Journal Rebind Co. Ltd Unit 4, Pier Wharf Grays, Essex EAS 1 COUntY Burough OF ??? NHM. Annual Report of M.O.H. for 1925. to gerther with The School MOH's Report for the same 4005 EAST HAM CORPORATION. PUBLIC HEALTH COMMITTEE. Also Committee under Blind Persons Act, 1920, Sec. 2. *The Mayor (Alderman N. A. Papworth, J.P.). *The Deputy-Mayor (Councillor E. Shanahan). *Alderinan W. G. Davie, J.P. (Chairman). Alderman E. Edwards, J.P. *Alderman H. Osborn, J.P. Alderman F. Webster. *Councillor Mrs. B. Allwright. *Councillor C. W. Brading. *Councillor J. Brooks, J.P. *Councillor P. Y. Gerrard. *Councillor H. B. Harper, J.P. *Councillor Mrs. E. J. Jacobs (Vice-Chairman). *Councillor G. Manser. *Councillor W. T. Newling. Councillor A. Rhodes. *Councillor Mrs. M. Ridler. Councillor H.N. Ridler. * Also Members of the Hospital, Sanatorium and Sewage Works Sub-Committee. MATERNITY AND CHILD WELFARE COMMITTEE †‡The Mayor (Alderman N. A. Papworth, J.P.). †‡The Deputy-Mayor (Councillor E. Shanahan). Alderman E. Edwards, J.P. Alderman W. C. Ford, J.P. †‡Councillor Mrs. H. Allwright. Councillor H. E. Jerram. †‡Councillor Mrs. E. J. Jacobs (Chairman). Councillor A. Jones. †‡Councillor Mrs. M. Ridler (Vice-chairman). Councillor A. Trinder. ‡Miss E. R. Davies (co-opted). †‡Mrs. A. A. Dean (co-opted). +Mrs. L. K. Gerhard (co-opted). †‡Mrs. L. H. Wright (co-opted). t+Mrs. F. Norman (co-opted). †Also Members of the Provision of Milk Sub-Committee. ‡Also Members of the Maternity Hospital Accommodation Sub-Committee. COMMITTEE FOR THE CARE OF THE MENTALLY DEFECTIVE. The Mayor (Alderman N. A. Papworth, J.P.). The Deputy-Mayor (Councillor E. Shanahan). Alderman W. C. Ford, J.P. Alderman T. M. McGiff. Alderman F. Webster. Councillor C. W. Brading (Vice-Chairman). Councillor J. Brooks, J.P. Councillor D. Gordon. Councillor P. Y. Gerrard (Chairman). Mrs. G. Banks-Martin, J.P. (co-opted) Mrs. C. J. Cross (co-opted). Mrs. A. McGiff (co-opted) (Vice-Chairman). Mr. P. Goth (co-opted). Mrs. T. M. Twitchett, J.P. (co-opted). 68582 WHOLE TIME STAFF OF THE PUBLIC HEALTH DEPARTMENT. Clerks: Miss D. Gordon, Miss D. Scarborough, L. P. Read, *W. Lank, *H. G. Luckett, *G. W. Friend. *F. J. Kendall, A.R.San.I., Chief Clerk. Home Visitor, Blind Persons Act: *Miss L. Kingston. Child Welfare Clerk: *Miss M. A. McCall. Health Visitors: *Mrs. A. A. Woodman, S.R.N., M.R.San.I. Certified Midwife (Senior), *Miss K. Bower, S.R.N, Certified Midwife, *Miss L. Barrett, S.R.N., Certified Midwife, *Miss A. E. O'Leary, S.R.N., Certified Midwife and *Miss M. A. Redcliffe, Certified Midwife. Tuberculosis Dispensary Clerk: *Miss V. Reid. Tuberculosis Nurses: *Miss L. E. Mallon, S.R.N., *Miss E. E. Cook, S.R.N., Certified Midwife. Assistant Nurse: Miss A. Meadhurst. Matron of Isolation Hospital-. Miss H. M. McLoughlin, S.R.N., from March. Matron of Harts Sanatorium: *Miss R. Small, S.R.N., Certified Midwife. Assistant Sanitary Inspectors: W. S. C. Tooby, A.R.San.I., M.S.I.A., W. J. Worley, A.R.San.I., W. H. Thurston, R.P., A.R.San.I., M.S.I.A. Sanitary and Food Inspectors: *M. J. J. Hillyard, M.S.I.A., *G. D. Lill, M.S.I.A., *R. A. Baskett, M.S.I.A. Chief Sanitary, Food and Shops Act Inspector, Inspector Contagious Diseases (Animals) Act and Supt. Refuse Collection : *Joseph G. Banks, A.R.San.I., F.S.I.A. School Dentist and Dentist to Maternity and Child Welfare Centre . *C. S. Neame, L.D.S., Eng. Medical Officer to Maternity and Child Welfare Centre, Inspector of Midwives and Assistant to Tuberculosis Officer: *Dorothy M. Gowers, M.R.C.S., L.R.C.P., D.P.H., to May. *Elsie Thomson, M.B., Ch.B., from June. Assistant School Medical Officers : *M. M. Thomson, L.R.C.P., L.R.C.S., D.P.H. *T. P. Evans, M.R.C.S., L.R.C.P. *T. J. Clayton, M.R.C.S., L.R.C.P (temporary). Tuberculosis Officer and Resident Medical Superintendent, Harts Sanatorium: *G. W. Cheater, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Deputy Medical Officer of Health, Senior Assistant School Medical Officer and Resident Medical Superintendent, Isolation Hospital: *F. E. Bendix, M.R.C.S., L.R.C.P., L.D.S. 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 Mentally Defective, and Medical Officer, Blind Persons Act: *W. Benton, M.R.C.S., L.R.C.P., D.P.H. * Proportion of Salary contributed under Public Health Acts or by Exchequer grants To His Worship the Mayor, Aldermen, and Councillors of the County Borough of East Ham. Mr. Mayor, Ladies and Gentlemen, I beg to submit the Annual Report on the state of the Public Health and the record of sanitary work carried out during the year 1925, together with my report as School Medical Officer, as requested by the Ministry of Health and Board of Education. The Borough still occupies a very satisfactory position in regard to mortality statistics, the death rate being as low as 10.58, and infant mortality 53. The birth rate still shows a further decrease, being 17'3 as against 23'2 in 1920, due to the present unsatisfactory social conditions, but it is satisfactory to note that the infant mortality is still low, as it is important with the ever decreasing birth rate that the life of every child born should be maintained. I regret the Council have not seen fit to increase the staff of Health Visitors to the required standard, as recommended by the Ministry of Health. I repeat the following extract from my Annual Report for 1914:— "This work (Maternity and Child Welfare) is very necessary in such a district as this. The fact that so many children found at the medical inspection of school children to be suffering from various ailments which might have been prevented in early life, makes it the duty of the Public Health Authority to take steps to prevent this, so that children arriving at school age will be better able to benefit by the education provided." With the present staff of Health Visitors it is not possible to extend the visits and superintend the toddlers up to school age. The School Medical Service continues to carry out very efficient work, as will be noted in the report. The position in regard to housing is still very unsatisfactory and is the one great outstanding defect. The majority of the houses built in the Borough are only for sale, so that this does not actually relieve the overcrowding in the Borough, as those 6 who apply for further accommodation are unable to purchase. I frequently have applications from families of five or six living in one room, which in ordinary times would be dealt with as cases of overcrowding, but which have to be tolerated under the present conditions. A Tuberculosis patient is at a disadvantage in respect of housing accommodation. A worker is found to have Tuberculosis and applies for treatment. He is probably sent to a Sanatorium for several months and improves in health. In the meantime he loses his employment and on his return home is unable to pay the rent of his house or rooms and sublets to others, with the result that he is unable to follow out the advice and education received at the Sanatorium, and the vitiated atmosphere naturally has a marked effect on the condition of his lungs, so that the disease rapidly progresses. The following statistics of 1904 and the past five years are interesting — 1904 1921 1922 1923 1924 ] Death-rate 14.7 10.1 11.0 9.0 9.7 10.6 Birth-rate 31.8 20.3 21.0 19.4 18.3 17.3 Infant Mortality 154 67 62 51 54 53 Zymotic Death Rate... 2.9 0.57 0.66 0.3 0.38 0.4 Pulmonary Tuberculosis death-rate 1.68 0.85 0.95 0.88 0.78 0.90 I am, Your obedient Servant, W. BENTON. Town Hall, East Ham. April, 1926. 7 8 9 10 11 12 13 14 15 16 17 18 Summary of Report for 1925. 1. GENERAL STATISTICS. Area in statute acres (land and inland water), 3,324. Population. Census 1921, 143,246 (males 69,342, females 73,904). Adjusted to mid 1925, 147,200. Census 1921:— Number of inhabited houses 27,024 Number of families or separate occupiers 33,937 Ward Population. Manor Park 14,966 Little Ilford 17,602 Woodgrange 13,954 Plashet 14,700 Kensington 12,970 Castle 15,420 Central 15,516 Wall End 15,070 Greatfield 11,694 South 15,308 Rateable Value:— Borough Rate £637,497 Assessable Value :— General District Rate £591,286 Sum represented by a Penny Rate :— Borough Rate £2,536 net General District Rate £2,367 net 2. EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total number of births, 2,553 (males 1,262, females 1,291). Total number of illegitimate births, 64. Birth-rate, 17.3. Deaths, 1,500 (males 796, females 704). Crude Death-rate, 10.18. Standardized Death-rate 10.58. 19 Number of women dying in, or in consequence of, childbirth: from sepsis, 2; other causes, 6. Deaths of Infants under one year of age per 1,000 births registered: legitimate, 52; illegitimate, 62; total, 53. Deaths from Measles (all ages), 2. Deaths from Whooping Cough (all ages), 23. Deaths from Diarrhoea (under 2 years of age), 13. Zymotic Death-rate, 0.4. COMPARATIVE STATISTICS. Annual Rate per 1,000 Living. Rate per 1,000 registered Births. Births. Deaths. Diarrhoea & Enteritis (under 2 years). Infant mortality. England & Wales 18.3 12.2 8.4 75 105 Great Towns 18.8 12.2 10.8 79 London 18.0 11.7 10.6 67 EAST HAM 17.3 10.6 5.1 53 East Ham is bounded on the north by Wanstead, south by the River Thames, adjoins West Ham on the west, and Ilford and Barking east. The subsoil is sand and gravel, with the exception of a portion in the south of the Borough, where it consists of alluvium overlying London clay. The altitude is low, the highest point being about 50 feet above ordnance datum. It is well served by railways, viz., District, L. M. & S., and L. & N. E., also by a through service of trams and motor 'buses which convey a large number of the population, chiefly consisting of clerks, warehousemen, mechanics, postal and telephone officials to and from the City of London. 20 COUNTY BOROUGH OF EAST HAM PUBLIC HEALTH DEPARTMENT. REPORT OF THE MEDICAL OFFICER OF HEALTH For the year 1925. 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. Midwlves. No Midwives are subsidised by the Authority, but a large amount of the Midwifery work is undertaken by twenty-six Nurses of the Plaistow Maternity Charity, in addition to eleven Midwives who have private practice in the Borough, and four 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. 50-59. Infant Consultations and Ante-Natal Clinics are conducted daily. Branch Clinics are also held once a week at Wesleyan Church Hall, Manor Park; and St. John's Schoolroom, North Woolwich. At the present time there is no Day Nursery in the Borough. 21 The School Clinics are referred to in the report on the School Medical Service pp. 79-81. Tuberculosis Dispensary, Wakefield Street. Tuberculosis Officer in attendance one morning, three afternoon and one evening session each week. For report see pp. 42-43. Venereal Diseases. East Ham forms a part of the joint scheme with the London County Council. For summary, see page 60. Lectures have been given to various organisations in the Borough by the staff of the British Social Hygiene Council. A local medical practitioner is qualified to receive free supplies of arseno-bcnzol compounds. HOSPITALS PROVIDED OR SUBSIDISED BY THE LOCAL AUTHORITY. 1. Tuberculosis. Harts Sanatorium, Woodford Green, has accommodation for fifty patients (for report see pp. 43-44). Arrangements have been made for children to be sent to various Sanatoria as occasion arises. Ex-service men were admitted either to Papworth Hall or Preston Hall Tuberculosis Colonies. 2. Maternity. Arrangements have been made for cases to be admitted to Plaistow Maternity Home or Queen Mary's Hospital, West Ham. 3. Fever. (For report see pp. 45-48.) 4. Small-Pax. The West Ham Corporation, by agreement, deal with cases of this disease arising in the Borough. 5. Other. The general and special hospitals of London, and the Whipps Cross Hospital of the West Ham Board of Guardians, are within easy access. There is no local institutional provision for unmarried mothers, illegitimate infants, and homeless children. 22 AMBULANCE FACILITIES. (a) For Infectious Diseases.—Two motor ambulances are garaged at the Isolation Hospital. (b) For non-infectious and accident cases.—A motor ambulance, kept at the Fire Station, conveyed 914 cases to and from various hospitals. These consisted of 181 accidents and1 733 cases of illness. 851 journeys were made, and 10,001 miles run. East Ham cases removed by other ambulances numbered 80, made up as follows: Barking 46, Ilford 19, West Ham 15. HEALTH PROPAGANDA. Synchronising with the twenty-first anniversary of East Ham as a municipality a very successful Health Week, opened by Sir H. Kingsley Wood, M.P., Parliamentary Secretary to the Ministry of Health, was held from 5th to 10th October. The daily programmes consisted of appropriate lectures, exhibits, and visits to municipal undertakings, Royal Albert Docks and Beckton Gas Works. The estimated number of visitors was between 50,000 and 60,000, who exhibited a keen interest throughout. It is proposed to repeat the effort. PROGRAMME. Sunday, 4th October. 11 a.m.—Civic Service at Plashet Park Congregational Church. Monday, 5th October. 12 noon.—Exhibition opened by Sir H. Kingsley Wood, M.P. (Parliamentary Secretary to the Ministry of Health). Chairman : His Worship the Mayor of East Ham (Alderman Noble A. Papworth, J.P.). During the week the following Lectures were given in the Large and Minor Halls as under :— Monday, 5th October. 7.30 p.m. (Minor Hall).—"The State of Public Health in East Ham." By Dr. W. Benton, D.P.H., Medical Officer of Health. Chairman : Mr. Councillor Brooks, J.P. 23 8.30 p.m. (Minor Hall).—"Public Libraries and the People." By W. Bridle, Esq., F.L.A., Borough Librarian. Chairman : Mr. Councillor Masset. Tuesday, 6th October. 6 p.m. (Minor Hall).—"Electricity." By W. R. Elliott, Esq., A.M.I.E.E. Chairman : Mr. Councillor Shanahan, J.P. 7 p.m. (Large Hall).—"Sunlight and Health." By C. W. Saleeby, Esq., M.D., F.R.S.E. Chairman: Mr. Councillor Harper, J.P. Wednesday, 7th October. 3.30 p.m. (Council Chamber).—"The Health of the School Child." By Dr. F. E. Bendix. Chairman: Mr. Councillor Oakes, J.P. 6.30 p.m. (Minor Hall).—"Rats" (Lantern Lecture). By J. G. Banks, Esq. Chairman : Mr. Councillor Kybert. 7 p.m. (Minor Hall).—"Cinematograph Lecture of the British Social Hygiene Council." Speaker: Dr. I. Feldman (Lecturer in Physiology at the London Hospital). Chairman : Mr. Councillor Gerrard. 8.15 p.m. (Minor Hall).—"Careers for Boys." By W. H. Barker, Esq., B.Sc., F.C.S. Chairman: Mr. Alderman Osborn, J-P. Thursday, 8th October. 3 p.m. (Council Chamber).—"The Care of the Baby." By Dr. Thomson. Chairman : Mrs. Councillor Jacobs. 4 p.m.—"The Care of the Teeth" (Lantern Lecture). By the School Dentist. Chairman : Mr. Councillor Ridler. 6.30 p.m. (Minor Hall).—"What can we expect from our Schools." By F. R. Thompson, Esq. Chairman: Mr. Alderman Cross. 8 p.m. (Minor Hall).—"A Walk in Wanstead Park" (Lantern Lecture). By A. E. Farrants, Esq. Chairman: Mr. Councillor Boultwood. Friday, 9th October. 3 p.m. (Council Chamber).—"Healthy Children." By Dr. Mary Thomson. Chairman : Mr. Councillor Manser. 24 4 p.m. (Council Chamber).—"The Cause and Prevention of Defective Sight in School Children." By the School Ophthalmic Surgeon. Chairman : Mr. Councillor Newling. 7.30 p.m. (Large Hall).—"The Life History of the House Fly and How it affects the Health of Man." By G. H. Rodman, Esq., M.D., Past President of R.P.S. of Great Britain. Chairman : Mr. Alderman Davie, J.P. 9 p.m. (Minor Hall).—"Rats." By G. D. Lill, Esq. Chairman : Mr. Councillor Bagot. Saturday, 10th October. 6 p.m. (Minor Hall).—"The Use and Abuse of the Dustbin." By J. G. Banks, Esq., Chief Sanitary Inspector. Chairman : Mr. Councillor Brading. 7.30 p.m. (Minor Hall).—"Domestic Sanitation and Refuse Disposal." By J. Birch, Esq., Borough Engineer. Chairman: Mr. Alderman McGiff, J.P. A Special Lecture on "London's Water Supply," by Sir Alexander Houston, K.B.E., C.V.O., M.B., C.M., D.Sc. ; Chairman : Mr. Alderman Dean, J.P. Arrangements were made for parties to be conducted over the following undertakings during the afternoons of the days stated. Monday.—King George V. and Royal Albert Docks. (One party of 20 persons.) Electricity Generating Station, Nelson Street. (Two parties of 25 persons each.) Tuesday.—King George V. and Royal Albert Docks. (One party of 20 persons.) Beckton Works of the Gas-Light & Coke Co. (One party of 70 persons.) Wednesday.—King George V. and Royal Albert Docks. (One party of 20 persons). Electricity Generating Station. (Two parties of 25 persons each.) Corporation Sewage and Destructor Works. (One party of 25 persons.) Thursday.—Corporation Sewage and Destructor Works. (One party of 25 persons.) Beckton Works of the Gas-Light & Coke Co. (One party of 70 persons.) 25 Friday.—Corporation Sewage and Destructor Works. (One party of 25 persons.) Electricity Generating Station. (Two parties of 25 persons each.) Saturday.—Corporation Sewage and Destructor Works. (One party of 25 persons.) Through the kind permission of the Management of the respective Cinematograph Theatres, the film, "The Invisible Enemy," was shown as under :— Monday.—Premier Super Cinema, High Street North. Tuesday.—The Picture Coliseum, Upton Park. Wednesday.—The Picture Coliseum, High Street North. Thursday.—Broadway Cinema, High Street South. Friday.-—Boleyn Electric Theatre, Barking Road. Saturday.—Coronation Super Cinema, Manor Park. Displays of Physical Drill, Selections of Part Songs, Country Dances, etc., were given in the Large Hall by the Scholars of the following Schools :— Monday, 5th October. 5.30-7.30 p.m.—Fourth Avenue Boys, Napier Road Boys' Brampton Road Girls, Shaftesbury Road Boys. Tuesday, 6th October. 5-7 p.m.—Hartley Avenue Boys. 8-8.30 p.m.—High Street Senior, Shaftesbury Road Girls, Winsor School Intermediate, Fourth Avenue Infants. Wednesday, 7th October. 5-7 p.m.—Shaftesbury Road Boys, Hartley Avenue Boys, Silvertown R.C., Hartley Avenue Infants. 8-9 p.m.—Napier Road Boys, Vicarage Lane Boys. Thursday, 8th October. 5.30-8 p.m.—Kensington Avenue Girls, Winsor School Intermediate, Vicarage Lane Girls, Wakefield Central School. 26 Friday, 9th October. 5.30-7.30 p.m.—Kensington Avenue Boys, Vicarage Lane Infants. Saturday, 10th October. 5.30-8 p.m.—Napier Road Boys, Monega Road Boys, Walton Road Boys, Sandringham Central. The Medical Officer of Health has also given a number of addresses to the various Women's Guilds in the Borough, and through the good offices of the Borough Librarian, book-marks containing Health Maxims issued by the East Ham Insurance Committee, are distributed to borrowers. 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 Health Acts Amendment Act, 1907, Part 10, Sec. 95. 16th October, 1923. 17 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 24 th Nov., 1908 24th Nov., 1908 Local Government and other Officers' annuation Act, 1922 17th July, 1923 1st Oct., 1923 Bye-Laws, Regulations, etc. The following Bye-laws, Regulations, etc., are in force in the County 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. 28 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. 29 MENTAL DEFECTIVES. Work of the Voluntary Association The Council's duties under the Mental Deficiency Act of "ascertaining" and "supervising" mental defectives in the Borough are carried out by the Essex Voluntary Association in return for a grant. The Association also investigates, makes enquiries, and reports for the information of the Visiting Justices on the home conditions of defectives under Order. Similar reports on defectives whose parents have applied for discharge, or on those on leave of absence, etc., are made by the Association for the Council for submission to the Board of Control. The East Ham Education Committee now employ the Association to visit, befriend, and report on feeble-minded children between 7 and 16 years of age so that the arrangements in the Borough for ascertainment under the Mental Deficiency Act would be complete were there to be a scheme for the Association to be notified of defectives receiving poor relief and those leaving the Guardians' care. The lack of institution accommodation for East Ham defectives is creating a serious condition of affairs both for defectives and the community. There is a list of several urgent cases now awaiting custodial care. After 12 years' operation of the Mental Deficiency Act it is apparent that many defectives can be quite safely and happily boarded out in small households. It is also apparent that many defectives, after a year or two in an institution, may safely and satisfactorily come out on leave of absence either to their own friends or to the care of kindly and capable foster parents. Leave of absence may be extended indefinitely if progress is satisfactory, or immediately cancelled if the defective does not do well. The Voluntary Association is submitting the names of suitable persons to act as foster parents for defectives recommended for boarding out. The Association's centre for defective children held in St. Michael's Institute, and the Handicraft Class for older boys and men at St. Barnabas Church Room are making steady headway. 30 The following is an analysis of case work during the year ended 31st December, 1925 :— Sent to Institutions by the Council under Order 6 Placed under statutory supervision 12 Died 3 Sent to Mental Hospitals under the Lunacy Act 2 At the close of the year there were :— 45 East Ham defectives in certified institutions under Order. 6 under order of guardianship with relatives with an order for maintenance. 53 under statutory supervision in their own homes. 60 under voluntary care. BLIND PERSONS ACT, 1920. Since the appointment of a Home Visitor in June last, the Register has been revised, and there are now 1120 technically blind persons known to belong to the Borough. Some of these are children at Blind Schools, and men and women at workshops, who are visited during their holidays. The remainder are regularly visited, and such of them able to benefit have been taught suitable occupations, and others assisted to obtain Blind Pensions. The members of the local Welfare Association continue to carry on their good work. Inter alia, all cases were visited and taken out for walks. Grants of clothing and provision of extra nourishment have been made, with additional gifts at Christmas; a day's visit to Clacton by motor char-a-banc arranged; a Blind Club formed at the local Church Army Social Centre; social evenings given; training centres visited; and orders obtained for articles made by blind persons. INVALID CHILDREN'S AID ASSOCIATION, The work of the Invalid Children's Aid Association (East Ham Branch) has steadily increased during the year; 226 cases having been dealt with consisting of 188 cases new to the Branch, and 38 cases already on the books. During the 21 years of the work of the Branch, 387 children have been assisted. The 226 cases dealt with during the year have been drawn from all parts of the Borough, the figures for each Ward being as follows :— 31 East Ham North. East Ham South. Little Ilford 29 Central 29 Manor Park 19 Wall End 27 Woodgrange 14 Castle 29 Plashet 25 Greatfield 21 Kensington 15 South 18 In addition to the local cases recommended by the Medical Officer of Health, School Medical Officer and Local Practitioners, a large number of cases have been received from the large General Hospitals, the Association having acted as Convalescing and Visiting Agent on behalf of the following :— Great Ormond Street Hos- Queen Mary's Hospital. pital. St. Barts. Hospital. London Hospital. Guy's Hospital. East London Hospital. Royal National Orthopaedic Hospital. Infants' Hospital, Westminster. Queen's Hospital. Westminster Ophthalmic Hospital. Balaam Street Hospital. Belgrave Hospital. All types of cases have been dealt with, and a large proportion have received great benefit from the treatment afforded. Types of Cases Dealt with :— T.B.—Lungs 8 Bronchitis and Asthma 25 Spine 5 After acute illness 2 Hips 14 Paralysis 16 Bones 9 Chorea 9 Peritonitis 2 Heart 5 Glands28 Nervous System 2 Anasmia and Debility 57 Skin Diseases 3 Rickets 3 Eye Diseases 6 Malnutrition 7 Various 25 Cases Referred by:— Medical Men, Hospitals and Dispensaries 105 T.B. Dispensary 39 School Medical Officer and Care Committee 56 Invalid Children's Aid Association 3 Guardians 1 Parents 5 Other Agencies 17 32 A feature of this year's work has been a considerable increase in the number of cases recommended by the Public Health Committee for Sanatorium Institutional treatment, in accordance with the scheme for co-operation adopted last year. The arrangements made with the Borough Council and the Education Committee have worked smoothly, and it is no idle boast to say that as a result of co-operation between these governing bodies and the Association, no sick or crippled child in this Borough need want for convalescent or surgical treatment. Help has been given during the year as follows :— Sent to Sanatoria or Special Hospitals 35 Convalescent Homes 101 Boarded out 3 Provided with surgical appliances 41 Invalid carriages 6 Hospital letters 2 Visiting and advice on behalf of Hospitals 21 Referred to other agencies 17 Convalescent or institutional treatment has been arranged for varying periods according to medical advice at the following places :— Alton, Ascot, Brighton, Bushey, Banstead, Broadstairs, Dover, Eastbourne, Folkestone, Hastings, Hayling Island, Holt, Kingsnorth, Kearsney (Dover), Margate, Northwood, Naylands, Romsey, St. Leonards, Seaford, Seven Oaks, Tunbridge Wells, Torquay and Worthing. LABORATORY WORK. 774 Bacteriological examinations of "swabs" for suspected Diphtheria were undertaken in our own Laboratory. 184 " swabs " were examined at the Isolation Hospital. Other pathological and bacteriological specimens were sent to London and provincial laboratories for examination. Diphtheria and other sera and vaccines were supplied free of charge to Medical Practitioners as required. MEDICAL EXAMINATION. Fifty-two examinations have been made during the year upon request of the various committees of the Town Council. 33 VERMINOUS PERSONS. No facilities are yet available for the cleansing and disinfection of verminous persons, but with the strict supervision of the School Nurses the number of cases occurring in school children is limited. OUT-DOOR RELIEF. The amount of poor relief paid by the West Ham Union in the East Ham Relieving Officers' Districts was £210,967, during the twelve months' ended the 31st December, 1925. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. Small Pos. Fortunately no case of this disease has occurred in the Borough since 1920. There have been a number of severe cases of Chicken Pox in adults, to which I have been called in consultation by Medical Practitioners during the year. One very suspicious case I was asked to see of a rash similar to Small Pox was interesting and on investigation I discovered that the man had been taking large doses of Iodide of Potassium. Scarlet Fever. The number of cases of Scarlet Fever notified has been small and the cases have been mild in character; 221 cases with 4 deaths. No use has been made of the Schick and Dick tests in Diphtheria and Scarlet Fever. Diphtheria. There has been an increase in the number of cases during 1925, but the mortality is low, being only 12 deaths out of 246 cases, of which 224 were treated at the Isolation Hospital. A number of cases were traced to one school and on bacteriological examination of "swabs" from the noses and throats of the other children a nasal carrier of the Bacillus was discovered. In the majority of cases the disease is diagnosed early on account of the facilities given to Medical Practitioners for the bacteriological examination of "swabs" from the nose and throat. The fatal cases are usually those whose parents have neglected to call in medical men until the case is serious. 34 Enteric Fever (Typhoid and Para-Typhoid). The two fata! cases of the above disease were, in one case that of a seaman who had contracted the disease abroad and was in a serious condition when landed from his ship, and the other of a woman patient belonging to the Borough who died at Brentwood Mental Hospital. Erysipelas. 41 cases occurred, with 3 deaths. Puerperal Fever. Five cases were notified during the year, with two deaths, both of which were hospital cases. Cerebro-Spinal Meningitis. Only one case was notified, which recovered. Encephalitis Letbargica. There were three deaths out of six cases notified. Pneumonia. There were 114 deaths from pneumonia, the majority of cases being a complication of Influenza. Dysentery and Trench Fever. No cases were notified. Malaria. One fatal case occurred, which had been contracted abroad. Preventive Methods Undertaken to Control the Spread of Infectious Disease. On receipt of the notification of a case the patient is at once removed to Hospital, if this is desired or necessary, and the room previously occupied and its contents are disinfected. Library books, if present, are removed for disinfection. Whether the patient be removed to Hospital or not, the Sanitary Inspector at once calls and obtains all particulars of the case and endeavours to trace the source of infection. He also leaves a printed form giving full instructions as to isolation, etc., and the precautions 35 which should be adopted to prevent the spread of infection. Information is obtained as to the Day and Sunday schools attended, either by the patient or by children in the house, the school authorities are notified, and all children living- in the house are for a time excluded. The source of the milk supply, the occupation of the inmates, home work, sanitary condition of the premises, water supply, presence of animals, etc., are all investigated, and a report made to me on the same day. The name of the laundry is also ascertained, the proprietor is notified, and the sending of clothes there is prohibited until the premises are free from infection. Disinfection of premises and articles which have been exposed to infection is undertaken by the Sanitary Department. Disinfectants in every case are supplied free of charge. The Council also supply Anti-toxin "gratuitously to all medical practitioners for the treatment of cases in the Borough. DISEASE NOTIFICATION 1920-1925. Disease. 1920 1921 1922 1923 1924 1925 Small Pox 10 – – – – – Scarlet Fever 718 1355 502 170 215 221 Diphtheria 426 309 198 160 128 246 Enteric Fever (Typhoid and Para-Typhoid) 10 7 4 3 5 9 Erysipelas 72 57 34 32 38 41 Puerperal Fever 6 3 5 5 5 Cerebro-Spinal Meningitis 3 4 — 1 1 1 Encephalitis Lethargica 5 7 — — 9 6 Ophthalmia Neonatorum 30 – 11 11 11 6 Dysentery — 1 — — — — Malaria -— 1 —* 1 — 1 Acute Polio Myelitis 1 — — 3 1 1 Anthrax 2 1281 1749 752 386 415 537 Pneumonia — 85 92 54 79 91 36 TUBERCULOSIS. Notifications, 1920-1925. 1920 1921 1922 1923 1924 1925 Pulmonary Tuberculosis 242 287 209 220 249 254 Other Forms do. 68 66 69 76 95 64 310 353 278 296 344 318 New Cases and iMortality during 1925. Particulars of new cases of tuberculosis and of deaths from the disease in the area during 1925 :— Age Periods. New Cases. Deaths. Pulmonary. Non-Pulm. Pulmonary. Non-Pulm. M. F. M. F. M. F. M. M. Under 1 — 1 — — — 1 1—5 4 1 10 4 2 — 8 — 5 — 10 9 6 8 4 — — — — 10 — 15 3 1 8 8 — — 1 1 15 — 20 13 20 4 3 6 7 1 1 20 — 25 17 22 2 2 8 9 1 -• 25 — 35 32 38 4 1 14 15 1 1 35 — 45 25 17 1 2 19 7 2 1 45 — 55 23 5 1 — 19 6 — — 55 — 65 10 6 — — 9 6 — 2 65 and upwards . . 2 — 1 — 3 J 1 — Totals ... 138 116 39 25 80 52 16 9 TUBERCULOSIS SCHEMES. Dispensary at 19, Wakefield Street. Branch Dispensaries, nil. Visiting Stations, nil. "Photo by Surrey Flying Services." harts sanatorium 37 List of Tuberculosis Officers :— One Chief Administrative Tuberculosis Officer. One Tuberculosis Officer (Clinical, part time). One Assistant Tuberculosis Officer (part time). Other officers :— Two Nurses. One Assistant Nurse. One Clerk. List of Residential Institutions :— (1) Harts Sanatorium, Woodford Green, 50 Pulmonary cases (30 men, 18 women, and 2 girls). Exclusively for patients residing within the Borough of East Ham. (2) Royal Sea Bathing Hospital, Margate, Non-Pulmonary, usually adults. (3) Children :— Treloar Home, Alton—Non-Pulmonary. Swanley Hip Hospital—Hip Cases. Heatherwood Hospital—Non-Pulmonary. Church Army Sanatorium—Pulmonary. National Children's Sanatorium, Harpenden—Pulmonary. St. Catherine's Home, Ventnor—Pulmonary and Glands. Victoria Home, Margate—Pulmonary. Oak Bank Sanatorium, Sevenoaks—Pulmonary. (4) Adults :— At Sanatoria other than " Harts," Woodford Green :— Royal National Sanatorium, Ventnor—Pulmonary. King Edward Sanatorium, Midhurst—Pulmonary. The majority of the children's cases are admitted to these Sanatoria through the instrumentality of the local branch of the Invalid Children's Aid Association. Co-operation with this voluntary body is particularly welcome and works to the advantage of all concerned. For their co-operation during the year we thank them cordially. Beds are not usually reserved at any of these institutions, except at " Harts," for the exclusive use of patients from the Borough, but little difficulty is experienced in obtaining admission for recommended cases of non-pulmonary tuberculosis. 38 The only available accommodation for advanced cases is Whipps Cross Hospital. Co-operation is maintained with the general London Hospitals —the special Hospitals for Diseases of the Chest and the local general Hospital (Queen Mary's, Stratford). Where a patient has been attending any of these hospitals, a request is made for the medical and X-ray findings; where recommendations are made by the authorities of these institutions they are as a rule carried out if concurred by the Tuberculosis Officer, e.g., Sanatorium treatment, the provision of instruments, etc. Use, too, is made of the facilities for special forms of treatment in cases of Lupus. With the School Clinics and School Medical Service generally there is close co-operation. Where minor ailments are discovered at the Dispensary in children of school age, they are referred to the School Medical Service for appropriate treatment, teeth, tonsils, adenoids, etc. The usual certificates of inability to attend school on the re-admission to school are granted at the Dispensary, and the School Medical Service is acquainted with the fact. The number of chalets in use by patients at their own homes is 5 ; they are all visited periodically. The arrangements set out in Memorandum 286 have been adopted and are working satisfactorily. The model forms suggested in the Memorandum are in use, the co-operation of local medical practitioners continues to increase, and their relationship with the work of the Dispensary is intimate. Where the diagnosis of a case is doubtful, arrangements are made for the patient's frequent attendance, during which time several investigations of the sputum are made, opportunity is taken for consultation, and arrangements made for special forms of diagnosis, viz., X-ray. The Dispensary Nurses visit all notified cases, noting the hygienic, financial, and home conditions, and appointments are made for the examination of all contacts. Where, upon examination, the teeth of insured notified cases are found to require attention, patients are recommended to obtain treatment through their approved societies; and in the case of uninsured patients, they are advised to obtain treatment through their own dentist; children are dealt with through the agency of the School Medical Service. 39 Extra nourishment is available for a number of patients, the amount spent during the year in this direction being £101. This ensures one pint of milk per day for each patient. Where, however, the patient is in receipt of relief from the Guardians, that authority makes itself responsible for the issue of extra nourishment, which includes butter, milk and eggs. A Tuberculosis "Care" and "After Care" Committee has been appointed by the Council, and it is hoped that it will soon function vigorously. For the situation which confronts many patients, particularly the men, is fraught with many difficulties, especially with regard to housing, suitable employment, etc. Prevention of Tuberculosis consists largely in the education of public opinion. In this direction, during the Borough Health and Civic Week, advantage was taken of the opportunity to bring home elementary lessons concerning this disease. Lectures were given on Tuberculosis at the Town Hall, and films illustrating a typical case were shown at all the leading Cinemas. In both lectures and exhibits the Tuberculosis Scheme of the Council was explained and the means of combating the disease emphasised. Provision is made for the treatment of Non-Pulmonary cases, especially those of Tuberculosis of bones and joints in both adults and children by co-operation with the London Hospitals. Where splints, instruments or appliances are recommended by Hospital or sanatorium authorities, after an investigation of the patients ability to pay for them, the Council decides to what extent, if any, monetary assistance should be given in order to provide such instruments, etc. The treatment of Tuberculosis of bones and joints often requires a prolonged period of residence at a sanatorium—as a rule anything from 18 months to 2 years. During the year, 12 such patients have been admitted to various sanatoria (9 cases of hip disease, and 3 cases of spinal disease). The total number of patients suffering from this type of the disease at present receiving treatment at sanatoria, for whom the Council is financially responsible, is 22. The number of new cases notified does not diminish in spite of the measures at present taken to reduce its incidence. I still hold the view that I expressed 16 years ago that the only means of reducing the incidence of Tuberculosis is the 40 tion of advanced cases, and with this view I admitted cases into the Isolation Hospital, at one time having as many as 35 patients under treatment. The beds were recognised by the Local Government Board as being suitable for the purpose, and in 1914 the Board recommended the Council to erect a special pavilion in the grounds adjacent to the Isolation Hospital. The admission of such cases to Isolation Hospitals has since been followed by a large number of authorities. At the same time arrangements were made for early cases to be admitted to various Santoria outside the district. There was objection raised at cases being admitted to the Isolation Hospital and the Council eventually purchased Harts at Woodford Green. The question has been raised as to whether the cost of the treatment of patients at Harts is economical and full benefit derived therefrom. At the enquiry held by the Ministry of Health when Harts was purchased I stated that the site was not an ideal one for early cases but it had the advantage of being near the Borough for removal of advanced cases thereto and convenient for friends to visit, but as at present arranged the buildings are not suitable for dying cases. Roughly speaking, Tuberculosis patients may be divided into three classes :— 1. Early cases with good general health, whose condition is curable. Unfortunately these cases are rare owing to the fact that the case is not often diagnosed early. 2. More advanced cases who will recover to a certain extent under suitable conditions but will probably lapse after discharge from the Institution. N.B.—About 40 per cent. of the cases which have been admitted to Harts since it was opened had died by the end of 1925. 3. Advanced cases which may be in an acute or chronic condition and will probably get worse and die. The advantage of sanatorium treatment to the first two classes is that they are educated to live non-infectious lives and thus the 41 community is benefited—although, as stated in my previous note, under the present conditions of overcrowding in most cases it is not possible to carry out the advice given. The cases which from a public health point of view in my opinion require nursing in an Institution are Class 3. These advanced cases are a danger owing to their infectious condition, which is accentuated by deficient housing accommodation. Under the Public Health Act, 1925, Sec. 62, the Council may apply for an order for compulsory removal to Hospital of such cases, but as it is not convenient to nurse them at Harts Sanatorium, no action has been taken in this respect. 42 Report on the Work of the Tuberculosis Dispensary during 1925. Summary of the Cases added to or removed from the Dispensary Register during the Years 1924-5 1925 1924 Adults. Children. Total. Pulm. NonPulm. Adults. Children. Total. Pulm. NonPulm. M. F. M. F. M. F. M. F. Number on Register 432 347 168 103 1050 758 292 404 289 156 106 955 688 267 Deaths 61 37 – – 98 98 — 54 32 3 2 91 88 3 Left District 24 17 5 5 51 41 10 35 19 7 6 67 57 10 Discharged 13 4 3 3 23 14 9 7 8 2 4 21 16 5 Total removed 98 58 8 8 172 153 19 96 59 12 12 179 161 18 Number added 112 93 39 23 267 216 51 128 106 58 28 315 224 91 43 TUBERCULOSIS DISPENSARY. Of the 267 cases added during the year, 254 were new cases and 13 were re-admissions. 317 sputum examinations were made, 59 were found to contain Tubercle Bacilli, 258 were negative. 667 patients were examined for diagnosis, 254 were found to be suffering from some form of Tuberculosis and attended for treatment; of these, 203 were found to have Pulmonary Tuberculosis, 26 were contacts, and 51 were found to have Non-Pulmonary Tuberculosis, 12 of these were contacts. 54 were of doubtful diagnosis, so were allowed to attend for observation. Number of Pre-tuberculars and cases attending for observation, 229. Number of Nurses' visits, 3,771; of these, 356 were primary visits and 3,415 secondary. Number of attendances at Dispensary during 1925 4,049 Number of medical examinations 2,097 Number of transfers from East Ham to other districts 29 Number of transfers to East Ham from other districts 23 HART'S SANATORIUM REPORT. Patients discharged, classified according to stages of disease on admission :— Early 86 Intermediate (mod. advanced) 55 Advanced 12 Observation cases 2 155 Patients discharged, 155 (including 3 cases who were in an insufficiently long time to be included in the following results, and excluding one death). Result of treatment :— Arrested 15 Much improved" 54 Improved 53 Not improved 30 44 Of 152 patients, 123 gained weight—average gain in weight, 8 23 lbs. 29 patients lost weight or unable to be weighed—average loss of weight, 5'5 lbs. Average duration of stay, excluding observation cases, 17 weeks. Number of patient days, 18,309. Number of beds available, 51. Average number of beds occupied, 50.74. The number of cases admitted shows an increase of 2 over the previous year. The type of patient who seeks admission shows a definite increase in favour of the early case, 86 as against 54 in the preceding 12 months. This is a welcome feature, as the result of treatment in such cases is maximal. The average duration in the institution for treatment was 17 weeks. This is, of course, a comparatively short average period of residence as far as the treatment of the disease is concerned; yet it is a period of time that many notified patients are reluctant to devote to the treatment of their disease; whilst others are utterly unable to prolong their stay for financial or domestic reasons. Of the special forms of treatment, artificial pneumothorax has been performed regularly throughout the year ; the number of refills being 184. The arrangement for X-ray control of the refills and X-ray definition and location of the disease with the Forest Hill Hospital authorities has been quite satisfactory. The results of this special treatment seem to conform with those obtained in other sanatoria. During the year the recreation side of the institution has been developed. Amongst the patients a Recreation Club has been formed. Throughout the winter performances of plays have been given by amateur Dramatic Clubs, and Concert Parties have provided additional entertainment. Wireless, too, has been installed—the male wards having been provided with individual headphones and the female ward's with loud speakers. These activities doubtless provide such relaxation and amusement as conduce to mental serenity, and certainly tend to relieve the tedium that treatment necessarily involves. 45 REPORT UPON THE WORK OF THE BOROUGH HOSPITAL. The year 1925 has witnessed the occurrence of a fairly large increase in the number of cases of acute infectious disease treated at the Borough Hospital; the patients admitted during the year totalled 442 as compared with 304 in the year 1924. The following table indicates the number of patients admitted for each disease and the number discharged, or who have died, in the year 1925:— Disease. Remaining at end of 1924. Admitted during 1925. Discharge during 1925. Died during 1925. Remaining at end of 1925. Scarlet Fever 33 196 204 3 22 Diphtheria 27 230 219 6 32 Enteric Fever — 4 3 1 — Erysipelas — 2 1 1 — Parotitis — 1 1 — — Influenza — 1 1 — — Broncho-Pneumonia – 1 — 1 — Morbilli — 4 3 1 — Urticaria — 1 1 — — Tonsillitis — 1 1 — — Encephalitis lethargica — 1 1 — — Total 60 442 435 13 54 Scarlet Fever. Excluding the 22 patients remaining in the hospital at the end of the year 1925, there were 174 completed cases of this disease treated; of these 3 died, giving a death rate of 1.7 per cent., as compared with a rate of 0.7 per cent. for the previous year. In each of the fatal cases a serious complication was present; one was admitted from Queen Mary's Hospital, where he had been under treatment for acute Bronchitis and subsequently developed Broncho-pneumonia. In another case Scarlet Fever was complicated by severe Diphtheria infection, whilst the third child developed Meningitis. The chief complications which occurred in the 229 cases under treatment during the year were as follows:— Cervical Adenitis 13 Otitis Media 19 46 Rhinorrhoea 11 Rheumatism 3 Nephritis 2 Bronchitis 1 The following table gives particulars of the chief diseases and conditions associated with Scarlet Fever, which were present in the patients admitted during- the year :— Measles 4 Diphtheria 6 Scabies 1 Septic wounds 2 Impetigo 3 Whooping Cough 1 Chicken Pox 3 Conjunctivitis 1 Keratitis 1 Urticaria 1 Diphtheria. Excluding the 32 cases remaining in the hospital at the end of the year, 192 completed cases of Diphtheria were treated during the year 1925, and of this number six died. This equals a case mortality of 3.12 per cent. as compared with a rate of 3.57 per cent. in the year 1924. Of the six patients who died, one was suffering from the hæmorrhagic type of the disease, one was a cretin, one died within 12 hours of admission, in one the disease was complicated by Measles and Whooping Cough, whilst the remaining two children had been ill for several days prior to admission, and antitoxic serum treatment was carried out too late to prove successful. Included in the total number of patients admitted are 17 cases in which the disease was of the laryngeal type. The chief complications which occurred in the 257 cases under treatment during the year were as follows :— Paralysis 10 Cervical Adenitis 13 Otorrhoea 7 Broncho-pneumonia 4 Myocarditis 6 47 In some instances patients were admitted who were suffering from some other1 disease in addition to Diphtheria, and the following table gives particulars of these :— Whooping Cough 5 Cretinism 1 Chorea 2 Scarlet Fever 6 Pulmonary Tuberculosis 1 Measles 4 Scabies 1 Impetigo 9 2,576,000 units of antitoxin were administered to the patients under treatment during the year, the average dosage per head being 13,000 units. Other Diseases. Of the four cases of Measles three were notified as Scarlet Fever, and one as Diphtheria, and with the exception of the one fatal case which was complicated by Broncho-pneumonia and Laryngitis, all made an uneventful recovery. Four children notified and admitted for Diphtheria were diagnosed on admission as cases of Parotitis, Influenza, Tonsillitis and Broncho-pneumonia respectively; the latter was a very severe case and died within 12 hours of admission to hospital. The fatal case of Erysipelas was complicated by Lobar Pneumonia and Septicaemia. Three of the four cases of Enteric Fever presented no serious complications: the patient who died of this disease had been ill for three weeks and was suffering from severe hæmorrhage on admission to hospital. Laboratory Work. One hundred and eighty-four Bacteriological examinations of "swabs" for the identification of the diphtheria bacillus were carried out at the hospital. Conclusion. The result of the year's work at the hospital is very satisfactory and, although it is ever our keen desire to eliminate the 48 occurrence of fatal terminations, in patients suffering from the acute infectious diseases, this ideal can only be reached with the full co-operation of the general practitioners and the parents. Too often are children admitted who have been suffering from diphtheria for several days, when the hope of success from antitoxic serum treatment is greatly lessened; many of the cases of severe and septic scarlet fever might! be prevented, or at least modified, by timely attention to chronic disease of the nose and throat. However, bearing in mind the very far from ideal conditions under which the treatment is carried out—the need for a properly planned and excuted partial re-erection and extension of the hospital is pressing and should be taken in hand as soon as the general economic circumstances make it possible—the Local Authority may be justly proud that the mortality rate for the acute infectious diseases in East Ham is so far below the average. It is gratifying to be able to report that only four members of the staff suffered from acute infectious disease contracted during the course of their duties; one case of Scarlet Fever, two of Diphtheria, and one of Measles occurred, and all made a very satisfactory recovery. In conclusion I wish to express my great appreciation and thanks to the Matron, whose efficient management and guidance have done so much towards the promotion of a successful year's work, and to the Home Sister, Night Sister, and Ward Sisters for their untiring devotion to duty, which has gone so far in ensuring such satisfactory results. COUNTY BOROUGH OF EAST HAM. Report ON THE WORK AT THE Maternity & Child Welfare Centre FOR THE YEAR 1925. 50 MATERNITY AND CHILD WELFARE CENTRE REPORT. The work of the Maternity and Child Welfare Centre is carried on under the provisions of the Maternity and Child Welfare Act, 1918. There were two changes on the staff during the Dorothy M. Gowers resigned in May, and Dr. ???mson assumed duty in June. Miss Cubberley, one or the Health Visitors, left the staff in the early Summer, and Miss Redcliffe was appointed to fill the vacancy. The continuing vacancy on the staff of Health Visitors, referred to in previous reports, has not yet been dealt with ; and consequently the visiting of children at the ages between two and five years has not been so systematic as one would desire. The present staff consists of the Assistant Medical Officer in charge, five Health Visitors, and a Clerk. Infant Welfare Clinics. Clinics are held as follows :— White House, Plashet Grove, on Monday, Wednesday, Thursday and Friday, at 2 p.m. St. John's Church Hall, North Woolwich, on Tuesday, at 2.30 p.m. Wesleyan Church Hall, Manor Park, on Tuesday, at 2 p.m. There is urgent need of another Clinic near the south-west boundary of the Borough, as the distances to the present Clinics are far too great for many mothers in that area. Unfortunately at four of the Clinics the Medical Officer is only in attendance at alternate sessions. This is on account of the fact that the Medical Officer is also Assistant Tuberculosis Officer, and because two of the Clinics are held on the same day. Attendances at Infant Welfare Clinics, 1925. Number of Clinics held during the year 300 Number of individual children who attended the Clinics 2,477 Total number of attendances 13,347 white house maternity and child welfare centre. 51 Individual advice on matters of feeding, clothing and hygiene is given to all the mothers. A large proportion of infants attending the Clinics are cases of difficulty in reference to feeding, etc. Diseases and Minor Ailments, as shown in the following lists, were discovered at the Clinics. Simple conditions were dealt with by the Clinic Staff. Cases of more serious illness were referred to parents' own private doctors or to special Hospitals. Skin. Urticaria 45 Impetigo 24 Ringworm, Scalp 4 Ringworm, Body 3 Septic Sores 27 Other diseases (including Seborrhoea) 53 Eye Blepharitis 5 Conjunctivitis 3 Squint 26 Inflammation of Eye 23 Ptosis 1 Ear. Otorrhœa 24 Deafness 1 Enlarged Tonsils or Adenoids or both 49 Enlarged Cervical Glands. Non-Tuberculous 33 Tuberculous 3 Thrush. 22 Heart and Circulation. Organic Disease 4 Anaemia 27 Lung. Bronchitis 58 Tuberculosis 1 Other Respiratory Diseases 12 52 Intestinal. Diarrhœa 88 Marked Constipation 15 Jaundice 1 Worms 42 Rickets. Definite 34 Slight 27 Miscellaneous. Requiring Circumcision 103 Fits 7 Umbilical Hernia 43 Moist Umbilicus 14 Congenital Malformation 5 Hydrocele 5 Paralysis following birth injury 1 Burns 1 Greenstick Fracture 1 Enuresis 5 Infectious Diseases. Mumps 2 German Measles 1 Whooping Cough 16 (The above Table includes cases seen in the mornings.) Ringworm Cases. Four cases of Ringworm of the scalp were treated in the School X-Ray Department. Tonsils and Adenoids Cases. Five cases of enlarged Tonsils and Adenoids in children under five years of age were successfully operated upon at St. Mary's Hospital, Plaistow, at the cost of the Council. Dental Treatment, The School Dentist has continued to devote Wednesday afternoons to the treatment of infants, young children and nursing and expectant mothers, referred from the Maternity and Child Welfare Clinics. This is a very valuable adjunct to the work of the Clinics. 53 Mr. Neame supplies the following Table showing the work done during 1925:— No, of Days devoted to Treatment No. of Attendances No. of Permanent Teeth No. of Temporary Teeth Total Extracted Total Filled No. of Anaesthetics given No. of other Operations Adults Children Extrac ted Filled Extrac ted Filled Permanent Temporary 41 178 229 227 35 214 102 441 137 79 65 31 Morning Clinics. Special cases are seen at the White House Centre in the morning by appointment from the Clinics or in the course of home visiting by the Health Visitors, e.g., infants whose conditions require careful investigation by means of test feeds, children suffering from skin or other infective conditions who cannot suitably attend at the ordinary Clinics, and whose mothers require advice regarding feeding, etc., and other similar cases. It has been proved to many mothers by these test feeds that they are able to continue to feed the baby on the breast only—a fact which has an enormous psychological effect on the supply of milk and on the present and future health of the child. Number of cases seen in the morning 1,556 Health Visiting. Visiting in the homes of infants and children under school age is the most important work of the Health Visitors, as so many of the mothers cannot, and in many cases will not, bring their babies to the Clinics. Infants are visited as soon after the fourteenth day as possible, and the mothers are helped in the many difficulties which arise in connection with the hygiene and feeding of infants and young children. Other visits include those to expectant mothers, to cases of Ophthalmia Neonatorum and other special visits. The visits of the Health Visitors are spread over the cases as evenly as possible, but necessarily a larger number of visits are made to premature and delicate infants than to healthy children, 54 Births during 1925. Total number of births registered (including transfers) 2,553 Total number of still-births 69 Total number of un-notified births 152 Particulars of Visits made by Health Visitors. Visits to infants under 1 year of age 7,035 Visits to children over 1 year of age 3,489 Visits to Ante-Natal cases 114 Re-visits to Ante-Natal cases 65 Ophthalmia Neonatorum visits 6 Re-visits to Ophthalmia Neonatorum cases 8 Special visits 192 Total number of visits 10,927 1,169 more visits were made by the Health Visitors during 1925 than in the previous year. Ante-Natal Clinic. An Ante-Natal Clinic is held every Friday morning at the White House, and at this Clinic expectant mothers are advised in matters relating to their health, primarily in regard to conditions directly associated with pregnancy. The aim is to prevent or remove avoidable discomfort in the later months of pregnancy, and to render the confinement itself safer to both mother and child. Mothers from East Ham under the care of the nurses at the Maternity and District Nurses' Home, Plaistow, or any of its branches, or at Queen Mary's Hospital, Stratford, attend the Ante-Natal Clinics of their own hospitals. No cases attending private doctors are examined at the Clinic, unless such patients bring a letter from their doctors requesting examination. The Health Visitors follow up the cases requiring Ante-Natal supervision, where necessary. Number of cases attending the Clinic:— First visits 152 Subsequent visits 83 Number of Ante-Natal visits made by Health Visitors :— First visits 114 Subsequent visits 65 55 Maternity Accommodation. There being; thus far no Maternity Home under the direct control of the Borough Council of East Ham, arrangements are made for the accommodation of necessitous cases requiring inpatient treatment at the cost of the Council at Queen Mary's Hospital, Stratford, and at the Maternity and District Nurses' Home, Plaistow, upon the written recommendation of the Medical Officer. During 1925 seven cases were sent into the former Hospital, and one into the latter. Infant Mortality and Deaths of Children under 5 years. The following Table shows the causes of deaths during 1925 at the different periods of infant life:— Legitimate. Illegitimate. Number of deaths under 1 year M. 72 2 F. 59 2 Causes of Death. Sex. 0 1 1—2 2—5 All Causes M. 74 16 21 F. 61 10 21 Measles M. — — — F. — 1 Scarlet Fever M. :— — 2 F. — 1 Whooping Cough M. 5 2 3 F. 6 4 S Diphtheria M. — — 1 F. — — 5 Influenza. M. — 1 — F, — — 1 Encephalitis Lethargica M. — — 1 F Tuberculosis of Respiratory System M — 1 1 F. — — — Other Tuberculous Diseases M, — 3 5 F. 1 — 2 Bronchitis M. 3 1 — F. 1 — 1 Pneumonia (all forms) M. 13 3 2 F. 9 5 3 Diarrhoea, &c. M. 9 — — F. 4 — Congenital debility and malformation, premature birth M. 35 1 — F. 36 — — Deaths from violence M. 1 1 2 F. 1 — 1 Other defined diseases M. 8 3 4 F. 3 1 3 56 It is encouraging to note that the Infant Mortality continues to decrease. COMPARATIVE INFANT MORTALITY RATE. Birth-rate per 1,000 total population. Rate per 1,000 Births. Diarrhoea and Enteritis (under 2 yrs.) Total deaths under 1 year England and Wales 18.3 8.4 75 105 County Boroughs and Great Towns (including London) 18.8 10.8 79 157 Smaller Towns (1921 adjus-ted populations, 20,000—50,000) 18.3 7.6 74 London ... 18.0 10.6 67 EAST HAM 17.3 5.1 53 In 1924 the infant mortality rate was 54. The birth-rate was 18.3, and the lower birth-rate in East Ham in 1925 may have a direct bearing on the lowered death-rate. Of the 135 infant deaths under the age of one year, 63 occurred in the first fourteen days of life—the period before the first visit of the Health Visitor. Of the 203 children who died in East Ham under five years of age, only 24 had attended the Clinics, and of the 24 nine attended once only. Infectious Diseases. Infants suffering from certain infectious diseases are treated in the Borough Hospital. Twenty-three deaths occurred from Whooping Cough. Unfortunately many cases of this disease and of Measles, both of which are very serious factors in the mortality rate among very young children, have to be nursed in their own homes. 57 Ophthalmia Neonatorum. Five cases were notified as follows :— Notified. Treated. Vision Impaired. Vision Impaired. Total Blindness. At Home. At Hospital. 1 1 1 2 1 1 — 3 — 1 1 — i - 1 1 — 5 — 1 — 1 — No deaths occurred as a result of Ophthalmia Neonatorum. Careful enquiry is made regarding all cases of Ophthalmia Neonatorum, and, so far as is desirable, such cases are kept under the observation of the Health Visitors. Voluntary Associations. The Invalid Children's Aid Association has rendered invaluable help to the work of the Centre by arranging for holidays in the country for delicate children referred from the Clinics. Mid wives Acts, 1902 and 1918. The Assistant Medical Officer of the Maternity and Child Welfare Centre is also Inspector of Midwives under the Borough Council, in this capacity maintaining a general supervision over the work of all Midwives practising in East Ham. Forty-one Midwives notified their intention to practise in the Borough during 1925. Of these, 26 worked in connection with the Maternity Charity and District Nurses' Home, Plaistow, and its branches, and four with the Sir Henry Tate Nurses' Home at Silvertown. Eleven practised independently. Twenty-one visits of inspection were made, and conditions on the whole were satisfactory. 58 Medical Help was sent for in 160 cases, as follows :— For the Mothers— Ruptured perineum Prolonged labour Retained Placenta Ante-partum Haemorrhage Post-partum Haemorrhage Temperature Inflamed breasts Malpresentations Other causes For the Infants— Dangerous feebleness Deformities Discharging eyes Pemphigus Jaundice ... Other causes 41 23 8 1 2 8 2 17 7 27 3 8 1 2 10 Puerperal Fever Cases. Five cases of Puerperal Fever were notified during the year. 3 cases occurred in Hospital practice. 2 cases occurred in private practice. 2 of the Hospital cases died. Maternal Deaths. The following causes of death were registered in connection with parturition :— Puerperal Septicaemia Protracted Labour Abortion Pulmonary Embolism Puerperal Haemorrhage 2 2 2 1 1 Such investigation as is possible is made into the circumstances of all cases of death during parturition and all still-births. Free Milk. Under the Council's Scheme £1,100 worth of free milk was given to expectant and nursing mothers and young children. Careful investigation is made into the family circumstances, so as to secure that only necessitous cases shall receive this benefit. 59 Co-ordination of the Maternity and Child Welfare Work with other Public Health Services in the Borough. There is very considerable co-ordination between the Maternity and Child Welfare work of the- Borough and the other Departments of the Public Health Service. The records of children on reaching the age of five years are sent to the School Medical Department for information regarding entrants to school life. The services of the School Dentist are at the disposal of expectant and nursing mothers and young children whenever required by the Assistant Medical Officer of the Maternity and Child Welfare Department. Cases of Ringworm of the Scalp occurring in children under school age are referred to the School X-Ray Department. Cases of Tuberculosis discovered at the Maternity and Child Welfare Centres are at once referred to the Tuberculosis Officer. The treatment of Tonsils and Adenoids is carried out under the same arrangement existing for purposes of the School Medical Services. The use of the Public Ambulance is granted, when required, to convey expectant mothers to maternity wards of hospitals. Financial investigations into the circumstances of parents applying for grants of milk, etc., are referred to the financial officer. Premises found in an insanitary condition by Health Visitors in connection with their routine work are reported to the Chief Sanitary Inspector for further investigation and such action as he may find desirable. 60 VENEREAL DISEASES. Summary of work done by the Hospitals during the Year 1925. London Middlesex Essex Surrey Kent Herts. Bucks. E. Ham W. Ham Croydon Total Other Places Grand Total New Patients:— Syphilis 4,284 375 216 152 143 56 31 44 120 33 5,454 448 5,902 Soft Chancre 109 9 8 11 3 2 — 5 5 — 212 67 279 Gonorrhoea 8,60.5 677 336 294 203 82 34 86 198 35 10,550 771 11,312 Not Venerea 6,508 638 339 245 152 65 35 97 238 70 8,387 293 8,680 Total 19,566 1,699 899 702 501 205 100 232 561 138 24,603 1,579 26,182 Total Attendances 539,353 33,633 15,143 15,144 7,933 3,167 1,303 4,314 10,089 2,648 632,677 13,454 646,131 No. of " In-patient" days 65,902 3,342 2,819 1,471 3,349 1,589 1,155 385 1,227 90 81,335 21,119 102,454 Salvarsan Substitutes, doses given 38,149 3,575 1,738 1,621 1,010 471 215 318 921 319 48,237 2,459 50,696 Pathological Ex aminatio ns. For or at Centre:— Spirochaetes 1,153 50 6 34 1 8 5 5 4 2 1,268 62 1,330 Gonococci 48,923 2,034 1,070 1,297 1,037 347 178 437 910 317 57,150 1,652 58,802 Wassermann 25,014 1,597 930 960 585 304 125 207 495 209 30,426 1,177 31,603 Others 11,918 572 237 801 236 90 71 32 39 114 14,110 219 14,329 Total 87,008 4,253 2,843 3,092 1,859 749 379 681 1,448 642 102,954 3,110 106,064 For Practitioners :— Spirochaetes 20 2 8 — — 30 30 Gonococci 2,386 251 140 453 35 6 4 30 15 602 3,922 5 3,927 Wassermann 15,636 2,011 955 571 101 49 100 172 480 465 20,540 170 20,710 Others 1,416 47 22 132 18 7 3 1 2 2 1,650 29 1,679 Total 19,458 2,311 1,117 1,164 154 62 107 203 497 1,069 26,142 204 26,346 61 TOTAL CASES NOTIFIED DURING 1925. 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 3 15 15 34 91 34 15 10 3 ... ... 221 196 4 Diphtheria 1 11 15 16 30 118 31 7 14 1 1 1 246 232 12 Enteric Fever (Typhoid & Paratyphoid) ... ... ... 1 ... 1 1 1 2 1 2 ... 9 8 2 Erysipelas ... ... ... ... ... 1 1 2 6 4 20 7 41 10 3 Puerperal Fever ... ... ... ... ... ... ... ... 4 1 ... ... 5 3 2 Cerebro-Spinal Meningitis ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Ophthalmia Neonatorum 5 ... ... ... ... ... ... ... ... ... ... ... 5 3 ... Pneumonia 3 7 5 4 6 6 2 9 15 13 13 8 91 27 114 Encephalitis Lethargica. ... ... ... 1 ... ... 1 2 1 1 ... ... 6 3 3 Malaria ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 1 Acute Poliomyelitis ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Total 10 21 35 37 70 219 70 37 52 24 36 10 627 485 141 (a) Pulmonary M ... ... ... 1 3 9 3 13 49 25 33 2 138 168 80 F ... ... ... ... 1 6 1 20 60 17 11 ... 116 98 52 Total ... ... ... 1 4 15 4 33 109 42 44 2 254 266 132 (b) Non-Pulmonary M ... 1 2 3 4 8 8 4 6 1 1 1 39 29 16 f 1 1 1 1 1 4 8 3 3 2 ... ... 25 18 9 Total 1 2 3 4 5 12 16 7 9 3 1 1 64 47 25 * The five cases of Ophthalmia Neonatorum were visited and in one case theie was partial loss of vision in one eye. Notification of Tuberculosis is not completely satisfactory inasmuch that cases are frequently un-notified until the disease is we'll 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 6. 62 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN EAST HAM, 1925. CAUSES OF DEATH. Net Deaths at the subjoined ages of "Residents" whether occurring within or without the Borough. Sex. All agrs. 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 upwards. All Causes M 796 74 16 21 18 42 108 247 169 101 F 704 61 10 21 19 29 84 165 137 178 1. Enteric Fever M 1 ... ... ... ... ... 1 ... ... ... F 1 ... ... ... ... ... 1 ... ... ... 2. Small-pox M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 3. Measles M ... ... ... ... ... ... ... ... ... ... F 2 ... ... 1 1 ... ... ... ... ... 4. Scarlet Fever M 2 ... ... 2 ... ... ... ... ... ... F 2 ... ... 1 1 ... ... ... ... ... 5. Whooping Cough M 10 5 2 3 ... ... ... ... ... ... F 13 6 4 3 ... ... ... ... ... ... 6. Diphtheria M 4 ... ... 1 2 ... 1 ... ... ... F 8 ... ... 5 2 ... 1 ... ... ... 7 Influenza M 14 ... 1 ... 1 2 2 5 3 ... F 16 ... ... 1 1 ... 3 4 4 3 8. Encephalitis Lethargica M 2 ... ... 1 1 ... ... ... ... ... F 1 ... ... ... ... ... ... 1 ... ... 9. Meningococcal Meningitis M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 10. Tuberculosis of Respiratory System M 80 ... 1 1 ... 14 33 28 2 1 F 52 ... ... ... ... 16 22 12 2 ... 11. Other Tuberculous Diseases M 16 ... 3 5 2 2 3 ... 1 ... F 9 1 ... 2 1 1 2 2 ... ... 12. Cancer, Malignant Disease M 102 ... ... ... ... ... 6 55 28 13 F 98 ... ... ... ... 1 10 38 29 20 13. Rheumatic Fever M 3 ... ... ... 1 1 1 ... ... ... F 8 ... ... ... 5 1 ... l 1 ... 14. Diabetes M 8 ... ... ... ... 1 2 2 1 2 F 8 ... ... ... ... ... 1 3 3 1 15. Cerebral Haemorrhage, &c. M 28 ... ... ... ... ... 2 9 10 1 F 43 ... ... ... ... ... 2 15 10 16 16. Heart Disease M 104 ... ... ... 4 3 12 30 37 18 F 105 ... ... ... ... 2 11 24 32 34 17. Arterio-sclerosis M 13 ... ... ... ... ... ... 7 5 1 F 18 ... ... ... ... ... ... 2 5 11 18. Bronchitis M 74 3 1 ... ... ... 3 19 20 28 F 65 1 ... 1 ... ... ... 11 11 41 19- Pneumonia (all forms) M 64 13 3 2 1 2 7 20 9 7 F 50 9 5 3 1 ... 3 11 8 01 20. Other Respiratory Diseases M 10 ... ... ... ... ... 1 5 3 1 F 8 ... ... ... 1 ... 1 2 3 1 21. Ulcer of Stomach or Duodenum M 13 ... ... ... ... 1 2 9 1 ... F 3 ... ... ... ... ... ... 2 1 ... 22. Diarrhoea, &c. M 10 9 ... ... ... ... ... 1 ... ... F 6 4 ... ... ... ... ... 1 ... 1 23. Appendicitis and Typhlitis M 3 ... ... ... ... ... 2 ... 1 ... F 3 ... ... ... ... 1 2 ... ... ... 24. Cirrhosis of Liver M 2 ... ... ... ... ... ... 2 ... ... F 3 ... ... ... ... ... 1 1 ... 1 25. Acute and chronic nephritis M 29 ... ... ... 1 1 2 10 12 3 F 23 ... ... ... 1 ... 3 11 6 2 26. Puerperal Sepsis M ... ... ... ... ... ... ... ... ... ... F 2 ... ... ... ... ... 2 ... ... ... 27. Other Accidents and Diseases of Pregnancy and ??? M ... ... ... ... ... ... ... ... ... ... F 6 ... ... ... ... ... 6 ... ... ... 28. Congenital debility and malform ation, premature birth M 36 35 1 ... ... ... ... ... ... ... F 37 36 ... ... ... ... ... 1 ... ... 29. Suicide M 11 ... ... ... ... ... 4 5 ... ... F 2 ... ... ... ... ... ... 1 1 ... 30. Other deaths from violence M 35 1 1 2 2 8 9 8 4 ... F 11 1 ... 1 ... ... 3 3 1 2 31. Other defined diseases M 121 8 3 4 3 5 14 32 32 20 F 100 3 1 3 3 7 10 19 19 35 32. Causes ill-defined or unknown M 1 ... ... ... ... ... 1 ... ... ... F 1 ... ... ... ... ... ... ... 1 ... 63 METEOROLOGICAL RECORD—YEAR 1925. 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 56° 24° 48°.6 38°.4 42°.5 13 1.69 0.13 0.65 1st February 54° 27° 47°.7 39°.8 43°.7 15 2.53 0.17 0.46 25th March 54° 25° 47°.7 34°.1 44°.2 13 0.67 0.05 0.10 13th&22nd April 62° 28° 54°.6 38°.6 46°.6 13 1.61 0.12 0.29 28th May 81° 36° 64°.2 45°.8 55°.0 14 1.28 0.08 0.34 22nd June 86° 43° 71°.0 50°.0 60°.5 1 0.13 0.13 0.13 24th July 87° 49° 74°.0 54°.7 64°.3 13 3.96 0.30 1.73 22nd August 81° 44° 69°.7 53°.6 61°.7 14 2.87 0.20 0.50 23rd September 68° 37° 62°.2 47°.3 54°.7 16 1.86 0.12 0.35 20th October 70° 36° 59°.9 45°.7 52°.8 13 3.13 0.24 0.88 22nd November 61° 27° 46°.3 36°.3 41°.3 14 1.35 0.09 0.30 2nd December 57° 22° 43°.6 34°.3 38°.9 16 2.56 0.16 0.65 30th Means and Totals for the Year. 87° 22° 57°.3 43°.2 50°.5 155 23.64 0.15 1.73 July 22nd The Rainfall for the Year was 5.86 ins. below, and the number of days on which rain fell 16 below the year 1924, at East Ham. COUNTY BOROUGH OF EAST HAM EDUCATION COMMITTEE. Hnnual IReport or THE School Medical Officer FOR THE YEAR 1925. 66 EAST HAM EDUCATION COMMITTEE Alderman P. P. Cross (Chairman). Alderman W. G. Davie, J.P. (Vice-Chairman). Alderman N. A. Papworth, J.P. (Mayor). Councillor E. Shanahan (Deputy Mayor). *Miss A. Pockney. Alderman G. P. Dean, J.P. Alderman H. Osborn, J.P. Councillor (Mrs.) E. J. Jacobs Councillor (Mrs.) M. Ridler. Councillor W. W. Bagot. Councillor G. W. Boultwood. Councillor P. Y. Gerrard. Councillor H. B. Harper. Councillor T. J. Hawkins. Councillor H. J. Kybert. Councillor T. I. Lethaby. Councillor G. H. Manser. Councillor J. Milton. Councillor R. W. Moger. Councillor W. T. Newling. Councillor M. Oakes, J.P. Councillor A. H. W. Owen. Councillor J. J. Pope. Councillor A. Rhodes. Councillor H. N. Ridler. Councillor E. H. Thompson. Councillor H. R. Wing. †E. T. Andrews, Esq., B. A. Dr. D. W. Grice, D.Sc. E. J. Sullivan, Esq. R. Whitfield, Esq. *Resigned July, 1925. † Appointed October, 1925. School Nurses. Mrs. Nears, S.R.N., Miss Kekwick, S.R.N., A.R.San.I., Mrs. Sorrel, S.R.N., A.R.San.I., Miss Case, R.F.N., A.R.San.I., Mrs. Childs, S.R.N., A.R.San.J.., Certified Midwife, Miss Olifent, R.F.N., Miss Mai.tby, R.R.C., and Miss Young, S.R.N., Certified Midwife. Clerical Staff. F Bead, 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. Gimblett, M.D., M.R.C.P., F.R.C.S. ( Two sessions per week.) Aural Surgeon: Gilbkht C. Chubb, F.R.C.S..Eng., D.Sc., Etc. (One session per week.) .lasufant Medical Officers: Miss M. M. Thomson, L.R.C.P., L.R.C.S.. D.P.H. (full lime). (Temporary), T. P. Evans, M.R.C.S.. L.R.C.P., to August 28th, 1925. (Temporary), T. J. Clayton, M.R.C.S., L.R.C.P., from September 28th, 1925. Deputy and Senior Assistant Medical Officer. F. E. Beniux, M.R.C.S., L.R.C.P., L.D.S. Medical Officer: W. Bbnton, M.R.C.S.. L.R.C.P., D.P.H. 67 County Borough of East Ham Education Committee. TO THE CHAIRMAN AND MEMBERS OF THE EDUCATION COMMITTEE. Ladies and Gentlemen,— I have the honour to present my Annual Report upon the work of the School Medical Service of the County Borough of East Ham for the year ended 31st December, 1925. The number of routine and special cases examined of elementary school children totalled 13,201, as compared with 9,467 in 1924, and a complete medical inspection of all children in the Secondary School has also been carried out. These inspections have revealed the fact that the general physical condition of the scholars exhibits a very apparent improvement (see Table, under 5, p. 71). This is the result of the marked progress and development, not only in connection with the School Medical Service, but also in the direction of general preventive medicine and hygiene, which have been so evident in recent years. The keen interest of the members of the Local Authority in all matters relating to the maintenance of health, and an increase in physical fitness has been largely responsible for the achievement of such encouraging results. I should like to take this opportunity of expressing my appreciation of the work carried out by the local branch of the Invalid Children's Aid Association, whereby, apart from the 31 children who have been sent to Schools of Recovery by arrangement with the Local Authority, 97 children have received open-air and convalescent treatment. I also wish to express my thanks to the teachers for their great help and courtesy, the whole of my staff for the excellent work carried out, and to Mr. Thompson and his staff for their co-operation. 68 In conclusion, I respectfully beg to express my indebtedness to the Chairman and Members of the Local Education Authority for the interest, assistance, and earnest consideration they have given to the work of the School Medical Service, and to the many suggestions and recommendations which I have placed before them from time to time. I have the honour to be, Ladies and Gentlemen, Your obedient servant, W. BENTON, School Medical Officer. 69 1. STAFF. A list of the Staff of the School Medical Department will be found on page 66 of this Report. 2. CO-OHDINATION. The scheme for the co-ordination of the various health services of the County Borough was fully discussed in my report for the year 1923, and there is no doubt that the scheme has achieved a great deal towards ensuring co-ordination in the work of disease prevention. At the present time, however, there is need for the extension and elaboration of the resources at our disposal for maintaining a healthy child population. The importance of concentrating more attention upon children of pre-school age requires little comment, and a great deal remains to be done in this direction. The work of the School Medical Service has established the necessity not only for health education but also for seeking out physical defect at its inception. Unfortunately the scope of the Maternity and Child Welfare Centre is confined, and, whilst maternal and infant care has resulted in a decided diminution in the infant mortality rate, there is no doubt that physical defect in our future citizens could be prevented by adopting a more complete system of medical examination and nursing supervision of children during the period from infancy to school age. A very large number of school entrants are found with long standing defects, e.g., strabismus, chronic blepharitis, conjunctivitis, keratitis, ulceration of the cornea, chronic inflammation of the tonsils with the presence of adenoids, chronic adenitis, chronic otitis media, anaemia, malnutrition, debility, crippling due to infantile paralysis, etc. These potential scholars are of immediate interest to the Local Education Authority, and the question of bringing the work of the School Medical Service and of the Maternity and Child Welfare Centre into closer association is receiving careful consideration. If the deliberations of the Committee result in arrangements being made for the early ascertainment of defects in children under school age, and for their treatment at the existing Clinics of the Local Education Authority (Ophthalmic Clinic, Aural Clinic, Orthopaedic Centre, etc.), a very definite advance will have been accomplished. 70 3. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene. During the year 1925, 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. 4. MEDICAL INSPECTION. The following is a synopsis of School Medical Work for the year 1925.The figures for the year 1924 are also given for comparison:— COMPARATIVE STATEMENT OF WORK. 1924. 1925. Routine and Special Inspection (on School Premises) 7,284 10,728 Reinspections 3,951 3,784 Consultations at Inspection Clinic 13,080 13,445 Number of Treatments, at Clinic 18,319 18,665 General Cleanliness Visits to Schools 291 335 Nurses' Visits to Homes 3,541 3,840 Children Examined for Cleanliness 57,936 58,090 (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. In addition, provision was made for the re-inspection in the seven schools which had not been visited for this purpose during the year 1924, and for the Medical Inspection of all children in the Secondary School. I regret that the work for the year 1925 has suffered somewhat owing to an unavoidable shortage of staff during the month of September. The regrettable illness of Dr. G. W. Cheater, Temporary Tuberculosis Officer, which has unfortunately resulted if 71 prolonged leave of absence, necessitated the transfer of Dr. T. P. Evans (on August 28th, 1925) to perform the duties, and it was not until September 28th, 1925, that a suitable candidate was available to carry out the temporary appointment of Assistant School Medical Officer. The effect shows itself in the fact that medical inspection has not been carried out in one school, and reinspection of children found to be defective has not been completed in fifteen schools. This work must be dealt with early in the year 1926, and this entails a commencement of the year's activities with a debit balance of work. (b) 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. The percentage of children found to require treatment, as the result of Routine Medical Inspection in the Code Groups, shows an appreciable reduction over that for the year 1924. Group Number of Children Percentage of Children found to require treatment Inspected Found to require treatment 1924 1925 1924 1925 1924 1925 Entrants 1,171 2,960 187 340 15.97 11.5 Intermediates 2,172 2,961 384 445 17.68 150 Leavers 3,116 3,118 385 370 12.36 11.9 Total 6,459 9,039 956 1,155 14.8 12.8 72 (a) Uncleanliness. The School Nurses have carried out 3 cleanliness surveys of all the children in the elementary schools during the year. During the year the School Nurses made 58,090 examinations, as compared with 57,936 in 1924. Of this number 23 children were found who harboured body vermin (31 in 1924), 652 children showed vermin and many nits in the hair (826 in 1924), whilst 2,856 children showed only a few nits (2,648 in 1924). Comparative table:— Year Number Examined Number with Nits Number with Head Vermin Number with Body Vermin No. of Exclusion 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 1924 57,936 2,648 826 31 80 1925 58,090 2,856 652 23 45 73 TABLE VII. TABLE OF VERMINOUS CONDITIONS FOUND AT EXAMINATIONS FOR GENERAL CLEANLINESS. SCHOOLS Dept. Number Exam'd. Few Nits. Many Nits and Vermin. Body and Clothing Verminous. SCHOOLS. Dept. Number Exam'd. Few Nits. Many Nits and Vermin. Body and Clothing Verminous. Brampton Road Girls 663 6 2 ... Plashet Lane Girls 1371 59 10 ... Boys 732 12 3 ... Boys 1385 24 10 4 Jr. Mixed 629 7 5 ... Infants 984 40 31 1 Infants 492 23 7 ... Storey Street Mixed 826 30 15 1 Castle Street R.C. Mixed 473 20 1 ... Infants 769 40 22 3 Infants 283 9 ... ... Silvertown R.C. Mixed 835 37 52 ... Central Park Road Girls 1371 41 23 ... Infants 572 61 31 ... Boys 1344 7 1 ... St. Winefride's R.C. Mixed 81C 84 20 1 Infants 1254 34 14 ... Sandringham Road Mixed 1264 32 7 ... Dersingham Avenue Mixed 724 66 24 ... Infants 1442 38 3 ... Essex Road Girls 1139 100 9 ... Shaftesbury Road Girls 1472 125 2 ... Boys 1138 13 12 ... Boys 1425 8 ... ... Infants 959 49 16 2 Infants 1290 83 6 ... Fourth Avenue Girls 1022 92 13 ... "Salisbury" Inter. 940 58 9 ... Boys 961 48 1 ... Primary 1147 60 35 ... Infants 761 24 9 ... Shrewsbury Road Special 119 23 ... ... Hartley Avenue Girls 961 68 3 ... Vicarage Lane Girls 1127 100 22 1 Boys 1074 12 2 ... Boys 981 40 10 ... Infants 1130 59 5 ... Infants 1052 89 18 ... High Street S. Mixed 851 48 7 ... Walton Road Girls 1428 155 22 3 J. Mixed 702 68 18 1 Boys 1347 21 19 ... Kensington Avenue Girls 1122 36 5 ... Infants 1170 74 33 4 Boys 1166 9 1 ... " Winsor " Inter 813 29 ... ... Infants 817 24 3 ... Primary 1130 70 6 ... Lathom Road Girls 1365 75 4 ... ... Boys 1314 14 1 i ... Total 58090 2856 652 23 Infants 1103 50 4 ... Monega Road Girls 987 53 3 1 Boys 1234 ... ... ... Per cent. 4.9 1.1 .04 Infants 1129 30 4 1 Napier Road Girls 1185 117 24 ... Per cent. in 1924 4.57 1.42 05 Boys 1174 60 16 ... Infants 1132 196 29 ... 74 It will be noted that there is again a reduction in the percentage of children suffering from verminous conditions, but unfortunately there is an increase in the percentage of cases showing the presence of nits, and, as pointed out in my report for the year 1924, great credit is due to the School Nurses, whose untiring efforts have been entirely responsible for ensuring that the increased number of potential cases has resulted in a diminished incidence of active cases. (6) Minor Ailments. As has been the case in former years few minor ailments were discovered at routine medical inspection, owing- to the 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 1924 1925 1924 1925 Scabies 3 3 17 15 Impetigo 11 30 287 462 Conjunctivitis — 8 72 64 Blepharitis 9 7 59 50 Ear Disease 61 83 225 239 Ringworm (Scalp) 2 3 53 47 Ringworm (Body) 3 5 56 59 (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 3.95 per cent. in the year 1924. Of these, much enlarged tonsils accounted for 0.8 per cent. ; definite adenoids were present in 0.3 per cent., and the combined defect was diagnosed in 2.4 per cent.; the figures for 1924 were 0.5 per cent., 0.39 per cent., and 3.06 per cent. respectively. The percentage of children moderately affected and requiring to be kept under observation was 13.1, the corresponding percentage in 1924 being 9.83. In this case 10.8 per cent. had moderately enlarged tonsils, 0.9 per cent. exhibited signs of the presence 75 of adenoids, whilst 1.4 per cent, showed enlarged tonsils and adenoids of moderate degree, as compared with 8.56 per cent., 0.7 per cent., and 0.57 per cent., respectively in the year 1924. (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 12 7 19 Other forms of Tuberculosis 16 12 28 Totals ... 28 19 47 (e) Skin Disease. The number of these cases show very little change, except in regard to impetigo, the incidence of which has increased considerably. This increase has accompanied the occurrence of a larger number of cases of uncleanliness (see 5a, p. 72) and, our persistent campaign against infectious skin conditions has been continued assiduously, it is doubtful whether an appreciable reduction in the number of such cases is possible without the provision of a properly equipped clinic with facilities for bathing, shampooing, etc. (/) External Eye Disease. Cases of blepharitis and conjunctivitis show a numerical decrease, but in view of the serious defects which may arise from these conditions we cannot be satisfied with results which reveal an incidence of 129 such cases. (g) Vision. Only children with marked visual defect have been referred for treatment and these, including cases of strabismus, numbered 793. In addition there were 294 children in whom there was evidence of a lesser degree of visual defect and these are being kept under observation. (See also the report of the Ophthalmic Surgeon on page) 96). 76 (h) Ear Disease and Hearing. 1.3 per cent, of the children examined were found to be suffering from otitis media, as compared with 1.57 per cent, in 1924. The percentage of deaf children was 0.7, the corresponding number for last year being 1.09. (0 Dental Defects. The percentage of children exhibiting gross dental defect remains extremely high, and the fact that dental caries and oral sepsis play such a prominent part in the causation of other physical defects has prompted me on many occasions to advise and urge the Local Authority to adopt a more comprehensive scheme in connection with the School Dental Section. (See also report of Dental Surgeon on pp. 1100-103 and 8 (h), p. 81.) (j) Crippling Defects. Reference to Table III on p. 109 will furnish information with regard to the occurrence of crippling defects in the area. 54 cases of crippling due to tuberculosis and 127 cases due to other causes were discovered at routine medical inspection during the year. 8. INFECTIOUS DISEASES. A detailed account of the scheme adopted for the detection and prevention of infectious diseases was submitted in my reports for 1920 and 1923, and the accompanying table will furnish statistics in regard to the incidence of the acute infectious diseases during the year 1925. 7? Table of the Chief Infectious Diseases, Showing the Monthly Incidence in Children of School Age. Month Measles Chicken Pox Whooping Cough Mumps Scarlet Fever Diphtheria January 4 26 126 36 11 9 February - 13 39 73 9 2 March 7 19 24 155 7 11 April 48 5 19 79 12 8 May 44 75 29 90 5 6 June 12 40 19 59 7 21 July 42 35 6 30 11 23 August 22 1 2 1 8 11 September 7 13 13 9 14 3 October 21 79 4 10 12 17 November 25 69 — — 21 19 December 40 69 1 32 8 19 Totals 272 444 282 574 125 149 78 In addition to the acute infectious diseases, the following infectious conditions have occurred during the year : Nature of Complaint. Number Excluded. Number of Sessions involved. 1924 1925 1924 1925 Ringworm of Scalp 40 99 2229 3288 Ringworm of Body 63 45 634 571 Impetigo Contagiosa 106 81 848 695 Infective Eye Inflammation 145 79 2080 1361 Septic conditions 92 69 529 623 Verminous conditions 80 40 427 253 Scabies 20 34 379 416 Other Skin conditions 175 89 1370 1214 Acute Throat conditions 73 113 1038 1935 794 643 9554 10356 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 3,840 visits to the homes of children in whom defects were found at routine medical inspection. Of the 1,286 children referred for treatment 953, or 74.1 per cent., have obtained treatment. The corresponding percentage for the year 1924 was 76.33. The School Nurses have also paid 121 special visits to the Schools, and 22 visits to the Feeding Centres and have undertaken 32 journeys in connection with the admission and discharge of children to Institutions. In addition all children, referred for the operative treatment of tonsils and adenoids (319), have been visited by the School Nurses both prior to and after the operation. The work of following up forms a very important part of the many duties of the School Nurses, and the results obtained have been highly satisfactory seeing that the staff falls so far short of the estimated number for the school population (i.e., one School Nurse for every 2,000 children). 79 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, Fridays and Saturdays, 9 a.m. (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), North Woolwich—Mondays and Fridays at 2 p.m. (4) General Ear Clinic, Town Hall, Wednesdays at 2 p.m. (5) Eye Specialist Clinic, Town Hall, Thursdays at 9 a.m. Tuesdays at 9 a.m., and Fridays at 2 p.m. (6) Ear Specialist Clinic, Town Hall, Tuesdays at 3 p.rjv A full account of these clinics was set forth in my report for 1922. During the year 1925, 18,665 attendances were made for treatment at the various clinics, and there were 13,445 attendances for consultation of the Medical Officers. (a) Minor Ailments. An analysis of the chief minor ailments treated at the School Clinics, and otherwise, will be found in Table IV, Group 1. (b) Tonsils and Adenoids. In the case of children moderately affected and requiring to- be keipt under observation advice has been given as to general hygiene1, diet, the necessity for dental treatment and for breathing exercises, etc. Of the children referred for treatment 319 have received operative treatment with marked beneficial results to their general health. Arrangements for the performance of these operations are in force with two hospitals, viz., St. Mary's, Plaistow; and Balaam Street Children's Hospital. Arrangements have been made to :arry into effect the recommendation of the Board of Education in regard to the visitation of children after the operation. 80 (c) Tuberculosis. The arrangements for the treatment of Tuberculosis have been continued on the lines fully set forth in my reports for previous years. 0d) Skin Diseases. For the most part th^se are treated at the General Clinic, but some cases of chronic and of the rarer skin diseases are referred to hospital. The application of X-rays in cases of ringworm is performed at the School Clinic, and 38 children received this form of treatment during this year. (e) External Eye Disease. 224 cases (207 in 1924) 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. 96. (f) Vision. The number of cases of visual defect has continued high, but the decision of the Education Committee to hold the Ophthalmic Clinic on an additional session per week, should have the effect of eliminating a long waiting list of children requiring treatment. 793 cases were referred for treatment in respect of visual defect during the year 1925 and, including a large number of cases awaiting treatment at the termination of the year 1924, 963 cases have been treated in the past year. Unfortunately it has not been possible to give an opportunity of attending the Ophthalmic Clinic to the children with lesser degrees of visual defect. There were 294 such cases discovered during the year and it is hoped that these children will be dealt with as soon as the more urgent cases have been treated. (g) Ear Disease. 537 consultations were given and 399 children were treated at the General Ear Clinic. See report of Aural Surgeon, p. 94. 81 (h) Dental Defects. Unfortunately there are no new developments to report in connection with dental inspection and treatment. The character and amount of the work undertaken by Mr. Neame is extremely satisfactory but, as has been pointed out on many previous occasions, a scheme, which will embrace the whole of the children in the elementary schools, is the only efficient and economical means whereby dental disease and oral sepsis can be combated. The urgent necessity for improved Dental Clinic accommodation appears to be generally recognised and it is hoped that a new and up-to-date Clinic will be erected and equipped during the coming year. It is estimated that one Dental Surgeon can deal satisfactorily and efficiently with a school population of 5,000, that is to say, he should be able to give complete treatment to all cases found to require attention as the result of the dental inspection of 5,000 children, and subsequently to examine and treat all entrants and to re-inspect, and re-treat where necessary, at annual intervals, all the children previously dealt with. This is the only way to ensure freedom from oral sepsis and dental decay. I again respectfully advise the Committee to consider the necessity for extending their activities in endeavouring to ensure dental health and banish so many of those ills which originate in the mouth. To this end the appointment of at least one additional Dental Surgeon is a matter of extreme urgency. (<) Crippling Defects. Orthopedic treatment has been continued under arrangement made with the Balaam Street Children's Hospital of the Invalid and Cripple Children's Society. The treatment at the hospital includes operative, electrical and massage treatment, remedial exercises and the supply of surgical appliances, and is carried out under the direction of an orthoptedic surgeon. Hitherto the Hospital Authorities have undertaken this work voluntarily but, as mentioned in my report for the year 1924, towards the close of last year the Education Committee decided to make a contribution of £50 to the Hospital Authorities. 82 In July of this year the Committee resolved to seek approval from the Board of Education for the payment of a per capita grant contribution in respect of East Ham scholars sent to the Hospital through the School Medical Service. All children referred by the Authority's Medical Officers to the Hospital for treatment are kept under observation at frequent intervals at one or other of the School Clinics, in order that the progress of the cases may be watched and recorded, and to ensure that treatment has not been allowed to lapse. If at any time such a case fails to attend the School Clinic it automatically becomes included in the following up list of one of the School Nurses. A large amount of work has been undertaken at the Hospital and has been highly satisfactory. During the year 1925, 48 out-patients and 12 in-patients have received orthopaedic treatment. The total out-patients attendances was 1,670, whilst the average number of weeks involved in the case of each in-patient was 4.6. 9. OPEN-AIR EDUCATION. (а) Playground Classes. In a few cases playground classes continue to be held nccasionally. (б) School Camps. No School Camps were held during the year 1925. (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. 83 (e) Residential Open-Air Schools. There are no such schools under the direct control of the Local Education Authority; the Committee, however, have continued to send a certain number of children, for whom such treatment would be beneficial, to the Ogilvie School of Recovery at Clacton-on-Sea. Arrangements have also been made for the admission of children to the Russell Cotes School of Recovery at Parkestone, and to the Institutions of the Invalid Children's Aid Association. The accompanying table gives particulars in connection with these children. In addition, the Invalid Children's Aid Association have rendered assistance in 97 cases, financial responsibility for which was not undertaken by the Local Education Authority. 84 Particulars of the number of Children who were admitted to Schools of Recovery between 1st January and 31st December, 1925, and the periods of their stay between those two dates. School No. of Months Totals 1 2 3 4 5 6 7 8 9 10 11 12 B. G. b. G. B. G. B. G. B. G. B. G. B. G. B. G. b. G. b. G. B. G. b. G. b. G. Total Ogilvie — 1 1 3 4 2 2 5 3 2 1 2 — 1 2 3 1 1 — — — — 6 5 20 25 45 I.C. a.a. 2 2 — — 8 6 2 5 — 2 2 — 1 1 1 2 1 — — — — — 1 — 13 18 31 No. of Weeks Russell- Cotes — — — — — — 4 — — — 1 — — — — — 5 — — — — — 5 — — — — No. of Weeks RussellCotes (Cont.) 13 14 15 16 17 18 28 — — — — — — 1 — 1 — 4 — 1 — 22 — 22 85 10. PHYSICAL TRAINING. Physical training has been continued on similar lines to those quoted in previous reports, and instruction in swimming has been conducted as heretofore. 11. PROVISION OF MEALS. During the year 74,716 meals were provided for 292 children, as compared with 96,675 meals for 376 children in 1924. The 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. 12. SCHOOL BATHS. There are no baths used at the schools for the bathing of school children. 13. CO-OPERATION OF PARENTS. During the year 1925 the number of parents who were present at the routine medical inspections was 5,172 (2,738 in 1924), that is, in 51.4 per cent, of the cases examined (40.4 per cent, in 1924). The 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 out advice and directions are carefully carried out. 14. CO-OPERATION OF TEACHERS. The Teachers render most valuable assistance to the School 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. 15. 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, 86 16. CO-OPERATION OF VOLUNTARY BODIES. Reference to para 8 (i) on page 81 and to 9 (e) on page 83 will give some measure of the scope of the work carried out in association with Voluntary Bodies. 17. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Physically Defective Children. Table III reveals the very regrettable fact that 127 children 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 399 children (344 in 1924), 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 many of these cases it is highly probable that many of them will ultimately join the ranks of the unfit. There are then, at present, 526 children 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 98 children admitted to Residential Schools of Recovery. Mentally Defective Children. During the year 1925, the number of cases examined, for purposes of the Mental Deficiency Act of 1913, was 43 (42 in 1924). Of these 35 were classified as mentally deficient, and two as dull and backward, recommendations being made as shown in the following table :— Number examined 43 Classified as mentally deficient 30 35 Classified as morally deficient — Classified as imbeciles 5 Classified as dull and backward ... 2 Recommended for Special School ... 26 Recommended for Special Class ... 2 A reference to Table III will show that out of 115 children who have been certified as mentally defective but educable in a special school, 26 (47 in 1924) are having no education, no cases 87 are attending the ordinary elementary schools (14 in 1924), and 89 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, carried us a step towards increasing the facilities for educating the feeble-minded within the Borough, but the fact that 2G children are not receiving suitable instruction 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. 88 MEDICAL INSPECTION RETURNS. SECONDARY SCHOOL. TABLE I. RETURN OF MEDICAL INSPECTIONS (see note a). For the Year ended 31st December, 1925. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections— (see note b). Boys. Girls Entrants ... — — Intermediates — — Leavers 174 160 Total 174 160 Number of other Routine Inspections (see note c). 61 56 B.—OTHER INSPECTIONS. Number of Special Inspections (see note d). 3 6 Number of Re-Inspections (see note e). 33 45 Total 36 51 89 TABLE II. SECONDARY SCHOOL. A.—Return of Defects found by Medical Inspection in the Year Ended 31st December, 1925. 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 — — — 1 — — — — Uncleanliness : See Table IV., Group V. — — — — — — — — Skin Ringworm: Scalp — — — — — — — — Body — — — — — — — — Scabies — — — — — — — — Impetigo — 1 — — — — — — Other Diseases non-T uberculous — 1 5 3 — 4 — — Eye Blepharitis — — 2 — — 1 — — Conjunctivitis — — — — — — — — Keratitis — — — — — Corneal Opacities — — — — — — Defective Vision (excluding Squint) 31 23 14 12 — — — — Squint 1 — 1 — — — — — Other Conditions — — — — — — — — Ear Defective Hearing — 5 — 2 1 — — — Otitis Media — — — — — — — — Other Ear Diseases 6 — 2 — — — — — Nose and Throat 'Enlarged Tonsils only 1 10 4 — — — — Adenoids only — 1 — 1 — — — Enlarged Tonsils and Adenoids 5 — — 4 — — — — Other Conditions — 2 1 1 — — — — Enlarged Cervical Glands (Non-T uberculous) — — 54 4 — — — — Defective Speech . — — 5 2 — — — — 90 Table II.—(continued.) (1) (2) (3) W (5) B. G. B. G. B. G. B. G. Teeth—Dental Diseases (see note a) See Table IV., Group IV. 1 2 14 6 — — — — Heart and Circulation 'Heart Disease: Organic — — — — — — — — Functional ... — — — — — — — — .Anaemia ... — — 3 1 — — — — Lungs • 'Bronchitis 1 2 Other Non-Tuberculous Diseases — — — 1 — — — — Tuberculosis Pulmonary: Definite — — — — — — — — Suspected ... — — 1 — — — — — Non-Pulmonary : Glands — — — — — — — — Spine — — — — — — — — Hip — — — — — — — — Other Bones and Joints — — — — — — — — Skin — — — — — — — — Other Forms — — — — — — — — Nervous System Epilepsy — — — — — — — — Chorea 1 — 1 — — — — — Other Conditions — — 30 3 — — — — Deformities Rickets — — — 1 — — — — Spinal Curvature 3 8 3 — — — — — Other Forms — — — 2 — — — — Other Defects and Diseases 2 1 30 7 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 174 160 29 33 16.7 20.6 Total (Code Groups) 174 160 29 13 33 11 16.7 20.6 Other Routine Inspections 61 56 21.3 19.6 91 20. CONTINUATION SCHOOLS. There 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. Nineteen boys have been specially examined, in accordance with the Bye-Laws, and all of these were found to be fit for employment. 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. 23. MISCELLANEOUS. During the year 1925 the following special medical examinations were made :— Teachers 37 Officers 2 Student Teachers 11 Bursars 12 Scholarship Candidates 61 Workmen 25 W. BENTON, Medical Officer of Health and School Medical Officer. COUNTY. BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Annual Report on the work done in The Aural Clinic FOR THE YEAR 1925. 94 During- the year 1925, 437 cases were seen by the Aural Surgeon, 248 boys and 189 girls; these made together 927 attendances, whilst the visits to the Treatment Clinics totalled 3,902. All these figures show an increase in work as compared with those of 1924. Of these 437 cases, 315 were diagnosed as " Deaf," and 259 as having Discharging Ears, and in only 63 cases was improvement of hearing noted, while those suffering from discharging ears are in many cases incurable. This leads one to lay great stress on the need for early treatment, operative and otherwise, of all defective or catarrhal conditions of nose and throat before infection has reached the ears and while conditions are still curable. In 127 cases an operation for the removal of Tonsils and Adenoids was advised, and in this connection one can with satisfaction draw attention to the very excellent operative treatment now available at the Balaam-street Children's Hospital, where the great majority of East Ham children are treated. In conclusion, thanks are again due to the Sisters in Charge and the Clinic! Clerk for the excellent service rendered throughout the past year. Number of Cases seen by Specialist 437 Number of Visits made to Specialist 927 Number of Visits made to the Treatment Clinics 3902 Number of Cases of Deafness 315 Number of Cases of Discharging Ears 259 Number of Cases showing improvement in Hearing 63 Number of Tonsils and Adenoids operations ordered 127 Number of Boys 248 Number of Girls 189 Number of Cases discharged during 1925 131 COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Bnnual IReport of the opbtbalmic Surgeon FOR THE YEAR 1925. 96 To the School Medical Officer, County Borough of East Ham, Education Committee. Dear Sir, I have pleasure in sending you my report of the work of the Ophthalmic Clinic during the past year. During this period I have examined 890 cases of defective vision referred to me by the School Medical Officers at their routine examinations, and have also re-examined 645 children kept under observation for Myopia or some other condition which was likely to become worse. Such supervision lengthens the waiting list and increases the work of the clinic to a considerable extent, but it is the successful management of such cases which prevents their drifting into Myopic schools, and later, when they come to compete with normally sighted persons, falling into the lower ranks of wage earners through no, fault of their own. I would once more draw attention to the need, in East Ham, for a special school for weakly children (not necessarily those with defective sight). In many instances the natural reluctance of mothers to part with children who have occupied so much of their thoughts prevents their being sent to a residential school—at present the only course open to us. I have also treated 49 cases of eye disease—generally corneal ulcers and phlyctmular conjunctivitis. These conditions are almost entirely preventable by improving the conditions of life, and attending to the health of the teeth, tonsils, and hair of those who attend the schools, and friendly co-operation of parents is essential if we are to prevent these diseases—which look so innocent at their commencement—from resulting in serious impairment of vision and disfigurement. Those cases which do not improve we still send to Miss Hudson's Home at Bushey Park, and we have to thank her ,for some remarkable results. One or two children I have had up to the Royal Westminster Ophthalmic Hospital, and have seen them in consultation with my colleagues there and at Charing Cross Hospital. Working in a large Clinic such as that in East Ham one is distressed by many cases of squint. This deformity results from 97 poor development of binocular vision in early life, and should be treated at its first appearance—not by waiting- till the child is five years old. Difficulties beset the treatment, which in most cases extends over long- periods. I have taken seven cases of squint into the Royal Northern Hospital, Holloway, for operation during the past year with, I think, improvement in all and cure in several of them. These children remain under my observation. May I, in conclusion, Sir, thank my colleagues for their help, and draw attention to the excellent work done by the Nurses, the Optician, and the Clerical Staff. The measure of success that has been obtained is due to the kindly and efficient co-operation of all. 1 have the honour to remain, dear Sir, Yours very truly, CHARLES LEONARD GIMBLETT. COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Annual Report on the work done in The School Dental Clinic FOR THE YEAR 1925. 100 To the School Medical Officer, County Borough of East Ham Education Committee. Sir, I beg to submit to you my report for the year 1925. You will note from the following statistics that the age groups inspected were from 5 to 9 years (inclusive); treatment has been offered where necessary. The numbers inspected were 9,013, and those referred for treatment 6,488. To these figures must be added those which come under the heading of " Specials," numbering 257. These are cases of toothache, oral sepsis, etc., over ten years of age, either referred by the School Medical Officers, or sent by the Nurses and Head Teachers. Details will be found in the following table :— TABLE IV. Group IV.—Dental Defects. (1) Number of Children who were: — (a) Inspected by the dentist Routine Age Groups. Age. Total. Specials (see note d) Total. Grand Total. 0 6 7 8 9 10 11 12 13 14 2198 1656 1693 2153 1313 9013 257 9270 (b) Found to require treatment ... 6488. (c) Actually treated ... ... 2018. (d) Re-treated during the year as the result of periodical examination (see note e) Nil (2) Half-days devoted to :— Inspection ... 61) Treatment ... 320 Total 381 (3) Attendances made by children for treatment ... 4580. (4) Fillings:— Permanent teeth ... 516 iemporary teeth ... 1251 Total 1767 (5) Extractions :— Permanent teeth ... 553) Temporary teeth ... 3910 Total 4463 (6) Administrations of general anaesthetics for extractions ... 233. (7) Other operations:— Permanent teeth ... 320 iemporary teeth ... 160 Total 480 101 Progress is recorded by the fact that the percentage of children found to require treatment is steadily falling. In 1923 the percentage was 77, in 1924 it had fallen to 73.8, and in 192a to 71.9 per cent. Considering that the school dental work is carried on single-handed with a school population of 23,000, the result is very encouraging. Again this year, some 600 children who were inspected in 1925 could not be treated by December 31st, 1925, and they had to be seen in 1926, thereby hindering the routine work of the year. Once more this demonstrates the fact that at least two more Dental Surgeons should be appointed. The Board of Education stipulates that one Dentist should be appointed to deal with 5,000 children, thus in East Ham there should be at least four Dentists to cope with the number of children. In my former reports I have stressed this point, and there may be some who wonder if the insistence is justified. Dentistry to-day is regarded as one of the most important branches of preventive medicine. Sir George Newman, the Chief Medical Officer to the Board of Education, states in his report for the year 1924: "That the prevention of Dental Disease is well worth while has been demonstrated over and over again, and it is now a matter of general agreement that improvement in the health and physique of the nation as a whole, largely depends on taking effective measures to this end." Every member of the Dental Profession can give instances of marked improvement in the health of patients whose mouths have been put into a sound healthy condition. Hearing and sight has been improved, relief and often permanent cure has been effected in such diseases as anaemia, gastritis, dyspepsia and rheumatism. In the returns of an Approved Society, which was given as evidence before the Royal Commission on National Health Insurance, there was shown to be a reduction of 40 per cent, in the number of sickness claims since the institution of Dental Benefit for its members. The masses to-day are very careless, speaking generally, of their teeth; they do not even form the tooth-brush habit, much less the habit of visiting a dentist periodically, and the result is that they suffer needlessly. In most districts the Maternity and Child Welfare Centre has a dentist, to whom the expectant mother is sent, and the baby can have dental treatment, very often free of charge, up to school age. 102 Then the child passes into the hands of the School Dentist, and has its mouth inspected at least once a year. When it leaves school it is left more or less to its own devices, but in the future Dental treatment will become a statutory benefit under the National Health Insurance Acts, as recommended by the Majority Report of the Royal Commission on National Health Insurance; thus in the future the good work done during babyhood and childhood will be continued, and the benefits conferred by dental treatment will be within the reach of everybody. To remedy the apathy and ignorance of to-day, the children must be educated in the benefits of cleanliness. First of all the desire for cleanliness must be implanted in the childish mind, and then the way will be open for the children to practise cleanliness, and thus will habits be formed. This can be accomplished by short talks, illustrations, short lantern and cinema lectures, tooth-brush drill, etc. The teachers' services in this connection would be very valuable. Thus the gospel of preventive dentistry will spread, and in the future the appalling apathy and ignorance will disappear and a far healthier nation will be the result. The age groups to be inspected during 1926 will be the same as in 1925, namely 5 to 9 years inclusive. Particular attention has been paid during the past year to conservative work, fillings being done wherever possible to prolong the life of permanent and temporary teeth. The mouths of all children attending the Clinic have been rendered sound and clean, all sepsis being eliminated. Injections have been given for all extractions where possible; in cases of sepsis gas or ethyl chloride has been used. The Dental Clinic is still housed in the basement and working under its former unhealthy conditions, but as new premises have been promised, this state of things, one hopes, will not last much longer. The tact, patience, and conscientiousness of the Dental Nurse, Miss Olifent, has been a large asset in the success of the Clinic, and I should like to record my appreciation of her services during the year 1925. Details of treatment given to mothers and children sent from the Maternity and Child Welfare Centre are appended in the following statistical table :— 103 Maternity and Child Welfare Centre figures for 1925. 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. Extrac ted. Filled. Extrac ted. Filled. Permanent Teeth. Temporary Teeth. 41 178 229 227 35 214 102 441 137 79 65 31 It will be noted that there is a decided increase in the numbers of mothers and children attending the Dental Clinic. This is partly due to the making of dentures for the mothers and partly due to the keenness of Dr. Elsie Thomson in Oral cleanliness. I should like to thank the Medical Officers, Nurses, Teachers and Clerical Staff for their valued co-operation during the year 1925. I am, Sir, Vour obedient servant, C. S. NEAME. 104 TABLES GIVING SUMMARY OF WORK OF SCHOOL MEDICAL SERVICE from 1st JANUARY, 1925 to 31st DECEMBER, 1925. PUBLIC ELEMENTARY SCHOOLS. TABLE I. RETURN OF MEDICAL INSPECTIONS (see note a). For the Year ended 31st December, 1925. A.-ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections— (see note b). Entrants 2,960 Intermediates 2,961 Leavers 2,784 Total 8,705 Number of other Routine Inspections (see note c). 907 B.—OTHER INSPECTIONS. Number of Special Inspections (see note d). 3,489 Number of Re-Inspections (see note e). 3,784 Total 7,273 NOTES ON TABLE I. (a) The return refers to a complete calendar year. (fr) 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. 105 (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 are 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 be 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. 106 TABLE II. A.—A Return of Defects found by Medical Inspection in the Year Ended 31st December, 1925. 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 24 33 8 8 Uncleanliness : (See Table IV., Group V.) — — — — Skin Ringworm: Scalp 3 — . 47 — Body 5 — 59 1 Scabies 3 — 15 — Impetigo 29 16 462 — Other Diseases (non- Tuberculous) 25 28 316 5 Eye Blepharitis 7 21 49 — Conjunctivitis 8 2 64 — Keratitis — . 1 — 1 Corneal Opacities 6 2 10 3 Defective vision (excluding Squint) 589 218 155 12 Squint 29 33 20 4 .Other conditions 4 12 33 5 Ear Defective Hearing 29 23 32 2 Otitis Media 47 14 108 11 Other Ear Diseases 30 42 131 4 Nose and Throat Enlarged Tonsils only 29 1453 72 4 Adenoids only 17 113 20 2 Enlarged Tonsils and Adenoids 257 176 66 15 Other conditions 14 210 81 27 Enlarged Cervical Glands (Non- Tuberculous) 8 2525 49 6 107 Table II.—(continued). (1) (2) (3) 4) (5) Defective Speech 4 59 6 10 Teeth—Dental Diseases (see note a) (see Table IV., Group IV.) 140 1732 272 6 Heart and Circulation. Heart Disease : Organic 8 25 4 4 Functional 1 28 2 3 Anaemia 39 110 64 17 Lungs Bronchitis 40 195 52 12 Other Non-Tuberculous Diseases 4 25 20 8 Tuberculosis Pulmonary : Definite — 3 — — Suspected 1 11 7 6 Non Pulmonjiry Glands 1 6 3 4 Spine — — — — Hip — . 2 1 1 Other Bones and Joints — — — — Skin — — — — Other Forms — 5 2 — Nervous System Epilepsy 2 2 5 4 Chorea 5 9 36 15 Other conditions 16 81 160 39 Deformities Rickets — . 13 — . — . Spinal Curvature 17 38 12 3 Other Forms 2 14 10 9 Other Defects and Diseases 123 433 634 91 B.—Number ok Individual Children (see note b) found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). GROUP. Number of Children. Percentage ot Children found to require Treatment (see note d). Inspected (see note c). Found to require Treatment. (1) (2) (3) (4) Code Groups :— Entrants 2960 340 11.5 Intermediates 2961 445 15 Leavers 2784 308 11.1 Total (Code Groups) 8705 1093 12.6 Other Routine Inspections 907 107 11.8 108 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 1. A. (d) The figure in this column will be the percentage of the figure in column (3) of that in column (2). 109 TABLE III. Return of all Exceptional Children in The Area for the Year ended 31st December, 1925 (see note a). Boys. Girls. Total Blind (including partially blind) (see note b). (1.) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 7 5 12 Attending Public Elementary Schools (see note c) — — — At other Institutions 1 — 1 At no School or Institution — — — (ii.) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind 4 3 7 Attending Public Elementary Schools (see note c) — 1 1 At other Institutions 1 3 4 At no School or Institution — 2 2 Deaf(including deaf and dumb and partiallydeaf) (see note d). (j.) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools cr Classes for the Deaf... 6 5 11 Attending Public Elementary Schools (see note c) — — — At other Institutions — — — At no School or Institution 2 2 4 (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 49 36 85 Attending Public Elementary Schools (see note c) — — — At other Institutions 1 3 4 At no School or Institution 14 12 26 Notified to the Local Control Authority during the year. Feebleminded 1 4 5 Imbeciles 2 2 4 Idiots — — — Epileptics Suffering from severe epilepsy. (See note f.) Attending Certified Special Schools for Epileptics 3 3 6 In Institutions other than Certified Special Schools 1 — 1 Attending Public Elementary Schools (see note c) — — — At no School or Institution ... 1 5 6 110 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) — 1 1 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 3 2 5 At other Institutions 10 3 13 At no School or Institution 8 5 13 Non-infectious but active pulmonary aud 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 1 — 1 At Certified Day Open Air Schools — — — At Public Elementary Schools (See note c) 88 65 153 At other Institutions — — — At no School or Institution — — — Physically Defective. Delicate children {e.g., pre- or latent tuberculosis, malnutrition, debility, anaemia, etc). (Seemote h.) At Certified Residential Open Air Schools 24 25 49 At Certified Day Open Air Schools — — — At Public Elementary Schools (see note c) 80 103 192 At other Institutions 16 11 30 At no School or Institution — — — Active non-pulmonary tuberculosis. (See note h,) At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 1 2 3 At Public Elementary Schools (see note c) 40 14 54 At other Institutions 13 15 28 At no School or Institution 6 4 10 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 4 At Certified Day Cripple Schools — 1 1 At Public Elementary Schools (see note c).. 88 59 127 At other Institutions 3 4 6 At no School or Institution 28 17 45 111 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 ha^e 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 by 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 ordinary public 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. 112 (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 fiom 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. (/) 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 ot 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 disease 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. 113 TABLE IV. Return of Defects Treated during the Year ended 31st December, 19'25 (see note a1! 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 36 — 36 Ringworm—Body 43 1 44 Scabies 27 — 27 Impetigo 465 18 478 Other skin disease 209 8 217 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 224 9 233 Minor Ear Defects (see note c.) 276 19 295 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 958 223 1181 Total 2238 273 2511 114 TABLE IV.—continued. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.). No. of Defects dealt with. Defect or Disease. Jnder 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) (6) Errors of Refraction (including Squint) (Operations for squint should be recorded separately in the body of the Report.) 871 87 5 963 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 19 4 - 23 Total 890 91 5 886 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme ... 675 (b) Otherwise ... ... ... ... 84 Total number of children who obtained or received spectacles— (a) Under the Authority's Scheme ... 675 (b) Otherwise ... ... ... ... 84 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 SchemeinClinic or Hospital. (see note b.) By Private Practitioner or Hospital apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 246 73 319 81 350 115 Group IV.—Dental Defects. (1) Number of Children who were:— Age. Specials Grand Total. Routine Age Groups. Total (see note d) Total. 5 6 7 8 9 10 11 12 13 14 2198 1656 1693 2153 1313 9013 — — – — — 257 9270 (a) Inspected by the Dentist (b) Found to require treatment 6488. (c) Actually Treated 2018. (d) Re-treated during the year as the result of periodical examination (see note e) Nil (2) Half-davs devoted to.— Inspection 61 Treatment 320 Total 381 (3) Attendances made by children for treatment 4580. (4) Fillings:— Permanent Teeth 516 Temporary Teeth 1251 Total 1767 (5) Extractions:— Permanent Teeth 5531 Temporary Teeth 3910 Total 4463 (6) Administrations of general anaesthetics for extractions 233. (7) Other operations:— Permanent Teeth 320 Temporary Teeth 160 Total 480. Group V.—Uncleanliness and Verminous Conditions (see note f). (i.) Average number of visits per school made during the year by the School Nurses 3 (ii.) Total number of examinations of children in the Schools by School Nurses 58,090 (iii.) Number of individual children found unclean 2,861 (iv.) Number of children cleansed under arrangements made by the Local Education Authority Nil. (v.) Number of cases in which legal proceedings were taken:— (а) Under the Education Act, 1921 Nil. (b) Under School Attendance Byelaws 1 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 treat- 116 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 and Shops Inspector FOR THE YEAR 1925. 118 Annual Report of the Chief Sanitary, Food and Shops 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 thirtieth Annual Report of the work of the Sanitary Inspectors for the year 1925 The number of primary inspections made was 6,567. These included house-to-house inspections, visits to premises upon complaint of nuisance, inspection of markets, slaughterhouses, cowsheds, workshops, etc. 119 PRIMARY INSPECTIONS. Month Manor Park Little Ilford Woodgrange Plashet Kensington Castle Central Wall End Greatfield South 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. Ordinary House to House January 23 — 60 34 21 25 38 44 26 — 48 34 52 94 40 — 13 — 30 22 351 253 February 24 — 30 6 23 37 32 24 14 — 21 52 36 — 29 — 6 4 46 94 261 217 March 29 — 34 15 30 99 39 — 22 — 41 19 59 — 36 — 21 — 32 186 343 319 April 51 — 34 9 49 1 57 44 13 — 45 — 40 23 24 — 21 — 47 26 381 103 May 44 — 33 15 47 9 55 120 26 — 65 — 73 107 56 — 29 — 40 — 468 251 June 41 — 43 — 41 11 42 116 20 — 42 — 29 — 25 — 8 — 32 93 323 220 July 41 — 52 6 37 59 42 43 26 — 36 2 67 — 37 — 19 12 63 4 420 126 August 42 — 39 33 35 42 — 21 — 31 — 66 31 47 — 25 — 55 54 401 120 September 54 — 49 — 43 — 42 — 25 — 65 — 68 — 49 18 9 — 58 43 462 61 October 44 — 36 29 45 13 50 — 17 — 35 — 61 — 45 79 16 — 23 — 372 121 November 51 4 26 8 52 24 41 — 32 — 40 27 34 107 27 — 12 — 31 — 346 170 December 49 79 21 11 27 6 16 — 11 — 27 71 59 — 28 — 20 — 53 — 311 167 493 83 457 133 448 319 496 391 253 — 496 205 644 362 443 97 199 16 510 522 4,439 2,128 120 10,486 nuisances, caused principally by sanitary defects, were discovered and dealt with by the Inspectors. (These are fullydetailed on inset opposite page 143.) Of these nuisances, 5.045 were detected in routine work, and 5,081 by house-to-house inspection. To secure their abatement, Notices were served as follows:— Preliminary 3,213 Statutory 689 Dust Bin 602 Water 1 4,505 Complaints. 2,412 complaints were received—1,059 written and 1,353 verbal. The nature of the complaints covers a wide range, as it is generally believed that the Sanitary Inspector is the right person to enquire into every cause of trouble, and it is difficult sometimes to convince people where an Inspector's duties begun and end. A frequent request is to "get out" a sub-tenant, or to quieten a crowing cockerel. Manor Park Little Ilford Wood grange Plashet Kesington Castle Central Wall End Greatfield South Total January 12 17 20 18 19 25 30 15 5 18 179 February 9 15 13 18 11 12 33 17 8 11 147 March 17 26 10 24 10 14 34 21 10 16 182 April 12 18 19 16 15 16 30 16 16 14 172 May 19 34 24 35 11 19 31 21 15 16 225 June 14 21 20 21 15 14 26 19 7 14 171 July 17 30 23 21 16 21 62 18 7 27 242 August 19 32 28 18 21 19 40 32 4 46 259 September 17 20 24 17 16 26 37 17 13 17 204 October 12 39 24 39 19 30 49 31 7 25 275 November 15 26 17 13 20 20 26 15 10 15 177 December .. 8 22 10 24 13 27 33 11 9 22 179 171 300 232 264 186 243 431 233 111 241 2,412 121 COMPLAINTS RECEIVED—(continued). Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Drains 43 47 65 56 ' 47 38 60 70 59 46 43 46 620 Accumulations 15 8 9 8 12 15 15 9 7 24 9 13 144 Water — — — 3 1 — — — — — — — 4 Offensive Smells — 1 2 3 5 5 6 9 3 6 3 1 44 No Dustbin 12 3 10 3 7 4 10 8 5 8 3 9 82 Dilapidations 26 32 22 25 28 21 32 37 31 68 61 37 420 Overcrowding 2 5 6 3 5 5 7 5 3 5 4 2 52 Insanitary Condition 31 13 31 40 36 53 48 56 51 61 19 25 464 Dampness 23 22 12 10 16 5 24 34 21 26 10 12 215 Others 27 16 25 21 68 25 40 31 24 31 25 34 367 179 147 182 172 225 171 242 259 204 275 177 179 2412 Sanitary Administration. For the purpose of Inspectorial work the Borough is divided into three districts, with a Senior and Junior Inspector allotted to each. The tabular statement on inset opposite page 143 gives particulars of their work, and results of legal proceedings on pp. 137 and 138. SANITARY CIRCUMSTANCES OF THE AREA. Public Water Closets and Urinals. There are eleven public conveniences in the Borough excluding those in the public parks. 4 are underground and 7 on ground level. Attendants are engaged by the Corporation at those underground, whilst the others receive daily cleansing by an employee appointed for this purpose, and the state of sanitation is a credit to their work. At those urinals attached to licensed premises to which the public have access, 90 inspections were made and notices served as occasion arose. The principal causes of nuisance are insufficient water supply for cleansing purposes and want of light: the latter is often the cause of the abuse to which urinals are sometimes subjected. 122 Passages at Rear of Premises. Secondary means of access are provided for many business premises. They are of importance to owners, but unfortunately they can be a menace to public health, largely because the persons responsible do not display a more intelligent interest in sanitary conditions. There is invariably free access to these passages, which fact, together with lack of light, invites abuse. Where we have succeeded in having gates erected, they are usually left open, thus affording facilities for improper usage. If the entrance gates were shut, much of the trouble would be prevented, but when gates are left open and a van or cart is left in the carriageway, these conditions lend themselves to making the place a public convenience. Where there are a number of tradespeople whose duty it is to keep the gates closed it is a difficult matter to fix responsibility. House-to-House Inspection. The number of dwelling-houses visited during the year was 2,128, and at 74 per cent. of these, sanitary defects were discovered, whereas at premises visited in the course of routine work, defects were discovered at 52 per cent. This is explained by the fact that house-to-house inspections are made in selected areas. By reference to the table giving the number of nuisances it will be seen that some items are included which cannot be strictly classed as sanitary defects, i.e., sashcords, coppers, stoves, etc.—but the condition of these fittings largely contributes towards rendering a house reasonably fit for human habitation or otherwise, and owners, almost without exception, acknowledge this by making good these defects without recourse to legal proceedings. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920-23. 47 applications were made by tenants for certificates under Section 2 of the above-named Act, alleging that the premises were not reasonably fit for human habitation nor kept in a reasonable state of repair. At these houses the inspections were made by myself. 14 certificates were issued where the premises came within this designation, but in 33 instances conditions were not bad enough to warrant granting certificates. In every case a 123 schedule of dilapidations was forwarded to the owner and if the work of remedying defects constituting nuisances was not executed, a Notice was served under the Public Health Acts. Smoke Abatement. Observations were made of offending shafts with reference to the emission of black smoke. Notices were served and in one instance the nuisance was abated by means of a mechanical invention. No local records of atmospheric impurity are taken. Offensive Trades. The Borough is exceptionally free from offensive trades, there being only one small gut scraping business in Langdon Crescent. The business is well-conducted and no complaints have been made nor has there been any need to serve Notice in respect of nuisance. The collection of fish, offal and butchers' bones is carried out by private contractors, as far as possible during the night or early morning. Complaints were made in the summer months of offensive odours from the collecting vans. The principal offenders were butchers' bone and fat collectors, who have always used open vans unsuited for this work. The nuisance could be considerably mitigated if more modern methods were applied. Disinfection. 1,241 premises were disinfected, 740 for infectious diseases, 474 for tuberculosis, 3 for scabies, 24 for vermin. The steam disinfector at the Isolation Hospital is used for bedding and other articles requiring disinfection. Infections Diseases. In all cases of infectious disease notified, the premises are at once visited by the District Inspector. The sanitary arrangements of the house with its surrounding conditions are examined, and where any sanitary defects are discovered or stripping and cleansing required, Notices are served upon the persons responsible and the work carried out under the Inspector's supervision. A report of each case containing full particulars required for the Medical Officer of Health is prepared by the Inspector. 124 The Borough Librarian is notified of all infected premises, and books from infected houses are returnable direct to the Public Health Department and disinfected before their return to circulation. Workshops. There are 185 factories and workshops, including domestic workshops, laundries, blouse makers, shirt makers, tailors, boot repairers, etc. During the year, 181 inspections were made of workshops and outworkers under the Factory and Workshops Act, 1901, and the premises were found, with a few exceptions, in a satisfactory condition. For details see Table on p. 142. The Chief Inspector of Factories has informed us on 9 occasions of the existence of nuisances in workshops and factories. Collection of House Refuse. There are 28,683 houses in the Borough from which house refuse is collected weekly. During the year 21,920 tons were removed to the destructor. To carry out this work 8 electric and 2 horse vans were used for traction employing 30 men— foreman, 8 electric motor-van drivers, 2 horse-van drivers, 2 motor attendants and 17 fillers (one extra filler has been employed). The work is greatly facilitated by occupiers placing the bins out ready, on the day appointed, for collection. A re-arrangement of the district for daily collection was carried out, with no little trouble, so as to include the new houses tenanted. The two horse-vans are entirely engaged in collecting within a three-quarter mile radius from the destructor works. The average weight of refuse collected for the year was:— Per house, 15.3 cwts.; per head of population, 2.97 cwts., or 33 lbs. per house and 6.4 lbs. per person per week. Each electric van carried approximately 52 tons of refuse weekly. The total cost of collection, including all charges, was £7,996, which is under 5s. 7d. per house, or l¼d. per week, or 7s. 4d. per ton. The refuse is disposed of by burning, and the resultant heat utilised for generating steam for the purpose of sewage pumping. 125 HOUSE REFUSE COLLECTION. Loads. Tons. 1924 1925 1924 1925 January 897 979 2,163 2,261 February 725 782 1,779 1,925 March 1,042 891 2,339 2,076 April 895 889 1,911 1,957 May 890 852 1,895 1,748 June 741 929 1,502 1,362 July 675 868 1,289 1,480 August 697 830 1,334 1,698 September 982 828 1,891 1,571 October 854 895 1,903 1,788 November 767 1,019 1,893 2,118 December 772 949 1,909 1,936 Total 9,829 10,711 21,808 21,920 Trade Refuse Collection, The policy of the Council for many years has been to collect tradesmen's refuse free of charge twice weekly and this system continues to work satisfactorily, the only condition being that the refuse is placed in a convenient position ready for the collector, who calls regularly on the same day and hour. The refuse is taken to the destructor for disposal, and during the year 2,074 loads were collected. Dust-Bins. Under the provisions of the East Ham Improvement Act, 1903, the Council have power to call upon owners to provide every dwelling house with a suitable receptacle for containing house refuse, and during the year 602 such premises were reported to the Public Health Committee and Notices served upon the owners. In the event of failure to comply with this Notice, the 126 Council supply the bins, which are of excellent design and quality. They are made from a carefully prepared specification, purchased in large quantities by contract, and supplied at a low charge. Owners of property are well advised to purchase through the medium of the Council. Schools. The public elementary and private schools have been systematically inspected, special attention being given to the drains, gullies, latrines, urinals, etc. In the public schools the gullies and drains are flushed regularly by the Council's drain flushers. The caretakers are responsible for the cleansing of the latrines and urinals. The work is done satisfactorily. HOUSING STATISTICS FOR THE YEAR. New houses erected during the year:— (a) Total 650 (b) As part of a municipal housing scheme Nil. 1. Dwelling houses. Inspection—(1) Dwelling houses inspected for housing defects (under Public Health or Housing Acts) 5,533 (2) Dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (3) Dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 14 2. Defects remedied without Service or formal Notices. Defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their Officers 2,524 3. Action under Statutory Powers. A.—Proceedings under Section 28 of the Housing, Town Planning Etc., Act, 1919 (1) Dwelling houses in respect of which Notices were served requiring repairs Nil. 127 (2) Dwelling houses which were rendered fit:— (a) By owners Nil. (b) By Local Authority in default of owners Nil. (3) Dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. B. — Proceedings under Public Health Acts. (1) Dwelling houses in respect of which Notices were served requiring defects to be remedied 3,213 (2) Dwelling houses in which defects were remedied:— (a) By owners 2,039 (b) By Local Authority in fault of owners Nil. C.—Proceedings under Sections 17 and 18 of the Housing, Town Planning, Etc., Act, 1909. (1) Representations made with a view to the making of Closing Orders Nil. (2) Dwelling Houses in respect of which Closing Orders were made Nil. (3) Dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit Nil. (4) Dwelling houses in respect of which Demolition Orders were made Nil. (5) Dwelling houses demolished in suance of Demolition Orders Nil. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. The whole of the milk supplied is imported and there has been an ample supply during the twelve months. Distribution is carried out principally by large vendors by means of cans and bottles. Judging by the Public Analyst's reports the quality must be considered good. 128 Dairies and Cowsheds. For some time there were 2 cowkeepers in the Borough but they found it unprofitable to keep cows and have closed down. There are 138 dairies, including shops other than dairies where milk is sold. One general shopkeeper was removed from the register because of unsuitable premises, while 2 names were added to the register. There is a large sterilized milk factory in the Borough using the latest machinery for cleansing, sterilizing and bottling milk, and some 2,500 gallons of milk are sterilized and 20,000 bottles washed and filled daily. Milk (Special Designations) Order, 1923. 8 supplementary licences were granted for the sale of milk under this Order, 4 for Grade "A," 2 for Pasteurised, and 2 for Certified milk. One application was made for a licence for the bottling of graded milks. As the premises did not comply with the Council's requirements the application was refused. Public Health (Meat) Regulations, 1924. These Regulations became operative on 1st April, 1925. In the nine months from April 1st, 586 notifications of intention to slaughter were received referring to:— Cattle 1,253 Pigs 643 Calves 521 Lambs 897 Sheep 1,934 Total number of animals 5,248 Sunday is usually a busy time for killing, on which day an Inspector is on duty. On almost every occasion the slaughterhouses were visited by an Inspector during the killing process and carcases and offal examined. 54 offals and 4 carcases were condemned. Although the Regulations are of such recent date, much good has already been accomplished, 129 Some stalls outside butchers' shops have had glass frames fitted to protect the meat from dust and street mud. Notices prohibiting handling are now exhibited in almost every shop. The work of educating both the public and the butcher may appear to be slow, but there is no doubt that progress has been made. Slaughterhouses. There are 12 licensed slaughterhouses in the Borough and 454 visits were made during the year. The premises were generally well-conducted and regularly limewashed and cleansed in accordance with the Bye-laws. The increase in the number of inspections is in consequence of the compulsory notification of slaughter under Section 10 of the Public Health (Meat) Regulations. The annual issue of licences is an important factor in maintaining a standard of efficiency. Following is a list of slaughterhouses in the Borough:— Beckton Road. Manor Way Farm, New Beckton. 319, Green Street. 14, High Street North. 170, High Street North. 165, I ??? Grove. 843, ??? Road. 524, Romford Road. 737, Romford Road. Shaftesbury Road. 28, Station Road. 6, Station Road. In 1920. In Jan., 1925. In Dec., 1925 Number registered Number licensed – 14 – 12 – 12 Food Supply. The markets and shops were systematically inspected, two Officers taking duty in turn during the busy market hours. 130 The character of the food was generally good, but 15 consignments of unsound food were condemned—including fish, meat and fruit—and certificates given indicating the condition of the food when examined. In cases of wet fish condemned on the day of purchase, the Billingsgate Market Authorities were at once communicated with and information given respecting its condition; in some instances an Inspector from the market came to examine the fish, in every case confirming our action. Six churns of unsound milk were seized and condemned as unfit for human food. Legal proceedings were instituted but the summons could not be served as the defendant decamped. Bakehouses. There are 49 bakehouses in the Borough, I being underground. The others are of modern structure and well-maintained. During the year 81 inspections were made and limewashing and cleansing carried out in accordance with the Regulations. Sale of Food and Drugs Act. During the year 315 samples of milk were procured and submitted to the Public Analyst, who reported that seven of them were adulterated with added water or were deficient in fat (equalling 2.2 per cent.). In no instance, however, was there any report of excess of sediment in milk. Altogether 463 samples of food and drugs were taken, 7 of which were adulterated, equivalent to 1.5 per cent. Legal proceedings were instituted on 5 occasions, for results see p. 141. Milk and Cream Regulations. Milk & Cream not sold as Preserved Cream. (a) (b) Number of samples examined for the presence of a preservative. Number in which preservative was reported to be present, and percentage of preservative found in each sample. Milk 315 — Cream 5 — 131 Cream sold as Preserved Cream. Correct statements made 4 Statements incorrect — Total 4 Percentage of preservative found in each sample. .10 .34 .39 .40 Percentage stated on statutory label. .40 .40 .40 .40 Determination made of Milk Fat in Cream sold as Preserved Cream. (1) above 35 per cent. 4 (2) below 35 per cent. — Total 4 Contagious Diseases of Animals Act. The Borough has been free from any disease which comes within the provisions of the Diseases of Animals Act, although Foot and Mouth Disease was prevalent in different parts of the country, necessitating the scheduling of the Borough as an infected area at different periods : these measures prescribed that animals could only be moved in or out of the Borough by licence. Number of licences issued under Foot and Mouth Disease Order 309 Animals brought in under licence (Foot and Mouth Disease Order) Beasts 933 Sheep 2,335 Pigs 606 Calves 269 4,143 Animals moved under other Orders (see below) 1,365 5,508 132 Licences issued under Swine Fever Regulations 104 Pigs brought in under Swine Fever Regulations 975 Licences issued under Sheep Dipping Order 40 Sheep brought in under Sheep Dipping Order 390 Rats and Mice Act. Rat catching has continued throughout the year; 3,127 rats were destroyed and a large number killed in their runs and holes. Special efforts and devices have been used for the work, and when considering results it is difficult to say which is the most effective method. The smoke-ferret and the dog come in for a high place, while baits and traps serve their purpose. Visitors to the Exhibition during Health Week expressed some surprise at our rat-catching methods and displayed greater interest in them than they did in some of the more scientific exhibits. Petroleum Licences. 55 premises are licensed by the Council for the storage of petroleum. The total storage by licence in the Borough amounts to 58,031 gallons. At 25 of these premises, the storage is in underground tanks. The strictest care is taken to test the tanks and joints of all pipes connected with the tank and pump. 10 lbs. pressure to the square inch is kept on for not less than 4 hours before the work is passed. Underground storage and the supply of petrol through a pump is preferable to that of the old method of separate cans, funnels and measures. All licensed premises are visited before any renewals are made. Amusements—Music Hall and Theatres. The sanitary accommodation in the music hall and theatres has been regularly inspected and attention given to see that the 133 Home Office regulations were carried out. In every instance their provisions were well maintained. The only difficulty is that of providing for children at the cinemas, but proprietors have been anxious and willing to comply with any suggested improvement. Sbops Act. There are 2,407 retail shops in the Borough, comprising — Grocers and Provision Dealers 367 Butchers 89 Bakers 54 Drapers 159 Tailors 117 Boot and shoe shops 123 Fruiterers and Greengrocers 98 Confectioners and Tobacconists 296 Licensed houses 84 Others 1,020 2,407 7,138 visits were made by the Shops' Inspector for the purpose of noting that the provisions of the Shops Act and Early Closing Orders were being carried out. 104 contraventions were discovered, resulting in 56 summonses being taken out and convictions obtained. In 48 cases where the offence warranted it, offenders were cautioned. Traders' registers are systematically kept. 181 businesses changed proprietorship during the year. For details of prosecutions see pp. 139 and 140. Police Court Proceedings. Legal proceedings were instituted on 110 occasions, viz.:— Under Public Health Act (for non-com- pliance with Sanitary Notice) 47 Under Shops (Early Closing) Act and Closing Orders for contraventions 58 Under Sale of Food and Drugs Act for adulterations 5 134 It will be seen from the tabulated statement that the summonses under the Public Health Act were withdrawn after the work of complying with the Notices had been carried out and costs amounting to £7s. 6d. paid. The fines imposed under the Shops Act amounted to £36 7s. 6d. Only one conviction was obtained under the Sale of Food and Drugs Act. 3 cases were dismissed, 2 being against one defendant, for selling milk deficient in milk fat, who pleaded warranty and called evidence which satisfied the Court that the milk was sold in the same condition as when received. A summons was applied for and granted against the warrantor, which also failed. In the fifth case (hot milk) legal difficulties arose and it was decided not to proceed. Recent legislation has made material alteration in procedure where a warranty is pleaded as a defence. Formal Samples. Milk 311 Butter 30 Cream 5 Preserved Cream 4 Camphorated Oil 2 Ale 1 Sponge Cake 2 Cocoa 2 Vinegar 2 Salmon and Shrimp Paste 5 Mineral Water 3 Pepper 2 Lung Syrup 1 Cream Ice 1 Jam 3 Lard 6 Mustard 1 Jelly 1 Custard Powder 1 135 Lime Water 3 Margarine 4 Lemon Cheese 4 Mixed Pickles 2 Doughnuts 1 Chutney 1 Worcester Sauce 1 Tomato Ketchup 1 Dripping 5 Honey 1 Bread 4 Butter-like Substance 1 Tea 3 Chocolates 1 Puff Paste 1 Pork Sausages 2 Beef Sausages 2 Cheese 2 Sugar 1 Ground Almonds 7 Jam Sandwich 1 Ground Ginger 2 Flavouring Essence 1 Sweet Mixed Drops 1 Apples 5 Breakfast Sausage 1 Pure Glycerine 1 Essence of Rennet 1 443 Informal Samples. Banbury Cake 1 Butter 2 Milk 4 Coffee 1 Tea 1 Rice 1 136 Sago 1 Cocoa 1 Apple Rings 1 13 Total 463 Appeals to Cow 7 (3 of which were below standard) Adulterations. Milk 7 Mortuaries. There are two mortuaries. The central mortuary at High Street South, and the second at North Woolwich. Both buildings are under the control of a mortuary keeper and are kept in a satisfactory condition. There have been 71 bodies admitted and 56 post-mortem examinations held during the year. Common Lodging Houses. There is only one common lodging house in the Borough, with accommodation for 42 beds, situated in Albert Road, North Woolwich. It is regularly visited and on no occasion has it been necessary to serve any notice or complain of nuisance. J. G. BANKS, Chief Sanitary Inspector. 137 PROSECUTIONS UNDER THE PUBLIC HEALTH ACT FOR THE YEAR 1925. Date. Situation of Premises. Offence. Result. January Barking Road (3 houses) Non-compliance with sanitary notice Withdrawn. 7/- costs January Elizabeth Road (2 houses) do. do. 3/6 do. January Albert Road (7 houses) do. do. 14/- do. January Market Street (12 houses) do. do. 17/6 do. January Benson Avenue do. do. 3/6 do. January Alverstone Road (9houses) do. do. 24/6 do. February Prestbury Road do. do. 3/6 do. March Milton Avenue do. do. 3/6 do. March Henderson Road do. do. 3/6 do. March Brookwood Road do. Adjourned sine die. April Dorset Road do. Withdrawn. 3/6 costs April Florence Road do. do. 3/6 do. April Malvern Road (2 houses) do. do. 3/6 do. April Arthur Road (6 houses) do. do. 14/- do. April Talbot Road do. do. 4/6 do. April Alverstone Road (3 houses) do. do. 7/- do. April Grantham Road do. do. 8/6 do. May Alverstone Road do. do. 3/6 do. May Harcourt Avenue Unsound milk on premises Owner decamped June Winter Avenue (6 houses) Non-compliance with sanitary notice Withdrawn. 7/- do. June Stamford Road do. do. 3/6 do. July Bonny Downs Road (4 houses) do. do. 7/- do. July Mountfield Road (2 houses) do. do. 7/- do. September Dickens Road do. do. 3/6 do. September Frinton Road do. do. 3/6 do. September Blenheim Road (3 houses) do. do. 7/- do. November Rothsay Road (2 houses) do. do. 3/6 do. November Barking Road do. do. 3/6 do. November St. Stephens Road do. do. — 138 Date. Situation of Premises. Offence. Result. November Albert Road Non-compliance with sanitary notice Withdrawn. 3/6 costs November Derby Road (2 houses) do. do. 3/8 do. November Stamford Road do. do. 3/6 do. November Dorset Road (3 houses) do. do. 7/- do. November Cleves Road (3 houses) do. do. 8/6 do. November Holme Road do. do. 3/6 do. November Derby Road do. do. 3/6 do. November Ashley Road do. do. 3/6 do. November Halley Road do. do. 3/6 do. November Barking Road do. do. 3/6 do. November Sherrard Road do. do. 3/6 do. November Alverstone Road (2 houses) do. do. 7/- do. November Cleves Road do. do. 3/6 do. November Walton Road do. do. 10/- do. December Parr Road do. do. 4/6 do. December Browning Road do. do. 3/6 do. December Parr Road do. do. 4/6 do. December Browning Road do. do. 3/6 do. 139 PROSECUTIONS UNDER SHOPS ACT DURING 1925. Date. Offence. . £ s. d. January Grocers' and Provision Dealers' Closing Order, 1923 0 10 0 January do. 0 10 0 January Shops (Early Closing) Act, 1920 Withdrawn January do. 0 10 0 January do. 0 10 0 January do. 0 10 0 February Grocers' and Provision Dealers' Closing Order, 1923 0 10 0 February do. 0 10 0 February do. 0 10 0 February Shops (Early Closing) Act, 1920 0 10 0 February do. 0 10 0 February do. 1 0 0 February Grocers' and Provision Dealers' Closing Order, 1923 . 0 10 6 February do. 0 10 0 February do. 0 10 0 February do. 0 10 0 February do. 0 10 0 February do. 0 10 0 February do. 0 5 0 February Assault on Inspector 2 0 0 February Shops (Early Closing) Act, 1920 1 2 0 February do. 0 12 0 March Grocers' and Provision Dealers' Closing Order, 1923 0 5 0 March Shops (Early Closing) Act, 1920 0 15 0 March do. Withdrawn 2/6 costs March do. 0 10 0 March do. 0 10 0 March Grocers' and Provision Dealers' Closing Order, 1923 0 10 0 140 Date. Offence. Fines. £ s. d. March Shops (Early Closing) Act, 1920 0 10 0 March do. 1 0 0 March Grocers' and Provision Dealers' Closing Order, 1923 0 10 0 March do. 0 10 0 March Shops (Early Closing) Act, 1920 3 0 0 March do. 1 0 0 July Grocers' and Provision Dealers' Closing Order, 1023 0 10 0 July Shops (Early Closing) Act, 1920 1 0 0 July do. 1 3 0 July do. 2 0 0 September do. 0 10 0 September do. 0 10 0 September do. 0 10 0 September do. 0 10 0 September do. 0 10 0 November do 0 10 0 November Grocers' and Provision Dealers' Closing Order, 1923 0 10 0 November Shops (Early Closing) Act, 1920 0 10 0 November do. 0 10 0 November do. 0 10 0 November do. 0 10 0 November do. 0 15 0 November do. 0 10 0 November do. 0 10 0 December do. 0 10 0 December do. 0 10 0 December do. 0 10 0 December Grocers' and Provision Dealers' Closing Order, 1923 0 10 0 December Shops (Early Closing) Act, 1920 0 10 0 141 PROSECUTIONS UNDER THE SALE OF FOOD AND DRUGS ACT FOR THE YEAR 1925. Date. Offence. Result. January Margarine without proper wrapper Fined 40/- Costs 10/6 March Milk—33 per cent. deficiency Dismissed— Warranty defence March do. —25 per cent. deficiency do. May Giving false warranty Dismissed May Hot milk 8 per cent. added water Summons not served 142 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises Number of Inspections Written Notices Prosecutions (1) (2) (3) (4) Factories (including Factory Laundries) 28 2 — Workshops (including Workshop Laundries) 153 5 — Workplaces (other than Outworkers' premises) — — — 181 7 — 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H M. Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 6 5 — — Want of ventilation — — — — Overcrowding — — — Want of drainage of floors 2 2 — — Other Nuisances 21 20 — — Sanitary accommodation insufficient 1 1 — — unsuitable or defective — — — — not separate for sexes — — — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health Factories and Workshops Transfer of Powers) Order, 1921) — — — — Total 30 28 — — * Including those specified in sections 2, 3, 7 and 3 of the Factory and Workshop Act, 1901 as remediable under the Public Health Acts. 143 The Following is a Record in Detail of the Inspections made during the Year 1925:— 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 360 16 155 16 242 91 292 174 94 ... 236 51 299 81 167 8 101 ... 181 109 2127 546 Factory and workshop premises inspected 11 ... 6 ... 22 ... 26 ... 6 ... 27 ... 49 ... 22 ... 6 ... 6 ... 181 ... Outworkers' premises inspected 1 ... 12 ... 42 ... 27 ... 5 ... 45 ... 35 ... 12 ... 17 ... 16 ... 212 ... Bakehouses inspected 9 ... 6 ... 5 ... 9 ... 10 ... 19 ... 11 ... 2 ... 4 ... 6 ... 81 ... Slaughter-houses inspected 200 ... ... ... 109 ... 109 ... ... ... ... ... 18 ... 1 ... ... ... 17 ... 454 ... Dairies inspected 6 ... 20 ... 12 ... 9 ... 5 ... 16 ... 15 ... 9 ... 12 ... 12 ... 116 ... Urinals inspected 25 ... 9 ... 2 ... 11 ... 6 ... 3 ... 16 ... ... ... ... ... 18 ... 90 ... Walls and ceilings dirty and dilapidated 51 29 113 100 81 150 110 147 76 ... 116 121 125 168 114 60 51 11 149 266 986 1052 Yards improperly paved and dilapidated 13 26 40 51 12 33 5 17 15 ... 13 20 20 35 24 9 7 1 13 33 162 225 No forecourt paving 4 8 7 26 4 58 9 72 6 ... 1 15 3 1 2 20 ... ... 2 2 38 202 Defective drains 3 ... 5 ... 1 ... 1 ... 3 ... 2 ... 1 1 ... ... ... ... 1 ... 17 1 Defective w.c. connections 2 ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... 1 ... ... ... 6 ... Defective w.c. traps 2 4 7 2 2 1 1 ... 1 ... 1 2 8 1 ... ... 2 ... 6 7 30 17 Defective flushing apparatus 8 9 23 13 9 11 10 11 14 ... 15 5 21 23 14 8 11 4 25 36 150 120 Soil pans foul and broken 2 6 14 9 5 23 10 34 4 ... 7 18 11 11 6 2 3 ... 12 16 74 119 Defective vent pipes 3 4 13 11 3 8 2 12 8 ... 12 5 10 21 9 3 7 1 6 11 73 76 R.W. pipes and eaves gutters defective 23 12 59 85 25 17 27 22 38 ... 46 28 55 78 48 50 19 9 63 139 403 440 Do. connected to drain ... ... 2 1 ... ... 1 1 ... ... ... 7 ... 1 ... 3 ... ... ... ... 3 13 Roofs leaky 31 8 52 18 41 51 48 46 36 ... 52 37 103 63 64 39 15 ... 69 98 511 360 Defective sink waste pipes 5 7 12 25 4 4 7 1 8 ... 12 5 15 31 14 11 2 2 19 38 98 124 Houses without water (M.W.Bd.) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cisterns without covers ... ... ... ... ... ... ... 2 ... ... 1 ... ... ... ... ... ... ... l ... 2 2 Drinking water improperly stored 5 ... 4 ... 1 26 ... ... 3 ... 1 ... 2 4 3 ... ... ... 1 6 20 36 Dilapidated floors 9 7 26 81 7 8 10 8 11 ... 15 10 12 10 9 11 2 ... 30 31 131 166 Insufficient underfloor ventilation 8 12 20 10 2 13 1 10 5 ... 10 9 14 39 9 4 1 1 14 43 84 141 Dampness 27 5 56 35 22 18 28 23 41 ... 33 15 92 39 51 28 18 ... 59 86 427 249 Accumulations 7 ... 12 4 15 ... 6 ... 6 ... 17 ... 22 15 21 ... 1 ... 21 21 128 40 Defective sashcords and windows 17 11 43 50 23 36 20 27 28 ... 29 23 38 64 28 23 18 ... 69 127 313 361 Overcrowding 1 ... 14 ... 2 ... 3 ... 3 ... 5 1 3 1 ... 2 ... ... 8 9 39 13 Unsound food 2 ... 1 ... 47 ... 7 ... ... ... 3 ... 5 ... ... ... ... ... 1 ... 66 ... No dust bins 9 7 10 14 9 28 3 36 9 ... 16 36 22 48 18 17 11 ... 37 71 144 257 Defective stoves 11 3 37 17 19 33 25 51 18 ... 27 19 27 29 23 10 8 1 33 44 228 207 Defective coppers 3 7 21 32 8 13 12 27 15 ... 12 28 16 28 17 7 8 1 20 32 132 175 Animals improperly kept ... ... 2 3 2 ... 2 1 1 ... 5 ... 1 1 4 1 ... 1 ... ... 17 7 Temporary buildings found ... ... 2 ... 1 ... 1 ... ... ... 1 ... 2 ... 1 ... ... ... ... ... 8 ... Smoke nuisances 2 ... 3 ... 3 ... 3 1 3 ... 4 ... 24 1 2 ... 1 ... 3 ... 48 2 Rear passages unpaved or undrained ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gipsies ... ... ... ... ... ... ... ... ... ... ... ... ... ... 107 ... ... ... 20 ... 127 ... Breaches of Bye-Laws and Regulations 3 ... ... ... ... ... 1 ... ... ... ... ... 3 ... ... ... ... ... ... ... 7 ... Other nuisances 62 35 129 89 46 54 95 42 84 ... 105 112 126 51 151 85 46 6 109 182 953 656 Drains unstopped and cleansed 77 ... 236 ... 116 ... 109 ... 139 ... 173 ... 362 ... 190 ... 64 ... 276 ... 1742 ... Drains tested 14 ... 31 2 8 ... 18 ... 11 ... 25 ... 21 ... 23 ... 21 ... 27 ... 199 2 Inspections 493 83 457 133 448 319 496 391 253 ... 496 205 644 362 443 97 199 16 510 522 4439 2128 Total Inspections 576 590 767 887 253 701 1006 540 215 1032 6567 144 INDEX. A. Abatement of Nuisances 120 Abbatoirs 128, 129, 143 Acreage 18 Acts of Parliament 26, 27 Adenoids 51, 69, 74, 78, 79, 89, 94, 106 Air temperature 63 Alleys 122 Altitude 19 Ambulances 22 Antitoxin 32, 35, 47 Area 18 Assessable value 18 Attendance Officers, co.-op of 85 Aural Clinic 94 B. Bacteriological Laboratory 32, 47 Bakehouses 130, 143 Baths 85 Births 18, 54 „ Illegitimate 18 „ Still 54 Birth-rate 5, 6, 7, 18, 19, 54, 56 Blind persons 30, 86, 109, 111 Boundaries 19 Bye-laws 27,28,91,115 C. Cancer 62 Cerebro-Spinal Meningitis 34,61 Chart, birth-rate, 21 yrs. 7 ,, death-rate, 21 yrs. 8 ,, Infantile Mortality, 21 yrs. 9 ,, Enteric Fever, 31 yrs. 15 ,, Tuberculosis, 11 yrs. 16 ,, Zymotic death-rate, 21 yrs. 10 ,, Relative fatality, 20 yrs. 11 „ Notifiable Diseases, 21 yrs. 12 ,, Scarlet Fever and Diphtheria, 31 yrs. 13 ,, Scarlet Fever and Diphtheria Mortality, 31 yrs. 14 ,, Tuberculosis death- rate, 21 yrs. 17 Chicken-pox 77 Children, Medical Inspection of 67, 69, 70, 71, 88, 89, 90, 104-115 Chorea 31 Cinemas and Music Halls 25, 132, 133 Cleanliness of School Children 70, 72 Clinic, Ante-Natal 20, 54 Clinics, Infant 20, 50, 53 Clinics, School 21, 38, 70, 79 Climate 63 Closing Orders (Shops) 28 Common Lodging Houses 136 Communicable Diseases (non- notifiable) 77, 78- Complaints of Nuisances 120 Contagious Diseases (Animals) Act 131 Continuation Schools 91 Convalescent treatment 31, 32, 82, 83, 96 Co-ordination 59, 69 Cowsheds 128 Cripples 76,81,107110 D Dairies 127, 128, 143 Day Nursery 20 Deafness 76, 86, 94, 109, 111 Deaths, Causes of 11, 62 Deaths, No of 18, 62 Death-rate, General 5, 6, 8, 18, 19 Death-rate, Infantile 5, 6, 9, 19, 55, 56 Death-rate, Tuberculosis 6 Death-rate, Zymotic 6, 10, 19 Deaths in Large Towns 19, 56 Dentistry 52, 53, 76, 81, 100, 101, 107 Diarrhoea 19, 52, 56, 62 Diphtheria 13, 14, 33, 46, 61, 62 Dirty premises 143 Disinfection 35, 123 Dispensary 21, 42, 43, 80 Dispensary attendances 43 Drainage works 143 Dust Bins 120,125,143 E Ear Disease 51, 74, 76, 80, 89, 94, 106,113 Employment of Children 91 Encephalitis Lethargica 34, 61, 62 Enteric Fever 15, 34, 47, 61, 62 Epileptic Children 86, 109, 110, 111 Erysipelas 34, 47, 61 Exclusions 78 Explosives Act 132 Eye Diseases of School Children 31, 74, 75, 89, 96, 106, 113 Eye, External Inflammation of 51, 75, 78, 80, 113 F Factory and Workshop Act 124, 142, 143 Following-up 78, 82 Food and Drugs Act 130, 133, 134, 135, 136 Food inspection 127, 129, 130 Food supply 129, 130 Food, Unsound and Diseased 130, 143 Foot and Mouth Disease 131 145 INDEX—continued g Gipsies 143 Glands, enlarged 51, 89, 106 H Harts Sanatorium 21, 37, 40, 43 Health propaganda 22 Health Week 22, 39 Hearing of School Children 51, 76, 80, 89, 94, 106, 113 Heart Diseases 31, 51, 62, 90, 107 Hospital accommodation 21, 79, 80, 97, 114 Hospital, Children's 79 Hospital Staff, Health of 48 Hospitals, Maternity' 21, 55 House Refuse removal 124 House to House inspection 120, 122 Housing 5, 6, 126, 127 I Imbecile Children 86, 109 Impetigo 74,75,78,113 Increase of Rent (Restriction) Acts 122 Infant Consultations 50 Infantile Mortality 5, 6, 9, 19, 55, 56 Infectious Diseases 12, 14, 34, 35, 56, 61, 76, 77, 123 Infectious Diseases (non-noti- fiable) 77, 78 Influenza 34, 62 Inspection of Borough 118, 119, 121, 143 Inspection of School Children 67, 69, 70, 71, 88, 89, 90, 104-115 Invalid Children's Aid Association 30, 57, 67, 83, 84 isolation Hospital 21, 45 K Kinemas 25, 132, 133 L Laboratory work 32, 47 Legal proceedings 115, 130, 133, 134, 137, 141 Licences, Contagious Diseases (Animals) Act 131, 132 Licences, Petroleum 132 Lung Diseases 16, 31, 36, 51, 61, 62, 75, 80, 90, 107, 110 Lupus 38 M Malaria 34, 61 Malnutrition 31, 89, 106, 110 Market places 118, 129 Maternity and Child Welfare 9, 20, 50-59 Maternity Homes and Hospitals 21, 55 Meals, provision of 85 Measles 19, 47, 52, 62 Meat Regulations 128 Medical examination 32, 91 Mental defects of School Children 86, 109 Mental Defectives, Statutory supervision 30 Mental Defectives, voluntary care 30 Mental Deficiency 29, 30, 86, 109, 111 Meteorology 63 Midwifery 20, 57 Milk and Cream Regulations 130, 131 Milk, Free supplies 39, 58 Milk Order 128 Mortuaries 136 Mumps 52, 77 Music Halls 132, 133 Myopia 96 n Nervous Diseases 90, 107 Notices served 120, 126, 127 Notification of Births 54 Notification of Infectious Diseases 12 Nuisances abatement 118, 121 Nuisances discovered 120, 143 Nursing arrangements 20 Nursery Schools 87 0 Offal collection 123 Offensive trades 123 Open-air Education 82, 83 Ophthalmia Neonatorum 54, 57, 61 Ophthalmic Clinic 96 Orders 26 Orthopaedic treatment 81 Outdoor Relief 33 Outworkers 124, 143 Overcrowding 6, 143 P Parents, co-operation of 85 Passages 122 Petroleum Licences 132 Physical training 85 Playground classes 82 Pneumonia 34, 61, 62 Polio-Myelitis 61 Population 18 Pre-tubercular patients 43, 110 Prosecutions, Public Health Act 137, 138 146 INDEX- -continued Prosecutions, Sale of Food and Drugs Act 139, 140, 141 Prosecutions, Shops Act 139, 140 Provisional Orders 26 Puerperal Fever 34, 58, 61, 62 R Rainfall 63 Rateable Value 18 Rat extermination 132 Refraction cases 96, 114 Refuse Removal and Disposal 124, 125 Regulations 27, 28, 128 Re-inspection 70, 88, 104 Rent (Restriction) Act 122 Rickets 31, 52, 90 Ringworm 52, 74, 78, 113 Roofs, leaky 143 s Sale of Food and Drugs Act 130, 133, 134, 135, 136 Sanatoria 21, 32, 37, 40, 43 Scabies 74,78,113,123 Scarlet Fever 13, 14, 33, 45, 61, 62 School Attendance Officers' Co-operation 85 Baths 85 Camps 82 ,, Children, Blind 86, 109 „ Cripples 76,81,107,110 ,, Children, Diseases of Nose and Throat 51, 69, 74, 78, 79, 89, 94, 106, 114 „ Children Defective Speech 89, 107 ,, Children, exclusions 78 ,, Children, general cleanliness 70, 72 Children, Heart Diseases of 90, 107, 110 Children, Hearing 51, 76, 80, 89, 94, 106, 113 ,, Children, Nutrition of 31, 85, 89, 106, 110 Children Physical Training of 85 ,, Children, Skin Diseases of 31, 51, 75, 78, 80, 89, 106, 113 ,, Children, Teeth of 52, 53, 76, 81, 100, 101, 107, 115 ,, Children, Minor Ailments 74, 79, 113 Children, No of Medical Examinations 67, 70, 71 ,, Children, Verminous Conditions 33, 72, 73, 74, 78, 115, 123 „ Continuation 91 School Dentistry 52, 53, 76, 81, 100, 107 ,, Hygiene 70 ,, Meals 78, 85 ,, Medical Treatment 21, 78, 79, 80, 81 Nursery 87 ,, Open-air 82, 83 ,, of Recovery 82, 83, 84, 86 Secondary 87 Schools, Survey of 70 Sheep Dipping Order 132 Shops Act 133,134 Skin Diseases 31, 51, 75, 78, 80, 89, 106, 113 Slaughter Houses 128, 129, 143 Small-pox 21, 33, 62 Smoke abatement 123 Special enquiries 91 Special examination 91, 105 Spectacles, supply of 114 Speech, defective 89,107 Sputum examination 32, 38 Squint 96, 114 Staff 4, 37, 66 Subsoil 19 Summary of Report 18 Surgical appliances 32, 38 Swimming 85 Swine Fever 132 T Table—Air temperature 63 ,, Birth-rate 6, 19, 54, 56 Causes of Death 62 ,, Clinic, Treatment at 50, 51, 52, 53, 113, 114, 115 Comparative Statistics 6, 19 ,, Complaints received 120, 121 ,, Deaths 6, 19, 36, 45, 61, 62 Dental Treatment 53, 90, 100 ,, Eye examinations 89, 106, 109, 113, 114 Exceptional children 109, 110 Exclusion Forms issued 78 Factories and Workshops 142, 143 Food and Drugs Act, Legal Proceedings 141 ,, Housing 126, 127 Infantile Mortality 55, 56 ,, Infectious Cases notified 35, 61, 77 ,, Infectious Cases removed to Hospital 45, 61 ,, Maternity and Child Welfare 53, 54, 103 ,, Medical Help 58 147 INDEX—continued Table—Mental Defectives 109 Meteorological record 63 Minor ailments 74, 113 Notifications 35, 36, 61 ,, Nuisances 143 ,, Public Health Act prosecutions 137 ,, Rainfall 63 „ Records of Inspections 88, 89, 90, 100, 103, 104, 106, 107, 109, 110, 119, 143 ,, Refuse Collection 125 School Children Crippled 90,107,110 School Children, Defects of 71, 74, 78, 89, 90, 100, 106, 107, 109, 110, 113, 114, 115 „ School Children examined 70, 71, 104 „ School Children excluded 78 ,, School Children found to require treatment 107 „ School of Recovery admissions 84 „ Secondary School examinations 88, 89, 90 „ Shops Acts prosecutions 133, 139, 140 ,, Tuberculosis deaths 36 „ Tuberculosis 36, 42, 61, 90, 107, 110 „ Tuberculosis Dispensary cases 42 ,, Tuberculosis Notifications 36 „ Venereal Diseases 60 Verminous condition of School Children 72, 73, 115 ,, Vision of School Children 89, 106, 109, 113, 114 Tables, Notes to 104, 105, 108, 111, 112, 115, 116 Teaching Staff, co-operation of 85 Teaching Staff, Medical Examination 91 Teeth of School Children 52, 53, 76, 81, 100, 101, 107, 115 Temperature 63 Throat affections 51, 69, 74, 78, 79, 89, 94, 106 Tonsils 51, 69, 74, 78, 79, 89, 94, 106 Trade Refuse, removal of 125 Training Centre, Mental Defectives 29 Transit, Means of 19 Tuberculosis 16, 31, 36, 61, 62, 75, 80, 90, 107, 110 Tuberculosis Death-rate 6, 17 Tuberculosis Deaths 36 Tuberculosis Dispensary 21, 42, 43, 80 Tuberculosis, Treatment of 21, 37-44, 110 Tuberculosis Visits 43 u Unsound Food 130, 143 Urinals 121, 126, 143 v Venereal Diseases 21, 60 Verminous condition of School Children 33, 72, 73, 74, 78, 115, 123 Vision of School Children 31, 74, 75, 80, 89, 96, 106, 113 Visits, Nurses 43, 53, 54, 70, 78 Voluntary workers 29, 30, 86 w Whooping Cough 19, 52, 56, 62, 77 Workshops 124, 142, 143 x X-ray treatment 38, 52, 59, 80 z Zymotic Deaths 6, 10, 14, 19, 61