May Park Avenue do. do. No costs May Langdon Crescent do. do. Costs 3/6 October Market Street do. do. 3/6 October Brookwood Road do. do. 3/6 December Langdon Crescent (2 houses) do. do. 7/- 98 PROSECUTIONS UNDER THE SHOPS ACT FOR THE YEAR 1923. Date. Order Infringed. Fines. May Grocers & Provision Dealers Closing Order £ s. d. 0 10 0 May „ „ „ 0 10 0 May „ „ „ 0 10 0 June Shops (Early Closing) Act, 1920 0 15 0 June Grocers & Provision Dealers Closing Order 0 15 0 June „ „ „ 0 15 0 June „ „ „ 0 15 0 July Shops (Early Closing) Act, 1920 0 10 0 July „ „ „ 0 10 0 July „ „ „ Dismissed July Grocers & Provision Dealers Closing Order 0 10 0 July Shops (Early Closing) Act, 1920 0 10 0 July „ „ „ 0 10 0 July „ „ „ 0 10 0 FOOT & MOUTH DISEASE. May Moving calves without licence 0 15 0 — May „ „ 0 15 0 — PETROLEUM ACT. August Keeping Petroleum on unlicensed premises 5 0 0 - The Following is A Record in Detail of the Inspections made during the Year 1923:- Manor Park Ward. Little Ilford Ward. Woodgrange Ward. Plashet Ward. Kensington Ward. Castle Ward. Central Ward. Wall End Ward. Greatfield Ward. South Ward. Total. 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. Ord. H. to H Ord. H.to H. Ord. H. to H. Ord. H. to H. Premises found in fair condition 188 12 144 37 131 82 153 79 70 4 238 128 276 131 140 122 107 44 150 86 1597 725 Factory and workshop premises inspected 28 ... 6 ... 24 ... 24 ... 7 ... 47 ... 50 ... 49 ... 12 ... 10 ... 257 ... Outworkers'premises inspected 46 ... 76 ... 55 ... 52 ... 19 ... 75 ... 56 ... 42 ... 38 ... 15 ... 474 ... Bakehouses inspected 12 ... 4 ... 10 ... 11 ... 9 ... 14 ... 20 ... 4 ... 2 ... 8 ... 94 ... Slaughter-houses inspected 13 ... 2 ... 17 ... 14 ... ... ... 1 ... 29 ... ... ... 1 ... 1 ... 78 ... Dairies inspected 21 ... 29 ... 14 ... 23 ... 2 ... 29 ... 25 ... 18 ... 18 ... 21 ... 198 ... Urinals inspected 60 ... 22 ... 4 ... 23 ... 13 ... 6 ... 11 ... 8 ... 7 ... 14 ... 168 ... Walls and ceilings dirty and dilapidated 73 46 221 202 68 185 101 258 80 2 95 260 119 109 162 106 29 99 127 1047 1301 Yards improperly paved and dilapidated 28 12 55 213 13 100 17 59 33 2 18 70 20 18 32 32 4 ... 18 39 238 545 No forecourt paving 1 1 15 56 44 5 4 14 6 4 31 1 1 4 1 ... ... 5 7 49 151 Drains unstopped and cleansed 69 ... 427 ... 66 ... 108 ... 64 ... 181 ... 235 ... 213 ... 92 ... 328 ... 1783 ... Defective drains 6 ... 12 1 2 ... 2 ... 2 ... 5 1 1 ... 4 ... ... 3 ... 37 2 Defective w.c. connections 2 ... 6 ... ... 1 ... ... 1 ... ... ... 2 ... ... ... ... ... 1 ... 12 1 Defective w.c. traps 12 ... 15 7 ... ... 3 1 6 ... 1 1 7 2 5 1 ... ... 9 1 58 13 Defective sashcords and windows 28 14 70 143 10 33 20 65 29 1 24 76 33 76 65 44 15 4 45 108 339 564 Defective flushing apparatus 15 5 42 44 6 8 16 15 15 2 16 33 22 18 30 21 8 ... 10 19 180 165 Soil pans foul and broken 16 2 30 27 5 5 12 10 8 3 11 40 9 25 13 28 2 ... 12 32 118 172 Defective vent pipes 10 5 17 34 5 32 9 11 8 ... 9 18 7 18 17 8 5 ... 5 13 92 139 R.W. pipes and eaves gutters defective 63 5 107 238 26 44 34 76 22 1 40 122 49 62 72 65 16 ... 45 137 474 762 Do. connected to drain ... ... ... ... ... 4 1 11 ... ... ... 3 ... 6 ... 1 3 ... 1 1 5 26 Roofs leaky 31 5 75 79 27 38 58 73 21 1 30 109 57 63 71 58 16 ... 47 69 433 498 Defective sink waste pipes 13 1 32 80 6 5 25 10 6 ... 15 24 12 19 22 17 2 ... 12 22 145 178 Houses without water (m.W.Bd.) 1 ... ... ... 1 ... ... ... ... ... ... 1 1 ... 1 1 ... ... 1 ... 5 2 Cisterns without covers 1 ... ... ... 2 ... 1 2 ... ... 4 7 1 1 3 2 ... ... 2 1 14 13 Drinking water improperly stored 6 ... 4 4 2 ... 1 ... 2 ... 3 1 4 ... 6 3 ... ... 2 ... ...30 8 Dilapidated floors 13 3 54 142 8 14 11 39 9 ... 14 27 22 14 24 8 ... ... 13 37 108 284 Insufficient underfloor ventilation 12 10 16 65 5 21 1 25 6 ... 5 40 6 10 13 13 9 ... 3 10 69 199 Dampness 50 10 104 76 24 28 26 21 29 2 35 52 53 26 54 29 21 3 49 71 4405 318 Accumulations 19 ... 10 9. 15 2 4 1 9 ... 34 6 16 1 39 10 4 ... 36 3 186 32 Inundations 14 6 49 27 6 30 15 78 6 ... 14 68 17 18 24 26 12 ... 17 49 154 302 Overcrowding 2 ... 9 ... 2 ... 2 ... 2 ... ... ... 3 ... ... 1 1 ... ... ... 21 1 Unsound food 1 ... ... ... ... ... ... ... ... ... 2 ... 9 ... ... ... ... ... ... ... 12 ... No dust bins 16 10 42 22 7 43 12 88 7 ... 4 63 16 19 39 32 20 8 24 47 187 332 No manure bins 18 18 91 46 9 70 32 93 20 ... 25 19 33 35 47 35 10 4 26 74 311 334 Animals improperly kept 2 ... 5 7 1 ... ... ... 2 ... 1 ... 1 1 2 1 4 ... 2 ... 20 9 Temporary buildings found ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... 1 ... ... ... 3 ... 8 ... Smoke nuisances 2 ... 3 2 7 ... 3 1 3 ... 1 4 14 2 2 1 2 ... 2 ... 39 10 Rear passages unpaved or undrained ... ... ... ... ... ... ... ... 5 ... ... ... ... ... ... ... 1 ... 2 ... 7 ... Gipsies ... ... ... ... ... ... ... ... ... ... ... ... 7 ... 138 ... 1 ... 19 ... 165 ... Breaches of Bye-Laws and Regulations ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... ... ... ... ... ... 4 ... Other nuisances 159 37 334 502 84 142 137 191 120 2 126 199 194 101 183 102 59 8 144 — 136 1540 1420 Drains tested 29 ... 23 ... 10 ... 23 ... 29 ... 35 2 27 ... 25 ... 62 ... 39 ... 302 2 Inspections 462 72 690 363 293 340 402 369 235 13 475 538 624 352 529 352 274 83 481 387 4465 2869 Total Inspections 534 1053 633 771 248 1013 976 881 357 868 7334 99 INDEX. A. Abatement of Nuisances 86 Abbatoirs 88 Acreage 6 Acts of Parliament 10, 11 Acute Encephalitis Lethargica 26 Adenoids 18, 41, 42, 47, 62, 64 Air Temperature 27 Ambulances 9 Antitoxin 10 Area 6 Assessable Value 6 Attendance Officers, Co.-op. of 52 B. Bacteriological Laboratory 10, 14, 22 Bakehouses 88 Baths 41, 52 Births 6, 10 „ Illegitimate 6, 16 Still 16, 19 Birth-rate 6, 7 Blind Children 53, 77, 79 Bye-laws 11, 12, 58 C. Cancer 26 Ocrebro-Spinal Meningitis 25 Children, Medical Inspection of 31, 37, 72-84 Chorea 75 Cinemas and Music Halls 94 Cleanliness of School Children 38-11 Cleansing Station 41, 48, 65 Clinic, Anite-Natal 8, 16, 17 Clinics, Infant 8, 16, 17, 71 Clinics School 8. 45, 46, 49, 82 Climate 27 Closing Orders (Shops) 12 Communicable Diseases (non- notifiable) 45 Complaints of Nuisances 86 Contagious Diseases (Animals) Act 93 Continuation Schools 58 Co-ordination 33-56 Cowsheds 89 Cripples 39, 43, 49, 50, 75, 78 D. Dairies 89 Day Nursery 8 Deafness 42, 53. 62, 77, 79, 80 Deaths, Causes of 26 Deaths, No. of 6, 26 Death-rate, General 6, 7 Death-rate, Infantile 7 Death-rate. Zymotic 7 Deaths in Large Towns 7 Dentistry 18, 43, 49, 68-71, 82 Diarrhœa 7. 26 Diphtheria 14, 25, 26 Dirty Premises 99 Disinfection 88 Dispensary 9, 20, 34, 35 , 44, 47, 48 Dispensary Attendances 23 Drainage Work 99 E. Ea.r Disease 41, 42, 43, 49, 62, 74, 81, 84 Employment of Children 58 Encephalitis Lethargica 26 Enteric Fever 14, 25, 26 Epileptic Children 53, 75, 77, 78 , 79. 80 Erysipelas 14, 25 Exclusions 44, 45 Explosives Act 94, 98 Eye Diseases of School Children 41, 42, 64, 74. 81 Eye, External Inflammation of 42, 45, 48 F. Factory and Workshop Act 88 Following-up 45 Food and Drugs Act 88, 89 Food Inspection 51, 89-92 Food Supply 89 Food, Unsound and Diseased 89 Foot and Mouth Disease 93, 98 G Gipsies 97 Glands, Enlarged 74 H. Harts Sanatorium 9, 19 Hearing of School Children 42, 43, 62, 74, 77 Heart Diseases of School Children 57, 75, 78 Hospital Accommodation 9 Hospital, Children's 49 Hospitals, Maternity 9 House Refuse Removal 93 House to House Inspection 86, 87 Housing 94 I. Imbecile Children 53, 79 Impetigo 41, 45, 74, 81 Increase of Rent (Restriction) Acts 87 Infant Consultations 8, 16 Infantile Mortality 7 Infections Diseases 25, 43 Infectious Diseases (non-noti- fiable) 45 Influenza 26 Inspection of Borough 86, 87 Inspection of School Children 31, 72, 73 Invalid Children's Aid Association 53 Isolation Hospital 9, 10. 14-16 . 34, 35, 44 Isolation Hospital Improvements 15 K. Kinemas 94 L. Laboratory Work 10 Legal Proceedings 83, 87 Licences, Contagious Diseases (Animals) Act 93, 98 Licences, Petroleum 94 Lung Diseases of School Children 47, 57, 75, 78 M. Malnutrition 52, 74 Market Places 89 Materrnitv and Child Welfare " 8, 9, 16, 30, 34, 35, 36, 71 Maternity Homes and Hospitals 8, 9, 17 Meals, Provision of 51 Measles 7, 26 Mental Defects of School Children 53, 54 Mental Defectives, Statutory Supervision 13 Mental Defectives. Voluntary Care 13 Mental Deficiency 13, 14, 34-35, 53, 54, 77, 79 Meteorology 27 Midwives 8, 18 Milk and Cream Regulations 98 Milk. Free Supplies 17 Music Halls 94 Myopia 64 100 INDEX—continued. N. Notices Served 86 Notification of Births 17 Notification of Infectious Diseases 25 Nuisances Abatement 86-88 Nuisances Discovered 86, 99 Nursing Arrangements 8 Nursery Schools 36, 54 O. Offensive Trades 89 Open-air Education 50, 51 Ophthalmia Neonatorum 16, 25 Orders 10, 12 P. Parents, Co-operation of 52 Petroleum Licences 94 Physical Defects of School Children 43, 49, 50, 53, 78, 80 Physical Training 51 Playground Classes 50 Population 6 Pre-tubercular Patients 22, 48, 51, 78 Prosecutions, Gipsy Byelaws 97 Prosecution, Petroleum Act 98 Prosecutions, Public Health Act 95 Prosecutions, Sale of Food and Drugs Act 97 Prosecutions, Shops Act 98 Provisional Orders 10 Puerperal Fever 6, 19. 25. 26 R. Rainfall 27 Rateable Value 6 Rat Extermination 93 Refraction Cases 64, 82 Refuse Removal 93 Regulations 11, 12 Re-inspection 72, 73, 88 Rent (Restriction) Act 87 Ringworm 18. 41, 45, 48, 74. 81 Roofs, Leaky 99 S. Sale of Food and Drugs Act 88, 89 Sanatorium 9, 19, 34, 35 Scabies 41. 45, 74, 81 Scarlet Fever 14, 25, 26 School Attendance Officers' Co-operation 52 „ Baths 41, 52 „ Camps 50 Children, Blind 53, 77 Cripples 43, 49, 75, 78 Children, Diseases of Nose and Throat 41, 45, 47, 56, 62, 74 „ Children, Defective Speech 75 Children. Exclusions 43, 44 „ Children. General Cleanliness 38, 39 „ Children, Heart Diseases of 57, 75, 78 Children, Hearing 42, 53, 62, 77 „ Children, Lung Diseases of 42, 47, 57, 75, 78 Children, Nutrition of 52, 74 „ Children, Physical Training of 51 Children, Skin Diseases of 42, 45. 48 Children, Teeth of 43 49, 68-71, 75 „ Children. Minor Ailments 41, 46, 81 School Children, No. of Medical Examinations 25, 31, 38 „ Children, Verminous Conditions 39, 40, 41 „ Dentistry 43, 39, 64, 68-71, 75 „ Continuation 58 „ Furniture 37 „ Heating 37 „ Hygiene 37 Meals 51 „ Medical Treatment 45, 81, 82 „ Medical Treatment, Scale of Charges 46, 47 „ Nursery 30 „ Open-air 50 „ of Recovery 51, 53 Secondary 54-57 Schools, Survey of 37 Shops Act 98 Skin Diseases 42, 45, 48. 65, 74, 81 Slaughter Houses 88 Small-pox 9, 26 Special Examinations 59, 72 Special Enquiries 59 Sputum Examination 22 Staff 4, 17, 30, 31 Summary of Report 6 Swimming 51 T. Table—Air Temperature 27 „ Birth-rate 7 „ Causes of Death 25 Clinic, Treatment at 68, 71, 81, 83 Comparative Statistics 7 Deaths 26 Dental Treatment 68, 71 „ Eye Examinations 56, 74, 81, 82 Exceptional Children 77, 78 „ Exclusion Forms Tssued 45 „ Explosives Act Prosecution 98 „ Food and' Drugs Act, Legal Proceedings 97 Infantile Mortality 7 Infectious Cases Notified 25 „ Infectious Cases Removed to Hospital 14, 25 Maternity and Child Welfare 16. 71 „ Medical Help 19 Mental Defectives 13. 53 ., Meteorological Record 27 „ Minor Ailments 41. SI „ Notifications 25 ,. Notices Served 86 ., Nuisances 99 „ Public Health Act Prosecutions 95, 96 „ Rainfall 27 Record of Inspections 55, 72, 99 School Children Crippled 57, 75, 78 School Children Defects of 53. 56. 57, 68. 74, 75, 77, 78, 81-83 School Children Examined 72 „ School Children Excluded 45 Secondary School Examinations 55-57 „ Shops Act Prosecutions 98 Tuberculosis 21, 22, 25, 57, 75, 78 101 INDEX -continued. Table — Tuberculosis Sanatorium Patients 19, 25 „ Tuberculosis Notifications 25 „ Venereal Diseases 24 „ Verminous Condition of School Children 39, 40, 45 „ Vision of School Children 56, 74, 77, 81, 82 Tables, Notes to 72, 73, 76, 79, 80 Teaching Staff, Co-operation of 52 Teeth of School Children 64, 68-71, 75 Temperature 27 Throat Affections 41, 45, 47, 56. 82 Tonsils 18, 41, 42, 47, 56, 62, 64. 74, Trade Refuse, Removal of 93 Training Centre, Mental Defectives 13 Tuberculosis 9, 19, 23, 25, 26, 42, 47 Tub?rculosis Dispensary 9, 20-23 „ Treatment of 9, 20 Tuberculosis Visits 23 Tuberculous Diseases of School Children 42, 44, 47, 57, 75, 80 U. Unsound Food 89 V. Venereal Diseases 9, 24 Verminous Condition of School Children 39, 40, 41, 45, 53, 83, 84 Vision of School Childr?n 42, 48, 49, 82 Visits, Nurses 16, 17, 23, 38, 15, 51, Voluntary Workers 53 W. Whooping Cough 7, 26 Workshops 88 X. X-ray Treatment 18, 20, 18