COUNTY BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1930. 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 1930. 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. I. Lethaby, J.P.). The Deputy-Mayor (Councillor E. H. Thompson). *†Alderman C. W. Brading (Chairman Public Health Committee, Hospital and Sanatorium Sub-Committee, and Maternity and Child Welfare Sub-Committee). *+Alderman J. Brooks, J.P. (Vice-Chairman). *Alderman H. B. Harper, J.P. Alderman H. Osborn, J.P. *†Alderman H. N. Ridler. ‡Councillor R. Banks-Martin, J.P. Councillor J. W. Barton. *†Councillor T. W. Burden. Councillor F. P. Cross. Councillor C. F. H. Green. *†Councillor E. Makkey. †Councillor T. M. McGiff, J.P. *†Councillor Mrs. M. Ridler. *Councillor Mrs. A. Taylor. *†Councillor T. Watts. §Councillor T. W. Williams. 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). *Al90 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. 1. Lethaby, J.P.). The Deputy-Mayor (Councillor E. H. Thompson). Alderman J. Brooks, J.P. (Chairman). Councillor Mrs. A. Taylor (Vice-Chairman). Alderman C. W. Brading. Alderman H. B. Harper, J.P. Alderman F. Webster. Councillor F. P. Cross. Councillor A. E. Dennington. Councillor C. F. H. Green. Councillor Mrs. M. Ridler. Mrs. C. J. Cross (co-opted). Mrs. K. Moger (co-opted). Mrs. B. Wilkens (co-opted). ‡ Died 21st May, 1930. § Appointed vice Councillor Banks-Martin (Deceased). STAFF OF THE PUBLIC HEALTH DEPARTMENT. Clerks: Miss H. E. Rittebspack, Miss D. Gobdon, O. B. Lorence, G. H. Green, G. W. Friend (until 21-6-30). F. J. Kendall, A.R.San.1., Chief Clerk and Vaccination Officer. T. B. Clark, Chief Administrative Clerk (from 15-9-30). 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 Clerks: Miss M. Pratt, F. L. Gosling. Tuberculosis Nurses: Miss L. E. Mallon, S.R.N., Miss E. E. Cook, S.R.N., Certified Midwife. Assistant Nurse: Miss A. Meadhurst. Nurse at Arragon Road Dispensary: Miss E. E. Kelly, S.R.N., Certified Midwife, Fever Trained. 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 E. E. Roberts, S.R.N., Certified Midwife, Miss D. E. Skeggs, S.R.N., Certified Midwife, R.S.I. (Health Visitor's Cert.), 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 G. E. Sharpe, S.R.N. Shops Act Inspector: C. H. Pursall, A.R.San.I. Assistant Sanitary Inspector : H. G. Luckett, M.S.I.A., A.R.San.I. 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., \V. J. Wobley, A.R.San.I., M.S.I.A., W. H. Thubston, 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. District Medical Officer and Public Vaccinator: L. F. A. Harbison, M.R.C.S., L.R.C.P. Medical Officer to Maternity and Child Welfare Centre, and Inspector of Midwives: Jessie A. .McLaren, M.B., Oh.B., D.P.H. Tuberculosis Officer and Besident Medical Superintendent, Harts Sanatorium: G. W. Cheater, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Senior Assistant School Medical Officer: F. E. Bendix, M.R.C.S., L.R.C.P., L.D.S. Deputy Medical Officer of Health and Besident Medical Superintendent, Isolation Hospital: Malcolm Babker, M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health, School Medical Officer, General Medical Superintendent and Chief Administrative Officer to the Borough Hospital and Sanatorium, Chief Tuberculosis Officer, Chief Medical Officer for Maternity and Child Welfare, Medical Officer to Committee for Care of Mentally Defective, and Medical Officer, Blind Persons Act: W. Benton, M.R.O.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.O.S. District Medical Officer: R. V. Brews, L.R.C.P., L.R.C.S., L.M. Medical Officer, Aldersbrook Homes: J. S. Greig, M.B., C.M. 5 Public Health Department, Town Hall, East Ham. June, 1931. To the Mayor, Aldermen and Councillors of the County Borough, of East Ham. Mr. Mayor, Ladies and Gentlemen, I beg to submit my Annual Report on the health and sanitary circumstances of the Borough, together with my Report to the Education Authority on the work of the School Medical Service for 1930. As requested by the Ministry of Health, this report is more comprehensive than previous reports in order that more detailed information may be given. This is the twentieth report I have had the honour of presenting. During this twenty years there has been a considerable increase in the duties—especially of recent years—of a Medical Officer of Health, and it is only possible to give a brief outline of important developments. There has been substantial progress made, especially in Maternity and Child Welfare, and School Medical Service, but I must express my disappointment that the progress has been slow in some respects. East Ham was one of the pioneers of Maternity and Child Welfare work, our first Health Visitor being appointed under the Notification of Births Act, 1907, and after twenty years we still have no permanent building for clinics. The same applies in connection with the School Medical Services. All the clinics are housed in temporary buildings, which are overcrowded and entirely unsuitable for the purposes. The Artificial Sunlight Clinic has to be conducted in the same room as the ordinary clinics, and the benefit that should be derived from such treatment is largely mitigated. Although plans for the extension of the Isolation Hospital were before the Ministry of Health in 1914, I am pleased to be able to report that the new administration Block and Wards are now nearing completion. 6 The provision of a Maternity Hospital which has been under consideration since 1921 has not yet materialised. Much difficulty still exists in providing Institutional care for Mental Defectives. With reference to housing conditions, statistics fail to indicate overcrowding in the Borough as a whole, but it is evident that in certain districts there exists a larger number of persons per house than is, warrantable. Absorption of the work of the Guardians by the Public Assistance Committee has materially increased my duties. It is extremely gratifying that the change should have been brought about with such goodwill by all concerned. It will De seen from a consideration of the statistics that the health of the Borough is still maintained at a high standard, the death rate being 9.8 per 1,000 per annum, and infant mortality 49 per 1,000 births. There has been less infectious disease during the year, but unfortunately small-pox of the mild variety still calls for urgent supervision in view of the fact that neighbouring boroughs show a considerable incidence of this disease. The formation of a Central Register as suggested will materially increase the duties of the Public Health Department. The appointment of a Chief Administrative Clerk was necessary owing to the many various duties placed upon the Health Authority, and this appointment has been fully justified. I wish to express my thanks to the Council for their support, and also accord my appreciation and thanks to the whole of the members of my staff for their zeal and loyalty in carrying out duties under difficult circumstances. 1 am, Your obedient servant, W. BENTON, Medical Officer of Health. 7 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in statute acres) land and inland water, 3,324. Population. Census 1921, 143,246 (males 69,342, females 73,904). Estimated 1930, 147,600. Number of inhabited houses (1921), 27,024. Number of inhabited houses (end of 1930), according to rate books (including tenements and shops), 31,982. Number of families or separate occupiers (1921), 33,937. Rateable value at 31st December, 1930, £679,212. Sum represented by a penny rate (rate made October, 1930), £2,741. Physical Features of the Area. 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. East Ham is bounded on the north by Wanstead, south by the River Thames, and adjoins West Ham on the west, and Ilford and Barking east. Social Conditions of the Area. East Ham is principally an artisan residential area, with very few industries carried on within its boundary. The bulk of the working population find their occupations in neighbouring boroughs or in the City, and although there has been a certain amount of unemployment present in the Borough throughout the year, which has tendered to lower the economic conditions of the people, I do not think that this has seriously affected the general health of the community. In my opinion, no particular occupation carried on within the Borough has had any influence on the health of the public. EXTRACTS FROM VITAL STATISTICS. Total. Males. Females. Live Births Legitimate 2,212 1,133 1,079 ] Birth Rate 15.3 Illegitimate 52 26 26 Still Births 80. Rate per 1,000 total births, 34. Deaths: Total 1,452. Males 772 ; Females 680. Death Rate 9.8. Number of women dying in, or in consequence of, childbirth : from sepsis, 4 ; other causes, 4. Death rate of infants under one year of age per 1,000 live births : legitimate, 48; illegitimate, 96 ; total, 49. Deaths from Measles (all ages), 14. Deaths from Whooping Cough (all ages), 8. Deaths from Diarrhoea (under 2 years of age), 12. Any Unusual or Excessive Mortality during the Year. The total deaths for the five years ending 1930, show no marked or unusual increase, the numbers being as follows :— 1926 1,410 1927 1,433 1928 1,461 1929 1,638 1930 1,452 The increase in the 1929 figures was due to the epidemic of influenza, which affected also- the deaths from other chest diseases. Cancer, Heart Diseases and Respiratory Diseases continue to account for over 50 per cent, of the total deaths. The mortality from Heart Disease has increased nearly 70 per cent. since 1926, and is now responsible for more deaths than any other single cause—the deaths from respiratory diseases, which include tuberculosis of the lungs, bronchitis, pneumonia, etc., for 1930, number 308—while those for heart disease number 299. The following table gives the deaths from this cause for the past five years :— 1926 177 Percentage of total deaths 12.5 1927 220 Percentage of total deaths 15.3 1928 271 Percentage of total deaths 18.5 1929 322 Percentage of total deaths 19.6 1930 299 Percentage of total deaths 20.5 8 9 Births. The number of births has slightly risen, the number for 1930 being 2,264, as compared with 2,169 for 1929. Since 1914 the rate has been gradually decreasing as will be seen from the birth and death-rate graph, the rate in 1914 being 24.4, whereas in 1930 it had dropped to 15.3 per 1,000 of the population. Infantile Mortality. The infantile mortality rate is the lowest yet recorded for East Ham, being only 49 per 1,000 births, the rate for England and Wales being 60, London 59, and the 107 County Boroughs and Great Towns, 64. TABLE 1.—Birth Rate, Death Rate and Analysis of Mortality, 1930. Rate per 1,000 Total Population. Annual Death Rate per 1,000 Population. Rate per 1,000 Live Births. Percentage of Total Deaths. Live Births. Still.Births. All Causes. Enteric Fever. Small.pox. Measles. Scarlet Fever. Whooping Cough Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under two years). Total Deaths under One Year. Certified by Registered Medical Practitioner. Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. England & Wales 16.3 0.69 11.4 0.01 0.00 0 .10 0.02 0.05 0.09 012 0.55 6.0 60 90.4 6.9 1.7 1.0 107 County Boroughs & Great towns including London 16.6 0.71 11.5 0.01 0.00 0.15 0.02 0.05 0.10 0.11 0.50 8.3 64 90.6 6.6 2.3 0.5 159 smaller towns (1921 adjusted populations, 20,000.50,000) 16.2 0.69 10.5 0.00 0.00 0.08 0.01 0.05 0.07 0.13 0.43 4.4 55 91.8 5.9 1.2 1.1 London 15.7 0.56 11.4 0.01 0.00 0.23 0.02 003 0.10 0.08 0.55 9.9 59 88.3 7.4 4.3 0.0 East Ham 15.3 0.54 9.8 0.00 0.00 0.09 0.01 0.05 013 0.08 0.53 7.5 49 89.6 6.9 3.4 0.1 TABLE 2.—Births in Wards. Wards. Total. Manor Park. Little Ilford. Wood. grange. Plashet. Kensington. Castle. Central. Wall End. Greatfield. South. 203 320 199 232 153 216 214 258 198 271 2,264 10 11 BIRTH AND DEATH RATES BIRTHS-RED 1914-1930 DEATHS-BLACK 12 Chart of Infantile Mortality 1914-1930. TABLE 3. Causes of Death in Age Groups 1930, together with the Total Deaths at Various Causes for 5 Years 1926-30. Causes of death. Sex. Net deaths at the subjoined ages of "Residents" whether occurring within or without the Borough during the year 1930. Deaths at all ages for the 5 years 1926-1930. Under 1 year. 1 and under 2 yrs. 2 and under 5 yrs. 5 and under 15 yrs. 15 and under 25 yrs. 25 and under 45 yrs. 45 and under 65 yrs. 65 and under 75 yrs. 75 and upwards. 1930 1929 1928 1927 1926 All causes M 64 12 15 26 34 92 219 161 149 772 815 740 728 751 F 47 8 15 25 29 88 171 140 157 680 823 721 705 659 1. Enteric Fever M — — — — — — — — — — 1 — — — F — — — - 1 - - - - 1 - 1 - - 2. Small Pox M F — — — — - — — — — — — — — — 3. Measles M 1 2 4 1 — — — — — 8 — 5 1 13 F 1 4 — 1 - - - - - 6 2 9 3 17 4. Scarlet Fever M — — 1 — — — — — — 1 — — 1 2 F — — 1 — — — — — — 1 3 2 3 1 5. Whooping Cough M 2 1 — — — — — — — 3 7 9 6 3 F 1 — 2 2 — — — — — 5 13 10 6 4 6. Diphtheria M 2 1 3 4 — — — — — 10 15 35 20 11 F — 1 2 7 — — — — — 10 7 20 14 10 7. Influenza M 1 — 1 — — — 2 1 2 7 28 6 20 11 F — — — — — 2 2 —- 1 5 36 6 23 4 8. Encephalitis Lethargica M - - - - - - — - — — 2 — 2 — F — — — — — 1 — 1 — 2 3 2 1 — 9. Meningococcal gitis M 1 — — — — 1 — — — 2 1 2 1 1 F — — 2 — — — — — — 2 1 1 2 2 10. Tuberculosis of Respiratory System M — — — 1 9 31 30 4 — 75 75 65 65 56 F — — — 1 15 24 7 — 1 48 49 52 53 63 11. Other Tuberculous eases M 1 2 1 3 3 1 — 1 — 12 2 11 10 8 F 3 — — 2 — — — — — 5 3 — 9 14 12. Cancer, Malignant Disease M - - - - - 3 37 27 9 76 91 93 76 93 F - - - - - 14 52 29 16 111 109 120 99 106 13. Rheumatic Fever M — — - - 1 - - - - 1 5 4 2 4 F — — - - - - 2 - - 2 5 3 6 5 14 Diabetes M — — - - - - 1 3 2 6 2 3 5 8 F - - - - - 1 7 4 1 13 5 12 6 4 15. Cerebral Haemorrhage, &c M - - - - - 4 7 19 12 42 33 29 31 51 F — — — — 1 — 7 23 14 45 40 34 36 44 16. Heart disease M — — - 4 2 11 46 47 40 150 158 127 110 88 F — — — 1 3 11 41 39 54 149 164 144 110 89 13 TABLE 3—continued. Causes of death. Sex. Net deaths at the subjoined ages of "Residents" whether occurring within or without the Borough during the year 1930 Deaths at all ages for the 5 years 1926-1930. Under 1 year. 1 and under 2 yrs. 2 and under 5 yrs. 5 and under 15 yrs 15 and under 25 yrs. 25 and under 45 yrs. 45 and under 65 yrs. 65 and under 75 yrs. 75 and upwards. 1930 1929 1928 1927 1926 17. Arterio-sclerosis M - - - - - - 5 4 9 18 17 24 25 24 F - - - - - - - 11 3 14 19 13 12 8 18. Bronchitis M 2 — — — — 1 10 12 16 41 60 30 59 47 F — — 1 — — — 6 4 15 26 52 36 61 53 19. Pneumonia (all forms) M 7 4 — 2 3 4 16 6 4 46 69 47 66 65 F 5 3 3 3 — 1 9 6 8 38 76 46 47 46 20. Other Respiratory eases M - - - - - 1 3 1 — 5 15 8 7 8 F 1 - — — 1 — 2 2 3 9 8 6 10 6 21. Ulcer of Stomach or Duodenum M - - - - - 5 7 1 1 14 4 10 12 10 F - - - - - - 3 1 - 4 4 1 3 6 22. Diarrhoea, &c. M 6 — 2 1 — — — — - 9 12 8 7 21 F 6 — — 1 — — — 1 - 8 9 6 5 5 23. Appendicitis and Typhlitis M — — — — 1 1 3 — - 5 6 5 6 4 F - — — 1 — 2 1 - - 4 5 4 8 3 24. Cirrhosis of Liver M — — — — — 2 2 1 — 5 2 1 4 4 F - - - - - - 1 — — 1 3 2 3 3 25. Acute and Chronic Nephritis M — — — — — 1 10 5 4 20 22 25 18 33 F — — — — 1 1 9 6 1 18 15 12 24 23 26. Puerperal Sepsis M — — — — — — — — — — — — - - F — — — — 1 3 — —. — 4 5 2 4 2 27. Other accidents and diseases of Pregnancy and Parturition M — — - - — - - - - - - - - - F — — — — 1 3 — — — 4 7 5 8 3 28. Congenital Debility and Malformation, Premature Birth M 30 - - - - - - - - 30 31 30 34 32 F 20 - 1 — — 1 — — — 22 24 19 26 22 29. Suicide M — — — — 1 2 6 — — 9 9 9 12 9 F - - - - - 6 2 — — 8 3 5 3 3 30. Other Deaths from Violence M — — 1 2 10 11 12 6 5 47 22 42 25 30 F — — 1 1 1 1 3 — 7 14 12 12 14 12 31. Other Defined Diseases M 11 2 2 8 4 13 22 23 45 130 126 112 103 115 F 10 — 2 5 4 17 17 13 33 101 121 129 106 100 32. Causes Ill-defined or unknown M — — - - - - - - - - - - - - F - - - - - - - - - - - - - 1 14 TABLE 4.—Ward Distribution of the Deaths, 1930. Cause of death. Wards. Manor Park. Little Ilford. Woodgrange. Plashet. Kensington. Castle. Central. Wall End. Greatfield. South. Total. 1. Enteric Fever - - - - 1 - - - - - 1 2. Smallpox — — — — — - - - - - - 3. Measles 1 2 1 2 1 2 1 1 1 2 14 4. Scarlet Fever - 1 - - - - - - 1 - 2 5. Whooping Cough 1 — 1 — 1 1 2 - - 2 8 6. Diphtheria 1 3 2 4 1 2 1 1 2 3 20 7. Influenza — 1 — 1 3 1 3 1 - 2 12 8. Encephalitis Lethargica — — — — — 1 — 1 — — 2 9. Meningococcal Meningitis 1 2 — — — 1 — — — — 4 10. Tuberculosis of Respiratory System 14 13 15 12 7 14 9 10 9 20 123 11. Other Tuberculous Diseases 4 — — 1 - 5 1 4 1 1 17 12. Cancer, Malignant Disease 11 22 17 17 20 23 24 22 13 18 187 13. Rheumatic Fever — — — 1 1 - - - 1 — 3 14. Diabetes 2 3 4 — 1 - 3 2 1 3 19 15. Cerebral Haemorrhage, &c. 2 11 6 8 6 9 14 16 7 8 87 16. Heart Disease 27 31 29 36 32 41 26 28 23 26 299 17. Arterio-Sclerosis 3 1 3 2 4 4 2 5 3 5 32 18. Bronchitis 10 7 12 4 2 4 6 5 4 13 67 19. Pneumonia (all forms) 10 8 7 4 13 6 7 7 9 13 84 20. Other Respiratory Diseases 1 1 3 2 — 2 1 2 1 1 14 21. Ulcer of Stomach or Duodenum 1 3 — 4 1 2 5 2 — — 18 22. Diarrhoea, &c. — 2 — 1 3 2 2 3 1 3 17 23. Appendicitis and Typhlitis — 3 — 1 2 — 1 1 1 — 9 24. Cirrhosis of Liver 2 — 3 — 1 — — — — 6 25. Acute and Chronic Nephritis 4 2 5 5 1 3 4 5 7 2 38 26. Puerperal Sepsis — 2 — — — — 1 — — 1 4 27. Other accidents and diseases of pregnancy and parturition - - - - - - 1 1 1 1 4 28. Congenital Debility and Malformation, Premature Birth 3 2 3 5 3 8 6 6 7 9 52 29. Suicide 1 1 2 5 1 - 2 1 2 2 17 30. Other deaths from violence 7 10 5 5 3 8 6 7 6 4 61 31. Other defined diseases 23 16 18 17 26 26 24 31 22 28 231 32. Causes ill-defined or unknown - — — — — — — — — — — Totals 129 147 136 137 134 165 152 162 123 167 1,452 15 16 TABLE 5. Sex Distribution of Deaths in Wards. Sex. WARDS. Manor Park. Little Ilford. Woodgrange. Plashet. Kensington. Castle. Central. Wall End. Greatfield. South. Total. Males 72 76 70 75 71 81 83 86 63 95 772 Females 57 71 60 62 63 84 69 76 60 72 680 Totals 129 147 136 137 134 165 152 162 123 167 1,452 TABLE 6. Infant Deaths under One Year of Age, 1930. Cause of Death. Sex. Ages. Total under 1 year. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Measles M - - - - - - - 1 1 F - - - - - - 1 - 1 Whooping Cough M — — — — 1 — 1 - 2 F - - - - - - - 1 1 Diphtheria M — — — — 2 — — — 2 F - - - - - - - - - Influenza M — — — — 1 — — — 1 F - - - - - - - - - Meningococcal Meningitis M - - - - - - 1 — 1 F - - - - - - - - - Tuberculosis (all forms) M - - - - - - - 1 1 F - - - - - - 1 2 3 Bronchitis M - - - - - 1 — 1 2 F - - - - - - - - - Pneumonia (all forms) M — — — — 2 3 2 — 7 F — — 1 — 3 — 1 — 5 Other respiratory diseases M - - - - - - - - - F — — — — 1 — — — 1 Diarrhoea, etc. M — — — 1 1 1 1 2 6 F — — — — 1 1 2 2 6 Congenital debility and Malformation, Premature Births M 18 3 1 1 4 2 — 1 30 F 16 2 2 - - - - - 20 Other Defined Diseases M 5 1 1 2 — — 1 1 11 F 2 — — 1 2 2 3 — 10 All causes M 23 4 2 4 11 7 6 7 64 F 18 2 3 1 7 3 8 5 47 17 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. (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 Nurses of the Plaistow Maternity Hospital, in addition to those midwives who have a private practice in the Borough. In the North Woolwich area the midwives attached to Sir Henry Tate's Home carry out such work. TABLE 7. Midwives Act, 1902 and 1918. Midwives on Roll, 1930. No. on Midwives Roll. Name. Address. 76751 Appleyard, Bertha Maternity Hospital and District Nurses Home, Howards Road, Plaistow, E.13 78013 Aukett, Jessie L. do. 30525 Bullett, Mary do. 55713 Bumpus, Grace D. do. 74373 Charlton, Margaret H. do. 49686 Dunning, Jessie M. E. do. 77051 Hooper, Emma do. 78349 King, Louie do. 78361 Lapham, Frances E. do. 74658 Lockwood, Ruth H. do. 77308 Steed, Dorothy F. do. 69754 Taylor, Ethel A. do. 78596 Watts, Marjorie do. 38487 Wilcox, Lucy G. do 77919 Trist, Dorothy M. P. do. 78026 Ball, Lily M. Maternity Hospital and District Nurses Home, 72, Burges Road, E.6 78035 Beard, Christabel A. do. 78072 Bush, Nellie do. 40720 Clunn, Emma J. do. 76937 Doward, Nora E. do. 78816 Dunk, Gertrude M. do. 77593 Ellis, Edith L. do. 79494 Evans, Eliz. S do. 18 TABLE 7—continued. No. on Midwives Roll. Name. Address. 77033 Haywood, Dorothea H. Maternity Hospital and District Nurses Homd, 72, Burges Road. E.6 79587 Hawkins, Beatrice do. 77694 Jones, Annie M. do. 78692 Jones, Annirene do. 29132 Latham, Helen A. do. 77147 Mathews, Hannah C. do. 79018 Marshall, E. M. do. 67950 Price, Doris M. do. 26270 Roberts, Mildred do. 48353 Gretton, Emily Maternity Hospital and District Nurses Home, 3, Grenadier Street, E.16 75098 Dykes, Kathleen M. Kelvingrove, Nursing Home, 121, Windsor Road, E.7. 74486 Francis, Adele L. do. 71905 Ashton, Rose E. Tate Nurses' Home, Savile Road, E.16 59764 Bunting, Florence M. do. 77784 Noble, Ida do. 35852 Smith, Fanny do. 74191 Town, Rebecca do. 25786 Twidell, Louisa K. do. 70338 Wright, Mabel A. L. do. 25827 Baird, Mary 7, Altmore Avenue, E.6 67293 Bishop, E. 450, High Street North, E.12 40752 Finn, Olive G. 83a, Wakefield Street, E.6 12378 Juggins, Phoebe A. 58, Herbert Road, E.12 65429 Miller, Sarah J. 54, Marlow Road, E.6 77104 Lawson, Winifred R. 58, Bedford Road, Ilford 26509 Pacey, Henrietta 441, High Road, Ilford 53404 Rurdi, Bertha E. 69, Coolfin Road, Custom House, E.16 13878 Smith, Florence E. 68, High Street South, E.6 34304 Southwell, Sarah A. 44, Neville Road, E.7 Arragon Road Dispensary. The Dispensary is situated at 95, Arragon Road, where the Medical Officer attends daily (Sundays excepted) and urgent calls are made at the address of Dr. Harrison or Dr. Brews. A fulltime State registered nurse, who is also a qualified midwife, is attached to the staff of this dispensary. Medicines are supplied through chemists on the lists of the National Health Insurance Acts. Laboratory Facilities. The arrangements for the examination of swabs remain the same as in previous years. The tests are carried out at the Town Hall Laboratory and at the Isolation Hospital. 19 During 1930 the numbers examined at the Town Hall were as follows :— No. Positive. Negative. 2,032 320 1,712 The examination of sputum, water, milk and foodstuffs is carried out at several outside laboratories on behalf of the Council. Legislation in Force. 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. Date of Date of coming Name of Act adopted. adoption. into operation. Infectious Disease (Notification) Act, 1889 l2th Nov., 1889 1st Jan., 1890 Infectious Diseases (Prevention) Act, 1890 14th Oct., 1890 18th Nov., 1890 Public Health Acts Amendment Act, 1890, Parts 2, 3 and 5 13th Jan., 1891 18th Feb., 1891 20 Name of Act adopted. Date of adoption. Date of coming into operation. Public Baths and Washhouses Acts 16th Mar., 1897 16th Mar., 1897 Housing of the Working Classes Act, 1890, Part 3 16th Feb., 1897 16th Feb., 1897 Public Libraries Act, 1892 l8th June, 1895 1st Aug., 1895 Infectious Disease (Notification) Act, 1889 (Extension) Education (Provision of Meals) Act, 1906 24th Nov., 1908 24th Nov., 1908 Local Government and other Officers' Superannuation Act, 1922 17th July, 1923 1st Oct., 1923 Public Health Act, 1925, Part 2, Sec. 25 13th April, 1926 1st June, 1926 Bye-Laws, Regulations, etc. The following Bye-laws, Regulations, etc., are in force in the County Borough of East Ham :— 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. 21 Closing: Order for Butchers. Closing Order for Chemists. Closing Order for Corn or Forage Dealers. Closing Order for Grocers and Provision Dealers. Tents, Vans, Sheds and similar structures used for Human Habitation. Standing Orders, Rules of Debate for regulating the Meeting and Business of the Council. Standing Orders re Licences for Cinematograph Exhibitions. Standing Orders re Licences for Public Performance of Stage Plays. Standing Orders re Licences for Music, Dancing and other Public Entertainments of the like kind, and Racecourses. Table of Fees to be taken by the Clerk to the Justices of the Peace. Unauthorised Persons on Elementary School premises. Sale of Coal. Cleansing and Disinfection, Essex (Parasitic Mange) Order, 1909. Lamps Marking Roads Obstructions. Provision of Means of Escape from Fire in case of certain Factories and Workshops. Wireless Loud Speakers. Advertisements. HOSPITALS. Provided by Local Authority. Hospital. No. of Beds. No. of Medical Staff. No. of Nursing Staff. Consultant Borough—Infectious Diseases 100 1 34 1 Harts Sanatorium 56 1 9 With regard to the Borough Isolation Hospital, building operations have been going on throughout the year, which will increase the accommodation up to 150 beds. Harts Sanatorium has accommodation for 35 males and 21 females. This will be increased in the near future by a pavilion for observation and advanced cases, 22 Arrangements are made for children to be sent to various Sanatoria as occasions arise, and isolated cases are sent to Papworth Hall and Preston Hall for treatment and training. Maternity. The question of a Maternity Hospital is still under consideration, and in the meantime arrangements have been made for cases to be admitted, to the Plaistow Maternity Home and Queen Mary's Hospital, West Ham. Smallpox. The West Ham Corporation, by agreement, deal with cases arising in this Borough. GENERAL. East Ham Memorial Hospital. No. of Beds. Medical. Surgical. Gynaecological. Aural. Ophthalmic. Balcony. Private. Children 100 28 28 8 4 4 4 4 20 (See also paragraph under Local Government Act, 1929). The general and special hospitals of London are within easy access and are very largely used by the inhabitants of the Borough. Cases are frequently referred to these hospitals by the Medical Officers of the Authority. Whipps Cross Hospital and Institutions Controlled by West Ham. Mr. Armstrong, Public Assistance Officer, has very kindly supplied me with the following information Beds Allocated on User Basis to East Ham. Institution. No. of Beds. Type. Whipps Cross Hospital 155 Medical and Surgical Central Homes 254 Able bodied and Sick Forest Gate Hospital 74 Sick, Maternity and Mental Defectives Forest House and Cottages 26 Chronic cases Margate Convalescent Home 11 Convalescent children to 16 years 28 TABLE 8. East Ham Cases Admitted to Public Assistance Institutions during the Nine Months ended 31st December, 1930. Number chargeable on 1.4.30 Number admitted to 31.12.30 Discharged. Died. Transferred to other institutions. Number remaining on 31.12.30 Whipps Cross Hospital (West Ham Corporation) 101 835 563 119 144 110 Central Home (West Ham Corporation) 270 353 98 136 107 282 Forest Gate Hospital (West Ham Corporation) 83 161 149 6 9 80 Forest House (West Ham Corporation) 53 10 4 — 10 49 Margate Home 6 4 — — 10 Nil 24 Aldersbrook Homes and Scattered Homes. I am indebted to Mr. W. Pitt Steele, the Superintendent of these Homes, for the report and statistics appended below:— Children. "The tendency during the past 18 months for children to be admitted at a much younger age than hitherto had become accentuated during the past half-year of 1930. There were 43 more children between the ages of 5 and 8 in the last six months of the year as compared with the first six months. These were mostly boys of 6 or 7 years. The general transition which has been taking place has converted the Torn Hood Lodge from a lodge housing 50 boys between the ages of 12-16 to a lodge almost entirely composed of children of half that age-group. Of the total number of our children 228 are under 8 years, and of that number about 140 are under 6 years. This change brings with it much increased work and responsibility, there being a greater need for supervision and individual attention than is necessary with older children." "The conduct of the children has generally been very satisfactory. The newly-admitted children continue to settle down in their new surroundings very quickly. Generally speaking, there is no improvement in the standard of the mental and physical condition of the children sent to us—usually backward at school and suffering from neglect." Food and Clothing. "The food supplied to the children continues to be of the best possible quality. The meals are constantly varied, and backward children are given special or extra foods under the direction of the Medical Officer." "They are supplied with warm and suitable clothing, and care continues to be exercised in the provision and fitting of suitable boots and shoes." Bedding. "The bedding is adequate and kept in clean and good order. Extra blankets are issued during cold spells, and the process of changing the mattresses in the various lodges was completed." 25 Bathing. "The bathing and washing arrangements are adequate with the exception of that in the Elizabeth Fry Lodge, the modernisation of which has been deferred pending consideration of further building. The installation by the Corporation of new baths at 12 Homes, and provision of new sinks and boilers ensuring constant hot water at the Ashford Road Homes is indeed a great boon and much appreciated." Workshops and Training Centres. "There has been a slight increase in the number of boys and girls under training, and there is no lack of keenness to learn. We have two or three high grade mental defectives under instruction and already one has shown marked aptitude for his work." Medical Attention. "The children receive prompt medical attention for sickness, injuries, etc., a doctor always being available. Apart from the periodical routine medical examinations carried out by the Medical Officers, the frequent bathing of the children, and the watchfulness of the staff ensures the Medical Officer's attention being drawn immediately to anything untoward." Recreation. "The children are encouraged to spend as much time in the open as possible. The younger ones are daily taken for walks, necessarily restricted in the winter time. The numerous activities of the elder children, Scouts, Cubs, Guides, Football, Cricket, Sports Meetings, etc., continue to flourish. The Recreation Hall, which is nearing" completion, will be of immense service. None look forward to its opening more than the children. This, too, will enable us to convert the existing Day Room into a Reading and Writing Room." Educational Facilities. "The reorganisation of the Schools under the Essex County Council (five of which are attended by various numbers of children from our Homes) has resulted in an extended syllabus, 26 and elder boys and girls are now taking subjects which they have not hitherto been taught. The formation of the Band is progressing satisfactorily." Religious Instruction. "All children receive religious instruction suited to their age and capacity and attend the services in the local churches at Woodford, Aldersbrook, Forest Gate and Leytonstone, whilst the Chaplain holds a service at Aldersbrook every Sunday afternoon. Several boys and girls were confirmed by the Bishop." Accommodation. "It will be noticed from the statistics that the Homes are full, and that we have no further accommodation. This will be met in part by the building of the new Nursery Block and the adaptation of the Elizabeth Fry Lodge." Statistics 1st April, 1930 to 1st January, 1931. The highest number chargeable was 501 „ lowest „ „ 447 In the Receiving Homes 1st April, 1930 228 ,, Scattered ,, „ „ 224 452 In the Receiving Homes 1st Jan, 1931 266 „ Scattered „ ,, ,, 233 499 The chargeability was apportioned as follows :— 1/4/30 1/1/31 To the C.B. of East Ham 69 72 ,, ,, West Ham 251 285 Essex C. C. 132 142 452 499 The average number of admissions weekly was 13 „ ,, discharges ,, 12 Number of deaths in the Institution — The number admitted from East Ham was 74 ,, „ ,, West Ham „ 267 „ ,, „ Essex „ 151 492 Transfers to other Institutions (not under the control of the East Ham or West Ham County Boroughs) 78 Total number of days maintenance 130,818 27 1/4/30 1/1/31 Infants under 3 44 45 Children over 3 and under 5 55 55 „ 5 „ 8 82 128 Boys over 8 and under 14 139 127 Girls „ „ 14 96 98 Boys over 14 and under 16 22 28 Girls „ 14 „ 16 14 18 Accommodation—(Beds provided)— Receiving Homes 263 Scattered Homes 235 498 Boys sent to situations 14 Girls „ „ 9 Boys returned from situations (for medical treatment) 1 Number of boys whose wages were subsidized (with the sanction of the Ministry of Health) 3 Infectious diseases— Chicken Pox 9 Measles 1 Mumps 20 Whooping Cough 3 Diphtheria 2 Scarlet Fever 1 — 36 Staff. On the 1st April, 1930, there were 128 persons employed (full and part time), and on the 1st January, 1931 (including temporary reliefs for sickness), 132. From approximately 32,500 working days, 1,250 were lost on account of sickness, or 3.8 per cent. During the period under review 8 female employees relinquished their posts (3 on account of marriage), 2 female employees were superannuated. One officer died during his term of office. The accommodation provided in the various Homes during the period under review was as follows:— Aldersbrook Homes. Accommodation for Elizabeth Fry Lodge 48 William Morris Lodge 52 Edward North Buxton Lodge 55 Tom Hood Lodge 54 Joseph Lister Lodge 54 263 28 Scattered Homes. Boys. Girls. 2-4, Ashford Road, South Woodford 15 — 6-8, Ashford Road, South Woodford 15 — 10-12, Ashford Road, South Woodford 15 - 14-16, Ashford Road, South Woodford 15 - 18-20, Ashford Road, South Woodford - 15 22, Ashford Road, South Woodford — 7 83, Capel Road, Forest Gate — 13 84, Capel Road, Forest Gate — 13 60, Davies Lane, Leytonstone 10 — 66, Davies Lane, Leytonstone 10 — 21, Pelham Road, South Woodford — 13 23, Pelham Road, South Woodford — 13 25, Pelham Road, South Woodford 13 — 27, Pelham Road, South Woodford 12 — 36, Pulteney Road, South Woodford — 14 38, Pulteney Road, South Woodford — 14 40, Pulteney Road, South Woodford — 14 42, Pulteney Road, South Woodford — 14 105 130 235 Venereal Diseases. As in previous years, the same facilities were available for the treatment of these diseases, and in the following tables the work carried out in connection with the joint scheme of the London County Council is shown. 29 TABLE 9.-VENERAL DISEASES. Summary of work done by the Hospitals during the Year 1930. London Middlesex Essex Surrey Kent Herts. Bucks. E. Ham W. Ham Croydon Total Other Places Grand Total New Patients:— Syphilis 3,527 413 233 165 110 41 17 35 117 13 4,671 554 5,225 Soft Chancre 217 5 14 9 7 3 1 3 13 1 273 86 359 Gonorrhoea 7,997 943 338 318 166 143 46 63 224 56 10,294 829 11,123 Not Venereal 7,343 961 448 390 193 115 38 73 212 55 9,838 324 10,162 Total 19,084 2,322 1,033 882 476 302 102 174 576 125 25,076 1,793 26,869 Total Attendances 664,102 59,168 26,579 24,123 9,780 6,090 2,244 5,106 16,352 3,150 816,694 19,525 836,219 No. of "In-patient" days 30,956 2,588 1,210 2,574 1,708 411 201 137 219 158 40,162 11,054 51,216 Salvarsan Substitutes, doses given 36,081 4,479 2,679 1,889 944 371 319 591 1,583 227 49,163 2,002 51,165 Pathological Examinations. For or at Centres:— Spirochaetes 1,323 75 73 47 26 11 2 23 26 3 1,609 114 1,723 Gonococci 53,658 3,758 2,734 1,946 1,305 712 103 544 1,417 351 66,528 1,512 68,040 Wassermann 27,332 2,294 1,345 1,244 669 317 147 256 630 187 34,421 1,260 35,681 Others 15,170 704 991 745 647 240 54 184 400 174 19,309 424 19,733 Total 97,483 6,831 5,143 3,982 2,647 1,280 306 1,007 2,473 715 121,867 3,310 125,177 For Practitioners:— Spirochaetes 51 1 — 1 — — 1 — — — 54 — 54 Gonococci 4,196 192 185 1,226 14 32 19 43 31 1,672 7,610 8 7,618 Wassermann 16,274 803 819 865 56 100 145 108 166 271 19,607 396 20,003 Others 4,420 106 257 378 16 24 16 22 33 254 5,526 108 5,634 Total 24,941 1,102 1,261 2,470 86 156 181 173 230 2,197 32,797 512 33,309 30 TABLE 10. VENEREAL DISEASES. Summary of the Work done at the London Clinics for all Areas from 1917. Year. New cases. Total venereal cases. Total Non-venereal cases. Total attendances. In-patient days. Pathological examinations for Syphilis. S. Chan. Gonorrhoea. M. F. M. F. M. F. M. F. M. F. M. F M. F. Clinic Practitioners 1917 4,427 3,351 199 11 3,830 1,207 8,456 4,569 1,192 1,168 120,659 63,923 13,988 3,649 1918 3,764 3,002 116 13 4,844 1,940 8,724 4,955 1,345 1,348 169,485 66,095 25,973 6,380 1919 6,394 3,391 463 18 10,441 2,440 17,298 5,849 3,418 1,700 201,626 106,096 24,025 49,186 51,554 10,464 1920 6,988 3,579 766 25 10,669 2,427 18,423 6,031 4,403 2,189 329,940 134,093 29,430 52,182 58,920 14,027 1921 5,088 3,100 458 13 8,573 2,136 14,119 5,249 3,696 2,354 357,503 138,706 30,272 49,420 66,134 18,472 1922 4,207 2,600 309 12 8,233 2,402 12,749 5,014 3,759 2,191 387,631 141,372 28,809 83,755 74,022 19,836 1923 4,497 2,631 311 4 9,043 2,520 13,851 5,155 4,167 2,477 412,915 142,594 29,661 77,001 69,784 24,403 1924 4,174 2,452 301 4 8,565 2,785 13,040 5,241 4,869 2,423 424,850 164,152 31,620 70,836 79,005 24,797 1925 3,556 2,346 268 11 8,464 2,857 12,288 5,214 5,726 2,954 459,011 187,120 29,313 73,141 106,064 26,346 1926 3,725 2,013 301 2 8,825 2,858 12,851 4,873 5,830 3,158 490,578 196,497 31,258 70,477 100,543 27,565 1927 3,886 2,209 203 7 9,637 2,859 13,726 5,075 6,799 3,365 554,171 213,107 21,268 91,145 107,512 27,046 1928 3,433 1,837 229 6 8,249 2,647 11,911 4,490 6,369 3,226 544,969 218,566 23,821 41,285 107,410 29,785 1929 3,303 1,628 276 4 8,271 2,503 11,850 4,135 5,656 3,145 557,747 211,125 23,121 28,399 114,840 32,605 1930 3,389 1,836 347 12 8,620 2,503 12,356 4,351 6,305 3,857 623,820 212,399 21,033 30,183 125,177 33,309 31 TABLE 11. Venereal Diseases. Utilization of Facilities at Hostels, 1930. Particulars of the work done on behalf of the participating authorities by the hostels in the scheme for the year ended 31st December, 1930. These institutions are as follows:— Royal Free: 20-22, Highbury Quadrant, N. Royal Free: 62, Regent's Park Road, N.W. St. Thomas's: 148, Lambeth Road, S.E. Southwark Diocesan : 80, Stockwell Park Road, S.W. Salvation Army: 122-4, Lower Clapton Road, E. Salvation Army: 126-8, Lower Clapton Road, E. West London Mission : 35, Parkhurst Road, N. The following table shows the allocation of the patients received at these institutions, to the areas in the scheme:— Area. No. of patients. Aggregate No. of days in residence. Percentage (days). London County 152 16,487 54.3 Surrey 18 2,176 7.2 Essex 18 2,601 8.6 Middlesex 25 2,985 9.8 Herts 20 1,930 6.3 Kent 27 2,766 9.1 West Ham 1 121 0.4 Croydon 5 819 2.7 Bucks 4 267 0.9 East Ham 2 210 0.7 272 30,362 100.0 32 TABLE 12.—VENEREAL DISEASES. Return showing the Extent to which the Facilities have been Utilised during the Year ended 31st December, 1930. HOSPITAL. New Cases. No. of Persons Total attendances. No. of Inpatient days. Sal. Subs. doses given. Pathological Examinations. Total. Syp. S.C. Gon. Not v.d. Total. Ceased to attend. Dis. charged Spiro. Gon. Wass. Others. (a) (b) (a) (b) (a) (B) (a) (b) Albert Dock 223 74 439 245 981 158 344 13,852 2,391 1,547 84 2 499 20 602 172 - - 1,379 Gt. Ormond Street 39 — 14 537 590 135 46 3,514 2,254 1,479 — 1 420 212 661 593 625 320 2,832 Guy's 513 63 876 845 2,297 284 754 64,880 2,338 4,843 479 — 9,514 756 3,838 2,475 7,305 1,744 26,111 King's College 184 2 129 171 486 166 202 14,253 904 969 10 13 2,630 147 1,227 2,694 82 - 6,803 L.C.C. Clinic (6 months) 298 31 676 522 1,527 293 86 76,183 — 4,051 379 — 6,612 284 2,743 1,320 3,076 1,236 15,650 London (6 months) 227 — 423 437 1,087 491 136 36,802 792 2,041 10 2 3,703 531 937 2,084 - - 7,267 Metropolitan 61 24 152 117 354 98 60 11,539 13 1,161 29 — 504 58 433 252 14 73 1,363 Middlesex 152 4 420 82 658 258 135 29,556 580 1,507 28 3 3,188 186 696 1,221 20 252 5,594 Miller General 126 13 270 81 490 219 130 14,397 152 1,272 36 — 1,207 6 349 216 - - 1,814 Royal Free 150 — 465 648 1,263 178 323 23,811 1,400 1,297 10 - 5,624 89 2,128 610 167 - 8,628 Royal London Ophth. 193 — 40 — 233 96 134 3,136 802 1,278 1 - 80 - 663 - 7 - 751 Royal Northern 234 10 521 224 989 141 357 24,601 167 2,021 63 4 1,770 73 1,056 1,442 5 1 4,414 St. George's 167 15 494 217 893 68 767 30,916 297 1,860 - 15 422 360 1,289 214 - - 2,300 St. John's, Lewisham 81 2 136 245 464 64 166 9,353 878 1,262 13 - 297 86 901 648 920 222 3,087 St. Mary's 235 4 402 192 833 240 179 10,308 729 1,488 8 4 890 333 416 1,351 - - 3,002 St. Paul's 260 1 1,148 1,182 2,591 229 932 131,516 1,859 4,196 275 - 9,023 1,642 2,954 426 155 67 14,542 St. Thomas's 830 70 2,006 2,789 5,695 1,097 1,558 178,299 3,488 9,490 — — 10,206 2,179 9,659 1,524 6,769 581 30,918 Seamen's 491 31 747 144 1,413 1,204 101 14,862 9,666 1,434 54 - 1,234 84 847 129 528 7 2,883 S. London for Women 42 1 85 151 279 27 74 4,074 664 396 11 2 756 81 231 641 1 - 1,723 University 214 1 467 63 745 355 196 34,975 485 1,845 - - 1,703 199 1,068 18 - - 2,988 West London 404 7 804 945 2,160 204 543 74,377 1,718 4,535 212 2 3,062 258 2,074 674 9 43 6,334 Westminster 71 6 176 24 277 87 107 19,257 117 1,157 18 6 960 34 480 1,299 50 1,088 3,935 S. A. Mothers' 24 - 170 301 495 176 4 11,758 6,687 36 3 - 3,736 - 429 - - - 4,168 Children's, Waddon 6 - 63 - 69 - 60 - 12,835 - - - - - - - - - - Total 5,225 359 11,123 10,162 26,869 6,268 7,394 836,219 51,216 51,165 1,723 54 68,040 7,618 35,681 20,003 19,733 5,634 158,486 (a) For Centre 125,177 (b) For Practitioners 33,309 33 Mental Hospital. Owing to the contract with the Essex County Council for the admission of patients having expired, there has been considerable difficulty in finding accommodation for these cases. East Ham patients have been accommodated in the following institutions as per the annexed table:— TABLE 13. Disposition of East Ham Mental Patients on 31st December, 1930. Institution. Contract Nos. Patients received. Male. Female. Male. Female. Canterbury 35 — 32 (3) — Worcester 70 — 60 (10 — Gateshead 20 55 17 (3) 50 (5) Taunton 10 — 10 — Colchester — — 2 54 Brentwood — — 35 97 Leicester — 2 — 2 Stone, near Dartford — 2 — 2 Various Institutions — — 2 7 Peckham House — — 18 32 176 244 Total 420. Figures in brackets indicate the number of spare beds, i.e., Males 16_ Females 5. Negotiations are at the present time proceeding between the Council of this Borough and the County Borough of Southend, to erect a Mental Hospital to accommodate patients from both Boroughs. Agreement has been reached upon the site, and it is to be hoped that within a few years the difficulty' and anxiety on this account will be overcome. Mental Deficiency. The same difficulty has occurred with institutional cases under the Mental Deficiency Acts, but it is hoped shortly to come to an agreement with the West Ham Council when their new institution is ere :ted at Ockendon. 34 Orthopaedic. An agreement exists between this Corporation and Queen Mary's Hospital, Stratford, for the reception and treatment of orthopædic defects. Ear, Nose and Throat. These cases are treated at Queen Mary's Hospital, East Ham Memorial Hospital, Invalid Children's Hospital, Plaistow. With the latter hospital an agreement has been entered into for the operative treatment of Mastoid disease. Puerperal Fever and Pyrexia. These cases are either admitted to Whipps Cross Hospital or to one of the London hospitals, but when the new extensions are completed at the Isolation Hospital it is intended to admit such cases into the new Cubicle Block. Ophthalmia Neonatorum. Cases of Ophthalmic Neonatorum are seen by the Ophthalmic Surgeon, and on his recommendation are admitted either to Whipps Cross Hospital or one of the London hospitals. Pathological work is usually carried out at Queen Mary's Hospital, Stratford, who possess an excellent pathological department. Clinics and Treatment Centres. The clinics and treatment centres set out in the table under this heading are all provided by the Corporation. The Central Maternity and Child Welfare Clinic at White House, Plashet Grove, was transferred to High Street Schools in October, 1930, owing to the White House being demolished to make room for the new Secondary School for Girls. This change is shown in the table, and it will be noted that an extra clinic was commenced in the Baptist Church Hall before the end of the year. 35 TABLE 14. CLINICS AND TREATMENT CENTRES. Situation. Purpose used. Sessions. *White House, Plashet Grove Infant Welfare Monday, Thursday and Friday, 2 p.m. Thursday, 9 a.m. *St. John's Church Hall, North Woolwich do. Tuesday, 2.30 p.m. *Wesleyan Church Hall, Manor Park do. Tuesday, 9 a.m. *St. George's Church Hall, Masterman Road do. Wednesday, 2 p.m. *White House, Plashet Grove Ante-natal clinic Friday, 9.30 a.m. †Central Clinic, High Street School Infant Welfare Monday, 2 p.m. Thursday, 9.30 a.m. † do. Special Clinics Monday, 9.30 a.m. Wednesday, 10 a.m. † do. Ante-natal Clinic ... Friday, 10 a.m. †Wesleyan Church Hall, Manor Park Infant Welfare Tuesday, 9.30 a.m. †St. John's Church Hali, North Woolwich do. Tuesday, 2.30 p.m. †St. George's Church Hall, Masterman Road do. Wednesday, 2 p.m. †Baptist Church Hall, Plashet Grove do. Thursday, 2 p.m. Friday, 2 p.m. Durban House, Katherine Road Tuberculosis & Chest Clinic Monday and Wednesday (adults if not working), 2-3.30 p.m. Saturday (children only), 9.15-10.30 a.m. Thursday (adults if working), 6-7.30 Town Hall, East Ham Immunization Friday, 3 p.m. do. General Clinic (minor ailments and observation cases) Monday, Wednesday and Saturday, 9 a.m. St. Michael's Institute, Manor Park do. Tuesday and Thursday, 9 a.m. St. John's Schoolrooms, High Street, North Woolwich do. Monday and Friday, 2 p.m. Town Hall, East Ham General Ear Clinic Friday, 2 p.m. (by appointment only) do. Eye Specialist Clinic Tuesday, Thursday and Friday, 9 a.m. (by appointment only) do. Ear Specialist Clinic Tuesday, 3 p.m. (by appointment only) do. Light Clinic Wednesday, 2 p.m. (by appointment only) Durban House, Katherine Road Dental Clinic By appointment only * January to October, 1930. † November to December, 1930. 36 MENTAL DEFICIENCY ACTS, 1913-27. The duties of ascertainment and supervision of mental defectives has been carried out in accordance with the provisions of the above Acts. In addition to the reports for the Board of Control and Visiting Justices, quarterly reports on a few feeble-minded children have been prepared for the information of the Education Committee. The necessary quarterly reports on all defectives placed under Statutory Supervision in their own homes have been made and filed. Cases under Guardianship have been visited by the Medical Officer of Health and the Supervisor, and help and advice offered regarding conduct, clothing and diet. Much time has been spent in educating parents on the management and control of defectives under supervision in their own homes, and in arranging for the patients to attend the Council's Training Centre, Barking Road. Training Centre. The work under Miss Fooks at the Centre in Barking Road has been carried out in a very satisfactory manner. The average attendance continues to increase. The concentration and general good behaviour of the defectives attending has improved greatly. Lessons in simple hygiene have been continued in addition to the following routine work:— Boys. Girls. Woodwork. Plain needlework. Leather-work. Rug making. Rush mats. Coloured embroidery. Wool mats. Raffia-work. Basket work. Bead-work. During 1930 the following cases were dealt with:— Sent to institutions 13 Removed to a "place of safety" pending the presentation of a petition 3 Placed under Statutory Supervision in their own homes 22 Under Friendly Care 5 37 At the end of the year the disposal of the cases was as follows:— 73 in institutions, of whom 2 were on long leave of absence in their own homes. 15 under Order of Guardianship. 120 under Statutory Supervision in their own homes. 3 in a "place of safety," Section 15. 77 under Friendly Care. The Supervisor under the Mental Deficiency Acts carried out the following duties:— Number of visits 1,264 Number of interviews 70 Sessions at Training Centre 22 TRAINING CENTRE. Males. Girls and Junior Boys. Average number on register 9 24 Average number of attendances during 1930 1,622 3,889 Average attendance per session 7.5 18 BLIND PERSONS ACT, 1920. In 1925, after the appointment of a Home Visitor, the register was revised. New cases were found, certified and added to the register. The number of technically blind persons has risen from 120 in December, 192G, to 185 in December, 1930. The Home; Visitor's work has naturally increased, and many blind persons have been trained and found work. Many of the unemployable blind have been taught suitable pastime occupations, and an increasing number can now read Braille and Moon types. Thus they are able to take advantage of weekly and monthly embossed magazines provided by the Local Association, and of the facilities allowed them by the Borough Libraries in 38 procuring books of all kinds from the National Library for the Blind free of charge. In addition, numbers of those afflicted have been assisted to obtain Blind Old Age Pensions and free wireless licences. The Council's scheme for providing grants (according to income) to all necessitous blind persons has been a great boon, as it has meant that all blind persons have an assured income, thus obviating appeals to public assistance. The East Ham Welfare Association for the Blind continues to carry out its splendid work for these sufferers. In the Annual Report of the Association for 1930-31 the Committee state that a large addition has been made to the numbers on the register, the number at the beginning of 1930 being 172, and on 31st March, 1931, 200. They are graded as follows:— In residential schools 4 In workshops 17 In training 5 At work 6 St. Dunstan's men 5 Street musicians and sellers 3 Home workers 2 Training and not at work 2 Awaiting training 4 Pastime occupations 36 Domestic duties at home 21 Doing no pastime occupation (owing to age) 95 Forty-one weekly and 17 monthly magazines are supplied by the Association for those desiring the same. Social evenings have been arranged for the blind and their guides, and the Annual Outing to Thorpe Bay was a great success. Groceries at Christmas to necessitous cases, grants, extra nourishments in case of sickness, tobacco and cigarettes, spectacles, dentures, ear trumpets, and through the Ladies' Clothing Sub-Committee, clothing, boots, etc., where needed, are a part of the activities of the Association. 39 TABLE 15. Work of the Visitor to the Blind. Year. No. of technically Blind Persons on Register. No. of Visits to same. No. of Partially Blind Persons. No. of Visits to same. Other Visits. Total Visits. No. of Lessons Given. Lessons Given in Cane Basket Work. Braille. Moon. Knitting. Crochet Wool Ball Work. Manual. Straw- bag making. Daily. Evening. 1926 120 1,699 118 — — 4 1,821 395 148 73 — 52 48 33 — 41 1927 145 1,838 102 — — 5 1,945 415 119 110 27 43 68 38 10 — 1928 149 1,827 184 — — 5 2,016 371 48 74 50 55 36 34 33 41 1929 173 2,751 178 — — 4 2,933 383 38 107 49 75 22 21 42 29 1930 185 3,445 158 40 57 4 3,664 398 27 173 103 25 14 22 34 - 40 INVALID CHILDREN'S AID ASSOCIATION (East Ham Branch). Again, I have to report on the excellent work carried out by the above Association, which has continued to co-operate with this department as in past years. New cases have been referred to them as follows:— School Medical Department 44 Tuberculosis Officer 16 Infant Welfare Department 5 During the year 183 cases have been assisted in the following manner: — Sent to Sanatoria, Schools of Recovery or Convalescent Homes 131 Boarded out 4 Surgical appliances 23 Food and clothing grants 13 Visiting, advice, loan of carriages, etc. 12 LOCAL GOVERNMENT ACT,' 1929. The following is a brief synopsis of the administrative scheme of the Council as approved by the Ministry of Health:— 1. All domiciliary assistance to blind persons shall be provided exclusively by virtue of the Blind Persons Act, 1920, and not by way of poor relief. 2. It is the intention of the Council that, as soon as circumstances permit, all assistance, other than such as is dealt with in paragraph (1) above, which could, after the 1st April, 1930, be provided either by way of poor relief or by virtue of any of the Special Acts, shall be provided exclusively by virtue of the appropriate Act, and not by way of poor relief, but nothing in this Scheme shall diminish or otherwise affect the duty of the Council under Section 34 of the Poor Law Act, 1927, to provide relief for the poor. 3. That a Committee of the Council, to be called the Public Assistance Committee, be constituted, consisting of 14 persons, who shall be members of the Council, and including the Mayor and Deputy Mayor, who shall be members of the Committee by virtue of their office, 41 4. It is the intention of the Council as soon as the necessary arrangements can be made to provide that the functions of the Public Assistance Committee in so far as they relate to:— (a) the maintenance of poor children apart from their parents; (b) the relief of expectant and nursing mothers; (c) the relief of the blind; (d) the care of the mentally defective persons; shall be discharged, on behalf of and subject to the general direction and control of the Public Assistance Committee, by the— (a) Education, (b) Maternity and Child Welfare Sub, (c) Public Health, and (d) Mental Deficiency Committees of the Council respectively. With regard to the relief of the blind, a scheme for the domiciliary assistance of blind persons is to be submitted to the Ministry of Health. With the exception of the Aldersbrook and Scattered Homes, which previously were controlled by the West Ham Board of Guardians, and which were transferred to East Ham, the West Ham Council retained possession of the rest of the institutions. Medical out-relief is administered by the Public Assistance Committee. The Medical Staff are, however, under the control of the Medical Officer of Health. Section 13, Local Government Act, 1929. An agreement has been entered into with the East Ham Memorial Hospital, wherein the Hospital agree to provide the following services:— The Council to contribute to the East Ham Memorial Hospital the sum of £3,000 per annum (such sum to exclude payments at present made under contract for specific classes of cases treated at the Hospital) and to be payable quarterly or half-yearly subject to the following terms and conditions:— 1. The Hospital Committee will co-opt three members to be nominated by the Council, on the Hospital Management Committee, it being understood that one of the Council's Medical Staff 42 be permitted to attend meetings of the Hospital Committee in an advisory capacity. 2. The Hospital Committee will provide the following services on behalf of the Council (a) Reservation of 6 beds for the treatment of general medical and surgical diseases in infants and children, and 4 beds for the treatment of general, medical and surgical diseases in adults, there to be no limit, however, to the number of beds used, provided beds are available. (b) Treatment of orthopaedic cases when accommodation can be provided. (c) The operative treatment of ophthalmic and aural cases referred by the Council's Medical Officer. (d) Tuberculosis, all forms—(a) provision for the reception of cases where surgical interference is indicated, (b) radiography. 3. In addition to the annual contribution, payment be made by the Council for each Council patient admitted on the basis of the maintenance cost per patient as ascertained for the previous year, which cost shall exclude all capital charges and other expenditure for the repairs, alterations, improvements or additions to the Hospital. 4. The Honorary Medical Stalf of the Hospital to have complete control and accept responsibility respecting treatment and discharge of all patients. 5. The Hospital Medical Staff and the Medical Officer of Health to meet periodically in order to ensure continuous co-operation and co-ordination. 6. Any allowances or services at present made or rendered by the Council which are in the nature of contributions to the Hospital to cease. (The following services are already provided by the East Ham Hospital under contract with the Council as the Local Education Authority and as a Maternity and Child Welfare Authority:— (i) Operative treatment of enlarged tonsils and adenoids in children, and provision of bed accommodation for 43 those cases when necessary, for cases referred by the Medical Officer of Health, and/or the School Medical Officer. (ii) The application of X-rays in cases of Ringworm of the Scalp). PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. Smallpox. Seventy cases were notified during the year as against 25 cases during 1929. The disease remained the mild type as in previous years, so mild that in many cases it was difficult to make a diagnosis. No case occurred in a person who had been vaccinated within 10 years. There were no deaths. If a school child had been in contact with a case the parents of the children attending the same school were notified and vaccination advised with very satisfactory results. No primary or re-vaccinations were performed by the Medical Officer of Health, but were referred to the Public Vaccinator. The following information relative to the cost of institutional treatment of small-pox cases for the financial year ending 31st March, 1931, is interesting. £ s. d. Cost of treatment ,557 8 7 Ambulance charges 271 6 1 £1,828 14 8 Number of patients treated 93 Number of days' maintenance 1,817 £ s. d. Cost per patient for treatment 16 14 11 Cost per patient for ambulance 2 18 4 Cost per patient for treatment and ambulance 19 13 3 Cost per patient per day for ment (ambulance included) 1 0 1½ Note.—Standing charges are not included in the above. 44 TABLE 16. SMALL POX, 1930. No. Initials. Date of Notification. Age. Sex. Probable Source of Infection. No. of contacts traced and kept under observation. Secondary Cases in same house. State of Vaccination of Patient. 1 L.A. 30.12.29 16 M Contact with Stepney case 7 1 Not 2 W.W. 2.1.30 20 M Unknown 11 — „ 3 A.A. 9.1.30 5 M Contact with case No. 1 Nil See case No. 1 „ 4 F.M. 9.1.30 40 F Unknown 4 1 „ 5 J.W. 16.1.30 21 M Contact with Stepney case 11 2 „ 6 J.V. 20.1.30 10 M Unknown 9 2 „ 7 A.G. 25.1.30 38 M Contact with Whitechapel case 3 — „ 8 N.P. 31.1.30 27 F Unknown 11 1 „ 9 M.V. 1.2.30 37 F Contact with case No. 6 4 See case „ 10 A.V. 1.2.30 15 F Do do. No. 6 „ 11 G.W. 3.2.30 ms. 45 M Contact with case No. 5 5 See case Infancy 12 O.W. 3.2.30 5 F Do. do. No. 5 Not 13 A.G. 4.2.30 35 F Unknown 5 — „ 14 A.W. 4.2.30 19 M do. 3 — „ 15 G.O. 17.2.30 18 M do. 6 — „ 16 A.P. 20.2.30 63 F Contact with case No. 8 4 See case Infancy 17 E.B. 22.2.30 37 F Contact with case No. 13 4 No. 8 Not 18 G.H. 11.3.30 49 M Contact with Shoreditch case 5 — Infancy „ 19 G.G. 12.3.30 57 M Unknown 2 — 20 E.A. 13.3.30 21 F Unknown 8 — Unkn'wn 21 W.W. 19.3.30 23 M do. 12 2 Not 22 E.B. 19.3.30 46 F do. 3 — „ 23 G.M. 21.3.30 72 M Contact at hospital in Leytonstone 3 See case No. 4 Infancy & some years ago 24 C.B. 5.4.30 33 F Contact with case No. 21 7 See case No. 21 Not 25 H.W. 7.4.30 21 M Contact with cases Nos. 2 and 24 8 See case No. 21 „ 26 J.M. 25.4.30 15 M Unknown 7 1 „ 27 P.M. 29.4.30 18 F Contact with case No. 26 7 See case No. 26 „ 28 A.V. 19.5.30 15 M Unknown 6 3 „ 29 W.W. 20.5.30 33 M do. 6 1 „ 30 E.W. 5.6.30 22 M Contact with case No. 29 5 See case No. 29 „ 31 G.V. 11.6.30 14 F Contact with case No. 28 5 See case „ 32 A.S. 12.6.30 10 M Contact with cases Nos. 28 and 31 No. 28 „ 33 A.S. 12.6.30 9 M „ 34 I.D. 13.6.30 29 F Unknown 6 — Infancy 35 M.G. 17.6.30 30 F do. 4 — Not 36 J.C. 16.7.30 13 F Contact with cases 31, 32 and 33 9 2 „ 37 J.S. 18.7.30 53 F Unknown 13 — Infancy 45 TABLE 16—continued. No. Initials. Date of Notification. Age. Sex. Probable Source of Infection. No. of contacts traced and kept under observation. Secondary Cases in same house. State of Vaccination of Patient. 38 E.T. 29.7.30 16 mos. M Contact with case No. 36 8 See case No. 36 Not 39 J.T. 31.7.30 25 F Contact with cases Nos. 36 and 38 8 See case No. 36 Infancy 40 AH. 5.8.30 10 M Contact with cases Nos. 36, 38 and 39 7 3 Not 41 A.H. 7.8.30 16 M Unknown 7 — „ 42 S.B. 13.8.30 19 M do. 7 1 „ 43 E.H. 18.8.30 9 F Contract with case No. 40 5 See case No. 40 „ 44 C.H. 18.8.30 7 M do. „ 45 G.H. 19.8.30 5 F do. „ 46 R.B. 26.8.30 13 M Contact with case No. 42 6 See case No. 42 „ 47 H.N. 28.8.30 21 F Unknown 4 1 „ 48 S.S. 6.9.30 42 M do. 4 — Infancy 49 F.T. 11.9.30 11 M do. 6 — Not 50 A.N. 14.9.30 56 F Contact with case No. 47 2 See case No. 47 Infancy 51 L.E. 1.10.30 17 F Contact with Finsbury cases 8 — Not 52 R.W. 21.10.31 18 M Contact with Bethnal Green case 7 - „ 53 G.H. 3.11.31 17 F Contact with West Ham case 7 1 „ 54 R.O. 8.11.31 44 F Unknown 9 2 Not 55 R.O. 12.11.31 15 F Contacts with case No. 54 13 See case No. 54 „ 56 R.B. 12.11.31 57 F Infancy 57 D.H. 23.11.31 8 F Contact with case No. 53 5 See case No. 53 Not 58 J.H. 24.11.31 34 F Unknown 1 — Infancy 59 J.S. 29.11.31 51 M do. 18 1 Infancy & about 15 yrs. ago 60 D.C. 1.12.30 19 F Contact with City case 2 — Not 61 w.s. 2.12.30 21 M Contact with case No. 59 17 See case No. 59 Infancy 62 S.L. 5.12.30 19 M Contact with Leyton case 8 2 Not 63 C.R. 5.12.30 20 M Unknown 3 — Infancy 64 E.M. 16.12.30 44 F Contact with Blackfriars case 4 1 Not 65 W.M. 16.12.30 22 M See case No. 64 „ 66 G.L. 18.12.30 32 F Contact with case No. 62 6 See case „ 67 S.L. 18.12.30 17 M No. 62 „ 68 D.W. 22.12.30 13 M Unknown 15 — „ 69 S.C. 24.12.30 68 M do. 8 — „ 70 M.M. 27.12.30 19 F do. 15 - „ 46 The following pamphlet was printed and circulated regarding Small-pox:— County Borough of East Ham. PUBLIC HEALTH DEPARTMENT. Warning SMALL-POX Warning During the past two years a mild form of small-pox has been prevalent in London (over 2,000 cases have occurred in neighbouring districts). Up to the present time East Ham has been very fortunate, only 69 occurring in the Borough during 1930, but there is a danger of spread of the infection. The difficulty of control lies in the mildness of most of the cases, many patients not consulting a doctor throughout the illness. Although the present cases are of the mild form of small-pox, the question has been raised as to whether vaccination is worth while for the prevention of such a minor ailment. It is important to note that not a single case has occurred in a person who had been vaccinated during the previous ten years, and where it has occurred in elderly persons vaccinated during infancy the attack has been extremely mild, thus showing that vaccination does afford protection. Investigation by the Ministry of Health has shown that one vaccination mark, which practically causes no inconvenience, protects the individual from this form of small-pox. The public should realise that although the illness is mild, considerable expense, owing to the necessity of isolation of the sufferers extending over some weeks, and also those who have been in contact are in most instances prevented from continuing their employment, often causing considerable hardship through loss of wages. The above facts surely point to the necessity of vaccination or revaccination, which I advise for the protection of the residents of East Ham. In those districts where vaccination has been previously neglected, continued and occasional serious epidemics have occurred at great cost to the Local Authority. The risk of vaccination with one mark is negligible. Town Hall, East Ham. WILLIAM BENTON, Medical Officer of Health. 47 TABLE 17. Vaccination, 1930. No. of Births. Certificates of Primary Vaccination. Statutory Declarations. Certificates of Postponement. Certificates of Insusceptibility. 2,264 1,267 816 58 5 Scarlet Fever. The number of cases of Scarlet Fever notified was 484, as against 743 in 1929. Two deaths resulted from this cause. The disease still continues to be of the comparatively mild type. Of the 484 cases, 325, or 07 per cent., were removed to hospital. Diphtheria. 473 cases were notified as against 578 in 1929. The number of cases removed to hospital were 460, or 79 per cent. There were 20 deaths from Diphtheria. For those patients treated at home the Corporation provide anti-toxin free of charge. Free bacteriological examination of the swabs from nose and throat of suspicious cases and contacts are made for medical practitioners. The majority of practitioners take full advantage of this service, and it is only when they neglect to do so that serious cases are admitted to Hospital with unfortunate results, as the early administration of Anti-toxin is a sure remedy for the disease. Shick Immunization Clinic. During the period 27th September, 1929, to 26th September, 1930, 449 infants and children have received three inoculations. The total number of inoculations performed has been 1,371, of which 285 were carried out by Private Practitioners and 1,086 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:— 48 1. Town Hall Clinic. Total number of inoculations 1,086 Number inoculated three times 354 Number inoculated twice 8 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 10 18 22 31 39 120 40 52 33 38 24 187 15 19 15 8 6 63 370 2. Private Practitioners. In addition to the above, 95 children have been inoculated three times by Private Medical Practitioners, and the ages at which inoculation was performed were as follow:— Ages in years 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 and over No. inoculated 1 4 4 9 6 24 13 13 14 5 13 58 4 2 5 1 1 13 95 N.B.—In considering the combined totals (1 and 2) it will be noticed that 30.9 per cent. of the cases were in the age group 1 to 5 years, 52.7 per cent. in the age group 6 to 10 years, and 16.3 per cent. in the group over 10 years. 3. The Schick Test. The Schick test for susceptibility to diphtheria has been performed in 199 of the completed cases, of which 197 proved negative. In the other two cases, positive results were obtained, and arrangements will be made for a further test to be carried out in these cases. Enteric Fever. During 1930 only 3 cases were notified, one death being certified to this cause. All these patients were treated in the Hospital. Erysipelas. 63 notifications were received, 17 of whom received Hospital treatment. There were no deaths. 49 Puerperal Fever. The cases numbered 10 and of these 4 died. All the cases were treated in Hospital. Puerperal Pyrexia. The notifications received for this disease numbered 14, no deaths occurring. Twelve were treated in hospital. Preventive Methods Undertaken to Control the Spread of Infectious Disease. On receipt of the notification of a case the patient is at once removed to Hospital, if this is desired or necessary, and the room previously occupied and its contents are disinfected. Library books, if present, are removed for disinfection. Whether the patient be removed to Hospital or not, the Sanitary Inspector at once calls and obtains all particulars of the case and endeavours to trace the source of infection. He also leaves a printed form giving full instructions as to isolation, etc., and the precautions which should be adopted to prevent the spread of infection. Information is obtained as to the Day and Sunday schools attended, either by the patient or by children in the house, the school authorities are notified, and all children living in the house are for a time excluded. The source of the milk supply, the occupation of the inmates, home work, sanitary condition of the premises, water supply, presence of animals, etc., are all investigated, and a report made to me on the same day. The name of the laundry is also ascertained, the proprietor is notified, and the sending of clothes there is prohibited until the premises are free from infection. Disinfection of premises and articles which have been exposed to infection is undertaken by the Sanitary Department. 50 TABLE 18. Total Cases of Notifiable Diseases, 1910-1930. Disease. 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 Smallpox — — — — — — — — 3 1 10 — — — — — — — 17 25 70 Scarlet Fever 329 377 435 526 677 499 267 341 272 530 718 1,355 502 170 215 221 350 798 832 743 484 Diphtheria 142 121 72 258 319 204 225 279 273 451 426 309 198 160 128 246 337 464 669 578 473 Enteric Fever 19 56 13 19 21 5 7 9 2 15 10 7 4 3 5 9 7 2 7 2 3 Erysipelas 104 134 152 119 130 96 86 66 52 72 72 57 34 32 38 41 41 38 60 49 63 Puerperal Fever 6 6 8 8 4 4 1 2 1 6 6 5 3 5 5 5 5 4 8 9 10 Puerperal Pyrexia Not Notifiable 11 11 12 14 Meningococcal Meningitis Not Notifiable 2 6 1 8 6 7 3 3 3 4 — 1 1 1 1 4 1 1 3 Encephalitis Lethargica Not Notifiable 4 5 7 — - 9 6 1 2 3 1 — Ophthalmia Neonatorum Not Notifiable — 17 16 16 7 11 13 30 3 11 11 11 6 8 10 12 3 8 Ac. Polio Myelitis Not Notifiable 2 8 4 1 10 — — 3 1 — — 3 1 1 — 5 — 2 — Dysentery Not Notifiable - - 1 - - - - - - - - - Malaria Not Notifiable — — 1 - - - - - - - - - Measles Not Notifiable 1,650 1,404 1,538 Not Notifiable German Measles Not Notifiable 123 115 134 Not Notifiable Continued Fever - - - - - - - - - 1 - - - - - - - - - - - Typhus Fever — — - 1 — — — — — — — — — — - — — — — — — Pneumonia Not Notifiable 85 92 54 79 91 70 114 82 102 59 Total 600 694 684 945 1,173 833 618 2,484 2,136 2,771 1,281 1,834 844 439 492 627 820 1,452 1,702 1,527 1,187 51 TABLE 19. Prevalence of and Control over Infectious Disease.—Notified Casks for the 53 Weeks ending 3rd January, 1931. Disease. Cases notified in whole district. Ward distribution of Cases. No. of Cases removed to hospital. Total deaths in Borough. At all ages—years Manor Park. Little Ilford. Woodgrange. Plashet. Kensington. Castle. Central. Wall End. Greatfield. South. At all ages Under 1 1 to 5 0 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and up. Smallpox 70 1 2 7 9 13 21 8 8 1 1 18 10 4 5 8 5 7 6 6 70 — Scarlet Fever 484 5 96 183 100 42 51 5 2 — 25 39 42 51 25 61 39 84 57 61 325 2 Diphtheria 473 9 101 226 78 24 28 3 3 1 39 43 44 49 40 64 41 56 40 57 460 20 Erysipelas 63 1 2 1 3 — 18 8 24 6 3 16 4 10 7 4 4 4 4 7 17 — Puerperal Fever 10 — — — - 1 9 - — - 1 6 — — — — 1 1 — 1 10 4 Puerperal Pyrexia 14 — — — — — 13 1 — — 2 3 2 2 1 2 1 1 — — 12 — Ophthalmia Neonatorum 8 8 - - - - - - - - - - 3 1 — — 1 — 1 2 6 — Meningococcal Meningitis 3 1 1 - - - - 1 - - 1 - - - 1 - - - - 1 3 4 Pneumonia 59 1 8 8 2 5 8 8 11 8 8 10 9 3 — 7 2 5 7 8 19 84 Enteric Fever 3 - - - - - 2 1 - - - - - - - 1 1 1 - - 3 1 52 TABLE 20. Ophthalmia Neonatorum, 1930 Disease. Cases. Vision Unimpaired Vision Impaired Total blindness Death Notified Treated At home Hospital Ophthalmia Neonatorum 8 2 6 6 *2 — — *1 Blind in right eye. CANCER. The deaths classified to Cancer have slightly diminished as compared with the previous year. Circulars have been issued and advertisements inserted in the local press giving advice as to early treatment of this scourge. No action has been taken on the lines suggested by the Ministry of Health regarding investigation into the causes of Cancer, as the Health Committee decided, on my advice, that the information available by co-operation of the medical practitioners was unlikely to prove helpful. TABLE 21. Cancer Deaths, 1930. Total deaths 187 Males 76 Females 1ll Classification. Number of deaths. Cancer (no classification) 16 Carcinoma 163 Epithelioma 3 Sarcoma 5 Total 187 53 Parts of Body Affected. Parts Affected Ages Under 35 years 35-45 45-55 55-65 65-75 75-85 85 years and over Total Sex M F M F M F M F M F M F M F M F Buccal Cavity — — — — — 1 — 3 - 1 — — — 5 — Peritoneum, Intestines & Rectum — — - 3 1 3 2 6 4 7 1 1 — — 8 20 Pharynx, Oesophagus, Stomach, Liver and Annexa — — 1 4 4 9 15 9 14 12 5 7 — — 39 41 Female Genital Organs — — — 3 — 2 — 3 — 2 — 3 — — — 13 Breast — — — — — 2 — 8 — 1 — 2 — — — 13 Skin — — — — — 2 — — — I — — — 3 — Other Organs 1 1 1 3 5 4 7 6 6 7 1 3 — — 21 24 Totals 1 1 2 13 10 20 27 32 27 29 9 16 - - 76 111 54 CHART OF TOTAL DEATHS and CANCER DEATHS 1914-1930. 55 REPORT ON WORK OF TUBERCULOSIS AND CHEST CLINIC. The Ministry of Health have agreed to sanction the alteration of the name "Tuberculosis Dispensary" to that of the " Tuberculosis and Chest Clinic." This re-naming of the clinic was thought to be justifiable to relieve to a certain extent the word "tuberculosis," and so get people to attend for examination who would otherwise be afraid of mixing with those suffering from this disease. From a preventive point the work of the clinic is of considerable value on account of the advice offered to those affected and warning of the risk of infecting contacts. It also acts as a clearing house for the diagnosis and treatment of tuberculosis, and in addition, its activities are also of great value to the medical practitioners of the Borough, who appreciate the services thus offered. An increasing number of X-ray examinations have been made as a routine method in diagnosis. With the formation of an After-Care Committee, which has just commenced to function, and the appointment of an experienced clerk, the value of this branch of the Public Health Service should increase rapidly. 56 TABLE 22. Return showing the work of the Tuberculosis Dispensary during the Year 1930. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 70 45 1 1 9 4 12 3 79 49 13 4 (b) Doubtfully tuberculous — — — — — - -` - 29 22 4 2 (c) Non-tuberculous — — — — — — — — 45 52 19 11 B.—Contacts examined during the year:— (a) Definitely tuberculous 6 6 1 1 — — 6 3 6 6 7 4 (b) Doubtfully tuberculous — — — — — - - - 15 36 9 14 (c) Non-tuberculous — — — — — — — — 24 66 29 33 C.—Cases written off the Dispensary Register as (a) Cured 3 3 - 1 - 1 - - 3 4 - 1 (b) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) - - - - - - - - 102 197 63 66 D.—Number of Persons on Dispensary Register on December 31st, 1930 (a) Diagnosis completed 394 304 37 26 79 51 84 60 473 355 121 86 (b) Diagnosis not completed — — — — — - — — 17 16 5 3 57 1. Number of persons on Dispensary Register on January 1st, 1930 1106 2. Number of patients transferred from other areas and of "lost sight of" cases returned 30 3. Number of patients transferred to other areas and cases "lost sight of" 109 4. Died during the year 93 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 19 6. Number of attendances at the Dispensary (including Contacts) 3796 7. Number of attendances of non-pulmonary cases at Orthopaedic Out-stations for treatment or supervision — 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (а) "Light" treatment 996 (b) Other special forms of treatment — 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary — 10. Number of consultations with medical practitioners:— (а) At Homes of Applicants 10 (b) Otherwise 343 11. Number of other visits by Tuberculosis Officers to Homes 43 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 4263 13. Number of (a) Specimens of sputum, &c., examined 802 (b) X-ray examinations made in connection with Dispensary work 302 14. Number of Insured Persons on Dispensary Register on the 31st December 570 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 47 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P. 17 — (b) Form G.P. 36 93 58 "HARTS" SANATORIUM. Dr. Cheater reports as follows:— Patients discharged, 117 (males 77, females 40). Of these 92(men 72, women 20), were insured persons. Deaths 13 (included in 117 above). Average duration of treatment, 17 weeks 4 days. Number of patient days, 20,257. Number of beds available at the end of year, 56. Average number of beds occupied, 55.77. The immediate results of treatment are as follows:— 43 cases were discharged as " Quiescent." 52 cases were discharged as "Improved," and 9 cases were discharged as "Not Improved." Of the 117 patients discharged, 27 had had one previous course of sanatorium treatment, and 2 had been in twice before. As regards the 9 who were discharged as "Not improved," it may be stated that they were discharged at their own requests, as it is the policy to keep patients under treatment until they have made some definite progress and have a fair chance of maintaining that progress on returning home. This is sometimes difficult in the case where a man is anxious to return to work to keep his job, or of a married woman having a young child to look after at home. However, patients are strongly advised to continue, as far as they are able, the mode of living they have been taught whilst in the sanatorium, and there is no doubt that the educational value of sanatorium routine is of great help when consumptives again resume ordinary life. Artificial Pneumothorax. Treatment by Artificial Pneumothorax continues its valuable place in cases of unilateral disease. The number of refilling operations performed in 1930 was 170. Several of the patients who are having this treatment are in active work, obtaining a 59 few hours leave to have their "refils," and then returning to their respective occupations. The one disadvantage experienced at "Harts" in carrying on artificial pneumothorax treatment is the lack of an X-ray plant on the premises. As mentioned in previous reports, the X-ray work is carried out at the Forest Hospital, Buckhurst Hill, and although this is efficient, nevertheless, there are many times and occasions where a " screening " done at once without the loss of time of arranging an appointment, etc., means much both to operator and patient. Also, in addition to artificial pneumothorax cases, an ambulance journey for patients with pleuritic effusions, etc., often has a deleterious effect upon the course of the disease. When, however, the proposed Pavilion for "Advanced" and "Observation" cases is erected, I hope that an X-ray apparatus will also be provided. Bacteriology. The number of sputa examined in 1930 was 235 as compared with 224 in 1929. The anti-formin method has been used in some cases, but it is found that careful selection of specimens of sputum is more important than any particular laboratory method. Several specimens of urine and pleural effusions were microscopically examined after centrifugalization, also pus from a pyopneumothrax. Two blood-sugar estimations were also obtained for a patient with diabetes. Complications met with and treated. (a) Those directly due to tuberculosis— Laryngitis 11(of these 5 died), hydropneumothorax 3, pyopneumothorax 1, meningitis 2 (these both died). (b) Not directly due to tuberculosis— Rheumatism 1, visceroptosis 1, haemorrhoids 2, bronchitis 3, diabetes 1, heart disease 2, eczema 1, neurasthenia 2, asbestosis 1, ototis media 2, tinnitus aurium 1. There were also 13 cases of dental disease, and those patients who were fit enough were given leave to obtain treament from their own dentists. This procedure naturally, to some extent, 60 interferes with their sanatorium treatment, seeing that after having teeth out they cannot eat for a few days, and it is somewhat surprising to find that many patients are ignorant of the fact that they are entitled to dental benefit under the National Health Insurance Acts, and could have had dental attention before admission. The number of admissions of "advanced" cases is increasing, and this tends to prolong the time that patients in a more favourable stage of the disease have to wait for a vacancy. It is a matter, therefore, of great satisfaction to me that the Council definitely contemplate the erection of a pavilion for "advanced" and "observation" cases at "Harts." As regards entertainments, several companies of artistes kindly arranged concerts and plays during the winter months, and their efforts were much appreciated both by patients and staff. "HARTS" SANATORIUM.—Year ended 31st March, 1931. Expenditure Cost per Patient per week. £ s. d. Salaries and Wages 2,496 17 2 Provisions 2,199 15 1 Disinfectants, Drugs and Appliances 128 11 Coal, Coke and Firewood 236 1 7 Electricity, Gas and Water 647 4 5 Furniture, Bedding and Linen 177 1 2 Uniforms and Dresses 64 5 Chandlery and Sundries 302 2 1 Crockery and Hardware 83 7 General Repairs 525 3 7 Garden Implements, Seeds, etc. 65 5 Printing, Stationery and Advertisements 41 4 Rent of Telephones 31 3 Rates, Taxes and Insurance 315 2 2 X-Ray Examinations 34 3 £7,343 50 5 61 TABLE 23. Average Number of Beds Available for Patients during the year 1930. harts sanatorium. Observation. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Total. "Sanatorium" Beds. "Hospital" Beds. Disease of Bones and Joints. Other Conditions. Adult Males — 28 7 — - 35 Adult Females — 13 6 — 19 Children under 15 - 2 — — 2 Total - 43 13 - — 56 TABLE 24. Return Showing the Extent of Residential Treatment during the Year 1930. harts sanatorium. 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. 34 77 68 9 34 F. 18 39 34 4 19 Chi1dren M. — — — — F. 2 2 2 — 2 Number of Observation Cases Adults M. - - - - - F - - - - - Children M. - - - - - F. — — — — - Total 54 118 104 13 55 62 TABLE 25. Return showing the immediate results of Treatment of Patients and of Observation of Doubtful Cases discharged from "Harts" Sanatorium during the Year 1930. 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 7 3 - 4 3 1 1 - - 1 - - 20 Improved 2 1 — 1 — — 1 1 — - — — 6 No material improvement 1 - — — — - - - - - - - 1 Died in Institution - — — — - — - — — — - — - Class T.B. plus. Group 1. Quiescent 2 1 - 4 9 - - 1 1 - - - 11 Improved 5 1 - - 1 - - - - - - - 7 No material improvement - 1 - - - - - - - - - 1 Died in Institution — — — - - — — — — — - — — Class T.B. plus. Group 2. Quiescent l 1 - 7 2 - - 1 - - - - 12 Improved 13 3 — 10 3 - 3 3 - - 1 - 36 No material improvement 1 1 - 1 - - 1 - - - - - 4 Died in Institution - - — - — — - — — — — — - Class T.B. plus. Group 3. Quiescent - - - - - - - - - - - - - Improved — 1 — 2 - - - - - - 3 No material improvement — 1 — — 1 — - 1 - - - 3 Died in Institution 6 1 — 1 1 — 2 2 — — — — 13 Total 38 15 — 30 13 1 8 9 1 1 1 — 117 Under 1 week 1-2 weeks. 2-4 weeks. More than 4 weeks. Observation for purpose of diagnosis. Tuberculous - - - - - - - - - - - - - Non-tuberculous — - - - - - - - - - - - - Doubtful — - - - - - - - - - - - - 63 TABLE 26.—RESIDENTIAL INSTITUTIONS (Including harts sanatorium.) Average Number of Beds Available for Patients during the Year 1930. Observation. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Total. "Sanatorium" Beds. "Hospital " Beds. Disease of Bones and Joints. Other Conditions. Adult Males - 34 8 2 1 45 Adult Females 14 7 1 — 22 Children under 15 1 12 — 8 13 34 Total 1 60 15 11 14 101 Return showing the Extent of Residential Treatment at all Institutions (including Harts Sanatorium) during the Year 1930. 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. 44 82 73 9 44 F. 20 44 37 4 23 Children M. 18 18 21 — 15 F. 21 12 19 — 14 Number of Observation Cases Adults M. — — — — - K - — — — Children M - - - - - F. — 1 1 — — Total 103 157 151 13 96 64 TABLE 27. Return showing the immediate results of Treatment of Patients and of Observation of Doubtful Cases discharged from Residential Institutions (including Harts Sanatorium) during the Year 1930. , 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 7 3 — 4 3 2 1 — 4 1 — 4 29 Improved 2 1 — i - — 1 1 1 1 — 1 9 No material improvement 1 - - - - - - - - - - - 1 Died in Institution — — — - — — — - — — — Class T.B. plus. Group 1. Quiescent 2 1 - 4 2 — - 1 1 - - - 11 Improved 5 1 — — 1 - - - - - - - 7 No material improvement — 1 — — - — — — — — — — 1 Died in Institution — — — — - - - - - - - - — Class T.B. plus. Group 2. Quiescent 1 1 — 7 2 — — 1 — — — - 12 Improved 13 4 — 10 5 — 4 3 — — 1 1 41 No material improvement 1 1 — 2 — — 1 — — — — - 5 Died in Institution — — — — — — — — — — — — — Class T.B. plus. Group 3. Quiescent — - - - - - - - - - - - - Improved — 1 — 2 - - - - - - - - 3 No material improvement — 1 — — 1 — — 1 - — — — 3 Died in Institution 6 1 — 1 1 — 2 2 - — — — 13 65 TABLE 27—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 - 2 4 Improved — — — — — — — - — — — — — No material improvement Died in Institution - - - - - - - - - - - - - Abdominal. Quiescent or Arrested - - - - - 1 - - - - - 1 2 Improved - — — — — — — — — — — — No material improvement - — — — — - — - - - - - — Died in Institution - — — — — — — — — — — — — Other Organs. Quiescent or Arrested - - - - - - - - - - - - - Improved - — — — — — — — — — — — — No material improvement - — — — — — — — — — — — — Died in Institution - — — — — — — — — — — — — Peripheral Glands. Quiescent or Arrested - - 1 - - 2 1 - 5 - - 1 10 Improved - - 5 — — 2 — — 1 — - 2 10 No material improvement - - 1 - - 1 - - - - - - 2 Died in Institution - - — — - — — — — — — — — Under 1 week 1-2 weeks. 2-4 weeks. More than 4 weeks. Observation for purpose of diagnosis. Tuberculous - - - - - - - - - - - - - Non-tuberculous - - - - - - - - - - - 1 1 Doubtful - — — — - — — - — - — - - 66 TABLE 28. Public Health (Tuberculosis) Regulations, 1924. Number of Cases of Tuberculosis Remaining on Register on 31st December, 1930. Pulmonary. Non-pulmonary. Total cases. Males. Females. Total. Males. Females. Total. 496 365 861 167 112 279 1,140 67 TABLE 29. Notified Cases of Tuberculosis, 1930. Ages. Pulmonary. Abdominal. Meninges. Bones and Joints. Glands. Other Organs. Disseminated. All forms. Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Under 1 year — — - - - - - - - - - - - - - - - - - - - - - - 1 and under 2 - - - - - - - - - 1 - 1 - - - - - - - - - 1 - 1 2-3 — — — - - - - - - - - - - - - - - - - - - - - - 3-4 — - - - - - - - - - - - 1 1 2 - - - - - - 1 1 2 4-5 1 - 1 - - - - - - - - - 1 - 1 - - - - - - 2 2 5-10 1 3 4 - - - 1 - 1 3 - 3 6 2 8 - - - - - - 1l 5 16 10-15 - 1 1 2 - 9 1 - 1 1 1 2 4 - 4 1 - 1 - - - 9 2 11 15-20 10 7 17 - - - 1 - 1 1 - 1 2 1 3 - - - - - - 14 8 22 20-25 17 14 31 - - - - - - 1 1 2 - 1 1 - - - - - - 18 16 34 25-35 25 20 45 - - - - - - - - - - - - 2 - 2 - - - 27 20 47 35-45 99 11 33 1 - 1 - - - - - - - - - - - - - - - 23 11 34 45-55 13 6 19 - - - - - - - - - - - - 1 - 1 - - - 14 6 20 55-65 8 - 8 - - - - - - - - - - - - 1 - 1 - - - 9 - 9 Over 65 1 1 2 - - - - - - - - - - - - - - - - - - 1 1 2 Totals 98 63 161 3 — 3 3 — 3 7 2 9 14 5 19 5 — 5 — — — 130 70 200 68 TABLE 30. Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications during the period from the 29th December, 1929, to the 27th December, 1930, in the area of the County Borough of East Ham. Notifications on Form A. Age periods. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 & over Total (all ages) Total notifications on Form A. Pulmonary Males — 1 — — 10 16 26 18 12 8 1 92 102 „ Females — — 2 1 7 15 17 11 6 — 1 60 63 Non-pulm. Males — 3 9 6 4 1 2 1 1 1 - 28 31 „ Females - 1 2 1 1 2 - - - - - 7 7 Notifications on Form B. Number of notifications on Form C. Under 5 5-10 10-15 Total 0-15 Total notifications on Form B. Poor Law Institutions. Sanatoria. Pulmonary Males — — — - - 35 113 „ Females — 1 — 1 1 23 63 Non-pulm. Males — 1 2 3 3 2 26 „ Females - — — — — - 9 69 TABLE 30—continued. Supplemental Return. New cases coming to the knowledge of the Medical Officer of Health other than by formal notification. Age periods. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and upwards. Total cases. Pulmonary Males — — 2 1 1 3 6 8 4 3 — 28 „ Females — — — 1 2 6 4 3 — — — 16 Non-pulm. Males 1 3 2 1 2 — — 1 — — 1 11 „ Females 3 — 1 - - - - 1 - - - 5 Source of Information. No. of Cases. Pulmonary. Non-pulmonary. Death returns from local Registrars 10 6 transferable deaths from Registrar General 4 4 Posthumous notifications 2 1 "Transfers" from other areas (other than transferable deaths) 25 5 Forms C and D (in respect of cases not previously known to the M.O.H.) — — Other sources if any (specify)—Merchant Seamen 3 — 70 TABLE 31. TUBERCULOSIS. New Cases and Mortality, 1930. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulm. Pulmonary. Non-Pulm. m. F. m. F. M. F. m. F. Under 1 year „ - - - - - - 1 3 1 — 5 years 1 — 3 1 — — 3 — 5 - 15 „ 1 4 19 3 1 1 3 2 15 - 25 „ 27 21 5 3 9 15 3 — 25 — 45 „ 47 31 3 — 31 24 1 — 45 — 65 „ 21 6 2 — 30 7 — 65 and upward ,, 1 1 — — 4 1 1 — Totals 98 63 32 7 75 48 12 5 The ratio of non-notified deaths to total tuberculosis deaths for the year was 1—17. 71 TABLE 32. Occupation and Tuberculosis. Notified Cases and Deaths, 1930. Occupations. Pulmonary. Non-pulmonary. Notifications. Deaths. Notifications. Deaths. M. F. M. F. M. F. M. F. Domestic — 42 — 30 — 1 — — Commercial 21 5 10 7 2 1 2 — Industrial 3 5 6 4 — — — — Transport 2 — 5 1 — — — — Provision and allied trades 8 — 5 2 — — — — Building trades 16 - 8 — 1 — — — Dock-workers 1 — 5 — — — — — Seamen 6 — 2 — — — — — General labourers 10 — 15 - 2 — 1 — School children 1 3 — 1 18 3 2 2 Others 40 8 19 3 9 2 7 3 72 TABLE 33. Deaths from Tuberculosis, 1930.—Interval Between Notification and Death. Not Notified Under 1 week 1-2 weeks 2-4 weeks 1-2 Months 2-3 Months 3-6 Months 6-12 Months 1-2 years 2-3 years 3-4 years 4-5 years 5-6 years 6-7 years 7-8 years 8 years and over Total Pulmonary 16 3 2 — 4 9 17 14 13 16 7 4 2 2 1 13 123 Non-pulmonary 11 4 - - - - - - - - - - - - - - 17 Total 27 7 2 — 4 9 17 16 13 16 7 4 2 2 1 13 140 73 REPORT ON THE WORK AT THE BOROUGH INFECTIOUS DISEASES HOSPITAL FOR 1930. Dr. Barker reports as follows:— Statistics for the year 1930 show a considerable decrease in the number of cases of infectious disease admitted to the hospital. This was particularly noticeable during the latter half of the year when the health of the Borough in this respect was reflected in the lowered incidence of Diphtheria and Scarlet Fever. Although fewer patients suffered from Diphtheria, many were extremely severe cases, either of a virulent type or late in coming under treatment. It may be surmised that when such an illness is prevalent throughout the district parents more readily seek medical advice for this serious malady, and for conditions such as Tonsillitis and simple Laryngitis, which stimulate diphtheritic infection. The importance of early diagnosis both as regards treatment and morbidity need not be stressed. Scarlet Fever was generally mild in character, and in the majority of cases complications and sequela did not exhibit serious manifestations. It is difficult to know to what this may be ascribed, but some credit must be given to improved methods of treatment, principally by the use of immune sera. It will be seen that of a total of 700 patients admitted to the hospital during the year 452 were found to be suffering from Diphtheria, and eight additional cases complicated by some other illness. There were 224 cases of Scarlet Fever, with five complicated cases. The admissions for the year 1929 were 557 and 314 respectively. The remainder consisted of cases of miscellaneous illnesses. Of the 460 cases admitted as suffering from Diphtheria, 366 were faucial or throat, 56 nasal, 25 laryngeal, 5 Diphtheria and Scarlet Fever, 3 Tonsillitis, 1 Diphtheria and Measles, 1 Whooping Cough and 3 not suffering'. Of 365 swabs examined of cases in hospital 311 showed presence of the diphtheria bacillus. The number of deaths from Diphtheria was 17, the case mortality being 3.3 per cent, as compared with 6.7 per cent, for 1929. Many of the cases that 74 recovered exhibited severe cardiac weakness in varying form and degree. Tracheotomy was performed on seven occasions. Of 229 cases admitted as suffering from Scarlet Fever, one patient succumbed to complications. The case mortality was 0.4 percent., compared with 1 per cent, for 1929. The complications arising were as follows Double Adenitis 56 Single Adenitis 54 Arthritis 1 Cardiac Arrhythmia 4 Rheumatism 3 Otorrhœa (severe) 8 Mastoid Abscess 1 Nephritis 2 Cases treated with anti-serum, 45. Apart from the advantages to the community by less illness, it was fortunate that during the time of rebuilding and enlargement of the hospital the restricted accommodation was not overtaxed. The adjustment of available beds to the requirements of the community called for some ingenuity and caused no little inconvenience to both nursing and domestic staff. Needless to add a rebuilding scheme of this magnitude is rendered more difficult when necessity may demand interference with its progress. No patient suffering from Diphtheria was refused admission, and in the majority of instances only a short delay, if any, supervened in furnishing beds for cases of Scarlet Fever. In order to comply with requirements of the Borough it is necessary to provide a total accommodation of at least 150 beds, which is one per 1,000 of the population. The completed hospital with additional wards will permit of 150 to 170 beds, that is allowing for a certain proportion of convalescent cases, where less space is requisite than in acute wards. Under these circumstances the accommodation should meet present needs. The arrangement of the wards in parallel series is ideal from the point of view of management, and in allowing free play of air between blocks. 75 The central administrative building will permit of easy access to all the various blocks or wards. As described in previous reports it was intended that a cubicle block consisting of 14 separate rooms, with the necessary sanitary accommodation and operating theatre, should be constructed first. This was commenced on June 27th, and was handed over for use on November 24th. The cubicles, which in effect are entirely separate rooms with glass partitions, are intended for the nursing of special cases necessitating isolation from others. For instance, patients suffering from two diseases simultaneously, doubtful cases, or again single cases of infectious illness requiring hospital treatment. Often such cubicles are used where complications render it desirable to separate the individual completely. During the building of this cubicle block D, another larger block E, consisting of two wards with verandah, separation room, accommodation for ward linen and all sanitary conveniences was in course of progress, and was completed on December 12th. Meanwhile considerable advance had been made with the demolition of the old administrative and staff building. Thus it will be seen that although alternative accommodation had to be provided in order to house the nursing and domestic staff, the two new wards were available for the needs of the hospital by the end of the year. As a training school for nurses in preliminary general work and for the "fever certificate," the hospital continues to obtain good results. With increased facilities and better accommodation some further improvement is anticipated in this' direction. All members of the Staff have been subjected to the Schick and Dick specific tests for susceptibility to Diphtheria and Scarlet Fever, and those reacting in any degree were immunized with prophylactic. During the year no person attached to the Institution suffered from either Diphtheria or Scarlet Fever, although there were a few cases of hospital sore throat. 76 TABLE 34. Borough Infectious Diseases Hospital. Disease. Remaining at end of 1929. Admitted during 1930. Discharged during 1930. Died during 1930. Remaining at end of 1930. Scarlet Fever 34 224 238 1 19 Diphtheria 88 452 481 17 42 Diph. and Scarlet Fever 4 5 9 — — Enteric Fever — 1 1 — — Diph. and Measles 1 1 2 — — Diph. and Whooping Cough - 1 1 - - Diph. and Congenital Malformation - 1 - 1 - Scarlet Fever and Measles — 1 1 — - Scarlet Fever and Mumps - 1 1 — - Scarlet Fever and Chickenpox - 2 2 - - Scarlet Fever and Chorea — 1 1 — — Pneumonia and Measles — 1 1 — — Measles — 3 — — Cerebro-Spinal Meningitis — 1 — 1 — Mumps — 1 1 — — Pneumonia and Whooping Cough — 1 1 - - Septic Pneumonia — 1 — 1 — Septic Throat — 2 1 — 1 Totals 127 700 744 21 62 77 BOROUGH INFECTIOUS DISEASES HOSPITAL. Year ended 31st March, 1931. Expenditure Cost per Patient per week. £ s. d. Salaries and Wages 4,468 25 0 Provisions 2,567 14 4 Anti-toxin 597 3 4 Disinfectants, Drugs and Appliances 249 1 5 Coal, Coke and Firewood 721 4 0 Electricity, Gas and Water 803 4 6 Furniture, Bedding and Linen 417 2 4 Uniforms and Dresses 194 1 1 Chandlery and Sundries 395 2 3 Crockery and Hardware 46 0 3 General Repairs 743 4 1 Garden Implements, Seeds, etc. 17 0 1 Maintenance and Upkeep of Ambulance; 522 2 11 Printing, Stationery and Advertisements 101 7 Rent of Telephones 58 4 Rates, Taxes and Insurance 267 1 6 £12,165 68 0 REPORT ON THE WORK OF THE MATERNITY AND CHILD WELFARE DEPARTMENT. Dr. Maclaren reports as follows:— 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:— 1. 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. 76 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 own 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 three years of age. G. 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. In October, 1930, the Central Maternity and Child Welfare Centre was transferred to temporary quarters at the High Street School. A portion of the west wing of this building was converted into a clinic, and consulting room, and and additional room was built for the Health Visitors. Staff. The staff of the Centre at present consists of the Assistant Medical Officer in charge, seven Health Visitors, and two Clerks. In April, 1930, a seventh Health Visitor was appointed, and in April of the following year an additional clerk was added to the staff. In October, 1930, owing to the increasing attendances at the Infant Welfare Centre, a temporary part-time Medical Officer was appointed to attend five sessions per week. 79 The enlargement of the Medical, Nursing and Clerical Staff is a matter of great satisfaction, as it should enable the department to undertake more efficiently the increasing work, which the expansion of the Council's Maternity and Child Welfare Scheme involves. It should provide for a more adequate supervision of the infant population, especially between the ages of 3—5 years which was lacking owing to the inadequacy of the existing staff. 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. For this purpose I suggest that Toddlers' Clinics be established as soon as possible. These clinics would also, to some extent, relieve the congestion which at present exists at the Infant Welfare Centres. Infant Welfare Clinics. l imes and places at which Infant Welfare Clinics are held are shown on page 35. There are seven Infant Welfare Clinics held weekly. At five of these two Doctors and two Health Visitors attend, at the remaining two one Doctor and one Health Visitor are present, assistance is also given by two voluntary workers. Previous to October, 1930, there was only one Medical Officer in attendance at each centre, but owing to the expansion of the work and the increasing high number of attendances of infants at the centres, it was found necessary to make arrangements for a temporary part-time Medical Officer to attend five of the clinics, pending: investigations with a view to appointing: an additional full-time Medical Officer. Attendances at Infant Welfare Clinics:— Number of General Clinics held during the year 318 Number of individual children who attended the Clinics 3,723 Total number of attendances 22,265 Tola! number of children who attended the Clinic for the first time during the year— 80 1. Children under 1 year 1,374 2. Children between the ages of 1—5 years 501 Number of medical consultations at General Clinics 9,660 Number of Medical Consultations at Special Clinics 945 Total number of visits to all Infant Welfare Clinics 23,210 The daily average attendances at the Clinics was as follows:— Central Clinic, Monday afternoon 77 Manor Park, Tuesday morning 74.3 North Woolwich, Tuesday afternoon 17.3 Masterman Road, Wednesday afternoon 90 Central Clinic, Thursday morning 45.2 Plashet Grove, Thursday afternoon 82.2 Plashet Grove, Friday afternoon 70.6 Excluding North Woolwich Infant Welfare Centre, which supplies a very small area, the average attendance of children per Session at all Centres during the year is 73 compared with 61 in 1929. The 1930 table referring to daily average attendances at the clinics cannot be compared with 1929, as the transference of the Central Infant Welfare Centre from the White House, Plashet Grove, to the High Street School, necessitated a re-arrangement of the clinics. It is noted that during 1930, 3,723 children attended the centres, this is an increase of 496 on the previous year. The total attendances of infants from 0—5 years increased from 18,612 in 1929, to 22,265 in 1930. Such large numbers attending the clinics must necessarily throw a great strain on the staff of the centres. Under existing conditions, the organisation of the clinics is becoming increasingly difficult, and both the medical and nursing staffs frequently find it difficult to devote sufficient time to individual cases, which is necessary if an efficient standard at the centres is to be maintained. In order to obviate this overcrowding at the centres, the only remedy is to increase the number of clinics, or sessions at each clinic. 81 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 earlystages. Preventive centres are not dispensaries for the treatment ol 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 Central Clinic. 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. Five children under the age of five were notified during 1930, 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 1930, 187 children have received operative treatment as compared with 95 in 1929. 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. Ringworm. No cases of Ringworm of the Scalp were referred to the School X-ray Department for radical treatment. 82 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. 98 mothers and 243 infants were referred to the Dental Department during 1930. Details of the work done for these cases will be found in the Dental Report submitted by Mr. Neame to the School Medical Officer. Ophthalmic Treatment. Ophthalmic defects requiring special consideration are seen at the Special Clinic each week by the School Ophthalmic Surgeon. During 1930, 44 cases were referred to the School Ophthalmic Clinic. Details of the work done will be found in the Report submitted by Mr. Reeve-Flaxman to the School Medical Officer. Treatment by Artificial Sunlight. Ultra-Violet Ray treatment has been continued throughout the year by means of the Arnold Alpine Sunlight Radial Arc Lamp, which is shared with the School Medical Service. Two sessions have been held each week, but the conditions under which the work is carried out is by no means satisfactory, as the room is required for use by the School Medical Service, and only a limited number of children can receive treatment in the short time allotted on these days. 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, sign 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. 83 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 statistics of 1930 are as follows:— Number of Light Sessions held 45 Number of attendances at these sessions 1,663 Number of individual children treated 106 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 defects and cases of difficult feeding, and children who have been referred to the Medical Officer by the Health Visitors from their district visits. 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. Special Morning Clinics are held at:— The Central Clinic, High Street School, on Monday and Wednesday, at 10 a.m. The statistics for 1930 are as follows:— Number of medical consultations 945 84 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. The work of the Health Visitors includes the following:— 1. Visiting in the Homes under the Notification of Births Act. 2. Home visiting of children up to 5 years of age. 3. Home visiting of pre-school children in regard to defects. 4. Home visiting of foster children. 5. Home visiting in connection with Ante-natal Clinic and expectant mothers. 6. Ante-natal Clinic for expectant mothers. 7. Infant Welfare Clinics for children up to 5 years of age. 8. Special visiting of (a) Still Births. (d) Visits to Tonsils and (b) Ophthalmia Neonatorum. Adenoid Cases. (c) Puerperal Fever and (e) Pneumonia. Pyrexia. (f) Infantile Diarrhcea. (g) Other special visits. Notification of Births. The Notification of Births Act, 1915, requires that all births be notified to the Medical Officer of Health within 36 hours of their occurrence. All cases notified are visited by the Health Visitor as soon as possible after the doctor or midwife has ceased to attend. Advice is given with regard to the care, management, feeding and clothing of the child, and also the general health and care of the mother. 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. The visits made by the Health Visitors during 1930 were 18,804, as compared with 16,329 in the previous year. 85 Visits to infants under one year of age 7,087 Visits to children over one year of age 10,873 Visits to Tonsils and Adenoid Cases 157 Visits to Ante-natal cases, first visits 286 Visits to Ante-natal cases, re-visits 84 Visits to Foster Mothers 97 Special visits, not included in above group 220 18,804 Ante-natal Work. An Ante-natal Clinic is held at:— The Central Clinic, High Street School, on Friday, at 10 a.m. Ante-natal care of the expectant mother is of the utmost importance in order to secure good health both for the mother and infant. Systematic supervision during pregnancy will minimise many dangers and prevent avoidable difficulties at the confinement. During the year efforts have been made to secure a closer co-operation of the midwives with the Ante-natal Clinic with considerable success. I would urge the necessity of midwives taking advantage of the clinic, and bringing their cases for medical examination and advice, for though many midwives carry out ante-natal supervision with satisfactory results, conditions may be present which can only be detected by medical examination. 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. During 1930, 370 visits were paid to expectant mothers. During the year the following attendances were recorded:— First visits 225 Subsequent visits 322 Total visits 547 Maternity Accommodation. Under the provisions of the Maternity and Child Welfare Act, 1918, empowering Local Authorities to make arrangements for the 86 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, the Maternity Charity District Nurses' Home, Plaistow, and Forest Gate Sick Home. During 1930, two cases thus provided for were confined in Queen Mary's Hospital, and a considerable number of patients attending the Ante-natal Clinic were admitted to Forest Gate Sick Home. 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, end 1926. 52 Midwives notified the Local Supervising Authority of their intention to practice within the Borough during 1930. Of these, 33 worked in connection with the Maternity Hospital and District Nurses' Home, Plaistow, and its branches, seven at the Sir Henry Tate Nurses' Home, Silver town, two at the Kelvingrove Nursing Home, and 10 Practised independently. 34 visits of inspection were made by the Inspecting Medical Officer during the year. Under the rules issued by the Central Midwives Board, a midwife must notify the Local Supervising Authority within 36 hours if she has summoned medical aid, during pregnancy, in a confinement, or within 10 days afterwards. During the year help was obtained in 206 cases as follows:— Mother— Ruptured perineum 40 Prolonged labour 34 Post-partum haemorrhage 7 Retained placenta 12 Ante-partum haemorrhage 8 Rise of temperature 15 Malpresentations 4 87 Mother—continued. Extended breech 4 Inflammation of breasts 1 Phlebitis 6 Albuminuria 2 Other causes 22 155 Child- Prematurity and dangerous feebleness 18 Unsatisfactory condition of infant 9 Deformities 4 Discharging eyes 3 Still-birth 2 Spina-Bifida 1 Skin eruptions 5 Other causes 9 51 Visits have been paid as required to one registered Nursing Home in the district. Puerperal Fever and Puerperal Pyrexia. During the year 10 cases of Puerperal Fever and 14 cases of Puerperal Pyrexia were notified under the Regulations of 192G and 1928. The Regulations of 1st October, 1926, extended notification to Puerperal Pyrexia, which means "any febrile condition (other than a condition which required to be notified as Puerperal Fever) occurring in a woman within 21 days after child-birth, or miscarriage, in which a temperature of 100'4 deg. Fahrenheit or more has been sustained during a period of 24 hours, or has recurred during that period." 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 wilh institutional treatment. Maternal Mortality. There were 8 deaths in connection with pregnancy, as compared with 12 in 1929, 88 Ophthalmia Neonatorum. During 1930, 8 cases of Ophthalmia Neonatorum were notified in East Ham. For table giving result of treatment, see page 52. Ophthalmia Neonatorum includes all cases of inflammation of the eyes of new-born babies, however slight, coming on within 21 days after birth. Under the Regulations for its notification that came into force in October, 1926, every effort is made to control and eradicate this disease. 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. All cases of Ophthalmia Neonatorum are visited by the Health Visitors and kept under observation. Free Milk. Under the Council's scheme £901 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. Five children were sent away through the auspices of the Association during 1930. Co-ordination. There is very considerable co-ordination between the Maternity and Child Welfare work of the Borough and other Departments of the Public Health Service. The records of clinic children on reaching the age of five years are sent to the School Medical Department for information regarding entrants to school life. Expectant and nursing mothers and young children requiring dental treatment are referred to the School Dental Surgeon from the Infant Welfare Clinics. 89 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. Aural cases are referred from the infant clinics to the School Aural 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. Maternity and Child Welfare. Return showing the arrangements made for maternity and child welfare by the Council and by Voluntary Associations providing maternity and child welfare services in respect of which the Council pay contributions under Section 101 of the Local Government Act, 1929, or otherwise; and (2) giving particulars of the work done during the year 1930. 1. Population of the area served by the Council: 147,600. 2. Number of births notified in that area during the year under the Notification of Births Act, 1907 :— (a) Live births, 2,213; (b) Still births, 80; (c) Total, 2,293; (d) By midwives, 987; (e) By doctors and parents, 1,150. 3. Health Visiting. (i) Number of officers employed for health visiting at the end of the year:— (а) by the Council, 7. (b) by Voluntary Associations, Nil. 90 (ii) If any of the Health Visitors are engaged on other work during part of their time, state the equivalent of whole-time services devoted by the whole staff to health visiting :—- (a) in the case of Health Visitors employed by the Council, 7. (b) in the case of Health Visitors employed by Voluntary Associations, Nil. (iii) Number of visits paid during the year by all Health Visitors :—- (a) To expectant mothers—First visits, 286 ; total visits, 370. (b) To children under 1 year of age—First visits, 2,194 ; total visits, 7,087. (c) To children between the ages of 1 and 5 years—Total visits, 10,873. 4. Infant Welfare Centres. (a) Number of Centres provided and maintained by the Council, 7. (b) Number of Centres provided and maintained by Voluntary Associations, Nil. (c) Total number of attendances at all Centres during the year :— By children between the ages of 0-5 years, 22,265. (d) Average attendance of children per session at all Centres during the year, 64.2. One Centre has an average attendance of 17.3— excluding this centre the average attendance of children per session at all centres is 73. (e) Total number of children who attended at the Centres for the first time during the year :— (i) Children under 1 year of age, 1,374. (ii) Children between the ages of 1 and 5 years, 501. (f) Percentage of total notified births represented by the number in (e) (i), 62. 5. Ante-natal clinics (whether held at Infant Welfare Centres or at other premises) :— (a) Number of Clinics provided and maintained by the Council, 1. (b) Number of Clinics provided and maintained by Voluntary Associations, Nil. (c) Total number of attendances by expectant mothers at all Clinics during the year, 547. (d) Average attendance of expectant mothers per session at all Clinics during the year, 10.5. (e) Total number of expectant mothers who attended at the Clinics during the year, 225. (f) Percentage of total notified births represented by the number in (c) 9.8. 6. Maternity Homes and Hospitals. Number of women (if any) sent by the Council during the year to Maternitv Institutions. 88. 7. Infectious Diseases. 91 Disease. Number of cases notified during the year. N umber of cases visited by officers of the Council. Number of cases for whom home nursing was provided by the Council. Number of cases removed to hospitals. (1) Ophthalmia Neonatorum 8 6 - 2 (2) Pemphigus Neonatorum 6 6 - (3) Puerperal fever 10 10 - 10 (4) Puerperal pyrexia 14 14 - 11 (5) Measles and German measles (in children under 5 years of age) Not notification - (6) Whooping Cough (do.) Not notification (7) Epidemic diarrhoea (do.) Not notification - - (8) Poliomyelitis (do.) — — — 8. Home Nursing. (а) Number of nurses employed at the end of the year for the nursing of expectant mothers and children under 5 years of age, maternity nursing, or the nursing of puerperal fever:— (i) by the Council, Nil. (ii) by Voluntary Associations, Nil. (b) Total number of cases attended during the year by these nurses, Nil. 9. Midwives. (а) Number practising in the area served by the Council for maternity and child welfare at the end of the year, 52. (b) Number (i) employed by the Council, Nil. (ii) subsidised by the Council, Nil. (iii) employed by Voluntary Associations, 42. (c) Number of cases attended by midwives during the year:— (i) as midwives, 902. (ii) as maternity nurses, 25. (d) Number of cases during the year in which the Council paid or contributed to the fee of a midwife, Nil. 10. Maternal Deaths. (a) Number of women who died in, or in consequence of, childbirth in the area served by the Council for maternity and child welfare during the year:— (i) from sepsis, 4. (ii) from other causes, 4. (b) Number of these cases which died :— (i) at home, 2. (ii) in institutions, 6, 92 Maternity and Nursing Homes. (Nursing Homes Registration Act, 1927). 1.—Number of applications for registration None 2.—Number of Nursing Homes on Register One 3.—Number of orders made refusing or cancelling registration None 4.—Number of appeals against such orders None 5.—Number of appeals in which orders have been:— (a) confirmed on appeal None (b) disallowed None 6.—Number of applications for exemption from registration None 7.—Number of cases in which exemption has been:— (a) granted None (b) withdrawn None (c) refused None MATERNAL MORTALITY. This subject has received widespread publicity in the Press and from the platform. The Ministry of Health has in recent years investigated and reported upon the causes and prevention of these deaths. investigations have been made into every Maternal Death, of cases of Puerperal Fever and Puerperal Pyrexia. More facilities for the ante-natal care of expectant mothers with the provision of a Maternity Home, would appreciably diminish the toll on the lives of the Mothers. The number of women dying from childbirth in 1930 was 8 as compared with 12 for the previous year. In the graph printed below is set out the Maternal Mortality Rates per 1,000 live births for the years 1914-30:— 93 Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children. The Council have no institution for unmarried mothers and their illegitimate children. Whipps Cross Hospital and Salvation Army Hostels accommodate some of these cases. With regard to homeless children these are sent to Aldersbrook Homes. Ambulance f acilities. (to) For infectious Diseases.— Two motor ambulances are garaged at the Isolation Hospital. (b) For Non-infectious Diseases and Accident Cases—two motor ambulances, operating from the Fire Station, carried out the following work during 1930:— Number. Cases conveyed to and from various hospitals 1,547 Accident cases 448 Illness cases 1,099 Journeys made 1,580 Miles run 14,292 East Ham cases removed by other ambulances:— Barking 18 Ilford 14 West Ham 29 Cases removed for other authorities:— West Ham 25 Barking 8 94 TABLE 35. METEOROLOGICAL RECORD—YEAR 1930. 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 ot No. of Days on which Rain fell, o' or 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 59° 30° 49.0° 39.7° 44.3° 20 2.17 0.11 0.30 4th February 51° 31° 42.4° 34.9° 38.7° 5 0.84 0.17 0.45 1st March 60° 27° 50.2° 37.5° 43.8° 11 1.45 0.13 0.67 15th April 69° 32° 54.8° 42.5° 48.6° 15 1.20 0.08 0.34 3rd May 71° 40° 61.4° 44.0° 52.7° 17 2.93 0.17 0.43 25th June 81° 45° 70.5° 53.6° 62.0° 6 2.55 0.42 1.83 18 th July 80° 51° 69.4° 55.9° 62.7° 13 1.90 0.15 0.46 20th August 92° 51° 71.9° 56.1° 64.0° 16 4.27 0.26 1.88 29th September 79° 46° 65.2° 53.2° 59.2° 16 2.67 0.17 0.43 6th October 69° 35° 59.6° 47.1° 53.4° 15 0.98 0.06 0.21 22nd November 59° 27° 51.6° 39.9° 45.8° 19 2.93 0.15 0.50 28th December 53° 29° 45.0° 36.5° 41.0° 15 1.60 0.11 0.36 11th Means and Totals for the Year. 92° 27° 57 .6° 45.1° 51.4° 168 25.49 0.15 1.88 Aug. 29th The Rainfall for the Year was 4'20 ins. above, and the number of days on which rain fell 38 above the year 1929, at East Ham. 95 REPORT OF THE CHIEF SANITARY INSPECTOR OF THE WORK PERFORMED BY THE SANITARY INSPECTORS FOR THE YEAR 1930. 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 by the Sanitary Inspectors during the year 1930. The Staff of the Sanitary Section consists of one Assistant Sanitary Inspector, five district Inspectors, and myself. There are also one Disinfector and 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. 96 SANITARY CIRCUMSTANCES OF THE BOROUGH. Water. Every house in the Borough has an ample and constant supply of wholesome water supplied by the Metropolitan Water Board. A large percentage of houses have a direct supply from the main in addition to the tank storage as required under the regulations of the Water Board. Only one complaint was received during the year of unwholesome water. Upon investigation this was found to be caused by the water being drawn from a dirty storage cistern. Rivers and Streams. On the eastern side of the Borough the river Roding and its back waters form the boundary for a distance of approximately 3,000 yards. This river is tidal and is navigable up to Ilford bridge. No complaint has been received during the year by this department as to the sanitary condition. There are no streams in the Borough other than the river Roding but there are several ditches under the control of the Essex Sewers Commission. Drainage and Sewerage. Every house in the Borough is connected to the main drainage system with the exception of two houses in Beckton Road. No important alteration or extension of the sewerage system was made in 1930. Closet Accommodation. Every house has at least one water closet and in many cases two, fitted with a suitable two or three gallon flush. This has been the condition for many years. Scavenging and Dusting. Up to July, 1928, the. collection of house refuse and the provision of dust bins was under the superintendence of my predecessor. On that date, however, this work was handed over to the Cleansing Superintendent under the Borough Engineer. 97 The house refuse is collected once weekly, most of it being burnt in the destructor and a small portion dealt with under the "controlled tipping "system. Sanitary Inspection of the Borough. The particulars of these inspections are set out in detail as follows:— INSPECTIONS FOR THE YEAR. Ordinary House-to-house  January 590 429 1,019 February 500 403 903 March 461 497 958 April 366 350 716 May 460 566 1,026 June 446 471 917 July 450 339 789 August 348 292 640 September 452 336 788 October 471 560 1,031 November 445 376 821 December 435 314 749 Total for Year 5.424 4,933 10,357 Small Pox Contacts. In addition to the foregoing inspections, 2,832 special visits were paid in connection with small pox contacts. House-to-House Inspection. As I have stated on former occasions, special attention has been given to this branch of the work. The above table shows 4,933 house-to-house inspections for the year 1930, as compared with 4,742 for the previous year. At 88.2 per cent. of these visits sanitary defects were found. TABLE SHOWING INSPECTIONS MADE IN EACH WARD PER MONTH. Month Manor Park Little Ilford Woodgrarge 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 105 — 58 54 45 51 42 82 49 57 71 3 51 43 110 30 - 96 72 590 429 February 106 — 44 58 50 59 60 5 21 48 40 79 51 — 49 96 20 44 59 14 500 403 March 65 — 33 60 71 75 69 108 22 73 34 1 32 — 32 88 37 63 66 29 461 497 April 62 — 31 73 58 44 46 2 30 54 24 88 30 5 25 16 8 — 52 68 366 350 May 59 — 40 58 63 95 49 56 24 66 39 41 38 — 42 139 32 47 74 64 460 566 June 51 33 51 80 50 35 67 68 18 — 28 45 54 5 54 113 31 59 42 33 446 471 July 62 5 50 114 68 51 33 35 20 — 30 — 73 — 31 110 33 — 50 24 450 339 August 64 — 41 38 40 — 47 68 19 — 28 — 30 — 28 118 15 67 36 1 348 292 September 67 — 43 106 57 34 32 76 35 — 43 13 42 — 37 56 18 51 78 — 452 336 October 72 — 33 55 68 26 46 86 34 90 27 66 38 — 36 129 38 73 79 35 471 560 November 52 — 59 29 49 28 34 25 27 64 54 62 36 — 37 92 21 51 76 25 445 376 December 97 — 54 77 34 14 34 72 25 — 42 35 46 — 32 62 12 9 59 45 435 314 862 38 537 802 653 512 559 683 324 452 460 433 541 10 446 129 295 464 767 410 5,424 4,933 98 99 COMPLAINTS RECEIVED FOR 1930. Manor Park Little Ilford Woodgrange Plashet Kensington Castle Central Wall End Greatfield South Total January 18 24 14 19 17 11 21 21 7 27 179 February 10 13 18 13 5 11 20 12 7 18 127 March 11 22 14 20 12 12 19 14 20 17 161 April 17 21 11 10 11 21 11 8 3 13 126 May 14 33 16 17 8 23 23 19 8 21 182 June 11 23 17 21 8 15 21 15 12 11 154 July 9 27 8 15 10 13 26 8 8 20 144 August 12 13 9 12 12 19 9 14 — 22 122 September 9 20 14 14 13 21 27 19 5 19 161 October 11 23 13 34 20 11 23 9 10 12 166 November 19 25 16 26 6 17 30 18 3 20 180 December 7 22 6 18 9 14 28 7 5 13 129 148 266 156 219 131 188 258 164 88 213 1,831 100 Complaints. The following table shows the number of complaints received for the year as compared with the previous year :— Year Written Oral Total 1930 635 1,196 1,831 1929 435 1,540 1,975 For detailed table see page 90. Notices Complied with during the year ended 31st December, 1930:— District No. 1 No. 2 No. 3 No. 4 No. 5 Total Complied 679 1,405 1,146 1,277 1,194 5,701 Notices Outstanding at 31st December, 1930:— District No. 1 No. 2 No. 3 No. 4 No. 5 Total Informal 107 260 402 490 430 1,689 Statutory 32 74 49 67 150 372 For table of prosecutions and results, see page 101. Rent Restrictions (Notice of Increase) Act, 1923. Fourteen applications were made by tenants for certificates under this Act. Two were granted, three were in suspense at the end of the year, and in the remaining nine 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. 101 PROSECUTIONS UNDER THE PUBLIC HEALTH ACT FOR THE YEAR, 1930. Date. Situation of premises. Offence. Result. January Kempton Road Non-compliance with sanitary notice Withdrawn 3s. 6d. costs February Shelley Avenue do. Summons not served. Owner not found February Lonsdale Avenue do. Withdrawn 3s. 6d. costs February Mitcham Road do. Withdrawn 3s. 6d. costs February Selborne Avenue do. Withdrawn 3s. 6d. costs February do. do. Withdrawn 3s. 6d. costs February do. do. Withdrawn 3s. 6d. costs February do. do. Withdrawn 3s. 6d. costs February do. do. Withdrawn 3s. 6d. costs February Bonny Downs Road do. Withdrawn 3s. 6d. costs February do. do. Withdrawn 3s. 6d. costs February do. do. Withdrawn 3s. 6d. costs February do. do. Withdrawn 3s. 6d. costs February do. do. Withdrawn 3s. 6d. costs February do. do. Withdrawn 3s. 6d. costs February Stamford Road do. Withdrawn 3s. 6d. costs February Shakespeare Crescent do. Withdrawn 3s. 6d. costs February Roman Road do. Withdrawn 3s. 6d. costs February Cromwell Road do. Withdrawn 3s. 6d. costs February Selborne Avenue do. Withdrawn 3s. 6d. costs March Boleyn Road do. Withdrawn 3s. 6d. costs March do. do. Withdrawn 3s. 6d. costs March do. do. Withdrawn March Barrington Road do. 3s. 6d. costs Withdrawn April Lonsdale Avenue do. 3s. 6d. costs Withdrawn 3s. 6d. costs May Hockley Avenue do. Withdrawn 3s. 6d. costs May Eastbourne Road do. Withdrawn 4s. 6d. costs May do. do. Withdrawn 4s. 6d. costs 102 PROSECUTIONS UNDER THE PUBLIC HEALTH ACT FOR THE YEAR 1930—continued. Date. Situation of premises. Offence. Result. May Eastbourne Road Non-compliance with sanitary notice Withdrawn 4s. 6d. costs May do. do. Withdrawn 4s. 6d. costs May do. do. Withdrawn 4s. 6d. costs May do. do. Withdrawn 4s. 6d. costs May do. do. Withdrawn 4s. 6d. costs May do. do. Withdrawn 4s. 6d. costs May do. do. Withdrawn 4s. 6d. costs May Bonny Downs Road do. Withdrawn 3s. 6d. costs May Mountfield Road do. Withdrawn 3s. 6d. costs May Wellington Road do. Withdrawn 3s. 6d. costs May Telham Road do. Withdrawn 3s. 6d. costs May do. do. Withdrawn 3s. 6d. costs May do. do. Withdrawn 3s. 6d. costs May do. do. Withdrawn 3s. 6d. costs May do. do. Withdrawn 3s. 6d. costs May do. do. Withdrawn 3s. 6d. costs May do. do. Withdrawn 3s. 6d. costs May do. do. Withdrawn 3s. 6d. costs May do. do. Withdrawn 3s. 6d. costs May do. do. Withdrawn 3s. 6d. costs May do. do. Withdrawn 3s. 6d. costs May do. do. Withdrawn 3s. 6d. costs May do. do. Withdrawn 3s. 6d. costs May do. do. Withdrawn 3s. 6d. costs May do. do. Withdrawn 3s. 6d. costs June Albert Road do. Withdrawn 3s. 6d. costs June Barrington Road do. Withdrawn 3s. 6d. costs June do. do. Withdrawn 3s. 6d. costs 103 PROSECUTIONS UNDER THE PUBLIC HEALTH ACT FOR THE YEAR 1930—continued. Date. Situation of premises. Offence. Result. June Barrington Road Non-compliance with sanitary notice Withdrawn 3s. 6d. costs June do. do. Withdrawn 3s. 6d. costs June do. do. Withdrawn 3s. 6d. costs June do. do. Withdrawn 3s. 6d. costs June do. do. Withdrawn 3s. 6d. costs June Sheringham Avenue do. Withdrawn 3s. 6d. costs June Gooseley Lane do. Withdrawn 3s. 6d. costs June do. do. Withdrawn 3s. 6d. costs June do. do. Withdrawn 3s. 6d. costs July Gillett Avenue do Withdrawn 3s. 6d. costs July Telham Road do. Withdrawn 3s. 6d. costs July Stanley Road do. Withdrawn 3s. 6d. costs July Rixsen Road do. Withdrawn 3s. 6d. costs July Marlborough Road do. Withdrawn 3s. 6d. costs July do. do. Withdrawn 3s. 6d. costs July Landseer Avenue do. Withdrawn 3s. 6d. costs July Sheridan Road do. Order made, Penalty £1 August Welstead Road do. Withdrawn 3s. 6d. costs August do. do. Withdrawn 3s. 6d. costs August do. do. Withdrawn 3s. 6d. costs August do. do. Withdrawn 3s. 6d. costs October do. do. Withdrawn Refused October Sandringham Road do. Withdrawn 3s. 6d. costs October do. do. Withdrawn 3s. 6d. costs October do. do. Withdrawn 3s. 6d. costs November Mountfield Road do. Withdrawn 3s. 6d. costs November Hubert Road do. Withdrawn 3s. 6d. costs December Welstead Road do. Adjourned to 8/1/31 Total number of prosecutions 84. 104 PROSECUTIONS UNDER THE SALE OF FOOD AND DRUGS ACT FOR THE YEAR, 1930. Date. Offence. Result. January Tripe—Preservative added to the extent of 180 parts per million Fined £5, costs 10s. 6d. Smoke Abatement. There are only a few factories in this Borough and complaints of black smoke are infrequent. In one case extensive flue alterations were made at three boilers in a factory in the northern part of the Borough in the early part of the year which cured a smoke nuisance that had occurred at irregular intervals. Upon investigation it is invariably found that the nuisance is caused by careless stoking and upon attention being drawn thereto the offence ceases. Premises and Occupations controlled by Byelaws. There is only one registered common lodging house for men in the Borough, which is maintained in a satisfactory manner. There are no underground sleeping rooms in East Ham. The list of Byelaws, Regulations, etc., is given on pages 19 to 21. In August, 1930, the Ministry of Health approved of an additional set of slaughter house byelaws relating to humane killing, of which the following is the most important:— "9. A person shall rot in a slaughter-house slaughter any animal until it shall have been effectually stunned with a mechanically operated instrument suitable and sufficient for the purpose: "Provided that this byelaw shall not require the stunning of sheep or the use of a mechanically operated instrument until the expiration of three months from the confirmation of these byelaws: "Provided further that this byelaw shall not be deemed to apply to any member of the Jewish faith, duly licensed by the Chief Rabbi as a slaughterer, when engaged in the slaughtering of cattle intended for the food of Jews according 105 to the Jewish method of slaughtering, if no unnecessary suffering is inflicted. "10. Every person engaged in slaughtering in a slaughter-house shall, before proceeding to stun any bull, ox, cow, heifer, or steer, cause its head to be securely fastened in such a position as to enable it to be stunned with as little pain or suffering as practicable, and shall use such instruments and appliances and adopt such method and otherwise take such precautions as may be requisite to secure the infliction of as little pain or suffering as practicable." Other Sanitary Conditions. The Council own and maintain the following Parks and Open Spaces:— Acres. Central Park 25 Plashet Part 18 New Beckton Park 15 Brampton Park 8 Barking Road Recreation Ground 8 Little Ilford Recreation Ground 8 Manor Park Recreation Ground 10 Gooseley's Playing Fields 17½ 109½ Wanstead Flats 96 Royal Victoria Gardens (North Woolwich) 9 214½ Wanstead Flats is an open unfenced space under the control of the City Corporation. The Royal Victoria Gardens are an enclosed park abutting on to the River Thames under the control of the London County Council. Cemeteries. The following is a list of the cemeteries in the Borough:— City of London. Manor Park. Woodgrange. Jews' Cemetery (Plashet). 106 Jews' Cemetery (Greatfield). St. Mary the Virgin Churchyard. St. Mary Magdalene Churchyard. With a total acreage of 278 acres. One complaint was received during the year, of burials taking place within eighteen inches of the surface, and a second complaint of a dilapidated fence adjoining the back gardens of dwelling houses. The Superintendent was interviewed in each instance and the offence was abated. 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 an occasional exception these are. also well maintained. Schools. There are 26 Elementary Schools and one Secondary School. All these buildings are comparatively modern, are well lighted, and have ample latrine and urinal accommodation and a constant supply of wholesome water from the Metropolitan Water Board's mains. Most of the schools have a resident caretaker and all are well maintained and kept in a cleanly condition. HOUSING STATISTICS. Number of new houses erected during the year (a) Total (including numbers given separately under (b). (i) By the Local Authority Nil. (ii) By other Local Authorities Nil. (iii) By other bodies and persons 237 (b) With State assistance under the Housing Acts: (i) By the Local Authority— (a) For the purpose of Part II. of the Act of 1925 Nil. 107 (it) For the purpose of Part III. of the Act of 1925 Nil. (c) For other purposes Nil. (ii) By other bodies or persons Nil. 1. Inspection of Dwelling Houses during the year:— (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) and the number of inspections made 9,125 (2) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925, and the number of inspections made Nil. (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 7,623 2. Remedy of Defects during the year without Service of formal Notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 4,460 3. Action under Statutory Powers during the Year:— A.—Proceedings under Section 3 of the Housing Act, 1925: (1) Number of dwelling houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners Nil. (b) By Local Authority in default of owners Nil. (3) Number of 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) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 5,132 108 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 1,208 (b) By Local Authority in default of owners Nil. C.—Proceedings under Sections 11, 14, and 15 of the Housing Act, 1925: (1) Number of representations made with a view to the making of Closing Orders Nil. (2) Number of dwelling houses in respect of which Closing Orders were made Nil. (3) Number of dwelling houses in respect or which Closing Orders were determined, the dwelling-houses having been rendered fit Nil. (4) Number of dwelling houses in respect of which Demolition Orders were made Nil. (5) Number of dwelling houses demolished in pursuance of Demolition Orders Nil. 4. Number of Houses Owned by the Local Authority:— Under Part III. of the Housing Act, 1925— Houses. Tenements. Built previous to the last two years 144 12 Built during the last two years 156 58 (Not yet all completed.) Under Part II. of the Housing Act, 1925 Nil. Built under Housing Act, 1890 220 Tenements Built under the Housing Act, 1919 36 Houses Housing Conditions. 1.—General Observations.—Nearly the whole of the available building land is filled up with brick-built houses of the terrace type. East Ham is mainly a domicilary town, a large proportion of the workers travelling to London daily and returning in the evening. The prevailing defect is dampness. 2.—Sufficient Supply of Houses.— (a) During the year under review the Council entered into a contract for the erection of 156 tenements and 48 houses for the working classes upon the Charlemont Road site to meet the present shortage. 109 (b) There has apparently been a slight decrease in the population during the past few years as judged by the number of residents per house. (c) As the district is becoming built up there is some difficulty in providing suitable sites for new houses. 3.—Overcrowding.—For the purpose of preparing a preliminary report under the Housing Act, 1930, a summary was made of the house-to-house inspections for the period 15th May, 1929, to 29th September, 1930, and the following facts were revealed:— Ward. No. of houses. Rooms. Persons. Woodgrange 634 3,563 3,030 Manor Park 106 625 614 Kensington 459 2,661 2,504 Little Ilford 1,077 4,848 5,301 Plashet 715 4,142 3,627 Castle 299 1,251 1,161 Central 448 2,606 2,390 Wall End 831 3,792 4,365 Greatfield 71 415 375 South 1,457 7,113 6,217 Total 6,097 31,016 29,584 (For the calculation neither bathrooms nor sculleries were counted.) From this table it will be seen that generally there is no overcrowding, but in individual cases there is an excessive number of persons per house. 4.— (a) No difficulties have arisen under the Public Health Acts or under Section .3 of the Housing Act, 1925. (b) Special measures have been taken by house-to-house inspection of selected areas in the Borough. (c) With few exceptions all houses have adequate internal water supply. 110 (d) (1) Two houses ,only with water closets connected to cesspool. (2) There is a small area of caravan dwellings which has a common water closet for each sex. 5.—Owing to the fact that the Council have under consideration the formation of clearance or improvement areas under the Housing Act, 1930, it is inadvisable to make comment at the moment. (a) INSPECTION AND SUPERVISION OF FOOD. Milk Supply. On this subject I repeat "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 113 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 (Special Designation) Order, 1923. Dealers' licences (Form B) were granted for the Sale of Milk under this Order. 3 for Grade A. 6 for Grade A (Tuberculin Tested). 4 for Pasteurised. 1ll One Pasteuriser's licence (Form C) was granted for the pasteurisation of milk under this Order. Supplementary licences (Form D) were granted for the Sale of Milk under this Order. —for Grade A. 1 for Grade A (Tuberculin Tested). 11 for Pasteurised. 2 for Grade A Pasteurised. 2 Certified. Four samples of milk were taken for bacteriological examination by the Counties Public Health Laboratories. All four samples were certified to comply with the bacterial standard of the various grades of milk. Early in the year I visited a large dairy farm at Ongar and examined the records of the bacteriological examination of the milk from a large herd of cattle, all of which milk comes into this Borough, and found the condition quite satisfactory. At the suggestion of an Inspector of the Ministry of Health arrangements have now been made for a larger number of samples to be taken, under this head in future. (b) MEAT AND OTHER FOODS. Public Health (Meat) Regulations, 1924. Considerable time has been spent by the Inspectors on this important branch of the work. All owners and occupiers of slaughter-houses are supplied with printed and addressed notification forms. During the year 983 notifications to slaughter were received referring to:— 1930. Cattle 2,210 Sheep 1,138 Pigs 7,124 Lambs 1,386 Calves 381 Total 12,239 112 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. Slaughterhouses. Following is a list of slaughter-houses in the Borough:— Beckton Road. Manor Way Farm, New Beckton. 319, Green Street. 167, Plashet Grove. 843, Romford Road. 524, Romford Road. 737, Romford Road. 28, Station Road. Forest View Road. 170, High Street North, and 638, Romford Road, formerly included in this list, have now been closed and converted into other premises. (c) FOOD AND DRUGS (ADULTERATION) ACT, 1928. 440 samples of food and drugs were taken under the above Act, of which 13d were milk. 432 samples were certified by Dr. Bernard Dyer, the Public Analyst, to be genuine articles of food. Of the remaining eight samples, three were of mixed herbs. In reference to those samples/ Dr. Dyer reported that they contained an excessive amount of sand (varying from 3.5—5.0 per cent.) indicative of carelessness in collection. After some correspondence and a visit to the factory it was arranged for a further and finer sifting of these herbs before packing, with the result that the sand is now reduced to about 2 per cent., below this amount it is impossible, commercially, to go. If this standard of purity is maintained I think it meets the requirements of all sampling Authorities in the country. One sample of ice-cream was reported to be "genuine in the sense of being free from any objectionable chemical contamination and it contained cream mixed with rice flour and sugar—but there is no standard for the quantity of cream in ice-cream." 113 One informal sample of milk was deficient in fat to the extent of at least 12 per cent of the normal quantity present in natural milk. This milk was taken from one of the Council's Institutions. It was found upon enquiry that no "plunging" takes place after delivery, so that the last milk would necessarily be deficient. The institution was supplied with churns fitted with plungers and subsequent samples have been satisfactory. One informal sample of vinegar taken from the Memorial Hospital, was reported to be genuine vinegar and of full strength but not properly described as "Malt" vinegar. Complaint was received of a cheap disinfectant being hawked from house to house; on analysis it was found to contain only 1 per cent. of tar acids (carbolic and cresylic acids) together with large bulk of neutral oils emulsified in a soap solution. As there is no standard for these inferior so-called disinfectants it was not possible to take action. An informal sample of sausages taken in December showed preservative to the extent of 300 parts per million. Further samples will be taken. The following is a detailed list of the articles sampled :— Ammoniated Tincture of Quinine 4 Baked Beans 1 Black Currant Wine 1 Bloater Paste 1 Brawn 4 Bread 4 Butter 54 Camphorated Oil 1 Cake 1 Cheese 2 Chelsea Bun 1 Chocolate Curd 1 Citrate of Magnesia 1 Coffee 4 Cocoanut Cream 1 Cocoanut Ice 1 Condensed Milk 2 Corn Flour 1 Crab Paste 1 Cream of Tartar 1 Currants 1 Curry Powder 1 Custard Powder 1 Cream 10 Dates 1 Dill Water 1 Disinfectant 1 Dripping 7 Fish Paste 1 Flour 5 French Ice 1 Ginger 1 Glauber Salts 1 Gravy Creme 1 Green Peas 2 Ground Ginger 2 Ground Almonds 7 Ground Nutmeg 1 Ground Rice 1 Home-made Candy 1 Jam 5 Jelly Cuttings 1 Jelly Crystals 1 Jelly (Table) 3 Ice Cream 1 Icing Sugar 3 Iodine 3 Iodine Fort 1 Kola 1 114 Lard 17 Lemonade Crystals 1 Lung Syrup 1 Margarine 17 Marmalade 4 Milk 136 Milk Chocolate 1 Minced Beef 1 Minced Meat 3 Mincemeat 5 Mint 1 Mixed Herbs 4 Mustard 1 Mixed Spice 3 Mixed Peel 1 Oatmeal 1 Paregoric 1 Pepper 9 Piccalilli 1 Raisins 11 Raspberry Cordial 1 Rice 2 Sage 1 Sago 1 Sal Volatile 1 Salicylate of Soda 1 Salmon and Shrimp Paste 1 Sauce 1 Sausage (Breakfast) 1 Sausages 12 Semolina 1 Suet 3 Suet (Shredded) 4 Sponge Cakes 2 Sultanas 3 Sweet Spirit of Nitre 1 Swiss Roll 1 Sugar 2 Syrup of Iodide of Iron 1 Tartaric Acid 1 Tea 8 Tinned Salmon 1 Tomato Sauce 1 Tripe 5 Turkey and Tongue 1 Turkish Delight 1 Veal Stuffing 1 Vinegar 5 Whisky 4 440 (d) LABORATORIES. The samples taken under the Food and Drugs Adulteration Act are analysed by Dr. Bernard Dyer, of 17, Great Tower Street, E.C., and bacteriological samples are examined by the Counties Public Health Laboratories, 91, Queen Victoria Street, E.C. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written notices. Occupiers prosecuted. (1) (2) (3) (4) Factories (including Factory Laundries) 14 1 - Workshops (including Workshop Laundries) 63 3 - Workplaces (other than Outworkers' premises) — - — Total 77 4 — 115 DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of defects. Number of offences in respect to which prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 5 4 Want of ventilation 3 2 Overcrowding — — Want of drainage of floors — — Other nuisances 11 3 1 Sanitary accommodation:— Insufficient ... — — Unsuitable or defective 4 2 Not separate for sexes — — Offences under the Factory and Workshop Acts: Illegal occupation of underground bakehouse (s. 101) Other offences 1 — (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories & Workshops Transfer of Powers) Order, 1921) Total 24 11 1 * Including those specified in sections 2, 3, 7and8ofthe Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 117 The Following is a Record in Detail of the Inspections made during the Year 1930:— DISTRICT No. 1 DISTRICT No. 2. DISTRICT No. 3. DISTRICT No. 4. DISTRICT No. 5. Manor Park Ward. Wood grange Ward. Kensington Ward. Little Ilford Ward. Plashet Ward. Castle Ward. Central Ward. Wall End Ward. Great field Ward. South Ward. Total. Orel. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H Ord. H. to H. Ord. H.toH. Ord. H. to H. Ord. H. to H. Premises found in fair condition 497 27 221 132 132 108 157 190 216 146 140 91 176 ... 166 316 142 148 194 62 2041 1220 Factory and workshop premises inspected 20 ... 10 ... 4 ... 4 ... 10 ... 6 ... 8 ... 3 ... 7 ... 5 ... 77 ... Outworkers premises inspected 1 ... ... ... 3 ... 1 ... ... ... 10 ... ... ... ... ... 3 ... 2 ... 20 ... Bakehouses inspected 11 ... 14 ... ... ... ... ... 4 ... ... ... 5 ... ... ... 1 ... 5 ... 40 ... Slaughter-houses inspected 389 ... 268 ... ... ... ... ... 173 ... ... ... 31 ... ... ... ... ... 135 ... 996 ... Dairies inspected 14 ... 11 ... 1 ... 3 ... ... ... 3 ... ... ... ... ... 3 ... 2 ... 37 ... Urinals inspected ... ... 2 ... 4 ... 6 ... 2 ... ... ... 6 ... ... ... 1 ... 14 ... 35 ... Walls and ceilings dirty and dilapidated 56 7 77 143 62 124 114 333 133 428 133 277 126 7 104 351 61 186 188 235 1054 2091 Yards improperly paved and dilapidated 18 6 26 102 16 27 12 36 25 125 30 86 51 1 42 158 6 51 21 66 250 658 No forecourt paving 3 2 5 13 17 59 8 88 15 51 13 111 23 ... 8 70 3 14 19 43 114 451 Defective drains 6 1 2 1 5 3 14 14 6 10 4 1 14 ... 9 22 2 5 12 17 74 74 Defective w.c. connections 4 ... 4 1 2 ... 3 2 ... ... 1 1 ... ... 2 2 ... 1 6 ... 22 7 Defective w.c. traps 9 3 16 33 8 53 11 71 14 36 17 44 12 ... 7 14 4 4 25 7 123 265 Defective flushing apparatus 16 4 20 26 8 22 19 36 15 41 13 20 25 1 24 85 7 34 18 22 165 291 Soil pans foul and broken 8 ... 11 20 9 35 17 34 21 45 17 64 21 7 39 5 3 19 12 135 252 Defective vent pipes 4 1 12 23 15 39 16 46 8 24 6 9 20 1 18 138 3 2 4 20 106 303 R.W. pipes and eaves gutters defective 34 7 45 72 32 97 50 181 59 119 50 98 111 3 79 387 54 102 110 129 624 1195 R.W. pipes connected to drain ... ... ... 2 1 4 3 5 1 15 ... 1 ... ... 2 3 1 ... ... 1 8 31 Roofs leaky 37 4 84 52 52 78 85 173 65 140 77 72 96 3 62 129 27 89 119 95 654 835 Defective sink waste pipes 5 ... 13 21 11 64 34 86 11 27 8 15 9 ... 17 72 7 12 26 34 141 331 Houses without water (M.W.Bd.) ... ... ... ... 1 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 3 ... Cisterns without covers ... ... ... ... ... ... ... ... 1 ... 1 20 1 ... ... ... 1 ... 1 ... 5 20 Drinking water improperly stored 8 ... 11 65 4 ... 2 ... 1 3 2 ... 5 ... 3 25 ... 2 1 4 37 99 Dilapidated floors 6 1 14 29 6 6 18 30 13 37 9 34 26 ... 17 12 1 7 29 26 139 182 Insufficient underfloor ventilation 5 ... 13 54 6 69 14 57 9 38 10 17 13 ... 15 104 3 2 17 53 105 394 Dampness 47 4 45 53 35 85 63 154 59 83 47 56 59 1 49 86 27 63 135 167 566 702 Accumulations 19 1 14 2 14 4 18 11 6 2 11 ... 13 ... 14 2 12 4 14 1 135 27 Defective sashcords and windows 21 1 39 73 19 46 26 115 69 182 35 105 45 4 32 30 27 71 82 114 395 741 Overcrowding 5 ... 1 1 2 ... 6 11 2 7 10 4 5 ... 1 1 ... ... 10 7 42 31 Unsound food 87 ... 197 ... ... ...3 ... 88 ... 2 ... 13 ... ... ... 1 ... 79 ... 470 ... No dust bins 4 ... 9 22 5 18 10 54 9 64 8 37 6 1 20 5 9 12 27 16 107 229 Defective stoves 10 1 20 19 18 9 37 33 41 153 40 98 18 l 25 11 18 36 62 80 280 441 Defective coppers 5 4 11 14 7 7 13 23 17 76 18 50 21 l 13 16 12 25 36 37 153 253 Animals improperly kept 5 ... ... ... 1 ... 9 1 1 ... ... ... 1 ... ... ... 1 1 4 1 22 3 Temporary buildings found 1 ... 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 4 ... Smoke nuisances 11 ... 1 ... ... ... 3 ... ... 1 4 ... 4 ... 4 ... ... ... ... ... 27 1 Rear passages unpaved or undrained ... ... ... ... 7 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 9 ... Gipsies ... ... ... ... ... ... ... ... ... ... ... ... ... ... 19 ... ... ... 9 28 ... Breaches of Bye-Laws and Regulations 8 ... ... ... 3 ... 5 ... ... ... 1 ... 5 ... 1 ... 1 ... 1 ... 25 ... Other nuisances 98 11 88 207 58 97 121 149 133 384 161 302 168 5 129 539 66 174 206 194 1228 2062 Drains tested 56 74 ... 56 ... 73 ... 20 ... 25 ... 38 ... 67 ... 17 ... 19 ... 445 ... Inspections 862 39 653 512 324 452 537 802 588 683 431 433 521 10 146 1129 295 464 767 410 5424 4934 Total Inspections 901 1165 776 1339 1278 864 531 1575 759 1177 10358 COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Annual Report OF THE School Medical Officer FOR THE YEAR 1930. 120 EAST HAM EDUCATION COMMITTEE Councillor J.J. Pope (Chairman). Councillor G. P. Dean, J.P. (Vice-Chairman) Councillor T. I. Lethaby, J.P. (Mayor). Councillor E. H. Thompson (Deputy-Mayor). Councillor Mrs. M. Ridler. Councillor Mrs. A. Taylor. *Councillor Mrs. A. Warne. Alderman W. W. Bagot. ||Alderman J. Brooks, J.P. Alderman G. H. Manser. Alderman C. L. E. Masset. Alderman H. Osborn, J.P. Alderman H. N. Ridler. Alderman E. Shanahan, J.P. Councillor J. W. Barton. Councillor T. W. Burden. *Councillor W. T. Bush. Councillor F. P. Cross, J.P. Councillor A. E. Dennington. Councillor E. C. Howlett. †Councillor W. E. Huggett. ‡Councillor H. P. Jackson. Councillor E. Markey. Councillor R. W. Moger. Councillor W. T. Newling. Councillor A. H. W. Owen. Councillor G. Pottinger. §Councillor A. C. Warner. Councillor T. Watts. Miss L. Butcher. E. T. Andrews, Esq., B.A. E. J. Sullivan, Esq. R. Whitfield, Esq. *Appointed Dec., 1929. †Resigned Dec., 1929. ‡ Appointed Mar., 1930. § Resigned Mar., 1930. ||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: Chief Administrative Clerk: *T. B. Clark. †G. W. Friend (Senior). ‡F. Rfad, M.S.M. (Senior). Miss F. E. Hales, Miss O. E. Griffin, Miss F. C. Wells and Miss J. M. Flynn Dental Surgeons (full-time): C. S. Neame, L.D.S., R.C.S., A. E. Hall, L.D.S. (Liverpool). Ophthalmic Surgeon: S. C. Reeve-Flaxman, M.R.C.S., L.R.C.P. (Three sessions per week). Aural Surgeon: R. Savege, M.B., Ch.B., F.R.C.S.Eng., D.L.O. (from April, 1929). (Two sessions per week). Assistant Medical Officers: Miss M. M. Thomson, L.R.C.P., L.R.C.S., D.P.H. Senior Assistant Medical Officer: F. E. Bendix, M.R.C.S., L.R.C.P., L.D.S. Deputy School Medical Officer: Malcolm Barker, M.R.C.S., L.R.C.P., D.P.H. School Medical Officer: W. Benton, M.R.C.S., L.R.C.P., D.P.H. From 15th Sept., 1930. †From June, 1930. ‡Until June, 1930. 121 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, 1930. The average school attendance throughout the year approximated closely to 17,500. The number of routine and special cases of elementary school children examined totalled 10,105, as compared with 12,870 in 1929, and a complete medical inspection of all the scholars in the Secondary Schools has also been carried out. I have no new departure or development to report in connection with the School Medical Department, but I am very pleased with the work accomplished and with the satisfactory results achieved. In spite of being considered unduly persistent I must reiterate the necessity for providing suitable and adequate premises for the conduct of the School Medical Service. The Central Clinic and Office accommodation is less than in the year 1918, yet, since that year, it has had to meet the demands of progress to such an extent that, at the present time, thirteen Clinics are held during the available eleven sessions each week. The Clinic and Office accommodation is situated on the top floor of the Town Hall Building and is reached by the ascent of 55 stairs; it consists of a Waiting Room (312 square feet), and a combined Treatment and Consulting Room (784 square feet)—the possibility of carrying out a satisfactory clinical examination while treatment is in progress is somewhat uncertain. Both of the rooms are in constant use throughout the week:- 122 Morning Sessions. Monday.—Minor Ailment and Consultation Clinic. Tuesday.—Ophthalmic Clinic (S.M.S.). Wednesday.—Minor Ailment and Consultation Clinic. Thursday.—Ophthalmic Clinic (S.M.S.). Friday.—Ophthalmic Clinic (S.M.S. and M. and C.W.C.). Saturday.—Minor Ailment and Consultation Clinic. Afternoon Sessions. Monday.—Light Clinic (M. and C.W.C. and S.M.S.). Tuesday.—Aural Clinic (S.M.S. and M. and C.W.C.). Wednesday.—Light Clinic (S.M.S.). Thursday.—Light Clinic (M. and C.W.C.). Friday.—Aural Clinic and Immunization Clinic (S.M.S. and M. and C.W.C.). The pioneer work initiated by the School Medical Department has resulted in the encroachment of the Maternity and Child Welfare Centre upon its Clinic accommodation. The average attendance at the School Minor Ailment and Consultation Clinic is ninety, at the Ophthalmic Clinic thirty, at the Aural Clinic twenty, at the Light Clinic seventy, and at the Immunization Clinic thirty. In addition all the special examinations, e.g., Student Teachers, scholarship holders, camp children, and physically defective children (recommended for admission to special schools) have to be carried out on the Clinic premises. The Treatment and Consulting Room also functions as the bacteriological laboratory of the Public Health Department. The Nurses' Office (146 square feet) has to serve for seven School Nurses who, of necessity, must complete their clerical work at one and the same time. The Clerks' Office (141 square feet) has to accommodate five clerks. I have endeavoured, so far as staff Requipment 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. 123 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. Eighteen 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 90 children of school age, for whom the Association has undertaken full financial responsibility. I wish to express my appreciation of the keen interest and loyal co-operation of the staff. 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. 124 1. STAFF. A list of the Staff of the School Medical Department will be found on page 120 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. There is no doubt that the arrangements made for the coordination of the medical and sanitary services is efficient in so far as present administrative control will allow. The scheme has proved of undoubted value and its gradual but sure consolidation has resulted not only in the elimination of much loss of professional effort, wastage of important information and overlapping but has also ensured that closer co-operation and increased consultation which is so imperative to the successful application of the principles of preventive medicine. The appointment of the Chief Administrative Clerk to the Public Health Services completes the scheme of co-ordination and, so far as the School Medical Service is concerned, this appointment, although quite recent, has strengthened very definitely the channels of co-ordination. 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. 3. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene. During the year 1930 a complete survey of the sanitary and hygienic conditions pertaining to all the schools of the 125 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 1930. The figures for the year 192G to 1929 are also given for comparison:— COMPARATIVE STATEMENT OF WORK. 1926. 1927. 1928. 1929. 1930. Routine and Special Inspection (on School Premises) 10,944 8,483 10,408 9,763 8,325 Re-inspection 4,737 4,175 4,061 4,821 3,574 Consultations at Inspection Clinic 14,575 13,530 16,533 15,675 14,490 Number of Treatments at Clinic 15,810 14,873 10,140 18,517 16,967 General Cleanliness Visits to Schools 297 257 274 322 309 Nurses' Visits to Homes 4,948 4,547 4,239 3,824 3,479 Children Examined for Cleanliness 58,683 58,588 55,351 53,009 51,607 (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 and Re-inspection was completed in all the schools of the Borough. 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 126 staffing difficulties resulting from the resignation, transfer and sickness of members of the Staff; except for the transfer of one school nurse to the Dental Clinic for a period of seven weeks the Department has been unusually fortunate in this respect. (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 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. The filing and compilation of complete and up to date records, schedules, and statistics 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. No important alteration in clerical organisation and administration has been considered necessary during the year 1930. The resignation of Mr. F. Read, the Senior Clerk was received with much regret. Fortunately Mr. G. Friend, who was transferred from the General Office to the vacancy, has filled the breach very satisfactorily and our programme and scheme of work has suffered very little in consequence. 127 (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, anil disturb-' ance 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, and, although there is a considerable reduction in this percentage as compared with that of the previous year, it will be noticed that the average remains fairly constant; the probable reason for this was outlined in my report for last year. The percentage in the case of the Entrant Group shows a gratifying reduction, although small. With a satisfactory scheme of routine medical examination such as is anticipated it will be possible to overcome the problem of complete medical supervision of children under school age. It is very interesting to consider the figure which represents the percentage of children found to require treatment in the Leaver Group (6.2) and to compare this with the figure for the Entrant Group in the year 1924, which embraces, for the most part, the same children at the age of five years. The latter figure was 15.97 per cent. and the inference demonstrates the very satisfactory results achieved by the School Medical Service. 128 FINDINGS OF MEDICAL INSPECTION. Group. NUMBER OF CHILDREN. Percentage of Children found to require Treatment. Inspected. Found to require Treatment. Entrants 1925 1926 1927 1928 1929 1930 1925 1926 1927 1928 1929 1930 1925 1926 1927 1928 1929 1930 2,960 3,345 2,468 3,197 2,998 2,314 340 454 244 354 411 264 11.5 13.6 9.9 11.1 13.7 11.4 Intermediates 2,961 1,991 1,295 2,424 2,208 2,207 445 270 133 291 316 237 15.0 13.6 10.3 12.0 14.3 10.7 Leavers 3,118 3,877 2,717 2,848 2,366 1,912 370 520 180 237 248 119 11.9 13.4 6.6 8.3 10.5 6.2 Totals 9,039 9,213 6,480 8,469 7,572 6,433 1,155 1,244 557 882 975 620 12.8 13.5 8.6 10.4 12.9 9.6 129 (a) Uncleanliness. The School Nurses have carried out 3 cleanliness surveys of all the children in the elementary schools during the year 1930. During the year the School Nurses made 51,607 tions, as compared with 53,009 in 1929. Of this number 510 children showed vermin and many nits in the hair (426 in 1929), whilst 1,844 children showed only a few nits (1,866 in 1929). Comparative table:— Year Number Examined Number with Nits Number with Head Vermin No. of Exclusion Certificates 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 1930 51,607 1,844 510 60 130 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 781 58 32 Myope Class - 51 1 - Girls 1186 151 83 Napier Infants 1074 56 25 Boys 1067 82 44 J. Boys 1213 13 4 Brampton Infants 1505 25 8 S. Boys 690 5 6 J. Girls 1326 46 7 Plashet Infants 768 34 4 S. Girls 777 21 — J. Boys 1127 7 - Castle Street R.C. Mixed 718 35 - S. Boys 739 4 - Central Park Infants 983 28 5 "Salisbury" Primary 1652 37 3 J. Boys 1362 14 - Inter. 522 4 - S. Boys 901 2 1 Sandringham Road J. Mixed 805 29 24 Cornwall Infants 1080 56 10 S. Mixed 917 18 7 Girls 842 55 9 Shaftesbury Road Infants 1048 67 8 Boys 714 6 2 Junior 1072 95 6 Dersingham Mixed 1130 42 8 Senior 612 28 1 Essex Road Infants 1197 22 2 Shrewsbury Road Special 179 14 - J. Boys 1229 6 2 Storey Street J. Mixed 725 46 22 S. Boys 1229 6 2 S. Mixed 970 40 16 Hartley Infants 1001 17 1 Silvertown R.C. J. Mixed 399 42 17 J. Girls 1148 42 5 S. Mixed 719 27 35 S. Girls 630 20 - St. Michael's R.C. Mixed 309 13 4 High Street J. Mixed 1044 41 1 St. Winefride's R.C. Mixed 801 39 10 S. Mixed 439 7 - Vicarage Infants 1005 39 12 Kensington Avenue Infants 897 14 7 J. Girls 1069 88 20 Junior M. 832 49 28 S. Girls 771 28 11 Senior M. 575 34 8 "Winsor" Primary 1141 72 5 Lathom Road Infants 976 31 3 Inter. 677 20 1 Girls 953 38 1 Total 51607 1844 510 Monega Road Boys 1225 3 - Infants 1033 22 — Girls 1052 3 — Per cent. in 1930 3.5 0.9 Boys 720 2 - Per cent. in 1929 3.5 0.8 131 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, frequently recognised in the early stages, have been immediately referred to one of the School Clinics. Chief Minor Ailments Discovered at Routine Medical Inspection, Discovered by Teachers and Nurses and sent to Clinic 1929 1930 1929 1930 Scabies 2 - 16 16 Impetigo 27 10 380 345 Conjunctivitis 3 7 82 87 Blepharitis 6 3 75 43 Ear Disease 89 62 111 158 Ringworm (Scalp) 4 — 45 5 Ringworm (Body) - - 16 36 (c) Tonsils and Adenoids. 4.9 per cent. of the children examined during the year were referred for treatment for "tonsils and adenoids," either separately or combined, as compared with 5.2 per cent. in the year 1929. Of these, much enlarged tonsils accounted for 1.4 per cent.; definite adenoids were present in 0.4 per cent., and the 132 combined defect was diagnosed in 3.1 per cent.; the figures for 1929 were 1.5 per cent., 0.2 per cent., and 3.5 per cent., respectively. The percentage of children moderately affected and requiring to be kept under observation was 11.3, the corresponding percentage in 1929 being 10.9. In this case 10.8 per cent. had moderately enlarged tonsils, 0.2 per cent. exhibited signs of the presence of adenoids, whilst 0.3 per cent. showed enlarged tonsils and adenoids of moderate degree, as compared with 9.3 per cent., 0.3 per cent., and 1.3 per cent., respectively in the year 1929. (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 — 4 4 Other forms of Tuberculosis 18 3 21 Totals 18 7 25 (e) Skin Disease and (f) External Eye Disease. The number of these cases still remains high. At medical inspections during the year 615 children were found to be suffering from skin affections (as compared with 851 in the year 1929). Cases of external eye disease also continue to show a high incidence, 140 in the year 1930 and 166 in the year 1929. (g) Vision. Only children with marked visual defect have been referred for treatment and these, including cases of strabismus, numbered 615. In addition there were 172 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. 161). 133 (h) Ear Disease and Hearing. 0.3 per cent. of the children examined were found to be suffering from otitis media, as compared with 0.6 per cent, in 1929. The percentage of deaf children was 0.3, the corresponding number for last year being 0.5. (i) Dental Defects. (See Report of Dental Surgeon on pp. 163-6). (j) Crippling Defects. Reference to Table III on page 59 will furnish information with regard to the occurrence of crippling defects in the area. There were no cases of crippling due to tuberculosis but 85 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 1930. The high incidence of the more serious acute infectious diseases has been followed by a very definite decrease during the years 1929 and 1930. 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. 123 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. 153 swabs were taken and 13 proved to be positive. (c) In cases where an undetected source of infection appears to be present in a class or school. 32 swabs were taken and none proved to be positive. 134 In regard to Small-pox there were thirteen actual cases and thirty-one contact cases in children attending schools in the Borough. Fourteen 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 re-vaccination. The result of this action is encouraging and a large number of children have been vaccinated. The statistics relating to protective immunization against Diphtheria are included in my report as Medical Officer of Health. Unfortunately the Immunization Clinic can only be held on one half session per week, owing to lack of accommodation, otherwise there is no doubt that, with the introduction of a scheme of propaganda, the number of applicants for this form of treatment would be greatly increased. Nevertheless, during the year 1930, 439 infants and children have received three inoculations, making a total of 572 since the Clinic was commenced in September, 1929. These figures are encouraging and so far the response has exceeded our expectations. Should the present number of applications be maintained, and providing that suitable accommodation becomes available, a very considerable reduction in the incidence of Diphtheria may be anticipated with confidence. 135 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 37 16 8 10 32 36 February 171 13 24 12 28 34 March 320 12 77 46 32 25 April 63 1 7 43 16 20 May 31 4 27 48 26 24 June — 2 18 21 11 15 July 2 — - 7 17 30 August - - - - 10 16 September - — — — - October — 19 - 1 22 39 November — 56 — 16 31 20 December 1 50 — — 25 12 Totals (262) 625 (132) 173 (139) 161 (80) 204 (377) 250 (298) 271 The totals in brackets are those for the year 1929 and are inserted for comparison. 136 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. 1929 1930 1929 1930 Ringworm of Scalp 23 5 834 122 Ringworm of Body 35 24 704 476 Impetigo Contagiosa 68 87 687 758 Infective Eye Inflammation 57 44 864 451 Septic conditions 152 69 1507 545 Verminous conditions 18 17 133 119 Scabies 12 20 264 252 Other Skin conditions 51 39 614 411 Acute Throat conditions 37 28 277 301 453 333 5947 3435 137 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 3,479 visits to the homes of children in whom defects were found at medical inspection, and for special investigation purposes. Of the 751 children referred for treatment, 571 or 76 per cent. have obtained treatment. The School Nurses have also paid 229 special visits to the Schools, and 31 visits to the Feeding Centres, and have undertaken 33 journeys in connection with the admission and discharge of children to Institutions. All children, referred for the operative treatment of tonsils and adenoids (549), 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. The difficulties encountered during the course of the Nurses' following-up visits are becoming less and less frequent each year and the majority of parents are not only willing but anxious to follow the advice given by the School Medical Officers. There are a minority however who consistently disregard the proffered advice and it is by no means uncommon for the School Nurse concerned to make six or seven visits in order to persuade or encourage a parent that the treatment prescribed is imperative to the health of the child. 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. 138 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 1930, 16,967 attendances were made for treatment at the various clinics, and there were 14,490 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, page 131. (b) 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 549 have received operative treatment with marked beneficial results to their general health. Arrangements for the performance of these operations are in force with four hospitals, viz., St. Mary's, Plaistow; Balaam 139 Street Children's Hospital, Queen Mary's Hospital, Stratford, and East Ham Memorial Hospital. Arrangements have been made to carry into effect the recommendation of the Board of Education in regard to the visitation of children after the operation. (c) Tuberculosis. The arrangements for the treatment of Tuberculosis have been continued on the lines fully set-forth in my reports for previous years. (d) Skin Diseases. For the most part 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 six children received this form of treatment during this year. (e) External Eye Disease. 164 cases (266 in 1929) of external eye disease were treated at the School Clinics. (f) Vision. During the year 1930 the Ophthalmic Clinic was held on five sessions per fortnight. 561 cases were referred for treatment in respect of visual defect during the year 1930 and, including 130 cases awaiting treatment at the termination of the year 1929, 553 cases have been treated in the past year. On the 31st of December, 1930, there were 138 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. Under these circumstances it is difficult for the Medical Officers and 140 School Nurses to impress parents in regard to the necessity of obtaining early treatment. There were 155 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. 161-2). (g) Ear Disease. 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 year 1930, 83 Aural Clinic sessions were held. The total attendances at the Aural Clinic was 1,572, making an average attendance, at each session, of 19 patients. Ionisation treatment was carried out in 41 cases, 85 applications being made; that is to say an average of 1.0 ionisation treatment was performed at each session; the treatment occupies just over half an hour in each case. 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. (Sea also Report of Aural Surgeon, p. 160). (h) Dental Defects. 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 141 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. (See also Report of Dental Surgeon, p. 163-6). (t) Crippling Defects. 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. 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. The treatment at the hospital includes operative, electrical and massage treatment, remedial exercises and the supply of surgical appliances, and is carried out under the direction of an orthopaedic surgeon. Payment is made to the Hospital Authorities by a per capita grant contribution in respect of East Ham scholars sent to the Hospital through the School Medical Service. All children referred by the Authority's Medical Officers to the Hospital for treatment are kept under observation at frequent intervals at one or other of the School Clinics, in order that the progress of the cases may be watched and recorded, and to ensure that treatment has not been allowed to lapse. If at any time such a case fails to attend the School Clinic it automatically becomes included in the following-up list of one of the School Nurses. During the year 1930, 21 out-patients have received treatment, the total out-patient attendances being 381. Negotiations are in progress with the East Ham Memorial Hospital for the provision of facilities for the treatment of certain defects in children elicited upon routine medical examination. 142 (j) The Light Clinic. A full account of the arrangements and methods adopted in regard to treatment by artificial light was included in my reports for the years 1928 and 1929. No variation has been made in connection with the methods described and very satisfactory results continue to be obtained. The great difficulty is the small and poor accommodation. The only rooms which can be used for ultra-violet ray treatment are those allocated for Clinic purposes generally, viz., the two comparatively small rooms situated on the top floor of the Town Hal! 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. 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. The following is a brief summary of the cases treated by general and local irradiation throughout the year:— CONDITION. Boys. Girls. Anaemia 13 21 Debility 57 56 Malnutrition 20 28 Malnutrition and Anaemia 6 9 Pretuberculosis 1 5 Rheumatism 3 3 Bronchial Catarrh and Bronchitis 22 12 Adenitis 18 11 Alopecia 1 2 Number of children treated 288 (317 in 1929). Number of attendances 3,917 (3,922 in 1929). Average number of attendances per child 14 Number treated by local application 16 143 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 167 scholars to the Dymchurch Holiday Camp during the year 1930, and in addition the following School Journeys were undertaken:— Cornwell Senior Boys 45 Plashet Senior Boys 70 Lathom Road Boys 40 Hartley Senior Girls 39 Salisbury Junior Mixed 40 Central Park Senior Boys 30 Brampton Senior Girls 60 Sandringham Central 100 Essex Senior Boys 60 Total 484 (c) Open-Air Classrooms in Public Elementary Schools. There are four open-air classrooms at the Brampton School and one at Castle Street School, and the benefit derived is very definitely reflected in the increased brightness and vivacity of the scholars attending these classes. (d) Open-Air Day Schools. There are unfortunately no open-air schools in the Borough. 144 (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, St. Dominic's School of Recovery at Godalming, St. Mary's School of Recovery at Dover, 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 176 cases, financial responsibility for which was not undertaken by the Local Education Authority. 145 Particulars of the number of Children who were resident in Schools of Recovery between 1st January and 31st December, 1930, 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. C. Total Ogilvie — — 8 7 — — 2 3 — 1 — — 6 4 1 3 1 — 2 1 — — 3 4 23 23 ' 46 I.C. a.a. (hqtrs.) — 2 2 1 1 1 2 2 — 2 2 1 1 1 — — — — — — — — — — 8 10 18 St. Dominic's — — 2 — — — 0 — — — 2 — — — 1 — 6 — 4 — — — — — 21 — 21 St. Mary's — — — — — — — 1 — — — — — — — — — — — — — — — — — 1 1 Other Schools of Recovery (sent by East Ham Branch of I.C.A.A.) 2 1 1 2 — 2 3 — — — — — — — — — — — — — — — — 7 4 11 No. of Weeks 11 12 15 26 Russell-Cotes 8 6 11 — 8 6 2 — — — — — — — — — — — — — — — — — 20 12 41 146 10. PHYSICAL TRAINING. Physical training has been continued on similar lines to those quoted in previous reports, and instruction in swimming has been conducted as heretofore. 11. PROVISION OF MEALS. During the year 136,406 meals were provided for 1,244 children, as compared with 136,534 meals for 529 children in 1929. The School Medical Officer suggests a suitable menu for the children's meals, and the Medical Officers and School Nurses visit the various feeding centres periodically. On these occasions the quality of the food and the preparation, distribution and service of the meals have been satisfactory. 12. SCHOOL BATHS. There are no baths used at the schools for the bathing of school children. 13. CO-OPERATION OF PARENTS. During the year 1930 the number of parents who were present at the routine medical inspections was 4,642 (5,215 in 1929, that is, in 57.4 per cent. of the cases examined (55.1 per cent. in 1929). The interest which parents take in the work of the School Medical Service demonstrates the value which they place upon this work, and assists greatly in ensuring that our advice and directions are carefully carried out. 14. CO-OPERATION OF TEACHERS. The Teachers render most valuable assistance to the School Medical Service, and the great interest which they exhibit in regard to all matters affecting the physical and mental condition of the scholars is extremely stimulating and encouraging to the School Medical Officers and Nurses. 15. CO-OPERATION OF SCHOOL ATTENDANCE OFFICERS. The co-operation of School Attendance Officers and the coordination of the School Medical Service with that of the School Attendance Department has been fully discussed in previous reports. 147 Many cases have been referred for special examination by the Attendance Officers on forms 21, and of these cases 94 were medically examined, reports and advice in each case being sent to the Secretary of the Education Committee. 16. GO-OPERATION OF VOLUNTARY BODIES. Reference to 9 (e) on page 141 will give some measure of the scope of the work carried out in association with Voluntary Bodies. The National Society for the Prevention of Cruelty to Children has been of great assistance in our efforts on behalf of children whose parents have proved indifferent or stubborn. Twenty-five such cases have been dealt with by the Society's Inspector, as the result of direct reference from the School Medical Service, during the year 1930:— Tonsils and Adenoids 10 Defective Vision 6 General Neglect 9 The Inspector has made over 150 visits in regard to these cases with the result that 9 of the cases of tonsils and adenoids and the 6 cases of defective vision have been successfully treated, whilst the 9 cases of neglect have responded satisfactorily. Legal action was unnecessary and the Inspector concerned is to be congratulated upon the result of his efforts. 17. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Physically Defective Children. Table III reveals the very regrettable fact that 44 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 429 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 thern will ultimately join the ranks of the unfit. The 223 children classified as delicate (in Table III) are all suffering from a chronic form of defect due to unsatisfactory 148 environmental, nurtural and congenital conditions, and the only treatment which holds out any hope of lasting benefit is their admission to residential schools of recovery for periods varying from three to twelve months or longer. Whilst there are many children who enter school in a fairly advanced stage of invalidity from the above causes, there are also a great number who exhibit early signs and predisposing conditions and for whom the routine, hygiene and education in a day open-air school, in addition to medical supervision and treatment at the School Clinic, would go far in the prevention of a more serious defect. These cases have not been classified in Table III in view of the fact that there is insufficient accommodation for the severer types of defect in residential open-air schools, and no openair school is available for their reception. As reported on previous occasions:— "The provision of a day open-air school, erected on a suitable site within the Borough, would tend markedly towards reducing the number of definitely physically defective children, with the result that, at no distant date, the present serious 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 98 children suffering from glandular and non-infectious pulmonary tuberculosis, and the 23 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 85 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 44 children, who come within this category, receiving no education, and there are 85 children of this type who have been allowed to attend the ordinary elementary 149 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, 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. During the year 1930, the number of cases examined for purposes of the Mental Deficiency Acts, was 59 (63 in 1929). Of these 34 were classified as mentally deficient, and 19 as dull and backward, recommendations being made as shown in the following table:— 150 Number examined 59 Classified as mentally deficient 34 Classified as morally deficient — Classified as imbeciles 6 Classified as idiots — 40 Classified as dull and backward 19 Recommended for Special School 34 A reference to Table III will show that out of 106 children who have been certified as mentally defective but educable in a special school, 2 (4 in 1929) are having no education, and 104 have been satisfactorily placed. 18. NURSERY SCHOOLS. There are at present no Nursery Schools in East Ham. 19. SECONDARY SCHOOLS. There is only one secondary school in East Ham, and tables relating to the work carried out in connection with this school are appended. 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. 19 boys have been specially examined in accordance with the Bye-laws, and these were found to be fit for employment. 151 In addition, 6 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. 23. MISCELLANEOUS. During the year 1930 the following special medical examinations were made:— Teachers 63 Officers 2 Student Teachers 15 Scholarship Candidates 94 Workmen 17 W. BENTON, Medical Officer of Health and School Medical Officer. 152 MEDICAL INSPECTION RETURNS. SECONDARY SCHOOL. TABLE I. RE'IURN OF MEDICAL INSPECTIONS (see note a). For the Year ended 31st December, 1930. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections— (see note b). Boys. Girls. Entrants — — Intermediates — — Leavers 167 180 Total 167 180 Number of other Routine Inspections (see note c). 96 78 B.— OTHER INSPECTIONS. Number of Special Inspections (see, note d). 8 12 Number of Re-Inspections (see note e). 26 24 Total 34 36 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. 153 (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. 154 TABLE II. SECONDARY SCHOOL. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1930. 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 — 2 — 1 — — — — Uncleanliness: See Table IV., Group V. — — — — — — — — Skin Ringworm: Scalp — — — — — — — — Body — — — — — — — — Scabies — — — — — — — — Impetigo — — — — — 1 — — Other Diseases non-Tuberculous 2 1 3 1 1 — — Eye Blepharitis — — — — — — — — Conjunctivitis. — — — — 1 — — — Keratitis — — — — — — — — Corneal Opacities — — — — — — — — Defective Vision (excluding Squint) 4 10 17 6 — 2 — — Squint — — 1 — 1 — — — Other Conditions — — — — — 1 — — Ear Defective Hearing — 2 4 — — — — — Otitis Media — — — — — — — — Other Ear Diseases — — — 4 — 1 — — Nose and Throat Enlarged Tonsils only — 5 to 7 — — — — Adenoids only — — — — — — — — Enlarged Tonsils and Adenoids 1 — — 1 — 1 — — Other Conditions — 2 — 3 — — — — Enlarged Cervical Glands (Non-Tuberculous) — — 15 3 — — — — Defective Speech — — — 1 — — — — 155 Table II.—(continued.) (1) (2) (3) (4) (5) B. G. B. G. B. G. B. G. Teeth—Dental Diseases (see note a) See Table IV., Group IV. — 2 22 12 2 2 — — Heart and Circulation Heart Disease: Organic — — — — — — — — Functional. — — 4 3 — — — — Anæmia — — — 1 1 — — — Lungs Bronchitis — — — — — — — Other Non-Tuberculous Diseases — — 1 — — — — — Tuberculosis Pulmonary: Definite — — — — — — — — Suspected — — — — — — — — Non-Pulmonary: Glands — — — — — — — — Spine — — — — — — — — Hip — — — — — — _ — Other Bones and Joints — — — — — — — — Skin — — — — — — — — Other Forms — — — 2 — — — — Nervous System Epilepsy — — — — — — — — Chorea — — — 1 — — — — Other Conditions — — — — — — — — Deformities Rickets — — — — — — — — Spinal Curvature — — — — — — — — Other Forms — 1 — 2 — — — — Other Defects and Diseases — 3 4 12 — 7 — — 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 167 180 2 10 1-2 5-5 Total (Code Groups) 167 96 180 2 10 — — Other Routine Inspections 78 3 14 3 1 179 156 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 counter! 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). 157 TABLE IV. SECONDARY SCHOOL. Return of Defects Treated during the Year ended 31st December, 1930. (See note a.) TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme (see note b). Otherwise. Total. (1) (2) (3) (4) B. G. B. G. B. G. Skin— Ringworm—Scalp — — — — — — Ringworm—Body — — — — — — Scabies — — — — — — Impetigo — 1 — — — 1 Other skin disease 1 — — — 1 — Minor Eye Defects (External and other, but excluding cases falling in Group II.) 2 — — — 2 — Minor Ear Defects (See note c.) — 4 — — — 4 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 12 16 — — 12 10 Total 15 21 — — 15 21 158 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) B. B. G. B. G. B. G. Errors of Refraction (including Squint) (Operations for Squint should be recorded separately in the body of the Report). — 3 — — 1 — 1 3 Other Defect or Disease of the Eyes (excluding those recorded in Group I.). — — — — — — — — Total — 3 — — 1 — 1 3 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme 2 (b) Otherwise — Total number of children who obtained or received spectacles— (a) Under the Authority's Scheme 2 (b) Otherwise — Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of Treatment. Total number treated. Under the Authority's Scheme in Clinic or Hospital (see note b). By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) B. G. B. G. B. G. B. G. B. G. 8 1 — — 8 1 — — 8 1 159 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. (f) A statement as to the arrangements made by the Local Education Authority for cleansing verminous children and a record of the cases in which legal proceedings were taken, should be included in the body of the School Medical Officer's Report. N.B.—Groups I.—V. above cover all the defects for which treatment is normally provided as part of the School Medical Service. Particulars as to the measures adopted by the Authority for providing treatment for other types of defect (e.g., for orthopædic 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. 160 REPORT OF THE AURAL SURGEON. To the School Medical Officer, Education Committee, County Borough of East Ham. Sir, I have the honour to present my second annual report on the work done in the Aural Clinic during the year 1930. Throughout the year, two clinics were held each week, in place of the former year's arrangement of one clinic per week. It has thus been possible to provide more efficient treatment including ionisation, and this is reflected in the great increase in the number of cases discharged, cured. During 1929, only 25 per cent. of the cases examined, were discharged, after treatment, as cured: whereas in this year, 63 per cent. of the cases treated, were discharged, cured. The statistical report is as follows:— Cases of Chronic Otitis Media 278 Discharged 178 Cases of Deafness 25 ,, 15 Other Ear Cases 12 ,, 8 Cases of Chronic Rhinitis 34 ,, 11 Cases of Sinus Disease 1 ,, — Other Nose Cases 21 ,, 17 Cases of Enlarged Tonsils and Adenoids 118 ,, 87 Total number of Cases 489 Discharged 316 During the year, I operated on 203 East Ham children in hospitals, mainly for the removal of enlarged Tonsils and Adenoids. I wish to thank the Nursing Staff, whose skilful co-operation has largely contributed to this great increase in the number of cases cured. I have the honour to be, Sir, Your obedient Servant, RONALD SAVEGE. 161 REPORT OF THE OPHTHALMIC SURGEON. To the School Medical Officer, County Borough of East Ham Education Committee. February, 1931. Sir, I have the honour to present my report for 1930-31. General Clinic. Number of new cases 506 Glasses prescribed 296 Glasses not necessary 159 Glasses obtained 294 Special treatments 51 Re-examinations 1,003 Discharged 125 Operations for Squint 2 Baby Clinic. Number of cases seen 44 Attendances 231 Number of Squints 27 Glasses prescribed 15 Treatments 11 Myope Class. Number of pupils 20 Squint.—This condition of cross eye has shown itself in about 400 of the children now in East Ham Schools taking all ages together. Treatment now adopted in the clinics consists in the intensive application of the principles of Claude Worth. One important end is to secure good acuity of vision in the squinting eye. Eyes optically corrected by glasses, but which still squint, commonly have defective vision in the squinting eye. Hitherto many of those which have become straight by treatment or otherwise have defective vision in the eye that used to squint. At the beginning the vision may be extremely poor, the eye being unable to fix on anything to appreciate it, probably seeing only hand movements. It appears possible for these eyes to attain good 162 vision in a varying, even short, time. Parents have co-operated well, especially in stimulating the children's powers of mimicry on which the vision testing depends at an age when the alphabet does not enter the region of practical politics. A less number of operations for squint is to be anticipated in consequence of this big treatment push. Baby Clinic.—Progress has been made in estimating the acuity of vision in these young children. Here is also the forcing house for squints, and at this age the best results in treatment should be obtained. Myope Class.—Every effort is made in this class to keep the standard of education up to normal for the age of the pupils who are of course mixed in this respect. All strain of school work upon the focussing and dynamic conditions of the eyes is as far as possible prevented. The recreation of the pupils has received attention, but very great difficulties are met here at once, and not very much is possible to be done. 1 am very glad to thank everyone in the School Medical Service for their efficient help and work in the clinic and their co-operation outside, for the skilled attention of the optician and the ministrations of the clerical staff. I have the honour to be, Sir, Your obedient Servant, S. C. REEVE-FLAXMAN. 163 REPORT ON THE WORK DONE IN THE SCHOOL DENTAL CLINIC. To the School Medical Officer, County Borough of East Ham Education Committee. Sir, I bey to submit to you my report for the year 1930. The age groups inspected were from 5 years to 11 years inclusive. The number of children inspected was 13,613, and the number referred for treatment was 9,203. The special cases, those referred by the School Medical Officers, Nurses, and Teachers, numbered 187. These are cases which do not come under the routine inspections, being usually children suffering from abscesses, or oral sepsis. Any school child suffering from tooth ache, on obtaining a form from the Head Teacher, can be seen and treated at the Dental Clinic. 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 1666 1040 2131 2175 2459 2436 806 13613 — — — 187 13800 (b) Found to require treatment 9203. (c) Actually treated 3167. (d) Re-treated during the year as the result of periodical examination 2700 (see note) (2) Halt-days devoted to:— Inspection 107 Total 788 Treatment 681 (3) Attendances made by children for treatment 7250. (4) Fillings:— Permanent teeth 1428 Total 2295 Temporary teeth 867 (5) Extractions:— Permanent teeth 7161 Total 8208 Temporary teeth 7492 (6) Administrations of general anaesthetics for extractions 376. (7) Other operations:— Permanent teeth 379 Total 688 Temporary teeth 309 164 School inspection is carried out so that every child under 12 years of age in the current year is examined once per annum. Sometimes it happens that a school is suffering from an epidemic such as measles or influenza when a high proportion are absent, in these cases it is arranged that another session is devoted to inspection of absentees in 2 or 3 months time. A child who is charted with a sound mouth has no sign of caries or oral sepsis, the tiniest cavity in both permanent and temporary teeth is put down for filling. During the period of inspection is a very good time for short personal talks with the children, those with dirty mouths, etc., this can be done in such a way that the children waiting can hear what is said, and, it is hoped, can benefit from it. These little chats doubtless do a great deal of good and tend to inspire confidence. The percentage of children with sound mouths has risen from 23 per cent in 1923 to 32.4 per cent. in 1930, the highest it has ever been in the County Borough of East Ham. The following table shows the percentages of the number of children with sound mouths up to the 12 year olds:— Year Percentage of number of children with sound mouths. 1923 23.0 1924 26.2 1925 28.1 1926 28.5 1927 31.6 1928 32.2 1929 28.0 1930 32.4 All work at the Dental Clinic is so performed that pain is almost non-existent, except for the slight pin-prick of the syringe needle and this can be made very slight if the finest pointed needle is used, and it is inserted carefully in the gum. An anaesthetic is used for all extractions either by local injection, where there is no apparent sepsis present, or by nitrous-oxide (gas) chiefly in the case of abscessed permanent teeth and other septic conditions, and also ethyl-chloride is used for freezing the gums in the case of loose or septic temporary teeth. A very important part of the work is the filling of permanent teeth with 165 special reference to the 6 year molars. In 1929 the number of permanent teeth filled were 1,289, and in 1930 was 1,428, an increase of 139, which is a step in the right direction—preservation in place of extraction. When a child has a very sensitive tooth to be filled an injtction is given to make it quite painless. A very disfiguring condition is the fracture of the upper central teeth, which is quite common. It is usually done by falling heavily, being hit in the mouth with a cricket bat, etc. When a nerve is exposed in such a condition it is extraordinarily painful, as can be imagined. In these cases usually the best method of taking out the nerve painlessly is by local injection. These broken teeth are only extracted when the root is fractured, which is very uncommon. The usual procedure is to extract the nerve, fill the root and tooth, so that it is and will be healthy and useful for the remainder of its life. Once again the importance of children having healthy and clean mouths, free from sepsis, must be stressed. This is the first attribute of the healthy child. Poisons are absorbed into the system from a dirty mouth and leads to a thoroughly unhealthy, condition of the whole body, affecting the child both physically and mentally. When a child starts at school with bad teeth and does not have them attended to, it is badly handicapped for the whole of its school life—and after. Maternity and Child Welfare Centre. Details of the dental work in connection with the Maternity and Child Welfare Centres are shown in the following table:— No. of Haif Daysdevoted 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. porary Teeth. 84 165 630 207 34 837 160 1,044 200 44 75 73 During 1930 two sessions per week were devoted to the work of the Maternity and Child Welfare Centres. Most of the mothers attending were given nitrous-oxide (gas) for the extraction of their teeth, except where mouths were clean, when a local 166 injection was given. Fillings were done where possible, and dentures supplied occasionally. In the case of babies (under 5 years of age) fillings were done when possible, and bad teeth extracted either by local injection or by freezing; the gums with ethyl-chloride. It would be a good thing if the expectant mother could be made to realise the utmost importance it is to her unborn child, for herself to have a clean and healthy mouth. May I record my appreciation of the conscientious hard work done by my colleague Mr. Hall, and also of the two Dental Nurses. My thanks are due to the School Medical Officers, Nurses and Teachers, and clerical staff for their kind assistance throughout the year. I have the honour to be, Sir, Your obedient Servant, C. S. NEAME. 187 TABLES GIVING SUMMING UP OF WORK OF SCHOOL MEDICAL SERVICE from 1st JANUARY, 1930, to 31st DECEMBER, 1930. PUBLIC ELEMENTARY AND CENTRAL SCHOOLS. TABLE I. RETURN OF MEDICAL INSPECTIONS (see note a) For the Year ended 31st December, 1930. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections— (see note b). Entrants 2,314 Intermediates 2,207 Leavers 1,912 Total 6,433 Number of other Routine Inspections (see note c). 1,134 B.—OTHER INSPECTIONS. Number of Special Inspections (see note d). 2,538 Number of Re-Inspections (see note e). 3,524 Total 6,062 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, 168 (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. 169 TABLE II. A. -A Return of Defects found by Medical Inspection in the Year ended 31st December, 1930. 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 underobservation, but not requiring Treatment. (1) (2) (3) (4) (5) Malnutrition 24 2 22 1 Uncleanliness: (See Table IV., Group V.) — — — — Skin Ringworm: Scalp — — 5 — Body — 1 36 — Scabies — 1 16 — Impetigo 10 12 345 8 Other Diseases (Non- Tuberculous) 14 25 189 4 Eye Blepharitis 3 9 43 — Conjunctivitis 7 2 . 57 — Keratitis — — — — Corneal Opacities — — — — Defective vision (excluding Squint) 298 139 263 16 Squint 28 16 28 1 Other conditions 3 13 60 1 Ear Defective Hearing 5 2 28 2 Otitis Media 29 5 1 — Other Ear Diseases 33 101 157 1 Nose and Throat Enlarged Tonsils only 89 1126 50 1 Adenoids only 6 16 15 1 Enlarged Tonsils and Adenoids 136 31 116 5 Other conditions 42 57 76 5 Enlarged Cervical Glands (Non- Tuberculous) 11 834 27 2 170 Table II.—(continued). (1) (2) (3) 4) (5) Defective Speech 4 16 6 5 Teeth—Dental Diseases (sec note a) (See Table IV., Group iv.) 19 2165 29 — Heart and Circulation. Heart Disease: Organic 3 10 8 1 Functional 2 104 2 3 Anaemia 20 47 59 5 Lungs Bronchitis 1 - 5 - Other Non-Tuberculous Diseases 26 60 68 11 Tuberculosis Pulmonary: Definite — — - — Suspected — — - - Non-Pulmonary: Glands - — 3 — Spine — — — — Hip — — 1 — Other Bones and Joints — — — - Skin — — — - Other Forms 1 1 — — Nervous System Epilepsy 1 4 6 1 Chorea 4 5 42 3 Other conditions 3 14 11 2 Deformities Rickets - 10 - 1 Spinal Curvature 4 5 4 — Other Forms 3 8 4 1 Other Defects and Diseases 72 369 1083 100 B.—Number ok Individual Children (see note b) found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). GROUP. Number of Children. Percentage of Children found to require Treatment (see note d). Inspected (see note c). Found to require Treatment. (1) (2) (3) (4) Code Groups:— Entrants 2314 264 11.4 Intermediates 2207 237 10.7 Leavers 1912 119 6.2 Total (Code Groups) 6433 620 9.6 Other Routine Inspections 1134 102 9.0 171 NOTES ON TABLE II. (a) The figures to be included in this space should refer to the finding's 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). 172 TABLE III. Return of all Exceptional Children in the Area during the Year ended 31st December, 1930 (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 2 1 3 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 14 15 29 Attending Public Elementary Schools (see note c) 1 - 1 At other Institutions - 2 2 At no School or Institution 1 3 4 14 Deaf (including deaf and dumb and partially deaf) (see note d.) (i.) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf 7 7 Attending Public Elementary Schools (see note c) - - - At other Institutions — - - At no School or Institution — 1 1 (ii.) Suitable for training in a School or Class for the partially deaf. Attending Certified Schools or Classes for the Deaf - 1 1 Attending Public Elementary Schools (see note c) - - - At other Institutions 1 - 1 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 Attending Public. Elementary 62 33 95 Schools (see note c) - - - At other Institutions 6 3 9 At no School or Institution 1 1 2 Epileptics Suffering from severe epilepsy. (See note f.) Attending Certified Special Schools for Epileptics 3 4 7 In Institutions other than Certified Special Schools - 1 1 Attending Public Elementary Schools (see note c) - - - At no School or Institution — — — Suffering from epilepsy which is not severe. (See note g.) Attending Public Elementary Schools (see note c) 2 2 4 At no School or Institution — — — 173 TABLE III.—continued. Boys. Girls. Total. Physically Defective. Infectious pulmonary and glandular tuberculosis (See note h.) At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board - - - At other Institutions — - — At no School or Institution — - — 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 12 7 19 At Certified Residential Open Air Schools - - - At Certified Day Open Air Schools - - - At Public Elementary Schools (See note c) 61 37 98 At other Institutions — 1 1 At no School or Institution 8 6 14 Delicate children (e.g., pre- or latent tuberculosis, malnutrition, debility, anaemia, etc). (See note h.) At Certified Residential Open Air Schools 41 22 63 At Certified Day Open Air Schools - - - At Public Elementary Schools (see note c) At other Institutions 124 99 223 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 - - - At Public Elementary Schools (see note c) 12 11 23 At other Institutions 6 7 13 At no School or Institution 1 3 4 Crippled Children (other than those with active tuberculous disease) e.g., children suffering from paralysis, etc., and including those with severe heart disease. (See note h.) At Certified Hospital Schools At Certified Residential Cripple — — — Schools 11 19 30 At Certified Day Cripple Schools 3 1 4 At Public Elementary Schools (see note c) 44 41 85 At other Institutions 4 3 7 At no School or Institution 9 17 26 174 NOTES ON TABLE III. (a) This Table is a return of all children in the area for whom the Local Education Authority are responsible, and who (except in the case of children suffering from epilepsy which is not severe) have been ascertained to be blind, deaf, defective or epileptic within the meaning of Part V. of the Education Act, 1921. It is the statutory duty of every Local Education Authority formally to ascertain all defective children in their area irrespective of the actual provision now made for their instruction in Special Schools. It is assumed that every Authority will have a complete list of such children compiled from returns made continuously during the year and kept constantly up to date. In order to secure uniformity, Authorities are requested to make up this Table from their list of defective children as it stands on the last day of each calendar year. Children who are living in residential schools in the area 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 by reason of mental or physical defect are incapable of receiving proper benefit from the instruction in the ordinary public elementary schools, but are not incapable by reason of that defect of receiving benefit from instruction in such special classes or schools as under Part V. of the Act may be provided for defective children. Epileptic children are children who, not being idiots or imbeciles, are unfit by reason of severe epilepsy to attend the ordinarypublic elementary schools. (b) For the purpose of this return the Board require that children who are blind within the meaning of the Act should be divided into two categories, i.e., (1) those who are totally blind or so blind that they can only be appropriately taught in a school or class for totally blind children, and (2) those who though they cannot read ordinary school books, or cannot read them without injury to their eyesight, have such power of vision that they can appropriately be taught in a school or class for the partially blind. 175 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 from such schools. (d) Children who are deaf within the meaning of the Act should be classified for the purpose of this Table as (1) totally deaf or so deaf that they can only be appropriately taught in a school or class for the totally deaf, and (2) partially deaf, i.e., those who can appropriately be taught in a school or class for the partially deaf. (e) This category includes only those children for whose education and maintenance the Local Education Authority are responsible, and who are not eligible for notification to the Local Control Authority under the Mental Deficiency Act. (/) 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. 176 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1930. (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 5 - 5 Ringworm—Body 84 34 Scabies 14 - 14 Impetigo 343 9 352 Other skin disease 188 14 202 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 164 2 166 Minor Ear Defects (See note c ) 284 11 295 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 1665 130 1925 Total 2697 166 2863 177 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.) 553 29 — 582 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 5 - - 5 Total 558 29 — 587 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme 296 (b) Otherwise 22 Total number of children who obtained or received spectacles— (a) Under the Authority's Scheme 294 (b) Otherwise 22 Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of Treatment. Total number Treated. Under the Authority's Scheme inClinic or Hospital. (see note b.) By Private Practitioner or Hospital apart from the Authority's Scheme. Total. (1) (2) (3) (4) (5) 502 47 549 — 549 178 TABLE IV.—continued. 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 1666 1940 2131 2175 2459 2436 806 13613 187 13800 (b) Found to require treatment 9203 (c) Actually Treated 3167 (d) Re-treated during the year as the result of periodical examination (see note e) 2706 (2) Half-days devoted to:— Inspection 107 Total 788 Treatment 681 (3) Attendances made by children for treatment 7250 (4) Fillings:— Permanent Teeth 1428 Total 2295 Temporary Teeth 867 (5) Extractions:- Permanent Teeth 716 Total 8208 Temporary Teeth 7492 (6) Administrations of general anaesthetics for extractions 376 (7) Other operations:— Permanent Teeth 379 Total 688 Temporary Teeth 309 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 52,816 (iii.) Number of individual children found unclean 1,069 (iv.) Number of children cleansed under arrangements made by the Local Education Authority Nil. (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 Nil. (b) Under School Attendance Byelaws Nil. 179 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. (f) A statement as to the arrangements made by the Local Education Authority for cleansing verminous children and a record of the cases in which legal proceedings were taken, should be included in the body of the School Medical Officer's Report. N.B.—Groups I.—V. above cover all the defects for which treatment is normally provided as part of the School Medical Service. Particulars as to the measures adopted by the Authority for providing treatment for other types of defect (e.g., for orthopaedic treatment) or for securing improvement in types of defect which do not all 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. 180 INDEX. A. Abatement of Nuisances 99-100 Abbatoirs 111-2 Acts of Parliament 19 Adenoids 81, 131, 138 Aldersbrook Homes 24-28 Ambulance Service 93 Attendance Officers, Cooperation of 146 Ante-Natal Clinic 85, 90 Artificial Sunlight 82, 142 Aural Surgeon, report of 160 B. Bacteriology 18, 59 Baths 146 Births 9, 10, 84, 89 Birth-rate 10, 11 Births, Illegitimate 8 „ Still 8 Blind Persons 37-39 Byelaws 20, 104 Byelaws—Premises and occupations controlled by 104 C. Cancer 52-53 Cemeteries 105 Chief Sanitary Inspector— Report of 95-117 Classrooms, Open Air 143 Clinic, Ante-natal 85, 90 Clinic, Artificial Sunlight 82, 142 Clinic, Aural 160 Clinic, Dental 163—165 Clinic Immunisation 47 Clinics, Infant 79, 83, 90 Clinic, Ophthalmic 161 Clinic, School 138 Clinics and Treatment Centres 34 Closet Accommodation 96, 106 Common Lodging Houses 104 Complaints of Nuisances 100 Continuation Schools 150 Co-ordination 88, 124 Cripples 133, 141 D. Dairies 110 Day-Schools, Open air 143 Deaths, Causes of 13, 14 Deaths, In Wards 15 Deaths, by Sex 16 Death-rate, General 10,11 Death-rate, Infantile 9 Dental Treatment 82, 163 Dental Surgeons Report of 163-6 Diphtheria 47 Dispensary, Arragon Road 18 Drainage and Sewerage 96 Dust Collection 96 E. Ear Diseases 133, 140 Ear, Nose and Throat Diseases 34 East Ham Memorial Hospital 22, 41-43 Employment of Children 150 Enteric Fever 48 Epileptic Children 147-150 Erysipelas 48 Eye Diseases of Children 132, 139 F. Factories and Workshops 114-115 Following-Up 137 Pood and Drugs 112-114 Food Inspection 110-114 H. Harts Sanatorium 21, 58-62 Health Visitors 84, 89, 90 Hospital Accommodation 21-34 Hospital, Infectious Diseases, 21, 22, 73-77 Hospital, Maternity 22, 85, 90, 92 Hospital, Mental 33 Hospital, Whipps Cross 22 House-to-House Inspection 97 Housing Conditions 108-110 Housing 106-110 I. Institutional Provision for Unmarried Mothers, Illegitimate Infants, etc. 93 Immunisation 47 Increase of Rent (Restriction) Act 100 Infant Consultations 79 Infantile Mortality 9 Infectious Diseases Hospital, 21, 22, 73-77 Infectious Diseases, Prevalence of and Control over 43-52, 133-136 Infectious Diseases (Non-notifiable) 136 Inspection of Borough 97 Inspection of School Children 128, 152—179 Invalid Children's Aid Association 40, 88 181 INDEX—continued. L. Laboratory Work 18, 59, 114 Legal Proceedings 101-104 Legislation in Force 19-21 Light Treatment 82, 142 Local Government Act, 1929 40-42 M. Maternal Mortality 87, 91, 92 Maternity and Child Welfare 77-93 Maternity Homes and Hospitals 22, 85, 90, 92 Meals, Provision of 146 Meat Regulations 111 Medical Officer of Health's Report 1-94 Mental Defects, School Children 149—150 Mental Deficiency 33, 36-7 Mental Hospital 33 Meteorology 94 Midwives 17, 86, 91 Milk, Free Supplies 88 Milk (Special Designation) Order 19, 23, 110 Milk Supply 110 Minor Ailments 131, 138 N. Notices Served 99 Notification of Births 84 Nuisances Abated 100 Nuisances Discovered 99 Nursing Arrangements 17,91 Nursery Schools 150 O. Open-air Education 143-145 Ophthalmia Neonatorum 34, 88 Ophthalmic Clinic 161 Ophthalmic Surgeon, Report of 161-2 Ophthalmic Treatment 82 Orders, Special Provisional 19 Orthopaedic Treatment 34 Overcrowding 109 P. Parents, Co-operation of 146 Parks and Open Spaces 105 Physical Features of Area 7 Physical Training 146 Playground Classes 143 Population 7 Prosecutions, Public Health Act 101-103 Prosecutions, Sale of Foods and Drugs Acts 104 Provisional Orders 19 Public Assistance Institutions 22 Puerperal Fever and Pyrexia 34, 49, 87 R. Rateable Value 7 Refuse Removal and Disposal ' 96 Regulations 20 Rent (Restriction) Act 100 Ringworm . 81 Rivers and Streams 96 S. Sanatoria 61-65 Sanitary Circumstances of Borough 96-106 Scarlet Fever 47 Scattered Homes 24-28 Schick Immunisation Clinic 47 School Attendance Officers, Co-operation of 146 School Baths 146 „ Blind Children 147-150 „ Camps 143 „ Children, Blind, Deaf, Defective and Epileptic 147-150 Children, General Cleanliness 129, 130 Children, Minor Ailments 138 „ Children, Medical Examinations 125-132 „ Children, Physically Defective 147-9 „ Children, Dental 133, 140, 163-166 „ Children, Verminous Conditions 129 „ Continuation 150 „ Cripples 133, 141 „ Exceptional Children 127 „ Hygiene 124 „ Meals 146 „ Medical Officer's Report 119-179 „ Medical Service in Relation to Public Elementary Schools 124 „ Medical Treatment 138-143 „ Nurses, Work of 129-130, 137 „ Nursery 150 „ Open-air 144 Schools of Recovery 145 182 INDEX—continued. Schools, Secondary 150 Schools, Survey of 106 Skin Diseases 132, 139 Slaughterhouses 111,112 Smallpox 22, 43-46, 97 Smoke Abatement 104 Social Conditions of Area 7 Staff 4,78,120,124,126 Statistics 7 T. Table, Births 10 „ Birth-rate 10, 11 „ Blind Persons 39 „ Cancer 53 „ Clinics 35 „ Complaints Received... 99. 100 „ Deaths, Causes of 13, 14 „ Deaths, Sex Distribution 16 „ Death Rate 10, 11 „ Deaths, Ward 15 Dentral Treatment 178 „ Exceptional Children 172-5 „ Factories and Workshops Act 114, 115 „ Food and Drugs Acts 113-114 „ Harts Sanatorium 60, 62 „ Housing 106-108 Infantile Mortality 12, 16 „ Infectious Diseases, Notifiable 50-51 „ Infectious Diseases Removed to Hospital 76 „ Infectious Diseases in School children 135-6 Maternal Mortality 93 „ Medical Help 86 „ Mental Defectives 36 „ Mental Hospitals 33 „ Meteorology 94 „ Midwives 17 „ Minor Ailments 176 „ Nuisances 99-100 „ Ophthalmia Neonatorum 52 „ Public Assistance Institutions 23 „ Public Health Act Prosecutions 101-103 „ Record of Inspections 97,98, 117 „ Sale of Food and Drugs Acts Prosecutions 104 Table, School Children, Defects of 154-6, 169-171 „ School Children Examined 128, 152-179 „ School Children Found to require Treatment 128, 157-158 „ Schools of Recovery 145 „ Secondary School Examinations 152-9 „ Smallpox 44-45 „ Sunlight Treatment 82, 142 „ Tuberculosis 55-72 „ Tuberculosis and occupation 71 „ Tuberculosis Deaths 70, 71, 72 „ Tuberculosis and Chest Clinic 56-57 „ Tuberculosis Notifications 66-72 „ Tuberculosis, Residential Treatment 61-65 „ Vaccination 47 „ Venereal Diseases 29-32 „ Verminous Condition of „ School Children 129, 130, 178 Teaching Staff, Co-operation of 146 Tonsils 81, 131, 138 Training Centre, Mental Defective 37 Tuberculosis 55-72, 132, 139 Tuberculosis and Chest Clinic 55-57 U. Urinals 106 Ultra-Violet Radiation 82, 142 V. Vaccination 47 Veneral Diseases 28-32 Vital Statistics, Extracts from 8 Vision 132, 139 Voluntary Associations 40, 88, 147 Visits, Health Visitors 90 Visits, School Nurses 129, 130, 137 W. Water Supply 96 Whipps Cross Hospital 22 Workshops 114-115