CI AC 44113 EAS 7 COUNTY BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report of the Medical Officer of Health and School Medical Officer FOR THE YEAR 1931. W. BENTON, M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health. recorders, ilford. 43 COUNTY BOROUGH OF EAST HAM PUBLIC HEALTH DEPARTMENT. Annual Report of the Medical Officer of Health and School Medical Officer FOR THE YEAR 1931. 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 W. T. Newling, J.P.). The Deputy-Mayor (Alderman W. W. Bagot). *Alderman C. W. Brading (Chairman, Public Health Committee, Institutions and General Sub-Committee, and Maternity and Child Welfare Sub-Committee). *Councillor E. Markey (Vice-Chairman). *Alderman J. Brooks, J.P. *Alderman H. B. Harper, J.P. Alderman G. H. Manser. * Alderman H. N. R idler. Alderman Mrs. A. Taylor. Councillor J. W. Barton. Councillor G. W. Boultwood. *Councillor T. W. Burden. Councillor F. P. Cross. Councillor A. E. Dennington. Councillor G. A. Honns. Councillor T. I. Lethaby. *Councillor Mrs. A. Warne. *Councillor T. Watts. §Councillor W. Thompson. MATERNITY AND CHILD WELFARE SUBCOMMITTEE. Same members as Public Health Committee with— The Deputy-Mayoress, Mrs. M. W. Bagot (co-opted). Miss E. R. Davies (co-opted). Mrs. B. Wilkens (co-opted). *Also Member of the Institutions and General Sub-Committee. +Died 4th June, 1931. §Appointed vice Councillor T. Watts (Deceased). COMMITTEE FOR THE CARE OF THE MENTALLY DEFECTIVE. The Mayor (Councillor W. T. Newling, J.P.). The Deputy-Mayor (Alderman W. W. Bagot). Alderman Mrs. A. Taylor (Chairman). Alderman J. Brooks, J.P. (Vice-Chairman). Alderman C. W. Brading. Alderman H. B. Harper, J.P. Alderman F. Webster. Councillor F. P. Cross. Councillor C. F. H. Grekn. Councillor T. 1. Lethaby. Councillor R. W. Mogf.r. Mrs. C. J. Cross (co-opted). Mrs. A. M. Gray' (co-opted). Mrs. B. Wilkens (co-opted). STAFF OF THE PUBLIC HEALTH DEPARTMENT. Clerks: M iss H. E. Ritterbpack, Miss D. Gordon, C. L. Durbin, A.C.I.S. (from 1-6-31), C. B. Lorence, G. H. Green. F. J. Kendall, A.R.San.I., Chief Clerk and Vaccination Officer. T. B. Clark, Chief Administrative Clerk. 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. Assistant, Miss Siers. Tuberculosis Dispensary Clerks: B. E. R. Hartley, A.C.I.S. (from 1-6-31), Miss M. Pratt, F. L. Gosling (until 1-6-31). 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: Mrs. E. E. Kelly, S.R.N., Certified Midwife, Fever Trained. Child Welfare Clerks: M iss M. A. McCall, Miss M. A. R. Gaster, Miss AY, M. Hales (from 13-4-31). 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, R.S.I. (Health Visitor's Cert.), Miss M. Preston, S.R.N., Certified Midwife, R.S.I. (Health Visitor's Cert.), 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. (Health Visitor's Cert.), Certified Midwife (Senior). Matron of Isolation Hospital: Miss H. M. McLoughlin, S.R.N. Matron of Harts Sanatorium: Miss G. E. Shabpe, 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. Baskf.tt, M.S.I.A., M. J. J. Hillyabd, M.S.I.A.. W. S. C. Tooby, A.R.San.I., M.S.I.A., W. J. Worley, A.R.San.I., M.S.I.A., W. H. Thurston, R.P., A.R.San.I., M.S.I.A. Senior Sanitary, Food and Shops Act Inspector, Inspector Contagious Diseases (Animals) Act: G. D. Lill, M.S.I.A. District Medical Officer and Public Vaccinator: L. F. A. Harrison, 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., Ch.B., D.P.H. Tuberculosis Officer and Resident. Medical Superintendent, Harts Sanatorium: G. W. Cheater, M B., B.S., M.R.C.S., L.R.C.P., D.P.H. Senior Assistant School Medical Officer: F. E. Bendix, M.R.C.S., L.R.C.P., L.D.S. Deputy Medical Officer of Health ami Resident Medical Superintendent, Isolation Hospital: Malcolm Barker, 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.C.S., L.R.C.P., D.P.H. PART TIME. Tuberculosis Officer: Philip Ellman, M.D., M.R.C.P. Ophthalmic Surgeon (Maternity and Child Welfare Service): S. C. Reeve-Flaxman, M.R.C.S., L.R.C.P. Dentist (Maternity and Child Welfare Service): C. S. Neame, L.D.S., R.C.S. 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, E.6. April, 1932. To the Mayor, Aldermen and Councillors of the County Borough oj East Ham. Mr. Mayor, Ladies and Gentlemen, 1 beg' lo submit my Annual Report on the health and sanitary circumstances of the Borough, together with my Report to tiie Education Authority on the work of the School Medical Service, for the year 1931. The report is based on the " Circular as to the Contents and Arrangement of the Annual Reports of Medical Officers of Health for 1931 " issued by the Ministry of Health, and is in no sense a " Survey " report as required for the year 1930. Although there is a slight increase in the death and infant mortality rates, the Borough still occupies a very satisfactory position as regards statistics generally. It will be noted that there is a considerable decrease in the number of cases of infectious disease notified, particularly in regard to Scarlet Fever and Diphtheria. In the case of Diphtheria there were 19G cases notified in 1931 as against 473 in 1930. This, in my opinion, is to some extent evidence of the success obtained by the immunising of children at the Clinic established in recent years. It is gratifying^ to be able to record that the number of cases of Smallpox declined during the year and that the disease remained the mild type. I would again draw the attention of the Council to the urgent need of further accommodation for the use of maternity, child welfare and school clinics. The continued use of the old unsuitable building as a Tuberculosis and Chest Clinic calls for the immediate consideration by the Council. 6 Extensions and the new administrative block at the Borough Isolation Hospital were completed during- the year and the present accommodation should be amply sufficient for the needs of East Ham for many years to come. I wish to express my gratitude to the Chairman and Members of the Committee for the support I have invariably received, and to all the members of my staff for their continued co-operation and loyalty in carrying out the duties of the department. 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 1931, 142,460 (males 69,031, females 73,429). Estimated to middle of 1931, 142,800. Number of inhabited houses (end of 1931) according to rate books (including tenements and shops), 32,390. Rateable value at 31st December, 1931, ^688,777. Sum represented by a penny rate (rate made October, 1931), £2,784. Physical Features of the Area. As set out in my report for 1930. Social Conditions of the Area. As set out in my report for 1930. EXTRACTS FROM VITAL STATISTICS. Live (Legitimate Births (illegitimate Still Births Deaths ... Total. 2,002 43 72 1,526 Males. 1,022 25 43 762 Females 980 18 . 29 764 Birth rate per 1,000 of the estimated resident population 14 3. Rate per 1,000 total (live and still births) 34. Death rate per 1,000 of the estimated resident population 106. Deaths from diseases and accidentsl of pregnancy and childbirth ...I From Sepsis ... 6 From other causes 2 Death rate of infants under one year of age :— All infants per 1,000 live births 59 Legitimate infants per 1,000 legitimate live births 58 Illegitimate infants per 1,000 illegitimate live births 70 Deaths from Measles (all ages), Nil. Deaths from Whooping Cough (all ages), 9. Deaths from Diarrhoea (under 2 years), 11. 8 Any causes of Sickness or Invalidity which have been specially noteworthy in the Borough during the year; and any Conditions of Occupation or Environment which appear to have had a prejudicial effect on Health. East Ham, as befits an artisan residential area, is normally a healthy town, but I would again direct the attention of the Council to the increase, in recent years, of deaths from heart disease. As I pointed out in my previous report the mortality from this cause had risen nearly 70 per cent, in the five years ending 1930, and I have to report for the year 1931 another increase, i.e., 299 deaths for the year 1930 as against 329 deaths for the year under review. The deaths from Heart Disease are set out as distributed in the wards :— Manor Park 47 Little Ilford 44 Woodgrange 41 Plashet 44 Kensington 30 Castle 29 Central 31 Wall End 21 Greatfield 22 South 20 Comprising this total there were 141 males and 188 females. Only 29 deaths occurred under 45 years and 223 of the 329 deaths were of persons over 65 years. These figures tend to show little evidence of fatal acute rheumatic endocarditis in children and young adults. The number of births has decreased from 2,264 in 1930 to 2,045, and the birth rate has fallen from 15.3 in 1930 to 14.3 It is interesting to note that the pre-war rate in 1914 was 24.4 per 1,000 inhabitants. « Infantile Mortality. I regret that I cannot record another drop in the infantile mortality rate, the rate being 59 per 1,000 births as compared with Births. 9 49 for the previous year. This figure (59) however, compares very favourably with that for England and Wales, 60 ; 107 County Boroughs and Great Towns, 71 ; 159 Smaller Towns, 62; and London, 65. The principal causes of death amongst these infants were:—Congenial Debility, Premature Birtlis, etc., 52; Pneumonia, 16; Diarrhoea, etc., 10; and Cerebro.Spinal Fever, 6. Maternal Mortality. The maternal mortality rates for England and Wales and East Ham are compared and are as follows :— Puerperal Sepsis. Other Diseases. Total. England and Wales. East Ham. England and Wales. East Ham. England and Wales. East Ham. Per 1,000 Live Births 1.66 2.93 2.45 0.97 411 3.90 ,, „ Total „ 1.59 2 83 2.35 0.94 3.94 3.77 It will be seen from the above that the rate for Puerperal Sepsis for East Ham is much higher than that of England and Wales whereas the local rate for other maternal deaths is very much lower than the country as a whole. The total rate for East Ham is even less. A decrease in maternal mortality would, in my opinion, be brought about by the provision of a Maternity Home, so long delayed. With reference to the circular letter of the Ministry of Health No. 1167, and Memorandum 156/M.C.W., drawing attention to the Interim Report of the Departmental Committee on Maternal Mortality and Morbidity, a special report was presented to the Maternity and Child Welfare Sub.Committee and the following statement shows the Committee's findings :— Report of the Medical Officer of Health. 1. Ante Natal Clinics. Women mostly attended by Midwives of Plaistow Maternity Charity and Ante Natal Clinics. Private midwives advised to send cases to Municipal Ante Natal Clinics conducted by Assistant Medical Officers. 2. Supply of Midwives. Suggests municipal midwife service be attached to new Maternity Hospital, Recommendations or opinion of Sub. Committee. That this service needs extension and until a complete scheme is built up around the new Maternity Hospital, the appointment of a full time Assistant Medical Officer will greatly add to the existing efficiency of this service. Agreed. 10 Report of the Medical Officer of Health. 3. Consultants in Special Cases. Medical Officer of Health acts as Consultant in cases of Puerperal Fever and cases usually removed to an Institution. Suggest an isolation block for these cases should be provided in new Maternity Hospital and a Specialist appointed. 4. Provision of Ancillaries. (a) Sterilised Maternity Outfits. The issue of these Outfits was discontinued after experiments had proved unsatisfactory. (b) Home Helps. Does not consider them necessary, at present. Recommendatious or opinion of SubCommittee. That the Medical Officer of Health be directed to continue to act as Consultant for these cases until Consultant appointed to new Hospital. That Borough Engineer be directed to make provision in plans for new Hospital for an isolation block for cases of puerperal fever. (a) That this question be again considered when the new Maternity Hospital is erected. (b) That the Medical Officer of Health be directed to submit to a subsequent meeting of the Maternity & Child Welfare Sub-Committee a report on the conditions of service and appointment of Home Helps by neighbouring authorities. (c) Supply of Milk for Mothers. Provision already made with Maternity & Child Welfare Clinics. (d) Laboratory facilities. Specimens forwarded by Medical men or midwives are sent to London Laboratories for examination. 5. Post Natal Clinics. Should be conducted at new Agreed. Maternity Hospital. 6. Provision for Ophthalmia Neonatorum. Cases are seen by Ophthalmic Surgeon and, if necessary, are admitted to East Ham Memorial Hospital. 7. Provision for Unmarried Mothers. Cases are usually admitted to That arrangement be continued. Forest Gate Sick Home or Salva- pending erection of new Maternity tion Army Hostel. Hospital. With reference to clause 4 (b), a scheme of Home Helps was sanctioned by the Council and put into force, but time has been too short to form any opinion as to its success, 11 Population. The census for England and Wales was taken on the 26th April, 1931, and from the Preliminary Report issued by the Registrar-General in June, 1931, the following figures are abstracted as far as they relate to East Ham :— Area in Statute Acres (Land & Inland Water). Population. Censal Increase or Decrease 1921-1931 (Persons). 1921 1931 Numbers Percentage of 1921 Population Persons Males Females Persons Males Females Increase Decrease Increase Decrease 3,324 143,246 69,342 73,904 142,460 69,031 73,429 — 786 — 0.5 It is difficult to account for the decrease in the census population. One would have thought that with the number of new houses erected since 1921, the population would have tended to increase rather than decrease. Further comments will be made on these figures when the Final Report of the 1931 census is issued. The Registrar-General estimates the population of East Ham to the middle of 1931 as 142,800, and on this figure the rates in the report are based. 12 TABLE 1.—Birth Rate, Death Rate and Analysis of Mortality, 1931. 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 Practitioners. Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. England & Wales 15.8 0.67 12.3 001 0.00 0.08 001 006 0.07 0.36 0.54 60 66 91 18 6.17 1 . 70 0.95 107 County Boroughs & Great towns including London 16.0 0.67 12 3 0.00 0.00 0.10 001 0.07 0.08 0.33 0.48 8.4 71 91.43 5.84 2.24 0.49 159 smaller towns (1921 adjusted populations, 20,000.50,000) 15.6 0.73 11.3 0.00 000 0.C7 0.01 0.05 005 0.36 0.43 40 62 92 .17 5.49 1.25 1.09 London ... 15 0 0.f0 12.4 0.01 000 003 0.02 0.07 0.06 0.26 0.57 9.7 65 89.52 6.23 4.24 0.01 East Ham 14.3 0.50 10.6 0.00 0.00 000 0.01 0.06 0.12 017 0.49 5.3 59 92.2 5.1 2.7 0.00 TABLE 2.—Births in Wards. Wards. Total. Manor Park. Little Ilford. Wood. grange. Plashet. Kensington. Castle. Central. Wall End. Greatiield. South. 190 281 175 196 156 170 204 264 177 232 2,045 13 TABLE 3. Causes of Dkath in Age Groups for the Year 1931. Causes of death. Sex. All Ages. Causes of Death at different periods of life of Residents whether occurring within or without the district during the year 1931. 0- 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- All causes M 762 66 14 21 23 40 38 52 72 121 174 138 F 764 55 9 15 17 38 39 40 84 111 148 208 1. Typhoid and Paratyphoid Fevers M — — — — — — — — — — — — F — — — — — — — — — — — — 2. Measles M — — — — — — — — — — — — F — — — — — — — — — — — — 3. Scarlet Fever M 1 — 1 F 1 — — — — 1 — — — — — — 4. Whooping Cough M 4 2 2 — — — — — — — — — F 5 1 1 2 1 — — — — — — — 5. Diphtheria M 12 1 1 4 6 — — — — — — — F 6 — 1 2 3 — — — — — — — 6. Influenza M 10 — — 1 — — — 1 3 1 4 F 15 — — — — 1 — 1 3 — 3 7 7. Encephalitis Lethargica M — — — — — — — — — — — — F — — — — — — — — — — — — 8. Cerebro-Spinal Fever M 7 4 1 2 — — — — — — — — F 3 2 — — — — 1 — — — — — 9. Tuberculosis of Respira tory System M 55 — — — — 13 15 13 7 7 — F 45 — — — 1 17 8 8 7 3 1 — 10. Other Tuberculous Dis eases M 8 — 2 2 3 — 1 — — — — — F 7 1 1 2 1 2 — — — — — — 11. Syphilis M 5 1 — — — — — — 2 1 1 — F 1 1 — — — — — — — — — — 12. General Paralysis of the Insane, Tabes Dorsalis M 3 — — — — — 2 1 F 3 — — — — — — 1 1 1 13. Cancer, Malignant Disease M 89 — — 1 — — 1 5 15 24 32 11 F 94 1 — — — — 2 11 19 21 27 13 14 Diabetes M 10 — — 1 — 1 — 2 5 1 F 12 — — — — — 2 — 2 0 4 2 15. Cerebral Haemorrhage, &c M 41 — — — — — 1 — 2 11 13 14 F 46 1 — — . — 2 — 3 11 11 18 16. Heart Disease M 141 — — — — 3 5 5 6 28 53 41 F 188 — — — 1 6 4 5 9 34 47 82 17. Aneurysm M 6 1 2 1 2 F 1 — — — — — — — — — 1 — 14 TABLE 3—continued. Causes of death. Sex. All Ages. Causes of Death at different periods of life of Residents whether occurring within or without the district during the year 1931. 0- 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- 18. Other Circulatory Diseases M 25 — — 1 3 4 7 10 F 23 — — — — — — — 1 5 7 10 19. Bronchitis M 48 1 1 — — — 1 2 2 6 13 22 F 46 2 1 — — — 1 2 6 9 25 20. Pneumonia (all forms) M 58 8 4 2 3 4 1 6 6 9 9 e F 58 8 3 6 2 1 5 2 3 4 11 13 21. Other Respiratory Diseases M 9 — — — — — — — 2 3 3 I F 8 — — — — —- 1 — 1 — 2 4 22. Peptic Ulcer M 11 — — — — 1 — 2 4 3 1 F 4 — — — — — — 1 1 — 2 23. Diarrhoea, &c. M 8 7 — — 1 — — — F 6 3 1 2 24. Appendicitis M 6 — — 1 1 1 1 — — — 2 — F 5 — — — 2 — 1 — — 2 — 25. Cirrhosis of Liver M 4 ] 1 1 1 F — — — — — — — — — — — — 26. Other Diseases of Liver, &c. M 3 — — — — 1 1 1 F 5 — — — — — — 1 1 1 2 27. Other Digestive Diseases M 14 2 1 —- 1 — 2 2 2 1 1 2 F 17 1 — — 1 1 2 1 4 1 3 3 28. Acute and Chronic Nephritis M 26 — — 2 1 — 2 3 3 3 7 5 F 15 — — — — — 1 2 4 3 4 1 29. Puerperal Sepsis F 6 — — — — 3 1 o — — — — 30. Other Puerperal Causes F 2 — — — — — 2 — — — — — 31. Congenital Debility, Premature Birth, Mai-formations, etc. M 28 28 — — — — — — — — — — F 24 24 — — — — — — — — — — 32. Senility M 10 — — — — — — — — — 2 8 F 26 — — — — — — — — — 1 25 33. Suicide M 13 — . — — — 1 2 2 2 — 4 2 F 8 — — — 1 2 3 2 — 34. Other Violence M 34 2 1 3 4 9 — 2 3 5 1 4 F 16 — 1 2 2 2 2 — 1 2 2 2 35. Other Defined Diseases M 73 10 1 3 1 5 6 4 7 13 12 11 F 66 10 — 1 3 4 4 4 18 12 8 2 36. Causes Ill-defined or known M — — — — — — — — — — — — F 2 — — — — — — — — — 1 1 15 TABLE 4.—Ward Distribution ok Deaths, 1931. Cause of death. Wards. Total. Manor Park. Little Ilford. Woodgrange. Plashet. Kensington. Castle. Central. Wall End. Greatfield. South. 1. Typhoid & Paratyphoid Fevers — — — — — — — — — — — 2. Measles — — — — — — — — —m — — 3. Scarlet Fever — 1 1 — — — — - — — 2 4. Whooping Cough 1 1 — — — — — 3 — 4 9 5. Diphtheria 1 4 3 3 — 1 — 1 — 5 18 6. Influenza 2 1 2 1 3 4 3 3 9 4 25 7. Encephalitis I.ethargica — — — — — — — — — — 8. Cerebro-Spinal Fever 2 2 1 — — 1 1 2 1 10 9 Tuberculosis of Respiratory System 8 15 8 5 6 13 8 9 8 20 100 10. Other Tuberculous Diseases — 3 1 5 1 2 1 1 1 — 15 11. Syphilis 1 1 — — — — 1 2 — 1 6 12. General Paralysis of the Insane, Tabes Dorsalis 1 1 1 1 — 1 1 6 13. Cancer 19 26 11 13 15 26 23 J7 14 19 183 14. Diabetes 3 6 2 1 1 2 1 2 2 2 22 15. Cerebral Haemorrhage, etc. 11 6 6 9 8 10 10 13 8 b 87 16. Heart Disease 47 44 41 44 30 29 31 21 22 20 329 17. Aneurysm — — 1 — 1 1 1 1 2 — 7 18. Other Circulatory Diseases 9 7 4 5 4 5 3 5 3 3 48 19. Bronchitis 8 9 15 9 6 11 9 10 5 12 64 20. Pneumonia (all forms) 8 12 10 12 13 12 11 18 5 15 116 21. Other Respiratory Diseases 1 2 — 3 — 2 3 3 2 1 1 / 22. Peptic Ulcer — 2 5 1 — 1 - — 3 3 15 23. Diarrhoea, etc. — 1 2 1 — 2 2 2 1 3 14 24. Appendicitis 1 — 1 1 2 2 — 1 1 2 11 25. Cirrhosis of Liver — 1 — — — 1 — — — 2 4 26. Other Diseases of Liver, etc. 1 1 — 1 — 1 1 1 —- 2 8 27. Other Digestive Diseases 5 4 3 2 3 5 1 1 3 4 31 28. Acute and Chronic Nephritis 4 5 9 7 1 3 5 4 1 2 41 29. Puerperal Sepsis — 1 — 2 1 — — — — 2 6 30. Other Puerperal Causes — — 1 — 1 — — — — * 31. Congenital Debility, Premature Birth. Malformations, etc. 4 5 8 3 2 6 6 8 3 7 52 32. Senility 2 2 5 1 6 2 8 4 3 3 36 33. Suicide 2 2 2 2 2 3 4 — 2 2 21 34. Other violence 10 7 3 3 4 6 5 7 2 3 50 35. Other defined causes 16 12 18 13 15 10 15 16 14 10 139 36. Causes ill-defined or unknown. — — —- — — — — — 1 1 2 Totals 167 184 163 147 125 162 154 155 109 160 1,526 16 TABLE 5. Sex Distribution of Deaths in Wards, 1931. Sex. WARDS. Total. Manor Park. Little Ilford. Woodgrange. Plashet. Kensing ton. Castle. Central. Wall End. Greatfield. South. Males 95 92 75 71 56 78 80 77 47 91 702 Females 72 92 88 76 69 84 74 78 62 69 764 Totals 167 184 163 147 125 162 154 155 109 100 1,526 TABLE 6. Infant Deaths under One Year of Age, 1931. 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. Whooping Cough M – – – – – – i ] 2- F – – – – – – – 1 1 Diphtheria M – – – – – – – 1 1 K – – – – – – – – – Cerebro-Spinal Fever M – – – – – 2 I 1 4 1< – – – – – – 2 — 2 Other T ubercu lou s diseases M – – – – – – – – – F – – – – – – 1 — 1 Syphilis M — — — — I — — ' — 1 F i – – – – – – – 1 Cancer, Malignant disease M – – – – – – – – – F – – – – – – 1 — 1 Cerebral Haemorrhage, etc M – – – – – – – – –— F i — — – – – – – 1 Bronchitis M — — — — — 1 — — 1 F — — — — 2 — — — 2 Pneumonia (all forms) M i — 1 — — 3 — 3 8 F — — — 1 1 4 1 1 8 Diarrhoea, etc. M F — — — 3 2 3 1 — 1 7 3 Other Digestive diseases M — 1 — 1 — — 2 f 1 1 Congenital Debility, Premature Births, Malformations, etc. M 20 — 4 — 3 1 — — 28 F 13 3 2 4 1 1 24 Other violence M – – – – – 1 1 — 2 F – – – – – – – – – Other defined diseases M 4 — — — 1 4 1 — 10 F 2 — 1 — 1 5 1 — 10 All causes M 25 — 5 1 8 16 4 7 66 F 17 3 3 1 11 11 7 2 55 17 Professional Nursing in the Home. (a) General.—The Nurses attached to the Branch Home in Katherine Road of the Plaistow Maternity Hospital are carrying out excellent work in the nursing of patients in their homes. (b) For Infectious Diseases, e.g., Measles or the treatment of Scarlet Fever, no provision is made. Midwives. No Midwives are subsidised by the Authority. The same remarks apply to the midwifery work undertaken by the nurses of the Plaistow Maternity Hospital and Sir Henry Tate's Home, Woolwich, as made in last year's report. Summary of Visits Paid during 1931 by Nurses of Plaistow Maternity Hospital and District Nurses Home. Midwifery 674, Monthly 205, Hospital 268. TABLE 7. Midwives Act, 1902 and 1918. Midwives on Roll, 1931. Name. No. on Midwives Roll. Address. Allen, Katie 80653 Maternity Hospital and District Nurses Home, Howards Road, Plaistow, E.I3 Aylott, Winifred Mary 78015 do. Bullett, Mary 30525 do. Bumpus, Grace Dorothy 55713 do. Charlton, Margaret Hope 74373 do. Dibden, A. M. M. 82209 do. Dunning, Jessie Maud E. 49686 do. Downing, Irene B. 55278 do. Field, Gertrude 80826 do. Henley, Frances Anne 46484 do. Lockwood, Ruth Hannah 74658 do. Lucas, Gladys W. 81020 do. Sandford, Jessie Marg 80484 do. Taylor, Ethel Ada 69754 do. Welsh, E. 82007 do. Weston, Gertrude E. 81320 do. Wilcox, Lucy Gladys 38487 do. Wright, Hilda G. 81358 do. 18 TABLE 7—continued. Name. No. on Midwives Roll. Address. Clunn, Emma Jane 40720 Maternity Hospital and District Nurses Home Branch, 72, Burges Road, E.6 Edmunds, Clara Eveline 78177 do. Evans, Elizabeth Sarah 79494 do. Evans, Elizabeth 81552 do. Griffin, Florence 80877 do. Griffiths, Martha Ann 80245 do. Griffiths, Nellie 61161 do. Hughes, G. W. 82377 do. Hughes, Olwen Eliz. 82381 do. Hughes, Maggie 80940 do. Hilton, Kathleen 79601 do. Hyde, Rose 80949 do. Jones, Minnie 80976 do. Latham, Helen Ann 29132 do. Manifold, Beatrice 82472 do. Mansfield, Ethel Caroline 80375 do. Price, Doris May 67950 do. Sumner, Margaret Annie 80533 do. Gretton, Emily 48353 Maternity Hospital and District Nurses Home Branch, 3, Grenadier Road, E.16 Smalldon, Emily Beatrice 78531 Maternity Hospital and District Nurses Home Branch, Lansdowne Road, E.16 Allpen, Florence 54621 Tate Nurses' Home, Savile Road, E.16 Booth, Amy Gertrude 55190 do. Bunting, Florence M. 59764 do. McDerby, Rose 64941 do. Noble, Ida 77784 do. Bailey, Kate 71910 128, First Avenue, E.12 Baird, Mary 25827 7, Altmore Avenue, E.6 Bishop, E. 67293 450, High Street North, E.12 Finn, Olive G. 40752 83a, Wakefield Street, E.6 Juggins, Phoebe Anne 12378 58, Herbert Road, E.12 Miller, Sarah Jane 65429 54, Marlow Road, E.6 Lawson, Winifred Rose 77104 58, Bedford Road, Ilford McArthur, McKinnon E. 63478 Oldchurch Hospital, Romford Rurdi, Bertha Ellen 53404 69, Coolfin Road, Custom House Smith, Florence Eliz. 13878 68, High Street South, E.6. Southwell, Sarah Ann 34304 44, Neville Road, E.7 Storey, Lilian May 53460 69, Coolfin Road, Custom House Turner, Frances Mary 61279 103a, Little Ilford Lane, E.12 Inspector of Midwives —Dr. J. A. MacLarcn, M.B., Ch.B., Ed., D.P.H., R.C.P.S.Ed. 19 Maternity and Nursing Homes—Nursing Homes, tration Act, 1927. 1. Number of applications for registration Nil 2. Number of Nursing Homes on register 1 3. Number of orders made refusing or cancelling registration Nil 4. Number of appeals against such orders Nil 5. Number of appeals in which orders have been :— (a) Confirmed on appeal Nil (b) Disallowed Nil 6. Number of applications for exemption from tration Nil 7. Number of cases in which exemption has been :— (a) Granted Nil (b) Withdrawn Nil (c) Refused Nil Institutional Provision for Unmarried Mothers and Homeless Children. No changes have occurred in the above institutional provision and details were set out in my previous report. Ambulance Facilities. As set out in my 1930 report. The two ambulances operating from the Fire Station carried out the following work during the year :— Cases conveyed to and from various hospitals ... 1,552 Accident cases 423 Illness cases 1,129 Journeys made 1,581 Miles run 15,933 East Ham cases removed by other ambulances :— Barking 30 Ilford 10 West Ham 22 Cases removed for other authorities :— West Ham 26 Barking 3 20 Arragon Road Dispensary. The arrangements are as set out in the 1930 report. The work carried out by Drs. Harrison and Brews, the District Medical Officers, during 1931, was as follows :— No. of visits No. of patients No. of to homes of seen at public prescriptions patients. Dispensary. issued. Dr. Harrison 3,400 5,030 3,573 Dr. Brews 264 518* 408 *Visits to Surgery. 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 Isolation Hospital, and during 1931 the numbers examined at the Town Hall were as follows :— No. Positive. Negative. 1,469 115 1,354 For other examinations, facilities are provided at several outside laboratories on behalf of the Corporation and in the following table the number examined is shown :— TABLE 8. Laboratory Examinations, 1931. Total Examinations - 979. Material. Norfolk & Norwich Hospital. R. Inst, of P. Health. Counties P. H. Labs. Sputum (ordinary) 510 273 152 Sputum (Antiformin) — 3 — Wasserman Test — — 1 Widal Test. — — 6 Hair (for ringworm) — — 1 Faeces — — 1 Rectal Swab (dysentery) — — 1 Smears — — 1 Totals 540 276 163 21 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:— (a) Ministry of Health. Public Health Acts Amendment Act, 1907, Part 10, Sec. 95. 16th October, 1923. (b) Home Office. Public Health Acts Amendment Act, 1907, Part 7, Sec. 85. 6th March, 1929. Acts of Parliament Adopted. Date of Date of coming Name of Act adopted. adoption. into operation. Infectious Disease (Notification) Act, 1889 1l2th Nov., 1889 1st Jan., 189C Infectious Diseases (Prevention) Act, 1890 14th Oct., 1890 18th Nov., 1890 Public Health Acts Amendment Act, 1890, Parts 2, 3 and 5 13th Jan., 1891 18th Feb., 1891 Public Baths and Wash- houses Acts 16th Mar., 1897 16th Mar., 1897 22 Date of Date of coming Name of Act adopted. adoption. into operation. Housing of the Working Classes Act, 1890, Part 3 16th Feb., 1897 16th Feb., 1897 Public Libraries Act, 11892 il8th 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 and 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. T ramways. Closing Order for Barbers and Hairdressers, Butchers, Chemists, etc. Tents, Vans, Sheds and similar structures used for Human Habitation. 23 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, il909. Lamps Marking Roads Obstructions. Provision of Means of Escape from Fire in case of certain Factories and Workshops. Wireless Loud Speakers. Advertisements. Registries for Female Domestic Servants. Fouling of Footways by Dogs. HOSPITALS. Provided by Local Authority. No. of Nursing No. of Medical Staff Consultant hospital. Beds. Staff. Complement. Borough—Infectious Diseases 150 1 34 1 Harts Sanatorium 56 1 10 The accommodation at Harts Sanatorium will be increased shortly by the addition of a pavilion for advanced and observation cases. The same arrangements apply for outside Sanatoria cases as mentioned in the 1930 report. Maternity. Under this heading there is nothing further to add to my previous report. Smallpox. The agreement with West Ham existed during 1931 for the reception of these cases. This agreement, however, expires in March, 1932, and efforts are being made to come to terms with 24 the London County Council for the treatment of cases of this disease. GENERAL. East Ham Memorial Hospital. The number of beds in the East Ham Memorial Hospital remain the same as set out in last year's report, namely 100. From the hospital report for 1931, the following figures are abstracted:— Average daily number of beds available 99.9 Average daily number of beds occupied 91.5 Average daily number of days each patient was resident 19.5 Number of operations performed 1,000 Number of patients in hospital on 1-1-31 92 Number of patients admitted during 1931 1,710 Number of patients in hospital on 31-12-31 89 Number of deaths during year 130 Out-Patients. Number of new cases 8,169 Number of attendances 38,271 The agreement between the Corporation and this hospital was set out in detail in the 1930 report, and under this agreement three patients were admitted during the year. The general and special hospitals of London are still very largely used by the inhabitants of this Borough. Whipps Cross Hospital and Institutions Controlled by West Ham. Mr. Armstrong, Public Assistance Officer, has kindly supplied the following statistics:— 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 25 TABLE 9. East Ham Cases Admitted to Public Assistance Institutions during 1931. West Ham Corporation Institutions. Number chargeable on 31.12.30 Number admitted to 31.12.31 Total. Discharged. Died. Transferred to other Institutions. Number remaining on 31.12.31 Whipps Cross Hospital 110 1,328 1,438 889 201 199 149 Central Home 282 487 769 199 149 148 273 Forest Gate Hospital 80 284 364 206 16 21 121 Forest House and Cottages 49 21 70 2 — 22 46 Margate Home — 19 19 8 — 1 10 26 I have endeavoured to obtain further information from West Ham in tabular form showing the various diseases, etc., from which these patients suffered, but I was informed that it was impossible to abstract the details required. The Medical Officer of Health, West Ham, however, furnished the following information, showing the number of East Ham cases in these institutions on the 19th February, 1932:— Central Homes. Men.—Chronic and infirm cases in Sick Ward 61 In other wards 50 Women.—Chronic and infirm cases in Sick Ward 78 In other wards 61 — 250 Whipps Cross. Tuberculosis cases—Men 14 Women 11 Children under 16 years 3 Other cases— Men 45 Women 52 Children under 16 years 33 Mental Observation Ward—Men 2 Women 2 — 162 Forest House and Cottages. Aged persons— Men 26 Women 11 Epileptic— Men 1 Lunacy Act, Sect. 24—Men 1 — 39 Forest Gate Hospital. Certified—Mental Deficiency Acts Men 11 Certified—Mental Deficiency Acts Women 4 Certified—Mental Deficiency Acts Children 9 Certified—Sec. 24 Lunacy Acts Men 5 Certified—Sec. 24 Lunacy Acts Women 5 Uncertified Mental Defectives and Epileptics Men 9 Uncertified Mental Defectives and Epileptics Women 13 Uncertified Mental Defectives and Epileptics Children 11 Able-bodied (helper) Men 1 Chronic Sick Women 35 Maternity Women 5 Infants of Maternity Patients 4 — 112 27 Margate Home. Boys 5 Girls 5 — 10 Grand Total 573 Aldersbrook Homes and Scattered Homes. I have to thank Mr. W. Pitt Steele, the Superintendent of these Homes, for the statistics appended below:— Half-year ending 30-6-31 Half-year ending 30-6-30 The highest number chargeable was 524 501 „ lowest „ „ 490 469 In the Receiving Homes on the 1st January, 1931 266 „ Scattered „ „ „ 233 — 499 In the Receiving Homes on the 1st July, 1931 286 266 „ Scattered „ „ „ 231 233 — 517 — 499 On the 1st July, 1931, the chargeability was apportioned as follows:— To the County Borough of East Ham 87 72 ,, ,, West Ham 306 285 ,, Essex County Council 124 142 — 517 — 499 The average number of admissions weekly was 11 14 „ ,, discharges „ 10 13 Number of deaths in the Institution (East Ham 2, West Ham ]) 3 0 The number of children admitted from East Ham was 31 40 „ „ ,, „ West „ „ 185 195 ,, „ .. ,, Essex ,, 72 119 Transfers to other Institutions (not under the control of East or West Ham County Boroughs) 20 65 Total numbers of days maintenance 91,984 89,059 Infants under 3 45 45 Children over 3 and under 5 71 55 „ 5 „ 8 117 128 Boys over 8 „ 14 139 127 Girls „ 8 „ 14 90 98 Boys „ 14 „ 16 34 28 Girls „ 14 „ 16 21 18 Accommodation :—(Beds provided) Receiving Homes 283 263 „ „ Scattered „ 235 235 518 498 Boys sent to situations 7 10 Girls „ „ 5 6 Boys returned from situations (sent to F.G. Hospital) 1 1 (for Med. treatment) No. of boys whose wages were subsidised (with the sanction of the Ministry of Health) 1 0 28  Half-year ending 31-12-31 Half-year ending 31-12-30 The highest number chargeable was 529 524 „ lowest „ „ 512 490 In the Receiving Homes on 1st July, 1931 286 „ Scattered „ „ „ 231 — 517 In the Receiving Homes on 1st January, 1932 292 286 „ Scattered „ „ „ 230 231 — 522 — 517 On the 1st January the chargeability was apportioned as follows:— To the County Borough of East Ham 83 87 „ „ „ West Ham 313 306 „ Essex County Council 126 124 — 522 — 517 The average number of admissions weekly was 12 11 „ „ discharges „ „ 11 10 Number of deaths in the Institution 0 3 The number of children admitted from East Ham was 30 31 „ „ „ „ West Ham „ 198 185 „ „ „ „ Essex 74 72 Transfers to other Institutions (not under the control of East or West Ham County Boroughs) 21 20 Total number of days maintenance 95,916 91,984 Infants under 3 55 45 Children over 3 and under 5 61 71 „ „ 5 „ 8 105 117 Boys „ 8 „ 14 134 139 Girls „ 8 „ 14 108 90 Boys „ 14 „ 16 38 34 Girls „ 14 „ 16 21 21 Accommodation:—(Beds provided) Receiving Homes 292 283 „ „ „ Scattered „ 230 235 — 522 — 518 Boys sent to situations 6 7 Girls „ „ 6 5 Boys returned from situations 2 (for Med. treatment) 1 No. of boys whose wages were subsidised since the last report (with the sanction of the Ministry of Health) 0 1 Dr. J. Sangster Greig, Medical Officer to the Homes, reported to the Committee that the health of the children continued to be very good, that the small amount of sickness amongst the schoolchildren and the elder boys and girls is a noticeable feature, but that the majority of the newly admitted children continue to be of poor physique and many require individual care and attention for some considerable time after admission, 29 Venereal Diseases. As in previous years, the same facilities were available for the treatment of these diseases and the following extracts from the official tables supplied by the London County Council, relate to East Ham patients. New Patients. Syphilis 49 Soft Chancre 3 Gonorrhoea 104 Not Venereal 112 Total 268 Total attendances 8,234 Number of in-patient days 569 Salvarsan Substitutes, doses 960 Pathological Examinations. For or at Centres— Spirochaetes 33 Gonococci 1,050 Wassermann 282 Others 889 Total 2,254 For Practitioners— Spirochaetes — Gonococci 4 Wassermann 34 Others 30 Total 68 Utilization of Facilities at Hostels, 1931. Two East Ham patients had 164 days in residence under the hostel scheme. The institutions concerned are as set out in the report for 1930. 30 Mental Hospital. The negotiations between this Council and that of the County Borough of Southend, to erect a mental hospital to accommodate patients from both boroughs, as mentioned in my report for last year, concluded with an agreement between both councils to erect such an institution. When this hospital is completed it will provide for the reception of all the patients from both boroughs. TABLE 10. Disposition of East Ham Mental Patients on 31st December, 1931. Institution. Male. Female. Total. Brentwood 19 70 89 Colchester 1 51 52 Canterbury 32 — 32 Cotford 10 — 10 Gateshead 15 62 77 Gloucester 18 10 28 Peckham House 22 23 45 Wells — 12 12 Worcester 69 — 69 Various institutions 12 15 27 Totals 198 243 441 Mental Deficiency. Although the same difficulty was met with during 1931 for obtaining institutional treatment for these cases as outlined in previous reports, it is hoped that during 1932, when West Ham open part of their new institution at Ockendon that the situation as regards these cases will be eased somewhat. Orthopaedic, Ear, Nose and Throat, Puerperal Fever and Pyrexia, and Ophthalmia Neonatorum. The same arrangements for out-patient and in-patient hospital treatment for these types of cases are in force as set out in my last report. 31 Clinics and Treatment Centres. The clinics and treatment centres are shown in the table below and are all provided by the Council:— TABLE 11. Clinics and Treatment Centres. Situation. Purpose used. Sessions. 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 Hall, North Woolwich do. Tuesday, 2.30 p.m. St. George's Church Hall, Masterman Road do. Wednesday, 2 p.m. Baptist Church Hall, Plashct 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 p.m. 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 Thursday, 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 32 MENTAL DEFICIENCY ACTS, 1913-27. The duty of the Local Authority as regards ascertainment and supervision of those cases coming within the scope of the Act of 1913 and its amendments, has been carried out satisfactorily. In the following table the work performed by Miss Hicks during the year is set out:— TABLE 12. visits. No. of half days teaching sessions at centre No. of reports made out for register, files, &c. Number of interviews Statutory Supervision Guardianship Institution Training Centre Friendly Care School Cases Total 1,163 150 69 116 219 21 1,738 13 986 98 TABLE 13. Particulars of Mental Defectives as on 1st January, 1932. (A) " Subject to be dealt with " by the Local Authority. (B) Who may become " subject to be dealt with " by the Local Authority. N.B.—No case is included under more than one main heading of A or B. A.—Number of Cases "Subject to be dealt with":— M. F. T. 1. Under "Order ":— (a) (1) In Institutions (excluding cases on Licence)— Under 16 years of age 13 6 19 Aged 16 years and over 30 24 54 (2) On Licence from Institutions— Under 16 years of age — — — Aged 16 years and over 5 2 7 (b) (1) Under Guardianship (excluding cases on Licence)— Under 16 years of age 4 — 4 Aged 16 years and over 8 4 12 (2) On Licence from Guardianship— Under 16 years of age — — — Aged 16 years and over — — — 2. In "places of safety":— Under 16 years of age 1 2 3 Aged 16 years and over 2 — 2 3. Under Statutory SupervisionOf whom:— 74 65 139 (a) Attending Occupation Centres 22 16 38 (b) Awaiting removal to an Institution 5 4 9 33 4. Action not yet taken under any one of the above headings:— (a) Notified by Local Education Authorities (Sec. 2 (2)) — — — (b) Mental Defectives in receipt of Poor Relief:— (1) Institutional— (a) In Public Assistance Institutions not approved under Sec. 37 (b) In Institutions certified under the M.D. Acts (including those approved under Sec. 37 — — — (1) Cases "placed" under Sec. 3 — — — (2) Other Cases — — — (2) Domiciliary (c) Otherwise " ascertained " — — — B.—Number of Cases who may become "Subject to be dealt with":— 1. In Institutions or under Guardianship—dealt with under Sec. 3:— (a) In regard to whom the Local Authority contributes under its permissive powers 1 — 1 (b) Maintained wholly by parents, relatives or others — 1 1 2. Reported to the Local Authority from any reliable source but as to whom no action has been taken — — — 3. Under Voluntary Supervision 23 31 53 Of whom attending Occupation Centres 2 — 2 DURING THE YEAR 1931. 1. (a) Number of instances in which Licence was granted during 1931:— M. F. T. (1) From Institutions 2 1 3 (2) From Guardianship — — — (b) Number of instances in which cases on Licence have been returned to Institutions or transferred to Guardianship during the year 1931:— M. F. T. (1) To Institutions — — — (2) To Guardianship... — — — 2. Cases notified by Local Education Authorities (Section 2 (2)) during the year 1931:— Method of disposal. M. F. T. Sent to Institutions (by Order) 1 2 3 Placed under Guardianship (by Order) — — — Placed under Statutory Supervision 11 9 20 Placed in "Places of Safety" — — — Died or Removed from Area — 1 1 Action not yet taken— (a) In receipt of Poor Relief — — — (b) Others 1 2 3 Total 13 14 27 34 3. Of the total number of mental defectives known to the Local Authority:— (a) Number who have given birth to children during 1931:— (1) After marriage Nil (2) While unmarried Nil Males. Females. (b) Number who have married during 1931 — 1 voluntary case Training Centre. During the year a general improvement in concentration and behaviour has been noted among the mental defectives who have attended the Training Centre. Their handwork has been remarkably good and has a more finished appearance; the following are a few of the articles made:—Sea-grass stools, glass based trays with cane border, baskets, screens, fretwork cut-outs, rugs, raffia weaving, drawn thread work, underwear, knitting and fancy articles. The younger children are responding to training and are beginning to show pride in their personal appearance and care in the rules of simple hygiene. Interest has been created in elementary handicraft and it is hoped, that with patience, some good results will be obtained at a later date. Of interest and showing the result of training, Miss Fooks informs me that one of the young men attending the centre in the mornings has recently earned a certain amount of pocket money by obtaining orders for cane work and making the articles at home. The annual Xmas Party at which the children gave an entertainment and exhibition of and sale of the articles was held. The Mayor, Mayoress and some members of the Council attended and were surprised at the manner in which these defectives had responded to the teaching and training, given with infinite patience, by Miss Fooks. TABLE 14. Statistics of Training Center, 1931. Morning Session—Males. Afternoon Session—Girls and Juniors. Grand Total Attendances No. on Register No. of Sessions held Total Attend- ances Average Attendance No. on Register No. of Sessions held Total Attend- ances Average Attendance 12 215 1,797 8-3 24 215 3,748 17 4 5,545 35 BLIND PERSONS ACT, 1920. The number of blind persons on the register on 31st December, 1931, was 204. They are graded as follows In residential schools 4 In workshops 16 In training 5 At work 10 St. Dunstan's men 5 Street musicians and sellers 4 Home workers 2 Trained and not at work 3 Awaiting training 4 Pastime occupations 39 Domestic duties at home 11 No pastime occupation (owing to age, etc.) 100 Collector 1 Numbers of the blind are taught suitable pastime occupations by the Home Visitor, and more have learned to read Braille and Moon types. The Council's scheme for providing grants (according to income) to all necessitous blind persons is greatly appreciated by the recipients. Many blind persons have been assisted to obtain Blind Old Age Pensions and free wireless licences. Since the Council has agreed that the school eye specialist should examine all cases and certify where necessary, many tedious journeys to hospital have been eliminated. The East Ham Welfare Association for the Blind continues to carry out its splendid work, and the lives of the blind have been considerably lightened by its continued efforts. The Association provides 45 weekly and 18 monthly embossed magazines for those who desire them. Many social evenings have been arranged for the blind and their guides, and the annual outing to Southend was the usual great success. The provision of groceries at Christmas and coal to necessitous cases, extra nourishment in cases of sickness, tobacco, 36 cigarettes, spectacles, dentures, surgical appliances, and convalescent treatment for a number of cases at the Blind Home at St. Leonards-on-Sea is another part of the valuable work undertaken by the Association during the year. The Ladies' Clothing Sub-Committee provide clothing, boots, etc. to all who need them. During the year, one of the technically blind men has been employed as Collector for the Association, and besides providing a regular income to one of its blind cases, the effort has shown a good result. Besides the many other activities, the local Association opened in November, 1931, a Social Club, which is held one afternoon weekly at St. Bartholomew's Hall, and is well attended and much enjoyed by the blind people. In July, the Rotary Club of East Ham very kindly provided white walking sticks for all those who desired them, and also provided for a tea on that date. The work of Miss Kingston, the Home Visitor and Teacher of the Blind, is shown in the table below. It will be noticed that the number of visits and lessons given have greatly increased. 37 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. Croche Wool Ball Work. Manual 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 — 1931 204 4,239 75 41 55 4 4,373 470 — 277 52 37 — 70 34 — 39 In the following tables, the registration of the blind, ages at which blindness occurred, training and employment and occupations, as at 31.3.32, as required by the Ministry of Health, are set out:— TABLE 16. Welfare of the Blind.—Registration. As at 31I3I32. Age Period 0—5 Age Period 5—16 Age Period 16—21 Age Period 21—30 Age Period 30—40 Age Period 40—50 Ape Period 50—60 Age Period 60—70 Age Period 70— Total. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. — — — 3 3 6 4 2 6 8 8 16 13 10 23 16 7 23 16 12 28 26 19 45 24 40 64 110 101 211 TABLE 17. Ages at which Blindness occurred. Age Period 0—1 Age Period 1—5 Age Period 5—10 Age Period 10—20 Age Period 20—30 Age Period 30—40 Age Period 40—50 Age Period 50—60 Age Period 60—70 Age Period 70— Unknown M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 17 10 27 2 4 6 6 9 15 3 6 9 10 6 16 12 9 21 12 4 21 21 14 35 12 14 26 e 11 20 10 TABLE 18. (a) Training and Employment. Age period 16 and upwards. Employed Undergoing Training Trained but Unemployed No Training but Trainable Unemployable Total By Blind Institutions All others not included in (a) & (b Total employed Industrial Secondary Professional or University Workshops Home Workers (a) (b) (c) (d) (e) (f) (g) (h) (i) (i) (k) M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. 12 6 18 1 2 3 15 4 19 28 12 40 4 1 1 6 — — — — — — 3 — 3 5 1 6 67 84 151 107 98 205 (b) Occupations of Employed. Agents, Collectors, etc. Basket Workers Bedding (including Divans and Ottomans) and Upholstering. Boot repairers Brushes Carpenters and Woodworkers Chair Seaters Ministers of Religion Clerks, Typists Telephone Operators Dealers (Tea Agents, Shopkeepers, etc.) Domestic Servants Farmers Hawkers Home Teachers Knitters Labourers Massage Mat Makers Musicians and Music Teachers Netting Makers Newsvendors Porters, Packers and Cleaners Poultry Farmers School Teachers Straw Bagmakers Tuners Weavers Miscellaneous Total Mattress Makers Machinists Upholsterers Pan Wiredrawn Hand Machine Within Institutions for the Blind — 3 — — — 4 — — — — — — — — — — — — — 1 — — 5 — — — — — — — — 5 — 18 In approved Home Workers Schemes — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — 1 — 1 3 Others (not pastime Workers) 1 1 — — — 1 — — 1 — — 1 1 3 — — 3 — — — — 1 1 — — — — — — — 1 — 4 9 Total 1 4 — — — 5 — — 1 — — 1 1 3 — — 3 — — 2 — 1 6 — — — — — — — 2 5 5 40 41 INVALID CHILDREN'S AID ASSOCIATION (East Ham Branch). The work of this Association for invalid children commends itself especially to a Health Department and its efforts on behalf of the children deserve the sympathy, encouragement and praise of every member of the public. It affords me great pleasure in recording a deep sense of gratitude to the East Ham Branch for all the help they have accorded this department during the year. In their Annual Report for 1931, it is stated that during the 8½ years that the branch has been in existence, they had expended nearly £21,000 in assisting about 1,500 children—truly wonderful work. New cases have been referred to them as follows:— Tuberculous and pre-tuberculous 31 Rheumatism 16 Anaemia and debility 53 Bronchitis and asthma 20 Malnutrition 3 Various 12 Total 135 These 135 cases were referred by:— School Medical Officer 47 Hospitals and Medical Practitioners 64 Tuberculosis Officer 15 Infant Welfare Department 9 185 cases were assisted during the year. The following are the particulars:— Sent to Sanatoria, Schools of Recovery and Convalescent Homes 131 Boarded out 2 Surgical appliances 27 Food and Clothing Grants 15 Visiting, Advice, Loan of Carriages 10 LOCAL GOVERNMENT ACT, 1929. The administrative scheme of the Council was set out in my last report, 42 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. General. Reference to table 21 will show that there was a very substantial decrease in the number of cases of notifiable infectious disease notified during the year, the figures being 654 against 1,187 in 1930. Smallpox. It is gratifying to be able to report that the number of cases of smallpox notified during 1931 had decreased from 70 (1930) to 51, and that the disease remained the mild type as experienced in recent years. The particulars of these 51 cases are shown in tabular form as follows:— TABLE 19. SMALLPOX, 1931. No. Initials. Date of Notification. Age (Yrs.) Sex. Probable Source of Infection. No. of contacts traced and kept under observation. Secondary Cases in same house. State of Vaccination of Patient. 1 F.W. 16.1.31 32 F Unknown 9 — Not 2 W.M. 17.1.31 12 M Contact of previous case in same house 6 — „ 3 L.B. 19.1.31 26 M Unknown 3 — „ 4 W.P. 23.l.3l 20 M do 9 — „ 5 L.P. 23.1.31 19 F Contact with case No. 4 — „ 6 J.M. 24.1.31 9/12 F Contact with cases Nos. 5 and 6 — „ 7 S.S. 26.1.31 40 F Contact with missed case 5 — „ 8 M.S. 26.1.31 14 F Contact with case No. 7 — „ 9 A.R. 26.1.31 9 M Unknown 8 — „ 10 J.T. 28.1.31 25 M Contact with case No. 9 6 — „ 11 R.H. 2.2.31 5 M Unknown 8 — „ 12 E.D. 2.2.31 17 F do 13 1 „ 13 M.D. 3.2.31 40 F Contact with missed case 15 3 „ 14 G.M. 3.2.31 12 F Unknown 9 1 „ 15 M.G. 4.2.31 27 F Contact with case No. 12 6 — Infancy 16 E.R. 9.2.31 50 F Unknown 9 — „ 17 G.L. 10.2.31 13 F Contact with case No. 8 12 — Not 18 W.F. 11.2.31 20 F Unknown 4 — Infancy 19 G.F. 12.2.31 39 M do. 9 — Not 20 W.M. 17.2.31 40 M do. 9 — „ 21 E.M. 17.2.31 49 F Contact with case No. 14 3 — „ 22 A.D. 21.2.31 18 M Contact with case No. 13 15 2 „ 43 TABLE 19—continued. No. Initials. Date of Notification. Age (Yrs.) Sex. Probable Source of Infection. No. of contacts traced and kept under observation. Secondary Cases in same house. State of Vacci nation of Patient. 23 D.F. 23.2.31 62 M Unknown 9 1 Infancy 24 J.M. 24.2.31 39 M Contact with case No. 21 10 — „ 25 R.L. 24.2.31 47 F Unknown 11 1 „ 26 W.L. 24.2.31 5 F Contact with case No. 25 Not 27 F.C. 24.2.31 37 M Contact with case No. 23 9 — Infancy & during war 28 J.B. 24.2.31 54 M Contact with 2 missed cases 12 — Infancy 29 W.D. 25.2.31 52 M Contact with case No. 12 8 — „ 30 F.L. 25.2.31 16 F Contact with cases Nos. 25 and 26 10 1 Not 31 J.F. 27.2.31 19 M Unknown 15 — „ 32 H.L. 3.3.31 17 M Contact with cases Nos. 25, 26 and 30 8 — „ 33 M.D. 10.3.31 14 M Contact with case No. 22 11 1 „ 34 L.S. 10.3.31 6 F Unknown 7 2 „ 35 M.W. 17.3.31 77 F Contact with case No. 33 7 — Infancy 36 R.T. 18.3.31 21 M Unknown 11 — Not 37 E.G. 20.3.31 23 F do. 13 — „ 38 C.S. 21.3.31 27 M Contact with case No. 34 6 1 Infancy 39 W.M. 21.3.31 16 M Contact with case No. 32 5 — Not 40 W.M. 22.3.31 15 M do. do. 13 — 41 A.S. 25.3.31 35 M Contact with cases Nos. 34 & 38 6 — Infancy & during war 42 M.F. 8.4.31 35 F Contact with West Ham case 7 — Not 43 A.M. 28.4.31 14 M do. do. 32 — „ 44 J.S. 30.4.31 19 M Unknown 12 — „ 45 F.T. 2.5.31 21 M Contact with Barking case 6 — Infancy 46 R.H. 20.5.31 14 M Contact with case No. 43 5 — Not 47 E.G. 11.6.31 61 M Unknown 5 — Infancy 48 A.E. 13.6.31 21 M Contact with West Ham case 8 — Not 49 A.E. 1.7.31 31 M Unknown 8 — Infancy 50 A.J. 3.10.31 29 M Contact with missed case 3 — „ 51 M.J. 3.10.31 67 F — „ TABLE 20. Vaccination, 1931. No. of Births. Certificates of Primary Vaccination. Statutory Declarations. Certificates of Postponement. Certificates of Insusceptibility. 2,045 1,084 739 80 8 44 TABLE 21. Return of Vaccination Officer of the East Ham C.B. Sub-District Respecting Vaccination of Children whose Births were Registered 1st January, 1930, to 31st December, 1930. Registration Sub-Districts comprised in the Vaccination Officer's District. No. of Births returned in the Birth List Sheets as registered from 1st Jan.to 31st Dec., 1930. Number of these births duly entered by 31st January, 1932, in Columns I, II, IV, and V, of the Vaccination Register. Number of these births which on 31st January, 1932, remained unentered in the Vaccination Register on account of No. of these births remaining on 31st Jan., 1932 neither duly entered in the Vaccination Register nor temporarily accounted for in the Report Book. Total No. of Certificates and copies of Certificates of successful vaccination of children under 14 received during the calendar year 1931. No. of Statutory Declarations of Conscientious Objections actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate during the calendar year 1931. Successfully vaccinated. Insusceptible of Vaccination. Had Smallpox. No. in respect of whom Statutory Declarations of Conscientious Objection have been received. Died Unvaccinated. Postponement by Medical Certificate. Removal to districts the Vaccination Officers of which have been duly apprised. Removal to places unknown or which cannot be reached and cases not having been found. 1. North 842 313 2 — 398 25 — 12 37 55 570 411 2. South 877 346 4 — 407 45 — 1 29 45 462 425 Total 1,719 659 6 — 805 70 — 13 66 100 1,032 836 45 During the year, the Public Vaccinator carried out the following vaccinations:— Number of successful primary vaccinations of children under one year of age 576 Number of successful primary vacinations of persons one year and upwards 341 Total 917 Number of successful re-vaccinations 217 Scarlet Fever. The notifications of Scarlet Fever again decreased from 484 in 1930 to 245 in 1931. The deaths resulting from these 245 cases numbered 2. Of the patients notified, 159 were removed to hospital or 69 per cent. Diphtheria. 196 cases were notified as against 473 for the previous year. 189 patients were removed to hospital or 96 per cent. The number of deaths was 18. The same arrangements exist for providing anti-toxin and examination of nose and throat swabs as outlined in my former reports. Schick Immunization Clinic. During the year 1931, 255 infants and children have received three inoculations. The total number of inoculations performed Has been 784, of which 63 were carried out by Private Practitioners and 721 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:— 1. Town Hall Clinic. Total number of inoculations 721 Number inoculated three times 234 Number inoculated twice 6 Number inoculated once 7 46 Number inoculated in the various age groups:— Ages in years 1 2 3 4 5 6 7 8 9 10 11 12 13 14 and over No. inoculated 14 V 9 22 24 40 32 21 20 25 13 12 6 7 2 109 111 27 247 2. Private Practitioners. In addition to the above, during the same period 21 children have been inoculated three times by Private Practitioners, and the ages at which inoculation was performed were as follows:— Ages in years 1 2 3 4 5 6 7 8 9 10 11 12 13 14 and over No. inoculated 2 — 2 2 4 4 1 4 2 — — — — 10 11 — 21 N.B.—In considering- the combined totals (1 and 2) it will be noticed that 44.4 per cent, of the cases were in the age group 1-5 years, 45.5 per cent, in the age group 6-10 years, and 10.1 per cent, in the group over 10 years. 3. The Schick test for susceptibility to diphtheria was performed during the year in 225 completed cases, of which 222 proved negative. In the other three cases, positive results were obtained. One of these has since received two further inoculations and one, one inoculation. Enteric Fever. Eight cases were notified during 1931, there were no deaths and six of the patients received hospital treatment. Erysipelas. Of 54 cases notified, 22 received hospital treatment. There were no deaths. Puerperal Fever. The cases numbered 4 and the deaths from this cause totalled 6. All the cases were treated in hospital. The reason for more deaths than notifications is due to inward transferable deaths and the death certificate indicating Sepsis, whereas the case was notified as Pyrexia. Puerperal Pyrexia. Six notifications were received, all of whom were treated in hospital and there were no deaths assigned to this cause. 47 TABLE 22. Total Cases of Notifiable Diseases, 1910-1931. Disease. 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 Smallpox — — — — — — — — 3 1 10 — — — — — — — 17 25 70 51 Scarlet Fever 329 377 435 526 677 499 267 341 272 530 718 1,355 502 170 215 221 350 798 832 743 484 245 Diphtheria 142 121 72 258 319 204 225 279 273 451 426 309 198 160 128 246 337 464 669 578 473 196 Enteric Fever 19 56 13 19 21 5 7 9 2 15 10 7 4 3 5 9 7 2 7 2 3 8 Erysipelas 104 134 152 119 130 93 86 66 52 72 72 57 34 32 38 41 41 38 60 49 63 54 Puerperal Fever 6 6 8 8 4 4 1 2 1 6 6 5 3 5 5 5 5 4 8 9 10 4 Puerperal Pyrexia Not Notifiable 11 11 12 14 6 Meningococcal Meningitis Not Notifiable 2 6 1 8 6 7 3 3 3 4 — 1 1 1 1 4 1 1 3 8 Encephalitis Lethargica Not Notifi able 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 6 Ac. Polio Myelitis Not Notifiable 2 8 4 1 10 — — 3 1 — — 3 1 1 — 5 — 2 — 1 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 75 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 1,187 654 48 TABLE 23. Prevalence of and Control over Infectious Disease.—Notified Cases for the 52 Weeks ending 2nd January, 1932. 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 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and up. Smallpox 51 1 — 3 7 9 14 8 7 2 3 2 2 4 4 11 6 8 3 8 51 — Scarlet Fever 245 4 51 114 37 14 18 5 2 — 26 50 18 31 9 17 18 31 18 27 159 2 Diphtheria 196 1 61 83 23 13 11 3 1 — 6 19 27 25 12 29 18 26 5 29 189 18 Erysipelas 54 5 — 1 — 3 5 10 25 5 6 7 4 5 2 9 6 7 4 4 22 — Puerperal Fever 4 — — — — 1 2 1 — — — — — 1 — 1 1 — 1 — 4 6 Puerperal Pyrexia 6 — — — — — 6 — — — — 2 1 — 1 — 1 — — 1 6 — Ophthalmia Neonatorum 6 6 — — — — — — — — — 1 2 — 1 — 1 — 1 — 1 — Meningococcal Meningitis 8 4 3 — — — 1 — — — 1 3 — — — 1 1 1 — 1 8 10 Acute Polio Myelitis 1 — — 1 — — — — — — 1 — — — — — — — — — 1 — Enteric Fever 8 — — — 4 2 — — 2 — — — — 1 — 2 1 1 1 2 6 — Pneumonia 75 3 8 3 2 7 23 7 13 9 13 14 7 9 3 8 5 3 4 9 29 116 49 TABLE 24. Disease. Cases. Vision Unimpaired Vision Impaired Total blindness Deaths Notified Treated At home Hospital Ophthalmia Neonatorum 6 5 1 6 — — — CANCER. As compared with 1930, the deaths from Cancer show a slight decrease, 183 as against 187. The same procedure has been followed as set out in my last report, i.e., the issuing of circulars and advertisements in the local press. Cancer Deaths, 1931. Total deaths 183 Males 89 Females 94 Classification. Number of deaths. Carcinoma 181 Epithelioma 2 Total 183 50 TABLE 25. Cancer Deaths.—Parts of Body Affected. Ages 0-1 1-2 2-5 5-15 15-25 25-35 35-45 45-55 55-65 65-75 75 and upwards Total Sex M F M F M F M F M F m F M F M F M F M F M F M F Buccal Cavity and Pharynx – – – – – – – – – – – – – – – – 6 1 1 — — 1 7 Digestive Organs & Peritoneum – – – – – – – – – – – – 2 5 10 8 10 10 23 15 8 8 53 46 Respiratory Organs – – – – – – – – – – – – – – 1 — 2 1 2 1 — — 5 2 Uterus — — — — — — — — — — — 1 — 1 — 2 — 2 — 4 — 1 — 11 Other Female Genital Organs – – – – – – – – – – – – – 1 – – – – – 1 – 1 – 3 Breast – – – – – – – – – – – – – – – 6 – 3 – 4 – 2 – 15 Male Genitourinary Organs – – – – – – – – – – – – 1 – – – 3 – 4 – 1 – 9 – Skin – – – – – – – – – – – – – – – – – – – – – – – – Other or Unspecified Organs — 1 — — 1 — — — — — 1 1 2 4 4 3 3 4 2 2 2 — 15 15 Totals — 1 — — 1 — — — — — 1 2 5 11 15 19 24 21 32 27 11 13 89 94 51 REPORT ON THE WORK OF THE TUBERCULOSIS AND CHEST CLINIC. Dr. Ellman reports as follows:— The work of the Clinic is increasing by leaps and bounds. Comparative figures of the number of attendances alone more than verify this fact. Number of Patients attending the Clinic:— 1928. 1929. 1930. 1931. 2398 3120 3796 3447 The various functions of the Clinic outlined in the 1929 report are being practically applied on an increasing scale. The value of the Clinic as a consultation centre in the diagnosis of diseases of the chest appears to be especially appreciated by the general practitioners of the Borough, with whom the number of consultations show definite and progressive signs of increase. The title of the "Tuberculosis Dispensary" having been replaced by our new designation, with the approval of the Ministry, has proved to be an undoubted step in the right direction, and is being greatly appreciated by our practitioners, who are now able to send patients to the "Chest Clinic" with greater ease. Our Nurses are constantly reporting that they have far less difficulty in persuading patients (more particularly those who have been in contact with a case of pulmonary tuberculosis) to attend the Chest Clinic. Co-operation of Practitioners in the Work of the Clinic. Special mention must here be made of the invaluable assistance rendered by our local Practitioners, by their active co-operation in the work of the Clinic. Without this co-operation, it must be admitted, the work could not have run so smoothly. A number of practitioners make a practice of attending the Clinic with the patient for the purpose of consultation. Almost all new cases are referred by practitioners with a letter giving particulars of the patient's history. These direct and indirect consultations continue to increase. 52 Consultations at Homes of Patients. These are increasing in number, and the consultations take place, in almost all cases, in the presence of the patient's General Practitioner, to our mutual advantage. Number of persons on the Register of the Clinic. It is not without interest to note that the number of persons on the register has been steadily declining since 1926, viz.:— 1926. 1927. 1928. 1929. 1930. 1931. 1346 1266 1089 1165 1106 1077 It is of interest to place side by side with these figures the number of persons notified as suffering from tuberculosis. The tendency is towards a decrease:— 1926. 1927. 1928. 1929. 1930. 1931. 287 251 278 259 200 226 The Clinic as a Sorting-out Centre. As reported in 1929, a large number of cases continue to be sent to the Clinic, apart from those who are definitely tuberculous, suspected cases of lung and other forms of tuberculosis who are found to be suffering, after close investigation, from other diseases of the chest (heart and lungs). I have estimated that of the number of new cases seen at each session at least 50 per cent. are non-tuberculous. Many cases of mischief in the upper air passages, especially in children, with secondary catarrhal lung changes, are not infrequently encountered, and the symptoms in these cases may closely resemble those of pulmonary tuberculosis. Several cases of cancer of the lung, suppurative diseases of the lungs, industrial diseases of the lungs, and heart disease with secondary lung changes, have been seen during the year. In all cases sent to the Clinic, where other diseases than tuberculosis have proved to be the cause of the patients symptoms, the general practitioner has been communicated with, so that the patients in question can be referred to the appropriate channels for treatment. This is apparently, from the number of letters we receive, greatly appreciated by practitioners. 53 Industrial Diseases of the Lungs—Pulmonary Asbestosis. So many cases have of late been seen at the Clinic (as suspected cases of pulmonary tuberculosis) of an industrial disease of the lunges occurring in asbestos workers exposed to asbestos dust, that special reference must be made to this condition here. A large asbestos industry is in the neighbourhood of the Borough, and several patients in East Ham exposed to this dusty trade have after a varying number of years, usually between 5-15 years, developed chest symptoms which, unfortunately, are not observed until then. My experience of the symptoms from the cases I have observed is briefly as follows:— The patient first notices some shortness of breath on exertion, on an average some 5-15 years after exposure to the dust, and with this a dry, hacking cough, so that an unfortunate patient may be exposed for many years to the dust of asbestos before he notices any harmful effects. The symptoms soon become persistent and progressive, and, after a time, following acute attacks of respiratory trouble, to which these patients are peculiarly susceptible during the winter months, the cough is accompanied by some expectoration. On examination of the sputum characteristic golden yellow asbestos bodies are found. Night sweats are not uncommon, and wasting occurs. In fact, symptoms may very closely resemble those of pulmonary tuberculosis. The symptoms become progressively worse, and the degree of respiratory embarrassment in an advanced case is hardly conceivable. The asbestos dust produces a fine diffuse fibrosis of the lungs, which commences at the base and spreads upwards, finally invading the rest of the lung. It has been estimated that there are roughly over 2,000 people employed in the industry in various parts of the country. The degree of mischief appears to vary not only with the length of exposure to the dust, but also, to some extent, with the process involved, namely carding, spinning, making of asbestos mattresses, etc. The condition has, in view of the fact that symptoms are only observed some years after exposure to the dust, only recently been recognised and placed on a sound clinical basis. Dr. Merewether of the Ministry of Health has recently written a very full report of the condition which must be carefully distinguished from silicosis—a well-recognised industrial lung disease occurring in workers associated with free silica dust—the dust in asbestos workers being produced by a complex magnesium silicate. 54 Relationship to Tuberculosis. In every industrial lung disease the risk of supervening tuberculosis inevitably arises. In silicosis it is almost invariable. In asbestosis the tuberculosis hazard has been regarded as an extremely rare occurrence, but much further work on this subject requires to be done before any definite opinion can be expressed. More recent experiences are tending to show that tuberculosis in conjunction with asbestosis are not quite so uncommon as one had thought, for I have, more recently, seen several cases of both diseases occurring in the same patient. It is therefore necessary to keep all cases of asbestosis under close observation in case tuberculosis should supervene. Dr. Merewether's medical investigations establish the facts that the inhalation of asbestos dust over a period of years results in the development of a serious type of fibrosis of the lungs, that the development of the disease varies in direct proportion to the length of the exposure to dust, and that susceptibility to the disease is not affected either by age or sex. The remedy is to be found, as in the case of so many industrial diseases, in the suppression of dust. Treatment, apart from that of a preventive nature, by adequate local exhaust ventilations, is merely symptomatic. Co-operation with Special and General Hospitals. Co-operation with the Special and General Hospitals is being utilised to the fullest extent with considerable benefit to the patients. Such specialised Hospitals as the Central London Ear, Nose and Throat Hospital for Diseases of the upper air passages, and the Brompton Hospital for patients in need of specialised Chest Surgery are utilised to the full, as, of course, are the General Hospitals, both in the locality and the larger London Hospitals. Special mention should be made of the constant help and courtesy received at all times from Dr. Muir, Medical Superintendent of the Whipps Cross Hospital, who is always ready to supply us with clinical data of patients attending the Clinic who happen to have been inpatients at Whipps Cross. Similar co-operation from the Staff of the East Ham Memorial and neighbouring Hospitals is likewise much appreciated. Furthermore, the assistance, ready help and co-operation we obtain from Dr. Harrison for necessitous cases is invaluable. 55 X-ray in Diagnosis. The differentiation of these varied conditions so closely allied could not have been so readily made without the help, in addition to clinical examination and bacteriological examinations, of X-ray examinations of the chest. So important has the development of radiology become in diseases of the chest, that it has been found necessary, in addition to the usual clinical sessions, to have a special X-ray session. The number of X-ray examinations in connection with the work of the Clinic has of necessity increased, and, in view of the help obtained from this form of examination, is likely to continue to increase. A large number of these examinations are "Screen" examinations only, with the remainder, X-ray films are taken in addition to "Screening." The comparative figures show to what extent use is being made of these examinations in the routine work of the Clinic. X-ray Examinations made in connection with the work of the Clinic. 1926. 1927. 1928. 1929. 1930. 1931. 19 15 29 97 302 352 It has been estimated that some 5 to 10 per cent. of cases of pulmonary tuberculosis reveal no physical signs by the usual methods of examination, but show definite X-ray evidence of tuberculous infiltration of the lung parenchyma. It is the definite opinion of many authorities that no adolescent who has been in contact with a case of pulmonary tuberculosis (with a positive sputum) should be discharged without an X-ray examination of the chest, even if no other signs present themselves. It is not untrue to say that X-ray examination of the chest in pulmonary tuberculosis is the greatest advance since Koch discovered the Tubercle Bacillus. It must, however, be remembered that this form of examination does not replace the usual clinical examination, but is supplementary to it. Recent Advances in the Treatment of Pulmonary Tuberculosis. Surgical methods in the treatment of pulmonary tuberculosis are now being increasingly utilised to keep the diseased lung at rest. The operations of Phrenic Evulsion and Thoracoplasty for 56 very carefully selected cases of pulmonary tuberculosis may prove to be the patient's only hope of salvation. This has in fact been the case in at least three of our patients. The operations have been done by an expert Chest Surgeon at the Brompton Hospital. PREVENTION. The work of the Clinic from the preventive point of view is never lost sight of. Early diagnosis and early treatment of pulmonary tuberculosis are vital in the interests of prevention. Contact Examination. The importance of this subject especially in young adolescents who have been in contact with a case of pulmonary tuberculosis, especially if the sputum be positive, cannot be over-emphasised. The high mortality rate, especially in female adolescents who have been in contact with the disease, but have failed to come up for examination, is especially noteworthy. These patients often develop a peculiarly virulent form of disease. The slogan that "Tuberculosis causes Tuberculosis—every case comes from another"—is one which is constantly used by us. The necessity of the preventive treatment of the whole family is urged whenever a case of pulmonary tuberculosis is observed, and the source of infection is especially sought. Only recently a child aged 4 years was notified as a case of tuberculous meningitis. On examination of the contacts the father was found to be suffering from advanced pulmonary tuberculosis, and obviously the source of infection in this case. Dental Treatment in Connection with the Work of the Clinic. The harmful effects of a septic mouth on tuberculous processes require no emphasis here. Hitherto it was only possible for dental treatment to be obtained for insured patients; and children through the School Medical Service. It is now possible for non-insured patients to obtain dental treatment through the medium of the Clinic. From the preventive point of view, attention to any sepsis in the mouth or upper air passages is strongly urged for all patients attending the Clinic. Attention to oro-nasal hygiene, as it is called, is a great factor in the prevention of chest disease. 57 After-Care. So important is this subject regarded by many authorities that it has been urged that if an Authority spends a certain amount of money on institutional treatment, twice that amount should be spent on After-Care. There is much to be said for this statement since it is well recognised that institutional treatment without adequate after-care is of little value. We are most fortunate this year in having an active After-Care Committee to whom we are able to refer necessitous cases at almost any time. Problems of suitable employment—Lady members attending to female cases, and Gentlemen members to male cases—handicraft classes, etc., are all being tackled. The importance of removing child contacts to healthy homes in the country—Grancher system—has all been under consideration. It is hoped in the near future to be able to obtain work for several adult male patients (with quiescent disease) as Car Park Attendants in the Borough. This part of the Scheme will be carried out as soon as the Minister of Transport's sanction has been obtained. Clothing has been provided for a number of necessitous cases. Some patients are unable to enter sanatoria on account of shortage of wearing apparel, and it is this class of patient we are eager to help. Several cases were helped in this way during the year. Village Settlements. Providing sanatorium treatment and a work-training Colony, enabling the patient and his family to settle on the estate, while ideal in theory, have, from our experience, not proved very practical. Patients, to whom the scheme of the Colony has been fully explained, have, despite this explanation, not settled down to the idea, and have, after a time, asked to be discharged. Thus the financial outlay has not been justified. The Urgent Need for a New Clinic with Adequate and Hygienic Accommodation. This matter was referred to in the 1929 report, but the problem has become so acute that special emphasis must be brought to bear on the urgency of the position. The place has become quite uninhabitable and a very real danger to both staff and patients. 58 In one small room is to be found dressing rooms for both sexes, and throat examination room. In this same room confidential histories have to be taken; weights, temperatures and pulse rates to be recorded; outfits to be given to patients for the collection of sputum, and, after clinical examination has been effected, further appointments made. There is the most urgent need for a new up-to-date Clinic which should be a credit to the Borough—with adequate hygienic accommodation, and with Pathological, Radiological and Dental Services, and, if possible, "Observation" beds in close association to the Clinic. There is some consolation in the fact that such a Clinic, it is to be hoped, is now very close at hand. Clerical Work. The appointment of a new Tuberculosis Administrative Clerk has oiled the internal machinery of the work of the Clinic. The Clinic is now run on efficient lines, the whole of the administration of which has been thoroughly re-organised. Card-index systems, to cope with the requirements of the Ministry of Health, and new forms have been brought into use. Statistics are readily available, and returns can be rendered without delay. Finally, in an excellent report on Tuberculosis Dr. A. S. Macnalty, Senior Medical Officer of Tuberculosis, Ministry of Health, the following suggestions on the future development of the work of Clinics such as ours is made:— (a) That the preventive side of dispensary work should receive more sustained attention. (b) That special efforts should be made to secure early nition of the disease. (c) To arrive at prompt decision in cases of " Suspects " under observation. (d) That due discrimination should be exercised in the selection of patients for different types of residential institutions, prompt admission to sanatoria being secured for all cases in whom arrest of the disease seems likely. 69 (e) That, whilst the consumptive patient should be kept under dispensary supervision through the whole of his illness, routine and frequent attendances of patients merely for the sake of receiving drug's should be discouraged. (/) That more effective machinery for care and after-care of the consumptive and his family should be provided. (It is of interest to note that these suggestions have actually been in practice for some time at the Clinic). To sum up, it will be readily appreciated from what has been said that the work of the Clinic is increasing in all its aspects to such an extent that the need for a new Clinic with suitable accommodation to meet the increasing demands has become so acutely urgent that immediate action is imperative. 60 TABLE 26. Return showing the work of the Tuberculosis and Chest Clinic, 1931. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand 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 51 42 — — 6 7 8 8 57 49 8 8 122 (b) Diagnosis not completed — — — — — — — — 4 3 1 2 10 (e) Non-tuberculous — — — — — — — — 85 83 21 16 205 B.—Contacts examined during the year:— (a) Definitely tuberculous 4 12 — — — 1 2 1 4 13 2 1 20 (b) Diagnosis not completed — — — — — — — — — 8 7 4 19 (c) Non-tuberculous — — — — — — — — 54 110 83 70 317 C.—Cases written off the Dispensary Register as (a) Recovered 2 1 — — 2 1 1 1 4 2 1 1 8 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous — — — — — — — — 149 211 104 89 553 D.—Number of Cases on Dispensary Register on December 31st, 1931 (a) Definitely tuberculous 371 291 40 30 77 56 75 51 448 347 115 81 991 (b) Diagnosis not completed — — — — — — — — 4 12 8 6 30 61 1. Number of cases on Clinic Register on January 1st, 1931 1077 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 33 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 147 4. Cases written off during the year as Dead (all causes) 74 5. Number of attendances at the Clinic (including Contacts) 3447 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 28 7. Number of consultations with medical practitioners:— (a) Personal 17 (b) Other 317 8. Number of visits by Tuberculosis Officers to Homes (including personal consultations) 50 9. Number of visits by Nurses or Health Visitors to Homes for Clinic purposes 4744 10. Number of (a) Specimens of sputum, &c., examined 802 (b) X-ray examinations made in connection with Clinic work 352 11. Number of "Recovered" cases restored to Clinic Register, and included in A (a) and A (6) above — 12. Number of "T.B. plus" cases on Clinic Register on the 31st December 338 Number of Clinics for the treatment of Tuberculosis (excluding centres used only for special forms of treatment):— Provided by the Council 1 Provided by voluntary bodies — 63 TABLE 27. 6 PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1931 of all patients remaining on the Clinic Register; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Clinic Register as definite cases of pulmonary tuberculosis, and their classification at that time. Condition at the time of the last record made during the year to which the return relates. Previous to 1926. 1926. 1927. 1928. Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total Class T.B. pluai Group 1 Group 2 Group 3 Total Claaa T.Bt plus) Group 1 Group 2 Group 3 ToUl|(Cla*a T.B. plua; Group 1 Group 2 Group 3 Total Claaa TB. Pluai (a) Remaining on Clinic Register on 31st December. Disease Arrested Adults M. 30 1 1 — 2 3 1 — — 1 2 1 1 — 2 4 1 1 — 2 F. 24 4 3 — 7 2 – – – – 3 – – – – 7 – – – – Children 12 – – – – 1 – – – – 5 – – – – 2 – – – – Disease not Arrested Adults M. 48 16 30 1 47 6 1 8 – 9 5 2 7 – 9 10 4 10 1 15 F. 35 12 19 2 33 6 2 5 — 7 2 — 3 — 3 18 3 5 — 8 Children 19 – – – – 3 – – – – 6 – – – – 6 – 1 – 1 Condition not ascertained during the year 9 3 3 — 6 — — 1 – 1 – 1 2 – 3 3 3 — — 3 Total on Clinic Register at 31st December 177 36 56 3 95 21 4 14 – 18 23 4 13 — 17 50 11 17 1 29 (6) Not now on Clinic Register and reasons for removal therefrom. Discharged as Recovered Adults M. 5 2 — — 2 – — — — — — — — — — — — — — — F. 8 – – – – – – – – – – – – – – – – – – – Children 5 – – – – – – – – – – – – – – – – – – – Lost sight of or otherwise removed from Clinic Register 258 26 44 3 73 47 6 25 — 31 36 10 17 2 29 30 12 17 3 32 Dead Adults M. 32 4 42 27 73 8 2 21 12 35 5 3 23 11 37 10 1 18 8 27 F. 23 3 24 21 48 6 6 20 10 36 1 – 15 8 23 3 5 8 9 22 Children 4 – 1 1 2 1 — – 1 1 4 1 – – 1 1 — 1 — 1 Total written off Clinic Register 335 35 111 52 198 62 14 66 80 23 103 46 14 55 21 90 44 18 44 20 82 Grand Totals 512 71 167 55 293 83 18 23 121 69 18 68 21 107 94 29 61 21 111 1929 1930 1931 (a) Remaining on Clinic Register on 31st December. Disease Arrested Adults M. 3 – – – – – – – – – – – – – – F. – – – – – – – – – – – – – – – Children – – – – – – – – – – – – – – – Disease not Arrested Adults M. 20 3 23 1 27 17 11 20 3 34 18 6 25 4 35 F. 11 6 8 2 16 16 6 16 1 23 21 11 22 5 38 Children 7 1 – — 1 5 – – — — 2 – – — – Condition not ascertained during the year 1 2 — 3 2 – 1 — 1 1 1 – — 1 Total on Clinic Register at 31st December 41 11 33 3 47 40 17 37 4 58 42 18 47 9 74 (b) Not now on Clinic Register and reasons for removal therefrom. Discharged as Recovered Adults M. – – – – – – – – – – – – – – – F. – – – – – – – – – – – – – – – Children – – – – – – – – – – – – – – – Lost sight of or otherwise removed from Clinic Register 22 5 13 — 18 1 3 4 2 9 3 1 4 — 5 Dead Adults M. 3 3 11 15 29 4 — 4 17 21 — — 2 3 5 F. 7 1 6 5 12 3 1 5 8 14 1 1 1 3 5 Children – – — — — – — — 2 2 – — — – — Total written off Clinic Register 32 9 30 20 59 8 4 13 29 46 4 2 7 6 15 Grand Totals 73 20 63 23 106 48 21 50 33 104 46 20 54 15 89 64 TABLE 28. NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1931 of all patients remaining on the Clinic Register; and (b) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the return relates. Previous to 1926. 1926. 1927. 1928. Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Clinic Register on 31st December. Disease Arrested Adults M. 6 — 3 5 14 2 — — 1 3 — — 1 — 1 — — — — — F. 6 — 1 5. 12 — 2 i — 3 — — — — — — — — — — Children 1 1 1 7 10 1 — — 3 4 — 1 — — 1 — — — i 1 Disease not Arrested Adults M. 9 — 4 8 21 — — 2 — 2 1 — — 1 2 3 — 1 — 4 F. 5 — — 2 7 — — — — — — — — 1 1 — 2 1 4 7 Children 5 2 2 26 35 — 1 — 1 2 3 1 — 6 10 3 — — 6 9 Condition not ascertained during the year 1 — 3 4 8 — — — — — — — — — — — — — — — Total on Clinic Register at 31st December 33 3 14 57 107 3 3 3 5 14 4 2 1 8 15 6 2 2 11 21 Transferred to Pulmonary 3 — 1 4 8 — — — — — — — — — — — — — — (b) Not now on Clinic Register and reasons for removal therefrom. Discharged as Recovered Adults M. 3 — — — 3 — — — — — — — — — — — — — — — F. 3 — — — 3 — — — 1 1 — — — — — — — — — — Children 7 2 1 11 21 — — — — — — — — — — — — — — — Lost sight of or otherwise removed from Clinic Register 45 8 15 72 140 10 1 5 13 29 6 — 2 8 16 4 9 13 Dead Adults M. 2 — 1 — 3 — — — — — — 1 — — 1 — — — — — F. 3 — — — 3 1 — — — 1 — — — — — 1 — — — 1 Children 4 — — — 4 — — — — — — — — — — — — — — — Total written off Clinic Register 67 10 17 83 177 11 1 5 14 31 6 1 2 8 17 1 — 4 9 14 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 100 13 31 140 284 14 4 8 19 45 10 3 3 16 32 7 2 6 20 35 1929 1930 1931 (a) Remaining on Clinic Register on 31st December. Disease Arrested Adults M. 1 — — — 1 — — 1 — 1 — — — — — F. 1 — — — 1 — — — — — — — — — — Children 3 — — 2 5 — — — — — — — — — — Disease not Arrested Adults M. 3 — — 2 5 2 1 3 2 8 3 — 1 2 6 F. — 1 — 4 5 1 2 3 8 14 — 1 1 1 3 Children 2 3 — 17 22 1 2 1 14 18 3 — 1 5 9 Condition not ascertained during the year 1 — 1 — 2 1 — — — 1 — — — 1 1 Total on Clinic Register at 31st December 11 4 1 25 41 5 5 8 24 42 6 1 3 9 19 (b) Not now on Clinic Register and reasons for removal therefrom. Transferred to Pulmonary — — — — — — — — — — — — — — Discharged as Recovered Adults M. — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — Children — — — 1 1 — — — 1 1 — — — — — Lost sight of or otherwise removed from Clinic Register 3 — 3 5 11 — — — 1 1 1 — — — 1 Dead Adults M. — — — — — — — 1 — 1 — — — — — F. — — — — — — — — — — — — — — — Children — — — 1 1 — — — 1 1 — — — — — Total written off Clinic Register 3 — 3 6 12 — — 1 2 3 1 — — — 1 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 14 4 4 31 53 5 5 9 26 45 7 1 3 9 20 65 "HARTS" SANATORIUM. Dr. Cheater reports as follows:— Patients discharged, 117 (males 65, females 52). Of these 81 were insured (55 males and 26 females), and 36 not insured (10 males, 26 females). Deaths 15 (included in 117 above). Average duration of treatment 25.8 weeks. Number of patients days 20,206. Number of beds available at the end of the year 56. Average number of beds occupied 55.36. The immediate results of treatment are as follows:— 56 cases were discharged as "Quiescent." 46 cases were discharged as "Not Quiescent." Of the latter 27 cases were "improved" and 19 cases "not improved." Of the 117 cases discharged 23 had had one previous course of sanatorium treatment and two had been in more than once. The number of deaths, 15, is fairly high this year and is due to the fact that more patients in the advanced stages are tending to seek admission to the sanatorium. This naturally creates pressure upon the present limited accommodation and maintains a fairly long waiting list, especially on the female side. The average number of the latter throughout 1931 has been 9, and seeing that sanatorium treatment is of necessity much more prolonged than in the case of diseases of an acute nature, it means that patients have to wait some time for admission. This, however, will be rectified when the new pavilion is completed, the plans of which are now before the Ministry of Health and will, no doubt, during the coming year be in the course of erection. In connection herewith it may be stated that cubicles in the contemplated new building will be of extreme value and convenience in dying cases not only for the nursing staff but also for the patients and relatives. A patient dying in a ward is a very depressing incident to all concerned, and the privacy which a cubicle affords will obviate this. The average duration of treatment this year has been increased, it being impressed upon patients to remain until they have 66 a fair chance at least of maintaining; the improvement they have made during their sojourn in the sanatorium. This was impossible in many cases during 1931, as the economic stringency compelled men, especially, to resume employment in order to keep their jobs. During the year there were three male and five female cases transferred from general hospitals to the sanatorium by ambulance, these naturally require a longer period of treatment than those in a more fit condition and further tends to make the pressure upon the present accommodation all the more intense. Artificial Pneumothorax. This surgical method of treatment continues to hold a foremost place in cases of severe hæmorrhage or where one lung only is affected, or at the most, the other lung is slightly infiltrated and is not active. In 1931 at Harts there were 151 refils done, several of the patients continuing in active work and attending at the sanatorium for their periodic refilling operations. The progress of this treatment is of course, carefully observed by frequent screenings, etc., by means of the X-rays, and the arrangement with The Forest Hospital, Buckhurst Hill, continues to function smoothly, but there is no doubt that more efficient work could be done if there were an X-ray apparatus at "Harts," not only for artificial pneumothorax patients but in many other cases. However, the plans of the new pavilion provide for an X-ray room, etc., so it is confidently hoped that this difficulty will be removed in the near future. The fact that in June the old direct current system of electric supply was discontinued and the alternating current system of the County of London Electric Supply Company installed will make the fitting up of an X-ray apparatus a simple matter. Bacteriology. The number of specimens of sputum examined in 1931 was 236, this being a slight increase on the number of 1930. In addition several specimens of pleural effusions, urine, pus, faeces, etc., were microscopically examined. Four blood-sugar estimations were obtained for a diabetic patient. 67 Complications met with and treated. (a) Those directly due to tuberculosis— Pleural effusions 2, laryngitis 7 (of these 4 died), rectal fistula 3 (1 died), tubercular sinus 2, and intestinal tuberculosis 2. (b) Not directly due to tuberculosis— Pyorrhoea 8, eczema 3, rheumatism 2, hyperthyroidism 1, diabetes 1, neurasthenia 2, varicose ulcer 1, subacute combined degeneration of the spinal cord with aneurysm of the aorta 1, haemorrhoids 1. Eight patients suffered from dental caries and were allowed leave to have the necessary treatment from their own dentists. The usual concert parties, players, etc. who have so kindly given entertainments in previous years, again arranged performances in the winter months and these were very much enjoyed both by patients and staff. "HARTS" SANATORIUM.—Year ended 31st March, 1932. Expenditure. Cost per Patient per week. £ S. d. Salaries and Wages . 2,459 17 2 Superannuation 88 0 8 Provisions 2,004 14 0 Disinfectants, Drugs and Appliances 139 0 11 Coal, Coke and Firewood 274 1 11 Electricity, Gas and Water 693 4 10 Furniture, Bedding and Linen 146 1 0 Uniforms and Dresses 63 0 5 Chandlery and Sundries 243 1 7 Crockery and Hardware 41 0 4 General Repairs 563 3 11 Garden Implements, Seeds, etc 74 0 6 Printing, Stationery and Advertisements 37 0 3 Rent of Telephones 30 0 2 Rates, Taxes and Insurance 275 1 11 X-Ray Examinations 44 0 4 £7,173 49 11 68 TABLE 29. Number of Beds Available for the Treatment of Tuberculosis on the 31st December, 1931, in Institutions belonging to the Council. Name of Institution. For Pulmonary Cases. For Non-Pulmonary Cases. Total. Adults. Children under 15. Adults. Children under 15. Harts Sanatorium 54 2 — — 56 TABLE 30. Return showing the extent of Residential Treatment and Observation during the Year in Harts Sanatorium. In Institution on Jan. 1 (1) Admitted during the vear. (2) Discharged during the year. (3) Died in the Institution. (4) In Institution on Dec. 31. (5) Number of doubtfully tuberculous cases admitted for observation Adults M. – 1 1 – – F. — — — — — Children – – 1 1 — — — Total ... ... — 2 2* — — Number of definitely tuberculous patients admitted lor treatment Adults M. 34 65 56 9 34 F. 19 46 41 6 18 Children ... 2 4 5 — 1 Total ... ... 55 115 102 15 53 Grand Total ... ... 55 117 104 15 53 *The 2 cases admitted for observation were found to be not suffering from tuberculosis. 69 TABLE 31. Average Number or Beds Available for Patients during the Year 1931. 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 70 TABLE 32. Return showing the immediate results of Treatment of definitely Tuberculous patients discharged during the Year from "Harts" Sanatorium. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Grand Totals. Under 3 months. 3-6 months. 6-12 months. More than 12 months. Total s. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Pulmonary Tuberculosis. Class T.B. minus. Quiescent 6 9 1 3 2 2 2 – – 2 – 1 13 11 4 28 Not quiescent 1 — — 1 1 – – – – – – – 2 1 – 3 Died in Institution — — — — — — — — — — — — – – — — Class T.B. plus. Group 1. Quiescent 1 4 – 3 2 – – – – – – – 4 6 – 10 Not quiescent – – — 1 – – – – – – – – 1 – – 1 Died in Institution — — — — — — — — — — — — — — – — Class T.B. plus Group 2. Quiescent 1 5 – 4 3 – 3 – – 1 – – 9 8 – 17 Not quiescent 3 5 — 9 3 – 5 2 – 3 2 – 20 12 – 32 Died in Institution — — — — — — — — — — — — — — — — Class T.B. plus Group 3. Quiescent – – – – – – – – – – – – – – – – Not quiescent 3 1 — 2 1 — 2 – – – 1 – 7 3 – 10 Died in Institution 3 o — 1 – — 3 3 — 2 1 – 9 6 – 15 71 TABLE 32—continued. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Grand Totals. Under 3 months. 3-6 months. 6-12 months. More than 12 months. Totals. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Non-Pulmonary Tuberculosis. Bones and Joints. Quiescent — — — — — — — — — — — — — — — — Not quiescent ... — — — — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — — — — Abdominal. Quiescent — — — — — — — — — — — — — — — — Not quiescent — — — — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — — — — Other Organs. Quiescent — — — — — — — — — — — — — — — — Not quiescent — — — — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — — — — Peripheral Glands. Quiescent — — 1 — — — — — — — — — — — 1 1 Not quiescent — — — — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — — — — 72 TABLE 33. Return showing the extent of Residential Treatment and Observation during the year in Institutions (including Harts Sanatorium) approved for the Treatment of Tuberculosis. In Institutions on Jan. 1 Admitted during the year. Discharged during the year. Died in the Institutions . In- Insti tutions on Dec. 31. (1) (2) (3) (4) (5) Number of doubtfully tuberculous cases admitted for observation Adults m. — 1 1 — – f. — — — — — Children ... — 1 1 — — Total ... ... — 2 2 — — Number of definitely tuberculous patients admitted for treatment Adults m. 44 71 67 9 39 f. 23 47 45 6 19 Children 29 26 33 1 21 Total 96 144 145 16 79 Grand Total 96 146 147 16 79 TABLE 34. RESIDENTIAL INSTITUTIONS (Including "harts" sanatorium). Average Number of Beds Available for Patients during the Year 1931. Observation. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Total. "Sanatorium" Beds. "Hospital" Beds. Disease of Bones and Joints. Other Conditions. Adult Males — 32 7 2 2 43 Adult Females — 15 7 — — 22 Children under 16 ... — 10 — 4 11 25 Total — 57 14 6 13 90 73 TABLE 35. Return showing the extent of Residential Treatment provided during the year in poor Law institutions for Persons Chargeable to the Council. In Institutions on Jan. 1 1931 Admitted during the year. Discharged during the year. Died in the institutions. In institutions on Dec. 31, 1931. Number of patients suffering from pulmonary tuberculosis admitted for treatment Adults M. 8 37 18 21 6 F. 3 29 13 10 9 Children ... — 2 — — 2 Total ... — 11 68 31 31 17 Number of patients suffering from nonpulmonary tuberculosis admitted for treatment Adult* M – 2 1 – 1 F. 2 1 1 — 2 Children ... — — — — — Total ... ... 2 3 2 — 3 Grand Total 13 71 33 31 20 74 TABLE 36 Return showing the immediate results of Treatment of definitely tuberculous patients discharged during the year from institutions approved for the treatment of tuberculosis (including "harts" Sanatorium) Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Grand Totals. Under 3 months. 3-6 months. 6-12 months. More than 12 months. Totals M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Pulmonary Tuberculosis. Class T.B. minus. Quiescent 6 9 1 3 3 3 2 2 4 2 – 2 13 14 10 37 Not quiescent 1 – 1 1 1 – – – 1 – – – 2 1 2 5 Died in Institution – – – – – – – – – – – – – – – – Class T.B. plus. Group I. Quiescent 1 4 – 3 2 – – – – – – – 4 6 – 10 Not quiescent – – – 1 – – – – – – – – 1 – – 1 Died in Institution – – – – – – – – – – – – – – – – Class T.B. plus. Group 2. Quiescent 1 5 – 4 3 – 3 – – 2 – – 10 8 – 18 Not quiescent 5 5 – 10 3 – 5 2 – 4 2 – 24 12 – 36 Died in Institution – – – – – – – – – – – – – – – – Class T.B. plus. Group 3. Quiescent – – – – – – – – – – – – – – – – Not quiescent 3 1 – 2 1 – 2 1 – – 1 – 7 4 – 11 Died in Institution 3 2 – 1 – – 3 3 – 2 1 – 9 6 – 15 TABLE 36—continued. Classification on admission to the Institution. Condition at time of discharge Duration of Residential Treatment in the Institution. Grand Totals. Under 3 months. 3-6 months. 6-12 months. More than 12 months. Totals. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Non-Pulmonary Tuberculosis. Bones and Joints. Quiescent – – – – – 1 2 – 1 1 – 1 3 – 3 6 Not quiescent – – 1 – – – – – – – – 2 – – 3 3 Died in Institution – – – – – – – – – – – – – – – – Abdominal. Quiescent – – 1 1 – – – – – – – 1 1 – 2 3 Not quiescent – – – – – – – – – – – – – – – – Died in Institution – – – – – – – – – – – – – – – – Other Organs. Quiescent 1 – – – – – – – – 1 – – 1 Not quiescent – – – – – – – – – – – – – – – – Died in Institution – – – – – – – – – – – – – – – – Peripheral Glands. Quiescent – – 1 1 – 1 – – 4 – – 6 1 – 12 13 Not quiescent – – – – – – – – – – – 1 – – 1 1 Died in Institution – – – – – – – – – – – 1 – – 1 1 75 76 TABLE 37. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications. Age periods. Formal Notifications. Number of Primary Notifications of new cases of tuberculosis. 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. Pulmonary Males — 1 1 1 5 14 31 23 11 5 3 95 101 „ Females 1 — — 3 12 16 21 13 15 3 – 84 96 Non-pulm. Males — 4 7 4 1 1 5 — — — – 22 23 „ Females – 1 5 4 5 2 5 3 — — — 25 26 Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise 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 — — — 1 — 1 4 4 1 — — 11 „ Females — — 2 1 — 4 1 4 1 2 1 16 Non-pulmonary Males — 1 1 2 — — 1 — — — — 5 ,, Females — 3 — — 2 — — — — — — 5 77 TABLE 37—continued. The source or sources from which above information as to the above-mentioned cases was obtained:— Source of Information. No. of Cases. Pulmonary. Non-pulmonary. Death returns from local Registrars 3 2 transferable deaths from Registrar General 4 1 Posthumous notifications 1 2 "Transfers" from other areas (other than transferable deaths) 18 5 Other sources if any (specify) 1 — Notification Register. Number of cases of Tuberculosis remaining at the 31st December, 1931, on the Registers of Notifications kept by the Medical Officer of Health of the County Borough. Pulmonary Non-pulmonary Total Cases Males Females Total Males Females Total 531 370 901 168 127 295 1,196 Number of cases removed from Registers during the year by reason inter alia of :— 1. Diagnosis not confirmed by T.O. (withdrawal of notification) 4 12 16 — — — 16 2. Recovery from the disease 3 1 4 2 2 4 8 3. Death 60 45 105 8 5 13 118 4. Removals to other areas 30 26 56 15 9 24 80 78 TABLE 38. Notified Cases of Tuberculosis, 1931. 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 1 – – – – – – – – – – – – – – – – – – – 1 1 1 and under 2 – – – – – – – – – – – – – – – – – – – – – 2 – 9 2-3 — – – – – – 1 – 1 – – – – – – – – – – – – 1 – 1 3-4 1 – 1 – – – – 1 1 1 – 1 – – – – – – – – – 2 1 3 4-5 – – – – – – – – – – – – – – – – – – – – – – – – 5-10 1 – 1 1 – 1 1 – – – 1 1 4 4 8 1 – 1 – – – 8 5 13 10-15 1 3 4 – – – – – 2 1 – 1 1 4 5 – – – – – – 5 7 12 15-20 5 12 17 – 1 1 – 1 1 – – – 1 9 3 – 1 1 – – – 6 17 23 20-25 14 16 30 – – – – – – – – – 1 9. 3 – – – – – – 15 18 33 25-35 31 21 52 – 1 1 – – – 3 1 4 – 3 3 9 – 2 – – – 36 26 62 35-45 23 13 36 – – – – – – – – – – – – – 3 3 – – – 23 16 39 45-55 11 15 26 – – – – – – – – – – – – – – – – – – 11 15 26 55-65 5 3 8 – – – – – – – – – – – – – – – – – – 5 3 Over 65 3 – 3 – – – – – – – – – – – – – – – – – – 3 – 3 Totals 95 84 179 1 2 3 6 2 8 5 2 7 7 15 22 3 4 7 — — — 117 109 226 79 TABLE 39. TUBERCULOSIS. New Cases and Mortality, 1931. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulm. Pulmonary. Non- Pulm. M. F. M. F. M. F. M. F. Under 1 year — 1 — — — — — 1 1 — 5 years 1 — 4 1 — — 4 3 5 — 15 „ 2 3 11 9 1 3 1 15 — 25 „ 19 28 2 7 13 17 2 25 — 45 „ 54 34 6 8 28 16 1 — 45 — 65 „ 16 18 — — 14 10 — — 65 and upward ,, 3 — — — — 1 — — Totals 95 84 22 25 55 45 8 7 The ratio of non-notified deaths to total tuberculosis deaths for the year was 1—11. 80 TABLE 40. Occupation and Tuberculosis. Notified Cases and Deaths, 1931. Occupations. Pulmonary. Non-pulmonary. Notifications. Deaths. Notifications. Deaths. M. F. M. F. M. F. M. F. Domestic — 49 — 31 – 8 – 1 Commercial 18 6 12 5 1 4 2 – Industrial 18 10 4 3 4 1 — – Transport 8 — 6 — 1 — – Provision and allied trades 9 3 6 1 — 1 — – Building trades 4 — 6 — — — — – Dock-workers 4 — 4 — — — — – Seamen 4 — 1 — — — — – General labourers 7 — 6 — — — — – School children 3 2 — — 8 9 1 2 Others 20 14 11 5 8 2 5 4 81 TABLE 41. Deaths from Tuberculosis.—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 7 2 2 7 2 4 4 11 23 12 8 5 3 2 1 7 100 Non-pulmonary 3 11 – – – – – 1 — – – – – – – – 15 Total 10 13 2 7 2 4 4 12 23 12 8 5 3 2 1 7 115 82 REPORT ON THE WORK AT THE BOROUGH INFECTIOUS DISEASES HOSPITAL FOR 1931. Dr. Barker reports as follows:— The year 1931 will be remembered in the history of the hospital as a year of transition, a period during which this Institution hav ing provided good service for a number of years, passed from a state of inadequacy both in size and structure to that of a modern well equipped hospital for the treatment of the various types of infectious disease. Although the two new ward blocks were practically completed by the end of 1930 the real difficulty commenced with the demolition of the old administrative buildings. The necessity for housing the nursing and domestic staff and at the same time maintaining the work of the hospital efficiently, called for no little ingenuity and resource. Additions and reconstructions were taking place simultaneously during the earlier months of the year in various parts of the Institution causing much makeshift and inconvenience, but such was met with a cheerfulness, goodwill, and devotion to duty, as was only to be expected of the staff. As will be seen later by a description of the completed hospital the scheme was one of considerable dimensions. It must be evident that a great amount of careful technique and foresight on the part of those responsible, and the Borough Engineer's staff, was required to ensure satisfactory, economical, and easy administration. The equipping of the newly constructed wards and operating theatre, the furnishing of the new administrative building and Nurses Home with its 100 rooms, was by no means a simple task and involved infinite detail. Much labour has been expended in improving the grounds of the hospital—nearly two acres of grass seed have been sown, numerous flower beds and paths provided with the result that the general appearance is now in conformity with that of similar hospitals placed in more advantageous surroundings. Machinery formerly in use in the Laundry for many years has been replaced by the latest type of equipment. General View of Hospital Ward Blocks. New Administrative Block and Nurses' Home. New Cubicle Block with Operating Theatre and New Ward Block (E) in Foreground. Operating Theatre. 83 The opening of the new Administrative Block and Extensions to the Hospital was performed by The Right Hon. Arthur Greenwood, formerly Minister of Health, on 5th December, 1931. The Worshipful the Mayor (Alderman C. W. Blading, J.P.) presided, accompanied by the Mayoress and members of the Council. The additions and reconstructions were carried out by direct labour under the supervision of the Works Committee (Chairman, Alderman G. Manser, J.P.) and A. T. Bridgewater, Esq., F.S.I., Borough Engineer. A description is given herewith, viz.:— Block A. The building consisting of two wards and separation rooms has been redecorated throughout and a verandah with glass roof provided. This has necessitated alterations to permit of the beds being wheeled out, and the electrical wiring has been renewed and more modern lighting installed. Block B. This Cubicle Block which has been in use for many years remains as heretofore. Block C. This is a two storey building, the upper floor of which formerly housed the nursing staff: the partitions have been removed and altered into two wards which are used for cases of Acute Scarlet Fever. The lower floor, also of two wards is available for the more convalescent patients. Access is obtained to a covered verandah by wide doors leading from the wards. An hydraulic lift permits of easy transference of patients, and for other purposes. A water tower has been added to ensure adequate circulation throughout the whole of the Institution by means of the low pressure hot water system connected with three boilers placed in a portion of the basement. Additional pumps driven by electric power maintain an equable temperature. Wide emergency exits have been arranged at each end of the building. Block D. A new Block comprising 14 cubicles or separate rooms for the nursing of different and complicated cases of illness; that is for 84 those who for some reason cannot be admitted to the general ward. If required, the accommodation can be increased to 20 patients. The Operating Theatre is situated at the end of the building and is equipped for general use as well as the specialised needs of the hospital. Adjoining the Theatre is a sterilising room fitted with electrical requisites and apparatus for rendering dressings aseptic. The table is of stainless steel and an excellent operating light is obtained by means of an adjustable shadowless lamp. A special cubicle connected with the Theatre by a covered way is used as an anaesthetic room, or for the reception of the patient. Block E. As previously mentioned this consists of two wards of 10 and 12 beds respectively with two separation rooms adjoining' for special cases. This block is used for patients suffering from acute Diphtheria. On both sides there is a verandah, glass covered on the south-eastern aspect, the wards are light and lofty, suitably decorated and have numerous power points for steam kettles, etc. Sanitary blocks at each end are roomy, well ventilated, and contain modern equipment for the disinfection of articles and utensils. The ward kitchen, as else where, is fitted with sterilising plant for crockery, etc., linen and store rooms adjoin. The entrance hall permits easy transference of patients from the ambulance under cover. Administrative Block and Nurses Home. This consists of a main block of three storeys comprising the following rooms:— Ground Floor.—Matron's Flat. Recreation rooms for Sisters, Staff Nurses, and Probationers. Domestic Staff Recreation Room. Dispensary and Laboratory. General Office and Waiting Room. Lecture Room. Medical Superintendent's Room. First Floor.— Sisters' Bed-sitting Rooms. Nursing Staff Bedrooms. 85 Second bloor.—Bed-sitting and other bedrooms for Domestic Staff. Night Nursing Staff Quarters at Western end divided off to ensure quietness during daytime. All bedrooms contain fixed washing basins with hot and cold water supply and also fitted wardrobes. Each member of the Nursing and Domestic Staff has a separate bedroom. Bathrooms, cloak rooms and lavatories are situated on each floor—those on the ground floor to enable the Staff to deposit cloaks, etc., without the necessity of entering bedrooms except when off duty. Connected with the main block by means of a covered passage way are the dining rooms for the nursing and domestic staff, with pantry adjoining. The newly constructed kitchen is in close proximity, the serving hatch of which permits of the efficient delivery of meals witVi much saving of labour. Beyond this portion of the building are the various stores for groceries, dry goods, earthenware, etc., and mattresses, also the refrigerator. From outside, entrance is obtained to the Porter's Room and other stores. A hut has been erected in a central position to provide accommodation as gardener's shed, vegetable and wood store, carpenter's shop, etc. In conclusion it may be stated that the layout of the Institution permits of easy access to the blocks from the administrative building. The verandahs attached to the various wards are a great acquisition in the treatment of patients on modern lines. The Hospital is a recognised training school for Nurses who are prepared for the examinations by the Medical Superintendent and Resident Sister Tutor. The results during 1931 were very satisfactory. The majority of candidates having obtained the Fever Certificate, enter general hospitals. Diphtheria. During the year 191 patients were admitted to the Hospital as compared with 452 for the previous year. Of this number 150 were faucial, 18 laryngeal, and 23 nasal and faucial. In addition 42 patients remained under treatment at the end of 1930. 86 Despite the comparatively low incidence of the disease many cases were of extreme severity, and it was not an uncommon occurrence to admit a patient in a grave condition who had been suffering for some days without the serious nature of the malady being recognised. This is more likely to occur when few cases are coming under notice and the attention of the public is not focussed on a prevailing epidemic. The age incidence was as follows, viz.:— Years 0-5 5-10 10-15 15 upwards. 70 70 24 27 Of the total cases receiving treatment the number of deaths was 17, giving a mortality rate of 7.2 per cent. as compared with 3.3 per cent. for last year. Three cases upon admission were found to be suffering from hemorrhagic diphtheria, a fatal form of the disease. Tracheotomy was performed on 7 occasions. It was necessary to give large amounts of Antitoxin in certain cases and 26 patients received from 50,000 to 100,000 units. In many instances in order to afford immediate benefit the administration was carried out intravenously. A combination of Antistreptococcic Serum and Diphtheria Antitoxin is administered to those patients in whom septic conditions are pronounced and such was given with considerable benefit in 24 cases. Severe complications of recovery cases were as follows, viz.:— Paralysis 9 Cardiac Vomiting 5 Otitis Media 2 Broncho-pneumonia 1 Myocarditis 5 Scarlet Fever. The number of cases admitted during the year was 160 as compared with 229 for 1930. Owing to lack of accommodation at certain times it was impossible to accept for treatment every case occurring in the borough. Where home conditions, however, indicated possible further infection of persons in the house or adjoining premises, every effort was made to provide a bed, and other cases were admitted at the earliest moment. 87 The number of patients treated with Scarlet Fever Antiserum totalled 42. These cases were generally those exhibiting severe toxicity or where septic complications appeared imminent. Some assistance is otherwise afforded by this treatment in that the period of infectivity is lessened, and consequently the length of stay in hospital reduced, and there is also probably a diminished likelihood of patients becoming infectious again should catarrh of the respiratory passages supervene after discharge. Such is a frequent cause of "return" cases, that is, new outbreaks of the illness arising a week or more after the return home of the original patient. One death occurred from sequelae of Scarlet Fever after a considerable interval had elapsed. The case mortality being 0.5 per cent as compared with 0.4 per cent. for the previous year. The illness varied much in severity but generally speaking was of the milder type. The age incidence was as follows, viz.:— Years 0-5 5-10 10-15 15 upwards. 42 66 23 29 Complications sufficiently serious to note— Double Adenitis Cardiac Arrythmia 11 Nephritis 2 Otitis Media (severe) 12 Mastoid Abscess 2 Thrombosis lateral sinus 1 It will be seen by a consideration of statistics here given that many cases of infectious illness other than Diphtheria and Scarlet Fever have been admitted, and thereby greater use has been made of the services of the hospital. Those presenting serious complications in cases of nonnotifiable infectious disease, such as Broncho-pneumonia following Measles and Whooping Cough have derived much benefit. Efficient nursing and methods of treatment rarely possible in the home are available in such cases, and it is not too much to say that the patients' recovery would have been jeopardised had such not been provided. 88 This is certainly an advance in the right direction as regards increasing; the usefulness of the hospital, although needless to add only cases of severity can be admitted and those only at a time when the incidence of Diphtheria and Scarlet Fever permits. General. Except for a series of cases of "Hospital" Sore Throat the health of the Staff has been particularly satisfactory. All members of the Nursing and Domestic Staff are tested for susceptibility to Diphtheria and Scarlet Fever and immunisation is offered to those reacting positively. Borough Infectious Diseases Hospital. Disease Remaining at end of 1930 Admitted during 1931 Discharged during 1931 Died during 1931 Remaining at end of 1931 Scarlet fever 19 160 155 1 23 Diphtheria 42 191 200 17 16 Diphtheria and scarlet fever — 1 — — 1 Cerebro-spinal Meningitis — 1 — 1 — Chicken Pox — 1 1 — — Enteric Fever — 3 3 — — Erysipelas — 7 4 2 1 Rubella — 1 1 — — Scarlet Fever and Whooping Cough — 1 1 — — Septic Throat 1 1 2 — — Streptococcal Infection — 1 1 — — Whooping Cough — 2 2 — — Whooping Cough and Bronchitis — 1 1 — — Whooping Cough and Pneumonia — 4 2 1 1 Measles with complications — 15 5 — 10 Pneumonia — 1 — 1 — 62 391 378 23 52 89 BOROUGH INFECTIOUS DISEASES HOSPITAL. Year ended 31st March, 1932. Expenditure Cost per Patient per week. £ s. d. Salaries and Wages 4,959 37 5 Superannuation 139 1 0 Provisions 2,240 17 0 Anti-toxin 339 2 7 Disinfectants, Drugs and Appliances 306 2 4 Coal, Coke and Firewood 815 6 2 Electricity, Gas and Water 935 7 1 Furniture, Bedding and Linen 361 2 9 Uniforms and Dresses 180 1 4 Chandlery and Sundries 425 3 3 Crockery and Hardware 93 0 8 General Repairs 979 7 8 Garden Implements, Seeds, etc. 108 0 10 Maintenance and Upkeep of Ambulances 503 3 11 Printing, Stationery and Advertisements 128 1 0 Rent of Telephones 61 0 5 Rates, Taxes and Insurance 286 2 3 Motor Vehicle Reserve 100 0 9 £12,957 98 5 90 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 clauses of this Act were set out in the report for 1930. Staff. The staff of the Centre at present consists of the Assistant Medical Officer in charge, one temporary part-time Medical Officer, seven Health Visitors, three Clerks and one St. John's Ambulance Nurse who attends five clinics per week. Infant Welfare Clinics. Times and places at which Infant Welfare Clinics are held are shown on page 31. There are seven of these clinics held weekly. At five two Doctors and two Health Visitors attend, at the remaining two one Doctor and one Health Visitor are present. Assistance is also given by one voluntary worker. Owing to the increasing number of attendances of infants at the centres it was found necessary to make arrangements for a St. John's Ambulance Nurse to attend five sessions per week in order to relieve the Nursing Staff. To obviate overcrowding arrangements have been made for extra accommodation at the following Infant Welfare Centres:— Masterman Road. Plashet Grove. Manor Park. Attendances at Infant Welfare Clinics:— Number of general clinics held during the year 346 Number of individual children who attended the clinics 3,820 Total number of attendances 26,256 Total number of children who attended the clinic for the first time during the year— 1. Children under 1 year 1,190 2. Children between the ages of 1—5 years 550 91 Number of medical consultations at general clinics 13,607 Number of medical consultations at special clinics 776 Total number of visits to all Infant Welfare Clinics 27,032 The daily average attendances at the clinics were as follows:— Central Clinic, Monday afternoon 73 Manor Park, Tuesday morning 96.2 North Woolwich, Tuesday afternoon 20.2 Masterman Road, Wednesday afternoon 99.4 Central Clinic, Thursday morning 59.1 Plashet Grove, Thursday afternoon 76.1 Plashet Grove, Friday afternoon 114 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 86, compared with 73 in 1930. During 1931, 3,820 children attended the centres, an increase of 97 on the previous year. The total attendances of infants from 0—5 increased from 22,265 in 1930, to 26,256 in 1931, an increase of 3,991 over 1930. The highest average attendances per session were recorded at Plashet Grove (Friday) 114, Masterman Road 99.4, and Manor Park 96.4. As stated in the Annual Report of 1930, owing to such large numbers attending the centres, the organisation of the clinics is becoming increasingly difficult, and though it indicates the appreciation of the mothers, the existing conditions jeopardise the maintenance of a high standard of efficiency. It is a matter of considerable regret that it has not been found expedient to increase the number of clinics, or establish Toddlers' Clinics, thus relieving the congestion which at present exists. 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 92 children. Mothers are encouraged to bring their children for periodical medical examination so that defects and incipient disease can be treated in the early stages. 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 1931, 213 children received operative treatment, as compared with 187 in 1930. Ringworm. No cases of Ringworm of the scalp were referred to the X-ray Department for radical treatment. Dental Treatment. Mothers and children referred from the Maternity and Child Welfare Centres are treated by the School Dentist, two afternoons in each week being set apart for this purpose. 67 mothers and 259 infants were referred to the dental department during 1931. 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 treatment are seen at the special clinic each week by the School Ophthalmic Surgeon. During 1931, 73 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. Aural Treatment. Aural cases requiring special treatment are referred to the School Aural Surgeon. 93 During the year 1931, 7 patients received treatment at the School Aural Clinic. Treatment by Artificial Sunlight. Two sessions weekly have been held until May of this year for the purpose of giving Ultra Violet Ray treatment by means of the Arnold Alpine Sunlight Radial Arc Lamp. As already stated in last year's report the conditions under which this form of treatment is carried out is by no means satisfactory for children under five years of age, as the rooms are required for use by the School Medical Service, and, therefore, the time allotted to the Maternity and Child Welfare Department is necessarily limited, taking also into consideration other adverse circumstances it was deemed advisable to discontinue the Sunlight Clinic until the new clinic in Manor Park is opened when satisfactory arrangements can be made for giving this particular form of treatment. The statistics for 1931 are as follows:— Number of Light sessions held 36 Number of attendances at these sessions 876 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. Special Morning Clinics are held at:— The Central Clinic, High Street School, on Monday and Wednesday, at 10 a.m. The statistics for 1931 are as follows:— Number of medical consultations 776 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. 94 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 1931 were 21,838, as compared with 18,804 in the previous year. Visits to infants under one year of age 10,121 Visits to children over one year of age 11,045 Visits to Tonsils and Adenoid cases 123 Visits to Ante-natal cases, first visits 206 Visits to Ante-natal cases, revisits 31 Visits to Foster Mothers 150 Special visits not included in above group 162 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 homes under the Notification of Births Act. 2. Home visiting of children up to 5 years of age. 3. Home visiting of pre-schoo1 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. (b) Ophthalmia Neonatorum. (c) Puerperal Fever and Pyrexia. (d) Visits to Tonsils and Adenoid Cases. (e) Pneumonia. (f) Infantile Diarrhcea. (g) Other special visits. 95 Still Births. The number of still births registered during the year was 72. The proportion of still births to live births was as 1 to 28.4. The still birth rate was 3.5 per cent, of the registered live births. On investigation it was found that in 67 cases the months of pregnancy at which the still births took place were as follows :— 7th month 10 8th month 12 9th month 45 An analysis of the causes to which the still births were attributable will be found in the following table :— Malpresentation 7 Prolonged labour 4 Excessive size of Foetus (including post maturity) 2 Prolapse of cord 2 Cord coiled round Foetus 3 Ante-partum hæmorrhage 4 Albuminuria 3 Hydrocephalus 1 Prematurity 14 Causes unknown 32 Ante-natal Work. An Ante-natal Clinic is held at :— The Central Clinic, High Street School, on Friday at, 10 a.m. During the year the following attendances were recorded Number of new cases 192 Subsequent attendances 369 Total number of attendances 561 Average attendance of expectant mothers per session 11.6 Number of patients referred to Dental Clinic 43 The following table gives an analysis of the pre-maternal cases found to be slightly or seriously abnormal:— Contracted pelvis 5 Albuminuria 15 96 Hyperemesis gravidarum 4 Ante-partum haemorrhage 2 Malpresentation 5 Cervicitis 9 Valvular disease of heart 4 Varicose veins 9 Phlebitis 1 Haemorrhoids 4 Anaemia 4 Bronchitis 3 Pulmonary tuberculosis 1 Dyspepsia 14 Constipation 28 Inguinal hernia 1 It is satisfactory to note that during this year a larger number of cases attending the Ante-natal Clinic were sent by midwives, but I would again urge the necessity of midwives taking more advantage of the Clinic, and bringing their cases for medical examination and advice, for though many midwives carry out ante-natal supervision with care and accuracy, conditions may be present or develop which can only be discovered by medical examination. The detection and treatment of these conditions would minimise many dangers and prevent avoidable difficulties at the confinement, thus safeguarding both mother and child. Expectant mothers are visited by the Health Visitors in their homes and given advice regarding arrangements for confinement and general hygiene of the mother. The following-up of cases also ensures regular attendance at the Clinic. During 1931, 237 visits were paid to expectant mothers. Maternity Accommodation. Under the provisions of the Maternity and Child Welfare Act, 1918, empowering Local Authorities to make arrangements for the institutional treatment of complicated midwifery cases, and for women whose homes are unsuitable for their confinement, the East Ham County Borough Council have arrangements for the 97 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 1931 three were referred to Queen Mary's Hospital, and 27 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, and 1926. 56 midwives notified the Local Supervising Authority of their intention to practice within the Borough during 1931. Of these 38 worked in connection with the Maternity Hospital and District Nurses' Home, Plaistow, and its branches, 5 at the Sir Henry Tate Nurses' Home, Silvertown, and 13 practised independently. 39 visits of inspection were made by the Inspecting Medical Officer during the year. The revised rules of the Central Midwives' Board for 1927 require all certified midwives to keep ante-natal records or send their cases to an Ante-natal Clinic. There is a marked improvement in the keeping of case records and ante-natal records, although in some cases they are still unsatisfactory. The personal cleanliness of the midwives and condition of their homes was satisfactory. Visits have been paid as required to one registered Nursing Home in the district. 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. 98 During the year help was obtained in 223 cases as follows :— Mother— Ruptured perineum 55 Prolonged labour 46 Ante-partum haemorrhage 2 Post-partum haemorrhage 4 Retained Placenta 7 Rise of temperature 13 Malpresentations 3 Extended breech 3 Inflammation of breasts 1 Phlebitis 4 Albuminuria 2 Other causes 33 173 Child- Prematurity and dangerous feebleness 16 Unsatisfactory condition of infant 11 Deformities 1 Discharging eyes 12 Still-birth 1 Skin eruptions 4 Other causes 5 50 Puerperal Fever and Puerperal Pyrexia. Four cases of Puerperal Fever and 6 cases of Puerperal Pyrexia were notified during the year under the Regulations of 192C 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 Puerperal Fever case rale was 2 per 1,000 births and the Puerperal Pyrexia case rate 3 per 1,000 births. 99 The death rate for Puerperal Fever was 2.93 per 1,000 live births. Maternal Mortality. There were 8 deaths associated directly with pregnancy. The maternal mortality rate was, therefore, 3.90 per 1,000 live births compared with 3.5 per 1,000 in 1930. Ophthalmia Neonatorum. During 1931, 6 cases of Ophthalmia Neonatorum were notified. For table giving result of treatment, see page 49. Ophthalmic Neonatorum includes all cases of inflammation of the eyes of new-born babies, however slight, coming on within 21 days after birth. Under the Ophthalmia Neonatorum Regulations, 1926, every effort is made to control and eradicate this disease. Since it came into force, the number of cases notified to the Local Authority have decreased ; by these regulations midwives can no longer notify, but are 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. Arrangements for the Supply of Free Milk. In accordance with the terms under the Milk (Mothers and Children) Order, assistance is granted to expectant mothers during the last three months of pregnancy, nursing mothers, and children under three years of age. The " free " assistance given is one pint of milk per day, or its equivalent in dried milk. The total amount spent on milk during 1931 was £1,229. In every case careful investigation of the family circumstances is made to ensure that only necessitous cases shall receive this benefit. Voluntary Associations. Appreciation and thanks are again gratefully accorded to the Invalid Children's Aid Association for their co-operation with the Maternity and Child Welfare department, and help in arranging Convalescent Home treatment for delicate children. 100 Co-ordination. There is considerable co-ordination between the Maternity and Child Welfare work of the Borough and other Departments of the Public Health Service. The records of children on reaching the age of five years are sent to the School Medical Department for information regarding entrants to school life. Expectant and nursing mothers and young children requiring dental treatment, are referred to the School Dental Surgeon from the Infant Welfare Clinics. Ophthalmic cases are referred to the School Ophthalmic Surgeon. 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 referred to the Tuberculosis Officer. Aural cases are referred to the School Aural Surgeon. The use of the public ambulance is granted, when required, to convey expectant mothers to the maternity wards of hospitals. Financial investigations into the circumstances of parents applying for grants of milk, etc., are referred to the Financial Officer. Premises found in an insanitary condition by Health Visitors are reported to the Senior Sanitary Inspector for further investigation and such action as he may find desirable. Maternity and Child Welfare. Return (1) 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 1931. 1. Population of the area served by the Council : 142,800 (estimated middle 1931). 2. Number of births notified in that area during the year under the Notification of Births Act, 1907, as adjusted by any transferred notifications : (a) Live births, 1,947 ; (b) Still births, 72 ; (c) Total, 2,019 ; (d) By midwives, 851 ; (e) By doctors and parents, 1,168. 101 3. Health Visiting. (i) Number of officers employed for health visiting at the end of the year :— (а) by the Council, 7. (б) by Voluntary Associations, Nil. (ii) Equivalent of whole-time services devoted by the whole staff to health visiting (including attendance at Infant Welfare Centres):— (а) 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 :— (а) To expectant mothers—First visits, 206 ; total visits, 237. (б) To children under 1 year of age—First visits, 2,004 ; total visits, 10,121. (c) To children between the ages of 1 and 5 years—Total visits, 11,045. 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 :— (i) By children under 1 year of age 16,221. (ii) By children between the ages of 1 and 5 years, 10,035. (d) Average attendance of children per session at all centres during the year, 76.5. One centre has an average attendance of 20.2— excluding this centre the average attendance per session at all centres is 86. (e) Total number of children who attended at the centres for the first time during the year :— (i) Children under 1 year of age, 1,190. (ii) Children between the ages of 1 and 5 years, 550. (f) Percentage of total notified (live and still) births represented by the number in (e) (i), 61-1%. 5. Ante-natal clinics (whether held at Infant Welfare Centres or at other premises) :— (а) 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, 561. (d) Average attendance of expectant mothers per session at all clinics during the year, 11.6. (e) Total number of expectant mothers who attended at the clinics during the year, 192. (/) Percentage of total notified births (live and still) represented by the number in (c) 9.5%. 6. Number of women (if any) sent by the Council during the year to Maternity Institutions, 96. 102 7. Infectious Diseases. Disease. Number of cases notified during the year. Number 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 6 6 - 1 (2) Pemphigus Neonatorum - - - - (3) Puerperal fever 4 4 - 4 (4) Puerperal pyrexia 6 6 - 4 (5) Measles and german measles (in children under 5 years of age) - - - - (6) Whooping Cough (do.) - - - - (7) Epidemic diarrhoea (do.) - - - - (8) Poliomyelitis (do.) 1 1 - 1 8. Midwives. (a) Number practising in the area served by the Council for maternity and child welfare at the end of the year, 56. (b) Number (i) employed by the Council, Nil. (ii) directly subsidised by the Council, Nil. (iii) employed by Voluntary Associations, 43. (c) Number of cases attended by midwives during the year :— (i) as midwives, 851. (ii) as maternity nurses, 18. (d) Number of cases during the year in which the Council paid or con tributed to the fee of a midwife, Nil. 9. 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, 6. (ii) from other causes, 2. (b) Number of these cases which died :— (i) at home, 0. (ii) in institutions, 8. 103 Maternity and Child Welfare. Return relating to the Administration of Part L of the Children Act, 1908, during the Year 1931. I. Notification :— (i) Number of foster parents on the Register :— (а) at the beginning of the year, 36. (b) at the end of the year, 44. (ii) Number of children on the Register:— (а) at the beginning of the year, 50. (b) at the end of the year, 54. (c) who died during the year, 1. (d) on whom inquests were held during the year, Nil. II. Visiting:— (i) Number of Visitors holding appointments under Section 2 (2) at the end of the year:— (a) Health Visitors, 7. (b) Female, other than Health Visitors, Nil. (c) Male, Nil. (ii) Number of persons or societies authorised to visit under the proviso to Section 2 (2), 7. III. Number of cases (if any) in which proceedings under Sections 1-8 were taken during the year, Nil. IV. Number of cases in which the local authority has given a sanction under Section 3 during the year, Nil. V. Number of orders under Section 5 obtained during the year, Nil. PROPAGANDA. During 1931 propaganda has been carried out by means of leaflets, posters, articles and advertisements. Advice on the following diseases was given by the methods outlined above:— Diphtheria (Immunization Clinic). Cancer. Small-pox. Measles. During the year under review, a number of lectures have been given by Dr. Barker and myself, on health matters, to different organisations in the Borough. 104 TABLE 41. METEOROLOGICAL RECORD—YEAR 1931. Rain Gauge 5.in. in diameter, placed 1.foot above ground, 15 feet above sea level. Temperature taken in the shade of a Stevenson's Screen, 5 feet from the ground. Months. Temperature of Air during the Month. Mean Temperature of Air. Rainfall. Highest Maximum. Lowest Minimum. Mean of No. of Days on which Rain fell, 0.01 and over. Amount collected in inches. Mean rate of fall for Rainy Days. Greatest fall in 24 hours. Date of greatest fall. All Highest. All Lowest. January 53° 46° 44.1° 35.3° 39.7° 16 1.15 0 .07 0.17 23rd February 56° 48° 45.4° 34.5° 40.0° 15 1.59 0.11 0.38 27 th March 67° 22° 47.6° 33.8° 40.7° 5 0.22 0.04 0.08 9th & 22nd April 65° 49° 54.3° 41.6° 47.9° 17 3.43 0.20 0.42 19th May 72° 40° 61.8° 47.3° 54.5° 11 2.54 0.23 0.87 3rd June 78° 45° 68.5° 53.6° 61.0° 11 1.34 0.12 0.55 5th July 77° 49° 69.0° 55.9° 62.2° 11 2.46 0.22 0.69 14th August 77° 44° 67 .5° 53.7° 60.6° 19 3.85 0.20 0.71 14th September 70° 39° 61.1° 38.5° 49.8° 16 1.44 0.08 0.43 3rd October 68° 27° 57.2° 43.7° 50.5° 7 0.68 0.10 0.35 6th November 63° 33° 51.9° 42.1° 47.0° 17 2.18 0.13 0.53 6th December 60° 27° 46.9° 38.8° 42.8° 9 0.75 0.07 0.23 28th Means and Totals for the Year. 78° 22° 56.3° 43.2° 49.7° 154 21.63 0.13 0.87 3rd May The Rainfall for the Year was 3.86 ins. below, and the number of days on which rain fell 14 below the year 1930, at East Ham. 105 REPORT OF THE CHIEF SANITARY INSPECTOR ON THE WORK PERFORMED BY THE SANITARY INSPECTORS FOR THE YEAR 1931. To the Medical Officer of Health. Sir, In accordance with the Ministry of Health Regulations 1 beg to report on the sanitary work carried out by the Sanitary Inspectors during the year 1931. 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. Temporary help has also occasionally been engaged during the year to assist in disinfection in Small Pox cases. As there has been no material alteration in the Sanitary circumstances of the Borough I do not feel that I can profitably re-write my notes thereon. These items are therefore, largely a reprint from last year. The tables are, of course, corrected to date and form a summary of the monthly reports submitted to the Public Health Committee. I am, Sir, Your obedient servant, GEORGE D. LILL. 106 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. No complaint was received during the year of unwholesome water. 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 1931. 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. 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. 107 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 Total January 399 613 1.012 February 329 694 1,023 March 375 775 1,150 April 312 597 909 May 364 660 1,024 June 546 472 1,018 July 429 458 887 August 398 371 769 September 333 589 922 October 453 723 1,176 November 392 620 1,012 December 487 298 785 Total for Year 4,817 6,870 11,687 Small Pox Contacts. In addition to the foregoing inspections, 579 special visits were paid in connection with small pox contacts. Lettings. Also 60 inspections were made in connection with houses vacated by tenants occupying Council flats. 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 6,870 house-to-house inspections for the year 1931, as compared with 4,933 for the previous year. At 71.6 per cent. of these visits sanitary defects were found. 108 TABLE SHOWING INSPECTIONS MADE IN EACH WARD PER MONTH. Month Manor Park Little Ilford Woodgrange Plashet Kensington Castle Central Wall End (Greatfield South Total Ord. H to H. 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. Old. H. to H. Ordinary Home to House January 90 — 46 148 38 80 39 95 18 - 31 43 39 — 33 131 13 55 52 61 399 613 February 78 — 33 40 15 94 32 134 19 78 25 9 33 152 30 82 21 96 43 9 329 694 March 67 1 57 99 50 81 25 133 29 92 17 51 35 70 35 108 15 95 45 45 375 775 April 51 — 25 140 41 73 26 36 20 21 22 59 34 56 25 106 13 34 55 72 312 597 May 53 — 35 50 58 31 2 33 117 30 106 26 128 31 138 22 97 53 14 364 660 June 61 — 55 — 42 30 47 37 47 94 48 38 87 111 69 95 21 61 69 6 546 472 July 69 35 38 — 47 33 36 117 50 30 17 18 55 105 45 40 27 80 45 — 429 458 August 64 24 39 — 49 8 41 1 29 67 19 53 35 23 31 105 32 89 59 1 398 371 September 65 68 32 — 55 29 32 12 34 125 17 76 24 48 22 107 19 104 43 20 333 589 October 71 90 50 — 47 120 50 60 53 133 26 76 48 131 20 — 30 107 58 6 453 723 November 61 111 52 — 45 62 34 84 28 114 21 47 32 95 31 13 18 85 70 9 392 620 December 88 29 77 — 72 12 23 — 63 67 11 59 38 60 30 6 24 65 61 — 487 298 808 358 539 427 551 680 416 711 423 938 284 635 486 979 402 931 255 968 653 243 4,817 6,870 109 COMPLAINTS RECEIVED FOR 1931. Manor Park Little Ilford Woodgrange Piashet Kensington Castle Central Wall End Greatfield South Total January 13 21 14 20 14 11 28 13 6 10 150 February 15 21 10 17 8 16 19 4 6 12 128 March 12 17 4 13 4 11 24 9 — 14 108 April 12 14 12 10 8 7 22 16 2 8 111 May 15 18 20 16 10 10 17 16 8 14 144 June 16 11 17 10 11 21 24 23 10 22 165 July 9 25 11 13 17 14 20 17 8 16 150 August 16 29 15 28 14 7 20 15 12 25 181 September 12 14 8 13 17 10 26 14 7 17 138 October 16 8 8 16 9 9 14 14 5 10 109 November 9 24 11 13 17 12 19 12 7 12 136 December 9 16 7 16 8 8 11 7 2 16 100 154 218 137 185 137 136 244 160 73 176 1,620 Nuisances. As a result of the inspections shown in the foregoing tables 25,379 nuisances were discovered. A detailed list is given in the inset table, page 127. To secure abatement the following notices were served :— 1930. 1931. Preliminary 5,132 5,865 Statutory 1,573 1,098 6,705 6,963 110 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 1931 471 1,149 1,620 For detailed table see page 109. Notices Complied with during the year ended 31st December, 1931 :— District No. 1 No. 2 No. 3 No. 4 No. 5 Total Complied 873 1,358 1,240 1,663 1,367 6,501 Notices Outstanding at 31st December, 1931 :— District No. 1 No. 2 No. 3 No. 4 No. 5 Total Informal 286 160 248 328 200 1,222 Statutory 25 13 76 79 140 333 Rent Restrictions (Notice of Increase) Act, 1923. Nine applications were made by tenants for certificates under this Act. Two were granted, in one case the work was carried out before my visit, and in the remaining six 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, 111 PROSECUTIONS UNDER THE PUBLIC HEALTH ACT FOR THE YEAR 1931. Date. Situation of premises. Offence. Result. January Wall End Road Non-compliance with sanitary notice Withdrawn * 3s. 6d. costs January do. do. Withdrawn 3s. 6d. costs February Parkhurst Road do. Withdrawn 3s. 6d. costs February do. do. Withdrawn 3s. 6d. costs February Grantham Road do. Withdrawn 3s. 6d. costs February do. do. Withdrawn 3s. 6d. costs February Stanley Road do. Withdrawn 3s. 6d. costs February Welstead Road do. Order 14 days Fine £2 February do. do. Order 14 days Fine £2 March Mountfield Road do. Withdrawn † without costs on account of age April Johnstone Road do. Withdrawn 3s. 6d. costs April do. do. Withdrawn 3s. 6d. costs April do. do. Withdrawn 3s. 6d. costs April do. do. Withdrawn 3s. 6d. costs April do. do. Withdrawn 3s. 6d. costs April do. do. Withdrawn 3s. 6d. costs April do. do. Withdrawn 3s. 6d. costs April do. do. Withdrawn 3s. 6d. costs April do. do. Withdrawn 3s. 6d. costs April do. do. Withdrawn 3s. 6d. costs April Norman Road do. Withdrawn 3s. 6d .costs Note.— * In all cases of withdrawal as shown, the defendants admitted the insanitary condition, and where the work was not completed at the time of hearing, asked for an extension of time. All summons shown in this table were satisfactorily disposed of before the end of the year. † This was a case of an aged M.D. who was subsequently removed to a home. 112 PROSECUTIONS UNDER THE PUBLIC HEALTH ACT FOR THE YEAR 1931—continued. Date. Situation of premises. Offence. Result. April Norman Road Non-compliance with sanitary notice Withdrawn 3s. 6d. costs April do. do. Withdrawn 3s. 6d. costs April do. do. Withdrawn 3s. 6d. costs April do. do. Withdrawn 3s. 6d. costs May Goldsmith Avenue .. do. Order 14 days Fine £2 May Mountfield 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 July Halley Road do. Withdrawn 3s. 6d. costs July do. do. Withdrawn 3s. 6d. costs July do. do. Withdrawn 3s. 6d. costs July Telham Road do. To be amended July Caledon Road do. Withdrawn 3s. 6d. costs July do. do. Withdrawn 3s. 6d. costs July do. do. Withdrawn 3s. 6d. costs July do. do. Withdrawn 3s. 6d. costs July do. do. Withdrawn 3s. 6d. costs July do. do. Withdrawn 3s. 6d. costs July do. do. Withdrawn 3s. 6d. costs September Colston Road do. Withdrawn 3s. 6d. costs September do. do. Withdrawn 3s. 6d. costs September do. do. Withdrawn 3s. 6d. costs September Watson Avenue do. Withdrawn 3s. 6d. costs October ... Bonny Downs Road do. Withdrawn 3s. 6d. costs October ... Grantham Road do. Withdrawn 3s. 6d. costs 113 PROSECUTIONS UNDER THE PUBLIC HEALTH ACT FOR THE YEAR 1931—continued. Date. Situation of premises. Offence. Result. October Grantham Road Non-compliance with sanitary notice Withdrawn 3s. 6d. costs October do. do. Withdrawn 3s. 6d. costs November Bonny Downs Road do. Withdrawn 3s. 6d. costs November do. do. Withdrawn 3s. 6d. costs November do. do. Withdrawn 3s. 6d. costs November do. do. Withdrawn 3s. 6d. costs November do. do. Withdrawn 3s. 6d. costs PROSECUTIONS UNDER THE SALE OF FOOD AND DRUGS ACT FOR THE YEAR 1931. Date. Offence. Result. — NIL. — Smoke Abatement. There are few factories in the Borough and no serious complaint of smoke nuisance has been received during the year. My attention has been drawn verbally to two cases where there was an emission of black smoke. Upon investigation it was found to be due to careless stoking. In both instances the stokers were seriously cautioned as to the result of any further dereliction. For the last quarter no complaint was received and it is hoped that this satisfactory condition will be maintained. In the large summary table appended hereto it will be found under item " smoke nuisance " that no fewer than eighty-five nuisances have been scheduled under this heading. These refer nearly entirely to smoke nuisances arising from defective kitchen ranges or other stoves. I find that this is misleading to a stranger reading the report. I have, therefore, had the analysis sheet 114 altered to show definitely which are nuisances from factories and those which cannot be dealt with under smoke abatement but under Section 91 of the Public Health Act, 1875. 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 22-23. Other Sanitary Conditions. The Council own and maintain the following Parks and Open Spaces :— Acres. Central Park 25 Plashet Park 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). Jews' Cemetery (Greatfield). St. Mary the Virgin Churchyard. St. Mary Magdalene Churchyard. With a total acreage of 278 acres. 115 No complaint was received during the year of improper burials, but complaint was received as to the neglected condition of one cemetery which was remedied after interview with the Superintendent. Rag Flock Act. There are no premises in the Borough at which Rag Flock is manufactured. Three shops use a small quantity of material for upholstering furniture. Upon examination it was found that much of this stuffing is not Rag Flock. I have taken this matter up with the National Federation of Bedding and Allied Trades, Ltd., and hope to be able to report satisfactorily at a later date. 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 172 (ii) By other Local Authorities — (iii) By other bodies and persons 196 116 (b) With State assistance under the Housing Acts : (i) By the Local Authority 172 (a) For the purpose of Part II. of the Act of 1925 — 1. Inspection of Dwelling Houses during the year:— 1. (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 10,196 (b) Number of inspections made for the purpose 10,196 2. (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 Nil. (b) Number of inspections made for the purpose 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 7,267 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 5,390 3. Action under Statutory Powers during the Year:— A.—Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (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. B.—Proceedings under Public Health Acts :— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 5,865 117 (2) Number of dwelling houses in which defects were remedied after service of formal notices :— (a) By owners 1,111 (b) By Local Authority in default of owners Nil. C.—Proceeding's under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which Demolition Orders were made Nil. (2) Number of dwelling houses demolished in pursuance of Demolition Orders Nil. D.—Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or ground rooms in respect of which Closing Orders were made Nil. (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil. E.—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. F.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925:— (1) Number of dwelling houses in respect of which Closing Orders were made Nil. (2) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit Nil. (3) Number of dwelling houses in respect of which Demolition Orders were made Nil. (4) Number of dwelling houses demolished in pursuance of Demolition Orders Nil. 118 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 have erected 64 tenements and 46 houses for the working classes upon the Charlemont Road site to meet the present shortage. (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 finding 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.) 119 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. (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 still 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. There are no Cowsheds in use in the Borough, therefore all milk is imported into the district. The greater bulk of this supply 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 their 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 sterilized or pasteurized—in capsuled bottles, thus avoiding any contamination in transit or in the house. Dairies. There are 117 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. 120 Milk (Special Designation) Order, 1923. Dealers' licences (Form B) were granted for the Sale of Milk under this Order. 3 for Grade A. 5 for Grade A (Tuberculin Tested). 5 for Pasteurised. One Dealer's licence (Form B) was granted for the bottling of Grade A (Tuberculin Tested) Milk under this Order. 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). 12 for Pasteurised. 3 for Grade A Pasteurised. 3 Certified. BACTERIOLOGICAL EXAMINATIONS. Thirty-five samples of Milk were procured for bacteriological examination. Thirty-two of these samples were certified by the Counties Public Health Laboratories to comply with the bacterial standards of the respective grades. Of the remaining three samples, two and one respectively were taken from firms of high reputation. Upon examination of their records, it was found that these were exceptional cases; every care was taken to secure perfect cleanliness. During the year I visited a 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. 121 PROSECUTIONS UNDER MILK AND DAIRIES ORDER DURING 1931. Date. Offence. Result. July Unlawfully causing a bottle to be filled and closed at a place other than registered premises Fined £1 November ditto Fined £1 (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 966 notifications (of intention to) slaughter were received referring to:— Cattle 1,903 Sheep 2,685 Pigs 10,618 Lambs 1,151 Calves 188 Total 16,545 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. This arrangement, which has been in operation for about four years, has been found to work very satisfactorily. Slaughterhouses. Following" is a list of slaughter-houses in the Borough : Beckton Road (not used during 1931). Manor Way Farm, New Beckton. 319, Green Street. 122 167, Plashet Grove. 843, Romford Road (not used during 1931). 524, Romford Road. 737, Romford Road. 28, Station Road. Forest View Road. (c) FOOD AND DRUGS (ADULTERATION) ACT, 1928 Four hundred and ten (410) samples were taken under the above Act, of which one hundred and fourteen (114) were Milk. These were all submitted to Dr. Bernard Dyer, the Public Analyst for the Borough. Of this number, one hundred and thirty-four (134) were taken formally, all of which were certified to be genuine articles of food. Two hundred and seventy-six (276) samples were taken informally. Of these 12 samples failed to comply with the regulations—4 were samples of Sausages bought by the halfpound, and were found to contain preservative but not in excess of that allowed, had the declaration been made. On enquiry it was found that these half-pound purchases had been taken from one pound labelled parcels of proprietary brands, and in the division, the label had been destroyed. I have advised vendors to get an additional supply of labels for these small purchases. One sample of rum and one sample of whisky were certified to be 36 degrees under proof. The vendors were cautioned. One sample of gin was diluted to the extent of 43 degrees under proof, but formal samples taken subsequently, failed to discover any breach of the Act. Three samples of mixed herbs contained 4.9, 5 and 5.3 per cent. of sand respectively, an excessive amount which has since been reduced by further sifting of later packings. Following on the Mixed Herbs report, a sample of green spinach was submitted for analysis. Dr. Dyer reports : " This contained in its fresh state (containing 89 per cent. of water) 0.57 per cent. of sand. If the spinach were dried so as to contain only 10 per cent. of water, the percentage of sand in the spinach thus dried, would be about 4.5 of sand." I do not think that any good purpose would be served by pursuing this subject further. The amount of sand contained in any ordinary helping of stuffing would be insignificant. 123 Two informal samples of Milk taken from the Council Institutions were found to be deficient in fat. On investigation one was found to be due to non-plunging (as I reported last year) by our own Staff, and in the other case extensive enquiries were made by the Contractors but without success. No complaint has since been received of the quality of the milk. The following is a detailed list of the articles sampled:— Anchovy Paste 1 Fruit Gums 1 Ammoniated Tincture of Quinine 2 Gin 2 Ginger 1 Ammoniated Tincture of Quinine and Cinnamon 1 Ground Almonds 3 Ground Cinnamon 1 Ground Ginger 2 Baked Beans 1 Ground Nutmeg 1 Beans, Pork and Tomato Sauce 1 Ground Rice 2 Glycerine 1 Bismuthated Magnesia Bottled Beans 1 1 Herrings in Tomato Sauce 2 Brawn 1 Honey 1 Bread 7 Hot Drink Cordial 1 Brompton Lozenges 1 Jam 5 Butter 34 Jelly (Table) 1 Camphorated Oil 1 Krusto Pastry Maker 1 Cascara Sagrada 1 Lard 13 Castor Oil 1 Lemonade 1 Cheese 1 Lemonade Powder 4 Cherry Ciderette 1 Limejuice Cordial 1 Chicken and Ham Roll 1 Margarine 14 Chocolate Fruit Roll 1 Meat Patty 1 Christmas Lanterns 1 Milk 114 Chutney 2 Mince 1 Cocoa 6 Mincemeat 2 Coffee 4 Minced Meat 4 Condensed Skimmed Milk 2 Mince Pie 1 Mint Sauce 1 Confectionery "City Mixtures " 1 Mixed Herbs 5 Mixed Pickles 1 Cream 14 Mixed Spice 1 Cream of Tartar 2 Mustard 1 Currant Cake 1 Mustard Pickles 1 Custard Powder 3 Oatmeal 1 Dessicated Cocoanut 1 Orange Marmalade 1 Dressed Crab 1 Orange Squash Drink 1 Dripping 3 Parish's Chemical Food 2 Fairy Cakes 3 Pearl Barley 1 Flour 1 Peas 1 Fish Paste 1 Peas (Soaked) 1 French Capers 1 Peas (Cooked) 1 124 Peas (Green) 2 Shredded Suet and Rice 1 Peeled Tomatoes 1 Spaghetti 1 Pepper 6 Spinach 1 Peppermint Creams 1 Sponge Cakes 6 Piccalilli 1 Steak and Kidney Pie 1 Pickling Spice 1 Sterilized Milk 3 Raspberry and Gooseberry Preserves 1 Sugar 1 Sweet Spirit of Nitre 1 Red Cherries in Syrup 1 Swiss Roll 1 Rice 4 Tea 12 Rum 1 Thick Cream 1 Sago 1 Thyme 1 Salmon 1 Tinned Tomatoes 2 Salmon and Anchovy 1 Tripe 2 Salmon and Shrimp Paste 3 Turkey and Tongue Paste 1 Sandwich Spread 1 Vinegar 5 Sausages 23 Wheat Flakes 1 Sausage (Breakfast) 1 Whisky 9 Sausage (Chipalata) 1 Bacteriological Milk Samples 35 Sausage (Liver) 1 Sausage (Luncheon) 1 Total 445 Sherbert 1 Shredded Suet 1 (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) 28 – – Workshops (including Workshop Laundries) 209 6 – Workplaces (other than Outworkers' premises) 5 — — Total 242 6 — 125 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) (6) Nuisances under the Public Health A cts :—* Want of cleanliness 20 15 — — Want of ventilation 4 4 — — Overcrowding — — — — Want of drainage of floors 3 2 — — Other nuisances 28 25 — — Sanitary accommodation :— Insufficient 3 — — — Unsuitable or defective 21 14 — — Not separate for sexes 2 1 — — Offences under the Factory and Workshop A cts : Illegal occupation of underground bakehouse (s. 101) — — — — Other offences 3 2 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 84 63 1 — * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 127 The Following is a Record in Detail of the Inspections made during the Year 1931 : — DISTRICT No. 1. DISTRICT NO. 2. DISTRICT No. 3. DISTRICT No. 4. DISTRICT No. 5. Total. Manor Park Ward. Woodgrange Ward. Kensington Ward. Little Ilford Ward. Plashet Ward. Castle Ward. Central Ward. Wall End Ward. Greatfield Ward. South Ward. Ord. H.to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H.to H. Ord. H.to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H.to H. Premises found in fair condition 459 60 215 214 219 345 210 161 183 166 96 127 182 191 168 199 103 381 158 23 1993 1867 Factory and workshop premises inspected 32 ... 27 ... 45 ... 29 ... 23 ... 18 ... 33 ... 18 ... 5 ... 11 ... 241 ... Outworkers'premises inspected 3 ... 1 ... 4 ... 7 ... 4 ... 4 ... 14 ... 14 ... 9 ... 7 ... 67 ... Bakehouses inspected 23 ... 15 ... 13 ... 9 ... 10 ... 5 ... 10 ... 2 ... 2 ... 9 ... 98 ... Slaughter-houses inspected 448 ... 226 ... ... ... ... ... 119 ... ... ... ... ... ... ... ... ... 132 ... 925 ... Dairies inspected 8 ... 23 ... 7 ... 26 ... 1 ... ... ... 1 ... ... ... 8 ... 17 ... 91 ... Urinals inspected 5 ... 1 ... 15 ... 9 ... 1 ... 2 1 13 ... 5 ... ... ... 13 ... 64 1 Walls and ceilings dirty and dilapidated 59 196 56 234 57 177 97 79 74 406 83 417 115 451 76 445 45 349 177 186 839 2940 Yards improperly paved and dilapidated 12 58 16 92 3 15 4 18 13 119 19 132 47 170 37 191 14 101 50 55 215 951 No forecourt paving 6 57 33 18 194 8 68 4 55 11 65 17 182 10 75 6 108 10 34 90 871 Defective drains 13 5 12 11 10 8 13 6 9 13 6 3 19 17 10 8 1 3 6 2 99 76 Defective w.c. connections ... ... 3 1 1 4 2 4 3 2 ... 5 1 ... ... 1 ... 2 ... 19 12 Defective w.c. traps 10 27 10 34 14 100 14 30 4 65 11 54 17 67 8 21 5 6 16 3 109 406 Defective flushing apparatus 10 37 9 26 9 46 20 9 9 26 16 32 19 63 20 78 4 25 22 23 138 365 Soil pans foul and broken 12 13 3 24 12 88 8 19 6 66 8 39 23 53 12 57 4 10 5 9 93 378 Defective vent pipes 10 30 5 51 5 73 9 28 5 22 5 16 10 89 7 87 24 7 2 63 422 Rain water pipes and eaves gutters defective 21 104 31 106 30 124 48 82 29 144 22 119 78 361 51 383 37 191 90 65 437 1679 Rain water pipes connected to drain 9 3 1 5 2 8 2 2 2 14 ... ... ... ... ... 1 6 43 Roofs leaky 29 80 32 72 45 127 66 55 39 142 39 150 64 166 49 208 31 102 104 59 498 1161 Defective sink waste pipes 8 18 8 29 11 59 12 30 4 20 8 18 26 79 10 89 3 26 16 47 106 415 Houses without water (Metropolitan Water Board) ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 ... 2 1 Cisterns without covers ... ... ... 1 ... ... ... ... ... ... 1 4 1 ... ... ... ... ... ... ... 2 5 Drinking water improperly stored 9 il 5 96 4 3 ... ... 3 5 3 1 1 20 3 8 1 i 1 2 30 147 Dilapidated floors 9 30 7 28 8 17 23 3 13 30 19 42 33 65 11 65 4 7 42 37 169 324 Insufficient underfloor ventilation 8 56 9 49 5 136 9 43 8 100 3 20 18 212 3 148 1 31 15 16 79 811 Dampness 26 83 25 119 37 134 50 73 32 155 31 86 39 250 24 78 33 157 122 116 419 1251 Accumulations 13 1 12 1 27 ... 34 4 11 ... 9 2 21 4 17 6 3 2 16 163 20 Defective sashcords and windows 24 85 24 81 30 122 31 45 26 175 30 198 31 179 28 141 29 139 100 95 353 1260 Overcrowding 3 1 1 ... 3 2 13 3 5 27 8 27 2 9 7 8 3 2 6 10 51 89 Unsound food 135 172 ... 5 ... 6 ... 34 ... 1 ... 9 ... 3 ... 1 ... 89 ... 455 ... No dust bins 5 6 3 5 11 16 14 7 8 40 10 56 10 18 3 5 10 15 20 18 94 186 Defective stoves 17 49 15 37 21 30 17 12 27 136 32 143 26 73 20 57 11 76 56 64 242 677 Defective coppers 9 32 6 20 9 12 16 3 12 70 13 78 19 49 18 42 22 63 38 44 162 413 Animals improperly kept 1 2 3 ... 5 ... 2 ... 1 ... 3 3 2 1 1 1 1 ... 21 5 Temporary buildings found ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 ... ... 2 1 Smoke nuisances 21 ... 5 3 4 1 7 1 5 1 4 5 ii 1 5 1 4 2 4 ... 70 15 Rear passages unpaved or undrained 1 ... ... ... 26 ... 3 ... ... ... ... ... 6 ... 3 ... ... ... 6 2 45 2 Gipsies ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... 4 ... Breaches of Bye-Laws and Regulations 3 ... ... ... ... ... 3 ... ... ... 1 ... 9 1 ... ... ... ... ... 17 ... Other nuisances 100 346 68 307 57 198 100 78 112 568 132 672 196 908 125 674 95 667 361 353 1286 4771 Drains tested 28 ... 40 ... 19 ... 57 1 20 ... 20 ... 31 ... 34 ... 19 ... 32 ... 300 1 Inspections 808 358 551 680 423 938 539 427 416 711 284 635 486 979 402 931 255 968 653 243 4817 6870 Total Inspections 1166 1231 1361 966 1127 919 1465 1333 1223 896 11687 COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Annual Report OF THE School Medical officer FOR THE YEAR 1931. 130 EAST HAM EDUCATION COMMITTEE Councillor G. P. Dean, J.P. (Chairman). Councillor J. J. Pope (Vice-Chairman). Councillor W. T. Newlinc., J.P. (Mayor). Alderman W. W. Bagot (Deputy-Mayor). Alderman Mrs. A. Taylor. Councillor Mrs. A. Warne. ||Alderman J. Brooks, J.P. Councillor H. P. Jackson. Alderman G. H. Manser. †Councillor C. H. Johnson. Alderman H. N. Ridler. Councillor T. I. Lethaby, J.P. Alderman E. Shanahan, J.P. Councillor E. Markey. Alderman L. H. Thompson. Councillor R. W. Moger. Councillor R. Bailey. Councillor G. Pottinger. Councillor T. W. Burden. Councillor H. Restarick. Councillor W. T. Bush. *Councillor W. Thompson. *Councillor G. J. Davies. ‡ Councillor T. Watts. Councillor A. E. Dennington. Councillor T. W. Williams. Councillor R. J. Fell. Miss L. Butcher. Councillor E. C. Howlett. Mrs. L. Lethaby. Councillor W. E. Huggett. E. T. Andrews, Esq., B.A. E. J. Sullivan. * Appointed Sept., 1931. † Resigned June, 1931. J Deceased June, 1931, II 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). 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-Fi.axman, 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. (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. 131 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, 1931. The average school attendance throughout the year approximated closely to 17,160. The number of routine and special cases of elementary school children examined totalled 10,016, as compared with 10,105 in 1930, and a complete medical inspection of all the scholars in the Secondary Schools has also been carried out. The administration of the Service has been continued along the lines adopted in previous years and, although I am pleased with the work accomplished and with the satisfactory results achieved, it is with regret that I find myself unable to report any new departure or development in connection with the School Medical Department. The Service is hampered by the very inadequate and unsuitable accommodation which continues to hinder progress and improvement in our methods for ensuring the health and physical welfare of the School child. Next year will witness the twenty-fifth anniversary of the School Medical Service. Since the year 1907 the extraordinary extension and growth in the scope of the Service has been remarkable, but it is quite impossible to further overcrowd the Clinics and Office. The Local Education Authority has reached the peak of that progress and efficiency which it is possible to attain under present 132 conditions of accommodation. For these reasons my report consists, for the most part, of statistical data in connection with duties performed during the year 1931. 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. Twenty-five 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 conv alescent treatment for 47 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. 133 1. STAFF. A list of the Staff of the School Medical Department will be found on page 130 of this Report. 2. CO-ORDINATION. The scheme for the co-ordination of the various health services of the County Borough has been fully discussed in previous reports, and 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 has been of much value and has strengthened very definitely co-ordination between the Public Health and School Medical Services. 3. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene. During the year 1931 a complete survey of the sanitary and hygienic conditions pertaining to all the schools of the Authority has been carried out. Reports upon matters requiring attention have been submitted month by month to the Committee In most instances my recommendations have received careful consideration, and an endeavour has been made to remedy defects where possible, but a good deal remains to be done in connection with improvements in lighting, heating, ventilation and overcrowding of certain classrooms, and in regard to the provision of sufficient and satisfactory sanitary and cloakroom accommodation. 134 4. MEDICAL INSPECTION. The following is a synopsis of School Medical Work for the year 1931. The figures for the year 1927 to 1930 are also given for comparison:— COMPARATIVE STATEMENT OF WORK. 1927. 1928. 1929. 1930. 1931. Routine and Special Inspection (on School Premises) 8,483 10,408 9,763 8,325 10,351 Re-inspection 4,175 4,961 4,821 3,574 2,883 Consultations at Inspection Clinic 13,530 16,533 15,675 14,490 13,241 Number of Treatments at Clinic 14,873 19,140 18,517 16,967 15,180 General Cleanliness Visits to Schools 257 274 322 309 307 Nurses' Visits to Homes Children Examined for 4,547 4,239 3,824 3,479 3,081 ness 58,588 55,351 53,009 51,607 48,607 (a) 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. 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. 135 (c) Places of Medical Inspection. The work of medical inspection is carried out during school hours and on school premises in every case, and disturbance of school arrangements is reduced to a minimum. 5. FINDINGS OF MEDICAL INSPECTIONS. The following comparative table serves to indicate the number and percentage of children found to be in need of medical or surgical treatment in the three age groups inspected during the year, and, although there is a slight increase 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 also shows a small increase. 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 (9.7) 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. FINDINGS OF MEDICAL INSPECTION. Group. NUMBER OF CHILDREN. Percentage of Children found to require Treatment Inspected. Found to require Treatment. 1926 1927 1928 1929 1930 1931 1926 1927 1928 1929 1930 1931 1926 1927 1928 1929 1930 1931 Entrants 3,345 2,468 3,197 2,998 2,314 2,047 454 244 354 411 264 263 13.6 9.9 11.1 13.7 11.4 12.8 Intermediates 1,991 1,295 2,424 2,208 2,207 1,987 270 133 291 316 237 217 13.6 10.3 12.0 14.3 10.7 10.3 Leavers 3,877 2,717 2,848 2,366 1,912 1,855 520 180 237 248 119 181 13.4 6.6 8.3 10.5 6.2 9.7 Totals 9,213 6,480 8,469 7,572 6,433 5,889 1,244 557 882 975 620 661 13.5 8.6 10.4 12.9 9.6 11.2 136 137 (a) Uncleanliness. The School Nurses have carried out 3 cleanliness surveys of all the children in the elementary schools during the year 1931. During the year the School Nurses made 48,607 examinations, as compared with 51,607 in 1930. Of this number 273 children showed vermin and many nits in the hair (510 in 1930), whilst 1,438 children showed only a few nits (1,844 in 1930). Comparative table :— Year Number Examined Number with Nits Number with Head Vermin No- of Exclusion Certificates 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 1931 48,607 1,438 273 58 The decrease in the number of children examined was occasioned by depletion of staff owing to the illness and transfer of members of the School Nursing Staff. Only two cleanliness surveys were possible in the following school departments—Lathom Girls, Lathom Boys, Winsor Senior and the Monega Myope Class. TABLE VII. TABLE OF VERMINOUS CONDI TIONS 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 648 31 15 Napier Infants 773 31 13 Girls 925 67 37 J. Boys 807 8 2 Boys 959 28 20 S. Boys 407 3 3 Brampton Infants 1535 36 — Plashet Infants 747 31 4 J. Girls 1414 35 6 J. Boys 1014 7 — S. Girls 642 15 1 S. Boys 906 4 — Castle Street R.C. Mixed 690 25 1 "Salisbury" Infants 716 23 2 Central Park Infants 909 32 — J. Mixed 1094 19 4 .1. Boys 1281 11 — S. Mixed 578 7 1 S. Boys 803 1 — Sandringham Road J. Mixed 1203 11 13 Cornwall Infants 1186 77 12 S. Mixed 900 7 4 Girls 923 43 9 Sandringham Central — 391 — — Boys 783 9 3 Shaftesbury Road Infants 1105 68 3 Dersingham Mixed 1121 43 9 Junior 1076 75 2 Essex Road Infants 997 22 4 Senior 594 20 — J. Boys 1242 4 1 Shrewsbury Road Special 210 28 — S. Boys 693 — Storey Street J. Mixed 667 38 12 Hartley Infants 931 14 1 S. Mixed 925 59 13 J. Girls 1101 61 5 Silvertown R.C. J. Mixed 395 34 4 S. Girls 606 23 1 S. Mixed 789 28 12 High Street J. Mixed 594 26 St. Michael's R.C Mixed 243 16 5 S. Mixed 656 11 1 St. Winefride's R.C. Mixed 777 45 5 Kensington Avenue Infants 620 2 3 Vicarage Infants 697 8 4 J. Mixed 798 16 6 J. Girls 768 57 11 S. Mixed 309 16 2 S. Girls 480 25 8 Lathom Road Infants 1278 14 2 "Winsor" Primary 1143 66 7 Girls 758 26 1 Inter 470 8 Boys 797 2 — Wakefield Central Girls 180 — — Monega Road Infants 1020 20 — Boys 186 — Girls 1193 — — Total 48607 1438 273 Boys 863 2 — Myope 36 — Per cent. in 1981 2.95 0 5 Per cent. in 1930 3.5 0 9 138 139 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 1930 1931 1930 1931 Scabies 3 16 11 Impetigo 10 11 345 232 Conjunctivitis 7 7 87 85 Blepharitis 3 2 43 41 Ear Disease 62 55 158 149 Ringworm (Scalp) — — 5 2 Ringworm (Body) — 1 36 23 (c) Tonsils and Adenoids. 4.6 per cent. of the children examined during the year were referred for treatment for "tonsils and adenoids," either separately or combined, as compared with 4.9 per cent. in the year 140 1930. Of these, much enlarged tonsils accounted for 1.2 per cent. ; definite adenoids were present in 0.2 per cent., and the combined defect was diagnosed in 3.2 per cent. ; the figures for 1930 were 1.4 per cent., 0.4 per cent., and 3.1 per cent., respectively. The percentage of children moderately affected and requiring to be kept under observation was 10.6, the corresponding percentage in 1930 being 11.3. In this case 10.0 per cent. had moderately enlarged tonsils, 0.2 per cent. exhibited signs of the presence of adenoids, whilst 0.4 per cent. showed enlarged tonsils and adenoids of moderate degree, as compared with 10.8 per cent., 0.2 percent., and 0.3 percent., respectively in the year 1930. (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 6 10 Other forms of Tuberculosis 14 9 23 Totals 18 15 33 (e) Skin Disease and (f) External Eye Disease. The number of these cases still remains high. At medical inspections during the year 526 children were found to be suffering from skin affections (as compared with 615 in the year 1930). Cases of external eye disease also continue to show a high incidence, 154 in the year 1931 and 140 in the year 1930. (g) Vision. Only children with marked visual defect have been referred for treatment and these, including cases of strabismus, numbered 141 488. In addition there were 146 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. 165). (h) Ear Disease and Hearing. 0.3 per cent. of the children examined were found to be suffering from otitis media. (0.3 per cent. in 1930). The percentage of deaf children was 0.5, the corresponding number for last year being 0.3. (i) Dental Defects. (See Report of Dental Surgeon on p. 166). (j) Crippling Defects. Reference to Table 111 on pages 173-5 will furnish information with regard to the occurrence of crippling defects in the area. 60 cases 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 1931. Except in the cases of Chicken Pox and Whooping Cough, the incidence of the Acute Infectious Diseases exhibits a marked decrease which is especially noticeable in regard to Diphtheria and Measles. The bacteriological examination of sw abs 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. 218 swabs were taken for this purpose, and the fact that four of these proved to be positive shov s the great importance of this procedure. 142 (b) In suspicious cases seen at the Clinics or Schools, 145 swabs were taken and 8 proved to be positive. (c) In cases where an undetected source of infection appears to be present in a class or school. 10 swabs were taken and none proved to be positive. In regard to Small-pox there were seven actual cases and eighty-eight contact cases in children attending schools in the Borough. Nineteen 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 many children have been vaccinated. The statistics relating to protective immunization against Diphtheria are included in my report as Medical Officer of Health. 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. 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 — 46 2 5 8 8 February 3 46 4 2 10 10 March 5 72 29 6 4 3 April — 11 11 — 4 8 May — 19 3 1 14 8 June 3 21 15 1 14 5 July — 25 29 4 8 10 August — 6 3 3 11 11 September — — — — — — October 1 — 25 — 14 12 November 4 80 32 75 39 10 December 154 18 15 97 14 4 Totals (625) 170 (173) 344 (161) 168 (204) 194 (250) 140 (271) 89 143 The totals in brackets are those for the year 1930 and are inserted for comparison. 144 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. 1930 1931 1930 1931 Ringworm of Scalp 5 1 122 610 Ringworm of Body 24 13 476 236 Impetigo Contagiosa 87 56 758 706 Infective Eve Inflammation 44 68 451 1482 Septic conditions 69 67 545 712 Verminous conditions 17 70 119 538 Scabies 20 14 252 360 Other Skin conditions 39 16 411 202 Acute Throat conditions 28 38 301 198 333 349 3435 5004 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 3,081 visits to the homes of children in whom defects were found at medical inspection, and for special investigation purposes. Of the 828 children referred for treatment, 803 or 96 per cent. have obtained treatment. The School Nurses have also paid 124 special visits to the Schools, and 22 visits to the Feeding Centres, and have undertaken 24 journeys in connection with the admission and discharge of children to Institutions. All children, referred for the operative treatment of tonsils and adenoids (527), have been visited by the School Nurses both prior to and after the operation 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. 145 (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) Eye Specialist Clinic, Town Hall—Tuesdays at 9 a.m., Thursdays at 9 a.m., and Fridays at 9 a.m. (5) Ear Specialist Clinic, Town Hall—Tuesdays and Fridays, at 3 p.m. (6) Light Clinic, Town Hall—Mondays and Wednesdays, at 2 p.m. (7) Immunization Clinic, Town Hall—Fridays at 3 p.m. A full account of these clinics was set forth in my report for 1922. During the year 1931, 15,180 attendances were made for treatment at the various clinics, and there were 13,241 attendances for consultation of the Medical Officers. (a) Minor Ailments. An analysis of the chief minor ailments treated at the School Clinics, and otherwise, will be found in Table IV, Group 1, p. 48. (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 527 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 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. 146 (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 five children received this form of treatment during this year. (e) External Eye Disease. 153 cases (164 in 1930) of external eye disease were treated at the School Clinics. (f) Vision. During the year 1931 the Ophthalmic Clinic was held on five sessions per fortnight. 419 cases were referred for treatment in respect of visual defect during the year 1931 and, including 191 cases awaiting treatment at the termination of the year 1930, 610 cases have been treated in the past year. On the 31st of December, 1931, there were 63 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 School Nurses to impress parents in regard to the necessity of obtaining early treatment. There were 121 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. 147 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. 165.) (g) Ear Disease. During the year 1931, 86 Aural Clinic sessions were held. The total attendances at the Aural Clinic was 1,615, making an average attendance, at each session, of 19 patients. Ionisation treatment was carried out in 28 cases, 52 applications being made; that is to say an average of 1.4 ionisation treatments were performed at each session ; the treatment occupies just over half an hour in each case. The Aural Surgeon has 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. Satisfactory arrangements have now been concluded whereby such cases are admitted to the Balaam Street Children's Hospital for treatment. The operations are performed by Mr. Ronald Savege, F.R.C.S., and payment is made to the Hospital Authorities on a per capita grant basis in respect of East Ham Scholars sent to the Hospital through the School Medical Department. A further step towards more complete co-ordination was reached by the agreement, between the Education Committee and the Maternity and Child Welfare Committee, that diseases of the ear, nose and throat, occuring in infants and children under school age, should be treated at the School Aural Clinic. (See also Report of Aural Surgeon, p. 164.) (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 be able to give complete treatment to all cases found to require 148 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. 166.) (i) Crippling Defects. 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 on a per capita contribution basis 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 1931, 21 out-patients have received treatment, the total out-patient attendances being 411. The highly satisfactory results achieved are due, in no small measure, to the efforts and keen co-operation of Mr. Lindsay, the responsible Orthopaedic Surgeon. (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. 149 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. A brief summary of the cases treated by general and local irradiation throughout the year is given on the following page. 150 SUNLIGHT FIGURES, 1931. CONDITION. Boys. Girls. Anæmia 10 18 Debility 45 48 Malnutrition 16 32 Malnutrition and Anæmia 1 1 Malnutrition and Debility 4 2 Debility and Anæmia 9 9 Debility and Catarrh 3 2 Debility and Bronchitis 1 1 Debility and Rheumatism 1 — Bronchial Catarrh and Anæmia 3 1 Bronchial Catarrh and Malnutrition 1 1 Bronchial Catarrh and Bronchitis 21 11 Bronchial Citarrh and Cervical Adenitis 1 1 Adenitis 13 11 Alopecia 1 2 Rheumatism 3 3 Pretuberculosis 2 5 Asthma 2 1 Underweight 6 2 Chorea — 3 Pulmonary Fibrosis 1 — Cough 2 2 Throat 3 — Sinus 1 1 Gastritis 1 1 Dermatitis — 1 Rickets 1 — Paralysis 1 — Total 153 159 Number of children treated 312 (288 in 1930). Number of attendances 3,470 (3,917 in 1930). Average number of attendances per child 11 Number treated by local application 15 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 151 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 191 scholars to the East Cowes Holiday Camp during the year 1931, and in addition the following School Journeys were undertaken :— Cornwell Senior Boys 30 Plashet Senior Boys 54 Lathom Road Boys 40 Central Park Senior Boys 30 Brampton Senior Girls 62 Sandringham Central 75 Essex Senior Boys 60 Total 351 (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. (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. 152 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 (p. 25) gives particulars in connection with these children. In addition the School Medical Service is indebted to the Invalid Children's Aid Association for rendering assistance in 47 cases, financial responsibility for which was not undertaken by the Local Authority. The facility and expeditiousness with which the cases were dealt with reflects great credit on the administration of this Association. Particulars of the cases dealt with are as follows :— Debility and Anæmia 30 Bronchial Catarrh 7 Rheumatic Heart 2 Chorea 3 Malnutrition 3 T.B. Spine (quiescent) 2 153 Particulars of the number of Children who were resident in Schools of Recovery between 1st January and 31st December, 1931, and the periods of their stay between those two dates. School No. of Months Totals 1 2 3 4 5 6 7 8 9 10 11 12 B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G Total Ogilvie – – 4 5 – 1 3 1 – – 8 2 – 2 2 1 1 1 4 3 — — 2 4 24 20 44 I.C A.A. (hqtrs.) 3 3 I 2 1 2 1 3 – 5 1 1 – – 1 – – – – – 1 – – – 9 16 25 St. Catherine's – – – – 1 – – – – – – – – – 1 – – – – – – – – – 2 – 2 St. Dominic's 2 – – – 5 — — — — — 4 -- 1 — 1 — – — 2 – — — 6 – 24 — 24 St. Marv's – – – – – – – – – – – – – 1 – – – – – – – – – – – 1 1 Other Schools of Recovery (sent by East Ham Branch of I.C.A.A.) – – 1 – – – – – – – – – – – – – – – – – – – – – 1 – 1 No. of Weeks 5 11 12 15 Russell-Cotes 1 – 20 11 9 6 10 5 – – – – – – – – – – – – – – – – 40 22 62 154 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 151,024 meals were provided for 593 children, as compared with 130,406 meals for 1,244 children in 1930. 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 on the whole. 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 1931 the number of parents who were present at the routine medical inspections was 4,496 (4,642 in 1930), that is, in 50.3 per cent. of the cases examined (57.4 per cent. in 1930). 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 155 Attendance Department has been fully discussed in previous reports. Many cases have been referred for special examination by the Attendance Officers on forms 21, and of these cases 84 were medically examined, reports and advice in each case being sent to the Secretary of the Education Committee. 16. CO-OPERATION OF VOLUNTARY BODIES. Reference to 9 (e) on page 151 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. Fifty-nine such cases have been dealt with by the Society's Inspectors as the result of direct reference from the School Medical Service, during the year 1931. The Inspectors have made over 200 visits in regard to these cases and the following table indicates the work performed by the Society:— CONDITION. Number of Cases. Treatment obtained. Treatment arranged. Tonsils and Adenoids 33 24 9 Defective Vision 8 7 1 Surgical Instruments 1 1 — Hospital Treatment 3 3 — General Neglect 14 14 Improved — TOTAL 59 49 10 Two of the cases of neglect to provide proper medical treatment involved thirty visits by an Inspector before the necessary attention was obtained. The fact that court proceedings were avoided in every case is deserving of special mention and the Society is to be congratulated upon the excellent results achieved. 156 17. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Physically Defective Children. Table III reveals the very regrettable fact that 36 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 264 children, who are considered physically defective, are attending public elementary schools, and since suitable treatment is not available for these cases it is highly probable that a number of them will ultimately join the ranks of the unfit. As reported on previous occasions :— " The provision of a day open-air school, erected on a suitable site 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 Physically Defective Centres and Residential Open-air Schools would be less urgent." In regard to the 112 children suffering from glandular and non-infectious 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. I would again emphasise the added importance of education in the case of those who are suffering from a physical handicap. There are in East Ham 36 children, who come within this category, receiving no education, and there are 103 children of this type who have been allowed to attend the ordinary elementary school under special conditions and with special precautions. A Day School for Physically Defective Children is urgently needed for these cases. Mentally Defective Children. During the year 1931, the number of cases examined for purposes of the Mental Deficiency Acts, was 64 (59 in 1930). Of these 19 were classified as mentally deficient, and 40 as dull and 157 backward, recommendations being made as shown in the following table:— Number examined 64 Classified as mentally deficient 19 24 Classified as morally deficient — Classified as imbeciles 5 Classified as idiots — Classified as dull and backward 40 Recommended for Special School 19 Reference to Table III will show that the 100 children, who have been certified as mentally defective (but educable in a special school), 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. 8 boys have been specially 158 examined in accordance with the Bye-laws, and these were found to be fit for employment. 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. 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. During the year 1931 the following special medical examinations were made :— 22. SPECIAL ENQUIRIES. 23. MISCELLANEOUS. Teachers 25 Student Teachers 14 Scholarship Candidates 127 W. BENTON Medical Officer of Health and School Medical Officer. 159 MEDICAL INSPECTION RETURNS. SECONDARY SCHOOL. TABLE I. RETURN OF MEDICAL INSPECTIONS For the Year ended 31st December, 1931. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections- Boys. Girls. Entrants — — Intermediates — — Leavers 272 252 Total 272 252 Number of other Routine Inspections 48 42 B.—OTHER INSPECTIONS. Number of Special Inspections 16 7 Number of Re-Inspections 20 32 Total 36 39 160 TABLE II. SECONDARY SCHOOL. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1931. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Defect or Disease. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation,but not requiring Treatment. (1) (2) (3) (4) (5) B. G. B. G. B. G. B. G. Malnutrition — 2 — — — — — — Uncleanliness : See Table IV., Group V. — — — — — — — — Skin Ringworm : Scalp — — — — — — — — Body — 1 — — — — — — Scabies — — — — — — — — Impetigo — 1 — — — — — — Other Diseases non-Tuberculous — 1 — — 1 — — — Eve Blepharitis — 1 — — — — — — Conjunctivitis — — — — — — — — Keratitis — — — — — — — — Corneal Opacities — — — — — — — — Defective Vision (excluding Squint) 20 14 16 2 3 1 — — Squint — 1 — — — — — — Other Conditions — — — — — — — — Ear Defective Hearing 1 1 — 1 — — — — Otitis Media — 1 — — 1 — — — Other Ear Diseases — 6 — 7 — 2 — — Nose and Throat Enlarged Tonsils only — 6 15 6 2 — — — Adenoids only — — — — — — — — Enlarged Tonsils and Adenoids — — — — — — — — Other Conditions — — — — — — — — Enlarged Cervical Glands (Non-Tuberculous) 2 — 11 — — — — — Defective Speech — — 1 — 1 — — — 161 Table II.—(continued.) (1) (2) (3) (4) (5) B. G. B. G. B. G. B. G. Teeth—Dental Diseases (sec note a) — — 30 13 — — — — See Table IV., Group IV. Heart and Circulation Heart Disease: Organic — — 1 — — — — — Functional — 1 1 3 — — — — Anæmia — 3 — — 1 — — — Lungs Bronchitis — 1 — — — — — — Other Non-Tuberculous Diseases — — — — — — — — Tuberculosis Pulmonary : Definite — — — — — — — — Suspected — — — — — — — — Non-Pulmonary : Glands — — — — — — — — Spine — — — — — — — — Hip — — — — — — — — Other Bones and Joints — — — — — — — — Skin — — — — — — — — Other Forms — — — — — — — — Nervous System Epilepsy — — — — — — — — Chorea — — — 1 — — 1 — Other Conditions — — — — — — — — Deformities 'Rickets — — — — — — — — Spinal Curvature — 2 — 1 — — — — Other Forms — 2 1 12 — — — — Other Defects and Diseases — 11 2 22 5 3 — — B.—Number of individual children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). GROUP. Number of Children. Percentage of Children found to require Treatment. Inspected Found to require Treatment. (1) (2) (3) (4) B. G. B. G. B. G. Code Groups :— Entrants — — — — — — Intermediates — — — — — — Leavers 272 252 20 44 7.3 17.4 Total (Code Groups) 272 252 20 44 — — Other Routine Inspections 48 42 3 6 6.2 14.3 162 TABLE IV. SECONDARY SCHOOL. Return of Defects Treated during the Year ended 31st December, 1931. 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 Otherwise. Total. (1) (2) (3) (4) B. G. B. G. B. G. Skin- Ringworm—Scalp — — — — — — Ringworm—Body — 1 — — — 1 Scabies — — — — — — Impetigo — — — — — — Other skin disease 1 1 — — 1 1 Minor Eye Defects (External and other, but excluding cases falling in Group II.) — — — — — — Minor Ear Defects — 7 1 1 1 8 Miscellaneous (e.g.,minor injuries, bruises, sores, chilblains, etc.) 7 13 — 2 7 15 Total 8 22 1 3 9 25 163 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. Submitted to refraction by private practitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) (5) B. G. B. G. B. G. B. G. Errors of Refraction (including Squint) (Operations for Squint should be recorded separately in the body of the Report). 6 6 — — 1 2 7 8 Other Defect or Disease of the Eyes (excluding those recorded in Group I.). 3 – – – – – 3 – Total 9 0 – – 1 2 10 8 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme 3 (b) Otherwise 2 Total number of children who obtained or received spectacles— (a) Under the Authority's Scheme 3 (b) Otherwise 2 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 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. 1 — — — 1 — — — 1 — 164 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 third annual report on the work done in the Aural Clinic during 1931. Eighty-six clinics were held during the year, with a total attendance of 1,615. Sixtyone per cent, of the cases were, after treatment, discharged cured. An arrangement was made, and is working satisfactorily, for the admission of children, suffering from chronic mastoid disease, into Balaam Street Hospital for operation by me. Five cases were treated under this arrangement during the year, and I also operated on 234 East Ham children for the removal of enlarged Tonsils and Adenoids. The statistical report is as follows :— Cases of Chronic Otitis Media 202 Discharged 138 Cases of Deafness 32 ,, 14 Other Ear Cases 45 ,, 39 Cases of Chronic Rhinitis 66 ,, 22 Other Nose Cases 17 ,, 7 Cases of Enlarged Tonsils and Adenoids 105 ,, 66 Total 467 Discharged 286 I wish to thank the medical, nursing and clerical staffs for their very helpful co-operation. I have the honour to be, Sir, Your obedient Servant, RONALD SAVEGE. 165 REPORT OF THE OPHTHALMIC SURGEON. To the School Medical Officer, County Borough of East Ham, Education Committee. February, 1932. Sir, I have the honour to present my report for 1931. General Clinic. Number of new cases 626 Glasses prescribed 380 Glasses not necessary 179 Glasses obtained 376 Special treatments 67 Re-examinations 2,533 Discharged 147 Baby Clinic. Number of new cases 42 Re-examinations 231 Glasses prescribed 24 Glasses obtained 24 Special treatments 6 Discharged 4 Myope Class. Number of pupils 20 Squint.—The number of cases of squint now in the schools appears to be slightly over 400. Attention having been concentrated during the last 12 months on improvement in the vision in all of these cases which have come for treatment, it will be noticed that no operations for squint have been performed. This is not to say that this procedure can be entirely eliminated in the future. Baby Clinic.—The numbers here are slightly higher. Myope Class.—Again it is pointed out that much effort is expended in keeping the standard of education in this class up to the normal for each child. I am most pleased to thank everyone in the School Medical Service for their efficient help, for the skilled work of the optician and the good services of the clerical staff. I have the honour to be, Sir, Your obedient Servant, S. C. REEVE-FLAXMAN. 166 REPORT ON THE WORK DONE IN THE SCHOOL DENTAL CLINIC. To the School Medical Officer, County Borough of East Ham, Education Committee. Sir, I have much pleasure in submitting to you my report for the year 1931. The age group inspected was from 5 years to 11 years inclusive. The number of children totalled 13,315 and of this number 9,448 were referred for treatment. In addition urgent treatment was carried out in 156 special cases, i.e., cases of oral sepsis, toothache, etc., referred by the Medical Officers and Head Teachers for immediate attention. Statistical details will be found in Table IV., Group IV., Dental Defects. TABLE IV. Group IV.—Dental Defects. (1) Number of Children who were:— (a) Inspected by the dentist:— Age. Routine Age Groups. Specials Grand Total. 0 6 7 8 9 10 11 Total. 12 13 14 1616 1823 1954 2104 2176 2383 1259 13315 — – — 156 13471 (b) Found to require treatment 9448. (c) Actually treated 3258. (d) Re-treated during the year as the result of periodical examination 2806 (2) Half-days devoted for — Inspection 1221 Treatment 658j Total 780 (3) Attendances made by children for treatment 7389. (4) Fillings:— Permanent teeth 1703 Temporary teeth 870 Total 2573 (5) Extractions: — Permanent teeth 641 Temporary teeth 7494 Total 8135 (6) Administrations of general anaesthetics for extractions 400. (7) Other operations:— Permanent teeth 400 Temporary teeth 247 Total 647 167 All the children in the routine age groups are inspected once a year, and treatment is offered where necessary. During the inspection the opportunity occurs to speak to the children individually about the benefit of dental cleanliness and other matters incidental to any particular case. Work in the clinic is carried out as painlessly as possible—a local or regional injection of a suitable anæsthetic is commonly given prior to the extraction of temporary teeth, or in cases where this is contra-indicated a local application of ethyl-chloride is used. One session per week is devoted to the administration of Nitrous Oxide Gas for the extraction of septic or difficult permanent teeth. Small cavities in temporary teeth, and all cavities in savable permanent teeth are filled, special attention being given to the first or six-year molars. It is certainly interesting and important to record that, whereas four or five years ago it used to be a very common thing for children to come to the clinic with extremely septic teeth, often complicated by abscess formation and accompanied bv severe oral sepsis due to neglect—which affected their general health and vitality—now it is unusual to find such conditions. Parents are gradually realising the importance of dental hygiene and treatment, with the ultimate benefit of improved health for their children. Ignorance and the " what-was-good-enough-for-me-is-goodenough-for-them " attitude of the parents is very difficult to overcome, no amount of talking or distribution of literature is of much avail and only personal experience seems to bring about the desired results. In 1930 and 1931 a Dental Clinic has been held at Woolwich for the treatment of the children at Silvertown and Storey Street Schools, because of the difficulty of parents finding the time, and money for fares, to attend at Durban House. When dental inspection is completed at the Schools, and the requisite notices sent out, a clinic is held for one session per week until the treatment for the area is completed. In spite of the handicap of unsuitable surroundings for operative work, the following table shows the percentage increase in the number of children treated compared with that for t-he year 1929. 168 School. 1930. Percentage increase over 1929. 1931. Percentage increase over 1929. Silvertown 30 100 Storey Street 34 57 As this opportunity of obtaining treatment in the immediate neighbourhood becomes known the work will increase still more. The percentage of children inspected (13,315) and who needed treatment (9,448) was 70 per cent., which approximates very closely to the figure for the whole of England and Wales, which is 69.5 per cent. Undoubtedly a great deal of dental trouble could be avoided or minimised if only the children from the earliest age could be fed on a different diet. No one to-day uses their teeth for mastication in the way that nature intended ; almost every meal consists of soft foods, which cling round the teeth, and are not removed till the time when the teeth are cleaned, if they are cleaned at all. If hard and fibrous foods were eaten they would have a selfcleaning action on the teeth and all the tissues of the mouth would benefit enormously. This lack of mastication is also an important predisposing cause of irregularity of the teeth. This condition is very common, and makes for dental inefficiency throughout life. As soon as the full complement of first teeth has arrived the young child should exercise the muscles of mastication in order that they should become fully developed. This development of the muscles assists the development of the bone of the jaws, and makes them the size which nature intended—to accommodate the permanent teeth when they arrive. At one of the schools I inspected 50 boys and girls at an average age of 11 years, and found that 58 per cent. had irregular teeth, and 12 per cent. with very bad irregularity. This, in my opinion, is a very high percentage, and a great deal of it could have beer avoided by proper diet. The teeth of these children will decay much quicker than normally, owing to the fact that it is almost impossible to keep them perfectly clean by mastication. The irregular teeth can be regulated by appliances, but it usually means that sound teeth have to be extracted to make room for the eruption of the other teeth in proper alignment. The dentist can 169 make an extraordinarily good compromise, but it is never as efficient as nature's regularity. Several of the worst cases have been regulated in the Clinic and good results obtained. A large number of cases have been referred to Guy's Hospital or the London Hospital. 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 Half Days devoted to Treatment. No. of Attendances. No. of Permanent Teeth. No of Temporary Teeth. Total No. of Extractions. Total No. of Fillings No. of Adminis trations of General Anaesthetics. No. of other Operations. Adults Children. Extrac ted. Filled. Extrac ted. Filled. Permanent Teeth. Temporary Teeth. 90 248 604 352 61 902 150 1,254 211 74 115 82 During the year two sessions per week have been devoted to the cases referred by the Medical Officers of the Maternity and Child Welfare Centres. These cases on the whole show a marked improvement in oral cleanliness when compared with those seen several years ago. I should like to record my appreciation of the conscientious work of my colleague, Mr. Hall, and the two Dental Nurses, and also to thank the Medical Officers, the Nurses, the Clerical Staff, and the teachers for their valued assistance during the year. I have the honour to be, Sir, Your obedient Servant, CYRIL S. NEAME. 170 TABLES GIVING SUMMING UP OF WORK OF SCHOOL MEDICAL SERVICE from 1st JANUARY, 1931, to 31st DECEMBER, 1931. PUBLIC ELEMENTARY AND CENTRAL SCHOOLS. TABLE I. RETURN OF MEDICAL INSPECTIONS. For the Year ended 31st December, 1931. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections— Entrants 2,047 Intermediates 1,987 Leavers 1,855 Total 5,889 Number of other Routine Inspections 1,422 B.—OTHER INSPECTIONS. Number of Special Inspections 2,705 Number of Re-Inspections 2,831 Total 5,536 171 TABLE II. A.—A Return of Defects found by Medical Inspection in the Year ended 31st December, 1931. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Malnutrition 24 8 12 — Uncleanliness : (Sec Table IV., Group V.) — — — — Skin Ringworm : Scalp — — 2 — Body 1 1 23 — Scabies 3 — 11 — Impetigo 11 10 232 1 Other Diseases (Non- Tuberculous) 9 29 238 1 Eye /Blepharitis 2 16 41 1 Conjunctivitis 7 2 85 — Keratitis 1 — 2 — Corneal Opacities 1 — — — Defective vision (excluding Squint) 272 88 147 33 Squint 29 23 40 2 Other conditions 6 13 62 2 Ear Defective Hearing 18 6 37 2 Otitis Media 27 19 57 Other Ear Diseases 28 99 92 1 Nose nd Throat Enlarged Tonsils only 87 1001 31 1 Adenoids only 12 17 5 — Enlarged Tonsils and Adenoids 167 34 158 4 .Other conditions 34 54 62 4 Enlarged Cervical Glands (Non- Tuberculous) 12 659 24 172 Table II.—(continued). (1) (2) (3) 4) (5) Defective Speech 1 16 8 I Teeth—Dental Diseases (See Table IV., Group IV.) 38 1576 16 — Heart and Circulation. Heart Disease : Organic 4 20 4 - functional 3 81 7 1 .Annemia 31 04 81 1 Lungs Bronchitis 3 2 9 1 Other Non-Tuberculous Diseases 32 62 68 3 Tuberculosis Pulmonary: Definite 1 1 - Suspected - - 2 2 Non-Pulmonary: Glands 2 3 1 Spine — — — — Hip — — — — Other Bones and Joints — — — — Skin — — — — Other Forms 1 1 1 - Nervous System Epilepsy 1 7 9 Chorea 3 4 32 1 Other conditions 1 10 4 — Deformities Rickets 1 8 3 Spinal Curvature 6 5 3 — Other Forms 3 15 7 2 Other Defects and Diseases 97 247 1073 81 B.—Number of Individual Children found at Routine Medicai Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). GROUP. Number of Children. Percentage ol Children found to require Treatment Inspected Found to require Treatment. (1) (2) (3) (4) Code Groups :— Entrants 2047 263 12.8 Intermediates 1987 217 10.9 Leavers 1855 181 9.7 Total (Code Groups) 5889 661 11.2 Other Routine Inspections 1422 152 10.6 173 TABLE III. Return of all Exceptional Children in the Area during the Year ended 31st December, 1931. Boys. Girls. Total. Children suffering from the following types of Multiple Defect, i.e., any combination of Total Blindness, Total Deafness, Mental Defect, Epilepsy, Active Tuberculosis, Crippling (as defined in penultimate category of the Tabled or Heart Disease The actual combination of defects and the type of School, if any, attended should be indicated on a separate sheet. 2 1 3* Blind (including partially blind) (i.) Suitable for training in a School for the totally blind. At Certified Schools for the Blind 1 1 2 At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — (ii) Suitable for training in a School for the partially blind. At Certified Schools for the Blind or Partially Blind 12 13 25 At Public Elementary Schools — 2 2 At other Institutions — 2 2 At no School or Institution — — — Deaf (including deaf and dumb and partially deaf) (i) Suitable for training in a School for the totally deaf or deaf and dumb. At Certified Schools for the Deaf 8 8 16 At Public Elementarv Schools — — — At other Institutions — — — At no School or Institution — — — (ii.) Suitable for training in a school for the partially deaf. At Certified Schools for the Deaf or Partially Deaf At Public Elementary Schools 1 i 2 At other Institutions — — — At no School or Institution — — — Mentally Defective Feebleminded (cases not notifiable to the Local Control Authority). At Certified Schools for Mentally Defective Children 59 32 91 At Public Elementary Schools — — — At other Institutions 5 4 9 At no School or Institution — — Notified to the Local Mental Deficiency Authority during the year. Feebleminded 9 9 18 Imbeciles 2 4 6 Idiots — — — * 1 Boy P.D. and M.D. No school. 1 „ Epileptic and M.D. „ 1 Girl Blind and M.D. „ 174 TABLE III.—continued. Boys. Girls. Total. Epileptics Suffering from severe epilepsy. At Certified Schools for Epileptics 2 1 3 At Certified Residential Open Air Schools — At Certified Day Open Air Schools — At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Suffering from epilepsy which is not severe. At Public Elementary Schools — At no School or Institution — — — Active pulmonary tuberculosis (including pleura and intrathoracic glands.) At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 4 3 7 At Certified Residential Open Air Schools — — At Certified Day Open Air Schools — — — At Public Elementary Schools 5 3 8 At other Institutions — — — At no School or Institution 2 3 5 Physically Defective. Quiescent or arrested pulmonary tuberculosis (including pleura and intrathoracic glands.) At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 2 — 2 At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 23 12 35 At other Institutions 1 — 1 At no School or Institution 1 2 3 Tuberculosis of the peripheral glands. At Sanatoria or Sanatorium Schools approved by the Min istry of Health or the Board 3 3 6 At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 35 21 56 At other Institutions — 1 1 At no School or Institution 6 3 9 Abdominal tuberculosis At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board — 1 1 At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — At Public Elementary Schools 6 4 10 At other Institutions 1 — 1 At no School or Institution 1 — 1 175 TABLE III.—continued. Boys. Girls. Total. Physically Defective. (contd.) Tuberculosis of bones and joints (not including deformities due to old tuberculosis). At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 2 6 8 At Public Elementary Schools 7 3 10 At other Institutions — — — At no School or Institution 2 2 4 Tuberculosis of other organs (skin, etc). At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board — — — At Public Elementary Schools 1 — 1 At other Institutions — — — At no School or Institution 1 — 1 Delicate Children, i.e., all children (except those included in other groups) whose general health renders it desirable that they should be specially selected for admission to an Open Air School. At Certified Residential Cripple Schools — — — At Certified Day Cripple Schools — — — At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools 100 58 158 At Public Elementary Schools 34 7 41 At other Institutions — — — At no School or Institution — — — Crippled Children (other than those with active tuberculous disease) who are suffering from a degree of crippling sufficiently severe to interfere materially with a child's normal mode of life. At Certified Hospital Schools — 1 1 At Certified Residential Cripple Schools 1 5 6 At Certified Day Cripple Schools 3 1 3 At Certified Residential Open Air Schools 2 1 3 At Certified Day Open Air Schools — — — At Public Elementary Schools 31 29 60 At other Institutions 3 1 4 At no School or Institution 3 3 6 Children with heart disease, i.e. children whose defect is so severe as to necessitate the provision of educational facilities other than those of the public elementary school. At Certified Hospital Schools 3 3 At Certified Residential Cripple Schools _ At Certified Day Cripple Schools — 1 1 At Certified Residential Open Air Schools 11 10 21 At Certified Day Open Air Schools — — At Public Elementary Schools 19 24 43 At other Institutions 1 2 3 At no School or Institution 4 3 7 176 TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group V.). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. (1) (2) (3) (4) Skin— Ringworm—Scalp 8 — 8 Ringworm—Body 19 — 19 Scabies 14 — 14 Impetigo 240 2 242 Other skin disease 185 5 190 Minor Eye Defects (External and other, but excluding casesfalling in Group II.) 153 5 158 Minor Ear Defectt 203 8 211 Miscellaneous (e.gminor injuries, bruises, sores, chilblains, etc.) 1195 112 1307 Total 2017 132 2149 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1931. 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. 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.) 559 27 51 637 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) — — — — Total 559 27 51 637 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme 380 (b) Otherwise 32 Total number of children who obtained or received spectacles— (a) Under the Authority's Scheme 376 (b) Otherwise 32 Group III.—Tre\tment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of Treatment. (4) Total number Treated. (6) Under the Authority's Scheme inClinic or Hospital. (1) By Private Practitioner or Hospital apart from the Authority's Scheme. (2) Total. (3) 391 37 428 99 527 178 TABLE IV.—continued. Group IV.—Dental Defects. (1) Number of Children who were : — (a) Inspected by the Dentist— Age. Routine Age Groups. Specials Grand Total. 5 6 7 8 9 10 11 Total 1616 1823 1954 2104 2176 2383 1259 13315 156 13471 (6) Found to require treatment 9448 (e) Actually Treated 3258 (d) Re-treated during the year as the result of periodical examination 2806 (2) Half-days devoted to:— Inspection 122 Total 780 Treatment 658 (3) Attendances made by children for treatment 7389 (4) Fillings :— Permanent Teeth 1703 Total 2573 Temporary Teeth 870 (5) Extractions:— Permanent Teeth 641 Total 8135 Temporary Teeth 7494 (6) Administrations of general anaesthetics for extractions 400 (7) Other operations :— Permanent Teeth 400 | Total 647 Temporary Teeth 247 Group V.—Uncleanliness and Verminous Conditions (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 48,607 (iii.) Number of individual children found unclean 864 (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 INDEX. A. Abatement of Nuisances 109-110 Abbatoirs 121 Acts of Parliament 21 Act, Rent Restriction 110 Adenoids 92, 139, 145 Aldersbrook Homes 27-28 Ambulance Service 19 Arragon Road Dispensary 20 Asbestosis 53 Attendance Officers, Cooperation of 154 Ante-Natal Clinic 31, 95 Artificial Sunlight 93, 148-151 Aural Surgeon, report of 164 Aural Treatment 92 B. Bacteriology 20 Bacteriological Examinations 120 Baths 154 Birth-rate 12 Births 8, 12, 93, 95 Births, Illegitimate 7 Births, in Wards 12 Births, Still 7 Blind Persons 35-40 Byelaws 22 Byelaws—Premises and occupations controlled by 114 C. Cancer 49-50 Cemeteries 114 Chief Sanitary Inspector— Report of 105-127 Children Act, 1908 103 Classrooms, Open Air 151 Clinic, Ante-natal 31, 95 Clinic, Artificial Sunlight 31, 93, 148 Clinic, Aural 31, 164 Clinic, Dental 31, 166-169 Clinic Immunisation 31, 45 Clinic, Mental Defectives 34 Clinic, Ophthalmic 31, 165 Clinic, School 31, 144 Clinic, Tuberculosis and Chest 31, 51-64 Clinics, Infant 31,90,93 Clinics and Treatment Centres 31 Closet Accommodation 106 Committees 3 Common Lodging Houses 114 Complaints of Nuisances 109, 110 Continuation Schools 157 Co-ordination 100, 133 Cripples 141, 148 D. Dairies 119 Day-Schools, Open air 151 Death-rate, General 12 Death-rate, Infantile 8 Deaths, Causes of 13-14 Deaths, Infants 16 Deaths, in Wards 15 Deaths, by Sex 16 Dental Treatment 56,92, 166 Dental Surgeons, Report of 166-169 Diphtheria 45, 85 Dispensary, Arragon Road 20 Drainage and Sewerage 106 Dust Collection 106 E. Ear Diseases 141, 147 Ear, Nose and Throat Diseases 30 East Ham Memorial Hospital 24 East Ham Welfare Association for the Blind 35 Employment of Children 157 Enteric Fever 46 Epileptic Children 156-157 Erysipelas 46 Eye Diseases of Children 140, 145 F. Factories and Workshops 124-125 Following-Up 144 Food and Drugs 122-124 Food Inspection 119-124 H. Harts Sanatorium 23, 65-71 Health Committee 3 Health Visitors 94 Homeless Children 19 Hospital Accommodation 23-30 Hospital, Infectious Diseases 23,82-89 Hospital, East Ham Memorial 24 Hospital, Maternity 23 Hospital, Mental 30 Hospital, Smallpox 23 Hospital, Whipps Cross 24—26 House-to-House Inspection 107 Housing 115-119 Housing Statistics 115-117 I. Immunisation 45 Industrial Diseases of Lungs 53 Increase of Rent (Restriction) Act 110 180 INDEX—continued. Infant Consultations 90 Infant Deaths 16 Infantile Mortality 8 Infectious Diseases Hospital 23, 82 89 Infectious Diseases, Prevalence of and Control over 42-49, 141-144 Infectious Diseases (Non-noti- fiable) 136 Inspection of and Supervision of Food 119-124 Inspection, House-to-House 107, 127 Inspection of Schoolchildren 136, 157-178 Institutional Provision for Unmarried Mothers, Illegitimate Infants, etc. 19 Institutions Controlled by West Ham 24-26 Invalid Children's Aid Association 41, 99, 132 L. Laboratory Work 20, 124 Legal Proceedings 111-113, 121 Legislation in Force 21-23 Lettings 107 Light Treatment 148-151 Local Government Act, 1929 41 M. Maternal Mortality 9, 10, 99 Maternity and Child Welfare 90-101! Maternity and Child Welfare Committee 3 Maternity Homes and Hospitals19, 23, 96 Meals, Provision of 154 Meat Regulations 121 Medical Officer of Health's Report 1-103 Mental Defects, School Children 156-157 Mental Deficiency 30, 32-34 Mental Deficiency Committee 3 Mental Hospital 30 Meteorology 104 Midwives 17-18, 97 Milk, Free Supplies 99 Milk (Special Designation) Order 120 Milk Supply 119 Minor Ailments 139, 145 Mortality, Analysis of 12 N. Nose and Throat—Treatment 30 Noteworthy Causes of Sickness or Invalidity 8 Notices Served 109 Notification of Births 93 Nuisances Abated 110 Nuisances Discovered 109 Nursing Arrangements 17 Nursing Homes Registration Act, 1927 19 Nursery Schools 157 0. Open-air Education 151-153 Ophthalmia Neonatorum 30, 49, 99 Ophthalmic Clinic 165 Ophthalmic Surgeon, Report of 165 Ophthalmic Treatment 92 Orthopaedic Treatment 30 Other Foods 121 Overcrowding 118 P. Parents, Co-operation of 154 Parks and Open Spaces 114 Physical Features of Area 7 Physical Training 154 Playground Classes 151 Population 11 Premises and Occupations Controlled by Byelaws 114 Prevalence of Infectious Diseases 42-49 Propaganda 103 Prosecutions, Milk 121 Prosecutions, Public Health Act 111-113 Prosecutions, Sale of Foods and Drugs Acts 113 Public Assistance Institutions 25 Puerperal Fever and Pyrexia 30, 46, 98 R. Rag Flock Act 115 Rateable Value 7 Refuse Removal and Disposal 106 Rent (Restriction) Act 110 Ringworm 92 Rivers and Streams 106 S. Sanatoria 23, 65-75 Sani I ary Inspection of Borough 107 Scarlet Fever 45, 86 Scattered Homes 27-28 Scavenging 106 Schick Immunisation Clinic 45 181 INDEX—continued. School Attendance Officers, Co-operation of 154 School Baths 154 „ Blind Children 156-157 „ Camps 151 „ Children, Blind, Deaf, Defective and Epileptic 156-157 „ Children, General Cleanliness 137-138 „ Children, Minor Ailments 145 ,, Children, Medical Examinations 134-141 ,, Children, Physically Defective 156-157 „ Children, Dental 141, 147, 166-169 ,, Children, Verminous Conditions 137 „ Continuation 157 „ Cripples 141, 148 ,, Exceptional Children 134 ,, Hygiene 133 ,, Meals 154 „ Medical Officer's Report 129-178 „ Medical Service in Relation to Public Elementary Schools 133 „ Medical Treatment 144-151 ,, Nurses, Work of 137, 138, 144 „ Nursery 157 ,, Open-air 151 Schools of Recovery 153 Schools, Secondary 157 Schools, Survey of 115 Sewage. 106 Sex Distribution of Deaths 16 Sickness or Invalidity, any Noteworthy Causes. 8 Skin Diseases 140, 146 Slaughterhouses 121 Smallpox 23, 42-43, 107 Smoke Abatement 113 Social Conditions of Area 7 Staff 4, 130, 133 Statistics 7 Still Births 95 Streams 106 T. Table, Births in Wards 12 Birth-rate 12 Blind Persons 37-40 „ Cancer 50 ,, Clinics 31 ,, Complaints Received 109 „ Death Rate 12 Table, Deaths, Causes of 13-14 ,, Deaths, Sex Distribution 16 „ Deaths, Ward 15 ,, Dental Treatment 178 ,, Exceptional Children 173-175 ,, Factories and Workshops Act 124—125 „ Food and Drugs Acts 123 ,, Harts Sanatorium 68-71 ,, Housing 115-117 ,, Infantile Mortality 16 ,, Infectious Diseases, Notifiable 47-48 ,, Infectious Diseases Removed to Hospital 88 ,, Infectious Diseases in Schoolchildren 143—144 ,, Inspections in Wards 108 „ Laboratory Examinations 20 ,, Mental Defectives 32-34 „ Mental Hospitals 30 ,, Meteorology 104 ,, Midwives 17 „ Minor Ailments 139, 176 „ Ophthalmia Neonatorum 49 „ Public Assistance Institutions 25, 73 „ Public Health Act Prosecutions 111-113 ,, Record of Inspections 127 ,, Sale of Food and Drugs Acts Prosecutions 113 ,, School Children, Defects of160-163, 171-175 ,, School Children Examined 136, 159-178 ,, School Children Found to require Treatment 136, 162-163 „ Schools of Recovery 153 „ Secondary School Examinations 159-163 „ Smallpox 42-43 ,, Sunlight Treatment 150 Tuberculosis and Occupation 80 ,, Tuberculosis Deaths 79-81 ,, Tuberculosis and Chest Clinic 60-64 ,, Tuberculosis Notifications 76-79 ,, Tuberculosis, Residential Treatment 68-75 „ Vaccination 43-44 ,, Verminous Condition of School Children 137, 138, 178 Teaching Staff, Co-operation of 154 182 INDEX—continued. Tonsils and Adenoids 92, 139, 145 Training Centre, Mental Defective 34 Treatment Centres 31 Tuberculosis 51-81, 146 Tuberculosis and Chest Clinic 51-64 U. Unmarried Mothers 19 Urinals 115 Ultra-Violet Radiation 148-151 V. Vaccination 43-45 Venereal Diseases 29 Vital Statistics, Extracts from 7 Vision 140, 147 Visits, Health Visitors 94, 101 Visits, School Nurses 137, 138, 144 Voluntary Associations 35, 41, 99, 155 W. Wards, Births in 12 Wards, Deaths in 15, 16 Water Supply 106 Whipps Cross Hospital 24 Workshops 124-125