AC 44113 EAS 2 COUNTY BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report on the Health and Sanitary Condition of the Borough, AND THE SCHOOL MEDIAL SERVICE, by W. BENTON, M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health. School Medical Officer. General Medical Superintendent and Chief Administrative Officer to the Borough Hospital and Sanatorium. Chief Tuberculosis Officer. Chief Medical Officer Maternity and Child Welfare Centre. Medical Officer to Committee for Care of the Mentally Defective. Medical Officer, Blind Persons Act. together with the report of the CHIEF SANITARY, FOOD & SHOPS INSPECTOR, For the Year ended 31st December, 1926. recorders, ilford. 1927. COUNTY BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report on the Health and Sanitary Condition of the Borough, and THE SCHOOL MEDICAL SERVICE, by W. BENTON, M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health. School Medical Officer. General Medical Superintendent and Chief Administrative Officer to the Borough Hospital and Sanatorium. Chief Tuberculosis Officer. Chief Medical Officer Maternity and Child Welfare Centre. Medical Officer to Committee for Care of the Mentally Defective. Medical Officer, Blind Persons Act. together with the report of the CHIEF SANITARY, FOOD & SHOPS INSPECTOR, For the Year ended 31st December, 1926. recorders, ilford. 1927. EAST HAM CORPORATION. PUBLIC HEALTH COMMITTEE. Also Committee under Blind Persons Act, 1920, Sec. 2. *The Mayor (Councillor E. Shanahan, J.P.). *The Deputy-Mayor (Councillor G. W. Boultwood). *Councillor P. Y. Gerrard (Chairman to February). *Alderman W. G. Davie, J.P. (Chairman from February). *Alderman F. P. Cross (Vice-Chairman). Alderman E. Edwards, J.P. Alderman H. Osborn, J.P. Councillor Mrs. H. Allwright. *Councillor C. W. Brading. *Councillor J. Brooks, J.P. *Councillor G. W. Durant. Councillor H. B. Harper, J.P. *Councillor G. Manser. *Councillor W. T. Newling. Councillor A. Rhodes. *Councillor H. N. Ridler. *Councillor Mrs. E. J. Tungate. • Also Members of the Hospital, Sanatorium and Sewage Works Sub-Committee. MATERNITY AND CHILD WELFARE COMMITTEE †‡The Mayor (Councillor E. Shanahan, J.P.). †‡The Depdty-Mayor (Councillor G. W. Boultwood). †‡Councillor Mrs. M. Ridler (Chairman). †‡Councillor Mrs. H. Allwright (Vice-Chairman). Alderman E. Edwards, J.P. Alderman W. C. Ford, J.P. Councillor E. Anderson. Councillor G. W. Durant. †‡Councillor Mrs. E. J. Tungate. Councillor H. R. Wing. ‡Miss E. R. Davies (co-opted). †‡Mrs. A. A. Dean (co-opted). †Mrs. L. K. Gerrard (co-opted). †‡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 (Councillor E. Shanahan, J.P.). The Deputy-Mayor (Councillor G. W. Boultwood). Councillor P. Y. Gerrard (Chairman to February). Alderman F. Webster (Chairman from February). Mrs. A. McGiff (co-opted) (Vice-Chairman). Alderman T. M. McGiff. Councillor E. Anderson. Councillor J. Brooks, J.P. Councillor Mrs. M. Ridler. Councillor Mrs. E. J. Tungate. Councillor H. R. Wing. Mrs. G. Banks-Martin, J.P. (co-opted.) Mrs. C. J. Cross (co-opted). Mrs. T. M. Twitchett, J.P. (co-opted). WHOLE-TIME STAFF OF THE PUBLIC HEALTH. DEPARTMENT. Clerks: Miss D. Gordon, Miss D. Scarborough, L. F. Read, *W. Lank, *H. G. Luckett, A.R.San.I., *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: *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. Redclote, Certified Midwife. *Mrs. A. A. Woodman, S.R.N., M.R.San.I., Certified Midwife (Senior), Tuberculosis Dispensary Clerk: *Miss V. Reid. Assistant Nurse: Miss A. Meadhurst. Tuberculosis Nurses: *Miss L. E. Mallon, S.R.N., *Miss E. E. Cook, S.R.N., Certified Midwife. Matron of Isolation Hospital: Miss H. M. McLoughlin, S.R.N. Matron of Harts Sanatorium: *Miss M. R. Small, S.R.N., Certified Midwife. Shops Act Inspector: C. H. Pursall, A.R.San.I. Assistant Sanitary Inspectors: W. S. C. Tooby, A.R.San.I., M.S.I.A., W. J. Worley, A.R.San.I., M.S.I.A., W. H. Thurston, R.P., A.R.San.I., M.S.I.A. Sanitary and Food Inspectors: *R. A. Baskett, M.S.I.A. *M. J. J. Hillyard, M.S.I.A., *G. D. Lill, M.S.I.A., Chief Sanitary, Food and Shops Act Inspector, Inspector Contagious Diseases (Animals) Act and Supt. Befuse 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: *Elsie Thomson, M.B., Ch.B. Tuberculosis Officer and Besident 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 Besident 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 Mcdical 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 upon the health and sanitary condition of the Borough for the year 1926, together with my report as School Medical Officer. The death rate shows a further reduction, from 10'6 in 1925, to 9.6 in 1926, whilst the rate of infant mortality (56 per 1,000 registered births) is still satisfactory. It should not be assumed from these figures that all is well in the Borough, as the housing conditions are still far from being satisfactory.. The birth rate still shows a further decline, being 17.1 per 1,000 of estimated population as compared with 17.3 in 1925 and 20.3 in 1921. The Maternity and Child Welfare Department still continues to do excellent work, as will be seen by the record of attendances at the various infant welfare clinics, but is still handicapped by under-staffing of Health Visitors. The School Medical Service also still carries out its duties in a most satisfactory manner, but I would remind the Council that defects are found at the medical inspection of entrants which might have been prevented if the staff of Health Visitors was sufficient to supervise the children up to school age. Again I beg to call attention to the scandalous overcrowding on the District Railway during the early morning and evening. Adequate means of transit are not available during these hours, and during epidemics, such as Influenza, this overcrowding is a menace to the inhabitants of the Borough as a means of spread of infection. 6 Statistics for 1904 and the past six years are given below, for comparison:— 1904 1921 1922 1923 1924 1925 1926 Death Rate 14.7 10.1 11.0 9.0 9.7 10.6 9.6 Birth Rate 31.8 20.3 21.0 19.4 18.3 17.3 17.1 Infant Mortality 154 67 62 51 54 53 56 Zymotic death rate 2.9 0.57 0.66 0.3 0.38 0.4 0.6 Pulmonary losis death rate 1.68 0.85 0.95 0.88 0.78 0.90 0.96 I wish to express my indebtedness to all the members of my staff for their support and loyalty in the way they have carried out their duties. I am, Your obedient Servant, W. BENTON. 7 Summary of Report for 1926. 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 1926, 1146,600. Census, 1921 :— Number of inhabited houses 27,024 Number of families or separate occupiers 33,937 Ward Population. Manor Park 14,906 Little Ilford 17,542 Woodgrange 13,894 Plashet 14,640 Kensington 12,910 Castle 15,360 Central 15,456 Wall End 15,010 Greatfield 11,634 South 15,248 Rateable Value :— Borough Rate £647,400 Assessable Value :— General District Rate £604,900 Sum represented by a Penny Rate :— Borough Rate £2,617 net. General District Rate £2,444 net. 2. EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total number of births, 2,505 (males 1,274, females 1,231). Total number of illegitimate births, 64. Birth-rate, 17*1. Deaths, 1,410 (males 751, females 659). Crude Death-rate, 9'62. 8 Number of women dying in, or in consequence of, childbirth : from sepsis, 2; other causes, 3. Deaths of Infants under one year of age per 1,000 births registered: legitimate, 55; illegitimate, 78; total, 56. Deaths from Measles (all ages), 30. Deaths from Whooping Cough (all ages), 7. Deaths from Diarrhoea (under 2 years of age), 21. Zymotic Death-rate, 0'6. COMPARATIVE STATISTICS. Annual Rate per 1,000 Living. Rate pei 1,000 registered Births. Births. Deaths. Diarrhœa & Enteritis (under 2 years). Infant mortality. England & Wales 17.8 11.6 8.7 70 105 Great Towns 18.2 11.6 11.8 73 London 17.1 11.6 11.8 64 EAST HAM 171 9.6 8.4 56 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. 9 COUNTY BOROUGH OF EAST HAM PUBLIC HEALTH DEPARTMENT. REPORT of the MEDICAL OFFICER OF HEALTH For the year 1926. 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 26 Nurses of the Plaistow Maternity Charity, in addition to 12 Midwives who have private practice in the Borough, and 5 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. 40—56. Infant Consultations and Ante-Natal Clinics are conducted daily. Branch Clinics are also held once a week at Wesleyan Church Hall, Manor Park; St. John's Schoolroom, North Woolwich ; and St. George's Hall, Masterman Road. At the present time there is no Day Nursery in the Borough. The School Clinics are referred to in the report on the School Medical Service pp. 74—76. 10 Tuberculosis Dispensary, Wakefield Street. Tuberculosis Officer in attendance one morning, three afternoons and one evening session each week. For report see pp. 27—30. Venereal Diseases. East Ham forms a part of the joint scheme with the London County Council. For summary, see page 57. 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-benzol compounds. HOSPITALS PROVIDED OR SUBSIDISED BY THE LOCAL AUTHORITY 1. Tuberculosis. Harts Sanatorium, Woodford Green, has accommodation for 51 patients (for report see pp. 33—35). 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. 35—38). 4. Small-Pox. 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. AMBULANCE FACILITIES. (a) For Infectious Diseases.—Two motor ambulances are garaged at the Isolation Hospital. 11 (b) For non-infectious and accident cases.—A motor ambulance kept at the Fire Station, conveyed 1,047 cases to and from various hospitals. These consisted of 125 accidents and 922 cases of illness. 965 journeys were made, and 10,321 miles run. East Ham cases removed by other ambulances numbered 61, made up as follows: Barking, 33; Ilford, 19; West Ham, 9. HEALTH PROPAGANDA. The second Health and Civic Week, held from 14th to 21st October, was again a great success. Dr. Gibbons, Principal Assistant Secretary, Ministry of Health, performed the opening ceremony. The daily programmes consisted of appropriate lectures, which were well attended, and visits to various municipal undertakings. Various films dealing with health subjects were shown in the Baths Hall. Scholars from the schools also attended in the afternoons to witness special selections of Educational Films. The Exhibition was crowded each evening, and the visitors displayed a keen interest in the exhibits. 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. 12 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. Acts of Parliament Adopted. Name of Act adopted. Date of adoption. Date of coming into operation. Infectious Disease (Notification) Act, 1889 l2th 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, 11892 l8th June, 1895 1st Aug., 1895 Infectious Disease (Notification) Act, 1889 (Extension) Education (Provision of Meals) Act, 1906 24th Nov., 1908 24th Nov., 1908 Local Government and other Officers' Superannuation Act, 1922 17th July, 1923 1st Oct., 1923 Public Health Act, 1925, Part 2, Sec. 25 13th April, 1926 1st June, 1926 13 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. Defacing Pavements, etc. 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. 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. 14 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, l909. Lamps Marking Roads Obstructions. Provision of Means of Escape from Fire in case of certain Factories and Workshops. MENTAL DEFECTIVES. Work of the Voluntary Association. Visitation. The Essex Voluntary Association, in return for a grant, continues to carry out in the Borough the duties of ascertaining and supervising defectives under the Mental Deficiency Act, 1913. The Association also visits and befriends defectives who are not subject to be dealt with under the Act. Special reports for the East Ham Council, for the Board of Control and for the Visiting Justices on the home conditions of defectives are also made by the Association. The Association during 1926 has visited, befriended and reported quarterly to the East Ham Education Committee on feeble-minded children not in regular attendance at a special school. The need for an institution for the reception of urgent cases is very great. Without institutional accommodation it is not possible adequately to carry out the provisions of the Mental Deficiency Act, 1913. Training and Handicrafts. The woodwork centre at St. Barnabas Church Room has been held for 230 sessions. The number of boys on the register is 13 and the average attendance is 8. 15 The training centre for imbecile children (excluded from special school) and older girls at St. Michael's Institute, Manor Park, has been held for 132 sessions. There are 21 on register and the average attendance is 11. The Council pays the Association for two guides to bring the children to centres. Mental Hygiene. The Council allowed the Association a stall for handicrafts at the East Ham Health Week celebration. Brentwood Mental Hospital furnished exhibits as well as the Association's boys' class and the children's centre. A number of orders for rugs and stools was obtained at the stall and some propaganda was done. Dr. Doris Odium, National Council of Mental Hygiene, spoke one evening on the need for local clinics for advice and treatment of early mental disorder. Case Work. The following is an analysis of case work during the year ended 31st December, 1926 :— Sent to Institution under Order chargeable to the Borough Council — Placed under an Order of Guardianship 1 Placed under statutory supervision in their own homes 12 Removed to a place of safety pending the presentation of a petition 2 Referred by the Association to the Local Authority for action 8 At the close of the year there were :— 49 mental defectives under Order in certified Institutions. 4 of whom were on long leave of absence either with their own relatives or with foster-parents. 9 were under Order of Guardianship with their own relatives. 53 were under statutory supervision in their own homes. 64 were under voluntary care. 1 was on the waiting list for admission to Institution. 16 BLIND PERSONS ACT, 1920. There are now 144 technically blind persons known to belong to the Borough, 37 of whom are either children at Blind Schools or men and women at workshops, and these are visited during their holidays. During the past year the Home Visitor has paid 1,699 daily visits, 118 evening visits and meetings, and 354 lessons, of which 148 were in cane basket work, 73 in Braille, 52 in knitting, 48 in crochet and 33 in woollen ball making. The remainder of the blind are visited regularly and assisted to obtain free wireless licences and blind pensions. Many of them were able to show goods on the stall at Civic Week Exhibition held in October, to their benefit, as over 600 orders were taken for basket work, knitting, weaving, crochet, mat-making, etc., and the majority were executed and delivered before Christmas. Good work continues to be done by the members of the Local Welfare Association. Necessitous cases are promptly dealt with and every effort taken to make the lives of the blind brighter, such as summer outings, social evenings and supplying parcels at Christmas. Grants for clothing, extra nourishment, etc., are made as cases are brought to the notice of the officers. INVALID CHILDREN'S AID ASSOCIATION (East Ham Branch). The year has been marked by a steady increase in all directions and an increased number of cases (269) has been dealt with. A great proportion of the cases required lengthy periods of convalescence, and a considerably increased income has enabled the Association to meet all legitimate demands. During the 3¼ years of the work of the Branch 587 children from all parts of the Borough have been assisted. The co-operation with the Public Health Committee has again resulted in an increased number of cases being recommended for Sanatorium or Institutional Treatment through the agency of the Association. A serious factor has presented itself in the number of children suffering from Rheumatism and Chorea, with heart complications. 17 A special enquiry is being instituted with regard to this type of case, as prolonged and specialised treatment is necessary. The types of new cases dealt with during the year may be summarised as follows :— T.B. Lungs 15 Bronchitis and Asthma 15 ,, Spine 5 Paralysis 12 ,, Hips 10 Chorea 11 ,, Bones 7 Rheumatism 6 ,, Glands 16 Heart 4 Anaemia and Debility 55 Eye Diseases 5 Malnutrition 11 Various 5 In addition to the cases recommended from the Public Health Agencies of the Borough, Tuberculosis Dispensary, Welfare Centre and School Clinics, the large General Hospitals have continued to use the Association as Convalescing and Visiting Agent. In addition to a large number of cases from the Great Ormond Street and London Hospitals, the Association also co-operated with the Almoners of St. Bartholomew's Hospital, Queen Mary's Hospital, East London Hospital, Royal National Orthopaedic Hospital, Queen's Hospital, Balaam Street Hospital, Westminster Ophthalmic Hospital, Guy's Hospital, and National Heart Hospital. Help has been given during the year as follows :— Sent to Sanatoria or Special Hospitals 41 Convalescent Homes 127 Boarded out 10 Provided with surgical appliances 38 Invalid carriages 6 Hospital letters 2 Visiting and advice on behalf of Hospitals 27 Referred to other agencies 8 Food and Clothing Grants 10 Convalescent or institutional treatment has been arranged for varying periods according to medical advice at the following places :— 18 Alton, Ascot, Brighton, Bognor, Bushey, Banstead, Broadstairs, Clewer, Coldash, Church Crookham, Dover, Eastbourne, Folkestone, Hastings, Hayling Island, Harpenden, Kingsnorth, Kearsney (Dover), Margate, Northwood, Naylands, St. Leonards, Seaford, Seven Oaks, Tilford, Tunbridge Wells, Torquay, and Worthing. LABORATORY WORK. 1,032 Bacteriological examinations of "swabs" for suspected Diphtheria were undertaken in our own Laboratory. 261 "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. 64 examinations have been made during the year upon request of the various committees of the Town Council, in addition to 161 examinations conducted on behalf of the Education Committee as reported on p. 84. 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 Guardians in the East Ham Relief Districts was £168,889, as compared with £210,967 for the year ending December, 1925. PREVALENCE AND CONTROL OVER INFECTIOUS DISEASES. Small Pox. There has been no case of this disease in the Borough since 1920. From time to time I am notified of contacts, whose home address is in this Borough, with cases of Small Pox which have occurred on board ship coming into the Docks. These contacts are visited and kept under observation until the incubation 19 period is over, but it makes one anxious as the community is insufficiently protected against Small Pox, although one has no difficulty in persuading the contacts to be vaccinated or re-vaccinated. Scarlet Fever. The number of Scarlet Fever cases notified was 350, of which 307 were admitted to Hospital. Only 3 deaths occurred. Scarlet Fever has changed in character during the past 20 years, from being a disease of considerable severity to one of comparative mildness, and this accounts for the increased number of cases. A case is admitted to the Hospital, and upon enquiry into the source of infection one often finds another member of the family has had a mild attack, which has not been diagnosed. An adult was recently admitted to the Isolation Hospital who had such a mild attack that the patient was not diagnosed as suffering from Scarlet Fever until three weeks after the early symptoms and was discovered to be desquamating. In the meantime this patient had been travelling to business in overcrowded trains and probably spreading infection. No use has been made of the Schick and Dick tests in Diphtheria and Scarlet Fever. Diphtheria. 337 cases of Diphtheria were notified, with 21 deaths, as against 2-16 cases with 12 deaths in 1925. 330 cases were treated in Hospital, and for those cases treated at home the Corporation provided antitoxin free to all medical practitioners in the Borough for the patients who were unable to afford the cost. Free bacteriological examination of " swabs " from the nose and throat of suspicious cases and contacts are made for medical practitioners. The majority of practitioners take full advantage of this service, and it is only when they neglect to do so that serious cases are admitted, with unfortunate results, as the early administration of antitoxin is a sure remedy for the disease. Enteric Fever (Typhoid and Para-Typhoid). Seven cases were notified, of which 6 were treated in hospital. No deaths occurred. All the cases were contracted outside the Borough. One of the cases was a youth who had been visiting a relative in a country district—the relative being later found to be a carrier of the disease. 20 Erysipelas. 41 cases were notified, of which 12 were treated in hospital. There were 4 deaths from the disease. Puerperal Fever. Five cases were notified during the year. All were treated in various hospitals outside the Borough, with two deaths. Three cases were notified as suffering from Puerperal Pyrexia, but recovered without complications. Cerebro-Spinal Meningitis. Only one case was notified, that of a child under one year of age, but three deaths were registered as due to this disease—the deaths taking place in institutions, but not notified. Encephalitis Lethargica. One case notified—no deaths registered from the disease. Pneumonia. 70 cases of Pneumonia were notified, of which 28 were removed to Whipps Cross Hospital, or other general hospitals, but there were 111 deaths registered as due to the disease, the majority being a complication of Influenza. 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 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 21 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 1921-1920. Disease. 1921 1922 1923 1924 1925 1926 Small Pox — — — — — — Scarlet Fever 1355 502 170 215 221 350 Diphtheria 309 198 160 128 246 337 Enteric Fever (Typhoid and Para-Typhoid) 7 4 8 5 9 7 Erysipela 57 34 32 38 41 41 Puerperal Fever 5 3 5 5 5 5 Cerebro-Spinal Meningitis 4 — 1 1 1 1 Encephalitis Lethargica 7 — — 9 6 1 Ophthalmia Neonatorum 3 11 11 11 6 8 Dysentery 1 — — — — — Malaria 1 — 1 — 1 — Acute Polio Myelitis — — 3 1 1 — Anthrax — — — 2 — — 1749 752 380 415 537 750 Pneumonia 85 92 54 79 91 70 22 TUBERCULOSIS. Notifications, 1921-1926. 1921 1922 1923 1924 1925 1926 Pulmonary Tuberculosis 287 209 220 249 254 237 Other Forms do. 66 69 76 95 64 50 353 278 296 344 318 287 New Cases and Mortality during 1926. Particulars of new cases of tuberculosis and of deaths from the disease in the area during 1926 :— Age Periods. New Cases. Deaths. Pulmonary. Non-Pulm. Pulmonary. Non-Pulm. M. F. M. F. M. F. M. F. Under 1 — — — — — — 1 2 1—5 2 2 6 4 1 1 3 3 5 — 10 4 6 6 3 — — 1 — 10 — 15 3 5 5 4 — 2 1 1 15 — 20 13 19 2 4 2 12 1 — 20 — 25 15 19 3 1 11 10 — 1 25 — 35 24 48 — 2 10 17 — 3 33 — 45 27 12 4 1 14 11 — 2 45 — 55 14 12 — 2 9 6 — 1 55 — 65 8 3 2 1 7 2 1 — 65 and upwards 1 — — — 2 3 — 1 Totals 111 126 28 22 56 63 8 14 Public Health (Prevention of Tuberculosis) Regulations, 1925. No action has been taken with regard to tuberculous employees in the milk trade. 23 TABLE I.—TUBERCULOSIS SCHEME. Return showing the work of the Dispensary during the Year 1926. Diagnosis. Pulmonary. N on-Pulmonary. Total. (6) Adults. (c) Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases (7) examined during the year (excluding contacts) :— (a) Definitely tuberculous 70 60 6 8 9 9 7 7 79 69 13 15 (b) Doubtfully tuberculous (8) — — — — — — — — 51 35 13 13 (c) Non-tuberculous — — — — — — — — 23 7 8 4 B.—Contacts examined during the year :—- (a) Definitely tuberculous ... 9 19 1 1 2 2 3 — 11 21 4 1 (b) Doubtfully tuberculous (8) — — — — — — — — 10 30 18 27 (c) Non-tuberculous — — — — — — — — 12 25 30 35 C.—Cases written off the Dispensary Register (9) as (a) Cured (10) 1 1 — — 1 1 1 — 2 2 1 — (fc) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) — — — — — — — — 82 97 75 84 D.—Number of Persons on Dispensary sary Register (9) on December 31st (a) Diagnosis completed 372 329 64 38 75 60 107 62 447 389 171 100 (6) Diagnosis not completed — — — — — — — — 53 40 31 35 24 1. Number of persons on Dispensary Register)9) on January 1st 1346 2. Number of patients transferred from other areas and of " lost sight of "(,l) cases returned 30 3. Number of patients transferred to other areas and cases " lost sight of" 227 4. Died during the year 94 5. Number of observation cases(s) under A (6) and B (6) above in which period of observation exceeded 2 months 71 6. Number of attendances at the Dispensary (including Contacts) 3179 7. Number of attendances of non-pulmonary cases at Orthopaedic Out-stations for treatment or supervision — 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (а) " Light " treatment 293 (б) Other special forms of treatment — 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 10. Number of consultations with medical practitioners :— (а) At Homes of Applicants 18 (б) Otherwise 190 11. Number of other visits by Tuberculosis Officers to Homes 37 12. Number of visits by Nurses or Health Visitors to Homes for pensary purposes 3599 13. Number of (а) Specimens of sputum, &c., examined 807 (б) X-ray examinations made in connection with Dispensary work 19 14. Number of Insured Persons on Dispensary Register(°) on the 31st December 530 15. Number of Insured Persons under Domiciliary Treatment^) on the 31st December 181 16. Number of reports received during the year in respect of Insured Persons :— (а) Form G.P. 17 — (б) Form G.P. 36 355 25 NOTES TO TABLE I. (1) Public Medical Treatment.—Treatment at a dispensary or residential institution or " general supervision," under a scheme approved by the Minister of Health for the treatment of tuberculosis, of a person who has been diagnosed to be suffering from tuberculosis. (Note.—A patient under domiciliary treatment is regarded as also under " general supervision " by the Tuberculosis Officer.) (2) Patient.—A person who has been diagnosed to be suffering from tuberculosis and is under public medical treatment for tuberculosis. (The term does not include a person who is kept under observation pending the establishment of the diagnosis, and who is referred to in the Memorandum as an " observation case," but includes all persons on the Dispensary Register who are under " general supervision," even if not in receipt of any treatment.) (3) Dispensary Treatment.—Treatment by a Tuberculosis Officer in cases where the patient is seen not less frequently than once in every month, and is examined not less often than once in three months. (4) Domiciliary Treatment.—Treatment of an insured patient by his Insurance practitioner on the recommendation of the Tuberculosis Officer. (5) Year.—The calendar year ending on the 31st day of December. (6) Adults.—For the purposes of Tuberculosis Records all patients of 15 years and upwards are classed as adults. (7) New Cases.— (a) All persons examined for the first time at, or in tion with, the Dispensary, except definite cases of tuberculosis transferred from the areas of other local authorities. Persons seen in consultation, who will subsequently be dealt with by their own private practitioners, are included. (b) Persons who have been dealt with previously by the Dispensary and discharged as " cured," or provisionally diagnosed as not, at that time, suffering from tuberculosis, who return to the Dispensary as suspected cases of tuberculosis. (8) Observation Cases.—Persons attending at, or in connection with, the Dispensary, in whose cases the Tuberculosis Officer cannot, within a period of one month from his first examination of the case, come to a definite diagnosis after physical examination and the application of the necessary tests. In completing sections A and B, such cases are entered under sub-head (b) in each section. (9) Dispensary Register.—List containing names of all persons attending at, or seen in connection with, the Dispensary for diagnosis or for treatment for tuberculosis, including patients under " general supervision " (whether or not accompanied by 26 domiciliary treatment), and patients or observation cases in residential institutions, and " contacts." (This is distinguished from the Notification Register kept by the Medical Officer of Health.) (10) Cured.—Patients with tuberculosis are not deleted from the Dispensary Register as " cured " until in the case of nonpulmonary tuberculosis, 3 years, and in the case of pulmonary tuberculosis, 5 years, have elapsed without any symptoms of active disease (i.e., arrest has been maintained for 3 years). (11) Cases " lost sight of."—Patients who have failed to submit themselves for examination during two consecutive calendar years notwithstanding all efforts to trace them. These are written off the Dispensary Register at the end of the year. (Patients who afe known to have left the district permanently but who cannot be transferred to another local authority because their destination is not known, and patients seen only in consultation for the purpose of diagnosis, and others who desire no further assistance under the tuberculosis scheme for public medical treatment, are marked off at once.) 27 REPORT ON THE WORK OF THE TUBERCULOSIS DISPENSARY. From Table I. it will be noted that there has been a decrease of 80 in the number of persons on the Dispensary Register. This, however, is not to be interpreted that the disease is on the decrease in the Borough, rather is it otherwise, for the actual number of " patients," i.e., persons definitely known to be suffering from tuberculosis has increased by 57. The decrease in the number of persons on the register (80) is to be accounted for by cases " lost sight of," cases not confirmed at the Dispensary, or definitely nontuberculous. Thus during the year to the " live " register has been added 57 patients. Regulations 37/T.—As from 31st January, 1926, the new regulations of the Ministry of Health with regard to tuberculosis became operative. The purpose of these regulations is " to ascertain the extent and to estimate the value of the work done under the approved schemes of Local Authorities for the treatment of tuberculosis, and to obtain a uniform presentation of the facts for the country as a whole." Such a codification of statistics, together with a definition of duties and responsibilities, has long been necessary, and with time will serve not only as the basis of much valuable information, but also will provide an instrument which will strike a blow against the bulwarks of tuberculosis. Treatment.—The number of patients in receipt of " treatment " at the Dispensary is limited. Ordinarily medicinal treatment is undertaken at the hands of the medical practitioner; under special circumstances only is any treatment of this character undertaken at the Dispensary. Ancillary treatment, viz., artificial pneumothorax, tuberculin (diagnostic and remedial) and dental treatment is undertaken in connection with the Dispensary. In both the former modes of treatment provision is made in emergencies for immediate in-patient treatment, should recourse to such steps be rendered necessary. Dental treatment, however, is not undertaken on any scale worthy of consideration. The recent extension of benefits under the National Health Insurance Acts has been purposely utilised in this connection, and insured persons are recommended to make all possible use of any such extended benefits to which they may be entitled. 28 Residential Treatment.—An accession of 57 cases to the Tuberculosis Register demands the ready availability of beds, either at a Hospital, a Sanatorium or an institution for advanced cases if any attempt is to be made to deal effectively with the disease and more particularly the prevention of its spread. Hospital Cases.-—The Council does not reserve beds at any hospital for the treatment of the cases of acute Tuberculosis within the Borough ; but no case requiring hospital treatment for this reason is denied the benefit of such treatment. When such cases arise, their admission is arranged to and adequate treatment is provided by one of the recognised hospitals in London, usually Victoria Park Hospital for Diseases of the Chest. Financial responsibility is undertaken by the Council after a complete survey of the patient's economic status. For their cordial co-operation in this matter we would thank the authorities of the London hospitals—particularly those of Victoria Park Hospital. Sanatorium Cases.—The desideratum in dealing with early sanatorium treatment is the immediacy of such treatment. Delay in this matter spells disaster. The ready availability of beds forms again the crux of the matter. In addition to the numbers of new cases requiring sanatorium treatment for the first time, the number of old patients who after an initial period of treatment require further periods of sanatorium treatment—sometimes for the second and even the third time—tends to overburden the present accommodation for chest cases, particularly women cases at " Harts." It certainly urges the consideration of an increased accommodation for these cases if the desideratum in treatment is to be achieved. Advanced Cases.—The only institution available for the accommodation of these cases is Whipps Cross Hospital. Admission there is voluntary, but by recent enactments, the power of compulsory removal of tuberculosis patients to an institution is vested in a court of summary jurisdiction, at the instance of the local authority. During the year no action has been taken by the authority in this matter, due regard being paid to the circumstances of each case, but in cases of flagrant disregard of medical advice, constituting a definite menace to the health of other persons, this power of removal will be implemented forthwith. 29 Surgical Cases.—These are treated chiefly at Margate. The substitution of conservative for operative treatment in these cases necessarily prolongs the period of treatment. The usual period undertaken by this method for the arrest of " hip " cases is at least 18 months, for " spine " cases 2 years; other sites of infection take correspondingly long periods of treatment. Of spine cases there were 8 receiving treatment during the year ; hip cases numbered 15. This prolongation of the period of treatment necessarily prolongs the period during which the Council undertakes financial responsibility. Extra Nourishment.—This, in any form, is only granted after a survey of the whole of the patient's financial circumstances by a representative of the Borough Treasurer's staff. It includes the issuing of a voucher enabling the patient to obtain a free supply of pure milk from authorised agents. The amount is 1 pint of milk per patient per day. The number of patients in receipt of this throughout the year is 32. Another form is the issuing of certificates to the patients for presentation to the Relieving Officer. The value of this extra nourishment is about 5s. per week. This enables the patient to obtain supplies of eggs and milk and sometimes of butter. Thus the eligibility of patients from an economic standpoint is controlled by the Borough Treasurer, whilst the eligibility on medical grounds rests with the Tuberculosis Officer. Pre Tuberculous Children.-—Delicate children predisposed to Tuberculosis reach the Dispensary through either of two avenues, viz., their School Medical Service or the examination of contacts of notified cases. Such children as are definitely suspicious cases of Tuberculosis remain under observation at the Dispensary and, where necessary, resort is made to their admission to Convalescent Homes or Open-air Schools. In this matter of the ready transmission of cases and for their co-operation throughout the year we would thank the medical officers and nursing staff of the School Medical Service. That there is so very little delay in the admission of pre-tuberculous to Convalescent Homes and of notified cases to Sanatoria is due to the active sympathy and ready cooperation of the local branch of the Invalid Children's Aid Association, for whose continued support we are grateful. The routine work of the Dispensary is of necessity increasing. During the year the number of sputa examined was 807. This 30 year, for the first time, X-ray examinations have been undertaken in connection with the Dispensary. The number of attendances for " light " treatment is exceptionally high, viz., 293, despite the fact that the number of skin cases is low. This, however, is due to the exceptional course taken by a patient who in order to give the treatment every chance attended three times a week regularly for a prolonged period. The cordial intimate relationship existing between medical practitioners of the Borough and the Dispensary staff has helped the work of that staff enormously, and we hope that that relationship will continue. To the Nurses and clerical staff of the Dispensary is of course due both gratitude and thanks for their unassuming, tactful and efficient service throughout the year. TABLE II.—RESIDENTIAL INSTITUTIONS. (A) Average Number of Beds Available for Patients during the Year 1926. Observation. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Total. " Sanatorium " Beds. " Hospital " Beds. Disease of Bones and Joints. Other Conditions. Adult Males — 34 1 3 — 38 Adult Females — 19 1 3 — 23 Children under 15 — 17 — 14 — 31 Total — 70 2 20 — 92 (B) Return showing the Extent of Residf.ntial Treatment during the Year 1926. In Institutions on Jan. 1 Admitted during the year. Discharged during the year. Died in the Institutions . In Institutions on Dec. 31. Number of Pa- j tients Adults M. 35 92 91 — 36 F- 21 69 66 2 22 Children M. 20 16 18 — 18 F. 14 12 11 1 14 Number of Observation Cases Adults M. — — — — — F. — — — — — Children M. — — — — — F. — — — — — Total 90 189 186 3 90 31 TABLE III. Return showing the immediate results of Treatment of Patients* and of Observation of Doubtful Cases discharged from Residential Institutions during the Year 1926. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Under 3 months. 3-6 months. 6-12 months. More than 12 months. Total. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Pulmonary Tuberculosis. Class T.B. minus. Quiescent 2 2 6 1 _ 11 Improved 13 11 3 5 4 8 1 — 7 2 — 1 55 No material improvement 3 3 — — — 1 — — 1 — — — 8 Died in Institution — — — — — — — — — — — — — Class T.B. plus. Group 1. Quiescent 1 — — 1 1 — — — — — — — 3 Improved b 7 — 2 7 — 3 — — — — — 24 No material improvement 2 1 — — — — — — — — — — 3 Died in Institution — 1 — — 1 — — — — — — — 2 Class T.B. plus. Group 2. Quiescent 1 1 1 3 Improved 7 4 — 13 7 — 1 2 — 2 — — 36 No material improvement 5 5 — 2 1 — 1 4 — 2 — — 20 Died in Institution — — — — — — — — — — — — — Class T.B. plus. Group 3. Quiescent — — — — — — — — — — — — — Improved — 1 — 1 — — 1 — — — — — 3 No material improvement 4 2 — 2 — — — — — — — — 8 Died in Institution — — — — — — — — — — — — — *It should be borne in mind that the definition of " patient " does not include persons in whom a definite diagnosis of tuberculosis has not been made. 32 Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Under 3 months. 3-6 months. 6-12 months. More than 12 months. Total. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Non-Pulmonary Tuberculosis. ' Bones and Joints. Quiescent or Arrested Improved — — — — 1 2 — 1 — 1 — 2 7 No material improvement — — 1 — — 1 — — 2 Died in Institution — — — — — — — — — — — — — Abdominal. Quiescent or Arrested — — — _ — Improved — 1 1 No material improvement — — — — — — — — 1 — — — 1 Died in Institution — — — — — — — — — — — — — Lupus. Quiescent or Arrested Improved — — — ___ 1 i No material improvement — — — — Died in Institution — — — — — — — — — — — — — Peripheral Glands. Quiescent or Arrested Improved — — — — — — — — — — — — — No material improvement — — — — — — — — — — — — — Died in Institution ~ 1 — — — — 1 Under 1 week 1-2 weeks. 2-4 weeks. More than 4 weeks. Observation for purpose of diagnosis. Tuberculous — — — — — — — Non-tuberculous — — — — — — — — — — — — Doubtful — — — — — — — — — — — — 32a (a) Pulmonary Tuberculosis. Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the East Ham Dispensary at the end of 1926, arranged according to the years in which the patients first came under Public Medical Treatment for pulmonary tuberculosis, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926. 1926. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Alive. Discharged as cured. Adults. M. 1 — — — — — — — — — F. 1 — — — — — — — — — Children. M. — — — — — — — — — — F. — — — — — — — — — Disease arrested. Adults. M. 18 7 — — 7 — — — — — F. 25 1 — — 1 1 — — — — Children. M. 3 — — — — — — — — — F. 8 — — — — — — — — — Disease not arrested. Adults. M. 118 23 74 12 109 17 10 37 2 49 F. 110 12 52 3 67 23 15 17 2 34 Children. M. 63 — — — — 5 — — — — F. 37 — — — — 8 — — 1 1 Condition not ascertained during the Year. 67 9 17 — 26 — — — — — Lost Sight of or otherwise removed from Dispensary Register 65 iJ 1 6 7 2 4 — 6 Dead. Adults. M. 14 2 15 10 27 5 1 2 4 7 F. 12 1 5 4 10 4 2 4 2 8 Children. M. — — — — — — — — — — F. — — — — 1 — — — — Totals 530 60 164 29 253 71 30 64 11 105 32b (b) Non-Pulmonary Tuberculosis. Annual Return showing in summary form the condition of all Patients whose case records are in the possession of the Dispensary at the end of 1926, arranged according to the years in which the patients first came under Public Medical Treatment, and their classification as shown on Form A. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926. 1926. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. 1 Bones and Joints. i Abdominal. Other Organs. Peripheral Glands. Total. Alive. Discharged as cured. Adults. M. 1 — — — 1 — — — — — F. 1 — — — 1 — — — — — Children. M. — — — — — — — — — — F. — — — — — — — — — — Disease arrested. I Adults. M. 7 — 3 1 11 — — — — — F. 2 — 1 — 3 — — — — — Children. M. tl — 4 5 20 — — — — — F.. 1 — — 3 4 — — — — — Disease not arrested. Adults. M. 10 — 6 3 19 3 — 3 4 10 F. 10 — 5 6 21 1 — 2 4 7 Children. M. 20 2 4 53 79 5 1 2 3 11 F. 11 3 2 41 57 2 — 2 4 8 Transferred to Pulmonary 1 — — 6 7 — — 1 — 1 Condition not ascertained during the year. 22 3 6 23 54 — — — — — Lost sight of or otherwise re moved from Dispensary Register 5 1 2 6 14 — — — — — Dead. Adults. M. — — 1 — 1 — — —_ — — F. 3 — — — 3 — — — — — Chil- dren. M. — — — — — — — — — — F. 2 — — — 2 — — — — — Totals 107 9 34 147 297 11 1 10 15 37 33 HARTS SANATORIUM. Average Number of Beds Available for Patients at Harts Sanatorium Observation. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Total. " Sanatorium " Beds. " Hospital " Beds. Disease of Bones and Joints. Other Conditions. Adult Males — 30 — — __ 30 Adult Females — 19 — — — 19 Children under 15 — 2 — — — 2 Total — 51 — — — 51 Return Showing the Extent of Residential Treatment during the Year. In Institution on Jan. 1 Admitted during the year. Discharged during the year. Died in the Institution. In Institution on Dec. 31. Number of Patients Adults M. 30 88 88 — 30 F. 19 62 60 2 19 Children M. — — — — — F. 2 5 5 — 2 Number of Observation Cases 1 Adults M. — — — — — F. — — — — — Children M. — F. — — — — — Total 51 155 153 2 51 34 Return showing the' immediate results of Treatment of Patients and of Observation of Doubtful Cases discharged from Harts Sanatorium during the Year 1926. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Under 3 months. 3-6 months. 6-12 months. More than 12 months. Total. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Pulmonary Tuberculosis. Class T.B. minus. Quiescent 2 2 — 6 — — — — 1 — — — 11 Improved 13 10 2 5 4 1 1 — 1 1 — — 38 No material improvement 3 3 — — — — — — — — — — 6 Died in Institution — — — — — — — — — — — — — Cass T.B. plus. Group 1. Quiescent 1 — — 1 1 — — — — — — — 3 Improved 5 7 — 2 7 — 3 — — — — — 24 No material improvement 2 1 — — — — — — — — — — 3 Died in Institution — 1 — — 1 — — — — — — — 2 Class T.B. plus. Group 2. Quiescent 1 1 I — — 3 Improved 7 4 — 13 7 — 1 2 — 2 — — 36 No material improvement 5 5 — 2 1 — 1 2 — 2 — — 18 Died in Institution — — — — — — — — — — — — — Class T.B. plus. Group 3. Quiescent — — — — — — — — — — Improved — 1 — 1 — — 1 — — — — — 3 No material improvement 4 2 — 2 — — — — — — — — 8 Died in Institution — — — — — — — — — — — — — Total 42 36 2 33 22 1 7 4 2 6 155 Under 1 week 1-2 weeks. 2-4 weeks. More than 4 weeks. Observation for purpose of diagnosis. Tuberculous — — _ — Non-tuberculous — Doubtful — — — — — — — — — — — — — 35 Patients discharged, 155. Average duration of stay, 19 weeks 2 days. Number of patient days, 18,452. Number of beds available, 51. Average number of beds occupied, 50.55. Number of patients admitted during the year was the same as in the previous year. The number of advanced cases has decreased ; the results of treatment have therefore improved. Another welcome feature is the prolongation of the duration of stay; this is still below the desirable period. Artificial pneumothorax is still regularly performed in suitable cases, the results being very beneficial. The arrangement with the Forest Hospital Authorities, Buckhurst Hill, for X-raying patients still works smoothly and much assistance has been derived from the radiographs obtained therefrom. The patients fully appreciate the efforts of the Dramatic Clubs and Concert Parties, also the very instructive lectures given from time to time. REPORT UPON THE WORK AT THE BOROUGH INFECTIOUS DISEASES HOSPITAL. During the year 1926 the number of cases of acute infectious disease, treated at the Borough Hospital, has shown a large increase over the corresponding figure for last year : the patients admitted totalled 645 as compared with 442 in the year 1925. The following table indicates the number of patients admitted for each disease and the number discharged, or who have died, in the year 1926 :— Disease. Remaining at end of 1925. Admitted during 1926. Discharged during 1926. Died during 1926. Remaining at end of 1926. Scarlet Fever 22 308 285 3 42 Diphtheria 32 327 310 18 31 Enteric Fever — 5 4 — 1 Broncho-Pneumonia — 1 — 1 — Morbilli — 1 — 1 — Rubella — 1 1 — — Tonsillitis — 1 1 — — Pulmonary Tuberculosis — 1 — 1 — Total 54 645 601 24 74 36 Scarlet Fever. Excluding the forty-two patients remaining in the hospital at the end of the year 1926, there were 288 completed cases of this disease treated. Of these three died, giving a mortality rate of 104 per cent, as compared with a rate of 1'7 per cent, for the previous year. The three fatal cases included a patient suffering from the severe septic type of the disease, a case of scarlatina maligna, and a third case in whom uraemia supervened. The chief complications which occurred in the cases under treatment during the year were as follows :— Cervical Adenitis 36 Otitis Media 22 Rhinitis 19 Arthritis 9 Nephritis 3 Bronchitis 2 Chorea 2 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 :— Morbilli 1 Diphtheria 6 Pertussis 1 Varicella 10 Scabies 2 Impetigo 7 Septic Wounds, Scalds and Burns 5 Conjunctivitis 3 Cretinism 2 Psoriasis 1 Rachitis 1 Diphtheria. Excluding the 31 cases remaining in the hospital at the end of the year, 328 completed cases of diphtheria were treated during the year 1926, and of this number eighteen died. This equals a case mortality of 5'5 per cent, as compared with a rate of 3T2 per cent, in the year 1925. Three of these fatal cases were of the haemorrhagic type of diphtheria, one was suffering from acute pulmonary tuberculosis and one from marasmus, whilst the remaining thirteen children were admitted to hospital in an advanced stage of the disease when toxaemia was so profound that antitoxic serum treatment fyas carried out too late to prove successful. The average period of illness, prior to admission to hospital, in these thirteen cases was 5"6 days, and in ten instances the patients died within twenty-four hours of their admission to hospital. 37 The chief complications which occurred in the cases under treatment during the year were as follows Paralysis 15 Cervical Adenitis 10 Rhinitis 5 Myocarditis 11 Broncho-Pneumonia 2 Laryngitis 22 In some instances patients were admitted who were suffering from some other disease in addition to diphtheria, and the following table gives particulars of these:— Scarlet Fever 1 Marasmus 1 Varicella 1 Psoriasis 1 Pertussis 3 Impetigo 5 Morbilli 5 Herpes 3 Pulmonary Tuberculosis 1 Scabies 1 Anti-diphtheritic Serum. 5,328,000 units of antitoxin were administered to the patients admitted during the year, the average dosage per head being 16,000 units. Other Diseases. A severe' case of morbilli, complicated by broncho-pneumonia, was notified as Scarlet Fever, and died soon after admission to the cubicle block. A case of broncho-pneumonia was sent into the hospital (notified as diphtheria), and died within 12 hours of admission. Five cases of enteric fever were admitted to the hospital during the year and all made a satisfactory recovery. Two cases, notified as Scarlet Fever were found to be suffering from rubella and tonsillitis respectively. Laboratory Work. Two hundred and sixty-one bacteriological examinations of "swabs" for the identification of the diphtheria bacillus were carried out at the hospital. Illness of Staff. Fourteen members of the nursing and domestic staff contracted acute infectious diseases during the year : there were nine cases of diphtheria, four of scarlet fever and one of measles. The 38 high incidence in the case of diphtheria is probably due to the fact that the nursing of patients suffering from this disease has to be carried out in a temporary wood and iron building under circumstances which render it difficult to maintain hygiene and satisfactory ventilation in the wards. Training and State Examination. During the year 1926, lectures and instruction in practical nursing and hygiene have been carried out in accordance with the syllabus of the General Nursing Council, and courses of lectures upon Infectious Diseases, Anatomy, Physiology, Hygiene, and Practical Nursing have been delivered. Four Nurses were successful at the Preliminary State Examination, and two Nurses passed the Final State Examination, which enables them to be placed upon the Register of the General Nursing Council. Conclusion. The result of the year's work at the Hospital, taking all the circumstances into consideration, is very satisfactory, and although the total mortality rate has increased (3.0 in 1925, 3.8 in 1926), the severity of the diseases, especially in the case of diphtheria, has been much greater than last year. The need for improved accommodation for the patients suffering from diphtheria and for the members of the nursing and domestic staff, together with the necessity for the provision of an admission and discharge block has been pointed out on many occasions, and is a matter which requires the early and earnest consideration of the Local Authority. It is my privilege again to place on record my appreciation and thanks to the Matron for the very efficient manner in which she has performed her duties: duties which have been rendered so much more difficult owing to the fact that they have been carried out under conditions which are far from ideal. It is mainly the result of her untiring effort, zeal and enthusiasm, that so much has been done to ensure a successful year's work. COUNTY BOROUGH OF EAST HAM. Report ON THE WORK OF THE Maternity and Child Welfare Department FOR THE YEAR 1920. 40 REPORT ON THE WORK OF THE MATERNITY AND CHILD WELFARE DEPARTMENT for the Year 1S26. The Staff. The work of the Maternity and Child Welfare Department is carried on under the provisions of the Maternity and Child Welfare Act, 1918, which authorises a local authority to make suitable arrangements for attending to the health of expectant and nursing mothers, and of children up to the age of five years. Legislation was initially undertaken to seek to remedy the very large infant mortality that formerly existed, and this object is being undoubtedly secured; but the greater concentration on the infants of the first two years of life has resulted in a somewhat scanty attention to the toddlers of two to five years of age that is unfortunate. At the age of five children come under continuous observation by the School Medical Officers, but there exists a break in adequate medical supervision that allows development of some of the " ailments " to which attention was directed a year ago (in the quotation from the Annual Report of 1914) as still persisting, a blank which can only be filled by an increase in the staff of Health Visitors. The present staff of the Department consists of the Assistant Medical Officer in charge, five Health Visitors and a Clerk. The staff of Health Visitors does not meet the recommendations of the Ministry of Health, and is actually smaller than it was formerly. The result is a loss of efficiency all round, which is to be deprecated. The appointment of an additional Health Visitor is urgently required. Further demands on the time of the present staff of Health Visitors have been made by the widening of the scope of the work of the Department, through the opening of clinics for Artificial Light Treatment and for Ophthalmic Treatment of infants. Infant Welfare Clinics. Infant Welfare Clinics are held as follows:— White House, Plashet Grove, on Monday, Thursday and Friday, at 2 p.m. St. John's Church Hall, North Woolwich, on Tuesday, at 2.30 p.m. 41 Wesleyan Church Hall, Manor Park, on Tuesday, at 9 a.m. St. George's Church Hall, Masterman Road, on Wednesday, at 2 p.m. In last year's report it was pointed out that a Clinic was urgently needed in the south-west of the Borough, on account of its distance from any existing centre; and this need has been met by the opening of a branch centre at St. George's Church Hall, Masterman Road, on Wednesdays, at 2 p.m. This is proving a great boon to many of the mothers of that part of the Borough, who are now able for the first time to avail themselves of the advantages offered by such a Clinic. Attendances at Infant Welfare Clinics, 1926. Number of Clinics held during the year 293 Number of individual children who attended the Clinics 2,743 Total number of attendances 16,231 Number of medical consultations at these Clinics 4,572 At the Clinics individual advice on matters of feeding, clothing and hygiene is given to all mothers, after careful examination of their children and consideration of the special circumstances of each child. Steady pressure is being maintained to convince the mothers of the Borough that the Clinics are initially open to them in order to help them to maintain their children in good health, and rear them normally and successfully. The idea of the Clinics as dispensaries for sick children has had to be continuously countered ; and sick children are recommended to their own doctors, or to suitable hospitals, for necessary treatment. A large proportion of infants, when they are first brought to the Clinics, are cases of difficulty in reference to feeding, and ailments obviously dependent on erroneous feeding, such as persistent vomiting, constipation and diarrhoea. Such cases are properly dealt with by the staff of the Clinics, and are taken under observation for advice after individual study of each such child. In a considerable proportion of cases attending the Clinics regularly, minor ailments or more serious conditions of many kinds come under the notice of the Medical Officer or Health Visitors, and are dealt with as circumstances render desirable. 42 For instance, Ringworm of the Scalp is referred to the School. X-ray Department for radical treatment there; Impetigo, Septic Sores, Inflammation of the Eyelids and other minor conditions are referred to the Morning Clinics at the White House (of which I shall speak later), and are treated by the Health Visitors under the supervision of the Medical Officer of the Clinic; Squint, to the School Ophthalmic Surgeon; Discharging Ears and cases of Enlarged Tonsils and Adenoids to the private doctor or to hospital ; cases of Disease of the Heart, Lungs, etc., to the appropriate quarter for adequate treatment; Dental troubles to the School Dentist. As is shown above, the Infant Welfare Clinic is a very important distributing centre for ailments, many of which would, but for the Clinic, be left untreated, and in many cases would become progressively worse, and often later go beyond any possibility of being treated. Another point emerges from the above statement—the very considerable amount of co-ordination that exists between the Infant Welfare Centre and other public services in the Borough, to which fuller reference will be made latter. See p. *56. Only a single case of Ringworm of the Scalp required to be referred for treatment during 1926. Eight cases of enlarged Tonsils and Adenoids in children under school age received treatment at St. Mary's Hospital, Plaistow, and six cases at the Balaam Street Hospital, during the past year, at the expense of the Borough Council. In many cases of enlarged tonsils the parents preferred to choose their own hospital, and were willing to pay the necessary fee. Young children are peculiarly liable to skin diseases, and slight injuries very readily become septic; and it is a great advantage to all such children to be under the systematic care of nurses specially trained in the observation of conditions existing or arising in babies, in order that such skin diseases may be early noted, and at once brought under appropriate treatment. Careful observation is made of the condition of the skin whilst the nurse is weighing the infant at the Clinics. 43 Morning Clinics. Reference has already been made to the Morning Clinics in connection with mention of the passing of some minor ailments to them for treatment. These Clinics are an important adjunct to the ordinary work of the Child Welfare Centre, both indoor and outdoor. There are always a proportion of cases that present features requiring individual, sometimes prolonged, attention that cannot be given at the ordinary Clinic or in the home. Some skin diseases, certain infective conditions, mothers needing special advice as to handling and feeding their babies, etc., are sent from the Clinics, or by Health Visitors when visiting the homes, to the Morning Clinics, and there they receive from the Medical Officer and Health Visitors on duty the help they need. One of the most important items of the work done at the Morning Clinic is the careful investigation of various conditions of young infants by means of "test feeds." Symptoms and signs may have suggested that the child is getting too little, or too much, breast-milk. The mother may report that her milk is failing, when there seems no reason to account for such failure; or there may be an actual failure, for which some remedy has to be found. The first thing to be done is to obtain exact information as to what the mother is actually giving to her baby, and this is accomplished at the Morning Clinics at the White House by " test feeds." The Medical Officer is able to compare the results obtained with what ought to be in the case under observation, and so a first factor is obtained for the treatment of mother or child, or both, or for necessary modification of the feeding. The Morning Clinics are held:— At White House, Plashet Grove, on Monday, Wednesday and Thursday, from 9 to 10.30 a.m. Number of cases seen at Morning Clinics during 1926 was 1,813 Number of medical consultations 1,194 Dental Treatment. It is becoming increasingly recognised that attention to the teeth of nursing and expectant mothers and of young children is one of the most important methods of preventing disease and securing healthy development of the child population; and a Clinic 44 is held by the School Dentist on Wednesday afternoons for the treatment of infants, other children under school age, and nursing and expectant mothers referred to him from the Maternity and Child Welfare Clinics. The personal kindness of the School Dental Surgeon is breaking down the opposition so often encountered from the mothers when dental treatment is advised at the Clinics for themselves or for their children. Mr. Neame supplies the table showing the work done in respect of cases referred from this Department during 1926 in his Dental Report. See p. 96. Ophthalmic Treatment. An important advance in the work of this Department was made when, in course of the past year, the Council arranged for the observation and treatment by the School Ophthalmic Surgeon of eye cases referred to him by the Medical Officer of the Infant Welfare Clinics. For report see pp. 91—92. It has been a distressing feature of the routine school inspection of entrants to school life that there are a considerable number of cases of defective eyesight in this first grouping of children for purposes of medical observation. It exists throughout the country. The most distressful circumstance is, that these widely prevailing defects could be to a large extent prevented. The mothers themselves have no idea of the importance of danger signals, such as slight squints, the holding of picture books too near the eyes, etc. But if the children come under the trained eye of a Health Visitor in their homes, she at once recognises that a condition of the eyes exists that will tend to become progressively worse, and if not attended to at once may, before the age of five years, become a grave condition, and a permanent one, that will require the unfortunate child to wear glasses all the time and for life. She will advise the mother to bring the child to the Infant Welfare Clinic to be examined by the Medical Officer, and, where necessary, passed on to the Ophthalmic Surgeon. In the Ophthalmic Clinic the probably still slight ailment is prevented by the Ophthalmic Surgeon's treatment from becoming the more serious condition already indicated. 45 It is too early to give figures, but already a considerable number of young children are benefiting by the opening of this Ophthalmic Clinic; and the sympathy of Mr. Gimblett, the School Ophthalmic Surgeon, with the work amongst the infants submitted to his care from the Infant Welfare Clinics, is doing much to promote a friendly relationship between the two Departments. The Work of the Health Visitors in the Homes of the Borough. As the name "Visitor" implies, visiting in the homes of young infants and children under school age was the original idea underlying the creation of the office of Health Visitor, and remains the most important part of the work of these officials. Infants come very early under the notice of the Medical Officer of Health in any district, under the provisions of the Notification of Births Acts, 1907 and 1915. If a child is born in East Ham the fact is reported at the Town Hall within 36 hours. The information is passed on to the Medical Officer of the Infant Welfare Department, and by her is transmitted to the Health Visitor of the district in which the event has occurred. As soon after the fourteenth day as possible the home is visited by the Health Visitor, and she does what she can to help the mother in the many difficulties that arise in connection with the hygiene and feeding of the infant and the other young children in the home. Especially in the case of young mothers tending their first babies, this is festly a very important public provision. The visits of the Health Visitors are spread over the cases on their lists as evenly as possible; but necessarily a very wide discretion must be left to them in respect of this. A larger number of visits must be made to the premature or delicate infant than to the healthy, and to the poor home than to the home where a private doctor and a trained nurse are already in attendance. Such are the routine and ordinary visits made by the Health Visitors. The visits are repeated as frequently as may be necessary and possible during the first year, less frequently in the second year, and then should go on occasionally in the other years till school life is to begin. Only, our staff in East Ham is so small that the years two to five can have but the scantiest attention. 46 Further, special visits to the homes have to be made by the Health Visitors in connection with all sorts of unusual circumstances that occur, e.g., in reference to Tonsils and Adenoids, cases of Pneumonia in infants, Ante-natal cases, cases of Puerperal Septicaemia and Pyrexia, cases of Ophthalmia Neonatorum, etc. Births during 1926. Total number of births registered (including transfers) 2,505 Total number of still-births 59 Total number of un-notified births 104 Particulars of Visits made by Health Visitors. Visits to infants under one year of age 5,809 Visits to children over one year of age 4,531 Visits to Ophthalmia Neonatorum cases 20 Visits to Tonsils and Adenoids cases 42 Visits to Ante-natal cases 221 Visits to Puerperal Fever cases 3 Special visits, not included in above groups 121 Total number of visits 10,747 The Question of Birtb Control in Relation to Maternity and Child Welfare Centres. It has, at different times, been stated that members of the staff at the White House give information to persons attending at the Centre, and in course of home visitation, in reference to methods of contraception. Indefinite information only could be obtained, and those making the assertions were unable or unwilling to give any names. The Medical Officer at the Infant Welfare Centre was requested to make enquiry into the matter, but results were entirely negative. I have come to the conclusion that the White House staff has been confused, in reference to this matter, with the staff of a neighbouring institution in an adjoining borough, members of whose staff are not precluded from discussing the subject I have named. The question, of course, is not whether such information should properly be given, but whether it should be given at, or in connection with, the Infant Welfare Department. 47 There is a recent direct statement on this subject by the Minister of Health, so that there can be no further doubt in the matter. A direct question was addressed to the Minister by the League of National Life, and a direct reply by him has set out the principles which determine the present policy of the Ministry. I beg leave to quote in full some paragraphs that appeared in the public newspapers a few months ago, i.e., late in 1926, the year under review:— "The Minister has, in agreement with his predecessors, adopted the policy with regard to the matter which is set out below:— "That the Maternity and Child Welfafe Centre should deal only with the expectant and nursing mother (and infant) and not with the married or unmarried woman contemplating the application of contraceptive methods. "That it is not the function of an Ante-natal Centre or a Maternity and Child Welfare Centre to give advice in regard to birth control, and that exceptional cases, in which the avoidance of pregnancy seems desirable on medical grounds, should be referred by the Medical Officer of the Centre for particular advice to a private practitioner or hospital." It is explained that the reference of exceptional cases by the Medical Officer of a Centre is a totally different matter from the giving of contraceptive advice and instruction at the Centre itself, and that such reference should be made only on medical grounds by the Medical Officer of the Centre, and not by nurses on general social grounds. This has been our policy; and I have reason to believe that the Health Visitors are loyally carrying into effect the wishes of the Medical Officer in charge of the Centre in reference to the question of Birth Control. The Ante-Natal Clinic. At the Ante-Natal Clinic provision is made for the care and examination of expectant mothers, to secure good health throughout the pregnancy, and a safe ending to it for both mother and child. 48 An Ante-Natal Clinic is held at the White House every Friday morning at 10 a.m. Expectant mothers are at this Clinic advised as to how to keep themselves strong and healthy, for the sake of the coming baby. In the later months of pregnancy a careful watch is maintained over all circumstances that may affect the confinement; and measures may be taken to render safe and easy what, without such previous care, might prove a difficult, obstructed, perhaps dangerous, labour. Much possible discomfort in the later months of pregnancy is avoidable, and much anxiety on the part of young mothers in their first pregnancies can be explained away, to their great comfort and happiness; and such explanations are part of the functions of the Ante-Natal Clinics. The Health Visitors follow up cases requiring home supervision after receiving medical advice at the Friday morning Clinics, when that further precaution is considered advisable by the Medical Officer. During 1926, 221 such visits to Ante-Natal patients were made in their homes by the Health Visitors. These visits were as follows:— First visits 166 Subsequent visits 55 The number of cases attending the Clinic was:— First visits 181 Subsequent visits 122 Total 303 Mothers from East Ham under the care of the nurses at the Maternity Charity 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 hospital. No cases attending private doctors are examined at the White House Clinic, unless such patients bring to the Medical Officer of the Clinic letters from their doctors requesting- examination for purposes of consultation. Maternity Accommodation. No maternity scheme can be considered complete without the provision of maternity beds for women who cannot suitably be confined in their own homes. Under the Maternity and Child Welfare Act, 1918, Local Authorities are empowered, with the approval of the Ministry of Health, to make arrangements for the 49 institutional treatment of complicated midwifery cases, and for women whose homes are unfit for their being confined in them. Where such provision is made, the cases are usually sent in after observation at the Pre-Maternity Clinic, so that all the advantages of ante-natal care are added to those of the Maternity Home or Hospital. So far, East Ham has no such institution of its own ; but the Borough Council has arranged for the accommodation of necessitous cases requiring in-patient treatment (at the cost of the Council) at Queen Mary's Hospital, Stratford, and at the Maternity Charity and District Nurses' Home, Plaistow, upon the written recommendation of the Medical Officer of this Department. During 1926 only two cases required to be thus provided for, and were sent to Queen Mary's Hospital, Stratford. Many other cases, however, who had attended the East Ham Ante-Natal Clinic went into hospital at their own expense, and many of the wives of men receiving relief from the Guardians were admitted for their confinements to the Forest Gate Sick Home. A considerable proportion of our cases, therefore, have the advantages of institutional treatment at the time of their confinement. 50 Infant Mortality and Deaths of Children under 5 years. The following Table shows the causes of death at the different periods of infant life during- the year 1926:— Legitimate. Illegitimate. Number of deaths under 1 year M. 79 3 F. 56 2 Causes of Death. Sex. 0-1 1—2 2—6 ALL CAUSES M. 82 26 15 F. 58 24 12 Measles M. 3 5 3 F. 3 11 2 Scarlet Fever M. — — — F. — — 1 Whooping Cough M. 1 2 — F. 2 1 — Diphtheria M. 2 3 F. — 2 2 Influenza M. — — — F. — — 1 Meningococcal Meningitis M. 1 — — F. 1 1 — Tuberculosis of Respiratory System M. — — 1 F. 1 — Other Tuberculous Diseases M. 1 2 1 F. 2 1 2 Rheumatic Fever M. — — 1 F. — — — Bronchitis M. 1 — — F. 2 — — Pneumonia (all forms). M. 17 8 1 F. 15 5 1 Other Respiratory Diseases M. — 1 — F. — — — Diarrhoea, &c M. 14 2 — F. 5 — — Appendicitis and Typhlitis M. — — 1 F. — — Acute and Chronic Nephritis M. 1 — — F. — — 1 Congenital debility and malformation, premature birth M. 30 2 — F 21 1 — Deaths from violence M. — — 2 F. 2 — 1 Other defined diseases M. 13 2 2 F. 4 1 1 Causes ill-defined or unknown M. — — — F. 1 — — 51 COMPARATIVE INFANT MORTALITY RATE—YEAR 1926. 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 17.8 8.7 70 105 County Boroughs and Great Towns (including London) 18.2 11.8 73 158 Smaller Towns (1921 adjusted populations, 20,000—50,000) 17.6 6.6 67 London 17.1 11.8 64 EAST HAM 17.1 8.4 56 The Comparative Infant Mortality Rate shows East Ham to be still greatly more healthy than England as a whole, and more healthy than London. The total deaths under one year per 1,000 births in England and Wales were 70; in London the figure was 64; in East Ham only 56 per 1,000 infants under one year of age died during 1926. The small actual increase in the Infant Mortality Rate over 1925 is accounted for by deaths during the epidemic of Measles during the Spring, and a slight increase of Diarrhoea deaths during the early Autumn. Infectious Diseases. Infants suffering from certain infectious diseases are treated in the Borough Hospital. Reference has already been made to the effect of deaths from Measles during 1926 on the Infant Mortality Rate. A serious outbreak of Measles during the Spring of last year resulted in the deaths of 27 children under the age of five years. In the previous year, 1925, only one death was due to this cause. The actual cause of death in Measles is usually really a sequel to that disease, Broncho-Pneumonia, which is very apt to follow and complicate Measles. A decision of the Metropolitan Asylums Board, which was agreed to by the Ministry of Health, the London County Council and the Medical Officers of all the Metropolitan Boroughs, was announced in October of last year, that must have a wide influence 52 in reference to infectious fevers policy in the future. For some reason not understood, Scarlet Fever has been becoming a milder illness and Measles a more and more dangerous fever. Very few cases of Scarlet Fever, formerly a very fatal condition, now die, whereas a very considerable proportion of the cases of Measles in young children prove fatal. In view of this, the Metropolitan Asylums Board, in October, 1926, made the following decision:— "In view of the much higher mortality of Measles and its far greater destructive effect on child life, the present practice of always admitting Scarlet Fever in preference to Measles should be abandoned . . . and, in times of Measles prevalence, the larger proportion of accommodation should be allotted to Measles." Another infectious disease that calls for very special notice at the present time is Small-pox, though, fortunately, East Ham has thus far escaped the widespread epidemic of it. Since the passing of the Vaccination Acts, 1898 and 1907, a great and increasing number of children escape vaccination, and the terrible disease that used to be so prevalent and so fatal in this country, but which had been practically wiped out by compulsory vaccination, is becoming an increasing menace to the well-being of the community. Fortunately, the present epidemic is of a mild type; but such an epidemic spreading to a city community living under such conditions as those of East Ham might very easily revert to the old-time virulence of Small-pox, when a large proportion of the cases that did not die were left with a permanent disfigurement from the marks on the face, and often with blindness or deafness from involvement of the eyes or ears. And the way to safety is simple and practically certain— vaccination. Needless to say, all the influence that can be brought to bear on the mothers attending with their babies at the White House and the branch Centres by the Medical Officer and the Health Visitors is exerted in the direction of persuading the parents of the unvaccinated children coming under their observation to have them vaccinated, and so save them from the threat of a terrible disease under which, being non-vaccinated, they live. Ophthalmia Neonatorum. New regulations for the notification of Ophthalmia Neonatorum (i.e., inflammation of the eyes of the new-born) came into force in October, 1926, placing responsibility for such notification 53 on the doctor attending the case. A midwife meeting the case of an infant with discharging eyes is required to summon a doctor, who then becomes responsible for its notification, if necessary, to the Medical Officer of Health. The information is then passed to the Medical Officer of the Child Welfare Department, and she keeps the case under observation either directly or through the Health Visitors. The reason for all this routine is that in the past this disease has been terribly injurious to the sight of babies who contracted it, very often leaving them permanently blind. During 1926, eight cases of Ophthalmia Neonatorum were notified in East Ham, with results of treatment as is shown in the following table:— Notified. Treated. Vision Unimpaired. Vision Impaired. Total Blindness. At Home. At Hospital or Clinic. 1 - 1 1 - - 2 — 1 1 - — 3 — 1 1 - — 4 1 — 1 - — 5 — 1 1 - — 6 — 1 1 - — 7 — 1 1 - — 8 — 1 1 - — For two of the cases treated in St. Margaret's Hospital (Metropolitan Asylums Board) the Borough Council incurred a cost of £60 10s.; so that the question is one that is being taken very seriously in this Borough. Inspection of Midwives The Assistant Medical Officer for Maternity and Child Welfare is also Inspector of Midwives under the Borough Council, in this capacity maintaining a general supervision over the work cf all midwives practising in East Ham, under the requirements of the Midwives Acts, 1902 and 1918. Forty-three midwives notified their intention to practise in the Borough during 1926. Of these, 26 worked in connection with the Maternity Charity and District Nurses' Home, Plaistow, and its branches, and five with the Sir Henry Tate Nurses' Home, at Silvertown ; 12 practised independently. 54 Eight visits were made by the Inspecting Medical Officer during 1926 to the Maternity Charity and District Nurses' Home and its branches, two to the Sir Henry Tate Nurses' Home, and 37 to the midwives practising independently. Fourteen midwives were interviewed by the Inspector of Midwives at the White House in connection with particular cases. One midwife practising in East Ham was reported by the Essex County Council to the Central Board of Midwives for certain remissnesses in her practice, and a report was called for regarding her work in East Ham. This midwife was cautioned by the Board. Otherwise the conditions found were on the whole satisfactory. By the rules of the Central Midwives Board, midwives must send for medical aid in certain specifically named conditions. In 1926 medical help was sent for in 1G5 cases, as follows:— For the Mothers— Ruptured perineum 35 Prolonged labour 41 Retained placenta 10 Ante-partum haemorrhage 3 Post-partum haemorrhage 3 Rise of temperature 7 Inflamed breasts 1 Malpresentations 7 Vomiting of pregnancy 3 Miscarriage 2 Other causes 13 For the Infants— Dangerous feebleness 23 Deformities 1 Discharging eyes 7 Baby found dead on arrival of midwife 4 Other causes 5 Puerperal Fever and Puerperal Pyrexia. New regulations for the control of Puerperal Fever and Puerperal Pyrexia came into force in October, 1926. Very definite requirements are laid down as to the notification of cases of 55 feverish conditions occurring soon after a confinement by the doctor attending such cases. The object of these regulations is to secure that women who suffer from such conditions may as quickly as possible come under special treatment where necessary, and be seen in consultation with their own doctors by an obstetric specialist where the private doctor considers this desirable; and also that they may, if necessary, be provided with skilled nursing or with institutional treatment. Five cases of Puerperal Fever were notified in East Ham during 1926, three occurring in hospital practice and two in private practice. One un-notified case died in hospital. Maternal Deaths. The following deaths occurred in connection with parturition:— Puerperal Septicaemia 2 Ectopic Gestation 2 Cardiac Failure after parturition 1 Such investigation as is possible and desirable is made into the circumstances of all cases of death during parturition and all stillbirths. 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. 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. Fourteen children were sent away through the Association during 1926. In 1926 the Infant Welfare Centre in East Ham became affiliated to the Association of Infant Welfare and Maternity Centres. Through this affiliation it will now be more easy for the Invalid Children's Aid Association to place children from the East Ham Centre in the different available Convalescent Homes. 56 Co-ordination. There is very considerable co-ordination between the Maternity and Child Welfare work of the Borough and other Departments of the Public Health Service. The records of Clinic children on reaching the age of five years are sent to the School Medical Department for information regarding entrants to school life. Expectant and nursing mothers and young children requiring dental treatment are referred to the School Dental Surgeon from the Infant Welfare Clinics. 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 arrangements existing for purposes of the School Medical Services. Ophthalmic cases are referred from the Infant Clinics to the School Ophthalmic Surgeon. 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. 57 VENEREAL DISEASES. Summary of work done by the Hospitals during the Year 1926. London Middlesex Essex Surrey Kent Herts. Bucks. E. Ham W. Ham Croydon Total Other Places Grand Total New Patients:— Syphilis 4,181 335 177 129 115 28 35 39 131 23 5,193 545 5,738 Soft Chancre 197 8 3 4 7 2 1 2 11 — 235 68 303 Gonorrhoea 8,581 821 419 318 180 87 45 104 223 56 10,834 849 11,683 Not Venereal 6,733 609 364 293 177 76 43 84 234 51 8,664 324 8,988 Total 19,692 1,773 963 744 479 193 124 229 599 130 24,926 1,786 26,712 Total Attendances 569,938 38,744 15,007 17,826 7,883 3,578 1,748 4,608 9,990 2,767 672,089 14,986 687,075 No. of " In-patient" days 58,469 3,383 2,743 1,989 3,780 1,502 1,408 779 1,355 330 75,738 25,997 101,735 Salvarsan Substitutes, doses given 37,325 3,791 1,693 1,510 894 385 333 326 1,053 218 47,528 1,787 49,315 Pathological Examinatons. For or at Centre:— Spirochaetes 755 34 2 8 6 5 — 1 18 1 830 85 915 Gonococci 44,703 2,193 1,765 941 1,040 286 113 527 1,009 248 52,825 1,638 54,463 Wassermann 24.621 1,674 996 877 537 249 139 185 491 164 29,933 1,294 31,227 Others 11,145 746 291 879 292 50 85 24 32 129 13,673 265 13,938 Total 81.224 4,647 3,054 2,705 1,875 590 337 737 1,550 542 97,261 3,282 100,543 For Practitioners:— Spirochaetes 19 7 — 7 — — — — 1 — 34 — 34 Gonococci 3,187 266 162 734 22 17 21 15 17 353 4,794 18 4,812 Wassermann 16,021 1,504 932 587 109 77 103 183 495 438 20.449 258 20,707 Others 1,433 31 15 433 23 6 9 1 3 8 1,962 50 2,012 Total 20,660 1,808 1,109 1,761 154 100 133 199 516 799 27,239 326 27,565 58 TOTAL CASES NOTIFIED DURING 1926. 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 3 14 21 23 37 153 54 14 28 3 ... ... 350 307 3 Diphtheria 2 10 13 15 30 176 53 9 22 6 ... 1 337 330 21 Enteric Fever (Typhoid & Paratyphoid) ... ... ... ... ... ... ... 2 4 1 ... ... 7 6 ... Erysipelas 1 ... 1 1 ... 2 4 6 9 11 6 41 12 4 Puerperal Fever ... ... ... ... ... ... ... ... 4 1 ... ... 5 5 2 „ Pyrexia ... ... ... ... ... ... ... ... 2 ... ... ... 3 1 ... Cerebro-Spinal Meningitis 1 ... ... ... ... ... ... ... ... ... ... ... 1 3 3 *Ophthalmia Neonatorum 8 ... ... ... ... ... ... ... ... ... ... ... 8 2 ... Encephalitis Lethargica ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... Pneumonia 2 3 2 1 1 12 1 7 12 10 16 3 70 28 111 Total 17 27 37 40 68 343 108 36 79 31 27 10 823 694 144 Tuberculosis:— (a) Pulmonary M ... 1 ... ... 1 4 3 13 39 27 22 1 111 164 56 F ... 1 1 ... ... 6 5 19 67 12 15 ... 126 135 63 Total ... 2 1 ... 1 10 8 32 106 39 37 1 237 299 119 (6) Non-Pulmonary M 2 1 2 1 6 5 2 3 4 2 ... 28 30 8 F ... ... 1 2 1 3 4 4 3 1 3 ... 22 23 14 Total ... 2 2 4 2 9 9 6 6 5 5 ... 50 53 22 * The eight cases of Ophthalmia Neonatorum were visited and treated with no impairment of vision. Notification of Tuberculosis is not completely satisfactory inasmuch that cases are frequently un-notified until the disease is well advanced. In cases where death occurs in a non-notified case the attention of the Medical Practitioner is drawn to the fact and the explanation is usually satisfactory. The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was 1 to 6. 59 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN EAST HAM, 1926. CAUSES OF DEATH. Net Deaths at the subjoined ages of "Residents" whether occurring within or without the Borough. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 yeart. 25 and under 45 years. 45 and under 65 years. 65 and under 75 years. 75 and upwards. All Causes M 751 82 26 15 22 35 102 197 145 127 F 659 58 24 12 23 39 78 159 129 137 1. Enteric Fever M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 2. Small-pox M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 3 Measles M 13 3 5 3 2 ... ... ... ... ... F 17 3 11 2 1 ... ... ... ... ... 4. Scarlet Fever| M 2 ... ... ... 1 1 ... ... ... ... F 1 ... ... 1 ... ... ... ... ... ... 5. Whooping Cough M 3 1 2 ... ... ... ... ... ... ... F 4 2 1 ... 1 ... ... ... ... ... 6 Diphtheria M 11 ... 2 3 5 1 ... ... ... ... F 10 ... 2 2 4 1 ... ... ... 1 7 Influenza M 11 ... ... ... 4 2 3 2 ... F 4 ... ... 1 1 1 ... ... ... 1 8. Encephalitis Lethargica M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 9. Meningococcal Meningitis M 1 1 ... ... ... ... ... ... ... ... f 2 1 1 ... ... ... ... ... ... ... 10. Tuberculosis of Respiratory System M 56 ... ... 1 ... 13 24 16 2 ... F 63 ... 1 ... 2 22 28 8 1 1 11. Other Tuberculous Di>eases M 8 1 2 1 2 1 ... 1 ... ... F 14 2 l 2 1 1 5 ... 1 ... 12. Cancer, Malignant Disease M 93 ... ... ... ... 2 10 40 29 12 F 106 ... ... ... 1 ... 9 50 34 12 13. Rheumatic Fever M 4 ... ... 1 1 2 ... ... ... ... F 5 ... ... ... 3 1 1 ... ... ... 14. Diabetes M 8 ... ... ... ... ... ... 5 1 2 F 4 ... ... ... ... ... 1 2 1 15. Cerebral Haemorrhage, &c. M 51 ... ... ... ... ... 4 8 21 18 F 44 ... ... ... ... ... ... 11 19 14 16- H^rt Disease M 88 v ... ... 3 2 12 23 25 23 F 89 ... ... ... ... 2 4 32 23 28 17. Arterio-sclerosis M 24 ... ... ... ... ... ... 6 8 10 F 8 ... ... ... ... ... ... ... 5 3 18. Bronchitis M 47 1 ... ... ... ... 6 8 15 17 F 53 2 ... ... ... ... ... 8 13 30 19- Pneumonia (all forms) F 65 17 8 1 2 ... 10 15 6 6 F 46 15 5 1 3 2 1 9 3 7 20. Other Respiratory Diseases M 8 ... 1 ... ... ... 2 3 1 1 F 6 ... ... ... ... ... 1 2 2 1 21. Ulcer of Stomach or Duodenum M 10 ... ... ... ... ... 2 8 ... ... F 6 ... ... ... ... 1 ... 4 ... 11 22. Diarrhoea, &c. M 21 14 2 ... ... ... 1 2 1 ... F 5 5 ... ... ... ... ... ... ... ... 23 Appendicitis and Typhlitis M 4 ... ... ... ... 1 1 1 ... ... F 3 ... ... ... ... 1 1 1 ... ... 24. Cirrhosis of Liver M 4 ... ... ... ... ... 1 2 1 ... F 3 ... ... ... ... ... ... 1 2 ... 25. Acute and chronic nephritis M 33 1 ... ... 1 1 1 12 10 7 F 23 ... ... 1 ... 2 5 9 6 ... 26. Puerperal Sepsis M ... ... ... ... ... ... ... ... ... ... F 2 ... ... ... ... 1 1 ... ... ... 27. Other Accidents and Diseases of Pregnancy and Parturition M ... ... ... ... ... ... ... ... ... ... F 3 ... ... ... ... ... 3 ... ... ... 28. Congenital debility and malformation, premature birth M 32 30 2 ... ... ... ... ... ... ... F 22 21 1 ... ... ... ... ... ... ... 29. Suicide M 9 ... ... ... ... ... 3 6 ... ... F 3 ... ... ... ... ... 2 1 ... ... 30. Other deaths from violence M 30 ... ... 2 2 6 8 4 4 4 F 12 2 ... 1 3 ... ... 1 2 3 31. Other defined diseases M 115 13 2 2 3 1 15 34 19 26 F 100 4 1 1 3 4 16 19 18 34 32. Causes ill-defined or unknown| M ... ... ... ... ... ... ... ... ... ... F 1 1 ... ... ... ... ... ... ... ... 60 METEOROLOGICAL RECORD—YEAR 1926. 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. Rainfall. Me^n of Mean Temperature of Air. No. of Days on which Rain fell, o'oi inches and over. Amount collected in inches. Mean rate of fall for Rainy Days. Greatest fall in 24 hours. Date of greatest fall. Highest Maximum. Lowest Minimum. All Highest. All Lowest. January 55° 15° 45°.9 35°.3 40°.6 17 2.13 0.12 0.35 1st February 59° 27° 51°.0 40°.6 45° .8 16 3 .07 0.19 0.91 17th March 60° 30° 51°1 39° 1 45°.1 5 0.17 0.03 0 05 4th April 69° 34° 57°'4 42°.5 49°.9 18 3.71 0.21 0.77 25th May 76° 35° 59° .5 45°.1 52°.3 12 1.60 0.13 0.41 14th June 76° 45° 66°.2 50° 5 58°.3 13 3.47 0.27 0.72 2nd & 17th July 84° 50° 71°.6 55°.8 63°.7 13 2.48 018 0.50 18th August 81° 48° 72°.5 55°.8 64°.1 11 2.74 0.25 1.40 31st September 87° 41° 69°.0 53°.0 61°.0 9 1.19 0.13 0.43 2nd October 72° 28° 55°.2 41°.5 48°.3 14 2.42 0.17 0 45 14 th November 56° 30° 50°.1 40° 3 45°.2 22 4.50 0.20 0.92 13th December 50° 30° 44°.5 35°.4 39°.9 6 0.62 0.10 0.31 17th Means and Totals for the Year. 87° 15° 57°.9 44°.6 51°.2 156 28.10 0.18 1.40 Aug. 31st The Rainfall for the Year was 4 "46 ins. above, and the number of days on which rain fell 1 above the year 1925 at East Ham. COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Hnnual IRepovt OF THE School Medical Officer FOR THE YEAR 1926. 62 EAST HAM EDUCATION COMMITTEE. Alderman N. A. Papworth, J.P. (Chairman). Alderman W. G. Davie, J.P. (Vice-Chairman). Councillor E. Shanahan, J.P. (Mayor). Councillor G. W. Boultwood (Deputy Mayor). Councillor (Mrs.) M. Ridler. Alderman P. P. Cross. ‡Councillor M. Oakes, J.P. Alderman G. P. Dean, J.P. Councillor A. H. W. Owen. Alderman H. Osborn, J.P. Councillor II. Perry. Councillor W. W. Bagot. Councillor J. J. Pope. Councillor C. W. Brading. Councillor G. Pottinger. †Councillor A. E. Dennington. Councillor A. Rhodes. *Councillor P. Y. Gerhard. Councillor H. N. Ridler. Councillor T. J. Hawkins. §Councillor E. H. Thompson. Councillor J. A. Horn. Councillor A. Trinder. Councillor H. J. Kybkrt. Councillor H. R. Wing. Councillor G. H. Manser. E. T. Andrews, Esq., B.A. Councillor R. W. Moger. **Dr. J. W. Gricb, D.Sc. Councillor W. T. Newling. E. J. Sullivan, Esq. R. Whitfield, Esq. †Appointed Marcli, 1926. 'Deceased January, 1926. ‡Deceased December, 1925. § Appointed February, 1926. **Resigned 28th September, 1926. School Nurses. Mrs. Nears, S.R.N., Miss Kekwjck, 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.I., Certified Midwife, Miss Olifent, R.F.N., Miss Maltby, R.R.C., and Miss Young, S.R.N., Certified Midwife. Clerical Staff. P. Read, M.S.M. (Chief 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. ( Three sessions per week.) Aural Surgeon: L. G. Brown, M.D., F.R.C.S.Eng. (One session per week.) Assistant 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. (part-time). (Temporary), T. J. Clayton, M.R.C.S., L.R.C.P (part-time). Deputy and Senior Assistant Medical Officer. F. E. Bendix, M.R.C.S., L.R.C.P., L.D.S. Medical Officer: W. Benton, M.R.C.S., L.R.C.P., D.P.H 63 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, 1926. The number of routine and special cases examined of elementary school children totalled 13,707, as compared with 13,201 in 1925, and a complete medical inspection of all children in the Secondary School has also been carried out. An examination of the statistics for the year shows that the amount of work undertaken by the School Medical Service is steadily increasing : this is only to be expected in view of the growing recognition of the great importance, to physical and mental health, of medical inspection and treatment in early life. The closing year has been one of considerable progress; facilities for ophthalmic treatment have been increased; arrangements have been made for the installation of the necessary apparatus to carry out both general and local ultra-violet radiation, and it is anticipated that an Artificial Sunlight Clinic will be available, for the treatment of suitable cases, early in the New Year; and the long delayed provision of improved accommodation for the Dental Clinic is approaching realisation. 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 25 children who have been sent to Schools of Recovery by arrangement with the Local Authority, 102 children have received open-air and convalescent treatment. 64 I also wish to express my thanks to the teachers for their great heip and courtesy, the whole of my staff for the excellent work carried out, and to Mr. Thompson and his staff for their co-operation. 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. 65 1. STAFF. A list of the Staff of the School Medical Department will be found on page 62 of this Report. 2. CO-ORDINATION. The scheme for the co-ordination of the various health services of the County Borough was fully discussed in my reports for the years 1923 and 1925. 3. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene. During the year 1926 a complete survey of the sanitary 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 1926. The figures for the year 1925 are also given for comparison:— COMPARATIVE STATEMENT OF WORK. 1925. 1926. Routine and Special Inspection (on School Premises) 10,728 10,944 Re-inspection 3,784 4,737 Consultations at Inspection Clinic 13,445 14,575 Number of Treatments at Clinic 18,665 15,810 General Cleanliness Visits to Schools 335 297 Nurses' Visits to Homes 3,840 4,948 Children Examined for Cleanliness 58,090 58,683 (a) (i.) Medical Inspection and Re-inspection. 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 66 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 15 schools which had not been visited for this purpose during the year 1925, and for the Medical Inspection of children in one Elementary School. A certain amount of disorganisation has occurred as the result of the illness of Dr. Cheater, but there is every reason to be satisfied with the fact that medical inspection has been fully carried out in the Schools of the Borough. Unfortunately it was not found possible to re-inspect, in all the Schools, the children found to be defective at routine medical inspection, seven schools remaining in which this work must be dealt with in the coming year. («) (ii.) Administration and Clerical Staff. The growth of the School Medical Service has been rapid during the past years, and the process of efficient organisation and development has produced a very live service; this is consequent upon the building up of a logical policy directed towards the promotion of schemes for the prevention and treatment of disease, which has depended, in no small measure, upon efficiency in administration. The duties of the Clerical Staff have become more onerous and numerous, and there is still a definite tendency in this direction. It has now become evident that the question of additional clerical assistance will require consideration at an early date, in order that efficiency may be maintained at its present high standard, and to ensure that the Education Authority's directions as to policy be properly carried out. (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. 67 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 a slight increase over that for the year 1925. Group Number of Children Percentage of Children found to require treatment Inspected Found to require treatment Entrants 1925 1920 1925 1920 1925 19-20 2,960 3,345 340 454 11.5 13.6 Intermediates 2,961 1,991 445 270 1.0 13.6 Leavers 3,118 3,877 370 520 11.9 13.4 Total 9,039 9,213 1*,155 1,244 12.8 13.5 (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 58,683 examinations, as compared with 58,090 in 1925. Of this number 19 children were found who harboured body vermin (23 in 1925), 668 children showed vermin and many nits -in the hair (652 in 1925), whilst 2,527 children showed only a few nits (2,856 in 1925). Comparative table:— Year Number Examined Number with Nits Number with Head Vermin Number with Body Vermin No- of Exclusion Certificates 1921 49,452 2,677 950 102 78 1922 65,464 3,333 1,071 62 95 1923 62,207 2,72a 1,313 46 62 1924 57,936 2,648 826 31 80 1925 58,090 2,856 652 23 45 1926 58,683 2,527 668 19 49 68 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 946 17 2 ... Plashet Lane Girls 1166 52 54 ... Boys 1016 7 2 ... Boys 1196 9 19 2 Jr. Mixed 908 13 1 ... Infants 1113 50 47 3 Infants 912 21 2 ... Storey Street Mixed 879 39 4 ... Castle Street Mixed 498 19 2 ... Infants 834 54 29 1 Infants 271 22 1 ... Silvertown R.C. Mixed 612 33 55 ... Central Park Road Girls 1372 71 12 ... Infants 604 69 58 ... Boys 1827 22 ... ... St. Michael's R.C. Mixed 85 7 5 ... Infants 1190 54 17 1 St. Winefride's R.C. Mixed 862 41 12 ... Dersingham Avenue Mixed 809 57 21 ... Sandringham Road Mixed 1390 33 2 ... Essex Road Girls 1160 81 10 1 Shaftesbury Road Infants 1278 56 4 ... Boys 1183 ... 3 ... Girls 1393 82 3 ... Infants 939 26 12 ... Boys 1290 3 1 ... Fourth Avenue Ciirls 1007 129 19 ... "Salisbury" Infants 943 56 2 ... Boys 968 42 6 ... Inter 828 41 13 2 Infants 027 50 8 ... Primary 1227 62 29 1 Hartley Avenue Girls 987 73 1 ... Shrewsbury Road Vicarage Lane Special 184 18 1 ... Boys 1085 8 1 ... Girls 1106 80 11 ... Infants 1037 52 4 ... Boys 967 12 4 ... High Street S. Mixed 880 51 6 ... Infants 1137 77 15 ... J. Mixed 760 65 2 ... Walton Road Girls 1439 96 13 ... Kensington Avenue Girls 1126 34 2 ... Boys 1386 27 11 ... Boys 1163 18 ... ... Infants 1253 49 30 3 Infants 937 24 3 ... "Winsor" Inter 818 41 6 ... La thorn Road Girls 1397 62 2 ... Primary 1085 66 6 ... Boys 1303 6 1 ... Infants 1361 42 4 ... Total 58683 2527 668 19 Monega Road Girls 1035 44 ... ... Boys 1192 ... ... ... Per cent. 4.3 11 .03 Infants 968 41 6 ... Napier Road Girls 1160 126 36 1 Per cent.in 1925 4.9 11 .04 Boys 1128 27 20 2 Infants 1016 70 28 2 69 It will be noted that there is again a reduction in the percentage of children suffering from verminous conditions, and great credit is due to the School Nurses, whose untiring efforts have been entirely responsible for ensuring this diminished incidence in cases of uncleanliness. (6) Minor Ailments. As has been thg case in former years few minor ailments were discovered at routine medical inspection, owing to the vigilance displayed by teachers and nurses. 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 1925 1926 1925 1926 Scabies 3 4 15 27 Impetigo 30 36 462 463 Conjunctivitis 8 12 64 87 Blepharitis 7 21 50 144 Ear Disease 83 77 239 171 Ringworm (Scalp) 3 2 47 36 Ringworm (Body) 5 3 59 61 (c) Tonsils and Adenoids. 4.6 per cent, of the children examined during the year were referred for treatment for "tonsils and adenoids," either separate or combined, as compared with 3.5 per cent, in the year 1925. Of these, much enlarged tonsils accounted for 0.6 per cent.; definite adenoids were present in 0.3 per cent., and the combined defect was diagnosed in 3.7 per cent.; the figures for 1925 were 0.8 per cent., 0.3 per cent., and 2.4 per cent. respectively. The percentage of children moderately affected and requiring to be kept under observation was 9.2, the corresponding percentage in 1925 being 13.1. In this case 7.3 per cent, had moderately enlarged tonsils, 0.7 per cent. exhibited signs of the presence of adenoids, whilst 1.2 per cent. showed enlarged tonsils and adenoids of moderate degree, as compared with 10.8 per cent., 0.9 per cent., and 1.4 per cent., respectively in the year 1925. 70 (d) Tuberculosis. The total number of cases of tuberculosis, occurring in children of school age, notified to the Medical Officer of Health during the year, was as follows :— Boys. Girls. Total. Pulmonary Tuberculosis 7 11 18 Other forms of Tuberculosis 11 7 18 Totals 18 18 36 (e) Skin Disease and (f) External Eye Disease. The number of these cases remains high. At routine medical inspection during the year 1,025 children were found to be suffering from skin affections (as compared with 964 in the year 1925). Cases of external eye disease also continue to show a high incidence, 264 in the year 1926 and 129 in the year 1925). It is doubtful whether an appreciable reduction in the number of such cases is possible without the elimination of overcrowding in many of the houses and the provision of a properly equipped Clinic for the treatment of skin disease. (See report of Ophthalmic Surgeon on p. 90.) (g) Vision. Only children with marked visual defect have been referred for treatment and these, including cases of strabismus, numbered 790. In addition there were 206 children in whom there was evidence of a lesser degree of visual defect and these are being kept under observation. (See report of Ophthalmic Surgeon on p. 90.) (h) Ear Disease and Hearing. 0.7 per cent. of the children examined were found to be suffering from otitis media, as compared with 1.3 per cent. in 1925. The percentage of deaf children was 0.9, the corresponding number for last year being 0.7. (i) Dental Defects. (See report of Dental Surgeon on p. 94.) 71 (J) Crippling Defects. Reference to Table III on p. 102 will furnish information with regard to the occurrence of crippling defects in the area. 37 cases of crippling due to tuberculosis and 169 cases due to other causes were discovered at routine medical inspection during the year. 3. INFECTIOUS DISEASES. A detailed account of the scheme adopted for the detection and prevention of infectious diseases has been submitted in previous reports, and the accompanying table will furnish statistics in regard to the incidence of the acute infectious diseases during the year 1926. 72 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 183 38 1 16 7 17 February 963 46 13 51 9 25 March 522 46 2 25 20 18 April 47 3 — 11 21 20 May 25 5 13 25 16 19 June 10 8 19 47 19 10 July 3 1 24 13 18 19 August 1 1 46 1 7 10 September — 6 9 2 14 17 October - 31 17 9 15 26 November 4 74 4 17 24 26 December 12 23 — — 20 15 Totals 1770 282 148 217 190 222 73 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. 1925 1926 1925 1926 Ringworm of Scalp 99 126 3288 2971 Ringworm of Body 45 87 571 989 Impetigo Contagiosa 81 133 695 988 Infective Eye Inflammation 79 126 1361 1761 Septic conditions 69 176 623 1431 Verminous conditions 40 36 253 230 Scabies 34 54 416 427 Other Skin conditions 89 123 1214 1135 Acute Throat conditions 113 116 1935 1475 643 977 10356 11407 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 4,948 visits to the homes of children in whom defects were found at medical inspection. Of the 1,451 children referred for treatment 1,006, or 69.3 per cent., have obtained treatment. The School Nurses have also paid 128 special visits to the Schools, and 21 visits to the Feeding Centres and have undertaken 16 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 (420), have been visited by the School Nurses both prior to and after the operation. The County Borough of East Ham is fortunate in possessing a very keen and efficient staff of School Nurses, upon whose work has depended, to a large extent, the highly satisfactory results obtained by the School Medical Service, both in the direction of ensuring the adoption by the parents of the advice given by the Medical Officers and of determining and securing for the children the necessary preventive and curative treatment required. 74 8. MEDICAL TREATMENT. The following clinics are held weekly for the treatment of defects in school children:— (1) General Clinic (Minor Ailments and Observation Cases), Town Hall—Mondays, Wednesdays and 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 9 a.m. (6) Ear Specialist Clinic, Town Hall, Tuesdays at 3 p.m. A full account of these clinics was set forth in my report for 1922. During the year 1926, 15,810 attendances were made for treatment at the various clinics, and there were 14,575 attendances for consultation of the Medical Officers. (а) Minor Ailments. An analysis of the chief minor ailments treated at the School Clinics, and otherwise, will be found in Table IV, Group 1, p. 106. (б) Tonsils and Adenoids. In the case of children moderately affected and requiring to be kept under observation advice has been given as to general hygiene, diet, the necessity for dental treatment and for breathing exercises, etc. Of the children referred for treatment 420 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 carry into effect the recommendation of the Board of Education in regard to the visitation of children after the operation. 75 (c) Tuberculosis. The arrangements for the treatment of Tuberculosis have been continued on the lines fully set forth in my reports for previous years. (d) Skin Diseases. For the most part these are treated at the General Clinic, but some cases of chronic and of the rarer skin diseases are referred to hospital. The application of X-rays in cases of ringworm is performed at the School Clinic, and 17 children received this form of treatment during this year. (e) External Eye Disease. 294 cases (224 in 1925) 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. 90. (f) Vision. During the first half of the year 1926 the Ophthalmic Clinic was held on three sessions per week, but in July it was decided that this number should be reduced to two sessions per week, although a large number of children were awaiting treatment. In November the sessions were increased to five per fortnight, and this arrangement remains in force. 790 cases were referred for treatment in respect of visual defect during the year 1926 and, including a large number of cases awaiting treatment at the termination of the year 1925, 844 cases have been treated in the past year. On the 31st of December, 1926, there were 195 children, with markedly defective vision, who had not been seen by the Ophthalmic Surgeon. A waiting list, such as this, results in considerable delay, and in many cases a period of from three to four months intervenes between the discovery of the defect and attendance for treatment. 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 206 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. 76 (g) Ear Disease. 677 consultations were given and 540 children were treated at the General Ear Clinic. (See report of Aural Surgeon, p. 86.) (h) Dental Defects. 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. 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. (See also Report of Dental Surgeon, p. 94.) (i) Crippling Defects. Orthopaedic 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 orthopaedic surgeon. Payment is made to the Hospital Authorities by 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 in- 77 eluded 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 1926, 24 out-patients and 2 in-patients have received orthopaedic treatment. The total out-patients attendances was 735, whilst the average number of weeks involved in the case of each in-patient was 10. 9. OPEN-AIR EDUCATION. (a) Playground Classes. In a few cases playground classes continue to be held occasionally. (6) School Camps. No School Camps were held during the year 1926. (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. (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 102 cases, financial responsibility for which was not undertaken by the Local Education Authority. 78 Particulars of the number of Children who were admitted to Schools of Recovery between 1st January and 31st December, 1926, 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 3 — 1 — 2 — 5 4 — — 4 6 2 2 — — — 2 — — 4 6 21 21 42 I.C. A.A. — 3 2 X — 1 5 3 1 — 4 3 — 1 1 — — — — — — — — 1 13 13 26 Russell- Cotes No. of Weeks — — — — — — — — — — — — — — 6 — — — — — — — 12 — — — — No. of Weeks RussellCotes (Cont.) 13 / 14 15 16 17 18 28 — — — — — — 1 — 5 — — — — — 24 — 24 79 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 89,606 meals were provided for 480 children, as compared with 74,716 meals for 292 children in 1925. 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 1926 the number of parents who were present at the routine medical inspections was 4,769 (5,172 in 1925), that is, in 45.3 per cent. of the cases examined (51.4 per cent. in 1925). 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. 80 16. CO-OPERATION OF VOLUNTARY BODIES. Reference to 8 (i) on page 76 and to 9 (e) on page 77 will give some measure of the scope of the work carried out in association with Voluntary Bodies. 17. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDRF.N. Physically Defective Children. Table III reveals the very regrettable fact that 87 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 618 children, who are considered physically defective, are attending public elementary schools, and since suitable treatment is not available for some of these cases it is highly probable that a number of them will ultimately join the ranks of the unfit. Mentally Defective Children. During the year 1926, the number of cases examined, for purposes of the Mental Deficiency Act of 1913, was 57 (43 in 1925). Of these 34 were classified as mentally deficient, and 10 as dull and backward, recommendations being made as shown in the following table:— Number examined ... 57 Classified as mentally deficient 29 34 Classified as morally deficient — Classified as imbeciles 5 Classified as dull and backward ... 10 Recommended for Special School ... 24 Recommended for Special Class ... 5 A reference to Table III will show that out of 112 children who have been certified as mentally defective but educable in a special school, 14 (26 in 1925) are having no education, 10 cases are attending the ordinary elementary schools (nil in 1925), and 88 have been satisfactorily placed. 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. 81 MEDICAL INSPECTION RETURNS. SECONDARY SCHOOL. TABLE I. RETURN OF MEDICAL INSPECTIONS (see note a). For the Year ended 31st December, 1926. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections— (see note b). Boys. Girls Entrants — — Intermediates — — Leavers 119 101 Total 119 101 Number of other Routine Inspections (see note c). 120 130 B.—OTHER INSPECTIONS. Number of Special Inspections (see note d). 11 11 Number of Re-Inspections (see note e). 36 42 Total 47 53 82 TABLE II. SECONDARY SCHOOL. A.—Return of Defects found by Medical Inspection in the Year Ended 31st December, 1926. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment.. Requiring to he 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 — 3 — — — — — — Uncleanliness: See Table IV., Group V. – – – – – – – – Skin Ringworm: Scalp — — – – – – – – Body — — – — – — – — Scabies — — – – – — – – Impetigo — – – 1 – — – – Other Diseases non-Tuberculous – – – – 3 – – – Eye /Blepharitis — — – — – 2 – – Conjunctivitis – — – — — — – – Keratitis – – – – – – – – Corneal Opacities – – – – – – – – Defective Vision (excluding Squint) 10 21 5 – 1 – – – Squint – — — — — — – – Other Conditions 1 1 — 1 — – — — Ear Defective Hearing – 4 – – – – – – Otitis Media — — — — — – – – Other Ear Diseases — — — — — — — — Nose and Throat Enlarged Tonsils only – – 8 9 2 – – – Adenoids only . — – — — — – – – Enlarged Tonsils and Adenoids 1 – – 2 – – – – Other Conditions 1 3 — 4 1 — — — Enlarged Cervical Glands (Non-Tuberculous) — 1 20 11 — – – – Defective Speech — — — — — 1 — — 83 Table II.—(continued.) (1) (2) (3) (4) (5) B. G. B. G. B. G. B. G. Teeth—Dental Diseases (see note a) See Table IV., Group IV. — 3 5 2 2 — — — Heart and Circulation Heart Disease: Organic – – – – – – – – Functional – – – – – – – – Anaemia — 5 — 2 — 1 — — Lungs Bronchitis – – 1 – – – – – Other Non-Tuberculous Diseases — — 1 – – — — — Tuber- culosis Pulmonary: Definite – – – – – – – – Suspected – – – – – – – – Non-Pulmonary: – – – – – – – – Glands – – – – – – – – Spine – – – – – – – – Hip – – – – – – – – Other Bones and Joints – – – – – – – – Skin – – – – – – – – Other Forms – – – – – – – – Nervous System Epilepsy – – – – – – – – Chorea — — — — — — — — Other Conditions – — 1 2 — — — — Deformities Rickets – – – – – – – – Spinal Curvature — — 1 — — — — — Other Forms – 1 1 3 – — — — Other Defects and Diseases 2 1 1 5 2 4 — – 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 119 101 5 20 4.2 25.7 Total (Code Groups) 119 101 5 26 4.2 25.7 Other Routine Inspections 120 130 11 19 9.2 14.6 84 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. Seventeen 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. MISCtLLANEOUS. During the year 1926 the following special medical examinations were made:— Teachers 42 Officers 3 Student Teachers 19 Bursars 16 Scholarship Candidates 60 Workmen 21 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 1926. 86 To the School Medical Officer, County Borough of East Ham, Education Committee. February 10th, 1927. Sir, I have the honour to submit to you my report of the work done in the Aural Clinic during the year 1926. The total number of cases that presented themselves for diagnosis or inspection was 473, consisting of 264 boys and 209 girls, necessitating 862 separate visits to the Specialist. On the other hand the Treatment Clinic, under the charge of its capable staff of Sister and nurses, dealt with 2,995 visits made by those children considered by the Specialist to require regular or particular attention, or where the home conditions were unsatisfactory. There were in all 555 cases showing defective hearing, and of these 283 had the added symptoms of aural discharge. 89 cases showed under treatment definite improvement in hearing, and should be numbered chiefly among those children who suffered from a catarrhal deafness without discharge, and who benefited from the operation for removal of their tonsils and adenoids, rather than those with suppurating ears where more or less damage to the hearing has permanently occurred, and where the aim of treatment is mainly directed towards the arrest of the active disease. In 255 children the operation for removal of tonsils and adenoids was advised, and in the greater proportion of these cases the operation was duly carried out, and with very beneficial results. More and more the qualms of parents and their resistance to the advice offered are being overcome, and this is due no doubt to a better education of the facts brought about largely by the visiting nurses as well as by the obvious results obtained by improved clinics throughout the district. The number of cases discharged during the year amounted to 161, a by no means satisfactory result when one considers the total number of afflicted cases, but certainly encouraging when one thinks of the many difficulties to be encountered, such as the amount of time and care to be given to each individual case, the limited accommodation in hospitals, and the retarding effects of conditions in certain classes of homes. The future, however, 87 vides a brighter prospect, and more and more the effects of better hygiene and preventive medicine are coming into play, and these will gradually diminish the number of cases as well as bring about earlier diagnosis and treatment. Lastly, I wish to draw attention to the class of patient that suffers from nasal catarrh. The cause of this is generally adenoids, the removal of which relieves the condition. In a by no means small proportion the cause lies in the nose itself or its accessory sinuses, and is very often due to a nasal obstruction, commonly a deflected septum brought about by trauma. The correct diagnosis is generally only made by the specialist himself, and in his hands lies the cure by operative treatment. During the year I have myself performed 10 operations in Hospital on the nasal septum, and, I am glad to say, with satisfactory results. I have the honour to be, Sir, Your obedient Servant, L. GRAHAM BROWN. Number of Cases seen by Specialist 473 Number of Boys 264 Number of Girls 209 Number of Visits made to Specialist 862 Number of Visits made to the Treatment Clinics 2995 Number of Cases of Deafness 272 Number of Cases of Discharging Ears 283 Number of Cases showing improvement in Hearing 89 Number of Tonsils and Adenoids Operations Ordered 255 Number of Cases Discharged during 1926 161 COUNTY BOROUGH OF EAST HAM EDUCATION COMMITTEE. Annual Report OF THE Ophthalmic Surgeon FOR THE YEAR 1926. 90 To the School Medical Officer, County Borough of East Ham, Education Committee. Sir, I have to report that in the Ophthalmic Clinic during the past year I have examined 762 cases of defective vision discovered and referred to me by the School Medical Officers in their routine examinations. Besides these I have had under observation 698 cases, previously seen, whose sight for various reasons was liable to be adversely affected by their school work or for whom special arrangements had to be made, their parents being reluctant that they should be sent to residential "Myope" schools. This step was rendered necessary by the absence of special "Myope" Classes in East Ham. Of this latter group 516 cases remain under observation, while 182 no longer require it. The re-examination of cases already seen adds very considerably to the work of the Clinic, but it is of the greatest importance. It brings home to all concerned, to the parents, the teachers, and the children themselves, that these conditions are only too liable to get worse, and that constant attention must be given both at school and at home if children with defective sight are to have good education and yet not suffer so much in the process that, in spite of considerable scholastic success, their wage-earning capacities are seriously reduced by damage to their eyes before they can begin to earn their own livings. Supervision consists in re-examining at regular intervals, usually of six months, and noting the deterioration or otherwise of vision, prescribing fresh glasses, or checking the amount of work done in school if necessary, and lastly, in keeping careful watch upon the condition of the teeth and the occurrence of unhealthy tonsils and adenoids, these conditions being specially liable to lead to increase in the degree of short sight. Besides cases showing vjsual defects, 55 cases of eye disease have been under treatment. Three serious cases of corneal ulceration have occurred in which I feared for the ultimate state of the eye. I had these cases admitted under me at the Royal Westminster Ophthalmic Hospital with, I am glad to say, happy results. These diseases—Corneal ulceration, Phlyctenular conjunctivitis, and Blepharitis, will, we hope, ultimately disappear as 91 housing conditions improve, and the factors which produce chronic ill-health in little children become more widely known. The presence of unhealthy teeth, tonsils and adenoids, with rickets, and combined with infection of the clothing and hair, which must occur where many children crowd together, and occurs in spite of the sustained efforts of the School Nurses, leads to a state of chronic ill-health before and during school life which does more harm than the School Medical Service can hope to rectify. Parents, desiring as they do to co-operate, sometimes find it difficult to believe this. In some cases we have been able to produce very surprising improvement by sending the children away to Miss Hudson's Home at Bushey Park, in others treatment by artificial sunlight, will, we hope, give good results. During the year five cases of squint have been referred for operative treatment, and I have operated upon G cases at the Royal Northern Hospital at Holloway. The long waiting list, a problem which the work of this hospital in a crowded area makes it difficult to solve, is patiently submitted to by parents and children alike. I would, lastly, Sir, like to draw attention to a new feature of my work at East Ham. On June 8th, 1926, I began to see cases under the age of five years referred to me from the Maternity and Child Welfare Clinics, and since the commencement have seen 39 cases. The work of this branch falls into three groups:— (a) Advising on the treatment of cases of incipient squint (29 cases). Many of these cases if taken at once on appearance (within a fortnight) can be cured, and much distress and disfigurement in school life, with perhaps ultimately an operation for its relief, thereby avoided. (In 11 cases of incipient squint glasses were prescribed.) (b) Treating conditions such as acute conjunctivitis, abscess of the tear duct, or corneal ulcer, which are liable to arise with surprising suddenness in very young children, doing irreparable damage before efficient treatment is provided (8 cases). (c) Advising on cases of congenital malformation of the eyes which may or may not be amenable to treatment, but for which help should be available as early as possible (2 cases). 92 Of the 39 cases seen 20 remain under observation. May I say in conclusion, Sir, that the work of the Ophthalmic Clinics is of a rather strenuous nature, and that it would be quite impossible to carry it out efficiently without the cordial and interested co-operation of my medical colleagues, the Optician, the School Nurses, and the Clerical Staff, who at all times give of their best and render the working of the Clinic smooth and easy. I have the honour to remain, Sir, Your obedient Servant, CHARLES LEONARD GIMBLETT. COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Annual Report on the work done in The School Dental Clinic FOR THE YEAR 1926. 94 To the School Medical Officer, County Borough of East Ham, Education Committee. Sir, I beg to submit to you my report for the year 1926. The age groups inspected were from 5 to 9 years inclusive; and treatment has been offered where necessary in all cases. The number of children inspected was 9,392 and those referred for treatment 6,716. This number must be augmented by those cases of oral sepsis and bad toothache referred by the School Medical Officers, nurses and head-teachers, which total 273. Details will be found in the following statistical table:— TABLE IV. Group IV.—Dental Defects. (1) Number of Children who were:— Age. Routine Age Groups. Specials Total.(see note d) Grand Total. (a) Inspected by the dentist 5 6 7 8 9 10 11 12 13 14 2137 2566 1753 1690 1240 — — — — – 9392 273 9665 (b) Found to require treatment 6710. (c) Actually treated 1929. (d) Re-treated during the year as the result of periodical examination (see note e) Nil (2) Half-days devoted to:— Inspection 62 Treatment 308 Total 370 (3) Attendances made by children for treatment 4305. (4) Fillines:— Permanent teeth 343 Temporary teeth 993 Total 1336 (5) Extractions:— Permanent teeth 509 Temporary teeth 4517 Total 5026 (6) Administrations of general anaesthetics for extractions 269. (7) Other operations:— Permanent teeth 240 Temporary teeth 155 Total 395 Notwithstanding the adverse conditions, and the numerous handicaps which beset a single-handed dentist in a County Borough with +a school population of 23,000, it is with satisfaction that one notes the percentage of children found to require treatment, under 96 10 years of age, is reduced to 71.5 per cent. Comparison with former years will be found in the following table:— Year. Percentage of Children found to require treatment under 10 years of age. 1923 77 1924 73.8 1925 71.9 1926 71.5 The age groups to be inspected during the year 1927 will be the same as in 1926, namely, 5 to 9 years inclusive. The work of the Clinic has been carried out in order to reduce pain to the utmost minimum. In the case of teeth which have to be extracted and are not too septic, local injections have been given, and in all other cases either gas has been administered or ethyl-chloride used. Teeth, both temporary and permanent, have been filled where possible, which process has been rendered practically painless. The mouths of all children attending the Clinic have been rendered clean and sound by the necessary treatment. In certain cases sound teeth have been extracted for regulation purposes. Many children require to wear a regulating appliance in order to make their teeth give the utmost service, and to give them a pleasing appearance; owing to lack of time, however, all these children have been advised to attend a large general hospital which has a dental department. The need for at least two more school dentists in the Borough is again emphasised. No real preventive dentistry can be undertaken until these be appointed, and that is the most important part of school dental work. Parents should be instructed in the importance of proper diet in babyhood and in early childhood, in order that the jaws will be properly developed and the mouth kept naturally clean. They should be instructed also in the periods when the temporary teeth come through, when they are lost, when the permanent teeth appear, the need of filling teeth, and oral cleanliness. All this is far more important than filling and extracting teeth, for it strikes at the root of all dental trouble. Only when preventive work is 96 undertaken and acted upon shall we be nearer the goal of giving the children of East Ham every possible chance of successfully fighting ill-health and disease. What time can be given to preventive work is shown by the fact that on December 31st, 580 children were awaiting dental treatment from the school inspections. During 1926 the Dental Clinic has been housed under its former unhealthy conditions, but at last there are signs that the Education Committee will, in the near future, sanction moving to more salubrious quarters. The tact and patience of the Dental Nurse, Miss Olifent, has been no mean asset in the successful running of the Clinic. Details of treatment given to mothers and children sent from the Maternity and Child Welfare Centre are given in the following table:— Maternity and Child Welfare Figures for 1926. 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. 40 163 258 204 33 266 113 470 146 G8 59 15 There has been an increase in the number of children of the Maternity and Child Welfare Centre attending the Dental Clinic over the figures for 1925. It is pleasing to record the fact that the septic mouth one used to see in babies of 18 months and over is now very rare. This, one hopes, is a sign of the times—that parents are realising the importance of oral cleanliness and its close relation to the health of the young child. In conclusion, I should like to thank the Medical Officer of the Maternity and Child Welfare Centre, Dr. Elsie Thomson, the School Medical Officers, the Nurses, the Clerical Staff, and teachers for their valued co-operation and assistance during the year 1926. I have the honour to be, Sir, Your obedient servant, CYRIL S. NEAME. 97 TABLES GIVING SUMMARY OF WORK OF SCHOOL MEDICAL SERVICE from 1st JANUARY, 1926, to 31st DECEMBER, 1926. PUBLIC ELEMENTARY SCHOOLS. TABLE I. RETURN OF MEDICAL INSPECTIONS (see note a). For the Year ended 31st December, 1926. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections— (see note b). Entrants 3,345 Intermediates 1,991 Leavers 3,657 Total 8,993 Number of other Routine Inspections 1,054 (see note c). B.—OTHER INSPECTIONS. Number of Special Inspections 3,660 (see note d). Number of Re-Inspections 4,659 (see note e). Total 8,319 NOTES ON TABLE I. (a) The return refers to a complete calendar year. (b) This heading relates solely to the routine medical inspection of the three ordinary age groups, i.e., to medical inspection carried out:— (i) in compliance with Article 7 of the Consolidated Regulations relating to Special Services—Grant Regulations No. 19; (ii) on the school premises (or at a place specially sanctioned 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. 98 (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 at 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 inspections 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. 99 TABLE 11. A.—A Return of Defects found by Medical Inspection in the. Year Ended 31st December, 1926. Routine Inspections. Special Inspections. No. of Defects. No. of Defects Defect or Disease. 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 57 18 6 2 Uncleanliness : (See Table IV., Group V.) — — — — Skin Ringworm: Scalp 8 - 36 - Body 3 — 61 — Scabies 4 — 27 — Impetigo 36 9 463 6 Other Diseases (non- Tuberculous) 24 21 369 8 Eye Blepharitis 21 6 144 — Conjunctivitis 12 9 87 3 Keratitis — — 5 — Corneal Opacities - 2 12 1 Defective vision (excluding Squint) 568 172 153 15 Squint 33 15 36 4 Other conditions 9 10 51 — Ear Defective Hearing 78 11 33 7 Otitis Media 36 12 42 5 Other Ear Diseases 41 44 129 6 Nose and Throat Enlarged Tonsils only 49 985 37 10 Adenoids only 18 96 23 — Enlarged Tonsils and Adenoids 264 168 240 3 Other conditions 42 178 93 12 Enlarged Cervical Glands (Non- Tuberculous) 6 1816 15 6 LOO ' Table II.—(continued). (1) (2) (3) 4) (5) Defective Speech 7 30 9 10 Teeth—Dental Diseases (sec note a) (see Table IV., Group IV.) 240 1095 214 29 Heart and Circulation. Heart Disease : Organic 3 21 9 - Functional — 16 3 3 Anaemia 42 43 84 3 Lungs Bronchitis 24 138 03 15 Other Non-Tuberculous Diseases 6 66 69 21 Pulmonary: Definite - - 3 - Tuberculosis Suspected 2 7 3 12 Non-Pulmonary: Glands 3 1 3 - Spine — — — — Hip — 1 1 — Other Bones and Joints — 1 — — Skin — — — 1 Other Forms — 9 3 - Nervous System Epilepsy 1 3 8 5 Chorea 2 15 30 9 Other conditions 11 27 88 45 Deformities Rickets 3 4 - - Spinal Curvature 12 12 2 7 Other Forms 18 48 9 2 Other Defects and Diseases 146 304 948 70 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 3345 454 13.6 Intermediates 1991 270 13.8 Leavers 3657 489 13.4 Total (Code Groups) 8993 1213 13.5 Other Routine Inspections 1054 177 16.8 101 NOTES ON TABLE II. (a) The figures to be included in this space should refer to the findings of the Medical Officer and not those resulting from dental inspection in the schools by the School Dentist. The findings of the School Dentist should be recorded in Table IV., Group IV. (b) No individual child should be counted more than once in this part of Table II., i.e., under B, even if it is found to be suffering from more than one defect. (c) The figures in this column will of course be the same as those given in Table I. A. (d) The figure in this column will be the percentage of the figure in column (3) of that in column (2). 102 TABLE III. Return of all Exceptional Children in the Area for the Year ended 31st December, 1926 (see note a). Boys. Girls. Total Blind (including partially blind)(see note b). (i.) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 7 4 11 Attending Public Elementary Schools (see note c) - - - At other Institutions — — — At no School or Institution — — — (ii.) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind 6 8 14 Attending Public Elementary Schools {see note c) 1 4 5 At other Institutions — — — At no School or Institution 1 5 6 Deaf(including deaf and dumb and partially deaf) (see note d). (i.) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf 7 5 12 Attending Public Elementary Schools (see note c) - - - At other Institutions — — — At no School or Institution — — - (ii.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf - — — Attending public Elementary Schools (see note c) — — — At other Institutions — - — At no School or Institution — 1 1 Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority). (Sec note e.) Attending Certified Schools for Mentally Defective Children 50 38 88 Attending Public Elementary Schools (see note c) 6 4 10 At other Institutions - — — At no School or Institution 8 6 14 Notified to the Local Control Authority during the year. Feebleminded 1 1 2 Imbeciles 11 5 16 Idiots - - - Epileptics Suffering from severe epilepsy. (See note f) Attending Certified Special Schools for Epileptics 4 3 7 In Institutions other than Certified Special Schools 1 - 1 Attending Public Elementary Schools (see note c) - - - At no School or Institution — 6 6 103 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 12 6 18 At other Institutions 2 2 4 At no School or Institution 3 4 7 Non-infectious but active pulmonary and glandular tuberculosis. (See note h.) At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At Certified Residential Open Air Schools 2 3 5 At Certified Day Open Air Schools - - - At Public Elementary Schools (See note c) 83 60 143 At other Institutions 2 — 2 At no School or Institution 19 7 26 Physically Defective. Delicate children (e.g., pre- or latent tuberculosis, malnutrition, debility, anaemia, etc). (See note h.) At Certified Residential Open Air Schools 21 19 40 At Certified Day Open Air Schools - - - At Public Elementary Schools (see note c) 122 147 269 At other Institutions 15 16 31 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 10 7 17 At Public Elementary Schools (see note c) 30 7 37 At other Institutions 9 5 14 At no School or Institution 8 3 11 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 - 2 2 At Certified Residential Cripple Schools 2 6 8 At Certified Day Cripple Schools - - - At Public Elementary Schools (see note c) 86 83 169 At other Institutions 3 4 7 At no School or Institution 26 17 43 104 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 hav'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 Dut 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 ordinarypublic elementary schools. (b) For the purpose of this return the Board require that children who are blind within the meaning of the Act should be divided into two categories, i.e., (1) those who are totally blind or so blind that they can only be appropriately taught in a school or class for totally blind children, and (2) those who though they cannot read ordinary school books, or cannot read them without injury to their eyesight, have such power of vision that they can appropriately be taught in a school or class for the partially blind. It should be understood that children who are able by means of suitable glasses to read the ordinary school books used by children without fatigue or injury to their vision, should not be included in this Table. 105 (c) It should be understood that none of the children in this Table (except children suffering from epilepsy which is not severe) should in fact be attending public elementary schools. When the heading is retained, it is merely because at present the insufficiency of Special School accommodation makes it impossible to do better for some defective children than to allow them to attend the ordinary school. No space is left for the entry of children with infectious pulmonary tuberculosis attending public elementary schools, as these children should of course be promptly excluded from such schools. (d) Children who are deaf within the meaning of the Act should be classified for the purpose of this Table as (1) totally deaf or so deaf that they can only be appropriately taught in a school or class for the totally deaf, and (2) partially deaf, i.e., those who can appropriately be taught in a school or class for the partially deaf. (e) This category includes only those children for whose education and maintenance the Local Education Authority are responsible, and who are not eligible for notification to the Local Control Authority under the Mental Deficiency Act. (f) In this part of the Table only those children should be included who are epileptic within the meaning of the Act. For practical purposes the Board are of opinion that children who are subject to attacks 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. 106 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1926 (see note a) TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme, (see note b). Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm—Scalp 34 - 34 Ringworm—Body 51 — 51 Scabies 28 — 28 Impetigo 473 9 482 Other skin disease 288 18 306 Minor Eye Defects (External and other, but excluding cases falling in Group 11.) 294 6 300 Minor Ear Defects (See note c ) 234 27 261 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 1299 276 1575 Total 2701 336 3037 107 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. Under the Authority's Scheme (see note b). Submitted to refraction by private practitioner or at hospital, apart from the Authority s Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) ... (Operations for squint should be recorded separately in the body of the Report.) 754 88 2 844 Other Defect or Disease of the Eyes (excluding those recorded in Group 1.) 8 2 - 10 Total 7G2 90 2 854 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme 706 (b) Otherwise 68 Total number of children who obtained or received spectacles— (a) Under the Authority's Scheme 701 (b) Otherwise 68 Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of Treatment. Total number Treated. Under the Authority's Scheme inClinic or Hospital. (see note 6.) By Private Practitioner or Hospital apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 282 138 420 23 443 108 Group IV.—Dental Defects. (1) Number of Children who were : — (a) Inspected by the Dentist Age. Specials Total (see note d) Grand Total. Routine Age Groups. 5 6 7 8 9 10 11 12 13 14 2137 2566 1753 1696 1240 - - - - - 9*592 273 9065 (6) Found to require treatment 6716. (c) Actually Treated 1929. (d) Re-treated during the year as the result of periodical examination (see note e) Nil (2) Halt-days devoted to:— inspection 62} Treatment 308} Total 370 (3) Attendances made by children for treatment 4365 (4) Fillings :— Permanent Teeth 343) Temporary Teeth 993 Total 1336 (5) Extractions:— Permanent Teeth 509} Temporary Teeth 4517} Total 5026 (6) Administrations of general anaesthetics for extractions 269. (7) Other operations:— Permanent Teeth 240) Temporary Teeth 155} Total 395. 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 58,683 (iii.) Number of individual children found unclean 1,926 (iv.) Number of children cleansed under arrangements made by the Local Education Authority Nil. (v.) Number of cases in which legal proceedings were taken :— (o) Under the Education Act, 1921 Nil. (b) Under School Attendance Byelaws 2 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 109 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. (/) 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 foob and Shops Inspector FOR THE YEAR 1926. 112 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 thirty-first Annual Report of the work of the Sanitary Inspector for the year 1926. The number of primary inspections made was 5,873. These included visits to premises where infectious diseases had occurred, house-to-house inspections, visits to premises upon complaint of nuisance, inspection of markets, slaughterhouses, bakehouses, eating houses, cowsheds, workshops, etc. 113 PRIMARY INSPECTIONS. Month Manor Park Little Ilford Woodgran.ge Plashet Kensington Castle Central W-ll End G-eatfiehl 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 Home to House January 48 74 26 2 27 8 46 - 12 - 25 132 42 — 52 79 19 — 34 — 331 295 February 44 10 43 — 32 1 42 2 15 — 30 152 46 — 54 — 9 — 46 — 361 165 March 57 — 38 — 44 5 42 — 19 — 55 128 52 — 40 — 14 — 38 31 399 164 April 48 4 47 22 39 1 57 — 19 — 38 17 63 — 29 — 25 — 78 1 443 45 May 35 — 26 21 23 - 16 — 12 — 26 40 35 12 54 — 13 — 37 73 277 146 June 49 — 48 22 30 — 34 — 20 — 33 — 34 97 36 — 23 — 56 59 363 178 July 50 — 45 — 31 — 39 — 21 — 24 — 45 14 29 40 25 — 52 — 361 54 August 47 — 32 7 31 — 35 — 16 — 29 — 25 21 25 72 17 — 55 — 312 100 September. 47 — 30 31 38 1 67 — 20 — 50 — 51 41 24 — 19 — 50 60 396 133 October 42 5 39 9 38 — 38 18 13 — 34 — 25 5 23 — 11 — 36 25 299 62 November 48 — 45 34 39 6 81 38 14 — 58 — 65 — 44 — 26 — 52 22 472 100 December 41 — 29 30 34 — 38 36 26 — 21 — 44 18 17 — 13 — 54 16 317 100 556 93 448 178 406 22 535 94 207 — 423 469 527 208 427 191 214 — 588 287 4,331 1,542 114 8,842 nuisances, generally the outcome of sanitary defects, were dealt with by the Inspectors. (These are fully detailed on inset opposite page 135.) Of these nuisances, 4,958 were detected in routine work, and 3,884 by house-to-house inspections. To secure their abatement, the undermentioned Notices were served :— Preliminary 2,909 Statutory 520 Dust Bin 356 Water 1 3,786 Complaints. 2,462 complaints were received—960 written and 1,502 verbal —the figures for the previous year being 1,059 written and 1,353 verbal. The complaints were of a varied nature, as many people have a wrong conception of an Inspector's powers—some of them referred to matters over which we have no jurisdiction. Others were anonymous, but received the same attention—we find from experience that there are sometimes good reasons for hidden identity. 115 COMPLAINTS RECEIVED. Manor Park Little Ilford Wood grange Plashet Kensington Castle Central Wall End Greatfield South Total January 8 30 13 22 6 23 27 12 11 17 169 February 14 29 9 24 23 26 35 21 5 20 206 March 12 36 12 11 9 24 21 15 13 18 171 April 17 31 13 21 14 14 35 17 11 24 197 May 13 34 15 9 12 13 20 13 11 23 163 June 17 37 18 20 23 28 34 16 16 21 230 July 20 34 18 20 16 21 35 23 9 19 215 August 24 45 11 15 17 16 34 15 11 28 216 September 18 41 14 27 22 30 27 19 17 28 243 October 14 40 16 29 17 23 26 25 9 21 220 November 16 40 23 32 25 30 50 26 11 27 280 December 16 23 16 15 11 7 31 10 5 18 152 189 420 178 245 195 255 375 212 129 264 2,462  Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Drains 54 42 49 71 59 63 62 84 42 57 69 44 696 Accumulations 6 16 9 4 5 11 14 15 17 11 13 6 127 Water 1 2 Offensive Smells 10 6 4 2 — 8 7 6 12 3 1 — 59 No Dustbin 5 5 3 2 8 4 4 5 8 6 5 3 58 Dilapidations 36 64 28 28 35 46 25 27 45 71 73 32 510 Overcrowding 2 2 1 5 8 4 3 6 3 4 6 2 46 Insanitary Condition 22 22 53 45 23 48 48 40 44 36 43 20 444 Dampness 17 30 3 9 11 11 19 7 30 11 45 9 202 Others 17 19 21 31 14 35 33 26 41 21 25 35 318 169 206 171 197 163 230 215 216 243 220 280 152 2462 116 Sanitary Administration. The Borough is divided into three districts for inspection purposes, with a Senior and Junior Inspector working- in each. This arrangement, which was made six years ago, has produced good results, but in view of the re-organisation of the inspectorial staff which will be occasioned by impending changes, the rearranging of the districts will be a matter for consideration by the Committee. The tabular statement inset following page 135 gives particulars of the inspections. Public Water Closets and Urinals. There are 11 public conveniences in the Borough, excluding those in the parks, which are well maintained. No complaints have been received either of nuisance or inattention. The urinals attached to public-houses have been regularly inspected and letters and notices have been sent in cases of neglect. The work of cleansing is usually relegated to a minor employee. Where the manager personally supervises the work there is seldom any cause for complaint. Passages at Rear of Premises. Inspections have been made and Notices served for the abatement of nuisances caused by deposits of filth and rubbish. These passages, which form secondary means of access to premises, usually constitute rights-of-way for several occupiers, with divided responsibility, with the result that they get into a dirty condition. Their darkness and comparative loneliness are inviting to persons who wish to dispose of objectionable matter. House-to-House Inspection. In previous reports reference has been made to the importance of this branch of the Public Health service. It is the only method whereby some nuisances are brought to light—for some occupiers would suffer any form of inconvenience rather than complain to the Local Authority. The number of houses visited during the year was 1,542, and at 81 per cent. of these sanitary defects were discovered for which Notices were served upon owners to remedy. 117 House-to-house inspections are made in selected areas, which explains the high percentage of defects. Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-23. 19 applications were made by tenants for certificates as provided by Section 2 of the 1923 Act, entitling the occupier to a reduction of rent equal to the amount provided by the Act for repairs. 2 certificates were issued. In 17 instances certificates were suspended and a schedule of dilapidations forwarded to the owner, and in most cases the work required has been carried out. By means of the Rent (Restrictions) Act, one has the advantage of being able to deal with defects which are outside the purview of the Public Health Acts. Smoke Abatement. Observations of shafts were made with reference to the emission of smoke, and in the case of one factory notices were served and the nuisance has been mitigated. In no instance was it of such a character as to warrant the institution of legal proceedings. Offensive Trades. There are only two small traders in the Borough, in the Langdon Crescent area, who carry on businesses which come within the designation of offensive trades. These works are well conducted and there have been no complaints. I have previously drawn attention to the collection of offal from butchers' and fish shops, especially in the summer, when offensive odours are emitted from the collecting vehicles, which could be reduced to a minimum if suitable vessels and vans were used. There is yet much room for improvement in this direction, but it is a matter for co-operation with adjoining districts, as the contracting collectors work in several areas. Disinfection. 1,504 premises were disinfected—897 for infectious disease, 467 for tuberculosis, and 140 for other causes. The steam disinfector at the Isolation Hospital is used for bedding and other articles requiring disinfection. 118 Infectious Diseases. In all cases of infectious disease notified, the Inspector at once visits the premises, the sanitary arrangements and general condition of the houses are examined and, where necessary, sanitary notices are served upon persons responsible. If the case is nursed at home, directions are given as to isolation and prevention of spread of the disease. A report of every case is prepared by the Inspector for the Medical Officer of Health. The infected part of the house is disinfected at the termination of the case. 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 return to circulation. Factories, Workshops and Outworkers' Premises. There are 191 factories and workshops in the Borough, including bakehouses and laundries. During the year 456 inspections have been made, of which 132 were to homes of outworkers. In comparing these figures with previous reports it will be observed that there is a considerable decrease in the number of inspections made at outworkers' premises—in consequence of a less number of persons obtaining goods to be worked upon at home. H.M. Inspector of Factories has been informed of any irregularities coming within his province, and we have been informed by him of 13 nuisances which required abatement. 119 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises (1) Number of Inspections (2) Written Notices (3) Prosecutions (4) Factories (including Factory Laundries) 22 — — Workshops (including Workshop Laundries) 106 9 — Workplaces (other than Outworkers' premises) 4 — — 132 9 — 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars (1) Number of Defects Number of Prosecutions (5) Found (2) Remedied (3) Referred to H.M. Inspector (4) Nuisances under the Public Health Acts:—* Want of cleanliness 5 5 — — Want of ventilation — — — — Overcrowding 2 2 — — Want of drainage of floors — — — — Other Nuisances 15 13 — — Sanitary dation insufficient — — — unsuitable or defective 1 1 — — not separate for sexes 1 1 — — 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 24 22 - - * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. There have been no instances of outwork in unwholesome premises, sec. 108. 120 Collection of House Refuse. 21,289 tons of house refuse have been collected as compared with 21,920 tons during the previous year, showing a decrease of 146 tons. In view of the fact that there were a large number of new houses constructed during the year, there should have been an increase of tonnage collected—the decrease is owing to the several months' coal stoppage and the consequent increased use of oil and gas stoves. There are 29,030 houses in the Borough from which house refuse is collected weekly, and the average weight of refuse per house per annum equals 14.6 cwts.—a decrease of over ¼ cwt. compared with the previous year. The average weight of refuse per head of population equals 2.9 cwts. and costs 1s. 2d. per annum to collect. The total cost of collection was £8,657, which works out at 8s. 1d. per ton, or under 6s. per house yearly, and under 1½d. per house weekly. HOUSE REFUSE COLLECTION. Loads. Tons. 1925 1926 1925 1926 January 979 949 2,261 2,152 February 782 862 1,925 2,014 March 891 1,032 2,076 2,193 April 889 957 2,000 1,965 May 852 882 1,748 1,708 fune 929 881 1,362 1,551 July 868 938 1,480 1,641 August 830 818 1,420 1,403 September 828 857 1,571 1,497 October 895 836 1,788 1,560 November 1,019 825 1,768 1,760 December 949 886 2,036 1,845 Total 10,711 10,723 21,435 21,289 121 Trade Refuse Collection. The policy of the Council for many years has been to collect trade refuse (excluding offensive matter) from shops twice weekly without charge. The system makes it obligatory for tradesmen to put the refuse in suitable receptacles and place them in a ready and convenient position for collection. During the year 2,068 loads were collected. Dust Bins. Under the provisions of the East Ham Improvement Act, 1903, 356 dwelling houses have been reported to the Public Health Committee as not being furnished with a suitable dust bin. The Council authorised the service of Notices upon the persons responsible, calling upon them to provide proper portable galvanized iron bins. Where Notices were not complied with, the Council exercised its powers by providing bins for the houses and recovering the cost from owners. The bins supplied by the Corporation are good in design and construction, and as they are purchased in large quantities under contract, can be supplied at a reasonable price. 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, 1926. New houses erected during the year:— (a) Total 347 (b) As part of a municipal housing scheme 24 1. Dwelling Houses. Inspection—(1) Dwelling houses inspected for housing defects (under Public Health or Housing Acts) 4,631 (2) Dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. 122 (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 2 2. Defects remedied without service of formal Notices. Defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their Officers 2,489 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. (2) Dwelling houses which were rendered fit:— (a) By owners Nil. (b) By Local Authority in fault 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 2,909 (2) Dwelling houses in which defects were remedied:— (a) By owners 1,609 (b) By Local Authority in default of owners Nil. C.—Proceedings under Section 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. 123 (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 pursuance 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 principally carried out by large vendors by means of cans and bottles. Judging by the Public Analyst's reports the quality can be considered to be good. Dairies. There are 105 premises in the Borough, including a few shops other than dairies where milk is sold. These shops are gradually being removed from the register. The provisions of the Milk and Dairies Order are being carefully applied, with good results. There are two large sterilized milk factories in the Borough treating several thousand gallons of milk daily. Every precaution is taken to protect the milk from contamination and the latest mechanical devices are used. Milk (Special Designations) Order, 1923. Nine supplementary licences were granted for the sale of milk under this Order—3 for Grade "A," 3 for Pasteurised, and 3 for Certified milk. Public Health (Meal) Regulations, 1924, and Slaughterhouses. The work of supervising the slaughter of animals for human food is one of great importance and occupies much of the Inspectors' time. To facilitate efficiency, all owners and occupiers of slaughterhouses are provided with printed and addressed notification forms for the purpose of giving the requisite notice of 124 intention to slaughter. During the year 671 such notifications were received referring to:— Cattle 1,348 Sheep 2,328 Pigs 1,213 Lambs 1,025 Calves 412 6,326 Slaughtering takes place at extraordinary times, and on most Sundays one or two Inspectors are on duty. There are 16 licensed slaughterhouses in the Borough and 631 official inspections have been made. The slaughterhouses are scattered over a large area, which makes the work a little difficult at times. The Public Health (Meat) Regulations have been working a sufficient length of time for good results to be appreciated. In one instance a local pig dealer was prosecuted and fined £10 for killing without giving notice of his intention to slaughter. The pigs proved to be diseased, and a penalty of £50 was imposed for failing to give notice of disease and a fine of £5 for killing on unlicensed premises. The penalties may appear heavy, but in the circumstances they were justified. The slaughterhouses generally are well-conducted and regularly lime-washed and cleansed in accordance with the Bye-Laws. The effect of the Regulations is to be seen in almost every retail butcher's shop. Glass window fronts have been erected in some instances, and glass portable screens in others. Notices are exhibited requesting customers not to handle meat, forks being provided for the purpose of inspection. The work is educational, and patience may be necessary before all the ideals which the Regulations aim at are accomplished. Following is a list of slaughterhouses in the Borough:— Beckton Road. Manor Way Farm, New Beckton. 319, Green Street. 363, Green Street. 14, High Street North. 170, High Street North. 125 167, Plashet Grove. 843, Romford Road. 524, Romford Road. 638, Romford Road. 737, Romford Road. Shaftesbury Road. 28, Station Road. 6, Station Road. Forest View Road. Wakefield Street. Food Supply. The markets and shops are regularly inspected. Two Inspectors are on special duty during busy market hours. The food is usually good, but 15 consignments were, last year, condemned as being unwholesome, and on one occasion several joints of meat were seized as being unsound and unfit for food—the responsible person was prosecuted and fined £5. There is still room for improvement in the matter of food protection, and one would like to see Regulations framed controlling all food similar to the Meat Regulations. It seems a little ludicrous that food which is eaten without cooking or cleansing is not protected from dust or road splashings. A common practice is to expose for sale fruit and confectionery on stalls and shops fronts. Vendors' attention has been frequently drawn, but with little success, to dust blowing on cakes or into an ice-cream vessel near to which people stand eating and waiting to be served. On such points one is often regarded as a faddist. Bakehouses. There are 44 bakehouses in the Borough, 8 being underground. The others are of modern structure and well-maintained. 79 inspections were made and limewashing and cleansing carried out in accordance with the Regulations. Sale of Food and Drugs Act. 403 samples of food and drugs were taken (including 257 milks) and submitted to the Public Analyst. Of these, 399 were 126 reported to be genuine and 4 milk samples deficient in fat. No case of excess of sediment in milk occurred. Formal Samples. Milk 257 Lung Cure 1 Butter 25 Lemonade 1 Cream 2 Lemonade Powder 2 Preserved Cream 5 Little Folk Mixture 1 Ale 1 Limewater 1 Apples 2 Lemon Cheese 1 Beef Sausages 1 Lemonsquash 1 Brawn 1 Margarine 9 Bread 2 Mincemeat 1 Corned Beef 1 Malt Vinegar 2 Chicken and Ham Roll 1 Menthol and Eucalyptus Pastilles 1 Camphorated Oil 1 Chocolate Cream 1 Olive Oil 1 Cream Hazel Nuts 1 Pepper 1 Cray Fish 1 Plain Cake 1 Cornflour 1 Peas 1 Cheese 5 Peaflour 1 Cocoa 2 Pork and Beans 1 Crushed Linseed 1 Porter 1 Dripping 2 Puff Paste 1 Fruit Cake 1 Pears 1 Flour 2 Salmon 1 French Nougat 1 Saveloy 1 Ground Rice Snowflake Caramels 1 Ground Almonds 1 Sponge Cakes 3 Gin 1 Shredded Suet 1 Head Powder 1 Sweet Spirit of Nitre 1 Honey 1 Tapioca 1 Herrings in Tomato Sauce 1 Tinned Loganberries 1 Worcester Sauce 1 Ice Cream 1 Whisky Jam Sandwich 2 Wholemeal Flour 1 Jelly 1 Jordan Almonds 1 384 Lard 7 127 Informal Samples. Blackcurrant Jam 1 Shredded Suet and Rice 1 Butter 2 Cheese 1 Vinegar 1 Coffee 2 19 Demerara Sugar 1 Lard 2 Total 403 Margarine 1 Milk 4 Peas 1 Pepper 1 Adulterations. Pork Sausages 1 Milk 4 Legal proceedings were instituted on 4 occasions. The high percentage of genuine milk is satisfactory. The unsatisfactory aspect is that the standard is altogether too low. Too much consideration is given to the cow that gives poor milk (and plenty of it). Much has been done by way of Milk Orders and Regulations, but little real progress has been made. A very large company trading in the Borough have recently inaugurated the sealed bottle system—this assures to purchasers milk as sent out from the dairy, correct measure, and improved cleanliness. Again, if the public insisted upon having milk served under hygienic conditions, it could have them, but if it is content to purchase milk supplied in a dirty can there is usually someone willing to oblige. Milk and Cream Regulations. Milk & Cream not sold as Preserved Cream. (a) Number of samples examined for the presence of a preservative. (b) Number in which preservative was reported to be present, and percentage of preservative found in each sample. Milk 257 — Cream 2 — Cream Sold as Preserved Cream. Correct statements made 5 Statements incorrect — 5 128 Percentage of preservative found in each sample. .15 .16 .20 .34 .36 Percentage stated on statutory label. .40 .40 .40 .40 .40 Determination made of Milk Fat in Cream sold as Preserved Cream. (1) above 35 per cent. 5 (2) below 35 per cent. — Total 5 Contagious Diseases of Animals Act. Foot and Mouth Disease was prevalent throughout the year, necessitating the issue of 121 licences for 2,890 animals which were brought into the Borough for slaughter, viz.:— Sheep 1,460 Pigs 542 Calves 433 Cattle 416 Lambs 39 2,890 Animals moved under other Orders (see below) 1,344 4,234 79 licences issued under Swine Fever Regulations. 22 licences issued under Sheep Dipping Regulations. Pigs brought in under Swine Fever Regulations 1,120 Sheep and lambs brought in under Sheep Dipping Regulations 224 No case of Foot and Mouth Disease occurred in the Borough, but there were two contact cases which were kept under strict observation. 129 The Swine Fever Movement Order continues in force. The Borough has been otherwise free from any disease notifiable under the Contagious Diseases of Animals Acts. Rats and Mice Act. Rat catching has been continued. The Council's contractor visits the Sewage Works, Dust Destructor, Hospital and other places when requested; baits are laid, traps set, and other devices such as smoke and poison gas used. The number of victims cannot be accurately recorded, but some 4,089 rats and 168 mice were known to be destroyed. The Council encourages the public to assist in removing the menace of these intruders by lending traps and, where safety warrants, poisoned baits are laid free of cost. Petroleum Licences. Since the passing of the first Petroleum Act the work of supervising the storage of petroleum has been vested in the Public Health Department. In recent years the work has considerably increased, occupying much of the Chief Inspector's time. Underground storage is the common method and is undoubtedly best and safest. Every care is taken at the time of installation—the tanks are bedded in concrete, ventilated, tested (10 lbs. to square inch), and finally a petrol test is applied. A report is then submitted to the Council before the licence is issued. There are 61 premises in the Borough licensed to store 58,649 gallons of petroleum. Amusements—Music Hall and Theatres. The places of public amusement have been regularly inspected (Sundays included) and although, generally speaking, they are well conducted, there have been occasions when complaints have had to be made in respect of breaches of the Council's Regulations. There is a tendency to overcrowd at certain hours and on particular days, but when attention has been directed to it the management have usually complied with any request. 130 Shops Act. There are 2,501 shops registered in the Borough, comprising:— Grocers and Provision Dealers 379 Confectioners and Tobacconists 275 Drapers 172 Boot and Shoe Salesmen 122 Tailors 104 Fruiterers and Greengrocers 102 Butchers 94 Licensed Houses 84 Barbers and Hairdressers 78 Domestic Stores 57 Bakers 54 Chemists 40 Others 940 2,501 The Shops Inspector regularly visited these shops for the purpose of compiling trade registers and seeing that the provisions of the Shops Act and Early Closing Orders were being complied with. During the year some 149 contraventions were reported, necessitating letters of caution being sent to offenders, and in 32 instances legal proceedings were instituted—in all cases penalties were imposed. For details of prosecutions see page 133. Trade registers are systematically kept. 308 businesses changed proprietorship during the year. Mortuaries. There are two mortuaries. The central mortuary at High Street South, and the other at North Woolwich. Both buildings are under the control of a mortuary keeper and are kept in a satisfactory condition. 80 bodies have been admitted and 60 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. 131 Police Court Proceedings. On 81 occasions it has been necessary to have recourse to legal proceedings, viz.:— Under Public Health Acts for non-compliance with Sanitary Notice 32 Contravention of Meat Regulations 4 Under Shops (Early Closing) Act and Closing Orders for contraventions 32 Under Gipsy Bye-Laws for failing to provide sufficient water supply 8 Under Sale of Food and Drugs Act for adulterations 4 Under Milk and Dairies (Consolidation) Act for name not being on vehicle 1 Fines and costs have been imposed amounting in all to £120 8s. 6d. See Tables pp. 132—135. 132 PROSECUTIONS UNDER THE PUBLIC HEALTH ACT FOR THE YEAR 1926. Date. Situation of Premises. Offence. Result. February Central Park Road Non-compliance with sanitary notice Magistrate's Order made February Bonny Downs Road (4 houses) do. \ Withdrawn. 7/- costs. February Sussex Road do. do. 3/6 do. March Eversleigh Road do. do. 3/6 do. March Barking Road do. do. 3/6 do. March Bonny Downs Road do. do. 3/6 do. March Rutland Road do. do. 3/6 do. March Alverstone Road (2 houses) do. do. 3/6 do. June - Unsound meat exposed for sale Fined £5 September Alverstone Road (4 houses) Non-compliance with sanitary notice Withdrawn. 7/- do. November Langdon Crescent Slaughtering on unlicensed premises Fined £5. November Alverstone Road (2 houses) Non-compliance with sanitary notice Withdrawn. 3/6 costs. November do. do. do. 3/6 do. November do. do. do. 3/6 do. November do. do. do. 8/6 do. November do. (2 houses) do. do. 3/6 do. December Roman Road (2 houses) do. do. 3/6 do. December Rosedale Road (2 houses) do. do. 3/6 do. December Monega Road (3 houses) do. do. 3/6 do. PROSECUTIONS UNDER PUBLIC HEALTH (MEAT) REGULATIONS, 1924. Date Situation of Premises. Offence. Result. November Langdon Crescent Slaughtering 3 pigs without proper notice Fined £10. November — do. Withdrawn. November — Failing to give notice of evidence of disease Fined £50. November — do. Withdrawn. PROSECUTIONS UNDER SHOPS ACT DURING 1926. Date. Offence. Fines. £ s. d. February Shops (Early Closing) Act, 1920 3 0 0 February do. 0 15 0 February do. 0 15 0 February Grocers' and Provision Dealers' Closing Order, 1923 ... 1 0 0 March Shops (Early Closing) Act, 1920 2 0 0 March do. 4 0 0 March do. 0 10 0 March do. 0 10 0 March do. 1 0 0 April do. 1 0 0 April do. 1 0 0 June do. 5 0 0 June do. 0 15 0 June do. 2 0 0 June do. 1 0 0 July do. 0 10 0 July do. 5 0 0 July do. 1 0 0 July Grocers' and Provision Dealers' Closing Order, 1923 ... 0 10 0 July Shops (Early Closing) Act, 1920 0 10 0 July Grocers' and Provision Dealers' Closing Order, 1923 0 10 0 September Shops (Early Closing) Act, 1920 2 0 0 September Grocers' and Provision Dealers' Closing Order, 1913 1 0 0 September do. 1 0 0 September do. 1 0 0 September do. 1 0 0 September do. 1 0 0 133 134 Date. Offence. Fines. £ s. d. September Grocers' and Provision Dealers' Closing Order, 1923 2 0 0 November Shops (Early Closing) Act, 1920 0 10 0 November do. 0 10 0 November do. 0 10 0 December do. 0 10 0 135 PROSECUTIONS UNDER THE SALE OF FOOD AND DRUGS ACT FOR THE YEAR 1926. Date. Offence. Result. June Milk—8 per cent. deficient in fat Fined 40/- Costs 10 6 July do. —23 per cent. deficient in fat Dismissed— Warranty proved July do. —wholesale, 3.3 per cent. deficient in fat Adjourned sine die. July do. —20 per cent. deficiency in fat Dismissed—Warranty proved MILK AND DAIRIES ACT. June Name and address not conspicuously inscribed on vehicle in highway Fined 10/- J. G. BANKS, Chief Sanitary Inspector. 136 The Following is a Record in Detail of the Inspections made during the Year 1926:— Manor Park Ward. Little Ilford Ward. Woodgrange Ward. Plashet Ward. Kensington Ward. Castle Ward. Central Ward. Wall End Ward. Greatifield 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 toH. Ord. H. to H. Ord. H.to H. Premises found in fair condition 390 21 149 32 195 3 310 31 103 ... 179 81 224 42 108 31 88 ... 207 54 2013 295 Factory and workshop premises inspected 17 ... 7 ... 13 ... 27 ... 4 ... 26 ... 21 ... 11 ... 2 ... 4 ... 132 ... Outworkers'premises inspected 66 ... 3 ... 26 ... 25 ... 13 ... 23 ... 22 ... 10 ... 9 ... 8 ... 145 ... Bakehouses inspected 13 ... 6 ... 6 ... 9 ... 7 ... 10 ... 15 ... 3 ... 1 ... 9 ... 79 ... Slaughter-houses inspected 225 ... ... ... 138 ... 181 ... ... ... ... ... 2 ... ... ... ... ... 85 ... 631 ... Dairies inspected 12 ... 45 ... 10 ... 12 ... 8 ... 17 ... 19 ... ... ... 5 ... 7 ... 142 ... Urinals inspected 18 ... 6 ... 3 ... 17 ... 2 ... 1 ... 11 ... ... ... ... ... 3 ... 61 ... Walls and ceilings dirty and dilapidated 50 56 126 119 76 10 92 19 50 ... 83 266 137 115 81 81 58 ... 144 123 897 789 Yards improperly paved and dilapidated 11 31 28 83 9 ... 7 4 6 ... 11 46 21 23 17 18 8 ... 26 24 144 229 No forecourt paving 1 11 5 47 5 ... 2 11 3 ... 8 41 3 ... 4 2 ... ... 5 8 36 120 Defective drains 3 ... 5 ... ... ... 1 ... 2 ... 1 2 3 ... 2 ... ... ... 5 4 22 6 Defective w.c. connections ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 3 1 5 2 Defective w.c. traps 4 5 9 2 ... ... 1 ... 7 ... 4 1 2 1 5 1 2 ... 10 5 44 15 Defective flushing apparatus 7 21 20 24 5 ... 11 ... 14 ... 13 15 20 11 14 11 5 ... 28 15 137 97 Soil pans foul and broken 9 4 16 21 5 ... 9 1 8 ... 9 8 11 10 6 9 1 ... 13 18 87 71 Defective vent pipes 4 3 11 20 3 1 4 5 3 ... 5 11 8 5 10 3 3 ... 13 14 64 62 R.W. pipes and eaves gutters defective 32 34 53 61 19 3 33 3 36 ... 34 100 50 30 44 56 45 ... 68 106 414 393 R.W. pipes connected to drain 2 ... ... ... ... ... ... ... ... ... 1 6 2 3 ... ... ... ... 1 2 6 11 Roofs leaky 17 10 59 29 36 9 52 6 23 ... 57 93 94 44 48 32 21 ... 78 64 485 287 Defective sink waste pipes 6 16 20 39 4 ... 7 ... 7 ... 11 22 18 7 13 41 6 ... 24 53 116 178 Houses without water (M.VV.Bd.) 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 3 ... Cisterns without covers ... ... ... ... 3 ... ... 1 1 ... 2 ... 1 ... ... 1 ... ... ... ... 7 2 Drinking water improperly stored 5 1 5 5 ... 9 ... 16 1 ... 6 4 1 ... 3 ... 1 ... ... 2 29 37 Dilapidated floors 7 11 28 22 3 1 5 ... 4 ... 10 28 11 4 8 11 4 ... 23 25 103 102 ...Insufficient underfloor ventilation 3 11 15 29 1 ... 2 ... 6 ... 2 10 6 14 4 20 ... ... 9 21 48 105 Dampness 34 13 65 24 14 7 22 11 29 ... 34 29 57 15 39 22 18 ... 81 68 393 189 Accumulations.. 22 ... 13 ... 5 ... 10 ... 7 ... 11 1 22 1 40 3 2 ... 15 5 147 10 Defective sashcords and windows 13 13 35 18 13 4 18 8 13 ... 25 80 30 35 28 42 12 ... 36 47 223 247 Overcrowding ... ... 5 ... ... ... 2 ... ... ... 2 ... 3 ... 4 5 1 ... 7 5 24 10 Unsound food 6 ... ... ... 68 ... 30 ... 1 ... 1 ... 8 ... 1 ... ... ... 32 ... 147 ... No dust bins 1 2 17 3 2 3 6 2 6 ... 12 80 16 24 24 14 7 ... 40 35 131 163 Defective stoves- 6 5 29 10 12 ... 14 3 9 ... 15 93 35 24 16 19 11 ... 24 14 171 168 Defective coppers 7 3 23 10 5 ... 11 4 4 ... 11 62 14 2S 10 10 11 ... 25 9 121 121 Animals improperly kept ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 5 ... 1 ... 4 3 13 3 Temporary buildings found 1 ... ... ... 1 ... ... ... ... ... 2 ... ... ... 1 ... ... ... ... ... 5 ... Smoke nuisances 1 ... 1 ... 2 ... 1 ... 1 ... 5 ... 3 1 1 ... 2 ... 1 ... 18 ... Rear passages unpaved or undrained ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gipsies ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 ... 1 ... 18 ... 33 ... Breaches of Bve-Laws and Regulations ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... 3 ... Other nuisances 70 38 121 84 53 3 79 2 45 ... 92 125 105 63 126 75 35 ... 158 86 882 476 Drains unstopped and cleansed 63 ... 311 ... 61 ... 138 ... 123 ... 178 ... 233 ... 116 ... 86 ... 238 ... 1547 ... Drains tested 20 ... 39 ... 11 ... 9 ... 11 ... 26 ... 19 ... 34 ... 17 ... 48 ... 234 ... Inspections 556 93 448 178 406 22 535 94 207 ... 423 469 527 208 427 191 214 ... 588 287 4331 1542 Total Inspections 649 626 428 629 207 892 735 618 214 875 5873 137 INDEX. A. Abatement of Nuisances 114 Abattoirs 123, 124, 125 Acreage 7 Acts of Parliament 11,12 Adenoids 42, 46, 56, 69, 73, 74, 86, 87, 91, 99 Air temperature 60 Alleys 116, 136 Altitude 8 Ambulances 10, 11, 56 Antitoxin 19, 21, 36, 37 Area 7 Assessable value 7 Attendance Officers, co-op. of 79 Aural Clinic 86 Ante-Natal Clinics 9, 46, 47, 48 B. Bacteriological Laboratory 18,37 Bakehouses 125 Baths 79 Births 7, 46 „ Illegitimate 7 „ Still 46 Birth-rate 5, 6, 8 Blind persons 16, 80, 102 Boundaries 8 Bye-laws 13, 84, 124, 130, 134,136 Birth Control 46 C. Cancer 59 Cerebro-Spinal Meningitis 20, 21, 58, 59 Chicken-pox 36, 72 Children, Medical Inspection of 40-46, 63, 65-73 Chorea 17, 83, 100 Cinemas and Music Halls 129 Cleanliness of School Children 65, 67, 108 Clinic, Ante-Natal 9, 46, 47, 48 Clinics, Infant 40, 41, 43, 91 Clinics, School 65, 74 Clinic, Artificial Sunlight 63, 91 Climate 60 Closing Orders (Shops) 13 Common Lodging Houses 130 Communicable Diseases (non- notifiable) 72, 73 Complaints of Nuisances 114 Contagious Diseases (Animals) Act 128 Continuation Schools 84 Convalescent Treatment 16, 17, 18, 55, 63, 78 Co-ordination 56, 65 Cripples 66, 71, 76, 83, 100, 103 D. Dairies 123, 135 Day Nursery 9 Deafness 80, 86, 87, 102, 105 Deaths, Causes of £9 Deaths, No. of 7, 59 Death-rate, General 5, 6, 7, £ Death-rate, Infantile 5, 6, 8, 50, 51 Death-rate, Tuberculosis 6 Death-rate Zymotic 6, 8 Deaths in Large Towns 8, 51 Dentistry 24, 27, 42, 43, 56, 63, 70, 76, 83, 94. 1C8 Diarrhoea 8 51 59 Diphtheria 19, 21, 35, 36, 38, 58, 59 72 Dirty premises 136 Disinfection 20, 21, 117, 118 Dispensary 24, 25, 27-30 Dispensary attendances 23 27 Drainage Works 136 Dust Bins 114, 121 E. Ear Disease 42, 69, 70, 76, 82, 99 Employment of Children 84 Encephalitis Lethargica 20, 21, 58, 59 Enteric Fever 19, 21, 35, 37, 58, 59 Epileptic Children 80, 100, 102, 104, 105 Erysipelas 20, 21, 58 Exclusions 73 Eye Diseases of Children 44, 52, 69, 70, 73, 82, 99, 106, 107 Eye, External Inflammation of 75, 82, 90, 99 F. Feeble minded 14, 102 Factory and Workshop Act 118, 136 Following-up 73 Food and Drugs Act 125-128, 135 Food Inspection 123, 127 Food Supply 125 Food, Unsound and Diseased 125, 136 Foot and Mouth Disease 128 G. Gipsies 134-136 Glands, enlarged 82, 99 H. Harts Sanatorium 10, 33, 34, 35 Health Propaganda 11 Health Week II, 15, 16 Hearing of School Children 70, 82, 86 Heart Diseases 42, 83, 100, 103 Hospital Accommodation, 10, 28, 30-38, 42, 74, 76, 90, 102, 103, 107 Hospital, Children's 74, 76 138 INDEX—continued Hospital Staff, Health of 37 Hospitals, Maternity 49 House Refuse remova 120 House to House inspection 113, 114, 116, 136 Housing 7, 121, 122, 123 Hospital Staff-training 38 I. Imbecile Children 15, 102 Impetigo 36, 42, 69, 32, 99, 106 Increase of Rent (Restriction) Acts 117 Infant Consultations 9 Infantile Mortality 5, 6, 8, 40, 50, 51 Infectious Diseases 10, 18, 19, 20, 21 35, 36, 37, 38, 50, 51, 58, 59, 71, 118 Infectious Diseases (non-noti- fiable) 72 Influenza 20, 59 Inspection of Borough 112-136 Inspection of School Children 63, 65-73, 81, 82, 83, 94, 97, 99, 100, 108 Invalid Children's Aid Association 16, 29, 55, 63, 77 Isolation Hospital 10, 35-38 K. Kinemas 129 L. Laboratory work 18, 37 Legal proceedings 108, 124, 125, 127, 131 Licences, Contagious Diseases (Animals) Acts 128 Licences, Petroleum 129 "Light" Treattnent 24, 30 Lung Diseases 21-35, 42, 58, 59, 70, 75, 83, 100, 103 Lupus 30 M. Malnutrition 82, 99, 103 Marketplaces 112, 125 Maternal Deaths 55, 59 Maternity and Child Welfare 9, 40-56, 91 Maternity Homes and Hospitals 10, 48, 49 Meals, provision of 79 Measles 9, 35, 37, 51, 52, 59, 72 Meat Regulations 123, 134 Medical examination 18, 65, 67, 84 Mental Defects of School Children 80, 102 Mental Defectives, Statutory supervision 15 Mental Defectives, voluntary care 15 Mental Deficiency 14, 15, 80, 102 Meteorology 60 Midwifery 9, 53 Milk and Cream Regulations 127 Milk and Dairies Act 135 Milk, Free supplies 29, 55, 56 Milk Order 123 Mortuaries 130 Mumps 72 Music Halls 129 Myopia 90 N. Nervous Diseases 83, 100 Notices served 114 Notification of Births 46 Notification of Infectious Diseases 18, 58 Nuisances abatement 112, 114 Nuisances discovered 114, 136 Nursing arrangements 9 Nursery Schools 80 0. Offal collection 117 Offensive trades 117 Open-air Education 63, 77 Ophthalmia Neonatorum 21, 46, 52, 56 Ophthalmic Clinics 44, 63, 75, 91 Orders 12, 14 Orthopaedic treatment 76 Outdoor Relief 18 Outworkers 118, 136 Overcrowding 5, 136 P. Parents, co-operation of 79 Passages 116, 136 Petroleum storage 129 Physical training 79 Playground classes 77 Pneumonia 20, 35, 37, 51, 58, 59 Population Pre-tubercular patients 29, 31, 32, 103 Prosecutions, Milk and Dairies Act 135 Prosecutions, Public Health Act 132, 134 Prosecutions, Sale of Food and Drugs Act 135 Prosecutions, Shops Act 133, 134 Provisional Orders Puerperal Fever 8, 20, 21, 46, 54, 58, 50 Puerperal Pyrexia 54, 58 139 INDEX—continued. R. Rainfall 60 Rateable Value 7 Rat extermination 129 Refraction cases 82, 90, 99, 107 Refuse Removal and Disposal 120, 121 Regulations 13, 22, 27, 125, 127 Re-inspection 65, 66, 73, 74, 77, 81, 97 Rent (Restriction) Act 117 Rickets 91 Ringworm 42, 56, 69, 73, 75, 99, 106 Roofs, leaky 136 S. Sale of Food and Drugs Act 125-128, 135 Sanatoria 10, 28, 30-34, 35 Scabies 69, 73, 99, 106, 117 Scarlet Fever 19, 21, 35, 36, 52, 58, 59, 72 School Attendance Officers Co-operation 79 „ Baths 79 „ Camps 77 „ Children, Blind 102, 104 „ Cripples 66, 71, 76, 83, 100, 103 „ Children, Diseases of Nose and Throat 69, 73, 74, 82, 87, 91, 99, 107 „ Children„ Defective Speech 82, 100 „ Children, exclusions 73 „ Children, general cleanliness 65, 67, 108 „ Children, Heart Diseases 83, 100, 103 „ Children, Hearing 70, 76, 82, 86, 87, 99, 102, 104, 106 „ Children, Minor Ailments 74, 106 „ Children, No. of Medical Examinations 63, 65, 67, 81, 97 „ Children Nutrition of 73, 79, 82, 99, 103 „ Children, Physical Training of 79 „ Children, Skin Diseases 70, 73, 75, 82, 106 „ Children, Teeth of 63, 70, 76, 83, 94, 96, 100, 108 „ Children, Verminous Conditions 69, 73, 108, 109, 117 „ Continuation 84 School Dentistry 63, 70, 76, 83, 94, 108 „ Hygiene 65 „ Meals 73, 79 „ Medical Treatment 65, 67, 74, 75, 76-80, 87, 91, 92 „ Nursery 80 Open-air 77 „ of Recovery 78 School, Secondary 80 Schools, Survey of 121 Sheep Dipping Order 128 Shops Act 130 Skin Diseases 42, 43, 70, 73, 75, 82, 106 Slaughter Houses 123, 124, 125 Small-pox 10, 18, 21, 52, 59 Smoke abatement 117 Special enquiries 84 Special examination 84, 98 Spectacles, supply of 107 Speech, defective 82, 100 Sputum examination 24, 29 Squint 42, 44, 91, 107 Staff 4, 40, 62, 65, 66 Subsoil 8 Summary of Report 7, 8 Surgical appliances 17, 29 Swimming 79 Swine Fever 128 T. Table—Air temperature 60 „ Birth-rate 6, 8, 46, 51 „ Cattle Slaughtering 124, 128 „ Causes of Death 59 „ Clinics, Treatment at 41, 53, 65, 69, 87, 94, 96, 106, 107, 108 „ Comparative Statistics 6, 8, 21, 51, 65 „ Complaints received 115 „ Deaths 6, 8, 50, 58 „ Dental Treatment 94, 95, 96, 108 „ Eye examinations 82, 99, 102, 106, 107 „ Exceptional children 102, 103 „ Exclusion Forms issued 73 „ Factories and Workshops 119 „ Food and Drugs Act, Legal Proceedings 135 „ Food and Drugs Act, samples taken 126,127 „ Housing 121, 122, 123 „ Infantile Mortality 50, 51 „ Infectious Cases notified 21, 58, 72 „ Infectious Cases removed to Hospital 35, 58 „ Invalid Children's Aid Association 17 „ Maternity and Child Welfare r 41, 46, 51, 53, 54, 96 „ Medical Help 54 „ Mental Defectives 15, 80 „ Meteorological record 60 ,, Minor ailments 69, 106 „ Notes to 25, 97, 98, 101, 104, 105, 108, 109 140 INDEX—continued. Table—Notifications 22, 58, 72 „ Nuisances 136 ,, Ophthalmia Neonatorum 53 „ Public Health Act prosecutions 132, 134 „ Rainfall 60 „ Records of inspections 65, 67, 68, 69, 73, 81, 82, 83, 87, 94, 96, 97, 99, 100, 113, 136 ,, Refuse Collection 120 „ School Children Crippled 83, 100, 103 „ School Children, Defects of 82, 83, 87, 94, 96, 99, 100, 102, 103, 106, 107, 108 „ School Children examined 65, 67, 97 „ School Children excluded 73 „ School Children found to require treatment 99, 100 „ School of Recovery admissions 78 ,, Secondary School examinations 81, 82, 83 „ Shops Acts prosecutions 133 „ Tuberculosis, Classification of Patients 32a-32b „ Tuberculosis deaths 22 „ Tuberculosis 21, 22, 23, 24, 30, 31, 32, 32a, 32b, 33, 34, 58, 59, 70, 100, 103 „ Tuberculosis Dispensary cases 23, 24 „ Tuberculosis Notifications 21 „ Tuberculosis, Residential treatment 30-34 „ Venereal Diseases 57 „ Verminous condition of School Children 67, 68, 108 „ Vision of School Children 82, 99. 102, 106, 107 Teaching Staff, co-operation of 79 Teaching Staff, Medical Examination 84 Teeth of School Children 63, 70, 76, 83, 94, 96, 100, 108 Temperature 60 Throat affections 42, 56, 73, 82, 87, 99 Tonsils 42, 46, 56, 69, 73, 74, 82, 86, 91, 99 Trade Refuse, Removal of 121 Training Centre, Mental Defectives 14, 15 Transit, Means of 5, 8 Tuberculosis 21, 22-35, 58, 59, 70, 71, 75, 103, 105, 117 Tuberculosis Deaths 22, 59 Tuberculosis Dispensary 10, 24, 25, 27-30 Tuberculosis, treatment of 23-35, 103 Tuberculosis Visits 24 Typhoid Fever 19, 21 Tubercular contacts 23,24 U. Unsound Food 125, 132, 136 Urinals 116,121 Ultra Violet Radiation 63, 91 V. Venereal Diseases 10, 57 Verminous Persons 18, 69, 73, 108, 109, 117 Vision of School Children 70, 73, 74, 75, 82, 90, 92, 99, 102, 106, 107 Visits, Nurses 45, 65, 73, 108 Voluntary Workers 14, 16, 55, 76, 77, 80 Vaccination 52 W. Whooping Cough 8, 36, 37, 59, 72 Workshops 118, 119, 136 X. X-ray 30, 35, 42, 56, 75 Z. Zymotic Deaths 6, 8, 50, 51, 59