AC44113 EAS 3 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 for Maternity and Child Welfare. 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, 1927. RECORDERS, ilford. 1928. 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 for Maternity and Child Welfare. 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, 1927. recorders, ilford. 1928. EAST HAM CORPORATION. PUBLIC HEALTH. COMMITTEE. Also Committee under Blind Persons Act, 1920, Sec. 2. *The Mayor (Alderman F. P. Cross, J.P.). *The Deputy.Mayor (Councillor A. H. W. Owen). *Alderman H. B. Harper, J.P. (Chairman Public Health Committee, and Hospital and Sanatorium Sub.Committee). *Alderman H. Osborn, J.P. (Vice.Chairman). Alderman E. Edwards, J.P. *†‡Councillor C. W. Brading (Chairman Maternity and Child Welfare Sub.Committee). *Councillor J. Brooks, J.P. *Councillor G. W. Durant. Councillor C. F. H. Green. Councillor E. C. Howlett. Councillor H. J. Kybert. Councillor W. S. Luton. Councillor T. M. McGiff, J.P. *Councillor B. W. Moger. *†(Councillor Mrs. M. Ridler. *†‡Councillor Mrs. E. J. Tungate. Councillor T. Watts. MATERNITY AND CHILD WELFARE SUBCOMMITTEE Same members as Public Health Committee with— ‡Miss E. R. Da vies (co.opted). †‡Mrs. A. A. Dean (co.opted). †‡Mrs. F. Norman (co.opted). * Also Members of the Hospital and Sanatorium Sub.Committee. †Also Members of the Provision of Milk Sub.Committee. ‡Also Members of the Maternity Hospital Accommodation Sub.Committee. COMMITTEE FOR THE CARE OF THE MENTALLY DEFECTIVE. The Mayor (Alderman F. P. Cross, J.P.). The Deputy.Mayor (Councillor A. H. W. Owen). Councillor H. E. Jerram (Chairman). Councillor G. W. Durant (Vice.Chairman). Councillor C. W. Brading. Councillor J. Brooks, J.P. Councillor A. E. Dennington. Councillor T. M. McGiff, J.P. Councillor Mrs. M. Ridler. Councillor Mrs. E. J. Tungate. Councillor A. Trinder. Mrs. G. Banks.Martin, J.P. (co.opted). Mrs. C. J. Cross (co.opted). Mrs. A. McGiff (co.opted). WHOLE.TIME STAFF OF THE PUBLIC HEALTH DEPARTMENT. Clerks: Miss L. Mullender, *Miss D. Gordon, *G. H. Green, *W. Lank, Cert. R.San.I., *H. G. Luckett, A.R.San.I., *G. W. Friend. *F. J. Kendall, A.R.San.I., Chief Clerk. Home Teacher, 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, *Miss M. A. Redcliefe, Certified Midwife, and *Miss S. Bowles, Certified Midwife (from December), *Mrs. A. A. Woodman, S.R.N., M.R.San.I., Certified Midwife (Senior). Tuberculosis Dispensary Clerk: *Miss V. Reid. Tuberculosis Nurses: *Miss L. E. Mallon, S.R.N., *Miss E. E. Cook, S.R.N., Certified Midwife. Assistant Nurse: *Miss A. Meadhurst. Matron of Isolation Hospital: Miss H. M. McLoughlin, S.R.N. Matron of Harts Sanatorim: *Miss M. II. 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. liefuse 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, and Inspector of Midwives. *Elsie Thomson, M.B., Ch.B., D.P.H. Tuberculosis Officer and Resident Medical Superintendent, Harts Sanatorium: *G. W. Cheater, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Deputy Medical Officer of Health, Senior Assistant School Medical Officer and 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 Medical Officer for Maternity and Child Welfare, Medical Officer to Committee for Care of Mentally Defective, and Medical Officer, Blind Persons Act: *W. Benton, M.R.C.S., L.R.C.P., D.P.H. * Proportion of Salary contributed under Public Health Acts or by Exchequer grants. To His Worship the Mayor, Aldermen, and Councillors of the County Borough of East Ham. Mr. Mayor, Ladies and Gentlemen, I beg to submit the Annual Report on the state of the Public Health and the record of sanitary work carried out during the year 1927, together with my Report as School Medical Officer in accordance with the Regulations of the Ministry of Health and the Board of Education. The Borough still occupies a very satisfactory position in regard to mortality statistics—the death.rate being as low as 9'7, and infant mortality 53. There has been a considerable increase in the number of cases of infectious disease notified—Scarlet Fever 798 as against 350 in 1926, and 221 in 1925; Diphtheria 464 as against 337 in 1926, and 246 in 1925. This is largely accounted for by the overcrowding in the Borough, difficulty in isolating the cases, and insufficient accommodation at the Isolation Hospital, although the majority of cases of Diphtheria were admitted. As far back as 1914 I called the attention of the Council to the inadequate accommodation, both for patients and staff, at the Isolation Hospital, and plans were prepared and submitted to the Ministry of Health, but owing to the outbreak of War they were not proceeded with. The following extract from a letter received from the Ministry of Health in November, 1922, also bears upon the question. “ It is clear that much of the accommodation at the hospital is of a temporary nature, and some of it, e.g., the military huts used for convalescent scarlet fever and diphtheria cases, ill.suited for the purpose, and the Minister accordingly suggests that the Council should prepare a complete scheme for the reconstruction of the Hospital, to be carried out in stages as circumstances permit.” 6 I would also remind the Council that an infectious case if treated at home—especially where there are two or three families in one house—may be the cause of a number of persons being kept out of employment. The standard laid down by the Ministry of Health is one bed for every 1,000 poptdation, so that we should have 150 beds available for our present population, whereas the present accommodation, without overcrowding, is 100 beds. Statistics for 1904 and the past seven years are given for comparison:— 1904 1921 1922 1923 1924 1925 1926 1927 Death Rate 14.7 10.1 11.0 9.0 9.7 10.6 9.6 97 Birth Rate 31.8 20.3 210 19.4 18.3 17.3 17.1 15.8 Infant Mortality 154 67 62 51 54 53 56 53 Zymotic death rate 2.9 0.57 0.66 0.3 0.38 0.4 0 .6 0.45 Pulmonary Tuberculosis death rate 1.68 0.85 0 95 08.8 0.78 0.90 0.96 0.80 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 1927. 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, 146,900. Census, 1921:— Number of inhabited houses 27,024 Number of families or separate occupiers 33,937 Ward Population. Manor Park 14,936 Little Ilford 17,572 Woodgrange 13,924 Plashet 14,670 Kensington 12,940 Castle 15,390 Central 15,486 Wall End 15,040 Greatfield 11,664 South 15,278 Rateable Value:— Borough Rate £643,935 Assessable Value:— General District Rate £598,171 Sum represented by a Penny Rate:— Borough Rate £2,622 net. General District Rate £2,449 net. 2. EXTRACTS FROM VITAL STATISTICS OF THE VEAR. Total number of births, 2,320 (males 1,214, females 1,106). Total number of illegitimate births, 69. Birth.rate, 15.8. Deaths, 1,433 (males 728, females 705). Crude Death.rate, 9.75. 8 Number of women dying in, or in consequence of, childbirth : from sepsis, 4; other causes, 8. Deaths of Infants under one year of age per 1,000 births registered : legitimate, 51; illegitimate, 101 ; total, 53. Deaths from Measles (all ages), 4. Deaths from Whooping Cough (all ages), 12. Deaths from Diarrhoea (under 2 years of age), 8. Zymotic Death.rate, 0.45. COMPARATIVE STATISTICS. Annual Rate per 1,000 Living. Rate per 1,000 registered Births. Births. Deaths. Diarrhoea & Enteritis (under 2 years). Infant mortality. England & Wales 16.7 12.3 6.3 69 107 Great Towns 17.1 12.2 8.3 71 London 16.1 11.9 7.5 59 EAST HAMl 15.8 9.7 3.4 53 East Ham is bounded on the north by Wanstead, south by the River Thames, adjoins West Ham on the west, and Ilford and Barking east, .The subsoil is sand and gravel, with the exception of a portion in the south of the Borough, where it consists of alluvium overlying London clay. The altitude is low, the highest point being about 50 feet above ordnance datum. It is well served by railways, viz., District, L. M. & S., and L. & N. E., also by a through service of trams and motor 'buses which convey a large number of the population, chiefly consisting of clerks, warehousemen, mechanics, postal and telephone officials to and from the City of London. 9 COUNTY BOROUGH OF EAST HAM PUBLIC HEALTH DEPARTMENT. REPORT of the MEDICAL OFFICER OF HEALTH For the year 1927. 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 or treatment of Scarlet Fever, no provision is made. Midwives. No Midwives are subsidised by the Authority, but a large amount of the Midwifery work is undertaken by 24 Nurses of the Plaistow Maternity Charity, in addition to 10 Midwives who have private practice in the Borough, and 6 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 ” is under the charge of a Lady Assistant Medical Officer, who also supervises the work of the Health Visitors. For report see page 51. 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. 91—96. 10 Tuberculosis Dispensary, Wakefield Street. Tuberculosis Officer in attendance one morning, three afternoons and one evening; session each week. For report see pp. 26—30. Venereal Diseases. East Ham forms a part of the joint scheme with the London County Council. For summary, see p. 68. 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 OH SUBSIDISED BY THE LOCAL AUTHORITY. 1. Tuberculosis. Harts Sanatorium, Woodford Green, has accommodation for 56 patients (for report see pp. 35—38). Arrangements have been made for children to be sent to various Sanatoria as occasions arose and ex-service men 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. Maternity Home Registration.—Only one application has been made for registration, which was granted. 3. Fever. (For report, see pp. 38—50). 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 1,091 cases to and from various hospitals. These consisted of 251 accidents and 840 cases of illness. 1,007 journeys were made, and 10,539 miles run. East Ham cases removed by other ambulances numbered 84, made up as follows : Barking-, 39 ; Ilford, 22 ; West Ham, 23. HEALTH PROPAGANDA. The third Health and Civic Week was held during October. The daily programmes consisted of appropriate lectures, which were well attended. Various films dealing with health subjects were shown. 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 Librarians book-marks containing Health Maxims issued by the East Ham Insurance Committee, are distributed to borrowers. SPECIAL ACTS OF PARLIAMENT. The following Special Acts of Parliament have been obtained by the Council:— The East Ham Improvement Act, 1898. The East Ham Improvement Act, 1903. The East Ham Corporation Act, 1914. The East Ham Corporation Act, 1919. Special Provisional Orders. The Tramways Orders Confirmation (No. 2) Act, 1898. The Electric Lighting Orders Confirmation (No. 2) Act, 1898. The Tramways Orders Confirmation (No. 3) Act, 1900. The Tramways Orders Confirmation (No. 2) Act, 1904. The Local Government Board's Provisional Orders Confirmation (No. 10) Act, 1904. The Local Government Board's Provisional Orders Confirmation (No. 12) Act, 1907. The Local Government Board's Provisional Orders Confirmation (No. 6) Act, 1908. 12 Acts of Parliament Adopted. Name of Act adopted. Date of adoption. Date of coming into operation. Infectious Disease (Notification) Act, 1889 12th Nov., 1889 1st Jan., 1890 Infectious Diseases (Prevention) Act, 1890 14th Oct., 1890 18th Nov., 1890 Public Health Acts Amendment Act, 1890, Parts 2, 3 and 5 13th Jan., 1891 18th Feb., 1891 Public Baths and Washhouses Acts 16th Mar., 1897 16th Mar., 1897 Housing of the Working Classes Act, 1890, Part 3 16th Feb., 1897 16th Feb., 1897 Public Libraries Act, 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 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. 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. 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. 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. 13 14 Cleansing and Disinfection, Essex (Parasitic Mange) Order, 1909. Lamps Marking Roads Obstructions. Provision of Means of Escape from Fire in case of certain Factories and Workshops. Defacing Pavements, etc. MENTAL DEFECTIVES. Work of the Voluntary Association. Visitation. The Essex Voluntary Association during 1927 continued to carry out in East Ham the duties of ascertainment and supervision delegated to them by the Borough under the Mental Deficiency Act, 1913. The Association has also visited and befriended a number of defectives who are not subject to be dealt with under the Act. Special reports on home conditions for the East Ham Council, for the Board of Control and for the Visiting Justices have also been made by the Association. In addition, the Association visited and reported quarterly to the East Ham Education Committee on feeble-minded children not in regular attendance at a special school. Experience of 14 years' operation of the Mental Deficiency Act leads one to believe that the number of defectives needing institutional care is far smaller than was at first supposed. It has become apparent that it is usually only when the lack of training and occupation has resulted in the defective becoming wilful and beyond control that the authorities are besieged to provide institution care. The Mental Deficiency Act now makes it incumbent on local authorities to provide training and occupation for defectives. Occupation centres are thus becoming of increasing usefulness and importance. Occupational Classes. The Woodwork Centre at St. Barnabas Church Room was held for 206 sessions. The number of boys on the Register was 14. The average attendance was 10'8. The Training Centre at St. Michael's Institute for imbecile children (excluded from special school) and for older girls was held for 133 sessions. There were 21 on the Register, with an average attendance of 13. 15 Boarding Out. The Board of Control having approved the system of boardingout suitable cases, the Essex Voluntary Association found foster parents for several East Ham defectives. Case Work, The following is an analysis of case work during year ended 31st December, 1927:— 2 defectives were admitted to Institutions under Order (chargeable to East Ham Borough Council). 19 were placed under statutory supervision in their own homes. 1 referred by the Association to the Local Authority. At the close of the year there were:— 48 defectives under Order in certified Institutions. 5 of whom were on long leave of absence with fosterparents (including one employed in domestic service at full wages). 8 were under Order of Guardianship with their relatives, with an allowance for maintenance. 83 were under Statutory Supervision in their own homes. 85 were under Statutory Supervision in their own homes. 85 were under voluntary care. BLIND PERSONS ACT, 1920. There are now 145 technically blind persons known to belong to the Borough, 36 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 1,838 daily visits, 102 evening visits and meetings, and given 415 lessons, of which 119 were in cane basket work, 110 in Braille, 10 manual alphabet, 27 Moon, 43 in knitting, 68 in crochet, and 38 in woollen ball making. The remainder of the blind are visited regularly and assisted to obtain free wireless licences and blind pensions. 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, e.g., 16 by summer outings, social evenings and supplying parcels at Christmas. The Association supplies 28 weekly and 10 monthly magazines, and embossed literature is obtained through the local libraries from the National Library for the Blind. 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). Continued progress has been made during the period under review, 220 cases having been dealt with, 147 of which were fresh cases. During the years of the work of the branch 707 children from all parts of the Borough have been assisted. The Association has continued to co-operate successfully with the Public Health Committee, Education Committee, Guardians, Pensions Committee and practically every London Hospital. Help has been given during the year as follow:— Sent to Sanatoria or Special Hospitals 23 Convalescent Homes 112 Boarded out 12 Provided with surgical appliances 36 Invalid carriages 5 Visiting and advice on behalf of Hospitals 26 Food and Clothing Grants 6 Convalescent or institutional treatment has been arranged for varying periods according to medical advice at the following places:— Alton, Ascot, Brighton, Bognor, Bushey, Banstead, Broadstairs, Clewer, Coldash, Church Crookham, Dover, Eastbourne, Folkestone, Hastings, Hayling Island, The types of new cases dealt with during the year may be summarised as follows:— T.B. Lungs 12 Bronchitis and Asthma 11 ,, Hips 4 Paralysis 6 ,, Bones 2 Chorea 5 ,, Glands 3 Rheumatism 7 Anaemia and Debility 45 Heart 8 Malnutrition 16 Eye Diseases Various 4 20 17 Harpenden, Kingsnorth, Kearsney (Dover), Margate, Northwood, Nayland, St. Leonards, Seaford, Seven Oaks, Tilford, Tunbridge Wells, Torquay, and Worthing. It is gratifying to report that a large proportion of the cases has benefited considerably; many remakable cures have been effected, and the whole of the year's work has been carried out without a single serious complaint. LABORATORY WORK. 1,750 Bacteriological examinations of “ swabs ” for suspected Diphtheria were undertaken in our own Laboratory. 449 “ 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. 65 examinations have been made during the year upon request of the various committees of the Town Council, in addition to 127 examinations conducted on behalf of the Education Committee as reported on p. 106. 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 £68,822, as compared with £168,889 for the year ending December, 1926. 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 18 tacts are visited and kept under observation until the incubation 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 798, of which 534 were admitted to Hospital. Only 4 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 had not been diagnosed. No use has been made of the Schick and Dick tests in Diphtheria and Scarlet Fever. Diphtheria. 464 cases of Diphtheria were notified, with 34 deaths, as against 337 cases with 21 deaths in 1926. 445 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). 2 cases were notified, both of which were treated in hospital. No deaths occurred. The 2 cases were of the Para-Typhoid type with no complications. Erysipelas. 38 cases were notified. 19 Puerperal Fever. Four cases were notified during the year, with four deaths. Eleven cases were notified as suffering from Puerperal Pyrexia, but recovered without complications. Cerebro-Spinal Meningitis. Four cases were notified, with three deaths. Encephalitis Lettaargica. Two cases notified, but three deaths were registered as due to this disease. Pneumonia. There were 113 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 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. 20 The Council also supply Anti-toxin gratuitously to all medical practitioners for the treatment of cases in the Borough. DISEASE NOTIFICATION 1922-1927. Disease. 1922 1923 1924 1925 1926 1927 Small Pox – – – – – – Scarlet Fever 502 170 215 221 350 798 Diphtheria 198 160 128 246 337 464 Enteric Fever (Typhoid and Para-Typhoid) 4 3 5 9 7 2 Erysipela- 34 32 38 41 41 38 Puerperal Fever 3 5 5 5 5 4 Puerperal Pyrexia ... ... ... ... ... 11 Cerebro-Spinal Meningitis — 1 1 1 1 4 Encephalitis Lethargica — — 9 6 1 2 Ophthalmia Neonatorum 11 11 11 6 8 10 Acute Polio Myelitis — 8 1 1 – 5 752 385 413 536 750 1338 Pneumonia 92 54 79 91 70 114 21 TUBERCULOSIS. Notifications, 1922-1927. 1922 1923 1924 1925 1926 1927 Pulmonary Tuberculosis 209 220 249 254 237 206 Other Forms do. 69 76 95 64 50 45 278 296, 344 318 287 251 New Cases and Mortality during 1927. Particulars of new cases of tuberculosis and of deaths from the disease in the area during 1927 :— Age Periods. New Cases. Deaths. Pulmonary. Non-Pulm. Pulmonary. Non-Pulm. M. F. M. F. M. F. M. F. Under 1 — — — — — 1 2 3 1—5 3 1 5 4 1 — 4 3 6 — 10 6 4 5 9 2 1 — 2 10 — 15 3 7 3 3 — 5 — — 16 — 20 14 11 3 1 5 8 1 — 20 — 25 19 17 — 3 6 9 — — 25 — 35 23 20 2 2 16 13 — — 85 — 45 15 19 — — 10 9 — 1 45 — 56 22 6 3 — 12 5 1 — 55 — 66 9 3 1 — 10 1 1 — 65 and upwards 4 — 1 — 3 1 1 — Totals 118 88 23 22 65 53 10 9 Public Health (Prevention of Tuberculosis) Regulations, 1925. No action has been taken with regard to tuberculous employees in the milk trade. TABLE I.—TUBERCULOSIS SCHEME. Return showing the work of the Dispensary during the Year 1927. Diagnosis. Pulmonary. Non-Pulmonary. Total. (6) Adults. (6) 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 56 36 4 3 5 2 10 8 61 38 14 11 (b) Doubtfully tuberculous (s) – – – – – – – – 70 43 15 18 (c) Non-tuberculous – — – — — – — — 22 13 7 2 B.—Contacts examined during the year:— (a) Definitely tuberculous 3 6 2 5 1 – – 1 4 6 2 6 (6) Doubtfully tuberculous (8) — — — — — – – — 11 18 14 12 (c) Non-tuberculous — — — — — — — — 31 62 49 60 C.—Cases written off the Dispensary Register (9) as (a) Cured (10 ) — 2 — — 2 1 6 3 2 3 6 3 (6) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) – – – – – – – – 120 132 97 102 D.—Number of Persons on Dispensary Register (9) on December 31st:— (a) Diagnosis completed 368 311 61 42 74 47 84 50 442 358 145 92 (b) Diagnosis not completed — — — — — — – — 19 16 11 6 22 23 1. Number of persons on Dispensary Register(9) on January 1st 1266 2. Number of patients transferred from other areas and of " lost sight of "(11 ) cases returned 30 3. Number of patients transferred to other areas and cases " lost sight of 240 4. Died during the year 91 6. Number of observation cases(8) under A (6) and B (b) above in which period of observation exceeded 2 months 33 6. Number of attendances at the Dispensary (including Contacts) 2698 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 (a) " Light " treatment 59 (b) 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 12 (b) Otherwise 244 11. Number of other visits by Tuberculosis Officers to Homes 36 12. Number of visits by Nurses or Health Visitors to Homes for pensary purposes 4305 13. Number of (a) Specimens of sputum, &c., examined 780 (b) X-ray examinations made in connection with Dispensary work 15 14. Number of Insured Persons on Dispensary Register (9) on the 31st December 518 15. Number of Insured Persons under Domiciliary Treatment(4) on the 31st December 144 16. Number of reports received during the year in respect of Insured Persons:— (а) Form G.P. 17 1 (б) Form G.P. 36 373 24 NOTES TO TABLE I.—TUBERCULOSIS. (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 25 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 are 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.) 26 REPORT ON THE WORK OF THE TUBERCULOSIS DISPENSARY. The regulations concerning the administration, both professional and clerical, of Tuberculosis schemes issued by the Ministry of Health in Memo. 37/T of November, 1926, have already during the year 1927 begun to show results which are at once both encouraging and valuable. The main purpose of the Memorandum 37/T was to systematise the methods, standardise classifications and codify the results of the various Tuberculosis schemes approved by the Ministry on behalf of the 156 local authorities recognised to deal with the disease. During the year, the Ministry of Health has been able for the first time since the initiation of the National Scheme for the Treatment of Tuberculosis to make a comprehensive survey of the work done under the scheme of each Local Authority. Such a survey has been based upon the returns furnished for 1926 by the Local Authorities. These have been scrutinized and analysed and the results published in Memo. 131/T of the Ministry. This memorandum, under 46 different headings, is an attempt to analyse the more important items in the returns for the year 1926, in relation to the figures as to population, notifications of Tuberculosis and the death-rates from Tuberculosis in each area. Its scope therefore is wide, as its character is national, but its interest and value are local as its scrutiny is close. Nationally it gives the percentage of all T.B. cases; locally it gives a comparison of the results obtained in each area. This provides an opportunity for each area to amend whatever portion of its approved scheme may be defective, and to pursue with zest whatever portion of its scheme is praiseworthy and efficient. Above all, it ensures within certain limits a basis upon which each Authority may determine whether the maximum results are being obtained for its financial outlay. Different Authorities vary enormously in the particular difficulties they have to overcome in order that their schemes may fulfil the function they were instituted primarily to perform. Tuberculosis schemes should pay as much attention (if not more) to the prevention of disease as to its egrly recognition and ready 27 treatment. The prevention of the disease, however, is as much in the hands of the individual as it is in the hands of the doctor and Tuberculosis Officer and Dispensary staff. The great deterrent to the full functioning of this aspect of the scheme has been hitherto the apathy of the individual and ignorance of its importance. This maybe is natural when the onset of the disease is insidious and its degree of virulence low, but when its onset is acute and its progress rapid, with a " bad " family T.B. history, the individual should know that consultation and treatment are available at the local dispensary. In any case the contacts of any such person should also avail themselves of the opportunity of medical examination and survey at the Dispensary. Yet, in fact, experience shows that owing to financial difficulties, the socalled lack of opportunity and ignorance of the elementary facts of the disease, many who should attend the Dispensary as contacts for examination fail to do so. Such ignorance and apathy can only be overcome by education. So long as such prejudice persists, so long will the preventive side of Tuberculosis schemes be crippled; yet future citizens can be taught by popular education in the schools the importance of the disease and the ready availability of preventive measures. It is worthy of note that there has been a steady decline of tuberculosis since the middle of last century throughout the country. Many influences no doubt are accountable for this, but their separate value is difficult to assess. Yet taken altogether they have undoubtedly exercised a profound influence on the trend of the disease. Roughly speaking, these influences emanate from two sources, viz., the progress of sanitary reform with a corresponding advance in social well-being and communal health, as well as the spread of the knowledge of the nature, prevention and treatment of the disease and the special measures of prevention against it. These two sources have percolated the community "in the mass" as it were. What is perhaps insufficiently realised is that the special knowledge of the disease and its treatment must be borne in upon the individual. As health is an individual matter, so should digressions from normal health be regarded as abnormal, and when such abnormality persists then recourse should be had, especially if there be any suggestive symptoms such as persistent 28 lassitude or loss of weight, to the Dispensary. How best to bring home this realisation to each individual constitutes a problem which the effective prevention of tuberculosis must solve. Indeed, some solution ofi the problem is vital to the health of the nation, and particularly if the decline in tuberculosis is to be maintained. For it is highly improbable that the progress of sanitary reform even as one of the factors in the decline of the disease will be of such importance in the next half-century as it was in the last. Hence to the individual must we look for the maintenance of the decline, and not to social or medical measures. A social scourge the disease has been; and such it remains, but social measures have reduced its proportions to well-defined limits. For the future, however, social measures alone will not suffice. The intelligent co-operation of the individual—be he "patient" or citizen—must be sought, and utilised in the prevention of the disease. Bearing this in mind, "Health Week" affords an excellent opportunity, by means of lectures, talks and films, of arousing the interest and developing the co-operation of the inhabitants of the Borough. Since the inception of such a week in East Ham, three years ago, much good has been done by the dissemination of knowledge of the disease and of the ready availability of consultation and co-operation with the Dispensary Staff. In as far as children within the area are concerned, the local organisation of the Invalid Children's Aid Association has given the Dispensary Staff very valuable assistance throughout the past year, and we would thank Mr. Metcalf (the local Secretary) and his staff cordially, and express the hope that our happy relationship will continue. As with the individual on the lay side rests the duty of cooperating with the Dispensary in the prevention of the disease, so on the professional side there rests with the private doctor the duty of notifying every tubercular patient. But were the private doctor's interest to extend only the length of his statutory duties, there would not be much hope for any great strides in the direction of prevention. In the matter of notification there has been great improvement of recent years. There is also a readiness to send cases to the dispensary for opinion. Rarely is there delay in returning the reports on domiciliary patients, and consultation with the 29 Tuberculosis Officer usually precedes the notification of a tuberculous patient by the practitioner. It is a matter of experience that within the Borough practitioners seek the co-operation of the Dispensary with the same readiness that they are prepared to give it, and for their cordial co-operation throughout the year we thank them. During the year, in its function as a receiving house and centre of diagnosis the Dispensary has not been able to increase the scope of its activities; but the numerous matters involved in investigation of sputa, the utilisation of X-Ray for diagnosing and the relationships with the various hospitals and voluntary bodies have continued to receive the same attention as heretofore, whilst the hearty co-operation of the Dispensary staff, both nursing and clerical has enabled greater numbers of contacts to be visited and examined, more detailed information to be given by the visiting nurses to the patients as to the regulation of their lives and conduct both with regard to themselves and others. Without such cooperation of the nursing and clerical staff much of the work of the Dispensary would bear but poor results; but for their patient, zealous and efficient co-operation we thank them In its function as a centre for "after care" the Dispensary, this year, might well review the prospects of success so that the preventive side of the Tuberculosis Scheme of the Council may bear fruit in the increasing health and vitality of the inhabitants. TABLE II.—RESIDENTIAL INSTITUTIONS. (A) Average Number of Beds Available for Patients during the Year 1927. Observation. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Total. "Sanatorium" Beds. "Hospital" Beds. Disease of Bones and Joints. Other Conditions. Adult Males – 32 1 2 – 35 Adult Females – 20 – — 1 21 Children under 15 — 15 — 13 7 35 Total 67 1 15 8 91 30 (B) Return showing the Extent of Residential Treatment during the Year 1927. In Institutions on Jan. 1 Admitted during the year. Discharged during the year. Died in the Institutions. In Institutions on Dec. 31. Number of Patients Adults M. 36 86 76 2 44 F. 22 46 45 — 23 Children M. 18 18 17 — 19 F. 14 14 13 — 15 Number of Ob- servation Adults M. — — — — F. — 2 2 — — Children M. — — — — — F. — 1 1 — — Total 90 167 154 2 101 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 1927. 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 1 — 1 2 1 4 1 1 6 — — 5 22 Improved — — — — 1 — 1 1 2 1 — 1 7 No material improvement — — — — — 1 1 — — — — — 2 Died in Institution — — — — — — — — — — — — — Class T.B. plus. Group 1. Quiescent 2 1 — 4 — — 1 1 — — — — 9 Improved 1 4 — 4 5 — 3 — — — — — 17 No material improvement — 1 1 1 — — — — — — — — 3 Died in Institution — — — — — — — — — 1 — — 1 Class T.B. plus. Group 2. Quiescent — — — 5 — — 2 — — — — — 7 Improved 7 3 — 13 8 — 4 2 — — 2 — 39 No material improvement 3 4 — 6 4 1 2 1 — — 1 — 22 Died in Institution — — — — — — — — — — — — — Class T.B. plus. Group 3. Quiescent — — — — — — — — — — — — — Improved — — — 1 — — — — — — — — 1 No material improvement 6 2 — — 1 — 1 — — — — — 10 Died in Institution 1 — — — — — — — — — — — 1 *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 TABLE III—continued. 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 — — 1 1 — 1 — — — 2 — 3 8 Improved — — — — — — — — — — — — — No material improvement — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — Abdominal. Quiescent or Arrested — — — — 1 — — — — — — — 1 Improved — — — — — 1 — — — — — — 1 No material improvement — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — Other Organs. Quiescent or Arrested — — — — — — — — — — — — — Improved — — — — — — — — — — — — — No material improvement — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — Peripheral Glands. Quiescent or Arrested — — — — — — — — 1 — — 1 2 Improved — — — — — — — — — — — — — No material improvement — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — Under 1 week 1-2 weeks. 2-4 weeks. More than 4 weeks. Observation for purpose of diagnosis. Tuberculous — — — — — — — — — — — — — Non-tuberculous — — — — — — — 1 — — 1 1 3 Doubtful — — — — — — — — — — — — — 53 (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 1927, 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. 1927. Class T.B. minus. Class T.B. plus 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). Group 1. Group 2. Group 3. Total (Class T.B. plus). Alive. Discharged as cured. Adults. M. — — — — — — — — — — — — — — — F. 2 — — — — — — — — — — — — — — Children. M. — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — Disease arrested. Adults. M. 25 5 — — 5 1 — — — — — — — — — F. 19 1 — — 1 1 — — — — — — — — — Children. M. 10 — — — — — — — — — — — — — — F. 8 — — — — — — — — — — — — — — Disease not arrested. Adults. M. 81 11 60 3 74 13 9 26 2 37 20 11 37 1 49 F. 70 15 39 2 56 18 5 17 3 25 25 7 21 2 30 Children. M. 52 — — — — 6 — — — — 10 — — — — F. 26 — — — — 4 — — — — 7 1 1 — 2 Condition not ascertained during the Year. 64 10 16 — 26 7 1 3 — 4 — — — — — Lost Sight ok or otherwise removed from Dispensary Register 56 7 15 2 24 12 2 4 — 6 5 — 3 — 3 Dead. Adults. M. 5 — 2 10 12 1 1 9 4 14 1 — 9 5 14 F. 4 1 8 3 12 1 1 7 4 12 — — 5 — 5 Children. M. — — — — — — — — — — — — — — — F. 2 — — — — — — — 1 1 2 — — — — Totals 430 50 140 20 210 64 19 66 14 99 71 19 76 8 103 34 (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 1927, 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. 1927. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Alive. Discharged as cured. Adults. M. 1 — — — 1 — — 1 — 1 — — — — — F. — — — — — — — — 1 1 — — — — — Children. M. — 2 1 3 6 — — — — — — — — — — F. — — — 3 3 — — — — — — — — — — Disease arrested. Adults. M. 8 — 3 1 12 — — — — — — — — — — F. 6 — 1 — 7 — 1 — — 1 — — — — — Children. M. 8 2 1 3 14 — — — — — — — — — — F. 1 1 — 1 3 — — — — — — — — — — Disease not arrested. Adults. M. 7 — 7 3 17 2 — 2 1 5 2 — 1 3 6 F. 7 — 2 3 12 1 1 1 2 5 — — 1 1 2 Children. M. 16 3 2 40 61 2 2 — 2 6 5 2 — 3 10 F. 7 1 — 25 33 2 — — 2 4 2 — 1 8 11 Transferred to Pulmonary 2 — — 1 3 — — — — — — — — — — Condition not ascertained during the Year. 11 3 7 18 39 3 — — 4 7 — — — — — Lost Sight of or otherwise removed from Dispensary Register 19 — 5 29 53 3 — 3 3 9 — — — — — Dead. Adults. M. — — — — — — — — — — — 1 — — 1 F. — — — — — — — — — — — — — — — Chil- dren. M. 1 — — — 1 — — — — — — — — — — F. — — — — — — — — — — — — — — — Totals 94 12 29 130 265 13 4 7 15 39 9 3 3 15 30 35 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 — 31 — — — 31 Adult Females — 19 — — — 19 Children under 15 — 2 — — — 2 Total — 52 — — — 52 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 Pa- tients Adults M. 30 76 71 2 33 F. 19 43 43 — 19 Children M. — — — — — F. 2 3 3 — 2 Number of Observation Cases Adults M. — — — — — F. — 2 2 — — Children M. — — — — — F. — 1 1 — — Total 51 125 120 2 54 36 Return showing the immediate results of Treatment of Patients and of Observation of Doubtful Capes discharged from Harts Sanatorium during the Year 1927. 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. minu Quiescent 1 — — 2 1 — 1 1 — — — — 6 Improved — — — — 1 — 1 1 — — — — 3 No materialimprovement — — — — — 1 1 — — — — — — Died in Institution — — — — — — — — — — — — — Cass T.B. plus. Group 1. Quiescent 2 1 — 4 — — 1 1 — — — — 9 Improved 1 4 — 4 5 — 3 — — — — — 17 No material improvement — 1 1 1 — — — — — — — — 3 Died in Institution — — — — — — — — — 1 — — 1 Class T.B. plus. Group 2. Quiescent — — — 5 — — 2 — — — — — 7 Improved 7 3 — 13 8 — 4 2 — — 2 — 39 No material improvement 2 4 — 6 4 1 2 1 — — 1 — 21 Died in Institution — — — — — — — — — — — — — Class T.B. plus. Group 3. Quiescent — — — — — — — — — — — — — Improved — — — 1 — — — — — — — — 1 No material improvement 6 1 — — 1 — 1 — — — — — 9 Died in Institution 1 — — — — — — — — — — — 1 Total 20 14 1 36 20 2 16 6 — 1 3 119 Under 1 week 1-2 weeks. 2-4 weeks. More than 4 weeks. Observation for purpose of diagnosis. Tuberculous — — — — — — — — — — — — — Non-tuberculous — — — — — — — 1 — — 1 1 3 Doubtful — — — — — — — — — — — — — 37 Patients discharged, 122 (including 2 deaths). Average duration of stay, 19 weeks 3 days. Number of patient days, 19,029. Number of beds available at end of year, 56. Average number of beds occupied, 52.13. The number of patients admitted in 1927 has been slightly less than in 1926. This is due to the fact that the average duration of stay has lengthened. Patients are beginning to realise that the "classical" three months' sojourn in a sanatorium is insufficient to render tuberculosis quiescent and, where financial or domestic conditions permit, are willing to prolong their stay, with corresponding beneficial results. During this year five additional shelters for male patients were purchased, and were brought into use early in October. These are of the non-revolving type, all four sides being made to open or shut, so that a patient can manipulate the shutters without going outside. These are a distinct advance on the old revolving type of shelter, whose runners and castors required frequent attention and necessitated the occupant going outside to push them round in inclement weather. During the three months the new shelters have been in use they have proved quite satisfactory, in fact, they are very popular with the patients. Treatment by artificial pneumothorax has been carried out in suitable cases; the number of refills being 114, and the results very beneficial. The agreement with the Forest Hospital, Buckhurst Hill, for the X-raying of patients has again worked quite satisfactorily. Bacteriological examination of patients' sputa is carried out at "Harts." The sputum of every patient is examined on admission and afterwards as and when necessary; the number examined in 1927 being 161. The entertainments given by Concert and Dramatic Parties have been much appreciated by the patients, as also was the singing of carols by a Choir on Boxing Day. 38 HARTS SANATORIUM.—Year ending 31st March, 1928. xpenditure. Cost per Patient per week. £ S. d. Salaries and Wages 2,433 17 6 Provisions 2,426 17 5 Disinfectants, Drugs and Appliances 95 0 8 Coal, Coke and Firewood 301 2 2 Lighting and Water 347 2 6 Furniture, Bedding and Linen 77 0 7 Uniforms and Dresses 36 0 3 Chandlery and Sundries 277 2 0 General Repairs 517 3 9 Garden Implements, Seeds, etc. 26 0 2 Horse Hire 14 0 1 Printing, Stationery and Advertisements 26 0 2 Rent of Telephones 29 0 3 Rates, Taxes and Insurance 391 2 10 X-Ray Examinations 21 0 2 Provision of Five New Shelters 170 1 2 £7,1186 51 8 REPORT ON THE WORK AT THE BOROUGH INFECTIOUS DISEASES HOSPITAL. During the year 1927 the incidence of Diphtheria and Scarlet Fever has assumed somewhat serious epidemic proportions and, in consequence, the amount of work undertaken at the Hospital has increased very markedly. The patients admitted totalled 984, as compared with 645 in the year 1926. The methods heretofore adopted for the control of these diseases, whilst having led to a tremendous reduction in the mortality rate (as the result of treatment carried out in infectious diseases hospitals), appear to have brought about very little, if any, result in lessening the incidence. The time seems opportune for reviewing these methods together with the more up-to-date means at our disposal for preventing infection. The time-honoured system of endeavouring to destroy the various infective agents outside the human body by disinfection has proved a costly and almost impossible one, whereas the more feasible and economical method of increasing the vitality, 39 and immunity to infectious disease, of susceptible individuals is economical, scientific and certain; and, with education and explanation and a desire for knowledge on the part of individual members of the community, public prejudice against inoculation and vaccination should be dispelled. There is no doubt that, just as in the case of small-pox and enteric fever, such methods constitute the only hope of eliminating the other acute infectious diseases. 1. TREATMENT OF THE ACUTE INFECTIOUS DISEASES. The following table indicates the number of patients admitted for each disease and the number discharged, or who have died, in the year 1927:— Disease. Remaining at end of 1926. Admitted during 1927. Diseharged during 1927. Died during 1927. Remaining at end of 1927. Scarlet Fever 42 532 522 2 50 Diphtheria 31 445* 386 28* 62 Enteric Fever 1 1 2 — — †Rubella — 5 5 — — Varicella — 1 1 — — Total 74 984 916 30 112 †Admitted for Scarlet Fever. *One case admitted for diphtheria died from tubercular peritonitis. (a) Scarlet Fever. Excluding the 50 patients remaining in the Hospital at the end of the year 1927 there were 524 completed cases of this disease treated. Of these two died, giving a mortality rate of 0'38 per cent., as compared with a rate of 104 per cent, for the previous year. The two fatal cases included a patient suffering from the severe septic type of the. disease and one in whom noma vulvae and inguinal cellulitis supervened. The chief complications which occurred in the cases under treatment during the year were as follows:— Cervical Adenitis 44 *Rhinitis 68 Nephritis 12 Noma vulvæ 1 Axillary Abscess 1 Otitis Media 34 Arthritis 7 Bronchitis 5 Diphtheria 12 Abscess of scalp 1 *In 42 of these cases the diphtheria bacillus was isolated and antidiphtheritic serum was administered. 40 % The following' operations were performed in connection with complications arising in patients suffering from Scarlet Fever:— Acute suppurative cervical adenitis 5 Abscess of scalp 1 Axillary abscess 1 Mastoid abscess 3 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:— Parotitis 2 Morbilli 8 Pertussis 3 Scabies 2 Septic Wounds, Scalds and Burns 5 Tinea 2 Diphtheria 54 Varicella 5 Impetigo 13 Tuberculosis 2 Pneumonia 1 It will be noticed that over 10 per cent, of the cases of Scarlet Fever were associated with infection by the diphtheria bacillus, and in these cases isolation and treatment by inoculation with anti-diphtheritic serum was necessary. In 20 patients, suffering from the more severe septic and toxic forms of Scarlet Fever, it was considered advisable to administer scarlet fever antitoxin and, with the exception of one very severe case, the results were highly satisfactory. Much difficulty has been experienced as the result of the persistence of nasal, pharyngeal and aural complications and, in some cases, the recurrence of these complications after discharge from Hospital. There is no doubt that these conditions supervene only in those patients who have suffered, over prolonged periods, from chronic naso-pharyngeal infection with hypertrophy of the tonsils and of adenoidal tissue in the naso-pharynx. (b) Diphtheria. Excluding the 62 cases remaining in the Hospital at the end of the year, 414 completed cases of Diphtheria were treated during the year 1927, and of this number 27 died from Diphtheria. This equals a case mortality of 6'5 per cent., as compared with a rate 41 of 5.5 per cent, in the year 1926. Eight of the fatal cases were of the haemorrhagic type of diphtheria, two died from postdiphtheritic paralysis of the respiratory muscles, nine died within 24 hours of admission to Hospital, whilst the remainder were suffering from profound toxaemia on admission. The average duration of illness, prior to admission to Hospital, in the 27 fatal cases, was four days, and the administration of anti-diphtheritic serum holds out little hope of recovery in cases so advanced in the disease Towards the end of the year Diphtheria assumed a more severe form than has occurred for many years, and the patients exhibited diffuse foul-smelling pharyngeal deposits with marked glandular enlargement, periglandular oedema and severe toxaemia with the frequent supervention of vaso-motor paralysis, cardiac dilatation and, in some cases, death in the first or second week of the disease. In these cases bacteriological examination has revealed the presence of diphtheria bacilli in chain formation and the presence of streptococci, and it is proposed to deal with the latter infection by means of inoculation with polyvalent antistreptococcus serum, whilst the increased virulence of the diphtheria bacilli may be met by intraperitoneal or intravenous inoculation of anti-diphtheritic serum. The chief complications which occurred in the cases of Diphtheria under treatment during the year were:— Paralysis 29 Rhinitis 25 Broncho-pneumonia 4 Cervical Adenitis 67 Myocarditis 14 Laryngitis 22 Epistaxis 19 In three cases operations were performed for acute suppurative cervical adenitis with satisfactory results. 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 6 Varicella 3 Pertussis 3 Morbilli 5 Facial Paralysis 1 Mitral Disease 2 Herpes 9 Impetigo 8 Scabies 3 Tuberculosis 1 42 9,504,000 units of antitoxic serum were administered to the patients admitted during the year, the average dosage per head being 18,000 units. 2. LABORATORY WORK. 449 bacteriological examinations of "swabs" for the identification of the diphtheria bacillus were carried out at the Hospital, as compared with 201 in the year 11926. 3. THE PREVENTION OF ACUTE INFECTIOUS DISEASE. The mere isolation of cases of acute infectious disease, without the very costly complete and thorough disinfection that is necessary to destroy the causative organisms which, according to the bacteriologists, are extremely tenacious of life over long periods and under adverse circumstances, has failed to reduce the incidence of acute infectious disease. On the other hand, the mere disinfection of the immediate surroundings of the patient, at the time that he comes under the notice of the Public Health Department, is only touching the fringe of the problem, and the long trail of infection, which has occurred during the incubation period and in the early stages of the disease, remains an open and potent danger. Apparently the organisms of Diphtheria, Scarlet Fever, Measles and the other acute infectious diseases, have no satisfactory natural pabulum outside the human bod)', although they are able to maintain their vitality for a considerable time under such circumstances. In the case of Typhoid Fever the natural habitat of the causative organism, outside the human body, has been attacked with satisfactory results, but statistics show that prophylactic inoculation during the war period has been responsible for a very marked reduction in the incidence of this disease. Very little evidence is required to prove the efficacy of vaccination against Small-pox, and to-day, with the vaccination incidence 'declining, the incidence of Small-pox is markedly increasing. To those versed in the science of immunology the only economical way in which to stamp 'out acute infections disease is by increasing the immunity of the members of the community by improving their vitality and by the 43 simple means of prophylactic inoculation. Is it not extraordinary that one seldom finds an objector to inoculation for the cure of disease? (unfortunately curative inoculation is only too often sought in the later stages of disease) yet the same people, who place no barrier in the way when their relatives are seriously ill, obstruct, at every opportunity, the adoption, during health, of similar methods which would prevent the occurrence of such illness. Proved and certain methods for the prevention of Diphtheria (Schick) and Scarlet Fever (Dick), dating back on the one hand to the year 1910 and on the other to the year 1923, are available, and, whilst one realises that a large section of the general public exhibit some antipathy to inoculation and vaccination, it is unfair to withhold the information from the more enlightened and amenable members 'of the community. Propaganda and active prophylactic work in this direction belong to those who are engaged in the prevention of disease in infants and young children, and here the Maternity and Child Welfare Centre possesses a wide field of very useful work. In this connection Dr. S. Monckton Copeman has said, " but I would suggest that it is of even more importance to aim at immunisation of all children of pre-school age*—at the period, that is, of greatest danger, and in order to obviate appreciable risk of contracting the disease when they come in close contact with other children on joining school." So much for the question of conferring artificial immunity upon susceptible individuals. Increasing the general vitality and resistance of the body is of even greater importance and should eventually eliminate the necessity for artificial immunisation. Apart from education in healthy habits, the importance of fresh air and sunshine and the observance of the simpler laws of hygiene, two factors remain paramount in considering the reduc- *The ages at which death occurred in the 30 fatal cases during the year 1927 were At 1 year of age 1 ,, 2 years of age 2 „ 3 „ 0 „ 4 „ 3 ,, 5 „ 7 „ 6 „ 5 ,, 7 „ 5 At 8 years of age 2 „ 9 „ 1 „ 10 „ 1 „ 11 „ 0 „ 12 „ 1 „ 13 „ 1 „ 14 „ 1 44 tion in the incidence of acute infectious disease and the associated complications; one is the question of dietary in infancy and childhood, and the other is the condition of the nose and throat in early life. Undoubtedly the vitamin content of the diet plays an important role in determining- susceptibility to infection, and where, unfortunately breast feeding is found to be impossible there is no doubt, according to the majority of authorities on the subject, that cow's milk is the most satisfactory substitute for ensuring normal metabolism and some degree of resistance to infection. A very active predisposing cause to the occurrence of infection and of severe types of acute infectious disease, and one which plays the most active part in the supervention of serious complications and sequelæ, is the presence of adenoids and of enlarged and unhealthy tonsils. Chronic infection of the throat and nasal passages with septic organisms leads to a definite undermining of the general health, a lowered resisting- power, and opens up a ready path for infection with the more malignant germs of the acute infectious diseases. When such conditions have been present over long periods palliative and operative treatment will not bring about an immediate return to health, and the longer the defect exists the greater will be the period of recuperation. Here again treatment of children in the early years of life is the only means of preventing the devastating results of chronic nasopharyngeal infection. Statistics show that 947 children of school age have been treated for unhealthy conditions of the nose and throat (356 having been operated upon for the removal of tonsils and adenoids) during the year 1927. The question is one which is receiving the serious consideration of the Maternity and Child Welfare Department, which reports 104 operations for the removal of tonsils and adenoids during the year. In conclusion reference is desirable as to the most useful manner in which the Hospital may perform its function. Facilities 45 should be available for the reception of patients suffering from any of the acute infectious diseases (with the exception perhaps of Small-pox) in all cases where isolation and suitable accommodation and treatment cannot be provided at home. In this way, and if such cases were admitted in the initial stage of the illness, fatal and debilitating complications would be eliminated. Far too often patients are admitted at a late stage of the disease when specific and routine treatment are powerless to avoid a fatal issue or the occurrence of serious sequelae, and the suggestion that hospitals should be utilised mainly for the admission of patients in whom complications have supervened can only be based upon a lack of scientific knowledge and ignorance of the principles of preventive medicine. 4. LIGHT TREATMENT. The use of a single arc lamp, carbon has been used for general irradiation and tungsten for local treatment, has afforded a very valuable means of dealing with debilitated patients and with those in whom localised complications, especially cervical adenitis and otitis media, have arisen. Unfortunately it is only possible to treat one patient at a time with general ultra-violet radiation, and the installation of a large quadruple arc lamp would prove a great boon during the winter months. 5. ILLNESS AMONGST MEMBERS OF THE STAFF. The year has been noteworthy for the few cases of illness which have occurred in members of the staff, and this in spite of the fact that duties have been very heavy and accommodation far from ideal; but it must be remembered that a high degree of physical fitness is demanded in candidates for appointment to the nursing or domestic staff of the Hospital. Five members of the nursing staff contracted Diphtheria and two contracted Scarlet Fever, whilst one member of the domestic staff contracted Diphtheria. Fourteen members of the nursing staff and 11 members of the domestic staff were vaccinated against Small-pox during the year 1927. The question of prophylactic immunisation to Diphtheria and Scarlet Fever has been carefully considered, and the results obtained in other Institutions are so very satisfactory as to warrant the application of these methods to the members of our own staff. 46 6. STATE EXAMINATION SUCCESSES. During the year 1927, 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. Two Nurses were successful at the Preliminary State Examination, and three Nurses passed the Final State Examination, which enables them to be placed upon the Register of the General Nursing Council. These successes are somewhat remarkable and certainly encouraging when considered in conjunction with the fact that one common nurses' room has to subserve the function of diningroom, sitting-room, recreation-room, study-room and lecture-room, and that adjuncts to study in the form of a library, diagrams, charts, models and apparatus are either absent or of a very crude nature. 7. ACCOMMODATION FOR PATIENTS AND STAFF. The question of accommodation for staff and patients becomes more acute each year, and in epidemic times, such as that which we have experienced during the past year, the difficulties are almost insurmountable. There is no necessity to reiterate the unfavourable conditions under which patients are treated, nor the former reports dealing with the very unsatisfactory accommodation available for the Staff, but the following brief summary will serve to indicate the position:— RÉSUMÉ OF PRESENT CONDITIONS AT THE BOROUGH HOSPITAL. (a) Accommodation for Patients. The area of the Hospital Wards, Temporary Wards and Huts, is insufficient to provide for the accommodation, of one patient per thousand of the population, if full compliance with the standards laid down by the Ministry of Health is to be observed, and it has been found necessary on many occasions and over long periods, to overcrowd the wards in order to provide necessary treatment during times of epidemic although the Ministry has issued a very strong report discouraging such a procedure. (Public Health and Medical Subjects. No. 16.) 47 The maximum accommodation for patients at the Borough Hospital is as follows:— Department. Ward. Length. Ft. Breadth. Ft. Area. Sq. ft. Maximum number of beds allowable by Ministry of of Health. *Acute Diphtheria Female 39 24 936 7 Male 39 24 936 7 * Convalescent Diphtheria Female 39 24 936 7 Male 39 24 936 7 A Block (Scarlet f Fever) Female 60 25 1,500 11 Male 60 25 1,500 11 B Block (Scarlett Fever and Side Wards) Female 72 26 1,872 13 Male 72 26 1,872 13 Cubicle Block 12x12 12x 12 1,728 12 *Scarlet Fever Army Hut 120 15 1,800 12 Total Patients 100 At the present time the hospital has 40 beds above the number for which accommodation is provided, and this fact must be considered in conjunction with the absence of an admission block, of a discharge block, of a convalescen t home, and with the fact that much of the accommodation is of a temporary nature and " ill-suited for the purpose." (b) Accommodation for Staff. In considering this matter it is unnecessary to emphasise the arduous nature of the Nurses' duties, that the Nursing Staff are working in an infectious atmosphere, and that, at the same time, considerable close study is imperative in order that such nurses may attain a sufficient standard of proficiency to satisfy the examiners of the General Nursing Council. The following return has been furnished by the Matron in regard to the allocation of the Nursing Staff :— No. of Staff. Nursing Staff 33 Domestic Staff (including 2 temporary). 24 *Diphtheria Home 3 *Diphtheria Home 10 Scarlet Fever Home 21 Scarlet Fever Home 2 *Night Hut 9 *Huts 12 (8 and 4) 33 24 "Denotes temporary buildings. 48 * Diphtheria Home.—1 Kitchen, 1 Pantry, 1 Sewing Room, 1 Dining Room (small), 1 Maids' Sitting Room, 8 Bedrooms (2 used as double rooms), Maids' Sitting Room used as double bedroom for Nurses, Matron's quarters. 13 accommodated including Matron. Scarlet Fever Home.—1 Kitchen, 1 Sister's Sitting Room, 1 Nurses' Dining Room and Sitting Room combined, 1 Staff Nurses' Sitting Room, 17 Bedrooms (6 used as double rooms). Staff Nurses' Sitting Room used as bedroom. 23 accommodated. * Night Nurses' Hut.—8 bedrooms— 1 used as double room. 9 accommodated. *Maids' Huts.—8 accommodated in 1st hut ; 4 accommodated in 2nd hut. The members of the Nursing Staff undertake to serve at the Hospital for a period of not less than two years and during that time, from the Nurse's point of view at least, she should be entitled to separate sleeping accommodation. Furthermore, it will be noticed that the members of the Nursing Staff have only one room for meals, recreation and study, and that the lectures, delivered in accordance with the requirements of the General Nursing Council, are given in this same room. It will also be noticed that the members of the Domestic Staff take their meals in the Kitchens and have no recreation or sitting room. The Night Staff Quarters are totally unsuited for the purpose both from the point of view of accommodation (an Army hut) and from the point of view of location. The Council have considered this important question on many occasions, but little has been done to remedy a very unsatisfactory situation. In the year 1922, when it appeared that, at long last, some material improvement might be made, the Council approached the Ministry of Health with a scheme for providing more and better accommodation for both patients and Staff. As a result the following letter was received from the Ministry:— "The Minister is advised that the present administration, diphtheria and typhoid blocks proposed to be demolished are in fair condition and should serve for another five to eight years, and it is considered that these should be retained for the present, and that the additional accommodation urgently needed for the staff should be provided by the erection of a separate nurses' home west of the laundry, with the necessary dining and sitting rooms, etc. The erection of such a building would render available for the reception of patients, the quarantine block, the three cubicles in the isolation block at present occupied by staff, and the upper storey of the *Denotes temporary buildings. 49 convalescent block (subject to suitable adaptation of the interior a total addition, on the Ministry's standard, of 27 or 28 beds to the existing ward accommodation. Some addition of a permanent nature is also necessary to the kitchen of the present administrative block. The Ministry suggest that plans and estimates of the cost of a revised scheme on these lines should be prepared and submitted as soon as possible. The Ministry point out that while the above represents the maximum extension which the Minister could approve at present, it is clear that much of the accommodation at the Hospital is of a temporary nature, and some of it, e.g., the military huts used for convalescent scarlet fever and diphtheria cases, ill-suited for the purpose, and the Minister accordingly suggests that the Council should prepare a complete scheme for the reconstruction of the Hospital to be carried out in stages as circumstances permit." Since that date an administrative kitchen (certainly a longdesired necessity) has been provided, but the patient and staff accommodation remains in statu quo. 7. CONCLUSION. The result of the year's work at the Hospital, taking all the circumstances into consideration, is very satisfactory, but although the total mortality rate has decreased (3'8 in 1926, 3'2 in 1927) the mortality rate for Diphtheria has increased perceptibly owing to the severity of the disease and to the late stage at which many of the patients are admitted to Hospital. I have nothing but praise for the excellent manner in which the Matron and the staff acting under her efficient direction have performed their duties in the face of very apparent difficulties in regard to accommodation and equipment for both patients and staff, and it is a great pleasure to be able to quote the following minute of the Council dated 6th December, 1927:— " Vote of Thanks to Staff—Isolation Hospital. "That the Committee unanimously decided to place on record their appreciation of the work carried out by the staff at the Isolation Hospital during the present epidemic of acute infectious disease. The pressure of work and the coincident anxieties have been severe and the Matron has earned great 50 thanks for her efficient and untiring efforts to promote smooth and satisfactory administration. Both she and the members of the Nursing and Domestic Staff have shown a very loyal and unselfish devotion to their duties." ISOLATION HOSPITAL.—Year ending 31st March, 1928. Expenditure Cost per Patient per week. £ S. d. Salaries and Wages 4,152 14 3 Provisions 3,619 12 5 Anti-Toxin 677 2 4 Disinfectants, Drugs and Appliances 283 1 0 Coal, Coke and Firewood 856 2 11 Lighting and Water 887 3 1 Furniture, Bedding and Linen 325 1 2 Uniforms and Dresses 82 0 3 Chandlery and Sundries 497 1 9 General Repairs 1,048 3 7 Garden Implements, Seeds, etc. 31 0 1 Maintenance and Upkeep of Ambulance 520 1 10 Printing, Stationery and Advertisements 60 0 2 Rent of Telephones 58 0 2 Rates, Taxes and Insurance ... 260 0 11 £13,355 45 11 COUNTY BOROUGH OF EAST HAM. Report ON THE WORK OF THE Maternity and Child Welfare Department FOR THE YEAR 1927. 52 Staff. The work of the Maternity and Child Welfare Department is carried on under the provision 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. The main Centre is at the White House, Plashet Grove, and there are subsidiary Centres at Manor Park, North Woolwich, and Greatfield Wards. The Staff of the Department consists of the Assistant Medical Officer in charge, six Health Visitors and a Clerk. Until December, however; the number of Health Visitors was five; the vacancy that occurred five years ago, and remained unfilled -for reasons then existing, being filled only at the end of the year by the appointment of Miss Bowles. The restoration of the Staff of Health Visitors to its former level is a matter for much satisfaction; but it requires to be borne in mind that, while we are now enabled to undertake more adequately than recently the oversight of the infant population, there is a wide interval of child age, between two and five years (when children come under the observation of the School Medical Officer), that can under present circumstances receive only scanty attention. It is widely realised throughout the country that the problem of the supervision of the toddlers is the next question to be faced, if the still regrettably large proportion of physical defects found in children on admission to school life is to be reduced. As the very large infant mortality that formerly existed has been reduced in the years since infant life came under trained observation and control, so will the incidence of defects still found in children arriving at school age be at least greatly modified when a similar oversight of children of the toddler age can be undertaken. When circumstances render it possible, an enlargement of the Staff of Health Visitors for this purpose is an advance greatly to be desired. Infant Welfare Clinics. Infant Welfare Clinics are held as follows :— White House, Plashet Grove, on Monday, Thursday and Friday, at 2 p.m. 53 St. John's Church Hall, North Woolwich, on Tuesday, at 2.30 p.m. 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 addition to the above, arrangements were in progress, at the close of the year under review, to relieve the overcrowding at the White House Clinic on Friday afternoons, shown in a table below, by the opening of a new Clinic at the White House on Thursday mornings. (Note.—The new additional Infant Welfare Clinic at the White House on Thursday mornings was opened in January, 1928.) Attendances at Infant Welfare Clinics, 1927. The attendances at the Infant Welfare Clinics during 1927 were as follows :— Number of Clinics held during the year 297 Number of individual children who attended the Clinics 2,733 Total number of attendances 16,376 Number of medical consultations at these Clinics6,140 The daily averages of attendances at the Clinics were as follows :— White House, Monday afternoon 64 Manor Park, Tuesday morning 55 North Woolwich, Tuesday afternoon 17 Masterman Road, Wednesday afternoon 66 White House, Thursday afternoon 55 White House, Friday afternoon 73 At the Clinics individual advice on matters of feeding, clothing and general hygiene is given to mothers, after careful examination of their children and consideration of the special circumstances of each child. It cannot be too frequently reiterated that the Infant Welfare Clinics are not dispensaries for the treatment of sick children, but seek to maintain the health of the healthy child, and to afford guidance towards its normal and successful upbringing. Yet, 54 while this is so, many departures from the normal are discovered at the medical examination of children, and such cases, medical or surgical, are referred to their own doctors for treatment, or to the hospitals or dispensaries suitable for their conditions. Simple ailments of infancy in children attending the Centres are treated at the morning Clinics at the White House. It is a significant fact that of the 13 children under the age of five who were notified during 1927 in East Ham as suffering from Tuberculosis, seven were cases referred by the Medical Officer of the Infant Welfare Clinics to the Tuberculosis Officer. On the other hand, young children under the age of five are frequently being referred to the Infant Welfare Clinics by the Tuberculosis Nurses from homes in which Tuberculosis has occurred, for examination as Contacts by the Clinic Medical Officer, and observation, if desirable, at the Clinics themselves. This co-ordination and co-operation between the departments named illustrates well the relationship that exists, wherever possible, between the Maternity and Child Welfare Department and other public Services in the Borough. It is also an illustration of the value of the Infant Welfare Clinics in reference to the detection of incipient illness in young children. Tonsils and Adenoids. When in children attending the Clinics operation for enlarged Tonsils and the presence of Adenoids is found to be desirable, the mothers are encouraged to choose hospitals on their own account, and are recommended accordingly. When, however, after careful enquiry into the family circumstances of such a case, financial aid is found to be necessary, the child is referred, at the cost of the Borough Council, to St. Mary's Hospital, Plaistow, or to the Balaam Street Children's Hospital, Plaistow, for the needful surgical treatment. During 1927, 26 children received treatment at St. Mary's Hospital, and 14 at the Balaam Street Hospital, at the expense of the Council. In such cases, on the day following the operation, a Health Visitor visits the home, and gives the mother general advice as to the after-treatment of the child. 104 visits of this character were made by the Health Visitors during the year. 55 Ringworm. Six cases of Ringworm of the Scalp were referred to the School X-ray Department for radical treatment. Dental Treatment. The School Dentist conducts a Clinic for the dental treatment of young children and of expectant and nursing mothers referred to his care from the Maternity and Child Welfare Department on Wednesday afternoon of each week. It is impossible to over-estimate the value and importance of this work. After treatment of the teeth, the health of the mother and of the toddler often improves in a remarkable way. Cordial acknowledgment is due to the School Dentist and the School Dental Nurse for their interest in, and kindness to, the patients referred to them from the Maternity and Child Welfare Clinics. The number of attendances of young children thus referred has risen from 258 in 1926 to 339 in 1927, but the number of mothers was smaller, 94 last year as against 163 in the previous year. Details of the work done for dental cases referred from this Department will be found in Mr. Neame's Annual Report on p. 120. Ophthalmic Treatment. Since June, 1926, the School Ophthalmic Surgeon has conducted a Clinic for the Eye treatment of children under the age of five years referred to him from the Maternity and Child Welfare Clinics, devoting half of Friday morning in each week to this Service. A Health Visitor attends at the Clinic. Mr. Gimblett has very kindly been willing to deal with special cases in young children under exceptional circumstances at his Tuesday morning School Clinic. The number of Infant Ophthalmic Sessions during 1927 was 38, and the attendances at these Sessions was 200. This new Clinic is proving a very important adjunct to the work of the Child Welfare Clinics. It is a great advantage to be able to refer for immediate treatment cases of early squint, at a stage when many such are curable, but would, if neglected, 56 duce disfigurement, often serious and sometimes irremediable; and even more so, to be able to submit to a specialist without delay the sometimes very urgent cases of external eye inflammation which in young children may in a very short time do permanent injury to vision. Details of the Eye work done for cases referred from this Department will be found in Mr. Gimblett's Annual Report on pp. 115—116. Treatment by Artificial Sunlight An apparatus for treatment by Artificial Sunlight has been installed recently by the Borough Council, the lamp used to produce the Ultra-Violet Rays being the Arnold Alpine Sunlight Radial Arc Lamp. The installation was made at the School Clinic at the East Ham Town Hall, and the Light Centre is shared with the School Medical Service. Treatment of Infants was commenced on 24th January, 1927. The periods available for the treatment of Infants are the afternoon of Wednesday and part of Monday afternoon in each week. Treatment was not given during the months of July to October inclusive. The Ultra-Violet Rays improve nutrition and vitality, promote the absorption of calcium and phosphorus, and increase resistance to infection. Most important is their value in Rickets, in which, especially if treated early, signs and symptoms rapidly improve under the action of Artificial Sunlight. In the process of treatment, reddening and dark colouration of the skin are produced, just as in prolonged exposure to the sun itself. In our East Ham experience, in the large majority of cases treated, mothers are satisfied that their babies have appeared brighter and more vigorous, sleep better, and are more contented and happy. It should be mentioned that Artificial Sunlight is not to be regarded as replacing the old-established methods of treatment, surgical, tonic, etc., but as a valuable aid to the effect of these. Abundance of fresh air, general sanitation, and good feeding retain their former values, even where Artificial Sunlight is available. So far as the Maternity and Child Welfare Department is concerned, the Senior Health Visitor is in charge of the actual treatment, and is assisted at each Clinic by one other Health 57 Visitor. The Medical Officer in charge of Infant Welfare visits the Light Clinics periodically for purposes of general control and guidance of dosage, and sees the infants systematically at the ordinary Infant Welfare Clinics throughout the Borough. The conditions so far referred for Light treatment from the Infant Welfare Clinics have been:—Rickets, Enuresis, Malnutrition and General Debility. The statistics for 1927 were as follows :— Number of Light Sessions held 47 Number of attendances at these Sessions1,213 Individual children treated 136 Of the 136 infants treated during the year, treatment was completed in 86 cases, with results as follows :— Total. Improvement. Attendance discontinued on account of:— Marked. Slight. None. Indifference of Mother Intercurrent Illness Closure for Summer Months. Rickets 38 8 15 1 2 2 10 Malnutrition and General Debility 46 10 12 2 8 9 5 Enuresis 2 — 1 — — — 1 In addition to the 11 cases referred to in the Table in which attendance was discontinued on account of intercurrent illness, there was considerable interruption of treatment due to colds and coughs. The temperature of each child is taken once a week, and oftener if considered necessary, and whenever any febrile condition is found to exist, the child is not exposed to the UltraViolet Rays. Morning Clinics. Special Clinics are held on certain mornings of the week at the White House, to deal with cases that cannot be adequately dealt with at the ordinary Infant Welfare Clinics, which, as has 58 been explained above, lay themselves out for the maintenance in health of the healthy child. Minor ailments requiring observation and treatment (in infants attending the Centres) are referred to these Morning Sessions; and also young infants whose cases require investigation by means of "test feeds," the value and importance of which were described in some detail in last year's Report of the Infant Welfare Centres. The special Morning Clinics have provided a means whereby the requirements of a Memorandum of the Ministry of Health, issued in August, 1926, to all Local Authorities, in reference to the Notification and Treatment of Ophthalmia Neonatorum (i.e., inflammation of the eyes of new-born infants), can be conveniently carried into effect. The Memorandum states that, "The arrangements made by the Maternity and Child Welfare Authorities should provide for the supervision of all cases in which inflammation of, or discharge from, the eyes is reported, and of all notified cases of Ophthalmia Neonatorum." All infants reported to be suffering from discharge from the eyes are at once visited by the Health Visitors. Should they not be under the care of family practitioners, or attending a suitable hospital, arrangements are made for their being brought for treatment at the Special Morning Clinics. Severe cases, and cases that do not yield satisfactorily to treatment, are referred to the School Ophthalmic Surgeon. Morning Clinics were held during 1927 :— At White House, Plashet Grove, on Monday, Wednesday, Thursday and Saturday, from 9 to 10.30 a.m. (Note.—Under circumstances described in a previous paragraph, it became necessary in January, 1928, to open an additional ordinary Infant Welfare Clinic at the White House on Thursday mornings, so the Special Morning Clinic on that day had to be discontinued.) The statistics for 1927 are as follows :— Number of cases seen at Morning Clinics 2,077 Number of Medical Consultations 1,596 The corresponding figures for the previous year were:—Cases seen, 1,813; Medical Consultations, 1,194; so that there is a substantial increase in the work being done at these Special and very practically important Clinics. 59 The Work of the Health Visitors in the Homes of the Borough. The visiting of young infants and children under school age was the primary object of the appointment of Health Visitors, and remains the most important part of their work. Information (within 36 hours after confinement) as to all births in the Borough reaches the Medical Officer of Health under the requirements of the Notification of Births Acts, 1907 and 1915, and is by him passed on to the Medical Officer of the Infant Welfare Department. A fortnight later, i.e., after the doctor or midwife has probably ceased to attend, the Health Visitor of the district in which a birth has occurred calls at the home, and does what she can to help the mother in regard to the care, management, feeding and clothing of the child, and of other young children in the house. This arrangement for advice by the Health Visitors is especially valuable in the case of young mothers with their first babies, and in poor homes where a trained nurse has not otherwise been available. Thereafter, periodic visits are made to the homes of the infants during the first two years of life, and, so far as possible, at wider intervals, during the next three years, up to the time when the child comes under the observation of the School Medical Service. The limitations that exist to this further visiting are, however, very great, and have already been touched upon at the beginning of this Report. In addition to the routine work of the Health Visitors, special Visits to the homes are made in reference to cases of Tonsils and Adenoids, cases of Pneumonia notified in infants, Ante-natal cases, cases of Puerperal Fever and Pyrexia, cases of Ophthalmia Neonatorum, etc. The visits made by the Health Visitors during 1927 were 12,484, as against 10,747 in the previous year. Births during 1027. Total number of births registered (including transfers) 2,320 Number of illegitimate births 69 Number of still-births 57 60 Particulars of Visits made by Health Visitors. Visits to infants under one year of age 6,343 Visits to children over one year of age 5,658 Visits to Ophthalmia Neonatorum cases 17 Visits to Tonsils and Adenoids cases 104 Visits to Ante-natal cases 231 Visits to Puerperal Fever and Pyrexia cases 10 Special visits, not included in above groups 121 Total number of visits 12,484 The Ante-Natal Clinic. One of the most important and pressing questions before those interested in the health of the nation at the present moment is that of the protection and care of the expectant mother. While the death-rate among children during the first year of life as a whole has dropped enormously during the last twenty years, the death-rate of the infant during the first four weeks of life remains but slightly altered. Also, the Maternal Mortality Rate is stationary. It is believed that an extension of careful supervision of expectant mothers during the last months of pregnancy will furnish at least some part of the remedy. A large proportion of those who die as a result of childbirth, or whose babies die during the first weeks of life, are found to have had no Ante-natal care or supervision whatever, and many such have only sent for a doctor or midwife at the last moment. The aims of the Ante-natal Clinic are to provide for the care and examination of the expectant mother; to maintain, or improve, the health of the mother, and so to increase the probabilities of the arrival of a healthy child; and, by anticipation of possible difficulties in the labour, to prevent avoidable calamity at the confinement itself, and secure a safe ending to it for both mother and child. An Ante-natal Clinic is held at :— White House, Plashet Grove, on Friday, at 10 a.m. The Health Visitors follow up in their homes cases of expectant mothers where this appears desirable. 61 Visits of Health Visitors to the homes of expectant mothers :— First Visits 170 Subsequent Visits 61 Total 231 Number of Ante-natal cases attending the Clinic :— First Visits 208 Subsequent Visits 147 Total 355 Mothers in East Ham who are under the care of the Nurses of the Maternity Charity and District Nurses' Home, Plaistow, or any of its branches, or of Queen Mary's Hospital, Stratford, attend the Ante-natal Clinics in connection with those Hospitals. No cases already under the care of 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. Under the provisions of the Maternity and Child Welfare Act, 1918, empowering Local Authorities to make arrangements for the institutional treatment of complicated midwifery cases, and for women whose homes are unsuitable for their being confined in them, the East Ham Borough Council has an arrangement (at the cost of the Council), for the accommodation of necessitous cases requiring in-patient treatment, at Queen Mary's Hospital, Stratford, and at the Maternity Charity and District Nurses' Home, Plaistow. During 1927, five cases thus provided for were confined in Queen Mary's Hospital. 62 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 1927 :— Causes of Death. Sex. 0-1 1—2 2—5 ALL CAUSES M. 71 9 24 F. 51 19 14 Measles M. — — 1 F. — 1 2 Scarlet Fever M. _ F. 1 Whooping Cough M. 3 1 2 F. 4 1 — Diphtheria M. — 1 4 F. — — 3 Influenza M. — 1 F 1 2 Meningococcal Meningitis M. — — 1 F. 1 1 — Tuberculosis of Respiratory System M, — — 1 F. 1 — — Other Tuberculous Diseases M. 2 _ 4 F. 3 3 — Diabetes M. 1 F. - - - Bronchitis M. 2 1 - F. 1 1 Pneumonia (all forms) M. 13 5 5 F. 6 6 4 Other Respiratory Diseases M. — — 1 F. — — 1 Diarrhoea, &c. M. 4 - — F. 3 1 — Appendicitis and Typhlitis M. — — 1 F. — _ — Congenital debility and malformation, premature birth M. 33 — — F. 26 — — Deaths from violence M. 1 1 F. 1 — — Other defined diseases M. 13 — 2 F. 4 2 4 Legitimate. Illegitimate. Number of deaths under 1 year M. 68 3 F. 47 4 63 COMPARATIVE INFANT MORTALITY RATE—YEAR 1927. 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 167 6.3 69 107 County Boroughs and Great Towns (including London) 17.1 8.3 71 155 Smaller Towns (1921 adjusted populations, 20,000—50,000) 16.4 5.0 68 London 16.1 7.5 59 EAST HAM 15.8 3.4 53 The comparative Infant Mortality Rate for the year 1927 shows that East Ham continues to be greatly more healthy than England as a whole, and more healthy than London. The total deaths under one year per 1,000 registered births in England and Wales were 69; in London the figure was 59; in East Ham only 53 infants under one year of age per 1,000 births died in 11927. The comparative rate for Diarrhoea and Enteritis in young children is also very favourable, being 3'4 per 1,000 births in East Ham, as compared with 6'3 in England and Wales, and 7.5 in London. Inspection of Midwives. The Assistant Medical Officer of Maternity and Child Welfare is also Inspector of Midwives under the Borough Council, and in that capacity maintains a general supervision over the work of all midwives practising in East Ham, under the requirements of the Midwives Acts, 1902 and 1918, and the Midwives and Maternity Homes Act, 1926. Forty-one midwives notified their intention to practise in the Borough during 1927. Of these, 24 worked in connection with the Maternity 'Charity and District Nurses' Home, Plaistow, and its branches; 6 at the Sir Henry Tate Nurses' Home, Silvertown; 1 at the Kelvingrove Nursing Home; and 10 practised independently. Forty-four visits of inspection were made by the Inspecting Medical Officer during the year. 64 Eleven midwives were interviewed by the Inspecting Medical Officer at the White House in connection with particular cases. The work of the midwives was, on the whole, found to be satisfactory. By the rules of the Central Midwives' Board, midwives must send for medical aid in certain specifically named conditions. During the year 1927 medical help was sent for in 159 cases, as follows :— For the Mothers— Ruptured perineum 34 Prolonged labour 28 Retained placenta 8 Ante-partum hæmorrhage 7 Post-partum hæmorrhage 4 Rise of temperature 8 Inflammation of breasts 2 Malpresentations 9 Other causes 12 For the Infants— Prematurity and dangerous feebleness 30 Deformities 4 Discharging eyes 5 Baby found dead on arrival of midwife 4 Pemphigus 1 Rash, undefined 2 Convulsions 1 Registration of Maternity Homes. The Midwives and Maternity Homes Act, 1926, which came into force on 1st January, 1927, provides for the registration and general supervision of Maternity Homes. An Officer duly authorised by the Local Supervising Authority may at all reasonable times enter and inspect any such Home and the records required to be kept. The authorised Officer in East Ham is the Inspector of Midwives, acting under the direction of the Medical Officer of Health. 65 Puerperal Fever and Puerperal Pyrexia. Notification of all feverish conditions occurring soon after a confinement, by doctors attending such cases, is required by Regulations for the control of Puerperal Fever and Puerperal Pyrexia that came into force in October, 1926. The object of these Regulations is to secure that women who suffer from such conditions may as quickly as possible come under special treatment, if necessary, or may be provided with skilled nursing or with institutional treatment. Four cases of Puerperal Fever were notified in East Ham during 1927. All occurred in private practice. All were removed to Hospital. Two of these cases proved fatal. Eleven cases of Puerperal Pyrexia were notified during the year. Eight of these cases occurred in private practice, and three were notified from Hospitals. Ten of these women recovered. The death of the remaining case was due to its being, complicated by Tuberculous Laryngitis. Maternal Deaths. The question of deaths occurring during or soon after childbirth has already been referred to in the section dealing with the Ante-natal Clinic, where it was mentioned that the Maternal Mortality Rate throughout the country is stationary. The number of these deaths has not been appreciably diminished by all the efforts so far made by Public Health Authorities in reference to this question. It is for this reason that careful investigation is made into the circumstances of all such deaths, that information may be obtained which may afford guidance towards future preventive work. During the year 1927, 12 deaths in connection with parturition occurred in East Ham cases as follows :— Puerperal septicæmia 2 Abortion 1 Puerperal embolism 1 Shock 1 Ante-partum hæmorrhage 1 Post-partum hæmorrhage 2 Ectopic gestation 1 Chloroform poisoning during confinement 1 Acute appendicitis complicating childbirth 1 Lobar pneumonia during pregnancy 1 66 Ophthalmia Neonatorum. Ophthalmia Neonatorum (i.e., inflammation of the eyes of new-born babies) has in past years been terribly injurious to the sight of infants who contracted it, frequently leaving them permanently blind; and every effort is now made to control and eradicate this disease, under Regulations for its notification that came into force in October, 1926. Any doctor attending such a case is required to notify it to the Medical Officer of Health. A midwife meeting the case of an infant having discharging eyes is required to summon a doctor, who then becomes responsible for notification, if he diagnose this disease. The information is passed by the Medical Officer of Health to the Medical Officer of the Child Welfare Department, and she keeps the case under observation, directly or through one of the Health Visitors. During 1927, 10 cases of Ophthalmia Neonatorum were notified in East Ham, with results of treatment as shown in the following table :— Notified. Case No 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 — — 9 1 — 1 — — 10 1 — 1 - - One case was treated at St. Margaret's Hospital (Metropolitan Asylums Board), the Borough Council meeting the cost. Free Milk. Under the Council's Scheme £900 worth of free milk was given to expectant and nursing mothers and young children during the past year. In every case careful investigation of the family circumstances is made, to secure that only really necessitous cases shall receive this benefit. Voluntary Associations. Thanks are again gratefully accorded to the Invalid Children's Aid Association for arranging periods of convalescence in the 67 country for delicate children referred from the Clinics. Fifteen young children were sent away through the Association during 1927. The Infant Welfare Centre in East Ham is affiliated with the Association of Infant Welfare and Maternity Centres. 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 treatment of infants by Artificial Sunlight is carried out at the School Clinic. The apparatus used for the Infant Clinics is shared with the School Medical Service. The use of the public ambulance is granted, when required, to convey expectant mothers to the 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. 68 VENEREAL DISEASES. Summary of work done by the Hospitals during the Year 1927. London Middlesex Essex Surrey Kent Herts. Bucks. E. Ham W. Ham Croydon| Total Other Places Grand Total New Patients:— Syphilis 4,349 380 194 150 130 53 25 50 127 30 5,488 607 6,095 Soft Chancre 123 3 4 1 6 1 — 1 8 3 150 60 210 Gonorrhœa 9,218 892 428 320 211 116 50 94 242 43 11,614 882 12,496 Not Venereal 7,598 735 417 321 165 94 42 98 242 56 9,768 396 10,164 Total 21,288 2,010 1,043 792 512 264 117 243 619 132 27,020 1,945 28,965 Total Attendances (531,473 44,604 17,227 19,129 9,445 4,546 2,193 5,328 11,944 3,160 749,049 18,229 767,278 No. of "In-patient" days 61,369 4,347 3,589 2,487 2,557 874 1,156 151 1,238 384 78,152 34,261 112,413 Salvarsan Substitutes, doses given 43,003 3,990 2,009 1,679 1,030 518 321 437 1,090 267 54,344 2,402 56,746 Pathological Examinations. For or at Centre :— Spirochaetes 897 69 10 8 5 10 — 6 12 1 1,018 78 1,096 Gonococci 44,503 2,334 2,095 977 975 381 189 485 1,186 241 53,366 2,300 55,666 Wassermann 27,265 1,756 912 917 579 252 154 213 523 158 32,729 1,285 34,014 Others 13,417 771 303 903 375 181 124 32 84 140 16,330 406 16,736 Total 86,082 4,930 3,320 2,805 1,934 824 467 736 1,805 540 103,443 4,069 107,512 For Practitioners :— Spirochaetes 30 8 — 7 — — 1 — — 46 — 46 Gonococci 2,992 237 212 535 15 16 3 25 32 287 4,354 26 4,380 Wassermann 15,406 2,047 1,053 696 84 67 131 195 347 375 20,401 325 20,726 Others 1,340 37 27 384 30 12 12 2 4 5 1,853 41 1,894 Total 19,768 2,329 1,292 1,622 129 95 147 222 383 667 26,654 392 27,046 69 TOTAL CASES NOTIFIED DURING 1927. 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 4 14 34 56 66 404 139 34 38 9 ... ... 798 534 4 Diphtheria 5 6 22 38 39 231 71 21 24 4 3 ... 464 445 34 Enteric Fever (Typhoid & Paratyphoid) ... ... ... ... ... ... ... 1 ... ... 1 ... 2 2 ... Erysipelas 1 4 ... 1 ... 1 1 1 3 20 6 38 11 3 Puerperal Fever ... ... ... ... ... ... ... ... 2 2 ... ... 4 4 4 „ Pyrexia ... ... ... ... ... ... ... ... 6 5 ... ... 11 6 ... Cerebro-Spinal Meningitis 1 1 1 ... ... 1 ... ... ... ... ... 4 3 3 Acute Polio-Myelitis 1 1 ... ... 2 ... 1 ... ... ... ... ... 5 3 ... *Ophthalmia Neonatorum 10 ... ... ... ... ... ... ... ... ... ... ... 10 1 ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... 2 ... 2 1 3 Pneumonia 3 4 2 3 3 19 3 9 24 16 20 8 114 66 113 Total 25 26 62 98 111 654 216 66 95 39 46 14 1452 1076 164 Tuberculosis :— (a) Pulmonary M 1 2 6 3 14 42 15 31 4 118 143 65 F 1 4 7 11 37 19 9 88 107 53 Total 1 3 10 10 25 79 34 40 4 206 250 118 (6) Non-Pulmonary M ... ... 2 1 2 5 3 3 2 ... 4 1 23 19 10 F ... 2 1 1 9 3 1 5 ... 22 21 9 Total ... 2 3 2 2 14 6 4 7 ... 4 1 45 40 19 * The ten 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. I he ratio of non-notified tuberculosis deaths to total tuberculosis deaths was i to 5. 70 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN EAST HAM, 1927. CAUSES OF DEATH. Net Deaths at the subjoined ages of "Residents" whether occurring within or without the Borough. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and under 75 years. 75 and upwards. All Causes M 728 71 9 24 32 40 86 211 145 110 F 705 51 19 14 35 40 86 159 130 171 1. Enteric Fever M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 2. Small-pox M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 3. Measles M l ... ... 1 ... ... ... ... ... F 3 ... 1 2 ... ... ... ... ... ... 4. Scarlet Fever M 1 ... ... ... 1 ... ... ... ... ... F 3 ... 1 ... 2 ... ... ... ... ... 5. Whooping Cough M 6 3 1 2 ... ... ... ... ... ... F 6 4 1 ... 1 ... ... ... ... ... 6. Diphtheria M 20 ... 1 4 15 ... ... ... ... ... F 14 ... ... 3 11 ... ... ... ... ... 7. Influenza M 20 ... ... 1 ... 2 9 3 2 ... F 23 1 2 ... ... ... 2 7 4 ... 8. Encephalitis Lethargica M 2 ... ... ... 1 ... ... 1 ... ... F 1 ... ... ... ... ... ... 1 ... ... 9. Meningococcal Meningitis M 1 ... ... 1 ... ... ... ... ... ... F 2 1 1 ... ... ... ... ... ... ... 10. Tuberculosis of Respiratory System M 65 ... ... 1 2 11 26 22 3 ... F 53 1 ... ... 6 17 21 6 1 ... 11. Other Tuberculous Diseases M 10 2 ... 4 ... 1 ... 2 1 ... F 9 3 3 ... 2 ... 1 ... ... ... 12. Cancer, Malignant Disease M 76 ... ... ... ... 1 5 34 27 9 F 99 ... ... ... ... ... 13 41 28 17 13. Rheumatic Fever M 2 ... ... ... 1 ... ... 1 ... ... F 6 ... ... ... 1 2 2 1 ... ... 14. Diabetes M 5 ... ... 1 ... 1 1 1 ... 1 F 6 ... ... ... ... ... ... 3 3 ... 15. Cerebral Haemorrhage, &c. M 31 ... ... ... ... ... ... 11 11 9 F 36 ... ... ... ... ... 1 7 13 15 16. Heart Disease M 110 ... ... ... 2 3 8 37 36 24 F 110 ... ... ... 1 7 4 28 30 40 17. Arterio-sclerosis M 25 ... ... ... ... ... 1 10 8 6 F 12 ... ... ... ... ... 1 4 4 3 18. Bronchitis M 59 2 1 ... ... ... 2 13 14 27 F 61 1 1 ... ... ... 1 9 12 37 19. Pneumonia (all forms) M 66 13 5 5 3 1 8 16 10 5 F 47 6 6 4 2 4 4 7 7 7 20. Other Respiratory Diseases M 7 1 1 2 2 1 F 10 ... ... 1 1 ... 2 1 3 2 21. Ulcer of Stomach or Duodenum M 12 ... ... ... ... ... 4 8 ... ... F 3 ... ... ... 1 ... ... 2 ... ... 22. Diarrhœa, &c. M 7 4 ... ... ... ... 1 1 ... 1 F 5 3 1 ... ... ... ... 1 ... ... 23. Appendicitis and Typhlitis M 6 ... ... 1 ... 2 1 1 1 ... F 8 ... ... ... 1 ... 3 4 ... ... 24. Cirrhosis of Liver M 4 ... ... ... ... ... ... 2 1 1 F 3 ... ... ... ... ... ... 2 ... 1 25. Acute and chronic nephritis M 18 ... ... ... ... ... ... 8 7 X 3 F 24 ... ... ... ... 1 5 9 6 3 26. Puerperal Sepsis M ... ... ... ... ... ... ... ... ... ... F 4 ... ... ... ... ... 4 ... ... ... 27. Other Accidents and Diseases of Pregnancy and Parturition M ... ... ... ... ... ... ... ... ... ... F 8 ... ... ... ... 2 6 ... ... ... 28. Congenital debility and malform ation, premature birth M 34 33 ... ... ... ... 1 ... ... ... F 26 26 ... ... ... ... ... ... ... ... 29. Suicide M 12 ... ... ... ... 1 4 3 4 ... F 3 ... ... ... ... ... 2 1 ... ... 30. Other deaths from violence M 25 1 ... ... 2 6 3 9 2 1 F 14 1 ... ... 2 2 2 4 ... 3 31. Other defined diseases M 103 13 ... 2 5 11 11 26 16 19 F 106 4 ... 4 4 4 11 21 19 37 32. Causes ill-defined or unknown M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 71 METEOROLOGICAL RECORD—YEAR 1927. Rain Gauge 5-in. in diameter, placed 1-foot above ground, 15 feet above sea level. Temperature taken in the shade of a Stevenson's Screen, 5 feet from the ground. Months. Temperature of Air during the Month. Mean Temperature of Air. Rainfall. Highest Maximum. Lowest Minimum. Mean of No. of Days on which Rain fell, 0.01 inches and over. Amount collected in inches. Mean rate of fall for Rainy Days. Greatest fall in 24 hours. Date of greatest fall. All Highest. All Lowest. January 53° 27° 46°.3 36°.1 41°.2 14 1.13 0.08 0.22 17th February 55° 27º 45°.6 35°.0 40°.3 13 3.12 0.24 0.72 1st March 67° 33° 52°.7 40°.6 46°.6 18 2.09 0.11 0.60 25th April 70° 32° 56°.1 41°.6 48°.9 12 1.69 0.14 0.50 5th May 75" 33° 64°.1 45°.5 54°.8 10 1.38 0.14 0.33 16th June 83° 44° 65°.4 49°.6 57°.5 17 2.60 0.15 0.49 30th July 80° 49° 69°.2 55°.1 62°.1 16 2.28 0.14 0.72 6th August 77° 49° 70°.4 55°.4 62°.9 18 3.65 0.20 0.55 17th September 75° 35° 63°.2 51°.2 57°.2 14 4.18 0.30 1.45 14th October 66° 35° 59°.0 45°.7 52°.4 11 1.05 0.09 0.29 27th November 64° 28° 48°.9 38°.1 43°.5 14 2.17 0.15 0.69 29th December 54° 20° 40°.0 31°.5 35°.7 11 3.14 0.28 0.85 25th Means and Totals for the Year. 83° 20° 56°.7 43°.8 50°.2 168 28.48 0.17 1.45 Sept. 14th The Rainfall for the Year was 0.38 ins. above, and the number of days on which rain fell 12 above the year 1926 at East Ham. COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Hnnual IReport OF THE School Medical Officer FOR THE YEAR 1927. EAST HAM EDUCATION COMMITTEE Alderman N. A. Papworth, J.P. (Chairman). Alderman W. G. Davie, J.P. (Vice-Chairman). Alderman F. P. Cross, J.P. (Mayor). Councillor A. H. W. Owen (Deputy Mayor). Councillor (Mrs.) M. Ridler. †Alderman C. L. E. Masset. Alderman H. Oshorn, J.P. Alderman H. N. Ridler. Alderman E. Shanahan, J.P. Councillor E. Anderson. Councillor W. W. Bagot. Councillor G. W. Boultwood. †Councillor J. Brooks, J.P. Councillor T. W. Burden. Councillor A. E. Dennington Councillor C. F. H. Green. Councillor T. J. Hawkins. *Councillor H. J. Kybert. Councillor G. H. Manser. Councillor R. W. Moger. Councillor W. T. Newling. Councillor H. Perry. Councillor J. J. Pope. Councillor G. Pottinger. Councillor A. Rhodes. Councillor E. H. Thompson. Councillor A. Trinder. *Councillor T. Watts. E. T. Andrews, Esq., B.A. G. P. Dean, Esq., J.P. E. J. Sullivan, Esq. R. Whitfield, Esq. *Appointed December, 1926. †Co-opted Members of Libraries Sub-Committee. School Nurses: Mrs. Nears, S.R.N., Miss Kekwick, S.R.N., A.R.San.I., Mrs. Sorrel, S.R.N., A.R.San.I., Miss Case, R.F.N., A.R.San.1., 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: F. Read, M.S.M. (Chief Clerk). Miss A. M. Dean, Miss F. E. Hales and Miss P. E. C. Rolfe. 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. 75 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 School Medical Service of the County Borough of East Ham for the year ended 31st December, 1927. The average school attendance during the year approximated closely to 19,000. The number of routine and special cases examined of elementary school children totalled 11,122, as compared with 13,707 in 11926, and a complete medical inspection of all children in the Secondary School has also been carried out. The activities of the Service have increased and widened considerably since its inception twenty years ago, and the general beneficial effect upon the health and physical condition of the children is very apparent in the statistical data presented with this report. In the past five years the percentage of children found at routine medical inspection to require some form of medical or surgical treatment, has dropped from 19'7 to 8'6, and although the latter figure appears to be in some degree remarkable, and may be exceeded in the forthcoming year, it is very encouraging to note the evident downward trend in the number of defective and unhealthy children ir the schools. The installation of the necessary apparatus for the purpose of carrying out both general and local ultra-violet radiation has been one of the decided forward steps during the year, and the results obtained have more than justified our hope of promoting a marked physical improvement in delicate and ailing children. More satisfactory accommodation for the Dental Clinic has been provided, but, unfortunately, only by removing to more distant quarters, a fact which complicates efficient and economical administration and tends to hamper the ideal of complete coordination. In this latter connection perhaps I may be permitted 76 to respectfully urge, in the interests of efficiency and ultimate economy, the necessity for arriving at a definite conclusion in regard to the provision of suitable accommodation for the Medical Services of the Borough, a matter which has been before the Authority for some considerable period. In regard to the cost of the School Medical Service, it is interesting to note that the expenditure upon this service only slightly exceeds half the average expenditure upon one elementary school. Handicapped as we are in possessing no open-air schools or schools for physically defective children, the work of the local branch of the Invalid Children's Aid Association has proved of the utmost value : 22 children have been sent to Schools of Recovery through this Association by arrangement with the local Authority, and 112 children have received open-air and convalescent treatment as the result of the direct activity of the Association and its cooperation with the Authority's Medical Officers. The Staff of the School Medical Service are to be congratulated upon the excellent work accomplished throughout the year, and I wish to express my appreciation of their keen interest and loyal co-operation. My sincere thanks are extended to the teachers for their great help and courtesy, and to Mr. Thompson and his staff for their invaluable assistance. 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. 77 1. STAFF. A list of the Staff of the School Medical Department will be found on page 74 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. In my report for the year 1922, the suggestion was made that the Local Insurance Committee should carry on the very important work of systematic medical supervision when children arrive at the school leaving age and that the medical records of such children should be passed on to the medical practitioner concerned. At that time it was considered that " no useful purpose would be served " by such procedure. It is interesting to note that the Medical and Science Councils of the People's League of Health, who formed the deputation which waited on the Minister of Health on 28th June, 1927, have embodied similar suggestions in the recommendations which were submitted to the Minister. 3. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene. During the year 1927 a complete survey of the sanitary and hygienic conditions pertaining to all the schools of trie 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, but a good deal remains to be done in connection with improvements in the lighting and heating of school premises. 4. MEDICAL INSPECTION. The following is a synopsis of School Medical Work for the year 1927. The figures for the years 1923 to 1926 are also given for comparison:— 78 COMPARATIVE STATEMENT OF WORK. 1923. 1924. 1925. 1926. 1927. Routine and Special Inspection (on School Premises) 8,344 7,284 10,728 10,944 8,483 Re-inspection 2,956 3,951 3,784 4,737 4,175 Consultations at Inspection Clinic 10,982 13,080 13,445 14,575 13,530 Number of Treatments at Clinic 16,616 18,319 18,665 15,810 14,873 General Cleanliness Visits to Schools 315 291 335 297 257 Nurses'Visits to Homes 2,919 3,541 3,840 4,948 4,547 Children Examined for Cleanliness 62,207 57,936 58,090 58,683 58,588 (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 of all children between 12 and 13 years of age, together with children over 13 years of age who had not already been examined after reaching the age of 12. In addition, provision was made for the re-inspection in the seven schools which had not been visited for this purpose during the year 1926. The half-time services of an additional Medical Officer for four months during the year has made it possible to complete this work, and also to carry out a special census of the "exceptional children " (Table III) in the schools (see 4 (b)). (a) (ii.) Administration and Clerical Staff. The Administrative Scheme adopted in the year 1922 has been considerably elaborated and extended to include methods for dealing with the new branches of the Service, which have been introduced during the past five years. As was expected at the outset, the Scheme has proved exceedingly successful, and has ensured that every child dealt with by the School Medical Service has a complete medical record, and that no child with a physical defect is lost sight of. Since the year 1922 the Education Committee have introduced facilities for the X-ray treatment of Ringworm, Orthopaedic treatment, and operative treatment for Strabismus. Children 79 are first examined at School or Clinic and referred for such treatment as may be necessary. Arrangements are then made through this office for application by the X-ray Operator, Orthopaedic treatment at the Balaam Street Hospital, or operations for Strabismus at the Royal Westminster Ophthalmic Hospital, as the case may be, and that scholars concerned are subsequently kept under observation at the School Clinic. In consequence of the operation of the Schemes in connection with these facilities, together with the provision of Light treatment, the extension of the arrangements for Ophthalmic treatment, in addition to Dental and other forms of Medical treatment, the administrative and clerical work of the Department has considerably increased and become of more consequence, and the further extensions of the School Medical Service, contemplated by the Committee, are bound to add to the responsibilities and duties already involved. The Education Authority accept financial responsibility for all forms of treatment recommended by the Medical Inspectors, provided that the required written authority has been issued by me, and parents contribute towards the cost in accordance with the Authority's Scale. The collection and recovery of fees and the various financial arrangements in connection with the Authority's Treatment Schemes are carried out entirely by the staff of the School Medical Service, and it is pleasing to record that there is complete co-operation with the staff of the Borough Treasurer's Department in relation to all financial matters affecting the Service. (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. During the year 1927 a special visit was made to all the schools with a view to ensuring that no " exceptional children " had been overlooked. 474 children were examined for this purpose and the following table indicates the result of this special survey:— 80 Result of Table III Census—November, 1927. Recomended for Boys. Girls. Total Blind (including partially blind) (i) Suitable for training in a School or Class for the totally blind. Certified Schools or Classes for the Blind — — — Public Elementary Schools — — — Other Institutions — — — No School or Institution — — — (ii) Suitable for training in a School or Class for the partially blind. Certified Schools or Classes for the Blind — 3 3 Public Elementary Schools 1 — 1 Other Institutions — — — No School or Institution — — — Deaf(including deaf and dumb and partially deaf) (i) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Certified Schools or Classes for the Deaf Public Elementary Schools — — — Other Institutions — — — No School or Institution — — — (ii) Suitable for training in a School or Class for the partially deaf. Certified Schools or Classes for the Deaf 1 1 Public Elementary Schools — — — Other Institutions — — — No School or Institution — — — Epileptics Suffering from severe epilepsy. Certified Special Schools for Epileptics 2 1 3 Institutions other than Certified Special Schools — — — Public Elementary Schools — — — No School or Institution — — — Suffering from epilepsy which is not severe. Public Elementary Schools 5 2 7 No School or Institution — — — 81  Recommended for Boys. Girls. Total. Physically Defective. Infectious pulmonary and glandular tuberculosis. Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 2 1 3 Other Institutions — — — No School or Institution — — — Non-infectious but active pulmonary and glandular tuberculosis. Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — — — Certified Residential Open Air Schools ... 1 1 Certified Day Open Air Schools 2 2 Public Elementary Schools 4 1 5 Other Institutions — — — No School or Institution — — — Active non-pulmonary tuberculosis. Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 1 — 1 Public Elementary Schools 2 1 3 Other Institutions — — — No School or Institution — — — Crippled Children (other than those with active tuberculous disease) e.g., children suffering from paralysis, etc., and including those with severe heart disease. Certified Hospital Schools — — Certified Residential Cripple Schools 11 8 19 Certified Day Cripple Schools 6 12 18 Public Elementary Schools 55 41 90 Other Institutions 1 — 1 No School or Institution — — — No. of Cases Examined—474. (c) The work of medical inspection is carried out during school hours and on school premises in every case, and disturbance of school arrangements is reduced to a minimum. 5. FINDINGS OF MEDICAL INSPECTIONS. The percentage of children found to require treatment, as the result of Routine Medical Inspection in the Code Groups, shows a marked decrease over that for the year 1926 and preceding years. 82 FINDINGS OF MEDICAL INSPECTION. Group. NUMBER OF CHILDREN. Percentage of Children found to require Treatment. Inspected. Found to require Treatment. 1923 1924 1925 1926 1927 1923 1924 1925 1926 1927 1923 1924 1925 1926 1927 Entrants 1,459 1,171 2,960 3,345 2,468 215 187 340 454 244 14.7 15.97 11.5 13.6 9.9 Intermediates 2,131 2,172 2,961 1,991 1,295 550 384 445 270 133 25.8 17.68 15.0 13 6 10.3 Leavers 3,717 3,116 3,118 3,877 2,717 681 385 370 520 180 18.3 12.36 11.9 13.4 6.6 Totals 7,307 6,459 9,039 9,213 6,480 1,446 956 1,155 1,244 557 19.7 14.8 12.8 13 5 8.6 83 It will be noticed that the percentage of children found, at routine medical inspection, to require treatment has undergone a very marked reduction, and one of the outstanding factors responsible for this appreciable diminution is the rapidly growing interest'and desire on the part of some parents to seek the advice of the School Medical Service in regard to minor defects and apparently trivial ailments. The popularity of the Clinics bears witness to the success of the uphill fight waged by the School Medical Service during the past twenty years. There is no doubt however that the earlier inculcation of healthy habits and the education of young parents and young children in the necessity for observing the laws of hygiene would prevent indifference and indolence to health matters, and procrastination on the part of so many parents who either hesitate to have treatment for their children " until they are a little older " or " until the warmer weather comes " or who retain the belief that their children will undergo a physical transformation on reaching the age of seven years. The number of defects found in the entrant and intermediate age groups is probably dependant upon these underlying causes, and should be a matter for the grave concern of the Maternity and Child Welfare Committee as well as of the Education Committee. It is indeed unfortunate that all children born in East Ham do not come under the control of the Maternity and Child Welfare Centre. The period between birth and five years of age is that in which children ai'e most prone to disease, and yet, to quote Sir George Newman in his report for the year 1926, " there is no continuous supervision by the same authority " and the Education Authority has to receive " damaged goods." The systematic and routine medical supervision of infants and children under school age, the early teaching of hygiene and healthy habits and the early treatment of minor defects would certainly prevent serious physical defects during school life and subsequently, and in many cases would avert the occurrence of one or more superimposed complications, whilst systematic, and casual, education in hygiene and the laws of health by the teachers in our schools would tend towards improvement in the physical condition of children in the present generation and still more so in the next generation. In almost all cases disease is predisposed to by faulty hygiene and 84 habits of life. Have the Local Education Authority determined that " the study and practice of health must form part of the everyday life of the school?" (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 58,588 examinations, as compared with 58,683 in 1926. Of this number 12 children were found who harboured body vermin (19 in 1926), 479 children showed vermin and many nits in the hair (668 in 1926), whilst 2,140 children showed only a few nits (2,527 in 1926). Comparative table :— Year Number Examined Number with Nits Number with Head Vermin Number with Body Vermin No. of Exclusion Certificates 1922 65,464 3,333 1,071 62 95 1923 62,207 2,722 1,313 46 62 1924 57,936 2,648 826 31 80 1925 58,090 2,856 652 23 45 1926 58,683 2,527 668 19 49 1927 58,588 2,140 479 12 50 85 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 Girls 1026 21 3 ... *Plashet Girls 1102 57 32 1 Boys 1131 7 1 ... Boys 1007 21 1 ... Jr. Mixed 972 25 6 ... Infants 1169 61 28 1 Infants 939 26 5 ... Storey Street Mixed 952 32 42 1 Castle Street Mixed 469 28 1 ... Infants 1011 49 18 1 Infants 244 24 1 ... Silvertown R.C. Mixed 599 24 19 ... *Central Park Girls 1211 58 13 ... Infants 477 25 35 ... Boys 1273 14 1 ... St. Michael's R.C. Mixed 324 13 21 ... Infants 1290 52 10 1 St. Winefride's R.C. Mixed 864 28 5 ... Dersingham Mixed 838 41 25 1 Sandringham Road Mixed 1243 30 1 ... Essex Road Girls 1061 33 5 ... Infants 1128 32 2 ... Boys 1138 3 ... ... Shaftesbury Road Girls 1270 73 2 ... Infants 1013 10 9 ... Boys 1300 8 ... ... Fourth Avenue Girls 995 90 4 ... Infants 1170 69 7 ... Boys 977 26 2 ... "Salisbury" Inter. 767 20 8 ... Infants 665 48 4 ... Primary 1463 51 20 2 *Hartley Girls 921 57 ... ... Shrewsbury Road Special 188 17 ... Boys 1016 12 ... ... *Vicarage Girls 1050 68 13 ... Infants 1050 48 6 ... Boys 923 23 4 ... High Street S. Mixed 793 39 6 ... Infants 1219 94 20 1 J. Mixed 707 47 10 ... Walton Road Girls 1417 88 12 ... Kensington Avenue Girls 1008 46 1 ... Boys 1364 13 3 ... Boys 1128 7 1 ... Infants 1458 49 11 ... Infants 893 15 1 ... " Winsor " Inter 676 24 ... Lathom Road Girls 127.1 61 6 ... Primary 1254 75 6 ... Boys 1220 5 ... ... Wakefield Central Girls 195 6 ... ... Infants 1330 22 3 ... Monega Road Girls 1115 36 3 ... Total 58588 2140 479 12 Boys 1158 4 ... ... Infants 1002 20 7 ... Per cEnt. 37 .8 .02 *Napier Girls 1098 89 8 2 Boys 1045 23 14 1 * Since re-organised. Per cent. in 1926 43 11 03 Infants 1006 53 13 ... 86 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, but there is no doubt that systematic and practical instruction in hygiene by the teachers would tend to eliminate completely such conditions. (b) Minor Ailments. As has been the case in former years, few minor ailments were discovered at routine medical inspection, owing to the vigilance displayed by teachers and nurses, and to the growing interest of parents in such matters. 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. 1926 1927 1926 1927 Scabies 4 2 27 5 Impetigo 36 11 463 496 Conjunctivitis 12 5 87 52 Blepharitis 21 3 144 59 Ear Disease 77 41 171 154 Ringworm (Scalp) 2 2 36 48 Ringworm (Body) 3 1 61 31 (c) Tonsils and Adenoids. 3.1 per cent, of the children examined during the year were referred for treatment for " tonsils and adenoids," either separate or combined, as compared with 4.6 per cent. in the year 1926. Of these, much enlarged tonsils accounted for 0.4 per cent. ; definite adenoids were present in 0.3 per cent., and the combined defect was diagnosed in 2.4 per cent. ; the figures for 1926 were 0.6 per cent., 0.3 per cent., and 3.7 per cent, respectively. The percentage of children moderately affected and requiring to be kept under observation was 5.5, the corresponding percentage in 1926 being 9.2. In this case 4.2 per cent, had moderately enlarged tonsils, 0.5 per cent, exhibited signs of the presence 87 of adenoids, whilst 0.8 per cent, showed enlarged tonsils and adenoids of moderate degree, as compared with 7.3 per cent., 0.7 per cent., and 1.2 per cent., respectively in, the year 1926. (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 8 11 19 Other forms of Tuberculosis 7 11 18 Totals 115 22 37 (e) Skin Disease and (f) External Eye Disease. The number of these cases, although less than last year, still remains high. At medical inspection during the year 951 children were found to be suffering from skin affections (as compared with 1,025 in the year 1926). Cases of external eye disease also continue to show a high incidence, 119 in the year 1927 and 264 in the year 1926. (g) Vision. Only children with marked visual defect have been referred for treatment and these, including cases of strabismus, numbered 609. In addition there were 85 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. 112.) (h) Ear Disease and Hearing. 0.1 per cent, of the children examined were found to be suffering from otitis media, as compared with 0.7 per cent, in 1926. The percentage of deaf children was 0.7, the corresponding number for last year being 0.9. (i) Dental Defects. (See report of Dental Surgeon on p. 118). 88 (j) Crippling Defects. Reference to Table III on p. 126 will furnish information with regard to the occurrence of crippling defects in the area. 29 cases of crippling due to tuberculosis and 154 cases due to other causes were discovered at routine medical inspection during the year. (See also 3 (b) ). 6. 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 1927. There has been a marked increase in the incidence of scarlet fever, diphtheria, and chicken pox, but that of measles and whooping cough has been exceptionally low. 89 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 18 2s 10 21 14 15 February 36 11 4 10 16 13 March 38 50 5 14 20 18 April 22 53 3 34 20 18 May 72 67 8 32 56 14 June 35 63 23 107 54 13 July 4 37 — 11 47 26 August 2 10 — 2 42 19 September 2 2 3 — 48 34 October 7 27 2 16 8.'! 51 November 14 20 1 10 74 39 December 11 66 3 11 52 41 Totals 261 429 62 268 526 301 90 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. 1926 1927 1926 1927 Ringworm of Scalp 126 50 2971 1968 Ringworm of Body 87 43 989 446 Impetigo Contagiosa 133 78 988 1114 Infective Eye Inflammation 126 62 1761 834 Septic conditions 176 125 1431 1314 Verminous conditions 36 23 230 254 Scabies 54 11 427 176 Other Skin conditions 123 65 1135 958 Acute Throat conditions 116 33 1475 804 977 490 11407 7868 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 4,547 visits to the homes of children in whom defects were found at medical inspection. Of the 706 children referred for treatment, 438, or 62 per cent., have obtained treatment. The School Nurses have also paid 170 special visits to the Schools, and 31 visits to the Feeding Centres, and have undertaken 14 journeys in connection with the admission and discharge of children to Institutions. All children, referred for the operative treatment of tonsils and adenoids (356), have been visited by the School Nurses both prior to and after the operation. The value of the work of the School Nurses cannot be overestimated : it is they who come in close touch with the children and parents in the home, and to the School Nurses belongs the satisfaction of knowing that it is largely owing to their efforts that the incidence of disease amongst the children is declining year by year. In the early days of the School Medical Service the life of the School Nurses was fraught with difficulty, anxiety and 91 ment, but gradually, with tact, patience and kindly persuasion and instruction, the barrier of indifference, indolence, ignorance and obstruction has been reduced, and to-day, although many difficulties and anxieties remain, the majority of parents look upon the School Nurse as one to whom they can turn for advice and help upon any matter in connection with the health of the children and upon many other matters which arc outside the scope of the School Medical Service. 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. 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, Fridays, 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. (7) Light Clinic, Town Hall, Mondays and Thursdays at 2 p.m. A full account of these clinics was set forth in my report for 1922. During the year 1927, 14,873 attendances were made for treatment at the various clinics, and there were 13,530 attendances for consultation of the Medical Officers. 92 (а) Minor Aliments. An analysis of the chief minor ailments treated at the School Clinics, and otherwise, will be found in Table IV, Group 1, p. 130. (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, 356 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. (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 the'se are treated at the General Clinic, but some cases of chronic and of the rarer skin diseases are referred to hospital. The application of X-rays in cases of ringworm is performed at the School Clinic, and 15 children received this form of treatment during this year. (e) External Eye Disease. 196 cases (294 in 1926) 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. 112. (f) Vision. During the year 1927 the Ophthalmic Clinic was held on five sessions per fortnight. 93 609 cases were referred for treatment 111 respect of visual defect during the year 1927 and, including a large number of cases awaiting treatment at the termination of the year 1926, 699 cases have been treated in the past year. On the 31st of December, 1927, there were 72 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 all the children with lesser degrees of visual defect. There were 85 such cases discovered during the year and it is hoped that these children will be dealt with as soon as the more urgent cases have been treated. (g) Ear Disease. 396 consultations were given and 296 children were treated at the General Ear Clinic. (See report of Aural Surgeon, p. 108.) (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. 118.) (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. 94 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 (he School Clinics, in order that the progress of the cases may be watched and recorded, and to ensure that treatment has not been allowed to lapse. If at any time such a case fails to attend the School Clinic it automatically becomes included in the following up list of one of the School Nurses. A large amount of work has been undertaken at the Hospital and has been highly satisfactory. During the year 1927, 26 out-patients and 3 in-patients have received orthopaedic treatment. The total out-patients attendances was 605, whilst the average number of weeks involved in the case of each in-patient was 9.4. (j) The Light Clinic. At the commencement of the year 1927 the Local Education Authority installed two arc lamps in the Town Hall Clinic : a quadruple carbon arc lamp of the radial type for general therapeutic purposes and a single tungsten arc lamp for local treatment. Although the Clinic is only available on two sessions per week for this form of treatment very satisfactory results have been obtained in the cases treated. A certain amount of unwarrantable disrepute has fallen upon actino-therapy and, in all probability, this is due to the fact that the general public, and unfortunately also some medical practitioners, have formed the opinion, as is so often the case with newly introduced therapeutic agents, that ultra-violet radiation is a panacea. Whereas, as a matter of fact, much harm may be done in certain cases by unskilled and injudicious use, and careful examination and complete diagnosis is a very essential preliminary to actino-therapy, frequent re-examination to determine the effect and to assess the dosage being also essential. In this connection it is obviously highly important in cases of malnutrition, debility, anaemia and so-called pretuberculosis to eliminate at the 95 outset definite underlying organic or constitutional disease which may require specific treatment; for whilst in some of these cases ultra-violet radiation may be of value when combined with specific treatment, in others it is definitely contra-indicated. Where, however, such conditions are hereditary, dietetic, environmental or catarrhal in origin the general application of ultra-violet radiation is of great value, and it is cases of this type which have been treated at the Town Hall Light Clinic. The treatment has also been used with very marked benefit in cases of chronic bronchial catarrh, bronchitis, rheumatism and adenitis. Children suffering from hypertonia of the nervous system, the highly strung, excitable, irritable and choreic types do not in all cases appear to respond very satisfactorily to ultra-violet radiation. Throughout general irradiation has been used chiefly as an adjunct to natural sunlight, during the period from September to May, and parents have been instructed and persuaded in regard to the importance of taking full advantage of natural sunshine and fresh air. The tungsten arc lamp has been used mainly in the local treatment of chronic cervical adenitis (in conjunction with general irradiation), and there is no doubt that the results achieved are far superior to those following" any other form of treatment : this lamp has also been used in the treatment of ringworm, but whilst satisfactory results have been obtained in ringworm of the body in the case of ringworm of the scalp the cure is tedious and the method is inferior to preliminary depilation by the application of X-rays : on the other hand indolent skin infections have responded very satisfactorily to this form of treatment. The following is a brief summary of the cases treated by general irradiation throughout the year :— CONDITION. Boys. Girls. Anaemia 7 7 Debility 17 18 Malnutrition 14 15 Malnutrition and Ansemia 1 3 Pretuberculosis 5 4 Rheumatism 1 4 Bronchial Catarrh and Bronchitis 13 8 Adenitis 10 5 96 Number of children treated 132 Number of attendances 2,706 Average number of attendances per child 20.5 Average gain in weight per month per child 1¼ pounds The marked general improvement, both physical and mental, in the cases under treatment has been amply verified by parents and teachers, and the former have exhibited a very firm conviction as to the efficacy of the treatment, both verbally and by their assiduous attendance at the Clinic; it has been noteworthy that there have been very few absentees. The extension of this form of treatment to suitable cases attending the Maternity and Child Welfare Centre should go far towards eliminating much of the invalidity amongst entrants to the Elementary Schools, and it is encouraging to note that, after a trial period of nine months, Dr. E. Thomson, Assistant Medical Officer at the Maternity and Child Welfare Centre, has reported : " Two sessions a week are reserved for the babies, and almost without exception benefit has resulted to those who have been sent to the Sunlight Clinic," and that the Members of the Maternity and Child Welfare Committee have been sufficiently convinced of the benefit to infants and young children of light treatment that application has been made to the Ministry of Health for recognition of the expenditure in connection therewith. The daily use of the artificial light apparatus would be a great asset in our endeavours towards the prevention of ill-health and disease in early life, and the provision of specific accommodation would make this possible. A much larger waiting room is urgently necessary to enable the children to have a comfortable period of rest after treatment before they leave the building. 9. OPEN-AIR EDUCATION. (a) Playground Classes. In a few cases playground classes continue to be held occasionally. (b) School Camps. No School Camps were held during the year 1927. 97 (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. (See also 17, page 100.) (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 112 cases, financial responsibility for which was not undertaken by the Local Education Authority. (See also 17, page 100.) 98 Particulars of the number of Children who were resident in Schools of Recovery between 1st January and 31st December, 1927, 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 2 2 1 3 — 2 3 2 4 4 2 3 4 2 3 — — 1 1 — — 5 3 25 23 48 i.c.A.A. 1 3 2 3 2 3 — 2 3 1 — — — 1 1 — — — — — — — 8 14 22 No. of Weeks Russell- Cotes — — — — — — — — — — 6 — — — 6 — — — — — 5 — 11 — — — — No. of Weeks RussellCotes (Cont.) 13 14 15 16 17 18 23 — — — — — — — — — — — — 1 — 29 — 29 99 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 123,645 meals were provided for 485 children as compared with 89,606 meals for 480 children in 1926. 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 1927 the number of parents who were present at the routine medical inspections was 3,603 (4,769 in 1926), that is, in 46.7 percent, of the cases examined (45.3 per cent, in 1926). 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 our 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. 100 16. CO-OPERATION OF VOLUNTARY BODIES. Reference to 8 (») on page 93 and to 9 (e) on page 97 will give some measure of the scope of the work carried out in association with Voluntary Bodies. 17. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Physically Defective Children. Table III reveals the very regrettable fact that 72 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 561 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. The 258 children classified as delicate (in Table III) are all X suffering from a chronic form of defect due to unsatisfactory environmental, nurtural and congenital conditions, and the only treatment which holds out any hope of lasting benefit is their admission to residential schools of recovery for periods varying from three to twelve months or longer. Whilst there are many children who enter school in a fairly advanced stage of invalidity from the above causes, there are also a great number who exhibit early signs and predisposing conditions and for whom the routine, hygiene and education in a day open-air school, in addition to medical supervision and treatment at the School Clinic, would go far in the prevention of a more serious defect. These cases have not been classified in Table III in view of the fact that there is insufficient accommodation for the severer types of defect in residential open-air schools, and no openair school is available for their reception. As reported on previous occasions :— " The provision of a day open-air school, erected on a suitable site within the Borough, would tend markedly towards reducing the number of "definitely physically defective children, with the result that, at no distant date, the present serious 101 need for a large number of places in a Physically Defective Centre and a Residential Open-air School would be less urgent." In regard to the 120 children suffering from glandular and non-infectious pulmonary tuberculosis, and the 29 children suffering from active non-pulmonary tuberculosis, who are attending ordinary elementary schools, it is obvious that all these cases would benefit far more from an open-air school life and the liability of relapses occurring would be almost eliminated. It will also be noticed that 154 crippled children (many of whom are suffering from severe heart disease) are attending ordinary elementary schools only because no special school is available for their reception. This appears to be a very appropriate section under which to make mention of " Health Teaching in Schools." It is very regrettable that no routine instruction is given by the teachers in the simple laws of health and hygiene. In the year 1925, a scheme was submitted to the Head Teachers' Association which embodied suggestions for a " School Children's Health Service," but the scheme was " considered impracticable " and no alternative suggestion was put forward. The following matters deserve very careful consideration in determining upon the question of the most satisfactory action to be taken in regard to defective, delicate and tubercular children :— 1. A more intensive health campaign in regard to children under school age, together with complete medical supervision and treatment of children up to the age of five years. 2. The systematic instruction and interesting study and practice of hygiene in the elementary schools. 3. The erectipn of a day open-air school to accommodate at least 500 children. 4. The provision of a Special School for Physically Defective Children to accommodate at least 200 children. 5. The improvement of home conditions, especially in the direction of reducing overcrowding. 102 Mentally Defective Children. During- the year 1927, the number of cases examined, for purposes of the Mental Deficiency Act of 1913, was 93 (57 in 1926). Of these 51 were classified as mentally deficient, and 11 as dull and backward, recommendations being' made as shown in the following table :— Number examined 93 Classified as mentally deficient 43 Classified as morally deficient 1 51 Classified as imbeciles 7 Classified as dull and backward 11 Recommended for Special School 41 A reference to Table III will show that out of 120 children who have been certified as mentally defective but educable in a special school, 7 (14 in 1926) are having no education, 5 cases are attending the ordinary elementary schools (10 in 1926), and 104 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. 103 MEDICAL INSPECTION RETURNS. SECONDARY SCHOOL. TABLE I. RETURN OF MEDICAL INSPECTIONS (see note a). For the Year ended 31st December, 1927. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections— (see note b). Boys. Girls Entrants — — Intermediates — — Leavers 120 112 Total 120 112 Number of other Routine Inspections (see note c). 121 122 B.—OTHER INSPECTIONS. Number of Special Inspections (see note d). 3 2 Number of Re-Inspections ... (see note e). 15 36 Total 18 38 104 TABLE II. SECONDARY SCHOOL. A.—Return of Defects found by Medical Inspection in the Year Ended 31st December, 1927. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) B. G. B. G. B. G. B. G. Malnutrition — — — — — — — — Uncleanliness : See Table IV., Group V. — — — — — — — — Skin Ringworm : Scalp — — — — — — — — Body — — — — — — — — Scabies — — — — — — Impetigo — 3 — — — — — — Other Diseases non-Tuberculous — 2 — — — — — — Eye Blepharitis — — — 1 — — — Conjunctivitis — — — — — — — Keratitis Corneal Opacities — — — — — — — — Defective Vision (excluding Squint) 10 10 5 1 — 1 — — Squint — — — — — —• — — Other Conditions — — — 1 — 1 — — Ear Defective Hearing 1 3 — — — — — — Otitis Media — — — — — — — — Other Ear Diseases — 1 — — — — — — Nose and Throat 'Enlarged Tonsils only 1 3 4 Adenoids only — — — — — — — — Enlarged Tonsils and Adenoids 1 Other Conditions — — — 1 — — — — Enlarged Cervical Glands (Non-T uberculous) 1 — 4 — — — — Defective Speech — — — — — — — — 105 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. 1 — — 8 — — — — Heart and Circulation Heart Disease: Organic — — — 1 — — — — Functional — — — — — — — — Anaemia — 1 — 2 — — — — Lungs j Bronchitis — — — — — — — — Other Non-Tuberculous Diseases 2 — — — — — 1 — Tuberculosis 'Pulmonary: Definite — — — — — — — — Suspected — — — — — — — — Non-Pulmonary : Glands — — — — — — — — Spine — — — — — — — — Hip — — — — — — — — Other Bones and Joints — — — — — — — — Skin — — — — — — — — Other Forms — — — — — — — — Nervous System Epilepsy — — — — — — — — Chorea — — — — — Other Conditions — 1 — 3 — — — — Deformities Rickets — — — — — — — — Spinal Curvature — 2 — — — — — Other Forms 1 11 — 4 — — — — Other Defects and Diseases 4 3 3 2 1 — — — B.—Number of individual children (see note b) found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). GROUP. (1) Number of Children. Percentage of Children found to require Treatment. (see note d). (4) Inspected (see note c) (2) Found to require Treatment. (3) Code Groups :— Entrants Intermediates — — — — — — Leavers 120 112 10 14 83 125 Total (Code Groups) 120 112 10 14 8.3 12.5 Other Routine Inspections 121 122 5 10 41 8.2 106 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. Fourteen boys have been specially examined, in accordance with the Bye-laws, and these were found to be fit for employment, with one exception. 22. SPECIAL ENQUIRIES. Again the amount of work undertaken by the staff of the School Medical Service during the year has been so great that no time was available for satisfactorily carrying out any of the special inquiries suggested by the Chief Medical Officer of the Board of Education. 23. MISCELLANEOUS. During the year 1927 the following special medical examinations were made :— Teachers 30 Officers 4 Student Teachers 18 Scholarship Candidates 58 Workmen 17 W. BENTON, Medical Officer of Health and School Medical Officer. COUNTY BOROUGH OF EAST HAM EDUCATION COMMITTEE. Annual Report OF THE WORK DONE IN The Aural Clinic for the Year 1927. 108 To the School Medical Officer, Education Committee. County Borough of East Ham 23rd January, 1928. Sir, I have the honour to submit my report for the work done in the Aural Clinic during the year 1927. The number of children seen by me amounted to 355, of whom 186 were boys and 169 girls. This necessitated a total number of visits of 871, but apart from these to the Specialist there were, of course, a great number made to the Treatment Clinic, amounting in all to 2,621. The number of cases classified as deafness only was 1120, but these with the added symptom of discharging ears came to 180. Of these the number that showed improvement in hearing and discharge were 78, which may be considered a fairly good result when one fully appreciates the stubbornness of certain types of aural discharge and the difficulties encountered in providing the very best methods of treatment always. The operation for removal of tonsils and adenoids was recommended in the case of 131 children, and in the majority of these it was duly performed. Considerable delay still occurs, however, owing to the lack of sufficient accommodation in the various hospitals concerned. The number of cases discharged as cured or for whom treatment was considered no longer necessary was 139. I should like to draw attention to the fact that very often a patient when ordered to attend a hospital for an operation upon the mastoid, chiefly in cases of a very chronic discharge, finds great difficulty in gaining early admission. Very often in these circumstances I have seen fit to deal with these cases in the wards of my 109 own Hospital. Besides these I have had admitted 6 cases for operation on the nasal septum. In conclusion, I take this opportunity of thanking the NursingStaff at the Clinic for their kind co-operation. I am, Sir, Your obedient Servant, L. GRAHAM BROWN. Number of Cases seen by Specialist 355 Number of Boys 186 Number of Girls 169 Number of Visits made to Specialist 871 Number of Visits made to the Treatment Clinics 2621 Number of Cases of Deafness 120 Number of Cases of Discharging Ears 180 Number of Cases showing improvement in Hearing 78 Number of Tonsils and Adenoids Operations Ordered 13l Number of Cases discharged during 1927 139 COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Annual Report OF THE Ophthalmic Surgeon for the year 1927. 112 To the School Medical Officer, County Borough of East Ham Education Committee. January, 1928. Sir, I have the honour to present by Fifth Annual Report. During the past year I have examined 656 children for defective vision—588 also remain under supervision from last year and 172 no longer require it. One finds that children with defective sight carry out instructions more carefully if they know that they are to be called to see the oculist again after a certain interval; the interest also of the teachers is thereby stimulated, while the parents feel that the defect, having been discovered, is still engaging our attention. Defective sight results from two main causes—errors of measurement in the eye as an optical instrument, and the effects of injury or disease. As to errors of refraction, the child may be long-sighted or short-sighted. If long-sighted the defect is greatest in infancy and improves with age, but, unless care is taken, may give rise to squint and defective vision in the squinting eye. Squints result from a relatively poor power of binocular vision combined with a defective muscle balance of the two eyes. They appear early in life—long before school age—as soon as the child begins to use its eyes in the middle of its second year, and are immensely favoured by the onset of infectious diseases in childhood. (At my special request Dr. Bendix allows children admitted to the Isolation Hospital to wear their glasses.) Hence the importance of the Ophthalmic Surgeon in the Maternity and Child Welfare Centres which will be referred to later. The treatment of squint consists in improving the power of binocular vision with glasses (and in a few cases by exercises) or by correcting the muscle balance defects by operation. The latter should never be resorted to until the former has been given a fair trial. If a squint is allowed to persist without treatment for any length of time—six months—the visual centres upon the two sides of the brain develop unequally and the chances of successful treatment by glasses is rapidly reduced to vanishing point. As the eyes 113 grow their errors alter, and the glasses must be repeatedly adjusted if the ground gained is not to be lost. Short sight does not—except in the congenital cases—arise in infancy. It appears usually between the ages of 7 and 12 years in children predisposed by a family history of myopia, often in a case previously recorded as being long-sighted. The tendency once developed " progresses "—that is, the myopia increases—sometimes with alarming rapidity. It never improves. Predisposition is assisted by weak general health in adolescence, and repeated attacks of infectious disease. Two important factors are the presence of infected teeth, tonsils and adenoids, and the element of " competition " which plays so large a part in education. In development the teeth and eyes are formed from nearly the same structures, so that it is not surprising that eyes liable to stretch before the intraocular fluid tension are often associated with soft teeth, unable to resist the bacteria which inhabit the mouth. The element of competition has a specially severe effect in myopia because these children are handicapped at games, and the desire to be good at something being a human characteristic they fall back on the sustained close work of their school studies for the necessary satisfaction. Myopia cannot be checked by the mere provision of glasses. It is necessary to attend to all the details of general health. The condition of the mouth must be watched and the amount of close work reduced to that which is suitable to the health of the eyes, even to the ordering of "oral teaching only." If this is not done, education will proceed at the expense of the vision, so that a child, although a scholarship candidate at 12, will need stronger and stronger glasses, and at 20 may not be able to obtain firstclass employment. A " vicious circle " is eventually set up, the standard of employment falling with the acuity of vision. Although checking a child's education while leaving it in the ordinary class insures disappointment to the child as well as to its parents and teachers, the only other course which has been so far open to us has been to send the child away to a residential special school. This has been a difficult matter. Parents are always loath to part with one who has occupied a large place in their affection by reason of its " defect," and one cannot but sympathise with them. The Council, by consenting to institute a special " Sight Saving Class " in East Ham—the word " blind " 114 should never be used in this connection—have helped materially the School Medical Officers. I watch the starting of this class with the greatest interest and hope to be able to report upon its progress next year. I pass now to some cases of defective vision following upon injury or disease of the eye. A boy of 12 presented himself with the history of having gone blind in his left eye after a blow received in school. On reference to the records it was found that, previously to the date of the blow, the eye had had very defective vision, for the investigation of which an appointment had been made. A left cataract limited his field of vision for 30 degrees to the left, being besides a very conspicuous visual defect. I admitted this case to the Royal Westminster Ophthalmic Hospital and removed the cataract. He now appears perfectly normal, has regained his visual field to the left, and can read the last line but one on the test card, and small print when the eye is corrected by glasses. Before the operation he could merely distinguish the light from the dark. Last year we had two cases of severe corneal ulceration which, in spite of energetic treatment, carefully and skilfully carried out by the school nurses, continued to spread. These cases were both admitted into hospital under me. In the first the eye was in serious danger and actually perforated. Recovery gradually took place. The iris remains adherent to the base of the ulcer at one point, but scarring is not excessive and the eye can see halfway down the test card without the aid of glasses. The second case also recovered with useful vision without having passed through so dangerous a phase. They were both under treatment for months, and had several spells at a special Ophthalmic Convalescent Home—Miss Hudson's at Bushey Park. Only untiring attention on the part of those who undertook the treatment retained useful sight to these eyes. Interstitial keratitis—a deep inflammation of the clear part of the eye occurring in children between 5 and 15 and lasting about six months, occasionally attacks both eyes in the school child. At the height of the attack there is extreme pain and the victim's general health is often seriously impaired. The cornea becomes 115 almost opaque and although considerable clearing takes place, much scarring results in the centre, leading to considerable reduction in the visual acuity which is permanent. During my period of work in East Ham several of these cases have been admitted into hospital for special treatment under me. They have been given the usual injections prescribed for this condition, but at the same time the inflammatory intraocular fluids have been tapped and allowed to escape from within the eyeball, through an incision made at the corneal margin. This treatment has met with very considerable success. In one of the cases during the past year the attack was checked in the affected eye and the second eye did not become involved. The above are some of the cases of external eye disease which have been seen and treated in the clinic. During the last year 57 new cases presented themselves. Many of these, especially those of lid infection (Blepharitis), Conjunctivitis, and Corneal Ulceration, are due to infection from the hair, hands and clothing in children, whose general health has been undermined by overcrowding, and chronic poisoning from the teeth, tonsils and adenoids. They will eventually disappear from our list of school diseases, but they would be of infinitely more frequent occurrence but for the work of the school nurses whose work in the clinics and schools is, from my point of view, beyond praise. I would lastly speak, Sir, of my work in connection with the Maternity and Child Welfare Clinics. I see cases referred to me from Dr. Elsie Thomson for half the time occupied by one session each week. One of her health visitors, usually the senior one, attends, and I send a personal report to Dr. Thomson on each case, so that she may be able to maintain touch as to what is being done. As I mentioned last year, this work divides itself into the following :— (a) Advising on the treatment of incipient squint. (b) Treating external eye disease. (c) Advising on cases of congenital malformation of the eyes. During the last year I have seen 57 cases of squint. Of these cases 27 are definitely improved, in many the deformity has disappeared to recur slightly when the child's health is depressed 116 and so indicating the need for caution. Still, the result as it stands is distinctly encouraging. I have also seen 15 cases of external eye disease, 3 being cases of Conjunctivitis in the new-born infant, which attended my clinic on discharge from the hospital or maternity home. All these cases have done well and no impairment of vision has resulted. No cases of congenital malformation have come for advice this year. During the past year, 1 have operated upon eight cases of squint in children of school age with, I think, a good result in most cases. For one, a case of bad vertical squint, something further may have to be done. Five new cases have been recommended for operative treatment. May I, in conclusion, Sir, say how much I appreciate the co-operation of my medical colleagues, the School Nurses, the Health Visitor who attends the Infant Welfare Clinic, and also of the Optician and the Clerical Staff. One and all have done their best for the comfort of the patients, and towards making the working of the clinic smooth and efficient. 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 1927. 118 To the School Medical Officer, County Borough of East Ham, Education Committee. Sir, I have much pleasure in submitting to you my report for the year 1927. The age groups inspected were from 5 to 9 years inclusive, treatment being offered where necessary. The number of children inspected was 9,691, and the number referred for treatment was 6,622 ; to these must be added the special cases, that is cases referred by the School Medical Officers, Nurses and Head Teachers, to the number of 220. Details will be found in the following table : TABLE IV. Group IV.—Dental Defects. (1) Number of Children who were:— (a) Inspected by the dentist Age. Routine Age Groups. Specials (see note d) Grand Total. 5 6 7 8 9 Total. 10 11 12 13 14 2028 2406 2631 171 914 9691 55 54 52 49 10 220 9911 (b) Found to require treatment 6622 (c) Actually treated 2118 (d) Re-treated during the year as the result of periodical examination (see note e) Nil (2) Half-days devoted to :— Inspection 66 Total 365 Treatment 299 (3) Attendances made by children for treatment 4441. (4) Fillings:— Permanent teeth 2621 Total 983 Temporary teeth 721 (5) Extractions : — Permanent teeth 590 Total 6392 Temporary teeth 5802 (6) Administrations of general anaesthetics for extractions 250. (7) Other operations:— Permanent teeth 234 otal 399 Temporary teeth 165 School inspection reveals the fact that there is an increase in the number of children having sound mouths, under 10 years of 119 age. The percentage in 1926 was 28.5, and this year it is 31.6. The following comparative table is interesting :— Year. Percentage of number of Children with sound mouths. 1923 23 1924 26.2 1925 28.1 1926 28.5 1927 31.6 This shows encouraging progress in one of the most important Health Services of the Borough, despite the fact that it is understaffed (1 Dental Officer to 20,000 children), and shows what an enormous benefit would accrue to the children if the Dental Service was fully staffed. Extractions and fillings have been rendered practically painless. A 2 per cent, solution of novocaine is used in ordinary extractions of temporary and permanent teeth, and nitrous-oxide gas or ethyl-chloride (local) for those which are septic and where an injection is contra-indicated. Teeth both temporary and permanent are filled when possible in order to prolong their life and to ensure the maximum masticating surface to the child. The age groups to be inspected in 1928 will be those from 5 to 9 years inclusive. A large number of parents show great ignorance of dental hygiene. An enormous amount of good could be done by propaganda and lectures—educating them in the importance of dental matters. This could be done if help were given by the appointment of two more Dental Officers. There is great need for this in the Borough, for instance, the number of cases untreated by December 31st, 1927, was 600. These cases have to be seen before the routine cases for 1928 can be commenced, which greatly hampers the work for the year. It is with pleasure that I record the fact that at last the Dental Clinic has been moved from its unhealthy quarters at the Town Hall to the salubrious and roomy quarters at Durban House. 120 The smoothness with which the Dental Clinic runs is in no small measure assisted by the tact and patience of the Dental Nurse, Miss Olifent. Details of treatment given to mothers and children under 5 years of age, sent from the Maternity and Child Welfare Centre, are given in the following table :— Maternity and Child Welfare Figures for 1927. No. of Half Days devoted to Treatment. No. 01 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 42 94 339 149 8 438 102 587 110 37 48 16 The number of children treated shows an increase over those for 1926. The work is very heavy and another session should be devoted to the tiny tots. This will be possible when the Dental Service is more fully staffed. In conclusion, I wish to thank Dr. Elsie Thomson, the School Medical Officers, the Nurses, the Clerical Staff, and teachers, for their valued co-operation and assistance during the year 1927. I have the honour to be, Sir, Your obedient servant, CYRIL S. NEAME. 121 TABLES GIVING SUMMARY OF WORK OF SCHOOL MEDICAL SERVICE from 1st JANUARY, 1927, to 31st DECEMBER, 1927. PUBLIC ELEMENTARY AND CENTRAL SCHOOLS. TABLE I. RETURN OF MEDICAL INSPECTIONS (see note a). For the Year ended 31st December, 1927. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections— (see note b). Entrants 2,468 Intermediates 1,295 Leavers 2,717 Total 6,480 Number of other Routine Inspections 757 (see note c). B.—OTHER INSPECTIONS. Number of Special Inspections 3,8S5 (see note d). Number of Re-Inspections 4,124 (see note e). Total 8,009 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. 122 (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 br 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. 123 TABLE II. A.—A Return of Defects found by Medical Inspection in thf. Year Ended 31st December, 1927. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Malnutrition 30 3 6 1 Uncleanliness : (See Table IV., Group V.) — — — — Skin Eye Ringworm : Scalp 2 2 48 Body 1 31 — Scabies 2 5 — Impetigo 11 3 496 4 Other Diseases (non- Tuberculous) 6 13 349 7 Blepharitis 3 10 09 1 Conjunctivitis 5 3 52 — Keratitis — 3 — — Corneal Opacities — — 7 — Defective vision (excluding Squint) 209 57 304 10 Squint 15 16 21 2 Other conditions 5 4 60 3 Ear Defective Hearing 20 9 51 3 Otitis Media 1 3 7 4 Other Ear Diseases 40 61 147 5 Nose and Throat Enlarged Tonsils only 22 461 18 8 Adenoids only 12 54 17 5 Enlarged Tonsils and Adenoids 149 80 115 6 Other conditions 21 38 104 19 Enlarged Cervical Glands (Non- Tuberculous) 6 632 45 10 124 Table II.—(continued). (1) (2) (3) 4) (5) Defective Speech 2 16 39 81 Teeth—Dental Diseases (see note a) (see Table IV., Group IV.) 47 334 104 11 Heart and Circulation. 'Heart Disease : Organic 1 6 2 9 Functional — 5 5 4 Anaemia 13 9 51 — Lungs - Bronchitis 7 50 67 3 Other Non-Tuberculous Diseases 15 73 55 12 Tuberculosis Pulmonary : Definite ! 1 2 Suspected — 2 2 4 Non-Pulmonary: Glands 3 2 1 Spine — 1 — — Hip 2 2 1 — Other Bones and Joints . — — 1 — Skin — — — — Other Forms — 7 1 3 Nervous System Epilepsy 2 5 6 10 Chorea 4 8 22 8 Other conditions 6 18 44 25 Deformities Rickets — 1 — — Spinal Curvature 8 8 5 Other Forms 7 21 21 16 Other Defects and Diseases 60 107 882 82 B.—Number of Individual Children (see note b) found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). GROUP. (1) Number of Children. Percentage of Children found to require Treatment (see note d). (4) Inspected (see note c). (2) Found to require Treatment. (3) Code Groups :— Entrants 2468 244 9.9 Intermediates 1295 133 10.3 Leavers 2717 180 6.6 Total (Code Groups) 6480 557 8.6 Other Routine Inspections 757 110 14.5 125 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). 126 TABLE III. Return of ali. Exceptional Children in the Area for the Year ended 31st December, 1927 (Se 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 Attending Public Elementary Schools (see note c) At other Institutions At no School or Institution 6 3 9 — — — — — — — — — (ii) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind Attending Public Elementary Schools (see note c) At other Institutions At no School or Institution 7 6 13 4 3 7 1 1 2 2 4 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 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 deaf. Attending Certified Schools or Classes for the Deaf Attending Public Elementary — — — Schools (see note c). 1 2 3 At other Institutions — — — At no School or Institution — — — Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority). (Sec note e.) Attending Certified Schools for Mentally Defective Children 63 41 104 Attending Public Elementary Schools (see note c) 3 2 5 At other Institutions 2 2 4 At no School or Institution 5 2 7 Notified to the Local Control Authority during the year. Feebleminded 9 4 13 Imbeciles 9 6 15 Idiots — — — Epileptics Suffering from severe epilepsy. (See note f.) Attending Certified Special Schools for Epileptics 3 5 8 In Institutions other than Certified Special Schools 1 — 1 Attending Public Elementary Schools (see note c) 1 1 2 At no School or Institution 1 4 5 127 TABLE III.—continued. Epileptics (continued). Suffering from epilepsy which is not severe. (See note g.) Attending Public Elementary Schools (see note c) At no School or Institution Boys. Girls. Total. 3 2 5 — — — Infectious pulmonary and glandular tuberculosis (See note h.) At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 7 2 9 At other Institutions — 2 2 At no School or Institution 2 5 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 1 — 1 At Certified Residential Open Air Schools ... 2 2 At Certified Day Open Air Schools — — — At Public Elementary Schools (See note c) 74 46 120 At other Institutions 3 3 At no School or Institution 7 1 8 Physically Defective. Delicate children (e.g., pre- or latent tuberculosis, malnutrition, debility, anaemia, etc). (See note h.) At Certified Residential Open Air Schools ... 17 12 29 At Certified Day Open Air Schools At Public Elementary Schools (see note c) 120 138 258 At other Institutions 14 10 24 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 5 4 9 At Public Elementary Schools (see note c) 23 6 29 At other Institutions 2 2 4 At no School or Institution 2 4 6 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 1 4 5 At Certified Day Cripple Schools 2 1 3 At Public Elementary Schools (see note c) 75 79 154 At other Institutions 6 4 10 At no School or Institution 26 25 51 128 NOTES ON TABLE III. (a) This Table is a return of all children in the area for whom the Local Education Authority are lesponsible, 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 out who come from other areas, should not be included in this Table; but children should be included who are living in residential schools outside the area and who are being maintained there by the Authority. For the purpose of this Table, no child should be included whose defect has not been ascertained by the School Medical Officer or a medical member of the Authority's staff. The definitions of defective children as given in the Act are as follows and must be very carefully borne in mind. A blind child is a child who is too blind to be able to read the ordinary school books used by children. A deaf child is a child who is too deaf to be taught in a class of hearing children in an elementary school. Mentally and physically defective children are children who, not being imbecile and not being merely dull and backward, are defective, that is to say, children who by reason of mental or physical defect are incapable of receiving proper benefit from the instruction in the ordinary public elementary schools, but are not incapable by reason of that defect of receiving benefit from instruction in such special classes or schools as under Part V. of the Act may be provided for defective children. Epileptic children are children who, not being idiots or imbeciles, are unfit by reason of severe epilepsy to attend the ordinarypublic elementary schools. (f?) 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. 129 (c) It should be understood that none of the children in this Table (except children suffering from epilepsy which is not severe) should in fact be attending public elementary schools. When the heading is retained, it is merely because at present the insufficiency of Special School accommodation makes it impossible to do better for some defective children than to allow them to attend the ordinary school. No space is left for the entry of children with infectious pulmonary tuberculosis attending public elementary schools, as these children should of course be promptly excluded fiom such schools. (d) Children who are deaf within the meaning of the Act should be classified for the purpose of this Table as (1) totally deaf or so deaf that they can only be appropriately taught in a school or class for the totally deaf, and (2) partially deaf, i.e., those who can appropriately be taught in a school or class for the partially deaf. (e) This category includes only those children for whose education and maintenance the Ix>cal Education Authority are responsible, and who are not eligible for notification to the Local Control Authority under the Mental Deficiency Act. (/) In this part of the Table only those children should be included who are epileptic within the meaning of the Act. For practical purposes the Board are of opinion that children who are subject to attacks ot major epilepsy in school should be recorded as " severe " cases and excluded from ordinary public elementary schools. (g) In this part of the Table should be entered the remainder of the epileptic children in the area, i.e., children whose disease is of such a kind as not to unfit them for attendance at an ordinary public elementary school. (h) The exact classification of physically defective is admittedly a matter of difficulty. Valuable information, however, will be obtained if School Medical Officers will record these defective children as accurately as possible under the selected sub-headings, taking care that no child is entered under more than one subheading. 130 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1927 (see note a) TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.). Disease or Defect. (1) Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. (see note b). (2) Otherwise. (3) Total. (4) Shin— Ringworm—Scalp 31 31 Ringworm—Body 43 — 43 Scabies 6 — 6 Impetigo 408 5 413 Other skin disease 297 19 316 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 196 5 201 Minor Ear Defects (See note c.) 148 12 160 Miscellaneous (e.g-, minor injuries, bruises, sores, chilblains, etc.) 1115 178 1293 Total 2244 219 2463 131 TABLE IV.— continued. Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I.) Defect or Disease. No. of Defects dealt with. Under the Authority's Scheme (see note b). Submitted to refraction by private practitioner or at hospital, apart from the Authority s Scheme. Otherwise. Total. (1) (2) (3) (4) (5) Errors of Refraction (including Squint) (Operations for squint should be recorded separately in the body of the Report.) 656 42 1 689 Other Defect or Disease cif the Eyes (excluding those recorded in Group 1.) 11 11 Total 667 42 1 710 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme 590 (b) Otherwise 34 Total number of children who obtained or received spectacles— (a) Under the Authority's Scheme 586 (b) Otherwise34 Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received Operative Treatment. Under the Authority's Scheme-in Clinic or Hospital. (see note b.) (1) By Private Practitioner or Hospital apart from the Authority's Scheme. (2) Total. (3) Received other forms of Treatment. (4) Total number Treated. (5) 249 117 356 36 392 132 Group IV.—Dental Defects. (1) Number of Children who were : — Age. Routine Age Groups. Specials (see note d Grand Total. (a) Inspected by the Dentist 5 6 7 8 9 Total. 10 11 12 13 14 2029 2406 2681 1711 914 9691 55 54 52 49 10 220 9911 (b) Found to require treatment 6622 (c) Actually Treated 2118 (d) Re-treated during the year as the result of periodical examination (see note e) Ni! (2) Half-days devoted to :— Inspection 66 Total 365 Treatment 299 (3) Attendances made by children for treatment 4441 (4) Fillings :— Permanent Teeth 262 Total 983 Temporary Teeth 721 (5) Extractions:— Permanent Teeth 590 Total 6392 Temporary Teeth 5802 (6) Administrations of general anaesthetics for extractions 250 (7) Other operations :— Permanent Teeth 234 Total 399 Temporary Teeth 165 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 58,588 (iii.) Number of individual children found unclean 1,511 (iv.) Number of children cleansed under arrangements made by the Local Education Authority Nil. (v.) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 1 (b) Under School Attendance Byelaws Nil. NOTES ON TABLE IV. (a) The Table should deal with all defects treated during the year, however they were brought to the Authority's notice, i.e., whether by routine inspection, special inspection, or otherwise, during the year in question or previously. (b) This heading should include all cases that received treatment under definite arrangements or agreements for treatment made by the Local Education Authority and sanctioned by 133 the Board of Education under Sections 16 and 80 of the Education Act, 1921. Cases which, after being recommended for treatment 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 ;.he course of the routine inspection of children in one of the age groups covered by the Authority's approved scheme, namely, to children specially selected by him, or referred by Medical Officers, Parents, Teachers, etc., on account of urgency. The number inspected in each age group should be separately shown, as well as the total, but under " Specials " only the total number should be given. (e) It should be understood that all the cases entered under this head are also entered under head c. (f) A statement as to the arrangements made by the Local Education Authority for cleansing verminous children and a record of the cases in which legal proceedings were taken, should be included in the body of the School Medical Officer's Report. N.B.—Groups I.—V. above cover all the defects for which treatment is normally provided as part of the School Medical Service. Particulars as to the measures adopted by the Authority for providing treatment for other types of defect (e.g., for orthopaedic treatment) or for securing improvement in types of defect which do not fall to be treated under the Authority's own scheme and for which the Authority neither incur expenditure nor accept any responsibility, together with a statement of the effect of the measures taken, should be included in the body of the School Medical Officer's Report. It is convenient for such particulars to follow the headings of Table II. Report OF THE Chief Sanitary, food and Shops Inspector FOR THE YEAR 1927. 136 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-second (and which is my last) Annual Report of the work performed by the Sanitary Inspectors for the year 1927. The number of primary inspections made was 7,107. These included visits to premises where infectious disease had occurred, house-to-house inspections, visits to premises upon complaint of nuisance, inspection of markets, slaughterhouses, bakehouses, eating houses, dairies, workshops, etc. This being the last official report it is my privilege to present, owing to my having reached the age when it is considered that rest from labour is desirable, there is no alternative but to accept the inevitable, although with many regrets and much gratitude for the provision graciously provided under the Superannuation Act. I desire to place on record my appreciation of the kindness received from members of the Council and colleagues during my 34 years in the Public Health Service. It has been my pleasure to serve under three Medical Officers of Health, and in a small degree help to fashion the Public Health Department. The population has increased from 40,000 to 150,000 and the number of houses from about 7,000 to 29,000 during my term of office. 137 PRIMARY INSPECTIONS. Month Manor Park Little Ilford Woodgrange Plashet Kensington Castle Central Wall End Greatfield South Total Ord H. to H Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H Ord. H. to H. Ordinary House to House. January 40 — 36 52 30 21 36 — 15 — 29 70 36 — 49 54 9 — 51 — 331 197 February 55 — 43 1 38 3 41 89 19 5 25 6 47 25 25 53 11 — 28 — 332 182 March 61 — 27 — 51 — 66 83 17 25 65 35 75 88 68 4 23 — 50 — 503 235 April 55 — 35 — 26 56 30 — 14 — 31 30 58 36 29 1 22 — 46 29 346 152 May 61 — 41 — 45 — 57 — 25 — 50 60 58 25 43 — 27 44 51 73 458 202 June 66 — 44 — 37 — 47 — 13 55 24 64 40 44 23 — 13 — 43 5 350 168 July 54 — 51 — 49 — 57 23 23 10 86 — 108 — 52 38 28 — 87 — 595 71 August 74 — 62 31 45 2 48 127 28 13 20 — 60 28 58 30 9 — 47 — 451 231 September 75 — 43 — 54 — 51 105 18 — 37 1 76 15 59 61 10 — 58 — 481 182 October 49 — 47 — 47 4 61 38 33 8 78 69 97 2 53 32 23 — 57 — 545 153 November 48 — 57 14 39 — 56 — 22 7 39 60 69 — 51 21 20 — 35 1 436 103 December 44 — 40 — 40 — 23 — 27 — 34 11 56 — 34 27 29 — 38 — 365 38 682 526 98 501 86 573 465 254 123 518 406 780 263 544 321 224 44 591 108 5,193 1,914 138 9,389 nuisances, generally the outcome of sanitary defects, were dealt with by the Inspectors. (These are fully detailed on inset p. 155). Of these nuisances, 5,062 were detected in routine work, and 4,327 by house-to-house inspections. To secure their abatement, the undermentioned Notices were served :— Preliminary 3,115 Statutory 533 Dust Bin 595 Water 2 4,245 139 COMPLAINTS RECEIVED. Manor Park Little Ilford Wood grange Plasbet Kensington Castle | Central Wall End Greatfield South Total. January 7 37 17 14 8 14 33 13 7 ii 161 February 22 30 10 13 18 17 26 22 3 12 173 March 21 25 17 26 20 33 27 17 7 16 209 April 16 25 15 15 7 25 22 13 10 18 166 May 24 33 17 21 20 24 32 22 14 20 227 June 13 35 16 22 13 8 29 11 9 18 174 July 11 35 15 18 26 13 27 17 8 15 185 August 14 47 8 15 15 16 28 5 5 16 169 September 16 23 15 18 11 24 46 19 5 26 203 October 18 37 25 27 21 24 23 21 7 18 221 November 14 54 31 18 16 20 37 17 4 28 239 December 7 33 10 13 7 12 20 10 8 9 129 183 414 196 220 182 230 350 187 87 207 2,256 Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Drains 45 52 47 52 58 44 34 47 49 45 62 32 567 Accumulations 9 8 8 6 7 13 12 8 8 8 10 6 103 Water cut off 1 - - - - - - - - - - - 1 Offensive Smells 1 3 1 5 4 2 12 4 2 11 3 1 49 No Dustbin 6 6 3 8 3 5 5 1 6 4 6 1 54 Dilapidations 25 26 92 26 68 27 59 72 77 62 91 33 658 Overcrowding 6 6 10 5 6 5 2 6 2 3 4 1 56 Insanitary Condition 15 24 22 24 41 37 13 6 17 46 14 16 275 Dampness 21 22 7 7 10 9 12 7 16 12 28 16 167 Others 32 26 19 33 30 32 36 18 26 30 21 23 326 161 173 209 166 227 174 185 169 203 221 239 129 2256 140 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 seven years ago, has produced good results, but in view of the re-organisation of the inspectorial staff which is occasioned by impending changes, the re-arranging of the districts is receiving consideration by the Committee. The tabular statement inset on page 155 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. 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 1,914, and at 79 per cent, of these sanitary defects were discovered for which Notices were served upon owners to remedy. 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. 12 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 under the Act for repairs. 141 5 certificates were issued. In 7 instances certificates were suspended and a schedule of dilapidations forwarded to the owner, and in most cases the work required has been carried out. Smoke Abatement. Observations of shafts were made with reference to the emission of smoke. 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. Disinfection. 1,970 premises were disinfected—1,299 for infectious disease, 586 for tuberculosis, and 85 for other causes. The steam disinfector at the Isolation Hospital is used for bedding and other articles requiring disinfection. 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 ans! Outworkers' Premises. There are 191 factories and workshops in the Borough, including bakehouses and laundries. During the year 366 inspections have been made, of which 139 were to homes of outworkers. 142 Collection of House Refuse. 21,241 tons of house refuse have been collected as compared with 21,289 during; the previous year. The collection and disposal of house refuse in recent years has received considerable attention. The Minister of Health has published a report showing the costs in the 80 Great Towns, some of the figures are extraordinary, when compared with East Ham, for example, our quantity of refuse is exactly half in weight compared with the average of the other Great Towns, and the cost per 1,000 of the population is £70 less. HOUSE REFUSE COLLECTION. Loads. Tons. 1926 1927 1926 1927 January 949 903 2,152 1,912 February 862 810 2,014 1,763 March 1,032 943 2,193 2,033 April 957 948 1,965 1,864 May 882 933 1,708 1,741 June 881 874 1.551 1,520 July 938 879 1,641 1,609 August 818 900 1,403 1,589 September 857 851 1,497 1,624 October 836 886 1,560 1,768 Nov< mber 825 906 1,760 1,886 December 886 905 1,845 1,932 Total 10,723 10,738 21,289 21,241 Trade Refuse Collection. The policy of the Council for many years has been to collect trade refuse (excluding offensive matter) from shops twice weekly 143 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 2,003 loads were collected. Dust Bins. Under the provisions of the East Ham Improvement Act, 1903, 375 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 YEAH, 1927. New houses erected during the year :— (a) Total 242 (b) As part of a municipal housing scheme ... 100 1. Dwelling Houses. Inspection—(1) Dwelling houses inspected for housing defects (under Public Health or Housing Acts) 5,531 (2) Dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. 144 (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 Nil. 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 1,042 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 3,115 (2) Dwelling houses in which defects were remedied :— (a) By owners 1,575 (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. 145 (3) Dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit Nil. (4) Dwelling houses in respect of which Demolition Orders were made Nil. (5) Dwelling houses demolished in suance of Demolition Orders Nil. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. The whole of the milk supplied is imported and there has been an ample supply during the twelve months. Distribution is principally carried out by large vendors by means of bottles, which is to be commended. 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. Dairies. There are 113 registered 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. Milk (Special Designations) Order, 1923. 13 supplementary licences were granted for the sale of milk under this Order—1 for Grade " A," 4 Grade " A " (Tuberculin tested), 4 for Pasteurised, and 4 for Certified milk. Public Health (Meat) 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 146 fication forms for the purpose of giving the requisite notice of intention to slaughter. During the year 983 such notifications were received referring to :— Cattle 1,800 Sheep 4,135 Pigs 4,786 Lambs 3,320 Calves 784 14,825 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 955 official inspections have been made. The slaughterhouses are scattered over a large area, which makes the work a little difficult at times. 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 portable glass screens in others. Notices are exhibited requesting customers not to handle meat, forks being provided for the purpose of inspection. 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. 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. 147 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 10 consignments were, last year, condemned as being unwholesome. Bakehouses. There are 44 bakehouses in the Borough, 8 being underground. The others are of modern structure and well-maintained. 67 inspections were made and limewashing and cleansing carried out in accordance with the Regulations. Sale of Food and Drugs Act. 387 samples of food and drugs were taken (including 233 milks) and submitted to the Public Analyst. Of these, 385 were reported to be genuine and 1 milk sample deficient in fat. No case of excess of sediment in milk occurred. 1 sample of cream was found to contain '3 per cent, boric acid. Formal Samples. Milk 233 Butter 37 Bread 2 Beer 1 Brawn 1 Bis. Dig. Tablets 1 Cheese 3 Cake 2 Cream 6 Do. (preserved) 6 Cough Cure 2 Custard Powder 3 Chicken and Ham Roll 1 Castor Oil 1 Crushed Linseed 11 Dripping 3 Demerara Sugar 1 Epsom Salts 1 Flour 2 Frying Oil 1 Gin 1 Jam 4 Lard 12 Liquid Paraffin 1 Lemon Squash 1 Liqorice Powder 1 Mixed Spice 1 Mince 4 Margarine 6 Minced Beef 1 Paste 2 Pea Powder 1 Pastry 5 Piccalilli 1 Parrish's Food 1 Rice 1 Sterilised Milk 2 Sweets 2 Sausages 4 Sponge 4 Salmon 1 Sauce 3 Suet 4 Tea 5 Vinegar 1 Wine (non-alcoholic) 3 Whisky 5 379 148 Informal Samples. Trufood l Ambrosia 2 Lacta 1 Lactagol 1 Cod Liver Oil and Malt 1 Parrish's Food 1 Butter 1 8 Legal proceedings were instituted on 1 occasion. The high percentage of genuine milk is satisfactory. The insatisfactory aspect is that the standard is altogether too low. 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 233 — Cream 6 1 Cream Sold as Preserved Cream. Correct statements made 2 Statements incorrect — 2 Percentage of preservative found in each sample. •25 .33 Percentage stated on statutory label. •40 •40 Determination made of Milk Fat in Cream sold as Preserved Cream. (1) above 35 per cent 2 (2) below 35 per cent — Total 2 149 Contagious Diseases of Animals Act. Foot and Mouth Disease was prevalent throughout the year, necessitating the issue of 123 licences for 3,330 animals which were brought into the Borough for slaughter, viz.:— Sheep 952 Pigs 1,270 Calves 373 Cattle 316 Lambs 419 3,330 No case of Foot and Mouth Disease occurred in the Borough. Swine Fever occurred at Langdon Crescent, caused by infected pigs being brought in from Romford Market. All the infected animals were killed, premises disinfected, and no further cases reported. The Borough has been otherwise free from any disease notifiable under the Contagious Diseases of Animals Acts. Hats 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 2,762 rats and 196 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. The work of supervising the storage of petroleum has been vested in the Public Health Department. 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. 150 Amusements Music Hall and Theatres. The places of public amusement have been regularly inspected. 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. Shops Act. There are 2,587 shops registered in the Borough, comprising:— Grocers and Provision Dealers 386 Confectioners and Tobacconists 286 Drapers 196 Boot and Shoe Salesmen 141 Tailors 126 Fruiterers and Greengrocers 107 Butchers 104 Licensed Houses 86 Barbers and Hairdressers 87 Domestic Stores 52 Bakers 54 Chemists 42 Others 920 2,587 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 121 contraventions were reported, necessitating letters of caution being sent to offenders, and in 23 instances legal proceedings were instituted—in all cases penalties were imposed. For details of prosecutions see page 153. Trade registers are systematically kept. 358 businesses changed proprietorship during the year. Explosives Act. During the year 153 visits were made under the Explosives Act for the purpose of re-registration. 17 cautions were given for offences, and in one instance legal proceedings were instituted and a penalty imposed. See page 154. 151 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. 66 bodies have been admitted and 48 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. Police Court Proceedings. On 60 occasions it has been necessary to have recourse to legal proceedings, viz.:— Under Public Health Acts for non-compliance with Sanitary Notice, etc. 22 Under Explosives Order—dangerously exposing fireworks 1 Under Shops (Early Closing) Act and Closing Orders for contraventions 23 Under Gipsy Bye-Laws for failing to provide sufficient water supply 11 Under Sale of Food and Drugs Act for adulterations 2 Sale of Food Order—Imported meat not labelled 1 Fines and costs have been imposed amounting in all to £57. See Tables pp. 152—154. 152 PROSECUTIONS UNDER THE PUBLIC HEALTH ACT FOR THE YEAR 1927. Date. Situation of Premises. Offence. Result. January Fifth Avenue Non-compliance with sanitary notice Magistrate's Order made March Alverstone Road do. Withdrawn. 3/6 costs. April Shrewsbury Road do. do. 3/6 do. April Welstead Road do. do. 3 6 do. April Talbot Road . do. do. 3/6 do. April do. do. do. 3/6 do. April do. do. do. 3/6 do. April do. do. do. 3/6 do. April do. do. do. 3/6 do. April do. do, do. 3/6 do. April do. do. do. 3/6 do. April do. do. do. 3/6 do. April — Obstructing Inspector in inspection of tinned goods Fined £5. Costs £4 4s. May Kempton Road Non-compliance with sanitary notice Withdrawn. 3/6 costs. May — Exposing unsound food for sale Fined £10. June Katherine Road Non-compliance with sanitary notice Withdrawn. 3/6 do. November Alverstone Road do. Withdrawn. November do. do. Magistrate's Order made. November do. do. do. November do. do. do. November do. do. do. November do. do. do. 153 PROSECUTIONS UNDER SHOPS ACT DURING 1927. Date. Offence. Fines. £ s. d. February Shops (Early Closing) Act, 1920 0 10 0 February do. 0 10 0 February do. 0 10 0 February do. 0 10 0 February do. 0 10 0 February do. 0 10 0 March Grocers' and Provision Dealers' Closing Order, 1923 0 10 0 March Shops (Early Closing) Act, 1920 1 0 0 March Grocers' and Provision Dealers' Closing Order, 1928 0 10 0 May Shops (Early Closing) Act, 1920 0 10 0 May Grocers' and Provision Dealers' Closing Order, 1923 0 10 0 May Shops (Early Closing) Act, 1920 5 0 0 May do. 2 0 0 May do. 0 10 0 May do. 0 10 0 May do. 0 10 0 May do. 0 10 0 May do. 0 10 0 May Grocers' and Provision Dealer's losing Order, 1923 ... 0 10 0 May Shops (Early Closing) Act, 1920 0 10 0 May do. 0 10 0 May do. 0 10 0 October do. 0 10 0 154 PROSECUTIONS UNDER THE SALE OF FOOD AND DRUGS ACT FOR THE YEAR 1927. Date. Offence. Result. April Milk—10 per cent. deficient in fat Withdrawn against Dairy Co. Roundsman Fined £5. Costs 10/0 PROSECUTIONS UNDER THE SALE OF FOOD ORDER, 1921. Date. Offence. Result. April Exposing imported meat without proper label Fined £2. PROSECUTIONS UNDER THE EXPLOSIVES ORDER. Date. Offence. Result. December Dangerously exposing fireworks in shop window Fined £5. PROSECUTIONS UNDER GIPSY BYE-LAWS Date. Offence. Result. March Failing to provide sufficient water supply Fined £2. Decamped. March do. Fined £1. March do. Fined £1. March do. Fined £1. March do. Decamped. March do. do. March do. do. March do. do. May Failing to provide sufficient water supply and dustbin Adjourned sine die. May do. do. do. May do. do. do. J. G. BANKS, Chief Sanitary Inspector. The Following is a Record in Detail of the Inspections made during the Year 1927 :— Manor Park Ward. Little Ilford Ward. Woodgrange Ward. Plashet Ward. Kensington Ward. Castle Ward. Central Ward. Wall End Ward. Greatfield Ward. South Ward. Total. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H.to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H.to H, Ord. H.to H, Ord. H. to H. Ord. H.to H. Premises found in fair condition 494 ... 183 6 229 12 318 125 125 33 237 82 421 52 211 76 137 11 213 8 2568 405 Factory and workshop premises inspected 7 ... 5 ... 3 ... 7 ... 15 ... 42 ... 33 ... 23 ... 11 ... 10 ... 160 ... Outworkers' premises inspected 4 ... 5 ... 17 ... 9 ... 4 ... 34 ... 36 ... 7 ... 15 ... 8 ... 139 ... Bakehouses inspected 9 ... 5 ... 5 ... 5 ... 4 ... 14 ... 14 ... 5 ... ... ... 6 ... 67 ... Slaughter-houses inspected 332 ... ... 191 ... 224 ... ... ... ... ... 82 ... ... ... ... ... 116 ... 955 ... Dairies inspected 6 ... 12 ... 6 ... 5 ... 3 ... 17 ... 18 ... 10 ... 19 ... 18 ... 114 ... Urinals inspected 15 ... 8 ... 3 ... 14 ... 3 ... 4 ... 10 ... 1 ... ... ... 5 ... 63 ... Walls and ceilings dirty and dilapidated 63 ... 134 64 93 57 94 265 55 66 105 207 125 157 97 122 31 23 123 81 920 1052 Yards improperly paved and dilapidated 17 ... 14 44 8 8 16 35 20 29 19 39 23 24 22 27 8 12 20 13 193 231 No forecourt paving 2 ... 7 29 7 1 4 3 7 12 11 3 3 14 6 4 ... ... 3 ... 50 86 Defective drains 3 ... 11 2 ... ... 3 ... 1 ... 3 6 2 ... 5 1 ... ... ... ... 28 9 Defective w.c. connections ... ... 1 ... ... 1 ... ... ... ... ... ... 1 1 1 ... ... ... 2 ... 5 3 Defective w.c. traps 9 ... 17 5 5 1 1 10 0 1 1 6 8 10 6 7 3 ... 4 1 60 41 Defective flushing apparatus 10 ... 27 17 13 5 12 10 17 17 20 24 17 19 17 16 9 3 17 8 159 119 Soil pans foul and broken 13 ... 17 7 10 5 12 14 13 16 9 12 11 13 6 8 2 ... 9 2 102 77 Defective vent pipes 9 ... 12 11 9 6 5 6 3 8 12 11 17 6 23 5 ... 8 3 80 74 R.W. pipes and eaves gutters defective 24 ... 55 54 25 11 25 57 24 32 63 128 52 82 54 60 16 9 65 15 403 448 R.W. pipes connected to drain 1 ... 1 ... ... ... 3 3 ... ... ... 2 1 ... 1 ... ... 2 1 ... 8 7 Roofs leaky 31 ... 47 22 25 12 35 54 26 18 37 66 52 43 50 53 8 4 71 18 382 290 Defective sink waste pipes 5 ... 12 16 2 ... 5 8 9 18 15 38 18 36 13 25 16 5 20 13 105 159 Houses without water (M.W.Bd.) ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 3 ... Cisterns without covers ... ... ... ... 2 ... 1 ... ... ... 3 4 ... 1 ... ... ... ... ... 1 7 5 Drinking water improperly stored 3 ... 5 ... ... ... ... ... 2 ... 5 6 4 4 ... ... ... ... 4 ... 23 10 Dilapidated floors 11 ... 25 8 9 5 8 10 7 14 12 9 11 24 8 8 "3 1 13 "2 107 81 Insufficient underfloor ventilation 1 ... 21 16 13 3 4 12 7 16 5 15 13 35 11 28 1 1 10 5 86 131 Dampness 24 ... 52 17 27 11 23 25 24 9 42 42 52 33 35 34 8 3 55 21 342 195 Accumulations 17 ... 20 1 1 4 2 4 14 ... 20 1 25 2 2 ... 13 3 100 8 Defective sashcords and windows 22 ... 34 12 7 13 15 67 13 17 19 83 23 46 27 32 13 4 32 13 205 287 Overcrowding 5 ... 12 ... ... ... ... ... 1 ... 10 ... 1 3 2 4 ... ... 3 4 34 11 Unsound food 21 ... 1 ... 98 ... 47 ... ... ... ... ... 27 ... 2 ... ... ... 90 ... 286 ... No dust bins 18 ... 17 5 10 14 5 62 4 9 14 42 14 20 58 31 9 2 28 13 177 198 Defective stoves 11 ... 34 5 14 18 11 74 11 10 14 94 8 33 21 38 6 1 26 5 152 248 Defective coppers 9 ... 33 5 12 7 8 49 2 15 24 33 8 27 9 19 9 4 18 2 132 161 Animals improperly kept 4 ... 5 1 ... ... ... ... ... ... ... ... 1 4 3 1 1 ... 8 1 22 7 Temporary buildings found 1 ... 1 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 4 ... Smoke nuisances ... ... ... ... ... ... 2 ... ... ... ... ... 5 ... ... ... ... ... ... ... 7 ... Rear passages unpaved or undrained ... ... 1 ... 2 ... ... ... 5 ... ... ... ... ... 1 ... ... ... ... ... 9 ... Gipsies ... ... ... ... ... ... ... ... ... ... ... ... ... ... 55 ... ... ... 2 ... 57 ... Breaches of Bye-Laws and Regulations 5 ... 1 ... ... ... 1 ... 1 ... 3 ... 10 ... ... ... ... ... 21 ... Other nuisances 57 ... 116 44 34 18 56 41 53 25 85 87 86 75 163 57 37 12 106 30 793 389 Drains unstopped and cleansed 64 ... 221 ... 46 ... 120 ... 80 ... 80 ... 247 ... 131 ... 56 ... 190 ... 1235 ... Drains tested 40 ... 70 ... 7 ... 14 ... 27 ... 28 ... 43 ... 76 ... 29 ... 54 ... 388 ... Inspections 682 ... 526 98 501 86 573 465 254 123 518 406 780 263 544 321 224 44 591 108 5193 1914 Total Inspections 682 624 587 1038 377 924 1043 865 268 699 7107 155 157 INDEX. A. Acute Polio-Myelitis 20, 69 Abatement of Nuisances 138, 144 Abattoirs 136, 145, 146, 155 Acreage 7 Acts of Parliament 11, 12 Adenoids 44, 54, 60, 86, 90, 92, 104, 108, 109, 113, 115, 123 Air temperature 71 Alleys 155 Altitude 8 Ambulances 10, 16, 67 Antitoxin 18, 20, 42 Area 7 Assessable value 7 Attendance Officers, co-op. of 99 Aural Clinic 108 Ante-Natal Clinics 9, 60, 61 B. Bacteriological Laboratory 17, 18, 37 Bakehouses 136, 141, 147 Baths 99 Births 7, 59 ,, Illegitimate 7, 59 „ Still 59 Birth-rate 6, 7, 8 Blind persons 15, 80, 100, 126, 128 Boundaries 8 Bye-laws 12, 106, 146, 151, 154, 155 C. Cancer 70 Cerebro-Spinal Meningitis 19, 20, 62 ,69, 70 Chicken-pox 58, 89 Children, Medical Inspection of 52-60, 77-90 Chorea 16, 105, 124 Cinemas and Music Halls 150 Cleanliness of School Children 78, 132 Clinic, Ante-Natal 9, 60, 61 Clinics, Infant 9, 52, 53, 57, 58 Clinics, School 9, 78, 79, 91, 118 Clinic, Artificial Sunlight 56, 57, 67, 75, 79 Climate 71 Closing Orders (Shops) 13 Common Lodging Houses 151 Communicable Diseases (non- notifiable) 89, 90 Complaints of Nuisances 138, 139 Contagious Diseases (Animals) Act 149 Continuation Schools 106 Convalescent Treatment 16, 28, 66, 76, 97 Co-ordination 54, 67, 75, 77 Cripples 79, 81, 88, 93, 101, 105, 124, 127 D. Dairies 136, 145 Day Nursery 9 Deafness 80, 100, 108, 109, 126 Deaths, Causes of 70 Deaths, No. of 7. 70 Death-rate, General 5, 78 Death-rate, Infantile 5, 6, 8, 63 Death-rate, Tuberculosis 6 Death-rate Zymotic 6, 8 Deaths in Large Towns 8, 63 Dentistry 23, 55, 67, 75, 79, 87, 93, 118, 124, 131 Diarrhœa 8, 62. 70 Diphtheria 5, 18, 20, 39, 40, 42, 43, 45, 62, 69, 70, 88, 89 Dirty premises 155 Disinfection 19, 42, 141 Dispensary 10, 22-29 Dispensary attendances 23, 24 Drainage Works 155 Dust Bins 140, 155 E. Ear Disease 86, 87, 93, 104, 123, 130 Employment of Children 106 Encephalitis Lethargica 19, 20, 69, 70 Enteric Fever 18, 20, 39, 69, 70 Epileptic Children 80, 100, 126, 127 Erysipelas 18, 20, 69 Exclusions 90 Eye Diseases of Children 45, 56, 66, 86, 87, 90, 92, 104, 112-116, 123 Eye, External Inflammation of 115, 116, 180 Explosives Act 150, 151 f. Feeble minded 14, 126 Factory and Workshop Act 141, 155 Following-up 90 Food and Drugs Act 147, 151, 154 Food Inspection 145, 147, 148 Food Supply 145, 147 Food, Unsound and Diseased 145, 155 Foot and Mouth Disease 149 G. Gipsies 154, 155 Glands, enlarged 104, 123 H. Harts Sanatorium 10, 35, 38 Health Propaganda 11, 43, 101 Health Week 11, 28 Hearing of School Children 86, 87, 93, 104, 123, 130 Heart Diseases 41, 70, 101, 104, 124, 127 Hospital Accommodation, 10, 46-49, 61,94 Hospital, Children's 54, 67, 92, 93 158 INDEX—continued. Hospital Staff, Health of 42 Hospitals, Maternity 10, 61, 64 House Refuse removal 142 House to House inspection 136, 138, 140, 155 Housing 7, 136, 143, 144 Hospital Staff training 46 I. Imbecile Children 15, 126 Impetigo 8, 86, 90, 130 Increase of Rent (Restriction) Acts 140, 141 Infant Consultations 9,52,53 Infantile Mortality 6, 8, 62, 63, 88 Infectious Diseases 6, 8, 10, 17-20, 38, 44. 141 Infectious Diseases (non-notifiable) 89, 90 Influenza 62, 70 Inspection of Borough 136-155 Inspection of School Children 75-88, 103-5, 118, 121-127 Invalid Children's Aid Association 16, 28, 66, 76, 97 Isolation Hospital 5, 6, 38-50 K. Kinemas 150 L. Laboratory work 17,18,42 Legal proceedings 148, 150, 151, 152-154 Licences, Contagious Diseases (Animals) Acts 149 Licences, Petroleum 149 "Light" Treatment 23, 45, 56-57, 67, 75, 79, 94 Lung Diseases 21-38, 40, 62, 69, 70, 87, 105, 124 M. Malnutrition 57, 95, 123, 127 Market places 136, 147 Maternal Deaths 8, 60, 65, 70 Maternity and Child Welfare 10, 52-67, 115 Maternity Homes and Hospitals 61, 64 Meals, provision of 99 Measles 8, 42, 62, 70, 88, 89 Meat Regulations 145,154 Medical examination 17, 78, 106 Mental Defects of School Children 102, 126 Mental Defectives, Statutory supervision 15 Mental Defectives, voluntary care 15 Mental Deficiency 14, 15, 102, 126 Meteorology 71 . Midwifery 9, 63, 64 Milk and Cream Regulations 148 Milk and Dairies Act 145 Milk, Free supplies 66, 67 Milk Order 145 Minor Ailments 58, 86, 92 Mortuaries 151 Mumps 89 Music Halls 150 Myopia 113 N. Nervous Diseases 105, 124 Notices served 138 Notification of Births 59 Notification of Infectious Diseases 20, 69 Nuisances abatement 144 Nuisances discovered 138, 155 Nursing arrangements 9,61 Nursery Schools 102 O. Occupations 8 Offensive trades 141 Open-air Education 76, 96, 97, 100, 101 Ophthalmia Neonatorum 20, 58, 60, 66, 69 Ophthalmic Clinics 55, 67, 92, 93 Orders 13, 14 145, 150, 151, 154 Orthopaedic treatment 78, 79, 93 Outdoor Relief 17 Outworkers 141, 155 Overcrowding 5, 101, 115 P. Parents, co-operation of 99 Post-Mortems 151 Petroleum storage 149 Physical training 99 Playground classes 96 Pneumonia 19, 20, 62, 69, 70 Population 7, 136 Pre-tubercular patients 127 Prosecutions, Public Health Act 152 Prosecutions, Sale of Food and Drugs Act 154 Prosecutions, Shops Act 153 Provisional Orders 11 Puerperal Fever 19, 20, 60, 65, 69, 70 Puerperal Pyrexia 19, 20, 60, 65, 69 159 INDEX—continued. R. Rainfall 71 Rateable Value 7 Rat extermination 149 Refraction cases 104, 123, 131 Refuse Removal and Disposal 142 Regulations 12, 13, 21, 26, 145, 146, 147, 148 Re-inspection 78, 90 Rent (Restriction) Act 140, 141 Rickets 57 Ringworm 55, 67, 86, 90, 104, 123, 130 Roofs, leaky 155 S. Sale of Food and Drugs Act 147, 151, 154 Sanatoria 10, 29, 30, 35-38 Scabies 86, 90, 123, 130 Scarlet Fever 5, 18, 20, 39, 42, 43, 45, 62, 69, 70, 88, 89 School Attendance Officers Co-operation 99 „ Baths 99 „ Camps 96 „ Children, Blind 113, 126 „ Cripples 101, 127 „ Children, Diseases of Nose and Throat 104, 109, 123 „ Children, Defective Speech 124 „ Children, exclusions 90 ,, Children, general ' cleanliness 78, 132 „ Children, Heart Diseases 101, 104, 124, 127 „ Children, Hearing 86, 87, 93, 104, 123, 130 „ Children, Minor Ailments 86, 92 „ Children, No. of Medical Examinations 75, 77, 78, 103 „ Children Nutrition of 95, 99, 123, 127 „ Children, Physical Training of 99 „ Children, Skin Diseases 87, 90, 92, 104, 123, 130 „ Children, Teeth of 75, 79, 87, 93, 118, 124, 131 „ Children, Verminous Conditions 84, 90, 132 „ Continuation 106 School Dentistry 75, 79, 87, 93, 118, 124, 131 „ Hygiene 77 „ Meals 99 „ Medical Treatment 91-96, 109, 130, 131, 132 „ Nursery 102 „ Open-air 76 School of Recovery 76 School, Secondary 102 Schools, Survey of 77 Shops Act 150, 151, 153 Skin Diseases 87, 90, 92, 104, 123, 130 Slaughter Houses 136, 145, 146, 155 Small-pox 10,17, 20, 42, 45, 70 Smoke abatement 141 Special enquiries 106 Special examination 106, 122 Spectacles, supply of 131 Speech, defective 124 Sputum examination 23 Squint 78, 79, 112, 115, 131 Staff 4, 52, 74, 77, 78 Subsoil 8 Summary of Report 7, 8 Surgical appliances 16 Swimming 99 Swine Fever 149 T. Table—Air temperature 71 ,, Birth-rate 6, 8, 63 „ Cattle Slaughtering 146, 149 ,, Causes of Death 70 ,, Clinics, Treatment at 54-58, 91-96 ,, Comparative Statistics 6, 8, 63, 78, 84 „ Complaints received 139 „ Deaths 6, 8, 61, 70 ,, Dental Treatment 118, 120, 132 ,, Eye examinations 104, 123, 126, 131 Exceptional children 80, 126, 127 ,, Exclusion Forms issued 90 „ Food and Drugs Act, Legal Proceedings 154 „ Food and Drugs Act, samples taken 147,148 „ Housing 143-145 ,, Infantile Mortality 6, 8, 62, 63 „ Infectious Cases notified 20, 69, 89 „ Infectious Cases removed to Hospital 39, 69 „ Invalid Children's Aid Association 16 „ Maternity and Child Welfare 53, 57, 60, 62-66 „ Medical Help 64 ,, Mental Defectives 15, 126 „ Meteorological record 71 „ Minor ailments 86, 130 „ Notes to 24, 121, 125, 128, 132 „ Notifications 20, 21, 69, 89, 90 „ Nuisances 155 „ Ophthalmia Neonatorum 66 160 INDEX—continued. Table—Public Health Act prosecutions 152 ,, Rainfall 71 „ Records of inspections 78, 80, 81, 82, 84, 85, 86, 103-105, 118, 120, 121, 123, 124, 132, 137, 138, 155 „ Refuse Collection 142 ,, School Children Crippled 127 „ School Children, Defects of 80, 82, 104, 105, 123, 124, 130-132 „ School Children examined 78, 82, 103, 121 „ School Children excluded 90 „ School Children found to require treatment 104, 105, 123, 124 ,, School of Recovery admissions 98 ,, Secondary School examinations 103-105 „ Shops Acts prosecutions 153 ,, Sunlight Treatment 57, 95, 96 „ Tuberculosis, Classification of Patients 31, 32 ,, Tuberculosis deaths 6, 21 „ Tuberculosis 29-36, 69, 70, 105, 124, 127 „ Tuberculosis Dispensary cases 22 „ Tuberculosis Notifications 21 „ Tuberculosis, Residential treatment 29-32 „ Venereal Diseases 68 „ Verminous condition of School children 84, 85, 90, 132 „ Vision of School Children 104, 123, 126, 130, 131 ,, Zymotic Death-rate 6 Teaching Staff, co-operation of 99 Teaching Staff, Medical Examination 106 Teeth of School Children 118, 119, 124, 132 Temperature 71 Throat affections 90, 123, 131 Tonsils 44, 54, 60, 86, 90, 92, 104, 108, 109, 113, 115, 123 Trade Refuse, Removal of 142, 143 Training Centre, Mental Defectives 14 Transit, Means of 8 Tuberculosis 10, 21-38, 40, 41, 54, 62, 69, 70, 81, 87, 92, 101, 105, 124, 127 Tuberculosis Deaths 6, 21, 69 Tuberculosis Dispensary 10,22-34 Tuberculosis, treatment of 22-38, 127 Tuberculosis Visits 23 Typhoid Fever 18, 20, 42, 69 Tubercular contacts 22,23 U. Unsound Food 155 Urinals 140, 143 Ultra Violet Radiation 23, 45, 56, 57, 67, 75, 79, 94 V. Venereal Diseases 10,68 Verminous Persons 17, 84, 90, 132 Vision of School Children 86, 87, 90, 92, 93, 104, 112-116, 123 Visits, Nurses 23, 60, 78, 84, 132 Voluntary Workers 16, 66, 93, 94 Vaccination 18, 42 W. Whooping Cough 8, 62, 70, 88, 89 Workshops 136, 141 X. X-rays 23, 29, 37, 55, 67, 78, 79, 92, 95 Z. Zymotic Deaths 6, 8, 69, 70