COUNTY BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report of the Medical Officer of Health and School Medical Officer FOR THE YEAR 1929. W. BENTON, M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health. recorders, ilford. COUNTY BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report of the Medical Officer of Health and School Medical Officer FOR THE YEAR 1929. W. BENTON, M.R.C.S., L.R.C.P., D.P.H.. Medical Officer of Health. recorders, ilford. EAST HAM CORPORATION. PUBLIC HEALTH COMMITTEE. Also Committee under Blind Persons Act, 1920, Sec. 2. *†The Mayor (Councillor T. M. McGiff, J.P.). *†The Deputy-Mayor (Councillor T. I. Lethaby). *†Councillor C. W. Brading (Chairman Public Health Committee, Hospital and Sanatorium Sub-Committee, and Maternity and Child Welfare Sub-Committee). *†Councillor J. Brooks, J.P. (Vice-Chairman). *Alderman H. B. Harper, J.P. Alderman H. Osborn, J.P. *†Alderman H. N. Ridler. *Councillor J. W. Barton. *Councillor G. W. Boultwood. *†Councillor T. W. Burden. Councillor F. P. Cross. Councillor C. F. H. Green. Councillor G. R. Hobbs. *Councillor E. C. Howlett. Councillor A. H. W. Owen. *†(Councillor Mrs. M. Ridler. *†Councillor Mrs. A. Taylor. MATERNITY AND CHILD WELFARE SUBCOMMITTEE. Same members as Public Health Committee with— Miss E. R. Davies (co-opted). Mrs. F. Norman (co-opted). Mrs. T. H. Twitchett, J.P. (co-opted). *Also Member of the Hospital and Sanatorium Sub-Committee. † ,, ,, ,, Committee under Blind Persons Act, 1920. COMMITTEE FOR THE CARE OF THE MENTALLY DEFECTIVE. The Mayor (Councillor T. M. McGiff, J.P.). The Deputy-Mayor (Councillor T. I. Lethaby). Councillor J. Brooks, J.P. (Chairman). Councillor Mrs. A. Taylor (Vice-Chairman). Alderman H. B. Harper, J.P. Councillor C. W. Brading. Councillor C. F. H. Green. Councillor W. T. Newling. Councillor G. Pottinger. Councillor Mrs. M. Ridler. Councillor F. Webster. Mrs. G. Banks-Martin, J.P. (co-opted). Mrs. C. J. Cross (co-opted). Mrs. A. McGiff (co-opted). STAFF OF THE PUBLIC HEALTH DEPARTMENT. Clerks: *Miss H. E. Ritterspack, *Miss D. Gordon, *G. F. Holmes, *F. L. Gosling, *G. H. Green, *G. W. Friend. * J. Kendall, A.R.San.I., Chief Clerk and Vaccination Officer. Home Teacher, Blind Persons Act : *Miss L. Kingston. Mental Deficiency Acts : Ascertainment and Supervising Officer, *Miss E. L. Hicks. Training Centre Supervisor, *Miss A. L. Fooks. Tuberculosis Dispensary Clerk: *Miss M. Pratt. Tuberculosis Nurses : *Miss L. E. Mallon, S.R.N., *Miss E. E. Cook, S.R.N., Certified Midwife. Assistant Nurse : *Miss A. Meadhurst. Child Welfare Clerks: *Miss M. A. McCall, *Miss M. A. R. Gaster. 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. Preston, S.R.N., Certified Midwife, *Miss W. A. Lewis, S.R.N., Certified Midwife (July, 1929 to Jan., 1930), and *Miss S. Bowles, Certified Midwife (from December), *Mrs. A. A. Woodman, S.R.N., M.R.San.I., Certified Midwife (Senior). Matron of Isolation Hospital: *Miss H. M. McLoughlin, S.R.N. Matron of Harts Sanatorium : *Miss M. R. Small, S.R.N., Certified Midwife (to October). Shops Act Inspector: C. H. Pursall, A.R.San.I. Assistant Sanitary Inspector: H. G. Luckett, M.S.I.A., A.R.San.I. (from June). Sanitary and Food Inspectors : *R. A. Baskett, M.S.I.A.,*M. J. J. Hillyard, M.S.I.A., *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. Senior Sanitary, Food and Shops Act Inspector, Inspector Contagious Diseases (Animals) Act: *G. D. Lill, M.S.I.A. Medical Officer to Maternity and Child Welfare Centre, and Inspector of Midwives, *Elsie Thomson, M.B., Ch.B., D.P.H. (to March). *Jessie A. McLaren (from September), 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 A ssistant School Medical Officer and Resident Medical Superintendent, Isolation Hospital: *F. E. Bendix, M.R.C.S., L.R.C.P., L.D.S. (to July). 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. PART TIME. Tuberculosis Officer: *Philip Ellman, M.D., M.R.C.P. Ophthalmic Surgeon (Maternity and Child Welfare Service): *S. C. Reeve-Flaxman, M.R.C.S., L.R.C.P. Dentist (Maternity and Child Welfare Service): *C. S. Neame, L.D.S., R.C.S. * 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 1929 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 11.1 and infant mortality 57. Statistics for 1904 and the past nine years are given for comparison:— 1904 1921 1922 1923 1924 1925 1926 1927 1928 1929 Death Rate 147 10 1 110 90 9.7 10 6 9.6 97 10 0 11.1 Birth Rate 31 8 203 210 19.4 18.3 173 171 15.8 15.3 14.7 Infant Mortality 154 67 62 51 54 53 56 53 49 57 Zymotic death rate 29 0.57 0.66 0.3 0.38 0. 4 0.6 0.45 0.72 0.6 Pulmonary Tuberculosis death rate 1.68 0.85 0.95 0.88 0.78 0.90 0.96 0.80 0 .80 0.84 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. 6 Summary of Report for 1929. 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 1929, 147,600 Census, 1921:— Number of inhabited houses 27,024 Number of families or separate occupiers 33,937 Ward Population. Manor Park 15,006 Little I ford 17,642 Woodgrange 13,994 Plashet 14,740 Kensington 13,010 Castle 15,460 Central 15,556 Wall End 15,110 Greatfield 11,734 South 15,348 2. EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total number of births, 2,169 (males 1,097, females 1,072). Total number of illegitimate births, 48. Total number of still births, 69. Birth-rate, 14.7. Deaths, 1,638 (males 815, females 823). Crude Death-rate, 11.1. Number of women dying in, or in consequence of, childbirth from sepsis, 5; other causes, 7. 7 Deaths of Infants under one year of age per 1,000 births registered: legitimate, 56.6; illegitimate, 83'3; total, 57. Deaths from Measles (all ages), 2. Deaths from Whooping Cough (all ages), 20. Deaths from Diarrhoea (under 2 years of age), 18. Zymotic Death.rate, 0.6. COMPARATIVE STATISTICS. Annual Rite per 1,000 Living. Rate per 1,000 Live Births. Births. Deaths. Diarrhcea & Enteritis (under 2 years). Infant mortality. England & Wales 163 134 8.1 74 107 Great Towns 16.6 13.7 10.9 79 London 15.7 13.8 10.7 70 EAST HAM 14 7 111 83 57 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. 8 COUNTY BOROUGH OF EAST HAM PUBLIC HEALTH DEPARTMENT. REPORT of the MEDICAL OFFICER OF HEALTH For the year 1629. 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 Hospital to which the Local Authority make no grant. . During the year 1929, 41,771 visits were made by the Nurses to 1,146 sick cases. (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 Midwifery work is undertaken by 36 Nurses of the Plaistow Maternity Hospital, in addition to 9 midwives who have privafe practice in the Borough, 5 practising in the North Woolwich area attached to Sir Henry Tate's Home, and 2 attached to a private Nursing Home. Cases attended by Midwives attached to:— Plaistow Maternity Hospital. Tate Nurses' Home. Cases. Visits. Cases. Visits. Midwifery 682 16,313 9 112 Monthly 230 3 27 Ante-Natal 932 820 — — 9 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 pages 47-60. Infant Consultations and Ante-Natal Clinics are conducted daily. Branch Clinics are also held once per 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 of the School Medical Service pp. 87-148. Tuberculosis Dispensary. Tuberculosis Officer is in attendance one morning, two afternoons and one evening session each week. For report see pp. 23-36. Venereal Diseases. East Ham forms a part of the joint scheme with the London County Council. For summary, see page 61. 2 local medical practitioners are qualified to receive free supplies of arseno-benzol compounds. HOSPITALS PROVIDED OR SUBSIDISED BY THE LOCAL AUTHORITY. 1. Tuberculosis. Harts Sanatorium, Woodford Green, has accommodation for 56 patients (for report, see pp. 37-41). Arrangements were made for children to be sent to various Sanatoria as occasions arose and ex-service men admitted to Papworth Hall Tuberculosis Colony. 2. Maternity. Arrangements have been made for cases to be admitted to Plaistow Maternity Home or Queen Mary's Hospital, West Ham. Nursing Homes Registration.—One Home is registered. 3. Fever. (For report, see pp 41-46.) 10 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. At East Ham Memorial Hospital are 100 beds:— 28 Medical. 4 Ophthalmic. 28 Surgical. 4 Balcony. 8 Gynaecological. 4 Private Bedrooms. 4 Aural. There is also an X-ray Department, Operation Theatre, OutPatient and Casualty Department, and 20 Children's Cots 10 Medical, 10 Surgical. 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. (b) For non-infectious and accident cases.—Two motor ambulances operating from the Fire Station, conveyed 1,566 cases to and from various hospitals. These consisted of 378 accidents and 1,188 cases of illness. 1,483 journeys were made, and 11,278 miles run. East Ham cases removed by other ambulances numbered 61, viz., by Barking, 32; llford, 11; West Ham, 18. East Ham ambulances attended to 9 West Ham and 1 Barking cases. HEALTH PROPAGANDA. The Medical Officer of Health has 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. 2,000 copies of "Better Health" are distributed in the Borough monthly, and are much appreciated. Lectures are also arranged by the East Ham Insurance Committee. 11 SPECIAL ACTS OF PARLIAMENT. The following Special Acts of Parliament have been obtained by the Council:— The East Ham Improvement Act, 1898. The East Ham Improvement Act, 1903. The East Ham Corporation Act, 1914. The East Ham Corporation Act, 1919. Special Provisional Orders. The Tramways Orders Confirmation (No. 2) Act, 1898. The Electric Lighting Orders Confirmation (No. 2) Act, 1898. The Tramways Orders Confirmation (No. 3) Act, 1900. The Tramways Orders Confirmation (No. 2) Act, 1904. The Local Government Board's Provisional Orders Confirmation (No. 10) Act, 1904. The Local Government Board's Provisional Orders Confirmation (No. 12) Act, 1907. The Local Government Board's Provisional Orders Confirmation (No. 6) Act, 1908. Acts of Parliament applied to the Borough by order of Ministry of Health. Public Health Acts Amendment Act, 1907, Part 10, Sec. 95. 16th October, 1923. 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 12 Name of Act adopted. Date of adoption. Date of coming into operation. Public Libraries Act, 11892 Infectious Disease (Notification) Act, 1889 (Extension) H8th June, 1895 1st Aug., 1895 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:— Defacing Pavements, etc. Removal of House Refuse. New Streets and Buildings. Alteration of Buildings. Common Lodging Houses. Slaughter Houses. Public Pleasure Grounds. 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. 13 Closing Order for Grocers and Provision Dealers. Tents, Vans, Sheds and similar structures used for Human Habitation. Standing Orders, Rules of Debate for regulating the Meeting and Business of the Council. Standing Orders re Licences for Cinematograph Exhibitions. Standing Orders re Licences for Public Performance of Stage Plays. Standing Orders re Licences for Music, Dancing and other Public Entertainments of the like kind, and Racecourses. Table of Fees to be taken by the Clerk to the Justices of the Peace. Unauthorised Persons on Elementary School premises. Sale of Coal. Cleansing and Disinfection, Essex (Parasitic Mange) Order, 11909. Lamps Marking Roads Obstructions. Provision of Means of Escape from Fire in case of certain Factories and Workshops. Wireless Loud Speakers. Advertisements. MENTAL WELFARE. Visitation. The duties of ascertainment and supervision of mental defectives under the Mental Deficiency Act, 1913, have been carried out in accordance with the provisions of the Act, and a number of voluntary cases have been dealt with, according to their needs, and the means available. (These are border-line and high grade cases, which are not at present certifiable, some of whom require psychological treatment.) Routine Work. The visitation of mental defectives under an Order of Guardianship in their own homes or with Foster-parents, also those placed under Statutory Supervision in their own homes, has been carried out. 14 New cases have been investigated, enquiries into home conditions made for the Visiting Justices, and reports prepared for the Board of Control. A considerable time was spent in persuading parents to allow their children to attend the Council's Training Centres; parents do not always see the necessity for this, or the benefit that will accrue to the child. Visits must also be paid to keep up the attendance. It is not always realised what a different position a mentally defective child holds in the home when he or she has attended a Training Centre. The child becomes, in a large number of cases, more able to adjust himself to his surroundings, and to some extent becomes a useful member of the family, whereas before Training Centres were opened he became more isolated as he became older, and a greater burden to his family. Training and Handicrafts. The work at the Training Centre at the Church Army Hall in Barking Road has been carried out on improved lines. The average attendance at both Centres has increased, and more saleable articles are being made. This means an increase in the small income derived from orders obtained and sales. Simple hygiene lessons are being given in addition to routine work:—Boys: Woodwork, leatherwork, rush and wool mats. Girls: Plain needlework, rugmaking, raffia, beadwork and leatherwork. The discipline is good, and is helping to form character. At Christmas the children were given a most enjoyable party and a Christmas tree, at which His Worship the Mayor presided, accompanied by the Mayoress, the Chairman, other members and officials of the Mental Deficiency Committee, and parents. Some of the children gave a short but very creditable entertainment, which was much enjoyed. Case Work. The following is an analysis of the case work during the year ending 31st December, 1929. Sent to institutions under Order 14 Removed to a "place of safety" pending the presentation of a petition 5 15 Placed under Order of Guardianship in their own homes or with Foster-parents 6 Placed under Statutory Supervision in their own homes 21 Under Voluntary care 9 At the close of the year, there were:— 65 in institutions, two of whom are on long leave of absence in their own homes. 18 under an Order of Guardianship with relatives or with foster-parents. 98 under Statutory Supervision in their own homes. 80 under Voluntary care. 12 Miscellaneous. 4 Died. WELFARE OF THE BLIND. There are now 173 technically blind persons on the register. 23 of these are at work—1 masseuse, 1 shorthand typist, 1 piano tuner, 5 loom weavers, 3 boot repairers, 5 mat makers, 2 basket makers, 1 machine knitter, 1 home worker, 1 sheet metal worker, 1 blind maker, and 1 rabbit breeder. There are also 4 ex-service men under the care of St. Dunstan's, 7 children in schools, and 8 training in knitting, boot repairing, mat making, basket making, piano tuning, and Braille transcribing. During the year the Home Visitor paid 2,751 daily visits, 178 evening visits and meetings, and gave 373 lessons, of which 75 were in knitting, 107 in Braille, 49 in Moon, 22 in Crochet, 38 in cane basket work, 19 in straw bag making, 42 in manual alphabet, and 21 in wool ball-making, 67 other visits to Hospitals, Stations, the Infirmary, etc., as an escort or in order to visit any of the local blind. At present there are 60 necessitous unemployable blind persons in receipt of grants of varying amounts (according to income) from the East Ham Council. This has made a great difference to the lives of those concerned as they have been taken away from receiving Poor Law Relief. Those who are able to come to the 16 Borough Treasurer's Department for their weekly grants and the Home Teacher (Visitor) pays the remainder. The Local Welfare Association continues its good work in spite of increasing numbers on the Register. The regular social evenings in the winter months still continue to be a great boon to the blind, also the summer excursion to Southend, and the parcels of groceries, tobacco, cigarettes and chocolates distributed at Christmas are greatly appreciated. The ladies of the Welfare Association have formed a special Sub-Committee to provide clothing, the funds for which have been raised by sales of jumble and tinfoil. Extra nourishment, spectacles, and surgical appliances are granted where necessary, also fares to hospitals for treatment, or to workshops when in training, when applied for. Crystal wireless sets and accessories are still supplied and maintained free of charge. Embossed monthly and weekly magazines, such as the Braille Mail and the Braille Radio Times, are regularly supplied, and cane, wool, etc., for pastime occupations. INVALID CHILDREN'S AID ASSOCIATION (East Ham Branch). The year 1929 has been notable for the large number of cases needing prolonged convalescence; 264 cases have been dealt with, 189 of which were new. During the 6 years of the work of the branch 1,200 invalid or crippled 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 most of the London Hospitals. Cases have been referred to them as follows:— Tuberculosis Officer 41 Infant Welfare Centre 13 School Medical Officer Private Practitioners 12 for Schools of Recovery 31 Gt. Ormond Street School Medical Officer Hospital 34 for General Convales- Other Hospitals and cence 65 Agencies 68 17 The types of new cases dealt with during the year may be summarised as follows:— Tubercular 41 Paralysis 7 Pre-tubercular 17 Chorea 8 Anaemia and Debility 53 Rheumatism 11 Malnutrition 12 Eye and Ear Diseases 6 Bronchitis and Asthma 23 Various 11 Help has been given during" the year as follows:— Sent to Sanatoria or Special Hospitals 41 Schools of Recovery 31 Convalescent Homes 119 Boarded out 2 Provided with surgical appliances 31 Visiting and advice on behalf of hospitals and loan of invalid carriages 23 Food and Clothing Grants 17 LABORATORY WORK. 2,163 (2,302 in 1928) microscopical examinations, of bacterial cultures from "swabs," submitted for the purpose of identifying the presence or absence of diphtheria bacilli, were undertaken at the Town Hall Laboratory and 391 at the Isolation Hospital Laboratory during the year 1929. Of this number 446 (456 in 1928) gave positive results : the comparative percentages of positive results being 19.8 per cent, in 1928 and 20.5 per cent, in 1929. The subjoined analysis is intended to show the sources from which the "swabs" were submitted for bacteriological diagnosis together with the results of the subsequent examination in each case:— A. "Swabs" submitted by General and Hospital Practitioners, B. "Swabs" submitted from the Maternity and Child Welfare Clinics. C. "Swabs," from School Children, submitted by the School Medical Service (see also the report of the School Medical Officer—6. Infectious Diseases):— 18 1. Prior to admission to Schools of Recovery, to ensure freedom from infection. 2. In suspicious cases seen at the Clinics or at School. 3. In cases where an undetected source of infection appeared to be present in a Class or School. D. "Swabs" taken at the Borough Infectious Diseases Hospital for verification of diagnosis in doubtful cases, etc: A. B. C. D. 1. 2. 3. Total. No. Pos. Total. No. Pos. Total. No. Pos. Total. No. Pos. Total. No. Pos. Total. No. Pos. 1,480 336 14 1 58 1 84 17 186 10 391 81 The fact that only 22 per cent of the "swabs," included under Column A., showed the presence of diphtheria bacilli is a satisfactory indication that the Medical Practitioners realise the very insidious nature of the signs and symptoms of diphtheria in its incipient stages: unfortunately many parents are not aware of the "silent" manner in which the disease progresses and so fail to obtain medical attention at the outset, and this in spite of the fact that advice upon the subject has been, and is being, emphasized again and again at every opportunity. MEDICAL EXAMINATION. 117 examinations have been made during the year upon request of the various committees of the Town Council, in addition to 156 examinations conducted on behalf of the Education Committee as reported on p 124. OUT-DOOR RELIEF. The amount of poor relief paid by the West Ham Guardians in the East Ham Relief Districts was £32,987, as compared with £43,611 for the previous year. 19 PREVALENCE AND CONTROL OVER INFECTIOUS DISEASES. Small Pox. 25 cases of Small Pox were notified during the year with no deaths. Number of Vaccinations. Primary 1,774 Re-vaccinations 451 2,228 Scarlet Fever. The number of Scarlet Fever cases notified was 743, of which 328 were admitted to Hospital. Only 3 deaths occurred. Scarlet Fever has changed in character during the past 20 years, from being a disease of considerable severity to one of comparative mildness, and this accounts for the increased number of cases. A case is admitted to the Hospital, and upon enquiry into the source of infection one often finds another member of the family has had a mild attack, which had not been diagnosed. Diphtheria. 578 cases of Diphtheria were notified, with 42 deaths, as against 669 cases with 55 deaths in 1928. 551 cases were treated in Hospital. For those cases treated at home the Corporation provided Anti-toxin 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 (see p. 18). 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 to Hospital with unfortunate results, as the early administration of Anti-toxin is a sure remedy for the disease. Schick Immunisation Clinic. During the period 27th September, 1929, to 28th March, 1930, 224 infants and children have received three inoculations and in these cases immunity to diphtheria should be established. 20 The total number of inoculations performed has been 732, of which 135 were carried out by Private Practitioners and 597 at the Town Hall clinic. The following figures are intended to indicate the number inoculated and the age groups involved in the cases treated at the Town Hall clinic and by General Practitioners (i) Town Hall clinic. Total number of inoculations 597 Number inoculated three times 179 Number inoculated twice 26 Number inoculated once 8 Average number of inoculations per session 22 Number inoculated in the various age groups:— Ages in years 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 and over No. inoculated 4 13 12 16 21 21 35 17 20 13 11 11 10 6 3 66 106 41 213 (ii) Private Practitioners, In addition to the above, 45 children have been inoculated three times by Private Medical Practitioners, and the ages at which inoculation was performed were as follows:— Ages in years 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 and over No. inoculated 0 1 3 3 2 6 8 3 3 5 2 1 5 1 2 9 25 11 45 N.B.—In considering the combined totals (i and ii) it will be noticed that 29.1 per cent, of the cases were in the age group 1 to 5 years, 50.8 per cent, in the age group 6 to 10 years, and 20.1 per cent, in the age group over 10 years. (iii) The Schick test for susceptibility to diphtheria has been performed in 34 of the completed cases, and has proved negative in each case. Enteric Fever (Typhoid and Para-Typhoid). 2 cases were notified. 1 case died. 21 Erysipelas. 49 cases were notified. Puerperal Fever. 9 cases were notified during the year, with 5 deaths. 12 cases were notified as suffering from Puerperal Pyrexia, but recovered without complications. Meningococcal Meningitis. One case was notified and 2 deaths registered. Encephalitis Lethargica. One case notified, but 5 deaths were registered as due to this disease. Pneumonia. There were 145 deaths registered as due to this 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. 22 Disinfection of premises and articles which have been exposed to infection is undertaken by the Sanitary Department. Disinfectants in every case are supplied free of charge. The Council also supply Anti-toxin gratuitously to all medical practitioners for treatment of cases in the Borough. DISEASE NOTIFICATION 1925—1929. Disease. 1925 1926 1927 1928 1929 Small Pox - - - 17 25 Scarlet Fever 221 350 798 832 743 Diphtheria 246 337 464 669 578 Enteric Fever (Typhoid and Para-Typhoid) 9 7 2 7 2 Erysipelas 41 41 38 60 49 Puerperal Fever 5 5 4 8 9 Puerperal Pyrexia — — 11 11 12 Cerebro-Spinal Meningitis 1 1 4 1 1 Encephalitis Lethargica 6 1 2 3 1 Ophthalmia Neonatorum 6 8 10 12 3 Acute Polio Myelitis 1 — 5 — 2 536 750 1338 1620 1425 Pneumonia 91 70 114 82 102 23 TUBERCULOSIS. Notifications, 1925-1929. 1925 1926 1927 1928 1929 Pulmonary Tuberculosis 254 237 206 232 211 Other forms do. 64 50 45 46 48 318 287 251 278 259 New Cases and Mortality during 1929. Particulars of new cases of tuberculosis and of deaths from the disease in the area during 1929:— Age Periods. New Cases. Deaths. Pulmonary. Non-Pulm. Pulmonary Non-Pulm. M. F. M. F. M. F. M. F. Under 1 - - - - - - - - 1—5 — 3 1 5 — 1 1 1 5 — 10 4 2 7 8 — — — — 10 — 15 4 5 4 4 2 — — 1 15 — 20 17 12 4 2 3 6 1 — 20 — 25 21 18 — 2 8 11 — 1 25 — 35 24 28 2 2 15 13 — — 85 — 45 17 6 2 — 11 11 — — 45 — 55 28 6 3 2 20 5 — — 55 — 65 8 3 — — 12 2 — — 85 and upwards 3 2 — — 4 — — — Totals 126 85 23 25 75 49 2 3 Public Health Act, 1925, Sec. 62, and Public Health (Prevention of Tuberculosis) Regulations, 1925. No action has been taken with regard to removal to Hospital of infectious persons suffering from pulmonary tuberculosis or to tuberculosis employees in the milk trade. 24 TABLE I.—TUBERCULOSIS SCHEME. Return showing the work of the Dispensary during the Year 1929. 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 77 52 - 3 10 5 9 11 87 57 9 14 (b) Doubtfully tuberculous (8) - - - - - - - - 23 24 12 9 (c) Non-tuberculous - - - - - - - - 45 33 19 13 B.—Contacts examined during the year :— (a) Definitely tuberculous ... 12 8 — 3 — — 4 5 12 8 4 8 (b) Doubtfully tuberculous (8) 20 44 20 26 (c) Non-tuberculous — — — — — — — — 34 76 71 72 C.—Cases written off the Dispensary Register (") as (a) Cured (10) — — 1 — — — 1 1 — 1 2 1 (6) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) - 1 - - - - - - 125 176 142 146 D.—Number of Persons on Dispensary Register (9) on December 31st (u) Diagnosis completed ... 400 343 41 39 72 49 75 57 472 392 116 96 (6) Diagnosis not completed — — — — — — — 9 14 3 4 No cases written off the Register in a previous year as "cured " after a course of treatment for Tuberculosis have again been entered on the Register as new cases during 1929. 25 1. Number of persons on Dispensary Register)0) on January 1st 1166 2. Number of patients transferred from other areas and of " lost sight of "(C) cases returned 27 3. Number of patients transferred to other areas and cases " lost sight of" 140 4. Died during the year 93 5. Number of observation cases(8) under A (b) and B (b) above in which period of observation exceeded 2 months 26 6. Number of attendances at the Dispensary (including Contacts) 3120 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 749 (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 :— (a) At Homes of Applicants 5 (b) Otherwise 357 11. Number of other visits by Tuberculosis Officer to Homes 29 12. Number of visits by Nurses to Homes for Dispensary purposes 4201 13. Number of (a) Specimens of sputum, &c., examined 719 (b) X-ray examinations made in connection with Dispensary work 97 14. Number of Insured Persons on Dispensary Register)9) on the 31st December 569 15. Number of Insured Persons under Domiciliary Treatment(4) on the 31st December 78 16. Number of reports received during the year in respect of Insured Persons :— (a) Form G.P. 17 — (b) Form G.P. 36 149 26 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 27 under " general supervision " (whether or not accompanied by 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.) 28 REPORT ON THE WORK OF THE TUBERCULOSIS DISPENSARY. Memo. 37/T issued by the Ministry of Health, continues to be of considerable value as a guidance for administrative work. The number of attendances shown in Table 1, viz., 3,120 this year compares very favourably with the number last year, viz., 2,398, showing quite conclusively that increased use is being made of the Dispensary. The various functions of the Dispensary, viz :— (a) To receive notifications. (b) To establish diagnosis. (c) To decide the form of treatment necessary. (d) To supervise domiciliary treatment carried out by private practitioners. (e) To keep in touch with general practitioners. (/) As a general bureau of information. continue to be used to the fullest advantage. The value of the Dispensary as a consultation centre for diagnosis is being recognised by both practitioners and patients, and this would increase were in not, as explained in a succeeding paragraph, on p. 31, for the supposed stigma attaching amongst a large section of the population to the term " Tuberculosis." For the mere fact that a patient is being sent to a Tuberculosis Dispensary does not by any means infer that they are going to be labelled tuberculous, for during the year we have encountered many affections, such as nasopharyngeal sepsis, bronchitis, cancer of the lung, bronchiectasis, dust diseases affecting the lung, abscess of lung, various types of heart disease with secondary changes in the lungs, and general systematic diseases such as exophthalmic goitre, whose symptoms have resembled those of pulmonary tuberculosis but which, after observation and careful routine examinations, have proved to be non-tuberculous. These patients have all had coughs with sputum, and in all such cases the general practitioners concerned have been communicated with and the cause of the cough, etc., indicated, so that the sufferers can be directed to the appropriate channels for treatment. 29 After Care. Those cases which have received treatment at Harts Sanatorium are seen, as a routine, soon after discharge and are carefully made to realise that their discharge from Sanatorium does not complete their treatment. They are all frankly informed that unless they realise that they must continue to live a form of life in keeping with their disease and take advantage of the education in the mode of living which they have received in the Sanatorium, especially with regard to their non-working hours, they run a real risk of a relapse. The more intelligent patients do realise this and always with considerable advantage to themselves. The recent advances in the Treatment of Pulmonary Tuberculosis. These are being made full use of for those cases which are likely to benefit and as time goes on, surgical collapse of the lung is being found to be increasingly useful for those patients who are unsuitable for pneumothorax treatment. Prevention. From a preventive point of view also, the Dispensary is of considerable value, especially in the advice it gives in the mode of living to those infected with the disease and its warning of the ask of infecting the contacts. The Work of the Tuberculosis Nurses and the need of an additional Nurse. The work that our two trained tuberculosis nurses do, both at the Dispensary and in the patients' homes, would appear to be insufficiently recognised, and it will be of advantage to enumerate their duties, as 1 am of opinion that unless another trained nurse be obtained to assist us in our work, very necessary duties will have to be neglected. Among their duties, those of :— (a) Primary visits in notified cases where diagnosis is confirmed at the Dispensary. (b) Secondary visits where patients have not attended after appointments have been made for examination at the Dispensary. 30 (c) Visits to domiciliary patients who are too ill to attend. (d) Visits to homes at request of patients or relatives, such visits becoming increasingly frequent. (e) Daily visits for temperature in certain observation cases. (/) Annual visits for purpose of house inspection. (g) Visits for purpose of following up contacts who have not attended. Include the various reasons for visiting patients in their homes. The advice given on elementary principles of hygiene and public health in connection with their disease, it will generally be admitted, is of a most useful nature in the anti-tuberculosis campaign. In so far as the examination of contacts is concerned, the work of well-trained, sympathetic and understanding nurses is invaluable to the Tuberculosis Officer. It is impossible without practical experience in visiting patients afflicted with this disease, to appreciate the difficulties which have to be contended with. It is because our two nurses are so familiar with and keen on the anti-tuberculosis campaign that they spare no efforts to induce the contacts to come to the Dispensary for examination, often having to suffer abuse, rudeness, and the like, and putting in more overtime than one cares to mention. Nevertheless, two nurses to visit the countless homes of the Borough and to spend time reasoning with many difficult patients with regard to the necessity of contact examination and to inculcate the importance of the principles of hygiene, preventive measures, etc., are quite inadequate. It is absolutely essential if the visiting work and the enormous benefits derived therefrom, are to continue, that a third trained nurse be appointed at the Dispensary, and it will, in the long run, be an unquestionable gain. The following items show the chief advantages which would be derived :— (a) A closer watch could be kept on contacts who have been examined and discharged, for many of these latter return to us as definite cases—sometimes after as long as ten years. 31 (b) Daily recording of temperature for short periods in observation cases could be carried out more extensively. (c) More visits could be made to domiciliary patients and to new patients notified to us as tubercular, but who are too ill to attend the Dispensary for examination. (d) Finally, it is necessary that one nurse have some spare time to supervise in consultation with the Tuberculosis Officer, the administrative work of the clerks, especially in so far as statistics are concerned. Co-operation with the Dispensary on the part of General Practitioners. This has again been extremely satisfactory as indicated by the increased number of consultations for the year shewn in Table 1, of 357 this year, compared with 262 last year. All doctors are communicated with in connection with their cases and quite frequently personal contact with the doctor is made with considerable all-round advantage, and the aim of the Dispensary in assisting the genera! practitioner in the diagnosis of his difficult cases is being fully maintained. Chest Clinic v. Tuberculosis Dispensary. The opinion of Dr. Ellman is that " the sooner the unfortunate title of ' The Tuberculosis Dispensary ' can be replaced by the more appropriate one of, e.g., ' Chest Clinic,' the brighter the prospects of the Anti-Tuberculosis Campaign will become, the fuller will be the necessary co-operation of both the General Practitioner and the patient, and even more important, the earlier will suspected cases of pulmonary tuberculosis be diagnosed. " For the position of the General Practitioner is a difficult one. The average patient dreads nothing more than the idea of having to attend a Tuberculosis Dispensary as such, where he fears the worst and believes himself to be a suspected consumptive. Not infrequently, as General Practitioners in the Borough have told me, the patient will resent the suggestion of visiting a Tuberculosis Dispensary and will seek advice elsewhere, till finally after very considerable delay and from sheer necessity he attends the Dispensary with advanced phthisis, by this time probably having 32 infected other members of the family. Such is the position we not infrequently have to face because of this Tuberculosis ' phobia.' " This unfortunate position could be very considerably remedied by replacing ‘ Tuberculosis Dispensary ' by ' Chest Clinic.' It is more appropriate and truer since numerous cases sent up are suffering from other pulmonary diseases than Tuberculosis. It would create less fear and more confidence in the mind of the patient." X-ray examination of the Chest in Diagnosis. As will be seen from Table 1, a very considerable increase in the number of X-ray examinations has been made this year. This has been of enormous advantage together with the other routine methods in the diagnosis of the disease, although it has meant additional work for the Dispensary staff. Moreover, in dismissing the question of pulmonary tuberculosis it has been invaluable and a glance at Table 1 will show that the number of cases written off the Dispensary register as " diagnosis not confirmed " has increased correspondingly. There is not the slightest doubt that the increase of expenditure on X-ray examinations of the chest is more than ever a financial gain in the long run as the figures will show conclusively. We are again indebted to Dr. Stanley Melville, Radiologist to Brompton Hospital, and this year to Dr. Mather Cordiner, Radiologist to East Ham Memorial Hospital, for the very excellent photographs we have had. To Dr. Cordiner we are also very much indebted for allowing us to examine many of our own cases under the X-ray screen. In a few cases this screening of the chest has given the desired information, no X-ray photograph has been taken and no charge has been made. So much benefit has been derived in this way that greater use of this form of examination is being made. Examination of Sputum. Examination by the concentrated antiformin method, where the ordinary method gives repeatedly negative results, has been increasingly helpful. 33 Temperature Observations. Full use is made of this procedure wherever possible but patients on the whole are not to be relied upon to take sufficiently accurate readings, and although the nurses help in this direction it is impossible to carry this out as fully as one would like without the assistance of another trained nurse. Contact Examinations. It is found from experience that the greatest benefit, in so far as preventive measures are concerned, is derived from the examination of adolescent contacts, i.e., between the ages of 14 and 21, for it is they who are particularly prone to infection and often of an acute nature. Children of school age rarely develop pulmonary tuberculosis and it would be of greater advantage if our contact examinations were more especially concerned with adolescents, whilst those of school age be examined in the first instance by the School Medical Service and then, if suspicious, referred to the Tuberculosis Officer. It is only in this way that concentration on the prevention of this acute form of adolescent pulmonary tuberculosis can be made. Source of Infection. Finally, it is very desirable in all cases suffering from the disease to endeavour to ascertain the source of infection. In some instances we meet with seven or more cases of tuberculosis in one house where the source of infection was in the old resident of the house. The view held by the general public that these old people never get tuberculosis is quite fallacious. They are often, in our experience, the direct source of infection. As a rule they are careless and unhygienic in their habits and as their disease is generally of a mild nature they often have much energy and are therefore unsuspected; and invariably, where repeated cases occur in a family, the old people are the last whom we are able to induce to come for examination, whereas, had they been examined first the trouble might have been prevented. Shelters. In view of the present state of overcrowding which exists in so many of the patients' homes, I am of the opinion that a larger supply of shelters would greatly assist us in solving the problem of isolating the patient from the other members of the family. 34 The problem of Observation Beds and Treatment of Advanced Cases. This problem still exists and continues to be a matter of urgent importance. Nothing can be added to the comments made last year on this subject. Accommodation at the Dispensary. The serious disadvantage of extremely limited accommodation reported last year is becoming increasingly acute, and the two existing dressing rooms are hopelessly inadequate for the patients. TABLE II.—RESIDENTIAL INSTITUTIONS. (A) Average Number of Beds Available for Patients during the Year 1929. Observation. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Total. " Sanatorium " Beds. "Hospital " Beds. Disease of Bones and joints. Other Conditions. Adult Males 32 8 3 1 44 Adult Females — 17 3 3 1 24 Children under 15 — 17 2 11 11 41 Total _ 60 13 17 13 109 (B) Return showing the Extent of Residential Treatment during the Year 1929. 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. 39 102 89 8 44 F. 24 65 66 3 20 Children M. 20 20 21 1 18 F. 16 22 17 — 21 Number of Ob- servation Cases Adults M. - - - - - F. - - - - Children M. - - - - - F. - - - - - Total 99 209 193 12 103 35 TABLE III. Return showing the immudiate results of Treatment of Patients* and of Observation of Doubtful Cases discharged from Residential Institutions during the Year 1929. 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 11 5 1 7 6 2 2 1 - 1 - 1 37 Improved 3 3 - 5 4 3 2 5 1 2 28 No material improvement - 4 - - - - - - 1 - - - 5 Died in Institution - - - - - - - - - - - - - Class T.B. plus. Group 1. Quiescent 1 - - 3 3 - - - - - - - 7 Improved 4 2 - 2 - 1 1 - - - - - 10 No material improvement - - - - - 1 - - - - - - 1 Died in Institution - - - - - - - - - - - - - Class T.B. plus. Group 2. Quiescent 1 - - 3 3 - - - - - - - 7 Improved 15 6 - 12 7 - 4 2 - 2 3 - 51 No material improvement 2 5 - 2 - - 1 - - 2 - - 12 Died in Institution 1 - - 1 1 - 1 - - - 1 - 5 Class T.B. plus. Group 3. Quiescent - - - - - - - - - - - - - Improved - 2 - - - - - 1 - - 1 - 4 No material improvement - 2 - - 2 - - - - - - - 4 Died in Institution 3 - - 1 - - 1 - - - - - 5 *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. 36 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 1 1 5 Improved - - - - - - - - - - - - - No material improvement - - - - - - - - 9 - - - 2 Died in Institution - - - - - - - - - 1 1 2 Abdominal. Quiescent or Arrested. - - - - - - - 1 - - - 1 Improved - - - - - - - - - - - - - No material improvement - - - - - - - - - - - - - Died in Institution - - - - - - - - - - - - - Other Organs. Quiescent or Arrested - - - - - - - - - - 1 - 1 Improved - - - - - - - 1 - - - 1 No material improvement - - - - - - - - - - - - - Died in Institution - - - - - - - - - - - - - Peripheral Glands. Quiescent or Arrested - - - - - 1 1 2 Improved - - 2 - - 3 - - 1 - - - 6 No material improvement - - 2 - - 2 1 5 Died in Institution - - - - - - - - - - - - - Under 1 week 1-2 weeks. 2-4 weeks. More than 4 weeks. Observation for purpose of diagnosis. Tuberculous - - - - - - - - - - - - - Non-tuberculous - - - - - - - - - - - - - Doubtful - - - - - - - - - - - - 37 HARTS SANATORIUM. Average Number of Beds Available for Patients during the Year 1929. Observation. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Total. " Sanatorium " Beds. " Hospital " Beds. Disease of Bones and Joints. Other Conditions. Adult Males - 27 8 - - 35 Adult Females - 16 3 - - 19 Children under 15 - 2 - - - 2 Total - 45 11 - - 56 Return Showing the Extent of Residential Treatment during the Year 1929. In Institution on Jan. 1 Admitted during the year. Discharged during the year. Died in the Institution. In Institution on Dec. 31. Number of Patients Adults M. 32 93 83 8 34 F. 17 64 61 2 18 Children M. - - - - - F. 1 4 3 - 2 Number of Observation Cases Adults M. - - - - F. - - - - - Children M. - - - - - F. - - - - - Total 50 161 147 10 54 CO GO Return showing the immediate results of Treatment of *Patients and of Observation of Doubtful Capes discharged from "Harts" Sanatorium during the Year 1929. 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 11 5 1 7 6 1 2 1 1 1 36 Improved 3 3 - 5 4 - 1 - - 1 - - 17 No material improvement - 4 - - - - - - - - - - 4 Died in Institution - - - - - - - - - - - - - Class T.B. plus. Group 1. Quiescent 1 - - 3 3 - - - - - - - 7 Improved 4 2 - 2 - - 1 - - - - - 9 No material improvement - - - - 1 - - - - - - - 1 Died in Institution - - - - - - - - - - - - - Class T.B. plus. Group 2. Quiescent 1 - - 3 3 - - - - - - - 7 Improved 14 6 - 11 7 - 4 2 - 1 3 - 48 No material improvement 2 5 - 2 - - 1 - - 2 - - 12 Died in Institution 1 - - 1 1 - 1 - - - 1 - 5 Class T.B. plus. Group 3. Quiescent - - - - - - - - - - - - - Improved - 2 - - - - - 1 - - - - 3 No material improvement - 2 - - 1 - - - - - - - 3 Died in Institution 3 - - 1 - - 1 - - - - - 5 Total 40 29 1 35 26 1 11 4 - 5 4 1 157 Under 1 week 1-2 weeks. 2-4 weeks. More than 4 weeks. Observation for purpose of diagnosis. Tuberculous - - - - - - - - - - - - - Non-tuberculous - - - - - - - - - - - - - Doubtful - - - - - - - - - - - - - * 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. 39 Patients discharged, 147. Deaths, 10. Average duration of treatment, 20 weeks 4 days. Number of patient days, 19,824. Number of beds available at the end of year, 56. Average number of beds occupied, 54.31. The average duration of treatment in 1929 was approximately the same as in 1928, viz., 20 weeks 4 days. There were 10 deaths, one being due to Cerebral Haemorrhage and Arterio-sclerosis. As regards the immediate results of treatment :— 50 cases were discharged as " Quiescent," 77 cases were discharged as " Improved," and 20 cases were discharged as " Not Improved." This may be regarded as very satisfactory, seeing that a considerable number of patients, especially men, have to make arrangements with employers to keep their situations open for them until they return from the Sanatorium. This naturally makes them anxious to return to work at the earliest possible moment, but in the majority of cases extension of time has been obtained either by the patient himself or by a personal letter from the Medical Officer to the employer. In this way the length of treatment has been prolonged sufficiently to enable the man to resume work with less likelihood of again breaking down. Treatment by Artificial Pneumothorax is increasing in extent yeas by year, as can be seen thus :— In 1927 there were 114 refilling operations performed. In 1928 there were 139 refilling operations performed. In 1929 there were 184 refilling operations performed. The results of this method of treatment continue to be very effective, and in cases of unilateral disease, whether moderate or extensive, it is the treatment " par excellence." In connection with Artificial Pneumothorax it is necessary for the patients to have frequent screenings by the X-rays in order that the condition of the lungs may be minutely observed, and although the arrangement with the Forest Hospital, Buckhurst Hill, for 40 X-raying " Harts " patients has, up to the present, worked quite smoothly and advantageously, yet, in view of the fact that Artificial Pneumothorax treatment is increasing fairly rapidly, in my opinion it will be advisable in the near future for the Council to consider the provision of an X-ray apparatus at " Harts," so that the institution may be brought into line with other upto-date sanatoria. Not only are X-rays necessary for patients undergoing the above treatment, but also for those cases having pleurisy with fluid and of course for taking films of chests in order to confirm the diagnosis, to ascertain the extent of the disease, or for other reasons. The number of sputa examined bacteriologically this year was 224 as compared with 199 in 1928, both the ordinary and the anti-formin methods being used. Furthermore, specimens of pleural effusions, a pyopneumothorax, and other pathological discharges were examined microscopically. As regards complications and their treatment, it is interesting to note that the following were dealt with :— 12 cases of laryngeal tuberculosis, 2 of pneumokoniosis, 2 of pyopneumothorax, and one each of diabetes, psoriasis, kidney disease, rheumatism, eczema, asthma, and tubercular rib. In one case of pyopneumothorax it was necessary to tap the patient's chest and withdraw the fluid on no less than seven occasions. There were 18 patients admitted with dental defects and the majority of these were given leave from time to time to visit their own dentist for the requisite treatment. In October the Matron, Miss M. R. Small, resigned and in November Miss G. E. Sharpe, of Raywell Sanatorium, Yorks, was appointed to succeed her, and the latter took up her duties on January 1st, 1930. During the winter months entertainments by concert parties, a Dickens lecture, and the singing of carols on Boxing Day, were highly appreciated both by patients and staff. 41 "HARTS" SANATORIUM.-Year ended 31st March, 1930. Expenditure. Cost per Patient per week. £ S. d. Salaries and Wages 2,408 16 7 Provisions 2,342 16 4 Disinfectants, Drugs and Appliances 117 0 10 Coal, Coke and Firewood 227 1 7 Lighting and Water 434 3 0 Furniture, Bedding and Linen 60 0 5 Uniforms and Dresses 8 0 1 Chandlery and Sundries 249 1 9 General Repairs 885 6 2 Garden Implements, Seeds, etc 44 0 4 Horse Hire 10 0 1 Printing, Stationery and Advertise ments 48 0 4 Rent of Telephones 27 0 2 Rates, Taxes and Insurance 308 2 2 X-Ray Examinations 41 0 3 £7,208 50 1 REPORT ON THE WORK AT THE BOROUGH INFECTIOUS DISEASES HOSPITAL. Disease. Remaining at end of 1928. Admitted during 1929. Discharged during 1929. Died during 1929. Remaining at end of 1929. Scarlet Fever 17 314 288 3 40 Diphtheria... 66 543 478 35 96 Diph. Scarlet Fever - 14 9 - 5 Enteric Fever - 2 2 - - Erysipelas - 1 1 - - Parotitis - 2 2 - - Bronchitis - 1 - 1 - Totals 83 877 780 39 141 A review of the year's work of the Isolation Hospital shows a total of 877 patients admitted for treatment, as compared with 977 for the previous twelve months. Of this number, 557 were suffering from diphtheria and 314 from scarlet fever. The admissions for the year 1928 were 445 and 532 respectively. It will thus be seen that a larger number of patients suffering from the more serious illness-diphtheria-were admitted to the Institution. Whereas, owing to the somewhat mild type of scarlet fever now 42 prevailing', a large percentage of cases can be safely discharged after four or five weeks, the length of stay with cases of diphtheria usually considerably exceeds this period. It may be concluded that the incidence of diphtheria was adequately met, but that many cases of scarlet fever were unable to be admitted. Probably on this account the prevalence of this illness was greater than it would otherwise have been. The uncertain nature of contagion and the varying opportunities under which this may occur necessitates every effort being made for its elimination. It must be conceded that an early diagnosis of infectious disease and prompt admission to the hospital are vital factors in public health. A consideration of the above data indicates the total inadequacy of the present accommodation to deal with more serious infectious disease during epidemic periods. It is sincerely hoped that the enlargement of the Hospital will commence at an early date, otherwise difficulty may arise during the winter of 1930-31. More modern buildings for the reception of patients will ensure increased efficiency, a higher standard of nursing and treatment—less risk of septic infection and a greater measure of comfort. Of the 557 patients admitted for diphtheria 479 were faucial or throat cases, 30 nasal, 19 laryngeal, 18 diphtheria with scarlet fever, 3 scarlet fever only, 5 tonsillitis, 1 Vincent's angina, 2 not suffering. Of 528 swabs examined of cases in hospital 488 showed the presence of diphtheria bacillus. The number of deaths occurring was 35, the case mortality being 6.7 per cent. Complications arising included the following :—Palatal paralysis, Cardiac Arrhythmia, Otorrhœa, Glands. Tracheotomy was performed on one occasion. Of the 314 cases of scarlet fever admitted there were three deaths. The complications were as follows :— Cervical adenitis 33 Rhinitis 41 Nephritis 11 Bronchitis 4 Abscess 3 Other conditions 21 The mortality of completed cases was 1 per cent. 43 RESUME 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.) 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 Fever) Female. 60 25 1,500 11 Male 60 25 1,500 11 B Block (Scarlet Fever and Side Wards) Female 72 26 1,872 13 Male 72 26 1,872 13 Cubicle Block 12 x 12 12 x 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 convalescent home, and with the fact that much of the accommodation is of a temporary nature and ill-suited for the purpose. 44 (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 24 *Diphtheria Home 3 (including 2 temporary) *Diphtheria Home 10 Scarlet Fever Home 21 Scarlet Fever Home 2 *Night Hut 9 *Huts 12 (8 and 4) 33 24 *Denotes temporary buildings. *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 45 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 NursingCouncil, 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 proposed enlargement of the Hospital will take the form of a new block consisting of two separate wards of 10 and 14 beds, each with additional separation rooms, kitchen, sanitary block, etc. A covered verandah on the south-east side will permit of patients obtaining the full benefit of fresh air and sunlight during later periods of treatment. A cubicle block consisting of 14 separate rooms with duty rooms, and an operating theatre will also be erected. The upper floor of the present scarlet fever " A " block, which has been in use as a nurses' home, will be reconstructed as two separate wards to provide 22 beds. The matron and nursing staff will be housed in a new administrative block and nurses' home to be erected after demolition of the present " temporary " buildings. This administrative section of the Hospital will contain recreation rooms, lecture room, and accommodation for office staff, laboratory, etc. Verandahs will also be provided for " A " and " B " blocks. The buildings to be displaced are the present corrugated iron administration block and two diphtheria wards adjoining, and the building used as a store. The two wooden temporary blocks at present used for the accommodation of night nurses and maids will be retained for use in cases of emergency. It is anticipated that the scheme will take approximately 18 months to complete owing to the difficulty of temporarily housing staff and patients during the alterations. 46 ISOLATION HOSPITAL.—Year ended 31st March, 1930. Expenditure Cost per Patient per week. £ s. d. Salaries and Wages 4,346 16 11 Provisions 3,306 12 10 Anti-Toxin 869 3 5 Disinfectants, Drugs and Appliances. 315 1 3 Coal, Coke and Firewood 690 2 8 Lighting and Water 833 3 3 Furniture, Bedding and Linen 395 1 6 Uniforms and Dresses 116 0 5 Chandlery and Sundries 464 1 10 General Repairs 1,065 4 2 Garden Implements, Seeds, etc. 29 0 1 Maintenance and Upkeep of Ambulances 571 2 2 Printing, Stationery and Advertise ments 106 0 5 Rent of Telephones 54 0 2 Rates, Taxes and Insurance 245 1 0 £13,404 52 1 47 REPORT ON THE WORK OF THE MATERNITY AND CHILD WELFARE DEPARTMENT. The work of Maternity and Child Welfare is carried on under the provisions of the Maternity and Child Welfare Act, 1918. The Act includes the following clauses :— 11. Arrangements for :— (a) Ante-Natal Clinic for expectant mothers. (b) Home visiting of expectant mothers. (c) Maternity Hospital or beds at a Hospital in which complicated cases of pregnancy can receive treatment. 2. Arrangements for :— (a) Such assistance as may be needed to ensure the mother having skilled and prompt attention during confinement at home. (b) The confinement of sick women, including women having contracted pelves or suffering from any other conditions involving danger to mother or infant at a Hospital. (c) The treatment in a Hospital of Post-Natal conditions of mother or infant. (d) Provision of systematic advice and treatment for infants at Clinics—up to school age. (e) Systematic home visitation of infants and children up to five years of age. 3. Provision of nurses for infectious cases among children in their homes. 4. Home Helps may be provided at the Council's expense. 5. Milk and food to necessitous cases of expectant and nursing mothers and children under five years of age. 6. Grants are available for provision of beds for children up to five years. This includes cases which require supervision as regards dietetics and general condition— Ophthalmia Neonatorum and epidemic Diarrhoea. 7. Provision of facilities for obtaining a Specialist's opinion in complicated cases ; before and after confinement. 48 The main centre is at White House, Plashet Grove, and there are subsidiary centres in Manor Park, Greatfield, and South Wards. Staff. The staff of the Centre at present consists of the Assistant Medical Officer in charge, six Health Visitors, and two Clerks. In April, 1930, an additional Health Visitor was appointed. The enlargement of the staff of Health Visitors to seven is a matter of great satisfaction, as it should now enable the department to undertake more adequately the supervision of the infant population, especially children between the ages of 3—5 years, for though the visitation of infants is fairly satisfactory, the same cannot be said as regards children between 3—5 years. The lack of satisfactory supervision over these children is largely due to the inadequacy of the existing Medical and Nursing Staff, which renders it impossible under present circumstances for children between 3—5 years of age to receive more than scanty attention, as so much time is spent on the close supervision of infants under 1 year for the purpose of reducing infant mortality. It is realised throughout the country, that the problem of the supervision of pre-school children must be faced, and increased efforts made to discover and deal with defects amongst children between 2—5 years, if the large proportion of physical defects found in children on admission to School is to be reduced. Infant Welfare Clinics. Infant Welfare Clinics are held as follows :— at White House, Plashet Grove, on Monday, Thursday, and Friday, at 2 p.m. Thursday, at 9.30 a.m. at St. John's Church Hall, North Woolwich, on Tuesday, at 2.30 p.m. at Wesleyan Church Hall, Manor Park, on Tuesday, at 9.30 a.m. at St. George's Church Hall, Masterman Road, on Wednesday, at 2 p.m. 49 Attendances at Infant Welfare Clinics. Number of General Clinics held during the year 297 Number of individual children who attended the Clinics 3,227 Total number of attendances 18,612 Number of medical consultations at General Clinics 7,473 Number of medical consultations at Special Clinics 544 The daily average attendances at the Clinics was as follows:— White House, Monday afternoon 64 Manor Park, Tuesday morning 54 North Woolwich, Tuesday afternoon 17 Masterman Road, Wednesday afternoon 71 White House, Thursday morning; 36 White House, Thursday afternoon 71 White House, Friday afternoon 73 White House, Special Clinics 16 At the Clinics special attention is paid to the education of mothers, individual instruction is given in general hygiene of childhood, correct methods of feeding and management of children. Mothers are encouraged to bring their children for periodical medical examination so that any deviation from the normal physiological state has a chance of being detected early, so that defects and incipient disease can be treated in the early stages. Preventive centres 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, 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 doctor for treatment, or to 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. Children under the age of five are frequently referred to the Infant Welfare Clinics by the Tuberculosis Nurses from homes in which tuberculosis has occurred, for examination as contacts by the Medical Officer, and observation, if desirable, at the Clinics themselves. 50 Nine children under the age of five were notified during 1929 in East Ham as suffering from tuberculosis. Tonsils and Adenoids. Children under five years of age who are found to be suffering from enlarged Tonsils and Adenoids are referred for treatment to St. Mary's Hospital, Plaistow ; Balaam Street Children's Hospital, Plaistow; East Ham Memorial Hospital, or Queen Mary's Hospital, Stratford. During 1929 95 children have received operative treatment, with beneficial results to their general health. In such cases, on the day following operation, a Health Visitor visits the home and gives the mother general advice as to after-treatment of the child. 131 visits of this character were made by the Health Visitors. Ringworm. No cases of Ringworm of the Scalp were referred to the School X-Ray Department for radical treatment. Dental Treatment. Mothers and children referred from the Maternity and Child Welfare Centres are treated by the School Dentist, two afternoons in each week being set apart for this purpose. Details of the work done for dental cases referred from this Department will be found in Mr. Neame's Annual Report, p. 135. Ophthalmic Treatment. Ophthalmic defects requiring special consideration are seen at the Special Clinic each week by the School Ophthalmic Surgeon. Details of the work done will be found in Mr. ReeveFlaxman's Annual Report, p. 132. Treatment by Artificial Sunlight. Ultra-Violet Ray treatment has been continued throughout the winter by means of the Arnold Alpine Sunlight Radial Arc Lamp, which is shared with the School Medical Service. The number of sessions held have been still more limited this year, as the rooms used for light treatment are required for other purposes, therefore during the latter part of the year the sessions have been one only each week instead of two. 51 The conditions referred for treatment from the Infant Welfare Clinics have been Rickets, Enuresis, Malnutrition, and General Debility. 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 East Ham our experience is that in the majority of cases treated the mothers are satisfied that their children have appeared brighter and more vigorous, sleep better, and are more contented and happy. Artificial Sunlight is not to be regarded as replacing the oldestablished methods of treatment, surgical, tonic, etc., but as a valuable aid to the effect of these. Abundance of fresh air, general sanitation, and good food retain their former values, even where Artificial Sunlight is available. The Senior Health Visitor is in charge of the actual treatment and is assisted by one other Health Visitor at each Clinic. The Medical Officer in charge of Infant Welfare visits the Light Clinic periodically for purposes of general control and guidance of dosage, and sees the infants systematically at the ordinary Infant Welfare Clinics held in the Borough. The statistics of 1929 were as follows:— Number of Light Sessions held 43 Number of attendances at these Sessions 1,101 Number of individual children treated 161 Morning Clinics. Special Clinics are held twice a week to deal with cases that cannot be satisfactorily dealt with at the ordinary Clinics. Minor ailments requiring observation and treatment are referred to these morning sessions, also cases of difficult feeding, and children who have been referred to the Medical Officer by the Health Visitors from their district visits. 52 All infants reported to be suffering from discharge from the eyes are at once visited by the Health Visitor. Should they not be under the supervision of a medical practitioner, or attending a Hospital, arrangements are made for their being brought for treatment at the special morning Clinic. Severe cases are referred to the School Ophthalmic Surgeon. Morning Clinics were held during 1929 :—At White House, Plashet Grove, on Monday and Wednesday, at 9.30 a.m. The statistics for 1929 are as follows:— Number of cases seen at morning Clinics 1,569 Number of medical consultations 544 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 with 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 infants during the first two years of life, and, as 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. In addition to the routine work of the Health Visitors, special visits to the homes are made in reference to cases of enlarged 53 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 1929 were 16,329, as against 17,074 in the previous year. Visits to infants under one year of age 6,717 Visits to children over one year of age 9,041 Visits to Tonsils and Adenoids cases 131 Visits to Ante-Natal cases, first visits 223 Visits to Ante-Natal cases, re-visits 59 Special visits, not included in above groups 153 16,324 Ante-natal Work. An Ante-natal Clinic is held at:— White House, Plashet Grove, on Friday, at 9.30 a.m. The function of an Ahte-Natal Clinic is primarily to provide for the care and examination of the expectant mother. Systematic supervision during pregnancy cannot be over-estimated, as it probably does more than anything else to secure good health both for mother and infant, and prevent avoidable difficulties at the confinement. Health Visitors follow up expectant mothers in their homes to advise regarding arrangements for confinement and general hygiene of the mother. The following-up of cases also ensures regular attendance at the Clinic. The value of the after-care of the mother is now beginning to be more fully recognised. The Ministry of Health urge the institution of Post-Natal Clinics for the supervision of mothers, thereby preventing much ill-health and disability. An Ante-Natal Clinic is held at:— White House, Plashet Grove, on Friday, at 9.30 a.m. During the year the following attendances were recorded :— First visits 221 Subsequent visits 243 54 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 confinement, the East Ham Borough Council have arrangements for the accommodation of necessitous cases requiring in-patient treatment, at Queen Mary's Hospital, Stratford, and at the Maternity Hospital and District Nurses' Home, Plaistow. During 1929 3 cases thus provided for were confined in Queen Mary's Hospital. There is an increasing demand for Hospital accommodation, and patients often experience great difficulty in obtaining admission. Frequently they have to be confined at home under unsatisfactory conditions. The number of beds reserved by the Council is quite inadequate to accommodate a sufficient number of cases. If a Municipal Maternity Hospital could be provided these defects would be overcome. 55 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 1929:— Causes of Death. Sex. Under 1 year 1—2 2—5 ALL CAUSES M. 64 6 23 F. 60 11 31 Measles M. – – F. 1 – 1 Scarlet Fever M. – – – F. – 1 1 Whooping Cough M. 5 1 – F. 5 1 6 Diphtheria M. – – 6 F. – 1 12 Influenza M. – 1 – F. – – – Meningococcal Meningitis M. 1 – – F. 1 – – Tuberculosis of Respiratory System M. – – – F – – 1 Other Tuberculous Diseases M. – 1 F. – – 1 Cancer M. – – — F. 1 – 1 Rheumatic Fever M. – – 1 F. – – – Bronchitis M. 2 – – F. – – 2 Pneumonia (all forms) M. 9 2 8 F. 12 6 3 Other Respiratory Diseases M. 1 – 1 F. – – – Diarrhoea, &c. M. 9 – – F. 9 – – Appendicitis M. – – 1 F. – – – Nephritis M. – – 1 F. – – Congenital debility and malformation, premature birth M. 29 – 1 F. 24 – – Deaths from violence M – – – F. – 1 – Other defined diseases M. 8 1 4 F. 7 1 3 Legitimate. Illegitimate. Number of deaths under 1 year M 62 2 F 58 2 56 COMPARATIVE INFANT MORTALITY RATE—YEAR 1929. 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 16.3 8.1 74 107 County Boroughs and Great Towns (including London) 166 10 9 79 156 Smaller Towns (1921 adjusted populations, 20,000—50,000) 16.0 5.9 69 London 15.7 10.7 70 EAST HAM 14.7 8.3 57 The comparative infant mortality rate for the year 1929 shows that East Ham continues to be greatly more healthy than England as a whole, and more healthy than London. The total number of deaths under one year per 1,000 registered births in England and Wales was 74, in London the figure was 70; in East Ham only 57 infants under one year of age per 1,000 births died. 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, 1918 and 1926. 52 Midwives notified their intention to practise in the Borough during 1929. Of these, 36 worked in connection with the Maternity Hospital and District Nurses' Home, Plaistow, and its branches, 5 at the Sir Henry Tate Nurses' Home, Silvertown, 2 at the Kelvingrove Nursing Home, and 9 practised independently. 36 visits of inspection were made by the Inspecting Medical Officer during the year. By the rules of the Central Midwives' Board, midwives must send for medical aid in certain specifically named conditions. During the year help was obtained in 178 cases as follows:— For the Mothers— Ruptured perineum 33 Prolonged labour 48 Post-partum hæmorrhage 4 Retained placenta 5 Ante-partum hæmorrhage 5 Rise of temperature 11 Inflammation of breasts 1 Malpresentations 3 Extended breech 3 Uterine inertia 1 Other causes 19 133 57 For the Infants— Prematurity and dangerous feebleness 15 Deformities 3 Discharging eyes 5 Baby found dead on arrival of midwife 3 Born before arrival 2 Rash, undefined 4 Unsatisfactory condition of infant 8 Spina Bifida 2 Other causes 3 45 Visits have been paid as required to one registered Nursing Home in the district. 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. 58 Nine cases of Pueperal Fever and 12 of Puerperal Pyrexia were notified. 12 of these occurred in private practice, and 9 were notified from hospitals. Maternal Deaths. Much attention has been paid to the question of Maternal Mortality, which in spite of all efforts, has not appreciably diminished. Full particulars of each maternal death are now entered on special Forms and reported to the Ministry of Health, and it is hoped by this means that new factors will be brought to light. During the year 1929 12 deaths in connection with par turition occurred to East Ham cases as follows:— Puerperal septicæmia 5 Post-partum haemorrhage 2 Ruptured uterus 1 Toxaemia of pregnancy 2 In addition to these there were 2 deaths due to diseases associated with childbirth. 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 ing 1929, 3 cases of Ophthalmia Neonatorum were notified in East Ham, with results of treatment as shown in the following table:— 59 Notified Case No. Treated Vision Unimpaired. Vision Impaired. Total Blindness. At Home. At Hospital or Clinic 1 1 1 1 – – 2 1 – 1 – – 3 1 – 1 – – Cots for Babies. In last year's report it was pointed out that the provision of some cots for Clinic babies who are suffering from malnutrition, marasmus, dietetic errors, infantile diarrhœa, rickets, etc., and requiring careful medical supervision for a short period, would be of great assistance in those cases where home conditions are unsuitable, and the mother unable for various reasons to attend the Clinic at frequent intervals. It may be pointed out that it is seldom possible to admit such cases in Children's or General Hospitals and these beds would provide accommodation for infants who would otherwise not be able to receive skilled care. Free Milk. Under the Council's scheme £1,060 worth of free milk was supplied to expectant and nursing mothers and young children during the past year. In every case careful investigation of the family circumstances is made, to ensure 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 country for delicate children referred from the Clinics. Seven young children were sent away through the auspices of the Association during 1929. 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. 60 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 School Medical Service cases. 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 being 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 unsanitary condition by Health Visitors in connection with their routine work are reported to the Senior Sanitary Inspector for further investigation and such action as he may find desirable. 61 VENEREAL DISEASES. Summary of work done by the Hospitals during the Year 1929. London Middlesex Essex Surrey Kent Herts. Bucks. E. Ham W. Ham Croydon Total Other Places Grand Total New Patients:— Syphilis 3.280 380 224 154 105 43 23 57 119 22 4,407 524 4,931 Soft Chancre 210 1 6 7 1 2 – 2 5 2 236 44 280 Gonorrhoea 7,755 1,010 310 311 165 148 35 74 244 47 10,099 675 10,774 Not Venereal 6,493 661 355 316 186 88 41 73 207 60 8,480 321 8,801 Total 17,738 2,052 895 788 457 281 99 206 575 131 23,222 1,504 24,786 Total Attendances 616,399 51,877 22,233 20,196 9,579 6,271 2,489 4,806 15,930 3,089 752,869 16,003 768,872 No. of "In-patient" days 32,487 2,154 1,469 2,004 823 908 168 93 252 71 40,429 11,091 51,520 Salvarsan Substitutes, doses given 35,333 3,881 2,164 1,607 1,052 404 450 417 1,261 300 46,929 1,800 48,729 Pathological Examinations. For or at Centres:— Spirochaetes 855 70 28 19 15 5 1 5 21 1 1,020 67 1,087 Gonococci 53,4.17 3,870 2,765 1,999 1,395 642 200 528 1,435 484 66,765 1,312 68,077 Wassermann 24.270 1,869 1,004 1,004 600 269 156 206 484 218 30,080 875 30,955 Others 11,522 650 441 656 534 147 61 72 143 221 14,447 274 14,721 Total 90,094 6,459 4,238 3,678 2,544 1,063 418 811 2,083 924 112,312 2,528 114,840 For Practitioners:— Spirochaetes 45 3 1 – – – – 1 1 – 51 1 52 Gonococci 4.292 199 191 2,139 12 26 10 43 39 491 7,442 71 7,513 Wassermann 15,879 1,708 1,152 787 101 79 136 175 248 313 20,578 407 20,985 Others 3,188 77 205 257 52 29 24 4 12 128 3,976 79 4,055 Total 23,404 1,987 1,549 3,183 165 134 170 223 300 932 32,047 558 32,605 62 TOTAL CASKS NOTIFIED DURING 1929. Disease. Under 1 1—2 2—3 3—4 4—5 S-10 10—15 15—20 20—35 35—45 45—65 65 an d over Total all ages Cases admitted to Hosp. Total Deaths. Small Pox ... ... ... ... ... ... ... 10 11 2 2 ... 25 25 ... Scarlet Fever ... 9 29 34 53 344 143 57 67 6 1 ... 743 328 3 Diphtheria 3 12 33 48 44 260 105 29 32 12 ... ... 578 551 42 Enteric Fever (Typhoid & Paratyphoid) ... ... ... ... ... ... 1 ... 1 ... ... ... 2 2 1 Erysipelas ... ... ... ... ... ... 1 3 8 9 22 6 49 12 4 Puerperal Fever ... ... ... ... ... ... ... ... 8 ... 1 ... 9 8 5 ,, Pyrexia ... ... ... ... ... ... ... ... 10 2 ... ... 12 6 ... Meningococcal Meningitis 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 2 Anterior Polio-myelitis 1 1 ... ... ... ... ... ... ... ... ... ... 2 1 ... Malaria (induced in Institution) ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... *Ophthalmia Neonatorum 3 ... ... ... ... ... ... ... ... ... ... ... 3 2 ... Encephalitis Lethargica ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 5 Pneumonia 1 3 5 5 3 9 1 6 25 18 19 7 102 44 145 Total 9 25 67 87 100 613 251 105 163 50 45 13 1528 981 207 Tuberculosis:— (a) Pulmonary M ... ... ... ... ... 4 4 17 45 17 30 3 126 154 75 F ... ... ... 1 2 2 5 12 46 6 9 2 85 109 49 Total ... ... ... 1 2 6 9 29 91 23 45 5 211 263 124 (b) Non-Pulmonary M ... 1 ... ... ... 7 4 4 2 2 3 ... 23 17 2 F ... 2 ... ... 3 8 4 2 4 ... 2 ... 25 17 3 Total ... 3 ... ... 3 15 8 6 6 2 5 ... 48 34 5 * The three cases of Ophthalmia Neonatorum were visited and treated with no impairment of vision. Notification of Tuberculosis is not completely satisfactory inasmuch that cases are frequently un-notified until the disease is well advanced. In cases where death occurs in a non-notified case the attention of the Medical Practitioner is drawn to the fact and the explanation is usually satisfactory. The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was 1 to 6. 63 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN EAST HAM, 1929. CAUSES OF DEATH. Net Deaths at the subjoined ages of "Residents" whether occurring within or without the Borough. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and under 75 years. 75 and upward- All Causes M 815 61 6 23 25 26 89 266 173 143 F 823 60 11 31 37 37 82 209 167 189 1. Enteric Fever M 1 ... ... ... ... ... 1 ... ... ... F ... ... ... ... ... ... ... ... ... ... 2 Small-pox M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 3 Measles M ... ... ... ... ... ... ... ... ... ... F 2 1 ... 1 ... ... ... ... ... ... 4. Scarlet Fever M ... ... ... ... ... ... ... ... ... ... F 3 ... 1 1 1 ... ... ... ... ... 5. Whooping Cough M 7 5 1 ... 1 ... ... ... ... ... F 13 5 1 6 1 ... ... ... ... ... 6. Diphtheria M 15 ... ... 6 8 1 ... ... ... ... F 7 ... 1 12 13 ... 1 ... ... ... 7. Influenza M 28 ... 1 ... 1 ... 3 15 5 3 F 36 ... ... ... ... 1 2 13 14 6 8. Encephalitis Lethargica M 2 ... ... ... ... 1 1 ... ... ... F 3 ... ... ... ... 1 ... 2 ... ... 9. Meningococcal Meningitis M 1 1 ... ... ... ... ... ... ... ... F 1 1 ... ... ... ... ... ... ... ... 10. Tuberculosis of Respiratory System M 75 ... ... ... 2 11 26 32 3 1 F 49 ... ... 1 ... 17 24 7 ... ... 11. Other Tuberculous Dieases M 2 ... 1 ... ... 1 ... ... ... ... F 3 ... ... 1 1 1 ... ... ... ... 12. Cancer, Malignant Diseases M 91 ... ... ... ... ... 4 44 34 9 H' 109 1 ... 1 ... ... 12 46 29 20 13. Rheumatic Fever M 5 ... ... 1 1 1 1 1 ... ... F 5 ... ... ... 3 ... 1 1 ... ... 14. Diabetes M 2 ... ... ... ... ... ... 1 1 ... F 5 ... ... ... ... ... 1 2 1 1 15. Cerebral Hemorrhage &c. M 33 ... ... ... ... ... 1 5 18 9 F 40 ... ... ... ... ... ... 11 14 15 16. Heart Disease M 158 ... ... ... 1 1 12 60 47 37 F 164 ... ... ... 2 5 8 49 46 54 17. Arterio-sclerosis M 17 ... ... ... ... ... ... 4 10 3 F 19 ... ... ... ... ... ... 4 7 8 18. Bronchitis M 60 2 ... ... ... ... 1 19 10 28 F 52 ... ... 2 ... ... 3 4 17 26 19. Pneumonia (all forms) M 69 9 2 8 1 1 11 17 9 1 F 76 12 6 3 3 4 9 17 10 19 20. Other Respiratory Diseases M 15 1 ... 1 ... ... 1 7 3 2 F 8 ... ... ... ... ... 1 1 5 1 21. Ulcer of Stomach or Duodenum M 4 ... ... ... ... ... 1 2 1 ... F 4 ... ... ... ... ... 1 3 ... ... 22. Diarrhoea, &c. M 12 9 ... ... ... ... ... 2 ... 1 F 9 9 ... ... ... ... ... ... ... ... 23. Appendicitis and Typhlitis M 6 ... ... 1 ... 1 1 2 ... 1 F 5 ... ... ... 1 ... 1 3 ... ... 24. Cirrhosis of Liver M 2 ... ... ... ... ... ... 1 1 ... F 3 ... ... ... ... ... ... 2 1 ... 25. Acute and chronic nephritis M 22 ... ... 1 ... 2 2 8 4 5 F 15 ... ... ... 1 ... 1 10 2 1 26. Puerperal Sepsis M ... ... ... ... ... ... ... ... ... ... F 5 ... ... ... ... 3 2 ... ... ... 27. Other Accidents and Diseases of Pregnancy and Parturition M ... ... ... ... ... ... ... ... ... ... F 7 ... ... ... ... 1 6 ... ... ... 28. Congenital debility and malformation, premature birth M 31 29 ... 1 ... ... 1 ... ... ... F 24 24 ... ... ... ... ... ... ... ... 29. Suicide M 9 ... ... ... ... ... 4 2 2 1 F 3 ... ... ... ... 1 ... 2 ... ... 30. Other deaths from violence M 22 ... ... ... 3 4 6 7 2 ... F 12 ... 1 ... 2 2 1 2 4 31. Other defined diseases M 126 8 1 4 7 2 12 37 23 32 F 121 7 1 3 9 3 7 31 19 41 32. Causes ill-defined or unknown. M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 64 METEOROLOGICAL RECORD—YEAR 1929. 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 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 50° 26° 34°.8 33°.5 35°.5 12 0.80 0.12 0.28 10th February 52° 15° 31°.1 30°.2 32°.8 7 0.34 0.07 0.13 2nd March 69° 24° 41°.5 39°.4 44°.1 2 0.03 0.01 0.02 21st April 73° 28° 45°.4 41°.5 45°.6 10 1.21 0.12 0.43 29th May 80° 32° 56°.1 50°.6 54°.1 9 1.83 0.20 0.40 5th June 80° 44° 59°.5 53°.8 59°.0 11 1.05 0.09 0.32 4th July 86° 45° 65°.4 58°.l 64°.5 8 1.71 0.21 0.76 3rd August 89° 46° 62°.1 57°.6 63°.1 10 2.04 0.20 0.72 16th September 88° 40° 63°.3 58°.5 64°.5 3 0.70 0.23 0.55 3rd October 64° 33° 51°.3 48°.4 52°.1 16 2.70 0.17 0.71 24th November 61° 29° 46°.0 43°.9 46°.4 19 4.85 0.25 0.66 11th &16th December 58° 27° 43°.9 41°.7 43°.9 23 4.03 0.23 0.58 6th Means and Totals for the Year. 89° 15° 50°.0 46°.4 50°.5 130 21.29 0.14 0.76 July 3rd I he Rainfall for the Year was 2.43 ins. below, and the number of days on which rain fell 42 below the year 1928, at East Ham. 65 REPORT OF THE CHIEF SANITARY INSPECTOR OF THE WORK PERFORMED BY THE SANITARY, FOOD AND DRUGS AND SHOPS INSPECTORS FOR THE YEAR 1929. TO THE MEDICAL OFFICER OF HEALTH. Sir, In accordance with the Ministry of Health regulations I beg to report on the sanitary work carried out in the Borough during last year. The Staff of the Sanitary section consists of one assistant Sanitary Inspector, five district Inspectors, one Shops Inspector and myself. There are also one Disinfector, one Mortuary attendant wholly engaged, and two men, as required, from the Engineer's department for drain clearing. I am, Sir, Your obedient servant, GEORGE D. LILL. 66 PRIMARY INSPECTIONS. Month Vlanor 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 85 – 59 111 58 – 38 49 36 – 59 22 105 105 49 – 21 – 89 122 599 409 February 58 – 68 82 61 – 54 72 42 – 49 – 71 130 49 91 25 – 87 60 564 435 March 70 – 61 77 78 33 49 26 26 – 46 – 55 239 46 — 38 – 69 68 538 443 April 113 – 73 118 64 22 72 – 48 – 72 18 81 223 114 — 57 – 88 33 782 414 May 139 50 114 49 129 85 120 – 71 – 85 73 88 146 116 28 81 – 105 89 1,048 520 June 67 51 74 49 48 26 43 – 35 – 60 2 81 39 57 97 43 – 62 39 570 303 July 64 – 52 92 43 7 62 46 34 – 41 77 86 – 63 117 24 – 57 67 526 406 August 45 – 58 53 33 – 27 109 12 21 39 – 48 – 26 72 18 – 45 69 351 324 September 75 – 64 – 74 11 53 96 28 87 71 – 70 8 40 89 25 – 76 94 576 385 October 93 – 93 91 83 65 101 3 55 44 102 88 98 – 59 121 41 – 110 86 835 498 November 103 – 82 83 75 55 66 – 57 – 85 84 96 – 73 70 37 – 88 83 762 375 December 117 – 60 62 102 15 88 29 50 9 70 26 58 – 80 51 67 – 82 38 774 230 1029 101 858 867 848 319 773 430 494 161 779 390 937 890 772 736 477 – 958 848 7,925 4,742 67 Nuisances. As a result of the inspections shown in the foregoing table, 19,001 nuisances were discovered. A detailed list is given in the inset table, page 85. To secure abatement the following notices were served:— 1929 1928 Preliminary 5,667 3,630 Statutory 861 436 6,528 4,066 Notices Outstanding at 31st December, 1929. District. No. 1 No. 2 No. 3 No. 4 No. 5 Total Informal 155 338 308 550 436 1787 Statutory 24 71 40 98 141 374 Complaints. The following table shows the number of complaints received for the year as compared with the previous year:— Year. Written. Oral. Total. 1929 435 1,540 1,975 1928 574 1,611 2,185 68 COMPLAINTS RECEIVED FOR 1929. Manor Park Little Ilford Woodgrange Plashet Kensington Castle Central Wall End Greatfield South | Total  January 7 28 16 16 8 14 21 14 5 12 141 February 9 21 11 8 11 8 33 4 11 23 139 March 15 18 15 19 13 18 28 8 8 29 171 April 16 16 14 23 9 18 22 21 19 17 175 May 10 21 20 16 13 15 22 17 7 28 169 June 11 28 22 32 10 10 28 13 8 21 183 July 12 25 11 9 11 16 28 23 8 24 167 August 14 35 8 14 15 10 21 8 6 19 150 September 14 21 11 14 12 15 21 23 16 21 168 October 11 29 19 20 11 28 20 17 9 13 177 November 15 23 17 7 16 12 30 14 10 22 166 December 18 21 14 20 15 18 12 23 7 21 169 152 286 178 198 144 182 286 185 114 250 1,975 69 INSPECTIONS FOR THE YEAR. Ordinary House-to-house Total January 599 409 1,008 February 564 435 999 March 538 443 981 April 782 414 1,196 May 1,048 520 1,568 June 570 303 873 July 526 406 932 August 351 324 675 September 576 385 961 October 835 498 1,333 November 762 375 1,137 December 774 230 1,004 Total for Year 7,925 4,742 12,667 Small Pox Contacts. In addition to the foregoing inspections, 1,891 special visits were paid in connection with small pox contacts. House-to-House Inspection. As was stated in the report under this head last year, special attention again has been given to this important branch of the Sanitary Inspectors' work. As shown in the above table, 4,742 house-to-house visits were made during the year 1929, as compared with 2,346 for the previous year, and a total of 12,667 visits for all purposes, as compared with 8,096 for the former period. At 84 per cent. of the house-to-house visits sanitary defects were found. This high percentage proves the necessity for this type of inspection; it must, however, be remembered that only the older and poorer class of property has been visited; the occupiers of better class premises rarely require, or desire, an official visit from the Officers of the Local Authority. 70 Rent Restrictions (Notice of Increase) Act, 1923. Nine applications only were made by tenants for certificates under this Act. 5 were granted, and in the remaining 4 cases the work was carried out by the owners on receipt of my letter notifying them that a certificate would be issued failing their immediate attention to the schedule of defects. Food and Drugs (Adulteration) Act, 1928. 430 samples of food and drugs were taken under the above Act, of which 145 were milk. 420 samples were reported by Dr. Bernard Dyer, the Public Analyst, to be genuine articles of food. Three samples of milk were deficient in fat. A summons was taken out in one case, but could not be served as the offender had absconded and at the date of writing has not been found. With regard to the two other samples, no action was taken on the advice of the Borough Analyst. He wrote:—" The 'Appeal to Cow' samples are just up to the mark in fat, but I do not think the difference is such as to make it wise to take any severe measures about 401 and 402 on account of the shortages. It is quite possible that they are natural milk of the morning milking, but no doubt the vendor will have his attention properly called to the matter." One sample of milk was reported to be "poor in quality but possibly genuine." Subsequent tests did not disclose any adulteration. One sample of whisky taken informally was found to be 42 degrees under proof, or seven degrees below the statutory limit. A formal sample taken a few days later was found to be in order and subsequent informal samples have also proved genuine. A sample of tripe was found to contain sulphur di-oxide to the extent of 180 parts per million contrary to the regulations of the Ministry of Health. The offender was fined £5 and 10s. 6d. costs in January, 1930. The remaining four samples were mixed herbs, which contained from 4.7 to 7.7 per cent. of sand. In reference to these samples Dr. Bernard Dyer wrote:—"I would suggest that it might be politic to deal with the matter by caution rather than by more severe steps because I have never before, as far as I remember, made an analysis of mixed herbs and I am not prepared to say what percentage of sand is usually present in such a mixture of herbs when carefully gathered or how much it is 71 likely to be under what one might call 'average conditions of carelessness!'" After consultation with an Officer of the Ministry of Health, I wrote to three firms who are actual packers of this article and steps were at once taken to withdraw packages, distributed to retailers, for re-sifting. The following is a detailed list of the articles sampled:— Ale 1 Ammoniated Tincture of Quinine 5 Butter 48 Brawn 2 Bread 1 Breakfast Sausage 1 Blancmange Powder 1 Baking Powder 1 Butter and Margarine Mixture 1 Chicken and Ham Roll 2 Cocoa 10 Custard Powder 3 Cheese 2 Coffee 8 Carbolic 1 Cake ("Tottenham") 1 Chutney 1 Castor Oil 1 Coffee and Chicory Extract 1 Cream 11 Creamy Bon-Bons 1 Cream of Tartar 2 Cocoanut Ice 2 Curry Powder 1 Camphorated Oil 3 Chelsea Buns 1 Cascara Sagrada 1 Christmas Pudding 1 Dripping 6 Dill Water 1 Desiccated Soup Powder 1 Egg Substitute 1 Essence of Ginger Wine 1 Fish Pastes 4 Flour 1 Ground Rice 1 Ground Almonds 2 Ground Ginger 1 Ground Nutmegs 2 Honey 1 Ice Cream 2 Jam 3 Lard 24 Lime Water 2 Lemonade Powder 1 Luncheon Sausage 1 Lemon Curd 2 Lemon Squash 1 Milk 145 Minced Beef 6 Margarine 18 Mustard 1 Meat Paste 2 Minced Meat 2 Marzipan Roll 1 Mixed Herbs 6 Peas 6 Pepper 7 Preserved Parisian Sausages 1 Rum 1 Rice 5 Russian Roll 1 Sponge Fingers and Cakes 5 Sausages 12 Sweet Spirit of Nitre 2 Sauce 3 Sauce (Fruit) 1 Syrup of Figs 2 Shortbread 1 Sugar 1 Sugar (Demerara) 1 Sugar (Pudding) 1 Scone 2 Suet 2 Tea 6 Toffee 1 Tripe 1 Vinegar 4 Veal and Ham 1 Wholemeal Flour 1 Whisky 9 Total 430 72 Milk Supply. There are no cowsheds in use in the Borough, therefore all milk is imported and, as I have before stated, " the greater bulk is distributed by three or four large firms who have adopted the latest hygienic methods of storing and cleansing. They have also their own Inspectorate, who take frequent samples from the milk carriers to ensure the milk being delivered as it comes from the cow. "An increasing number of consumers is being supplied with their milk—much of it sterilised or pasteurised—in capsuled bottles, thus avoiding any contamination in transit or in the house." Dairies. There are 114 registered premises for the sale of milk in the Borough. This number includes a few shops other than dairies where milk is sold. These premises have been periodically inspected and are maintained in good condition. Milk and Cream Regulations. Milk and Cream Not Sold as Preserved Cream. (a) (b) Number of samples examined for the presence of a preservative. Number in which preservative was reported to be present, and percentage of preservative found in each sample. Milk 143 — Cream 11 — Milk (Special Designation) Order, 1923. Dealers' licences (Form B) were granted for the Sale of Milk under this Order. 1 for Grade A. 2 for Grade A (Tuberculin Tested). 2 for Pasteurised. Supplementary licences (Form D) were granted for the Sale of Milk under this Order. 73 10 for Grade A. 1 for Grade A (Tuberculin Tested). 1 for Pasteurised. 9 for Grade A Pasteurised. Offensive Trades. There are two small traders in the Langdon Crescent area who carry on business under the above heading. The premises are satisfactory and no cause for service of sanitary notices has arisen. Disinfection. 2,344 premises were disinfected; 1,703 for infectious disease, 484 for tuberculosis, and 157 for other causes. 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, printed directions are given as to isolation and prevention of the spread of the disease, and a postcard is immediately sent by the Inspector to the school attended by any child in the house. A report of each 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 Librarians are notified of all infected premises and books from infected houses are returnable direct to the Public Health Department and disinfected before return to the respective libraries. All Head Teachers of schools and all pawnbrokers in the Borough are notified weekly of infected houses. Dust Collection. This work was carried out by my predecessor up to July, 1928. From that date the responsibility for dust collection was passed over to the Cleansing Superintendent under the Borough 74 Engineer. This officer also serves notices where necessary with respect to defective dust bins. The district Sanitary Inspectors are provided with small notice books for easily notifying the Cleansing Superintendent whenever they find a broken or improper dust bin. Factories, Workshops and Outworkers' Premises. There are 244 factories and workshops in the Borough, including bakehouses and laundries. During the year 268 inspections have been made, of which 125 were to homes of outworkers. Public Water Closets and Urinals. There are 11 public conveniences in the Borough under the supervision of the Cleansing Superintendent of the Borough Engineer's Department. No complaint has been received during the year and they have been well maintained in a satisfactory condition. There are 34 public houses and beer houses in the Borough, the majority of which are well equipped with sanitary conveniences and, with a few exceptions, these are also well maintained. Attention is being given to two houses in particular in which the conditions are not satisfactory. Public Health (Meat) Regulations, 1924. Considerable time has been spent by the Inspectors on this important branch of the work of the section. All owners and occupiers of slaughter.houses are supplied with printed and addressed notification forms. During the year 982 notifications to slaughter were received referring to :— Cattle 1,689 Sheep 880 Pigs 7,972 Lambs 1,482 Calves 1,244 Total 13,267 75 Slaughtering is carried out at all hours of the day up to late evening and also on Sundays. There is a rota for the District Inspectors to take extra office hours and Sunday duty in turn. The Inspector on duty rings up my house at 10.30 a.m. on Sundays to report and receive any further messages. The Inspectors receive no extra pay for this, as is arranged in some districts, but receive compensation leave on the following week. This scheme has worked very satisfactorily. Slaughter.Houses. Following is a list of slaughter.houses in the Borough :— Beckton Road. Manor Way Farm, New Beckton. 319, Green Street. 170, High Street North. 167, Plashet Grove. 843, Romford Road. 524, Romford Road. 638, Romford Road. 737, Romford Road. Shaftesbury Road. 28, Station Road. Forest View Road. 14, High Street North and 6, Station Road, formerly included in this list, have now been closed and converted into other premises. Food Supplies. The food supplies of the Borough are, generally speaking, exceedingly good. It is very infrequent, having regard to the number of shops in the Borough, to receive any complaint as to the quality of foods bought, only 12 parcels being condemned during the year. The shops and market places are regularly inspected at least one evening in the week as well as during the day. Shops Acts, 1912, 1928. There are 2,670 shops registered in the Borough comprising :— 76 Grocers and Provision Dealers 374 Drapers 212 Confectioners and Tobacconists 288 Boot and Shoe Salesmen 142 Tailors 134 Fruiterers and Greengrocers 108 Butchers 104 Licensed Houses 87 Barbers and Hairdressers 89 Bakers 55 Domestic Stores 52 Chemists 46 Corn Chandlers 33 Others 979 2,670 The Inspector regularly visited these shops for the purpose of compiling trade registers and seeing that the provisions of the Shops Acts and Early Closing Orders were complied with. During the year 158 contraventions were reported, necessitating letters of caution being sent to the offenders, and in 44 instances legal proceedings were instituted. During the year 6,531 visits were made by the Shops Inspector. On the Tobacco Hours Extension Petition 325 visits were made. There were reported to the Police 16 places where gambling machines were installed. The following Closing Orders have been made for the Borough:— Fridays. Saturdays. Other days. Butchers 8 p.m. 9 p.m. 7 p.m. Grocers and Provision Dealers 8 p.m. 8 p.m. 7 p.m. Corn Chandlers 8 p.m. 8 p.m. 7 p.m. Barbers 9 p.m. 8 p.m. Half.holiday Closing Orders :— Chemists Thursday or Saturday 1 p.m. Bakers Thursday or Saturday 2 p.m. Explosives Act, 1875. 271 visits were made for the purpose of enquiring if the provisions of the Act were complied with. 16 cautions were given for offences. 77 Rats and Mice (Destruction) Act, 1919. The Council entered into a contract with a firm of professional rat.catchers, who carry out work at the Isolation Hospital, the Sewage Works and other premises as required. Private houses which are rat infested are usually cleared by one of the drain. clearing gang. It is impossible to state the total number of rats and mice destroyed as poison is used as well as traps, but the actual numbers recorded are :—Rats, 1,803 ; and mice, 438. Cinemas, Music Halls and Dancing Licenses. A thorough annual inspection of all premises in the Borough licensed for dancing, singing, music, cinematograph, and stage plays is made prior to the annual licensing. Frequent evening visits are also paid to these premises to inspect for any breaches of the bye.laws. Complaints are sometimes received of overcrowding which, on investigation, are found to be unjustified. Most of our cinemas are specially designed to allow for standing room, and many visitors are of opinion that when these side spaces are full this constitutes a breach of the regulations, which are very fairly observed. On no occasion has it been necessary to summons the licence holder. HOUSING STATISTICS FOR THE YEAR 1929. New houses erected during the year :— (a) Total 158 (b) As part of a municipal housing scheme 8 1. Dwelling Houses. (1) Inspection—Dwelling houses inspected for housing defects (under Public Health or Housing Acts) 11,253 (2) Dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (3) Dwelling houses (exclusive of those referred to under the preceding sub.heading) found not to be in all respects reasonably fit for human habitation Nil. 78 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 4,516 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 5,667 (2) Dwelling houses in which defects were remedied :— (a) By owners 4,943 (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. (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. 79 Mortuaries. The Council have two mortuaries. The central at High Street South and the other at North Woolwich. 103 bodies have been admitted and 68 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, which is maintained in a satisfactory condition. Police Court Proceedings. On 73 occasions it has been necessary to have recourse to legal proceedings, viz. :— Under Public Health Acts for non.compliance with Sanitary Notice, etc. 25 Under Shops Acts and Closing Orders for contraventions 44 Under Gipsy Bye.laws for failing to provide sufficient water supply 4 Fines and costs have been imposed in all amounting to £41 5s. 6d. See tables, pp. 80.83. 80 PROSECUTIONS UNDER THE PUBLIC HEALTH ACT FOR THE YEAR 1929. Date. Situation of Premises. Offence. Result. March Langdon Road Non.compliance with sanitary notice Withdrawn. 3/6 costs. March do. do. do. 3/6 do. March do. do. do. 3/6 do. March do. do. do. 3/6 do. March do. do. do. 3/6 do. March do. do. do. 3/6 do. March Clacton Road do. Dismissed. April Harcourt Avenue do. Withdrawn. 3/6 costs. April St. Bernard's Road do. do. 3/6 do. April do. do. do. 3/6 do. April do. do. do. 3/6 do. May Vicarage Lane do. do. 3/6 do. May Napier Road do. do. 3/6 do. May Welstead Road do. Adjourned June Storey Street do. Withdrawn. 3/6 costs. September Alverstone Road do. Court Order to complete within 14 days. October Ernald Avenue do. Withdrawn. 3/6 costs. October do. do. Court Order to complete within 14 days. 7/6 costs. October do. do. Court Order to complete within 14 days. 7/6 costs. November Dersingham Avenue do. Withdrawn. 6/6 costs. December Bonny Downs Road do. Adjourned. December Harrow Road do. Withdrawn. 3/6 costs. December Grantham Road do. do. 3/6 do. December Bonny Downs Road do. Adjourned. December do. do. do. 81 PROSECUTIONS UNDER THE SALE OF FOOD AND DRUGS ACT FOR THE YEAR 1929. Date. Offence. Result. NIL. PROSECUTIONS UNDER THE EXPLOSIVES ACT FOR THE YEAR 1929. Date. Offence. Result. NIL. PROSECUTIONS UNDER THE MARGARINE ACT, 1887, FOR THE YEAR 1929. Date. Offence. Result. NIL. 82 PROSECUTIONS UNDER SHOPS ACTS DURING 1929. Date. Offence. Result. Fines. £ s. d. January Shops Acts, 1912 to 1928 1 0 0 January Grocers' and Provision Dealers' Closing Order, 1923 1 0 0 February Butchers' Closing Order, 1922 5 0 0 February Shops Acts, 1912 to 1928 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 1 0 0 February do. 0 5 0 February do. Removed. April Grocers' and Provision Dealers' Closing Order, 1923 1 0 0 83 PROSECUTIONS UNDER SHOPS ACTS DURING 1929 —continued. Date. Offence. Result. Fines. £ s. d. May Shops Act, 1912 Withdrawn. May do. Withdrawn. May do. Withdrawn. May do. Withdrawn. May do. Withdrawn. May do. Withdrawn. May do. Withdrawn. May do. Withdrawn. July Shops Acts, 1912 to 1928 1 0 0 September do. 0 10 0 September do. 0 10 0 October do. 0 10 0 October Grocers' and Provision Dealers' Closing Order, 1923 0 10 0 October Shops Acts, 1912 to 1928 Dismissed. Costs 4/. November Grocers' and Provision Dealers' Closing Order, 1923 2 0 0 November Shops Acts, 1912 to 1928 1 0 0 PROSECUTIONS UNDER GIPSY BYE.LAWS. Date. Offence. Result. January Vacant Land, Langdon Crescent Fined £1. January do. Adjourned sine die. January do. Adjourned sine die. January do. Adjourned sine die. 85 The Following is a Record in Detail of the Inspections made during the Year 1929:— 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 483 11 227 113 242 126 249 123 130 25 240 71 361 149 229 147 172 ... 241 98 2574 863 Factory and workshop premises inspected 17 ... 2 ... 11 ... 12 ... 8 ... 4 ... 19 ... 12 ... ... ... 7 ... 92 ... Outworkers' premises inspected 2 ... 10 ... 4 ... 19 ... 13 ... 27 ... 18 ... 17 ... 8 ... 7 ... 125 ... Bakehouses inspected 10 ... ... ... 9 ... 7 ... 4 ... 4 ... 7 ... 2 ... 2 ... 6 ... 51 ... Slaughter.houses inspected 340 ... ... ... 252 ... 70 ... ... ... ... ... 109 ... ... ... ... ... 213 ... 984 ... Dairies inspected 8 ... 13 ... 16 ... 12 ... 3 ... 18 ... 9 ... 6 ... 9 ... 12 ... 106 ... Urinals inspected 4 ... 1 ... 1 ... ... ... 5 ... 1 ... 3 ... 3 ... ... ... 10 ... 28 ... Walls and ceilings dirty and dilapidated 82 54 163 445 92 90 122 215 84 76 151 264 153 577 105 343 54 ... 197 488 1203 2552 Yards improperly paved and dilapidated 13 10 23 58 17 24 23 95 18 13 26 48 54 155 69 180 9 ... 34 127 286 710 No forecourt paving 8 26 15 27 2 2 13 35 18 2 8 25 13 86 11 61 1 ... 5 68 94 332 Defective drains 5 ... 5 ... 7 ... 7 ... 7 1 ... ... 6 ... ... ... ... ... 17 ... 54 1 Defective w.c. connections ... ... 3 ... 2 ... 1 ... ... ... ... ... ... ... 2 1 ... ... 3 ... 11 1 Defective w.c. traps 10 1 16 52 13 10 13 39 8 4 7 33 12 15 9 7 1 ... 31 38 120 199 Defective flushing apparatus 10 12 20 42 15 12 13 21 18 8 17 15 26 82 26 39 12 ... 25 52 182 283 Soil pans foul and broken 12 3 16 39 8 9 13 54 10 8 14 49 22 36 16 38 5 ... 28 45 144 281 Defective vent pipes 11 14 23 84 5 10 4 6 12 10 10 7 16 36 15 84 3 ... 9 26 108 277 r.w. pipes and eaves gutters defective 48 31 80 239 34 31 47 46 58 52 55 54 98 157 91 261 26 ... 87 220 630 1091 r.w. pipes connected to drain 1 ... 1 ... ... ... 2 3 1 2 ... ... ... 1 ... ... ... 1 2 6 8 Roofs leaky 25 13 106 149 40 20 48 61 46 47 74 88 70 102 64 123 21 ... 95 201 589 804 Defective sink waste pipes 20 17 28 134 12 12 5 15 28 25 9 12 19 48 24 76 5 ... 13 86 163 425 Houses without water (M.W.Bd.) ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Cisterns without covers ... ... 1 ... ... ... ... ... 1 ... ... 1 1 ... ... ... ... ... 1 ... 4 1 Drinking water improperly stored 7 1 ... 1 15 31 3 16 ... ... ... ... 3 13 3 1 2 ... 2 13 35 76 Dilapidated floors 9 2 18 50 13 9 13 19 13 7 14 20 34 66 34 44 1 ... 36 96 185 313 Insufficient underfloor ventilation 4 7 18 64 2 2 7 17 26 20 13 13 29 85 28 70 1 ... 12 99 140 377 Dampness 41 31 93 118 40 20 37 25 38 19 35 44 38 60 32 26 13 ... 104 256 471 599 Accumulations 45 2 24 16 5 ... 6 1 8 ... 6 ... 15 2 20 ... 5 ... 23 1 157 22 Defective sashcords and windows 19 11 29 95 34 32 32 61 21 26 30 77 28 115 32 29 14 ... 69 202 308 648 Overcrowding 2 ... 10 2 ... 1 ... 3 1 1 ... 2 ... 1 ... ... ... 3 2 23 5 Unsound food 83 ... ... ... 186 ... 26 ... ... ... ... ... 29 ... ... ... ... ... 142 ... 466 ... No dust bins 18 8 36 82 13 7 3 37 15 14 12 33 7 62 35 8 12 ... 31 71 182 322 Defective stoves 17 6 18 57 20 8 20 45 21 5 38 85 25 127 22 15 4 ... 47 160 232 508 Defective coppers 7 4 12 44 8 7 18 36 15 5 17 41 14 72 25 22 12 ... 31 89 159 320 Animals improperly kept 1 ... 2 2 ... ... 1 ... ... ... 1 ... 3 ... ... 1 1 ... 1 2 10 5 Temporary buildings found ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Smoke nuisances 13 ... 1 ... 1 ... ... ... ... ... 1 ... 2 ... ... ... 1 ... ... ... 19 ... Rear passages unpaved or undrained 1 ... ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... 6 ... 11 ... Gipsies ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28 ... ... ... ... ... 28 ... Breaches of Bye.Laws and Regulations 4 ... 1 ... ... ... 8 ... 1 ... 3 ... ... ... ... ... 1 ... ... ... 18 ... Other nuisances 98 21 140 204 102 63 106 129 110 41 136 175 172 382 180 329 46 ... 148 257 1238 1601 Drains unstopped and cleansed 64 ... 173 ... 57 ... 83 ... 47 ... 63 ... 127 ... 72 ... 51 ... 136 ... 873 ... Drains tested 73 ... 124 ... 92 ... 56 ... 35 ... 63 ... 54 ... 18 ... 12 ... 22 ... 549 ... Inspections 1029 101 858 867 848 319 773 430 494 161 779 390 937 890 772 736 477 ... 958 848 7925 4742 Total Inspections 1130 1725 1167 1203 655 1169 1827 1508 477 1806 12667 COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Annual Report OF THE School Medical Officer for the year 1929. 88 EAST HAM EDUCATION COMMITTEE Councillor J. J. Pope (Chairman). Councillor G. P. Dean, J.P. (Vice.Chairman). Councillor T. I. Lethaby, J.P. (Deputy Mayor). Councillor Mrs. H. N. Ridler. Alderman W. G. Davie, J.P. Councillor E. C. Howlett. Alderman C. L. E. Masset. Councillor H. J. Kybert. Alderman H. Osborn, J.P. Councillor G. H. Manser. Alderman N. A. Papworth. Councillor R. W. Moger. Alderman H. N. Ridler. Councillor W. T. Newling. Alderman E. Shanahan, J.P. Councillor A. H. W. Owen. Alderman E. H. Thompson. Councillor G. Pottinger. Councillor W. W. Bagot. Councillor A. C. Warner. Councillor G. W. Boultwood, J.P. Councillor T. Watts. *Councillor J. Brooks, J.P. Miss L. Butcher. Councillor T. W. Burden. E. T. Andrews, Esq., B.A. Councillor F. P. Cross, J.P. E. J. Sullivan, Esq. Councillor A. E. Dennington. R. Whitfield, Esq. Councillor T. J. Hawkins. *Co.opted Member 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.I., Mrs. Childs, S.R.N. A.R.,San.I., Certified Midwife, Miss Olifent, R.F.N., Miss Maltby, R.R.C., Miss Young, S.R.N., Certified Midwife, and Miss Nunn, Certified Midwife. Administrative and Clerical Staff : F. Read, M.S.M. (Chief). Miss A. M. Dean, Miss F. E. Hales, Miss O. E. Griffin and Miss I. R. Backer. Dental Surgeons (full.time) : C. S. Neame, L.D.S., R.C.S., A. E. Hall, L.D.S. (Liverpool). Ophthalmic Surgeon : C. L. Gimblett, M.D., M.R.C.P., F.R.C.S. (until April, 1929). S. C. Reeve.Flaxman, M.R.C.S., L.R.C.P. (from April, 1929). (Three sessions per week.) Aural Surgeon : L. G. Brown, M.D., F.R.C.S.Eng. (until March, 1929). R. Savege, M.B., Ch.B., F.R.C.S.Eng., D.L.O. (from April, 1929). (One session per week until September, 1929.) (Two sessions per week from October, 1929.) Assistant Medical Officers : Miss M. M. Thomson, L.R.C.P.,. L.R.C.S., D.P.H. (full time). W. E. Snell, M.D., M.R.C.S., L.R.C.P. (part.time). 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. 89 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, 1929. The average school attendance throughout the year approximated closely to 17,730. The number of routine and special cases of elementary school children examined totalled 12,870, as compared with 13,663 in 1928, and a complete medical inspection of all the scholars in the Secondary Schools has also been carried out. Considerable progress has been achieved during the year; the most gratifying and outstanding features in this respect being the appointment of a second full.time Dental Surgeon, the introduction of the ionization method of treatment in aural cases, the allocation of an additional session per week to the treatment of diseases of the ear, nose and throat, and the adoption of the principle of protective immunisation against diphtheria. On the other hand, the question of providing suitable premises for the conduct of the School Medical Service becomes still more pressing. Although I have endeavoured, so far as staff and equipment are concerned, to ensure that no useful means of preventing the occurrence of disease, ill.health and invalidity has been overlooked, yet, with the provision of suitable and adequate accommodation a much wider application of these methods could result. The wide scope and varied activities of the School Medical Service demand very careful administration and supervision in order to ensure the complete success of the Authority's endeavours to promote the health, hygiene and physical and mental development of the school children under their care, and one may be pardoned perhaps for exhibiting a little justifiable pride in reproducing the following extract from the letter received by the Authority from the Board of Education in November, 1929 :— 90 "The Board note with satisfaction the high level of efficiency reached in the working of the Authority's arrangements for the School Medical Service, particularly in regard to routine medical inspection, the school nursing services and the treatment of the various types of defect covered by the scheme." The difficulty of providing satisfactory treatment for delicate, malnourished, debilitated and physically defective children, who, in many cases, require a change of air and the regulation and routine of a healthy life, has been overcome largely as the result of the keen activity of the local branch of the Invalid Children's Aid Association. Thirty children have been sent to Schools of Recovery, through this Association, by arrangement with the Local Authority. In addition, the very courteous co.operation of the Association with the Authority's Medical Officers has secured open.air and convalescent treatment for 106 children of school age, for whom the Association has undertaken full financial responsibility. Probably the most important problem in connection with the health of the school child is the ever.growing necessity for complete medical supervision and treatment of the pre.school child. It is a matter for serious thought that a very large number of " entrants," seen at routine medical inspection, are found to be suffering from old.standing defects, and that the parents of these children have failed to avail themselves of the opportunities afforded for medical examination, advice and treatment at the Child Welfare Centres. (See 2. Co.ordination.) With this report I have great pleasure in presenting, as a supplement, the statistics and conclusions of Mr. C. L. Gimblett, the Ophthalmic Surgeon to the Education Committee, in regard to his special investigation upon the incidence of Myopia in scholars attending the elementary and secondary schools ; this report should prove of the greatest interest and value to those connected with public, social and professional life, not only in East Ham but throughout the country generally. Unfortunately Mr. Gimblett resigned his appointment in April last, after seven years' service, and the Local Education Authority has lost an extremely efficient and conscientious School Oculist; both parents and children will regret his departure but will remember him with feelings of 91 tude and pleasure, whilst the staff of the School Medical Department will miss very greatly the ever.ready and painstaking advice of a highly esteemed colleague. The Staff of the School Medical Service are to be congratulated upon the excellent work accomplished throughout the year (under conditions which are far from ideal), 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. 92 1. STAFF. A list of the Staff of the School Medical Department will be found on page 88 of this Report. 2. CO.ORDINATION. Suggestions for the co.ordination of the various health services of the County Borough have been fully discussed in previous reports, and I have indicated the general outline of an administrative scheme which should result in complete co.ordination, greater efficiency and, ultimately, a very apparent economy. One of the most urgent problems facing us at the present time is the supervision of the health, and the prevention of physical defect in infants and children under school age. Although the School Medical Service is fully equipped for dealing with these children, difficulties arise out of the fact that supervision and administration are performed by two Authorities, one of which is concerned with the pre.school child and the other with the school child. The various suggestions, put forward from time to time, for ensuring the medical inspection and supervision of children under school age, not excepting the provision and maintenace of Nursery Schools, do not appear to offer an economic solution. The average parent in East Ham cannot afford the time to visit two or three different Centres, especially for the medical examination of children who are apparently healthy or even in those cases where a parent feels that a child is not progressing quite satisfactorily. The work of the Health Visitors and School Nurses in the homes cannot be too highly estimated but, whilst they are in the position of being able to advise and encourage the seeking of medical attention for infants and children who exhibit obvious defect, nevertheless the absence of a definite scheme, for the routine medical examination of children under school age, prohibits the possibility of discovering incipient and latent manifestations of physical defect and thus precludes any complete application of the principles of preventive medicine. 93 Statistics show that only a very small proportion of the children entering school have attended the Child Welfare Centres and that a still smaller number have undergone a systematic medical examination. On the other hand, the percentage of parents attending the routine medical inspection of " entrants " to school life has been steadily increasing, and in 1929 nearly 80 per cent. of the children examined in the Infants Departments were accompanied by their parents. There is no doubt that a policy which offered the medical examination of children under school age at the time of routine medical inspection in the schools, would be met by a ready response and would tend to solve the difficulty under review. The School Medical Service is fully equipped for dealing with these children, and it is only administrative and legislative difficulties which stand in the way of the adoption and efficient performance of a scheme devised along these lines. 3. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene. During the year 1929 a complete survey of the sanitary and hygienic conditions pertaining to all the schools of the Authority has been carried out. Reports upon matters requiring attention have been submitted month by month to the Committee In most instances my recommendations have received careful consideration, and an endeavour has been made to remedy defects where possible, but a good deal remains to be done in connection with improvements in lighting, heating, ventilation and overcrowding of certain classrooms, and in regard to the provision of sufficient and satisfactory sanitary and cloakroom accommodation. 4. MEDICAL INSPECTION. The following is a synopsis of School Medical Work for the year 1929. The figures for the year 1925 to 1928 are also given for comparison :— 94 comparative statement OF WORK. 1925. 1926. 1927. 1928. 1929. Routine and Special Inspection (on School Premises) 10,728 10,944 8,483 10,408 9,763 Re.inspection 3,784 4,737 4,175 4.061 4,821 Consultations at Inspection Clinic 13.445 14,575 13,530 16,533 15,675 Number of Treatments at Clinic 18,665 15,810 14,873 19,140 18,517 General Cleanliness Visits to Schools 335 297 257 274 322 Nurses' Visits to Homes 3,840 4,948 4,547 4,239 3,824 Children Examined for Cleanliness 58,090 58,683 58,588 55,351 53,009 (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. Routine Medical Inspection was completed in all the schools of the Borough, but it was found impossible to carry out the re.inspection in twelve schools, so that, unfortunately, the programme for the year 1930 must include a debit balance in this respect. The fact that the work of the Department is generally more up to date than in former years is largely due to the absence of staffing difficulties resulting from the resignation, transfer and sickness of members of the Staff. Furthermore, the decision of the Local Authority to re.allocate the duties of Dr. Bendix, who has been responsible for the organisation and administration of the School Medical Department during the past eight years, so that more of his time is devoted to school work, made it possible to complete the Medical Inspections in spite of the resignation of Dr. Snell in the latter part of the year. (a) (ii.) Administration and Clerical Staff. In previous reports an attempt has been made to outline the scheme of organisation, administration and co.ordination of the School Medical Service but, without an inside knowledge of the 95 clerical work performed in the office, it is quite impossible to assess the marked degree to which the success of the Department depends upon efficient clerical administration. The ordinary office routine is intricate and requires meticulous care and precision in order to ensure smooth and efficient arrangements for medical and dental inspection, re.inspection, clinic attendance (15 clinics are held each week), following up, general cleanliness and sanitary surveys, the examination of special cases referred through various channels, the keeping of the necessary accounts and stock, and for prompt action in regard to notification of infectious and contagious diseases, in regard to notification of entrants, transfers, promotions and changes of address, and in regard to ensuring the reception and despatch of medical records. Co.ordination can only be assured by an alert and active office staff whereby reports and returns are promptly interchanged between the School Medical Department and the services with which it is intimately associated (the Education Department and the Schools, the Maternity and Child Welfare Service, the Tuberculosis Dispensary, the Hospitals, Convalescent Homes, Schools of Recovery, etc.), and whereby members of the professional staff are furnished immediately with any relevant and necessary information arising out of such reports. The filing and compilation of complete and up.to.date records, statistics and schedules is imperative, requires careful organisation and involves a great deal of thought and management in order to ensure the minimum amount of necessary work commensurate with a maximum amount of efficiency and accuracy. It is only possible to touch upon the fringe of the clerical activities of the Department, and I sincerely regret that the Authority were not convinced that my proposal, in regard to the position of Chief Administrative Clerk in the School Medical Department, was justifiable. Since that proposal was put forward developments, which have still further increased the work and responsibility, have accrued, and amongst these may be mentioned the addition to the Staff of a full.time dental surgeon, an increase in the number of sessions devoted to aural treatment, the treatment of orthopaedic cases at Queen Mary's Hospital, the operative treatment of tonsils and adenoids at the Memorial Hospital, and the 96 reservation of additional places in Schools of Recovery and Schools for Physically Defective Children. (b) Exceptional Children. Towards the termination of routine medical inspection in each school, teachers are requested to bring before the School Medical Officer any special cases who may require examination, and to include amongst these all cases falling within the category of "exceptional children" (Table III). In this way an annual census of all cripples is rendered possible, whilst particulars may be obtained and advice given as to their progress and treatment. (c) Places of Medical Inspection. 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 following comparative table serves to indicate the number and percentage of children found to be in need of medical or surgical treatment in the three age groups inspected during the year. Under present conditions it is probable that this percentage will not show any marked reduction or fluctuation from year to year, for the reasons which were discussed in my report for last year and which, in essence, embraced the fact that, unfortunately, a large majority of the defects found have had their inception before the children have reached school age and, in many cases, the defect is of such a nature that definite cure is impossible and all that can be expected is to check its progress, whilst in other cases prolonged treatment, sometimes throughout school life, is necessary in order to effect a cure. On the other hand, the past ten years has brought about a remarkable improvement in the general health, physique, vitality and personal hygiene; the delicate, dull and malnourished children, so commonly encountered ten years ago, have given place to the more robust, alert, clean and athletic type met with in our schools to.day. Similarly one seldom meets with that palpable neglect to seek treatment for conditions which are perfectly obvious to the parents, and one is more than gratified to think that the suffering and fatality, consequent upon neglect of defects, trivial perhaps at the onset, is now of very rare occurrence. 97 FINDINGS OF MEDICAL INSPECTION. Group. NUMBER OF CHILDREN. Percentage of Children found to require Treatment. Inspected. Found to require Treatment. 1924 1925 1926 1927 1928 1929 1924 1925 1926 1927 1928 1929 1924 1925 1926 1927 1928 1929 Entrants 1,171 2,960 3,345 2,468 3,197 2,998 187 340 454 244 354 411 15.97 11.5 13.6 9.9 11.1 13.7 Intermediates 2,172 2,961 1,991 1,295 2,424 2,208 384 445 270 133 291 316 17.68 15.0 13.6 10.3 12.0 14.3 Leavers 3,116 3,118 3,877 2,717 2,848 2,366 385 370 520 180 237 248 12.36 11.9 13.4 6.6 8.3 10.5 Totals 6,459 9,039 9,213 6,480 8,469 7,572 956 1,155 1,244 557 882 975 14.8 12.8 13.5 8.6 10.4 12.9 98 (a) Uncleanliness. The School Nurses have carried out 3 cleanliness surveys of all the children in the elementary schools during the year 1929. During the year the School Nurses made 53,009 examinations, as compared with 55,351 in 1928. Of this number 426 children showed vermin and many nits in the hair (387 in 1928), whilst 1,866 children showed only a few nits (2,020 in 1928). Comparative table :— Year Number Examined Number with Nits Number with Head Vermin No. of Exclusion Certificates 1925 58,090 2,856 652 45 1926 58,683 2,527 668 49 1927 58,588 2,140 479 50 1928 55,351 2,020 387 40 1929 53,009 1,866 426 26 99 TABLE VII. TABLE OF VERMINOUS CONDITIONS FOUND AT EXAMINATIONS FOR GENERAL CLEANLINESS. SCHOOLS. Dept. Number Exam'd. Few Nits. Many Nits and Vermin. SCHOOLS. Dept. Number Exam'd. Few Nits. Many Nits and Vermin. Avenue Infants 925 72 21 Myope Class 42 1 Girls 896 125 55 Napier Infants 978 71 22 Boys 816 65 14 J. Boys 1248 39 8 Brampton Infants 1634 24 5 S. Boys 723 14 6 J. Girls 1236 51 1 Plashet Infants 788 36 1 S. Girls 924 17 - J. Boys 1018 13 1 Castle Street R.C Infants J07 13 1 S. Boys 715 1 Mixed 437 13 1 "Salisbury" Primary 1548 27 1 Central Park Infants 891 37 9 Inter 640 7 J. Boys 1314 6 — Sandringham Road J. Mixed 1054 30 13 S. Boys 1095 2 — S. Mixed 898 26 5 Cornwall Infants 1292 61 15 Shaftesbury Road Infants 1082 57 7 Girls 1138 55 29 Girls 1283 75 3 Boys 1033 16 2 Boys 380 2 Dersingham Mixed 917 54 18 Shrewsbury Road Special 180 11 Essex Road Infants 904 23 6 Storey Street J. Mixed 723 27 6 Girls 1056 19 1 S. Mixed 940 34 27 Boys 1012 — - Silvertown R.C. J. Mixed 425 24 14 Hartley Infants 945 34 1 S. Mixed 661 30 26 J. Girls 1029 54 1 St. Michael's R.C. Mixed 295 10 6 S. Girls 915 29 1 St. Winefride's R.C. Mixed 790 40 14 High Street J. Mixed 936 34 Vicarage Infants 1123 45 17 S. Mixed 468 11 - .T. Girls 986 58 18 Kensington Avenue Infants 911 15 5 S. Girls 776 49 18 Junior 985 24 5 "Winsor" Primary 1097 86 12 Senior 938 29 2 Inter 764 46 Lathom Road Infants 1126 27 3 Wakefield Central Girls 190 3 Girls 1152 46 3 Other examinations 429 84 Boys 1184 3 — Monega Road Infants 1014 15 — Total 53009 1866 426 Girls 566 18 2 Boys 1327 4 - Per cent. Per cent. in 1928 3.5 3.6 •8 •7 100 It will be noted that the low incidence in the number of children suffering from uncleanliness is maintained, 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. In addition to the routine general cleanliness survey, some hundreds of children have been examined by the School Nurses at the request of the Authorities of the Children's Country Holiday Fund and other voluntary organisations. The examinations have been conducted just prior to the departure of the children for summer holiday camps. (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, frequentlyrecognised 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 1928 1929 ]928 1929 Scabies l 2 16 16 Impetigo 27 27 427 380 Conjunctivitis 2 3 57 82 Blepharitis 4 6 54 75 Ear Disease 50 89 187 111 Ringworm (Scalp) 3 4 61 45 Ringworm (Body) - - 36 16 (c) Tonsils and Adenoids. 5.2 per cent. of the children examined during the year were referred for treatment for "tonsils and adenoids," either separate or combined, as compared with 4.8 per cent. in the year 1928. Of these, much enlarged tonsils accounted for 1.5 per cent ; 101 definite adenoids were present in 0.2 per cent., and the combined defect was diagnosed in 3.5 per cent.; the figures for 1928 were 0.7 per cent., 0.5 per cent., and 3.6 per cent., respectively. The percentage of children moderately affected and requiring to be kept under observation was 10.9, the corresponding percentage in 1928 being 7.3. In this case 9.3 per cent. had moderately enlarged tonsils, 0.3 per cent. exhibited signs of the presence of adenoids, whilst 1.3 per cent. showed enlarged tonsils and adenoids of moderate degree, as compared with 6.4 per cent., . 0.5 per cent., and 0.4 per cent., respectively in the year 1928. (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 5 5 10 Other forms of Tuberculosis 13 13 26 Totals 18 18 36 (e) Skin Disease and (/) External Eye Disease. The number of these cases still remains high. At medical inspections during the year 857 children were found to be suffering from skin affections (as compared with 844 in the year 1928). Cases of external eye disease also continue to show a high incidence, 166 in the year 1929 and 117 in the year 1928. (g) Vision. Only children with marked visual defect have been referred for treatment and these, including cases of strabismus, numbered 636. In addition there were 81 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. 131). 102 (h) Ear Disease and Hearing. 0.6 per cent. of the children examined were found to be suffering- from otitis media, as compared with 0.2 per cent. in 1928. The percentage of deaf children was 0.5, the correspondingnumber for last year being 0.4. (i) Dental Defects. (See report of Dental Surgeon on p. 133.) (j ) Crippling Defects. Reference to Table III on page 141 will furnish information with regard to the occurrence of crippling defects in the area. 6 cases of crippling due to tuberculosis and 73 cases due to other causes were discovered at routine medical inspection during the year. 6. INFECTIOUS DISEASES. A detailed account of the scheme adopted for the detection and prevention of infectious diseases 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 1929. The high incidence of the more serious acute infectious diseases, which has been such a source of anxiety during the past two years, has been followed by a very definite decrease during the year 1929. The bacteriological examination of swabs from the throats and noses of school children is carried out:— (a) Prior to the admission of children to Schools of Recovery, Convalescent Homes, etc., in order to ensure freedom from infection. 58 swabs were taken for this purpose, and the fact that one of these proved to be positive shows the great importance of this procedure. (b) In suspicious cases seen at the Clinics or Schools. 84 swabs were taken and 17 proved to be positive. (c) In cases where an undetected source of infection appears to be present in a class or school. 136 swabs were taken and 10 proved to be positive. 103 It is with a great deal of pleasure that I am able to report that, at the instigation of the Education Committee, the Council have adopted the principle of protective immunization against Diphtheria, that the residents of East Ham have been offered this form of treatment and that the work was commenced in September, 1929. The matter is fully discussed, and the statistics included, in my report as Medical Officer of Health. So far the response has exceeded our expectations and, should the present number of applicants be maintained, there is no doubt that a considerable reduction in the incidence of Diphtheria may be anticipated. In regard to Small-pox there were no actual cases but twelve contact cases in children attending schools in the Borough. Eight schools were involved and, in addition to the usual precautions, it was thought desirable to circularise the parents of all the children attending these Schools and to advise them that, whilst everything possible had been done by the Local Authority to prevent the spread of infection, the only real safeguard was vaccination and revaccination. The result of this action is encouraging and a large number of children have been vaccinated. Table of the Chief Infectious Diseases, Showing the Monthly Incidence in Children of School Age. Month Measles Chicken Pox Whooping Cough Mumps Scarlet Fever Diphtheria January 4 10 9 18 18 9 February 1 8 2 9 33 21 March 4 2 10 8 16 20 April 29 19 17 7 39 14 May 142 10 19 7 14 12 June 69 26 26 4 30 35 July 5 9 8 16 38 14 August — — — — 9 9 September 1 1 11 — 17 19 October 1 2 1 1 65 60 November — 6 19 7 45 45 December 6 39 17 3 53 40 Totals (737) 262 (185) 132 (2961 139 (50) 80 (565) 377 (426) 298 The totals in brackets are those for the year 1928 and are inserted for comparison. 104 105 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. 1928 1929 1928 1929 Ringworm of Scalp 54 23 1966 834 Ringworm of Body 46 35 1324 704 Impetigo Contagiosa 158 68 1696 687 Infective Eye Inflammation 72 57 1246 864 Septic conditions 156 152 1540 1507 Verminous conditions 34 18 252 133 Scabies 30 12 560 264 Other Skin conditions 46 51 558 614 Acute Throat conditions 48 37 1000 277 644 453 10142 5947 7. FOLLOWING UP. The arrangements for following up defects found at medical inspection were set out fully in the report for 1920, and these have been continued throughout. The School Nurses have paid 3,824 visits to the homes of children in whom defects were found at medical inspection, and for special investigation purposes. Of the 1,176 children referred for treatment, 870 or 74 per cent, have obtained treatment. The School Nurses have also paid 160 special visits to the Schools, and 26 visits to the Feeding Centres, and have undertaken 20 journeys in connection with the admission and discharge of children to Institutions. All, children, referred for the operative treatment of tonsils and adenoids (594), 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. 106 The duties of the School Nurses are becoming much more elaborate and their responsibilities have increased, and are increasing very considerably. Special investigation and report by the School Nurse upon individual school children is becoming more important, and the number of cases dealt with is increasing rapidly; very full reports are required, and these necessitate careful preparation and a high standard of technical (nursing and sanitary) knowledge. In this connection also the large London General Hospitals are seeking the co-operation of the School Medical Service to a greater and greater extent with a view to ensuring the best possible line of treatment for children attending as OutPatients, and also as In-Patients prior to admission and after discharge. The duties of the School Nurses in East Ham are very varied and include much specialised work in connection with treatment by means of ultra violet radiation, the X-ray treatment of ringworm, ophthalmic treatment, aural treatment, dental treatment, etc., duties, which in many areas, are performed by specially appointed Nurses. It seems unfortunate that no standard has been indicated by the Board of Education in regard to the qualification and status of School Nurses along the lines taken by the Ministry of Health in connection with Health Visitors. There is no doubt that such a standard would be to the advantage of the School Medical Service generally, would certainly be a source of satisfaction to the more highly qualified members of the Nursing Staff and would remove any obstacle to complete co-ordination in the near future. The County Borough of East Ham is fortunate in possessing a very keen, efficient and well-qualified 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. 107 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—Tuesdays at 9 a.m., Thursdays at 9 a.m., and Fridays at 9 a.m. (6) Ear Specialist Clinic, Town Hall—Tuesdays and Fridays, at 3 p.m. (7) Light Clinic, Town Hall—Mondays and Wednesdays, at 2 p.m. A full account of these clinics was set forth in my report for 1922. During the year 1929, 18,517 attendances were made for treatment at the various clinics, and there were 15,675 attendances for consultation of the Medical Officers. {a) Minor Ailments. An analysis of the chief minor ailments treated at the School Clinics, and otherwise, will be found in Table IV, Group 1, p. 145. (ib) 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, 594 have received operative treatment with marked beneficial results to their general health. Arrangements for the performance of these operations are in force with three hospitals, viz., St. Mary's, Plaistow; Balaam 108 Street Children's Hospital and Queen Mary's Hospital, Stratford, and it is hoped that a similar arrangement will be made in regard to the East Ham Memorial Hospital early in the new year. 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. An agreement has been reached with the Hospital Saving Association which became effective on 1st October, 1928, by which the children of Hospital Saving Association contributors are issued with authorities for operative treatment of tonsils and adenoids on presentation of the necessary Hospital Saving Association voucher in lieu of the usual fee of 5s. required from the parent. Quarterly accounts are subsequently sent to the Hospital Saving Association. The arrangement has proved satisfactory and has eliminated many difficulties which were previously experienced with Hospital Saving Association cases. (c) Tuberculosis. The arrangements for the treatment of Tuberculosis have been continued on the lines fully set forth in my reports for previous years. (d) Skin Diseases. For the most part these are treated at the General Clinic, but some cases of chronic and of the rarer skin diseases are referred to hospital. The application of X-rays in cases of ringworm is performed at the School Clinic, and 14 children received this form of treatment during this year. (e) External Eye Disease. 266 cases (176 in 1928) of external eye disease were treated at the School Clinics. (/) Vision. During the year 1929 the Ophthalmic Clinic was held on five sessions per fortnight. 109 636 cases were referred for treatment in respect of visual defect during the year 1929 and, including 143 cases awaiting treatment at the termination of the year 1928, 607 cases have been treated in the past year. On the 31st of December, 1929, there were 130 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 81 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. A Sight-saving Class at Monega Road School was opened by the Education Committee in June, 1928. 20 children are in attendance at this class, and they are all kept under observation by the Ophthalmic Surgeon at certain intervals. (See also Ophthalmic Surgeon's Report, p. 131.) (g) Ear Disease. 155 consultations were given and 105 children were treated at the General Ear Clinic. This clinic was discontinued in October, 1929. Mr. R. Savege, the Authority's Aural Surgeon, commenced the ionisation method of treatment for cases of ear disease in June, 1929, and, in view of the fact that this form of treatment occupies a much longer period in each case and of the general increase in the attendance of cases at the Aural Clinic, the Education Committee decided that arrangements should be made for Mr. Savege to attend for two sessions per week as from the 1st October, 1929. During the period June to December, 1929, 36 Aural Clinic sessions were held. The total attendances at the Aural Clinic was 765, making an average attendance, at each session, of 21 patients. Ionisation treatment was carried out in 30 cases, 70 applications being made; that is to say an average of 2.5 ionisation treatments were performed at each session; the treatment occupies just over half an hour in each case. Although it is somewhat early to form an opinion, the results of ionisation have proved, for the most 110 part, the great advantage of this method over other forms of treatment (seven of the above cases have already been discharged as cured) and Mr. Savege gives a very favourable report of its efficacy in suitably selected cases. The Aural Surgeon has recently indicated the necessity for some arrangement being made in regard to the operative treatment of "mastoid cases," owing to the difficulty experienced in securing their admission to Hospital under present circumstances; the only satisfactory solution appears to be for the Authority to enter into an agreement for the reservation of the necessary accommodation in one of the local Hospitals. (See also Report of Aural Surgeon, p. 130.) (h) Dental Defects. The appointment of a second full-time Dental Surgeon will enable the Authority to double their activities in endeavouring to ensure dental health and to banish many of those ills which originate in the mouth. As I have pointed out on former occasions 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 reinspect 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. The Authority's Staff of two Dental Surgeons should be able therefore to deal effectively with about 50 per cent. of the children in our schools. (See also Report of Dental Surgeon, p. 133.) (i) Crippling Defects. Orthopaedic treatment has been continued under arrangement made with the Balaam Street Children's Hospital of the Invalid and Cripple Children's Society. The treatment at the hospital includes operative, electrical and massage treatment, remedial exercises and the supply of III surgical appliances, and is carried out under the direction of an orthopaedic surgeon. Payment is made to the Hospital Authorities by a per capita grant contribution in respect of East Ham scholars sent to the Hospital through the School Medical Service. All children referred by the Authority's Medical Officers to the Hospital for treatment are kept under observation at frequent intervals at one or other of the School Clinics, in order that the progress of the cases may be watched and recorded, and to ensure that treatment has not been allowed to lapse. If at any time such a case fails to attend the School Clinic it automatically becomes included in the following-up list of one of the School Nurses. It was with great regret that we were compelled to discontinue our arrangement with the Balaam Street Children's Hospital owing to the occurrence of staffing difficulties which interfered with treatment being carried out as expeditiously as was previously the case. A large amount of work has been undertaken at the Hospital and has been highly satisfactory. During the year 1929, 25 out-patients have received treatment, the total out-patient attendances being 474, but no in-patient treatment has been given for the reasons mentioned above. In November, 1929, the Authority entered into an agreement with Queen Mary's Hospital, Stratford, in respect of a complete scheme for the treatment of orthopaedic cases, a full report of which will be included in my report for next year. (j) The Light Clinic. A further twelve months experience of actino-therapy does not warrant any change of opinion as to the superior value of this form of treatment, in the type of cases selected, over all other measures which have been given a trial, and I can only confirm my reports of previous years in this respect. It is very unfortunate that what accommodation we have is only available for the holding of this Clinic on two sessions and that for the remainder of the week the apparatus is idle. (i) Apparatus. For the purpose of carrying out artificial light treatment there are two arc lamps in the Town Hall Clinic : a quadruple carbon arc 112 lamp of the radial type for general therapeutic purposes and a single tungsten arc lamp for local treatment. (ii) Accommodation. Unfortunately the only rooms which can be used for ultraviolet ray treatment are those allocated for Clinic purposes generally, viz., the two comparatively small rooms situated on the top floor of the Town Hall premises : these are only available on two sessions per week, and considerable difficulty is experienced as the result of overcrowding in the waiting-room : it is impossible under these circumstances to insist upon the very necessary period of rest after treatment before the children leave the building. (iii) Type and Selection of Cases for Treatment. This is of the greatest importance to the success of the treatment, and it must be realised at the outset that every case should be considered individually; that all cases, grouped under the heading of any definite disease or defect, will not benefit to the same extent. The following is a brief summary of the cases treated by general and local irradiation throughout the year:— CONDITION. Boys. Girls. Anaemia 15 21 Debility 66 43 Malnutrition 25 32 Malnutrition and Ansemia 10 10 Pretuberculosis 4 7 Rheumatism 1 3 Bronchial Catarrh and Bronchitis 29 9 Adenitis 20 18 Alopecia 3 1 Number of children treated 317 (255 in 1928). Number of attendances 3,922 (3,206 in 1928). Average number of attendances per child 12 Number treated by local application 20 113 Ultra-violet irradiation, like many other therapeutic measuies, cannot be employed in a specific capacity for any of the above conditions and, 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 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. 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. (iv) Dosage. The limitation of time, the poor accommodation, the large number of attendances and the fact that an endeavour is being made to give as many children as possible the benefit of attendance at the Clinic, have rendered it a somewhat difficult task to regulate the dosage as accurately as one would desire but, generally speaking, the exposure in each case has been so guaged as to produce the minimum possible degree of byperæmia, and the period varies from about three minutes in the case of new patients to fifteen or twenty minutes in the case of those who have been under treatment for some time. (v) Results. Results cannot be assessed by comparing the effects of different forms of treatment and of ultra-violet radiation upon groups of children who are apparently suffering; from a similar disease or defect : as indicated above there are so many factors to be considered in selecting suitable cases for treatment. Gain 114 in weight, important as it is in assessing satisfactory progress, cannot, even in cases of malnutrition, be our only criterion. The average gain in weight per month per child in the cases tabulated above was lib. 2ozs. It has been suggested that the administration of cod liver oil produces comparable results in this type of case, but this has not been our experience, and a large number of children who have received prolonged treatment with cod liver oil and malt or with virol, either alone or in combination with Parrish's food, have shown little or no improvement, whereas the subsequent treatment with artificial light has resulted in a very rapid improvement in the physical condition of these children. In this connection the fact must not be overlooked that on the one hand the child is receiving ready-made vitamin, whilst on the other hand the vitamin is manufactured within the tissues of the body as the result of stimulating a metabolic process which has become sluggish. Furthermore, the production of vitamin is only one of many of the proven beneficial results of exposure to ultra-violet radiation. The treatment has also been used with very marked benefit in cases of chronic bronchial catarrh, bronchitis, rheumatism and adenitis, after other methods of treatment had resulted in no amelioration of symptoms. Many of these cases have been under treatment for three years, and I would warn hasty observers that no considered opinion on the effects of treatment can be given in regard to children who have been attending for a few months only. If possible, I hope to include in my report for next year a resume of the progress and subsequent history of some of the children who have been discharged from the Clinic. 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 question of the novelty of the Clinic, after three years, can hardly operate as a factor in the regular attendance of an increasing number of scholars. The tungsten arc lamp has been used mainly in the local treatment of chronic cervical adenitis (in conjunction with general 115 irradiation), and there is no doubt that the results achieved are far superior to those following any other form of treatment. Extremely satisfactory results have been obtained also in cases of alopecia. 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. The Education Committee sent 158 scholars to the Dymchurch Holiday Camp during the year 1929, and in addition the following School Journeys were undertaken:— Cornwell (Boys) 21 Plashet Senior Boys 61 Lathom Road Boys 25 Kensington Boys 40 Avenue (Boys) 37 Central Park Senior Boys 28 Brampton Senior Girls 71 Sandringham Central 100 Total 383 (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) Open-Air Day Schools. There are unfortunately no open-air schools in the Borough. 116 (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 Parkstone, 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 106 cases, financial responsibility for which was not undertaken by the Local Education Authority. 117 Particulars of the number of Children who were resident in Schools of Recovery between 1st January and 31st December, 1929, and the periods of their stay between those two dates. School No. of Months Totals 1 2 3 4 5 6 7 8 9 10 11 12 B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G B. G. B. G. B. G. B. G. B. G Total Ogilvie — 1 — 1 3 — 3 2 3 3 - — 3 4 3 2 1 — 2 1 — — 4 6 22 20 42 I.C.A.A. 4 2 1 3 2 6 3 4 2 1 1 1 - - - - - - - - - - - - 13 17 30 No. of Weeks Russell- Cotes - - - - - - - - - - - - - - - - - - - - - - - - No. of Weeks . RussellCotes (Cont.) 13 14 15 16 17 18 23 24 - - - - 6 - - - - - - - - - 1 — 24 — 14 118 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. 11a. PROVISION OF MEALS. During the year 136,534 meals were provided for 529 children, as compared with 139,588 meals for 545 children in 1928. 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. l1b. PROVISION OF MILK. Provision of Milk in Schools. The present scheme in connection with the distribution of milk to children attending the elementary schools is too confined (inasmuch that, with very few exceptions, only those children, whose parents can meet the cost of the milk, are included in the scheme) to allow of a satisfactory assessment being made in regard to the effect of the provision of milk upon the physical and mental development in the children concerned. Most of the children participating are well nourished and healthy, and it is probable, in many of these cases, that more benefit would be derived from the fresh air, sunshine and exercise available at playtime. Children who are in the happy position of being provided with a good breakfast, including milk, should not require nourishment until dinner time; furthermore, over stimulation of the digestive organs, especially when associated with lack of exercise, is harmful to normal physical development. The value of the inclusion of milk in the diet of a child is undoubted and the Milk Publicity Council is doing valuable work in impressing this fact upon the public. On the other hand, it is important that the Local Education Authority should endeavour to ensure the introduction of a scheme which will be of primary advantage to those children who are in real need of extra nourishment. In one or two instances such children have been given the opportunity 119 of taking the mid-morning supply of milk, and one has been struck by the resulting improvement in their development. It would appear desirable to widen the scope of the present scheme in order that the obviously malnourished and debilitated children might be included; in most instances the Head Teachers are in a position to select the children who fall within this category and, except in cases of doubt, it would be unnecessary to refer the children to the School. Medical Department for an opinion. We usually find that the judgment of the Head Teachers, in regard to the health and physical development of the school children, is very accurate. In conclusion, I would not suggest that the present scheme should be discontinued, especially if there is a likelihood that its continuance will eliminate the practice adopted by some parents of bringing articles of food, often of an unsuitable nature, to the school playgrounds during the morning interval. 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 1929 the number of parents who were present at the routine medical inspections was 5,215 (5,685 in 1928), that is, in 55.1 per cent. of the cases examined (57.4 per cent. in 1928). 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. 120 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. Many cases have been referred for special examination by the Attendance Officers on forms 21, and of these cases 87 were medically examined, reports and advice in each case being- sent to the Secretary of the Education Committee. 16. CO-OPERATION OF VOLUNTARY BODIES. Reference to 9 (e) on page 116 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 48 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 450 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 294 children classified as delicate (in Table III) are all 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 121 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 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 75 children suffering from glandular and non-infectious pulmonary tuberculosis, and the 6 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 73 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. It appears necessary to emphasise the added importance of education in the case of those who are suffering from a physical handicap. There are in East Ham 48 children, who come within this category, receiving no education, and there are 73 children of this type who have been allowed to attend the ordinary elementary school under special conditions and with special precautions. A Day School for Physically Defective Children is urgently needed for these cases. Let us consider, for example, the unenviable position of children who are, or have been, suffering from tuberculosis:— Under the regulations a notified case of definite tuberculosis, whether pulmonary or non-pulmonary, cannot be denotified until a minimum period of five years has elapsed since the date of notification, and during this period the Public Health (Local Sanitary) Authority is entirely responsible for the welfare of the patient, 122 both as regards treatment and, especially in the case of children of school age, as regards education. It appears to be in the latter connection, the important question of education, that the difficulty originates. The Sanatorium School is available for the treatment and education of children suffering from tuberculosis until the disease is arrested. But for the subsequent years, pending denotification, the patient of school age is, in many instances, simply " marking time " in regard to education and consequent future welfare. A small number of these children are considered fit to attend the Ordinary Elementary School, but in many cases this course cannot be pursued owing to the danger of relapse from even slight injury or undue strain. On the other hand, the Local Education Authority is unable to deal with these children, in the first place because they have no power to incur expenditure in regard to notified cases of tuberculosis and, in the second place, because the Governing Authorities of the recognised schools for Physically Defective Children will not accept such cases. Mentally Defective Children. Duiing the year 1929, the number of cases, examined, for purposes of the Mental Deficiency Act of 1913, was 63 (66 in 1928). Of these 24 were classified as mentally deficient, and 11 as dull and backward, recommendations being made as shown in the following table:— Number examined ... 63 Classified as mentally deficient 19 24 Classified as morally deficient 1 Classified as imbeciles 3 Classified as idiots 1 Classified as dull and backward ... 11 Recommended for Special School ... 19 A reference to Table III will show that out of 96 children who have been certified as mentally defective but educable in a special school, 4 (4 in 1928) are having no education, and 92 have been satisfactorily placed. 123 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. 20. CONTINUATION SCHOOLS. There are no Continuation Schools in East Ham. 21. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. All children in their final medical examination prior to leaving school have a note placed on their medical card if there is any special point in their medical history likely to affect the choice of employment. In cases of definite disability steps are also taken to interview the parent and advise as to the choice of suitable employment. During school medical inspection no children were discovered whose health was considered to be adversely affected through employment outside school hours. Nineteen boys have been specially examined in accordance with the Bye-laws, and these were found to be fit for employment. In addition, 8 school children were examined under the Regulations dealing with the employment of children at entertainments and certified fit for participation in such employment. 22. SPECIAL ENQUIRIES. Again the amount of work undertaken by the staff of the School Medical Service during the year has been so great that no time was available for satisfactorily carrying out any of the special inquiries suggested by the Chief Medical Officer of the Board of Education. 124 23. MISCELLANEOUS. During' the year 1929 the following special medical examinations were made :— Teachers 36 Officers 4 Student Teachers 5 Scholarship Candidates 88 Workmen 23 W. BENTON, Medtcal Officer of Health and School Medical Officer. 125 MEDICAL INSPECTION RETURNS. SECONDARY SCHOOL. TABLE I. RETURN OF MEDICAL INSPECTIONS (see note a). For the Year ended 31st December, 1929. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections— (see note b). Boys. Girls. Entrants — — Intermediates — — Leavers 153 171 Total 153 171 Number of other Routine Inspections (see note c). 77 72 B.—OTHER INSPECTIONS. Number of Special Inspections (see note d). 11 11 Number of Re-Inspections (see note e). 34 42 Total 45 53 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. 126 (c) Under this heading may be recorded routine inspections, if any, of children who do not fall under the three code agegroups, e.g., routine inspections of a fourth age-group or of other groups of children, as distinct from those who are individually selected on account of some suspected ill-health for " Special " Inspection. (d) A Special Inspection is a medical inspection by the School Medical Officer himself or by one of the Medical Officers on his staff of a child specially selected or referred for such inspection, i.e., not inspected at a routine medical inspection as defined above. Such children may be selected by the Medical Officer during a visit to the School or may be referred to him by the Teachers, School Nurses, Attendance Officers, Parents, or otherwise. It is immaterial for the purpose of this heading whether the children are inspected at the School or at the Inspection Clinic or elsewhere. If a child happens to come before the School Medical Officer for special inspection during a year in which it falls into one of the routine groups, its routine inspection should be entered in Part A. of Table I. and its special inspection in Part B. The inspection to be recorded under the heading of special inspections should be only the first inspection of the child so referred for a particular defect. If a child who has been specially inspected for one defect is subsequently specially inspected for another defect, such subsequent inspection should be recorded as a Special Inspection and not as a Re-inspection. (e) Under this heading should be entered the medical inspections of children who as the result of a routine or special inspection come up later on for subsequent re-inspection, whether at the School or at the Inspection Clinic. The first inspection in every case will be entered as a routine or special inspection as tne 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 attendan may also of course be recorded as an attendance for treatment. 127 TABLE II. SECONDARY SCHOOL. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1929. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation,but not requiring Treatment. (1) (2) (3) (4) (5) b. G. B. G. B. G. B. G. Malnutrition — — 1 — — — — — Uncleanliness : See Table IV., Group V. — — — — — — — Skin Ringworm : Scalp — — — — — — Body — — — — — — — Scabies — — — — — — — Impetigo — — — — — — — — Other Diseases non-T uberculous — — 2 2 3 — — Eye Blepharitis — — 1 — — Conjunctivitis — — Keratitis — — . — — — — Corneal Opacities — — — — — — — — Defective Vision (excluding Squint) 17 14 2 4 3 2 — — Squint — — — — — — — — Other Conditions — 9 — — — — — — Ear Defective Hearing — — — 1 — — — — Otitis Media — — — — — — Other Ear Diseases — 2 1 — — — — — Nose and Throat Enlarged Tonsils only — 9 — 1 1 — — Adenoids only 7 — 1 1 — — Enlarged Tonsils and Adenoids — — — — — — — — Other Conditions 2 4 — 2 2 — — 1 Enlarged Cervical Glands (Non-Tuberculous) — — 7 1 — — — — Defective Speech 1 — — — — — — — 128 Table II.—(continued.) (1) (2) (3) (4) (5) Teeth—Dental Diseases (see note a) See Table IV., Group IV. B. G. B. G. B. G. B. G. 1 2 3 2 — 1 — — Heart and Circulation Heart Disease: Organic — — — — — — — — Functional — — 1 — — — — — Anaemia — — 1 1 — — — — Lungs Bronchitis — — — — — — — — Other Non-Tuberculous Diseases — — 1 — — — — — Tuber- culosis Pulmonary : Definite — — — — — — — — Suspected — — — — — — — — Non-Pulmonary: Glands — — — — — — — — Spine — — — — — — — — Hip — — — — — — — — Other Bones and Joints — — — — — — — — Skin — — — — — — — — Other Forms — — — — — — — — Nervous System Epilepsy — — — — — — — — Chorea — — — 1 — — — Other Conditions — — 1 — — — — — Deformities Rickets — — — — — — — — Spinal Curvature 2 1 2 — — — — — Other Forms — 2 2 8 1 — — — Other Defects and Diseases 1 1 2 11 1 3 1 — B.—Number of individual children (see note b) found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). GROUP. Number of Children. Percentage of Children found to require Treatment. (see note d). Inspected (see note c) Found to require Treatment. (1) (2) (3) (4) B. G. B. G. B. G. Code Groups:— Entrants — — — — — — Intermediates — — — — — — Leavers 153 171 16 15 10.5 8.8 8.8 Total (Code Groups) 153 171 16 15 10.5 Other Routine Inspections 77 72 9 7 11.7 9.7 1-29 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). 130 REPORT OF THE WORK DONE IN THE AURAL CLINIC. To the School Medical Officer, Education Committee, County Borough of East Ham. 17th January, 1930. Sir, I beg" to submit my report for the year ended December 31st, 1929. I had the honour to be appointed your Aural Specialist in April, 1929, so that the following figures include work done during the last quarter of my predecessor's term of office :— Number of cases examined Boys—282 Girls—276 558 Number of cases discharged 139 Number of visits made by patients to aural clinic 1 ,144 Number of visits made by patients to treatment clinic 1,987 Number of cases of discharging ears 143 Number of cases of deafness 90 Number of cases showing improvement in hearing 83 Number of cases of enlarged tonsils and adenoids 110 Number of applications of ionization 70 I have commenced the treatment of discharging ears by ionization, which in suitable cases gives excellent results. A small percentage of cases of discharging ears, however, require mastoid operations, and I hope that facilities for these to be done within the Borough will soon be afforded. I should like to take this opportunity of thanking the Nursing Staff for their skilful co-operation. I have the honour to be, Sir, Your obedient Servant, RONALD SAVEGE. 131 REPORT OF THE OPHTHALMIC SURGEON. To the School Medical Officer, County Borough of East Ham, Education Committee. Sir, I have the honour to present the Annual Report on the work carried out in the Ophthalmic Clinic during" the year 1929. During the past year 565 school children have been examined and treated for defective vision; these were all new cases. In addition 1,069 re-examinations were made in connection with children who are kept under periodical examination, and in 118 of these cases the visual condition was considered satisfactorily corrected and further supervision was unnecessary. Thirty-three children have attended the Clinic for the treatment of eye conditions, other than visual defect (conjunctivitis, blepharitis, foreign bodies, cysts of the eyelids, etc.), and 5 cases of squint have been operated upon successfully, under the Authority's arrangement with the Royal Westminster Ophthalmic Hospital. It is very unfortunate that such a large number of children, with minor degrees of visual defect, cannot be given the opportunity of attending the Ophthalmic Clinic, but the time allocated to ophthalmic work does not permit. Recently a visit was made to certain of the schools of the Borough in order to ascertain the local conditions, if any, which might have the effect of causing undue strain upon the visual function. Arresting facts in this connection were furnished in many directions, more especially perhaps in regard to firstly the advantage taken of natural and artificial lighting in the schools, and secondly in regard to the position assumed by the pupils in the course of their studies. In many cases a very simple rearrangement of the classes would result in a great improvement in the lighting" effect, and one cannot over estimate the importance of correct posture, during reading, writing, drawing, etc., in preventing eyestrain and consequent visual defect. Here, as in many other cases of physical defect, the application of the principles of hygiene depends upon the interest and keenness of the school teachers. On the other hand, certain problems of dazzle connected with the internal lighting and colouring of the schools have been 132 solved by their staff in a way which almost points to the defeat of the theoretical by the practical. The Sight-saving Class at Monega School is an extremely satisfactory asset in the treatment of those children who show evidence of progressive myopia or other eye condition in which the strain of ordinary education would tend to increase the defect. Mrs. Higginson has introduced many useful educational methods and the organisation and conduct of the class, from the ophthalmic • point of view, is very efficient. It is a great pity that the girls in this class are unable to take their places in the ordinary school for subjects which involve little or no eye strain. Apart from the fact that the outlook of the children is considerably broadened, this procedure gives them the feeling that they are not entirely cut off from the ordinary school life and so minimises the consciousness of their defect; the opportunity for individual education of the children who remain in the special class is also enhanced. The work in connection with the Infant Welfare Centre demands special mention. The value of this Clinic in allowing of the examination of children at an early age is very great. The acuity of vision has been accurately estimated in children of three years of age and, approximately, in one child of two years. The parents have given us the greatest help in teaching their children, at home, the simple method used in the test. Forty-six new cases were seen during the year and 224 attendances were made. Thirtythree cases of squint were dealt with and three cases of lacrymal obstruction have been treated successfully by me at Guy's Hospital. The increase and development of this branch of our work is imperative to any complete scheme of preventive medicine. In conclusion, Sir, please allow me to record my thanks for the cordial co-operation of the Medical Staff, and draw attention to the invaluable work done by the School Nurses and Health Visitors who attend the Clinic and help so materially with the treatment. These, together with the kindly efficiency of the Optician and the Clerical Staff, have made possible the measure of success attained. 1 have the honour to remain, Sir, Your obedient Servant, S. C. REEVE-FLAXMAN. 133 REPORT ON THE WORK DONE IN THE SCHOOL DENTAL CLINIC. To the School Medical Officer, County Borough oj East Ham Education Committee. Sir, I have much pleasure in submitting to you my report on the work of the Dental Clinic during the year 1929. The age groups inspected were from 5 years to 11 years inclusive. The number of children inspected was 12,893, and the number referred for treatment was 9,395. The number of urgent cases referred by the School Medical Officers, Nurses and Head Teachers was 160; these are cases of toothaches, oral sepsis, etc., outside the routine age groups. 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 10 11 Total. 12 13 14 1793 2042 2154 2259 2337 1590 718 12893 — — — 160 13053 (b) Found to require treatment 9395. (c) Actually treated 3454. (d) Re-treated during the year as the result of periodical examination 3051 {see note e) (2) Half-days devoted to :— Inspection 971 Treatment 605 Total 702 (3) Attendances made by children for treatment 7442. (4) Fillings— Permanent teeth .1289) Temporary teeth 981 Total 2270 (5) Extractions : — Permanent teeth 6761 Temporary teeth 8509 Total 9185 (6) Administrations of general anaesthetics for extractions 366. (7) Other operations:— Permanent teeth 346) Temporary teeth 267) Total 613 134 The aim of the Dental Clinic is to reduce all pain to the utmost minimum in order that the little patients will attend without that horrible fear of the dentist, which is so prevalent. This is carried out by giving injections for the extraction of temporary and permanent teeth, except in cases of abscesses or oral sepsis, when a general anaesthetic is administered (viz., nitrous-oxide) or a local application of ethyl-chloride is used. Great care is taken with conservative work, all permanent teeth being filled where possible and small cavities in temporary teeth. The preservation of the permanent teeth is of the utmost importance to the child, especially that of the first or six-year molar. It is gratifying to note that during the year there has been a substantial increase in the number of permanent teeth filled and a corresponding decrease in the number of permanent teeth extracted. The age groups to be inspected during the year 1930 will be those of 5 years to 11 years inclusive. It is with much pleasure that I have to record the appointment of Mr. A. E. Hall as School Dentist in March, 1929. The result of his work is very gratifying and his assistance has been invaluable. Progress in the School Dental Service of East Ham is being made, but very slowly. When the recommendations of the Board of Education are adopted, namely the appointment of two more Dental Surgeons, and permanent headquarters with branch clinics are built, a comprehensive progressive scheme can be adopted to deal with all dental defects of school children. The importance of this is shown by the following extract from the Report of the Chief Medical Officer to the Board of Education for the year 1928 : " These medical reports to the Board have, for 20 years, emphasised the gravity and far-reaching evils of (a) ill-constituted dentition, (b) premature decay of the teeth, and (c) oral sepsis, and it is unnecessary to deal with the subject every year. But the injury to, or impairment of, health exists every year, and it is of the utmost importance that Local Education Authorities through-. out the country should give close and continuous attention to the reduction of all conditions which lead to these three basic defects in many hundreds of thousands of school children." The dental nurses play an important part in the work of the Dental Clinic by interviewing parents, inspiring confidence in 135 nervous children, and by generally making the rough places smooth. Their work is often trying and exacting, but by cheerfulness and patience they overcome all difficulties. Details of treatment accorded the mothers and babies, referred from the Maternity and Child Welfare Centres, are shown in the following table :— No. of Half Days devoted to Treatment. No. of Attendances. No. of Permanent Teeth. No of Temporary Teeth. Total No. of Extractions. Total No. of Fillings No. of Adminis trations of General Anaesthetics. No. of other Operations. Adults Children. Extrac ted. Filled. Extrac ted. Filled. Permanent Teeth. Temporary Teeth 75 150 584 194 44 721 192 915 236 42 67 63 Two sessions per week have been devoted to the dental work referred from the Maternity and Child Welfare Centres during 1929, in place of one session. This is a big step in the right direction, for dental treatment must begin at the very earliest age, viz., 18 months. It is gratifying to note that the babies' mouths, on the whole, are much cleaner than they used to be ; it was not at all uncommon to find babies of 18 months with four incisor roots badly abscessed, now it is quite rare. Conservative work, even in babies, is important, and it is interesting to note that as more time has been devoted to the work the number of fillings has greatly increased in both permanent and temporary teeth. In conclusion, I should like to thank all the Medical Officers, the Nurses, the Clerical Staff, and the teachers for their valued co-operation during the year 1929. I have the honour to be, Sir, Your obedient servant, CYRIL S. NEAME. 136 TABLES GIVING SUMMING UP OF WORK OF SCHOOL MEDICAL SERVICE from 1st JANUARY, 1929, to 31st DECEMBER, 1929. PUBLIC ELEMENTARY AND CENTRAL SCHOOLS. TABLE I. RETURN OF MEDICAL INSPECTIONS (see note a). For the Year ended 31st December, 1929. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections— (see note b). Entrants 2,9.98 Intermediates 2,208 Leavers 2,366 Total 7,572 Number of other Routine Inspections (see note c). 1,421 B.—OTHER INSPECTIONS. Number of Special Inspections (see note d). 3,877 Number of Re-Inspections... (see note e). 4,745 Total 8,622 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. 137 (c) Under this heading may be recorded routine inspections, if any, of children who do not fall under the three code agegroups, e.g., routine inspections of a fourth age-group or of other groups of children, as distinct from those who are individually selected on account of some suspected ill-health for " Special " Inspection. (d) A Special Inspection is a medical inspection by the School Medical Officer himself or by one of the Medical Officers on his staff of a child specially selected or referred for such inspection, i.e., not inspected at a routine medical inspection as defined above. Such children may be selected by the Medical Officer during a visit to the School or may be referred to him by the Teachers, School Nurses, Attendance Officers, Parents, or otherwise. It is immaterial for the purpose of this heading whether the children are inspected at the School or at the Inspection Clinic or elsewhere. If a child happens to come before the School Medical Officer for special inspection during a year in which it falls into one of the routine groups, its routine inspection should be entered in Part A. of Table I. and its special inspection in Part B. The inspection to be recorded under the heading of special inspections should be only the first inspection of the child so referred for a particular defect. If a child who has been specially inspected for one defect is subsequently specially inspected for another defect, such subsequent inspection should be recorded as a Special Inspection and not as a Re-inspection. (e) Under this heading should be entered the medical inspections of children who as the result of a routine or special inspection come up later on for subsequent re-inspection, whether at the School or at the Inspection Clinic. The first inspection in every case will be entered as a routine or special inspection as the case may be. Every subsequent inspection of the same defect will be entered as a re-inspection. Care should be taken to see that nothing is included under the head of special inspections or re-inspections except such inspections as are defined above. Attendances for treatment by a Nurse, or for examinations by anyone other than a Doctor on the staff of the School Medical Service, should not be recorded as medical inspections. If, however, at any such attendance a child is also examined by one of the Authority's Medical Officers, this should be recorded as a special inspection or re-inspection as the case may be, even if treatment is also given ; but such attendance may also of course be recorded as an attendance for treatment. 138 TABLE II A.—A Return of Defects found bv Medical Inspection in thf. Year ended 31st December, 1929. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects Requiring Treatment. Requiring to be kept underobservation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Malnutrition 90 36 9 — Uncleanliness: (See Table IV., Group V.) — — — — Skin - Ringworm : Scalp 4 — 45 — Body — — 16 — Scabies 2 — 16 — Impetigo 27 11 380 — Other Diseases (Non- Tuberculous) 24 38 337 6 Eye Blepharitis 6 10 75 1 Conjunctivitis 3 3 82 — Keratitis — — 1 — Corneal Opacities — — — Defective vision (excluding Squint) 292 46 295 19 Squint 19 16 30 — Other conditions 8 14 95 7 Ear Defective Hearing 24 5 44 6 Otitis Media 33 10 41 Other Ear Diseases 56 74 170 — Nose and Throat Enlarged Tonsils only 138 1199 50 — Adenoids only 11 32 13 2 Enlarged Tonsils and Adenoids 295 164 150 7 Other conditions 42 64 80 3 Enlarged Cervical Glands (Non- Tuberculous) 16 887 19 9 139 Table II.—(continued). (1) (2) (3) 4) (5) Defective Speech 7 38 4 15 Teeth—Dental Diseases (see note a) (See Table IV., Group IV.) 89 608 40 2 Heart and Circulation. Heart Disease: Organic 4 36 3 1 Functional — 22 4 — .Anaemia 21 45 69 7 Lungs Bronchitis 8 (8 38 3 Other Non-Tuberculous Diseases 14 67 45 7 Tuberculosis Pulmonary : Definite 2 1 1 — Suspected — — — — Non-Pulmonary: Glands 3 4 — — Spine — — — 2 Hip 1 — 1 — Other Bones and Joints — — — — Skin — 2 — — Other Forms — 1 — 2 Nervous System 'Epilepsy 4 4 4 Chorea 2 10 25 7 Other condi tions 1 77 11 4 Deformities Rickets 19 1 Spinal Curvature 9 8 4 3 Other Forms 8 75 9 6 Other Defects and Diseases 160 428 1549 51 B.—Number ok Individual Children (.tee note b) found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). GROUP. Number of Children. Percentage of Children found to require Treatment (see note d). Inspected (see note c). Found to require Treatment. (1) (2) (3) (4) Code Groups :— Entrants 2998 411 13.7 Intermediates. 2208 316 14.3 Leavers 2366 248 10.5 Total (Code Groups) 7572 975 12.9 Other Routine Inspections 1421 154 10.8 140 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). 141 TABLE III. Return of all Exceptional Children in the Area for the Year ended SIst December, 1929 (See note a). Boys. Girls. Total Blind (including partially blind) (see note b). (i.) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 1 1 2 Attending Public Elementary Schools (see note c) — — — At other Institutions — — — At no School or Institution — — — (ii ) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind 15 15 30 Attending Public Elementary Schools (see note c) 1 — 1 At other Institutions — 2 2 At no School or Institution — — — Deaf (including deaf and dumb and partially deaf) (see note d.) (#.) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf 6 8 14 Attending Public Elementary Schools (see note c) — — — At other Institutions — — — At no School or Institution — — — (ii.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf — — — Attending Public Elementary Schools (see note c) 2 1 3 At other Institutions — — — At no School or Institution — — — Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority). (See note e.) Attending Certified Schools for Mentally Defective Children 50 33 83 Attending Public Elementary Schools (see note c) — 1 1 At other Institutions 5 3 8 At no School or Institution 2 2 4 Notified to the Local Control Authority during the year. Feebleminded 8 8 Imbeciles 3 5 8 Idiots 2 — 2 Epileptics Suffering from severe epilepsy. (See note f.) Attending Certified Special Schools for Epileptics 3 3 6 In Institutions other than Certified Special Schools — 1 1 Attending Public Elementary Schools (see note c) — — — At no School or Institution 2 2 4 142 TABLE III.—continued. « Boys. Girls. Total. Epileptics (continued). Suffering from epilepsy whi h is not severe. (See note g.) Attending Public Elementary Schools (see note c) 3 3 6 At no School or Institution - - - Infectious pulmonary and glandular tuberculosis (See note h.) At Sanatoria or Sanatorium Schools approved by the Min istry of Health or the Board 2 2 At other Institutions — — — At no School or Institution 1 — 1 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 14 13 27 At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools (See note c) 51 24 75 At other Institutions — — — At no School or Institution 5 5 10 Physically Defective. Delicate children (e.g., pre- or latent tuberculosis, malnutrition, debility, anaemia, etc). (See note h.) At Certified Residential Open Air Schools 27 14 41 At Certified Day Open Air Schools - - - At Public Elementary Schools (see note c) 137 157 294 At other Institutions 5 10 15 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 4 8 12 At Public Elementary Schools (see note c) 2 4 6 At other Institutions — 1 1 At no School or Institution 5 4 9 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 12 13 25 At Certified Day Cripple Schools 1 - 1 At Public Elementary Schools (see note c) 36 87 73 At other Institutions 5 3 8 At no School or Institution 10 18 28 143 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 have a complete list of such children compiled from returns made continuously during the year and kept constantly up to date. In order to secure uniformity, Authorities are requested to make up this Table from their list of defective children as it stands on the last day of each calendar year. Children who are living in residential schools in the area but who come from other areas, should not be included in this Table; but children should be included who are living in residential schools outside the area and who are being maintained there by the Authority. For the purpose of this Table, no child should be included whose defect has not been ascertained by the School Medical Officer or a medical member of the Authority's staff. The definitions of defective children as given in the Act are as follows and must be very carefully borne in mind. A blind child is a child who is too blind to be able to read the ordinary school books used by children. A deaf child is a child who is too deaf to be taught in a class of hearing children in an elementary school. Mentally and physically defective children are children who, not being imbecile and not being merely dull and backward, are defective, that is to say, children who bv reason of mental or physical defect are incapable of receiving proper benefit from the instruction in the ordinary public elementary schools, but are not incapable by reason of that defect of receiving benefit from instruction in such special classes or schools as under Part V. of the Act may be provided for defective children. Epileptic children are children who, not being idiots or imbeciles, are unfit by reason of severe epilepsy to attend the ordinarypublic elementary schools. (b) For the purpose of this return the Board require that children who are blind within the meaning of the Act should be divided into two categories, i.e., (1) those who are totally blind or so blind that they can only be appropriately taught in a school or class for totally blind children, and (2) those who though they cannot read ordinary school books, or cannot read them without injury to their eyesight, have such power of vision that they can appropriately be taught in a school or class for the partially blind. 144 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. (c) It should be understood that none of the children in this Table (except children suffering from epilepsy which is not severe) should in fact be attending public elementary schools. When the heading is retained, it is merely because at present the insufficiency of Special School accommodation makes it impossible to do better for some defective children than to allow them to attend the ordinary school. No space is left for the entry of children with infectious pulmonary tuberculosis attending public elementary schools, as these children should of course be promptly excluded fiom such schools. (d) Children who are deaf within the meaning of the Act should be classified for the purpose of this Table as (1) totally deaf or so deaf that they can only be appropriately taught in a school or class for the totally deaf, and (2) partially deaf, i.e., those who can appropriately be taught in a school or class for the partially deaf. (e) This category includes only those children for whose education and maintenance the Local Education Authority are responsible, and who are not eligible for notification to the Local Control Authority under the Mental Deficiency Act. (/) In this part of the Table only those children should be included who are epileptic within the meaning of the Act. For practical purposes the Board are of opinion that children who are subject to attacks ot major epilepsy in school should be recorded as " severe " cases and excluded from ordinary public elementary schools. (g) In this part of the Table should be entered the remainder of the epileptic children in the area, i.e., children whose disease is of such a kind as not to unfit them for attendance at an ordinary public elementary school. (h) The exact classification of physically defective is admittedly a matter of difficulty. Valuable information, however, will be obtained if School Medical Officers will record these defective children as accurately as possible under the selected sub-headings, taking care that no child is entered under more than one subheading. 145 TABLE IV. Return of Defects Treated during the Year kndbd 31st December, 1929 (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) Skin- Ringworm—Scalp 49 4 53 Ringworm—Body 28 4 32 Scabies 17 — 17 Impetigo 435 7 442 Other skin disease 380 19 399 Minor Eye Defects 266 6 272 (External and other, but excluding cases falling in Group II.) Minor Ear Defects (See note c.) 238 7 245 Miscellaneous 1801 156 1957 (e.g., minor injuries, bruises, sores, chilblains, etc.) Total 3214 203 3417 146 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.) 565 42 — 607 Other Defect or Disease of the Eyes (excluding those recorded in Group i.) 33 - - 33 Total 598 42 —- 640 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme 425 (b) Otherwise 33 Total number of children who obtained or received spectacles— (a) Under the Authority's Scheme 419 (b) Otherwise 33 Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of Treatment. (4) Total number Treated. (5) Under the Authority's SchemeinClinic or Hospital. (see note 6.) (i) By Private Practitioner or Hospital apart from the Authority's Scheme. (2) Total. (3) 454 140 594 55 649 147 TABLE IV.—continued. Group IV.—Dental Defects. (1) Number of Children who were : — (a) Inspected by the Dentist— Age. Routine Age Groups. Specials Grand (see note d) Total. 5 6 7 8 9 10 11 Total.| 1793 2042 2154 2259 2337 1590 718 12893 160 13053 (b) Found to require treatment 9395 (c) Actually Treated 3454 (d) Re-treated during the year as the result of periodical examination (see note e) 3051 (2) Halt-days devoted to:— Inspection 97 Treatment 605 Total 702 (3) Attendances made by children for treatment 7442 (4) Fillings :— Permanent Teeth 1289 Temporary Teeth 981 Total 2270 (5) Extractions:— Permanent Teeth 676) Temporary Teeth 8509 Total 9185 (6) Administrations of general anaesthetics for extractions 366 (7) Other operations :— Permanent Teeth 346 Temporary Teeth 267 Total 613 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 53,009 (iii.) Number of individual children found unclean 1,103 (iv.) Number of children cleansed under arrangements made by the Local Education Authority Nil. (v.) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 Nil. (6) Under School Attendance Byelaws Nil` 148 NOTES ON TABLE IV. (a) The Table should deal with all defects treated during the year, however they were brought to the Authority's notice, i.e., whether by routine inspection, special inspection, or otherwise, during the year in question or previously. (b) This heading should include all cases that received treatment under definite arrangements or agreements for treatment made by the Local Education Authority and sanctioned by the Board of Education under Sections 16 and 80 of the Education Act, 1921. Cases which, after being recommended for 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 the course of the routine inspection of children in one of the age groups covered by the Authority's approved scheme, namely, to children specially selected by him, or referred by Medical Officers, Parents, Teachers, etc., on account of urgency. The number inspected in each age group should be separately shown, as well as the total, but under " Specials " only the total number should be given. (e) It should be understood that all the cases entered under this head are also entered under head c. (/) A statement as to the arrangements made by the Local Education Authority for cleansing verminous children and a record of the cases in which legal proceedings were taken, should be included in the body of the School Medical Officer's Report. N.B.—Groups I.—V. above cover all the defects for which treatment is normally provided as part of the School Medical Service. Particulars as to the measures adopted by the Authority for providing treatment for other types of defect (e.g., for orthopaedic treatment) or for securing improvement in types of defect which do not fall to be treated under the Authority's own scheme and for which the Authority neither incur expenditure nor accept any responsibility, together with a statement of the effect of the measures taken, should be included in the body of the School Medical Officer's Report. It is convenient for such particulars to follow the headings of Table II. 149 INDEX: A. Acute Polio-Myelitis 22 Abatement of Nuisances 67, 77 Abattoirs 75, 78 Acreage 6 Acts of Parliament 11, 12 Adenoids 50, 60, 99, 100 Administration 94, 95 Air temperature 64 Alleys 85 Altitude 7 Ambulance service 10, 60 Antitoxin 19, 22 Area 6 Assessable value 6 Attendance Officers, co-op. of 120 Aural Clinic 107,130 Ante-Natal Clinics 8, 47, 53 B. Bacteriology 17, 19, 40, 42 Bakehouses 74, 79, 85 Baths 119 Births 6, 52 „ Illegitimate 6 Still 6 Birth-rate 5, 6, 7 Blind persons 15, 141, 143 Boundaries 7 Bye-laws 12, 13, 83, 85, 123 C. Cancer 63 Case Mortality 42 Cerebro-Spinal Meningitis 22,63 Chest Clinic 31 Chicken-pox 104 Children, Medical Inspection of 93, 97, 125, 136 Chorea 17, 128 Cinemas and Music Halls 77 Cleanliness of School Children 98 Clinic, Ante-Natal 8, 47, 53 Clinics, Infant 9, 51, 52 Clinics, School 107, 108, 109, 130-136 Clinic, Artificial Sunlight 107, 111, 113, 131 Clima e 64 Closing Orders (Shops) 76 Common Lodging Houses 79 Communicable Diseases (non- notifiable) 104, 105 Complaints of Nuisances 67, 68 Continuation Schools 123 Convalescent Treatment 17, 43, 116 Co-ordination 59, 92 Cripples 96, 102, 110, 122, 128, 142 D. Dairies 72, 85 Day Nursery 9,123 Deafness 120, 121, 122, 141 Deaths, Causes of 55, 58, 63 Deaths, No. of 6, 56 Death-rate, General 5, 6, 7, 63 Death-rate, Infantile 5, 7, 56 Death-rate, Tuberculosis 5 Death-rate, Zymotic 7 Deaths in Large Towns 7, 56 Dentistry 50, 133, 134, 135 Diarrhoea 7, 47, 57, 59, 63 Diphtheria 19, 20, 41, 42, 43, 44, 45, 62, 63, 102, 103, 104 Dirty premises 85 Disinfection 22, 73 Dispensary 9, 28-34 Dispensary attendances 24, 25 Drainage Works 85 Dust Collection 73 E. Ear Disease 102, 107, 109, 127, 138, 145 Employment of Children 123 Encephalitis Lethargica 21, 62, 63 Enteric Fever 20, 41, 42, 43, 45, 63 Epileptic Children 120, 121, 122, 141, 142, 143 Erysipelas 21, 62 Exclusions 105 Eye Diseases of Children 101, 105, 107, 108, 109, 127, 131, 132, 138, 145 Eye, External Inflammation of 108 127, 131, 132 Explosives Act 76,81 F. Feeble minded 13, 141 Factory and Workshop Act 74 Following-up 105, 106 Food and Drugs Act 70, 72 Food Inspection 71 Food Supply 75 Food, Unsound- and Diseased 75 G. Gipsies 79, 83, 85 Glands, enlarged 139, 142 H. Harts Sanatorium 9, 34-41 Health Propaganda 10 Health Visitors 48, 50, 51 52, Hearing of School Children 102, 109, 120, 130, 138 Heart Diseases 121, 128, 138 Hospital Accommodation 9, 16, 17,32, 37, 107, 108 150 INDEX—continued. Hospital, Children's 10, 16, 59, 96, 100, 107, 110, 111, 115, 116 Hospitals, Maternity 9, 54 House Refuse removal 73 House to House inspection 66, 69 Housing 77, 78 Hospital Staff-training 45 I. Immuni ation 19, 20 Imbecile Children 13, 141 Impetigo 100, 105, 108 Increase of Rent (Restriction) ,A.cts 70 Infant Consultations 8, 48, 49, 50, 51, 52 132 Infantile Mortality 5, 7, 55, 56 Infectious Diseases 7, 10, 19, 41-46, 56, 63, 73, 102 Infectious Diseases (non fiable) 104 Influenza 21, 63 Inspection of Borough 66, 69, 85 Inspection of School Children 94, 97, 125, 136 Invalid Children's Aid Association 16, 59, 90, 116 Isolation Hospitals 9, 16, 41-46 Industries 7, 75, 76 K. Kinemas 77 L. Laboratory work 17 Legal proceedings 79, 80, 81, 82, 83, 147 "Light" Treatment 25, 50, 60, 107, 111, 112, 113, 114, 115 Lung Diseases 23-41, 101, 108, 128, 139 M. Malaria 62 Malnutrition 127, 138 Marketplaces 75 Maternal Deaths 58, 63 Maternity and Child Welfare 47-60 Maternity Homes and Hospitals 9, 47, 54 Meals, provision of 105, 118-9 Measles 7, 63, 104 Meat Regulations 74 Medical examination 18, 123 Meningococcal Meningitis 21 Mental Defects of School Children 122, 141 Mental Defectives, Statutory supervision 13 Margarine Act 81 Mental Defectives, voluntary care 15 Mental Welfare 13, 14, 15, 122, 141 Meteorology 64 Midwifery 8, 56, 57 Milk and Cream Regulations 72 Milk, Free supplies 47,59 Milk Order 72 Minor Ailments 100, 107, 145-7 Mortuaries 79 Mumps 104 Music Halls 77 Myopia 108-9, 131, 132 N. Nervous Diseases 128, 139 Notices served 67 Notification of Births 52 Notification of Infectious Diseases 22, 62 Nuisances abatement 67, 77,^78 Nuisances discovered 67 Nursing arrangements 8,44,45 Nursery Schools 123 0. Occupations 7, 75, 76 Offensive trades 73 Open-air Education 90, 115, 116, 121, 142 Ophthalmia Neonatorum 22, 58, 62, 106 Ophthalmic Clinics 50, 131, 132 Orders 11, 12, 76 Orthopaedic treatment 102,110,111, 120-1, 139 Outdoor Relief 18 Outworkers 74, 85 Overcrowding 85 P. Para-Typhoid Fever 20, 22, 62 Parotitis 41 Parents, co-operation of 119 Post-Mortems 79 Physical training 118, 142 Playground classes 115 Pneumonia 21, 62, 63 Population 6 Pre-tubercular patients 142 Prosecutions, Public Health Act 80 Prosecutions, Sale of Food and Drugs Act 81 Prosecutions, Shops Act 82, 83 Provisional Orders 11 Puerperal Fever 6, 21, 22, 57, 62, 63 Puerperal Pyrexia 22, 57, 62 151 INDEX—continued. R. Rainfall 64 Rateable Value 6 Rat extermination 77 Refraction cases 127, 138 Refuse Removal and Disposal 73 Regulations 11, 12, 85, 123 Re-inspection 94, 125 Rent (Restriction) Act 70 Ringworm 50, 60, 100, 105, 108, 127, 138 Roofs, leaky 85 S. Sale of Food and Drugs Act 70, 71, 81 Sanatoria 9, 28, 34-41, 142 Scabies 100, 105, 127, 138 Scarlet Fever, 19, 22, 41, 43, 44, 55, 62, 63, 104 Schick immunisation Clinic 19 School Attendance Officers Co-operation 120 „ Baths 119 „ Camps 115 „ Children, Blind 120-4, 141-3 „ Cripples 96, 102, 110-1 120-1, 139, 142 ,, Children, Diseases of Nose and Throat 127, 138, 146 ,, Children, Defective Speech 139 „ Children, general cleanliness 98, 147 „ Children, Heart Diseases 120, 128, 139 „ Children, Hearing, 102,109,120,138 ,, Children, Minor Ailments 100, 107, 145 „ Children, No. of Medical Examinations 89, 93, 94, 97, 125, 136 „ Children, Nutrition of 112, 118-9, 125, 138, 142 „ Children, Physical Training of 118 „ Children, Skin Diseases 101, 105, 108, 127, 138, 145 „ Children, Teeth of 106, 110, 128, 133, 139, 147 ,, Children, Verminous Conditions 105, 147 „ Continuation 123 „ Dentistry 95, 110, 133-5, 147 „ Hygiene 93 „ Meals 105, 118 „ Medical Treatment 127, 138, 145 „ Nursery 123 „ Open-air 115-6, 121, 142 Schools of Recovery 116 School, Secondary 123, 125-9 Schools, Survey of 92 Shops Act 75, 79, 82-3 Skin Diseases 101, 105, 108, 138, 145 Slaughter Houses 75 Small-pox 10, 19, 22, 62, 69, 103 Smoke abatement 85 Special enquiries 123 Special examination 89, 93, 123, 125, 136 Spectacles, supply of 146 Speech, defective 127, 139 Sputum examination 32 Squint 127, 138 Staff 4, 48, 88, 92, 94 Subsoil 7 Summary of Report 6,7 Surgical appliances 17 Swimming 118 T. Table—Air temperature 64 ,, Birth-rate 5, 7, 56 „ Cattle Slaughtering 74 ,, Causes of Death 63 ,, Clinics, Treatment at 133, 135, 145, 146, 147 ,, Comparative Statistics 5, 7, 56, 94, 98, 100, 105 ,, Complaints received 68 Deaths 5, 62, 63 ,, Dental Treatment 133, 135, 147 „ Eye examinations 127, 138, 146 ,, Exceptional children 141,142 ,, Exclusion Forms issued 98 „ Food and Drugs Act, Legal Proceedings 81 „ Food and Drugs Act, samples taken 70, 71 Housing 77-78 „ Infantile Mortality 5,7,55-56 „ Infectious Cases notified 19, 20, 62, 104 „ Infectious Cases removed to Hospital 41, 62 „ Invalid Children's Aid Association 16, 17 ,, Maternity and Child Welfare 47-60, 135 „ Medical Help 56 ,, Mental Defectives 141 ,, Meteorological record 64 ,, Minor ailments 100, 145-7 „ Notes to 26, 27, 125, 126, 137-140, 143-4, 148 „ Notifications 19, 20, 21-2, 62, 104-5 „ Nuisances 85 „ Ophthalmia Neonatorum 59 „ Public Health Act prosecutions 80 „ Rainfall 64 152 INDEX—continued.. Table2—Records of inspections 66, 69, 85, 94, 97, 98, 99, 100, 112, 122, 125-128, 133, 135, 136, 138-9 „ School Children Crippled 142 „ School Children, Defects of 125, 127-8, 138-9, 145-7 „ School Children examined 94, 97, 125, 136 „ School Children excluded 98, 105 „ School Children found to require treatment 128, 139, 147 ,, School of Recovery admissions 117 ,, Secondary School examinations 125-128 ,, Shops Acts prosecutions 84 „ Sunlight Treatment 112 ,, Tuberculosis, Classification of Patients35, 36, 37, 38 ,, Tuberculosis deaths 5, 23 ,, Tuberculosis 23-5, 34-8 „ Tuberculosis Dispensary cases 24-25 „ Tuberculosis Notifications 23 ,, Tuberculosis, Residential treatment 34-7 ,, Venereal Diseases 61 ,, Verminous condition of School Children 94, 98, 99, 105, 147 „ Vision of School Children 127,138,141,145-6 ,, Zymotic Death-rate 5 Teaching Staff, co-operation of 119 Teaching Staff, Medical Examination 124 Teeth of Schoolchildren 128, 133-4-5, 139, 147 Temperature 64 Throat affections 126, 128, 138 Tonsils ... 50, 53, 60, 101, 105, 107, 130 Training Centre, Mental Defectives 14 Transit, Means of 7 Tuberculosis 23-41, 49, 50, 60, 62, 63, 73, 101, 108, 128, 139, 142 Tuberculosis, Co-operation of General Practitioners 31 Tuberculosis Deaths 5, 23, 62, 63 Tuberculosis Dispensary 9,28-34 Tuberculosis, treatment of 23-41,142 Tuberculosis Visits 25 Typhoid Fever 20, 22, 62 Tubercular contacts 24 U. Unsound Food 75 Urinals 74, 85 Ultra Violet Radiation 25, 50, 51, 60, 106, 107, 111-5 V. Vaccination 103 Venereal Diseases 9, 61 Verminous Persons 94, 98, 99, 100, 105, 147 Vision of School Children 101, 108, 109, 127, 131-2, 138, 141, 146 Visits, Nurses 25, 52-3, 94, 147 Voluntary Workers 16, 59, 90, 116, 120 W. Whooping Cough 7, 55, 63, 104 Workshops 74 X. X-rays 32, 50, 60, 106, 108 Z. Zymotic Deaths 5, 7,62,63 JR2/68