Ac 4413 EAS 8 COUNTY BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1932. W. BENTON, M.R.C.S., L.R.C.P., D.P.H.. Medical Officer of Health. recorders, ilford. COUNTY BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report OF THE Medical Officer of Health AND School Medical Officer FOR THE YEAR 1932. 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 (Alderman C. W. Brading, J.P.). *The Deputy-Mayor (Councillor T. W. Burden). Alderman G. H. Manser (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 H. N. Ridler. Alderman Mrs. A. Taylor. Councillor J. W. Barton. *Councillor G. W. Boultwood. Councillor W. T. Bush. Councillor F. H. Edwards. Councillor G. A. Hobbs. Councillor T. I. Lethaby. Councillor H. Restarick. Councillor A. Simons. *Councillor Mrs. B. Wilkens. MATERNITY AND CHILD WELFARE SUBCOMMITTEE. Maternity and Child Welfare Act, 1918, Sec. 2. Same members as Public Health Committee, with— Mrs. M. W. Bacot (co-opted). Miss E. R. Da vies (co-opted). Mrs. K. Moger (co-opted). *Also Member of the Institutions and General Sub-Committee. COMMITTEE FOR THE CARE OF THE MENTALLY DEFECTIVE. Mental Deficiency Act, 1913, Sec. 28. The Mayor (Alderman C. W. Brading, J.P.). The Deputy-Mayor (Councillor T. W. Burden). Alderman Mrs. A. Taylor (Chairman). Alderman J. Brooks, J.P. (Vice-Chairman). Alderman H. B. Harper, J.P. Alderman F. Webster. Councillor C. F. H. Gresn. Councillor T. I. Lethaby. Councillor R. W. Moger. Councillor W. Thompson. Councillor Mrs. B. Wilkens. Mrs. C. J. Cross (co-opted). Mrs. A. M. Gray (co-opted). Mrs. L. J. Nichols (co-opted). STAFF OF THE PUBLIC HEALTH DEPARTMENT. Clerks: Miss H. E. Ritterspack, Miss D. Gordon, C. L. Durbin, A.C.I.S., C. B. Lorence (to 23-7-32), G. H. Green, C. J. Hayes (from 18-7-32). F. J. Kendall, A.R.San.1., 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 Sier. Tuberculosis Dispensary Clerks: B. E. R. Hartley, A.C.I.S., Miss M. Pratt (to 3-9-32), Miss D. M. Greene (from 29-8-32). Tuberculosis Nurses: Miss L. E. Mallon, S.K.N., Miss E. E. Cook, S.R.N., Certified Midwife. Assistant Nurse: Miss A. Meadhurst. Nurse at Arragon lload Dispensary: Mrs. E. E. Kelly, S.R.N., Certified Midwife, Fever Trained. Child Welfare Clerks: Miss M. A. McCall, Miss M. A. R. Gaster, Miss W. M. Hales. Kealtli Visitors: Miss K. Bower, S.R.N., Certified Midwife (deceased 26-8-32), Miss L. Barrett, S.R.N., Certified Midwife, Miss E. Hazelden, S.R.N., Certified Midwife, R.S.I. (Health Visitor's Cert.) (from 7-12-32), Miss A. E. O'Leary, S.H.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. Sharpe, S.R.N. Shops Act Inspector: C. H. Pursall, A.R.San.I. Assistant Sanitary Inspector: H. G. Luckett, M.S.I.A., A.R.San.I. Sanitary and Food Inspectors: R. A. Baskett, M.S.I.A., M. J. J. Hillyard, M.S.I.A., \V. 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 Fublic Vaccinator: L. F. A. Harrison, M.R.C.S., L.R.C.P. Assistant Medical Officers: J. Crawford, M.B., Ch B., D.P.H. (M. and C.W. and General Public Health) (from 25-7-32). Miss Jessie A. McLaren, M.B., Ch.B., D.P.H. (M. and C.W. and General Public Health). Miss M. M. Thomson, L.R.C.P., L.R.C.S., D.P.H. (School Medical and General Public Health). 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 Medical Officer: F. E. Bendix, M.R.C.S., L.R.C.P., L.D.S Deputy Medical Officer of Health and 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., CM. 5 Public Health Department. Town Hall, East Ham, E.6. May, 1933. To the Mayor, Aldermen and Councillors of the County Borough of East Ham. Mr. Mayor, Ladies and Gentlemen, I beg to submit my Annual Report on the health and sanitary circumstances of the Borough, together with my Report to the Education Authority on the work of the School Medical Service, for the year 1932. The report is based on the "Circular as to the Contents and Arrangement of the Annual Report of Medical Officers of Health for 1932 " issued by the Ministry of Health. This is the last Annual Report it will be my privilege to submit to you. Since my appointment as your Medical Officer of Health the duties of a Health Department have increased very considerably, especially in connection with Maternity and Child Welfare and the School Medical Service. From the date of my appointment, 49 Acts of Parliament have become law—in addition to numerous Orders, Regulations and Bye-laws—dealing with matters relating to Public Health. It is very gratifying—before relinquishing the duties of my office—to be able to state that of recent years there has been a decline in the incidence of Tuberculosis. Although the number of notifications has shown little decline, Scarlet Fever is now of a much milder type than formerly was the case. Smallpox, in an epidemic form, has threatened the Borough on several occasions, generally by importation from other Boroughs in close proximity, but has always been checked, and 6 East Ham has suffered much less in this respect than other areas. This is partly accounted for by the fact that although there has been an increasing number of so-called conscientious objectors to vaccination, when an epidemic has threatened, the parents of contacts (and contacts) have taken my advice willingly and had their children or themselves vaccinated. The disease of latter years has been of the very mild form and one vaccination mark has proved sufficient to prevent infection of contacts. As mentioned later in my report, Maternal Mortality is still too high and I regret that I shall not see officially the provision of a Maternity Home, which I have advocated for a number of years. Such an institution, with the addition of a Municipal Midwifery Service, would do much to reduce the mortality among mothers. The provision of the pavilion at Harts Sanatorium and the extensions and additions to the Infectious Diseases Hospital are a source of satisfaction to me. To turn to the reverse side of the picture, it is regrettable that, although one of the pioneers in Maternity and Child Welfare and School Medical Services, the department has still to carry on the various clinics in improvised buildings, in spite of my repeated advocacy for up-to-date and permanent buildings for clinic purposes. I would in conclusion like to pay a tribute to my colleagues with whom I have laboured, both in the Council and on the staff, to their never failing kindness and help I have always received. I am, Ladies and Gentlemen, 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, 142,394 (males 68,923, females 73,471). Estimated to middle of 1932, 141,500. Number of inhabited houses (end of 1932) according to rate books (including tenements and shops), estimated 32,570. Rateable value at 31st December, 1932, £692,183. Sum represented by a penny rate, 1932, £2,795. Physical Features of the Area. See report for the year 1930. Social Conditions of the Area. See report for the year 1930. EXTRACTS FROM VITAL STATISTICS. Total. Males. Females. Live Births Legitimate 2,014 1,033 981 Birth rate per 1,000 of the estimated population 145. Illegitimate 48 20 28 Still Births 86 43 43 Rate per 1,000 total (live and still) births 40.0 Deaths 1,456 774 682 | Death rate per 1,000 of the estimated population 102. Deaths from puerperal causes :— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 5 2.3 Other puerperal causes 3 1.3 Total 8 3.6 Death rate of infants under one year of age:— All infants per 1,000 live births 54 Legitimate infants per 1,000 legitimate live births 54 Illegitimate infants per 1,000 illegitimate live births 62 Deaths from Measles (all ages) 10 Deaths from Whooping Cough (all ages) 6 Deaths from Diarrhoea (under 2 years of age) 18 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. Heart Disease, as in former years, again is responsible for the largest number of deaths from any one cause, although 1932 saw a decrease of 62 deaths as compared with 1931, namely; 267 against 329. As I have commented on this fact in my last two reports, it is not proposed to comment any further on this matter. Cancer again was responsible for a higher number of deaths than the previous year; 234 against 183. Reference is made to this disease at a later stage of the report. Births. The number of live births registered during the year was 2,062 as compared with 2,045 for 1931. The birth rate was 14.5 or .2 above that for the previous year. As is well known, the number of births has been steadily declining all over the country for the past 24 years and East Ham has followed the same tendency. In 1914, the rate for the Borough was 24.0, and with the exception of 1920, when there was a sharp jump in the rate to 23.2, it has steadily declined to its present level. Deaths. I have pleasure in recording a decreased number of deaths for 1932, 1,456, as compared with 1,526 for 1931. The rate was 10.2 or .4 below that of the previous year. As I have previously pointed out, East Ham is normally a healthy borough, and during my 24 years service with you the death rate (except in times of epidemic) has varied very slightly. In this report the table "Causes of Death in Age Groups" has been enlarged to show the causes under various groups of diseases. Of these sections, on reference to the table concerned, it will be seen that the following five groups were responsible for 74 per cent. of the total deaths :— 9 A. Infectious and Parasitic Diseases 202 or 13.8 per cent, of total B. Cancer and other Tumours 244 or 16.7 per cent, of total E. Diseases of the Nervous System and Sense Organs ... 129 or 8.8 per cent, of total F. Diseases of the Circulatory System ... 315 or 21.6 per cent, of total G. Diseases of the Respiratory System 191 or 13.1 per cent, of total The percentage of total deaths in the various age-groups was as follows :— Under 1 Year ' 1:2 Years 2-5 Years 5-15 Years 15-25 Years 25-35 Years 35-45 Years 45-55 Years 55-65 Years 05-75 Years 75 Years and upwards 7-7 1-2 1-7 30 4-9 5-7 5-5 10-5 16-2 21 0 221 Reference to the table " Ward Distribution of Deaths and Ward Death Rates " indicates that Kensington Ward had the highest death rate, 12.5, and Greatfield the lowest, 6.6. It is interesting to note that of the total deaths 715 occurred in institutions. Of the inward transferable deaths (those residents dying outside the Borough), 600 occurred in hospitals and institutions in and around London. Fifty deaths occurred in East Ham of non-residents, 40 of whom died in the East Ham Memorial Hospital. Infantile Mortality. The number of deaths of infants under one year of age was 112, equivalent to an infantile mortality rate of 54 per 1,000 live births, as compared with 121 deaths and a rate of 59 for 1931. In 1909 when I was appointed your Medical Officer of Health, the infantile mortality rate was 95 per 1,000 live births. Since the passing of the Notification of Births Act and the Maternity and Child Welfare Act, with the consequent formation of a subdepartment to deal with Maternity and Child Welfare, this rate has rapidly decreased. It will be seen that the difference between the rate of 1909 and that of 1932, results in the saving of 41 infant lives in every 1,000 babies born alive. 10 Maternal Mortality. The maternal mortality rate was 3.6 per 1,000 total (live and still) births, although slightly lower than that of the previous year (3.77), is, in my opinion, still too high. There has been a tendency to increase in the maternal mortality rate during my term of office, in spite of the fact that every effort has been made to ensure that all mothers should have every facility afforded them before and after the birth of the child. There is no doubt that efficient and monthly ante-natal examinations would do much to reduce the risk of fatal consequences of child-bearing, and this service is offered to all the mothers of the Borough. As this will be my last report, it is interesting to record here the powers the Council have to aid Maternal Welfare in the area and what services are in force in the Borough. The Maternity and Child Welfare Act, 1918, empowers a Local Authority to :— 1. Appoint Health Visitors A staff of Health Visitors is employed by the Council. 2. Establish Ante-natal and Post-natal Clinics. An Ante-natal Clinic is held weekly and mothers are seen after confinement at the special clinics. 3. Assistance to Midwives :— (a) Provision of sterilised maternity outfits free or at cost price. Provided. (6) Subsidies to midwives' (where necessary). Not provided. (c) Appointment of municipal midwives „ ,, (see No. 4). (d) Payment of part fees to midwives for patients who cannot cannot afford full fee " (e) " Refresher" courses for practising midwives „ 4. Maternity Homes or Beds in a Maternity Hospital for :— The provision of a Maternity Home (with a consultant) has been approved by the Council with an isolation block for puerperal sepsis. Attached to the Home would be a Municipal Midwife Service and extension of Ante-natal and Postnatal work. Cases in the meantime are sent to Forest Gate Hospital and other hospitals in the neighbourhood. (a) Complicated cases (6) Patients where home circumstances are unsuitable for confinement (c) Ante-natal supervision (d) Treatment of puerperal sepsis 5. Home Helps Provided. 6. Provision of Milk, etc. Provided. 11 7. Complicated Midwifery :— (a) Pay (in whole or part) fees of doctors called in by midwives for an " emergency " Provided. (6) Fees of " consultants " M.O.H. acts as such (see No. 4) (c) Skilled nursing of patients at home Not provided. Bacteriological examination of lochia, etc. Provided. 8. Convalescent Home Treatment ,, 9. Payments to Nursing Associations •• 10. Assisting Unmarried Mothers and their Children Not provided. Population. The Registrar General's estimate of the population of the Borough to the middle of 1932 is 141,500, and on this figure the various rates in the report are based, unless otherwise stated. Towards the end of the year under review, the Registrar General published part 1 of the Census figures and statistics for the County of Essex, and the following extracts from this return relate to East Ham:— Population. 1911 1921 1931 Persons Persons Males Females Persons Males Females 133,487 143,246 69,342 73,904 142,394 68,923 73,471 It will be seen that whereas there was an increase of the population from the 1911 Census to the 1921 (7.3 per cent.), within the next ten years there was a decrease (0.6 per cent.), which seems to indicate that the population of the Borough has now reached its peak and that for the next decade the figure will remain stationary. Within the period 1921-1931 there was an increase by excess of births over deaths of 7.1 per cent. but a decrease by migration of 7.7 per cent. In Table 1 is shown the Census population in wards, density of population, private families, etc., etc. 12 On analysing Table 1 it would seem that generally no serious overcrowding exists in the Borough, but reference to tables that follow indicate that there are many individual cases. The highest number of persons per room occurred in the South Ward, viz., 1.11. The largest number of persons per acre occurs in the Castle Ward, 83.4, with Plashet running this ward close with 81.6. A most interesting point will be noticed in the South Ward, which is the only ward with more males than females, the ratio being 8,180 to 7,336 (see page 13). The degree of overcrowding on Census night can be ascertained by a study of Table 2. It will be seen that in 15 cases families were occuping a structurally separate dwelling of one room, in three instances two families were occuping two rooms, and in three rooms there were 39 cases of two families living therein. In view of the shortage of housing accommodation it is surprising to find that 338 dwellings were wholly vacant (see page 14). Further light on the extent of overcrowding in the Borough is shown by Table 3. It will be seen that 1,456 private families lived in one room or 3.9 per cent., as compared with 4.6 per cent. in the 1921 Census. Of the 1,456 private families it will be noticed that 619 were composed of two or more persons, 324 of three or more persons, and 150 of four or more persons. In 15 cases six people lived and slept in one room, in 10 seven persons, and in one case, eight (see page 15). 13 TABLE 1. Acreage (Land and Inland Water). Total population. Private families and dwellings, 1931. 1921 1931 Private families. Population in private families. Structurally separate dwellings occupied. Rooms occupied. Persons per room. Persons. Persons. Males. Females. Persons per acre. East Ham 3,324 143,246 142,394 68,923 73,471 42.8 37,775 140,032 29,264 151,230 0.93 Wards :— Castle 163 15,024 13,600 6,541 7,059 83.4 3,588 13,535 2,686 13,782 0.98 Central 188 15,121 13,866 6,840 7,026 73.8 3,601 13,681 2,636 13,923 0.98 Greatfield 222 11,299 14,035 6,777 7,258 63.2 3,815 13,985 3,456 16,223 0.86 Kensington 180 12,573 11,675 5,536 6,139 64.9 3,385 11,605 2,504 14,312 0.81 Little Ilford 237 17,206 16,250 7,871 8,379 68.6 4,000 16,194 3,061 15,218 1.06 Manor Park 574 14,571 13,922 6,520 7,402 24.3 3,933 13,761 2,935 16,905 0.81 Plashet 168 14,304 13,705 6,396 7,309 81.6 3,746 13,455 2,670 14,665 0.92 South 1,092 14,913 15,516 8,180 7,336 14.2 3,574 14,464 2,807 12,993 .1.11 Wall End 328 14,676 17,143 8,312 8,831 52.3 4,540 16,707 3,693 18,201 0.92 Woodgrange 172 13,559 12,682 5,950 6,732 73.7 3,593 12,645 2,816 15,008 0.84 14 TABLE 2. - Structurally Separate Dwellings of Number of rooms. 1 Room 2 Rooms 3 Rooms 4 Rooms 5 Rooms 6-8 Rooms 9 or more Rooms All sizes. Total Occupied. Vacant. Furnished. Others. Dwellings occupied by 1 private family 15 63 1,300 4,176 10,145 5,405 80 21,184 105,638 105,062 367 209 Dwellings occupied by 2 private families — 3 39 431 2,406 4,774 23 7,676 43,687 43,657 21 9 Dwellings occupied by 3 or more private families - - 1 7 90 281 25 404 2,513 2,511 - 2 Total dwellings occupied 15 66 1,340 4,614 12,641 10,460 128 29,264 151,838 151,230 388 220 Dwellings whollv vacant :— Furnished 1 8 17 41 27 — 94 470 — 470 — Others — 2 8 49 101 82 2 244 1,257 — — 1,257 Total dwellings occupied and vacant 15 69 1,356 4,680 12,783 10,569 130 29,602 153,565 151,230 858 1,477 Number of private families therein 15 69 1,381 5,059 15,233 15,809 209 37,775 — — — — Miscellaneous habitations and institutions housing non-private families 232 15 TABLE 3. No. of persons in family. Number of private families occupying the following number of rooms. Total private families Population in private families Rooms occupied. Density of occupation. Average No. of persons per room. Populatio densities (Person n at following of occupation, s per room.) 1 2 3 4 5 6-7 8-9 10 or more. Over 3 3 and over 2 2 and over li li and over 1 1 837 590 493 149 146 67 3 — 2,285 2,285 5,258 0-43 — 2 295 1,897 2,709 1,137 1,501 701 19 2 8,261 16,522 28,755 0-57 — — 590 — 3 174 1,124 2,800 1,606 2,487 1,111 29 6 9,337 28,011 36,791 0-76 — 522 — 3,372 4 87 450 1,654 1,523 2,520 1,241 39 6 7,520 30,080 32,626 0-92 348 — 1,800 6,616 5 37 179 888 930 1,773 902 26 5 4,740 23,700 21,444 111 185 895 4,440 4,650 6 ' 15 73 477 583 1,015 573 26 1 2,763 16,578 12,744 1-30 90 438 2,862 9,588 7 10 31 221 301 538 300 10 5 1,416 9,912 6,607 1-50 287 1,547 2,107 5,579 8 1 12 110 150 287 138 14 2 714 5,712 3,378 1-69 104 880 3,496 1,104 9 — 9 79 79 147 82 7 2 405 3,645 1,886 1 -93 81 1,422 1,323 774 10 — 2 29 40 75 43 1 1 191 1,910 910 210 310 400 1,130 60 11 — — 12 21 27 25 2 1 88 968 434 2-23 132 528 275 33 12 6 6 13 9 1 — 35 420 170 2-47 72 228 108 12 13 — — 2 3 4 3 — — 12 156 56 2-79 65 91 — — 14 — — — 1 2 1 — — 4 56 20 2-80 14 42 — — 15 and over — — — 1 — 2 — 1 4 77 56 138 15 32 — — 2 persons and over 619 3,777 8,987 6,381 10,389 5,131 174 32 35,490 137,747 145,877 0-94 1,703 7,025 18,131 31,788 Total private families 1,456 4,367 9,480 6,530 10,535 5,198 177 32 37,775 Population in private families 2,650 11,303 31,887 26,270 44,312 22,554 859 197 — 140,032 — 0-93 1,703 7,025 18,131 31,788 Rooms occupied 1,456 8,734 28,440 26,120 52,675 31,868 1,464 378 — 151,135 — — — — — — 3-9 11-6 25 0 17-3 27-8 13-8 0-5 01 100 0 1931 Percentage of families living in various units of occupation 4-6 9-2 22-2 190 28-0 16-4 0-5 01 1000 1921 16 The census population was made up as follows :— No. Percentage. In dwellings occupied by private families ... 140,032 98-3 In hotels, boarding houses, lodging houses, etc. ... 857 0-6 In schools, orphanages and other educational institions (excluding reformatories) 22 00 In civilian hospitals, nursing homes and other institututions for the temporarily sick 279 0-2 In prisons, police stations and other places of detention (including reformatories) 17 0 0 In civilian ships, boats and barges ... 824 0-6 All others (including vagrants) 363 0-3 Total 142,394 It is interesting- to note that in the year I commenced duties with this Authority—1909—the estimated population was 149,575. The child population 0-4 years included in the total 142,394, was 9,823, 5-9 years 11,071, and 10-14 years 11,222. At the other end of the scale there were 1,985 persons 75-79 years, 901 between 80-84 years, 306 between 85-89 years, 50 between 90-94 years, and six over 95 years. 17 TABLE 4.—Birth Rate, Death Rate and Analysis of Mortality, 1932. 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* 15-3 0.66 12.0 0.01 0.00 0.08 0.01 0.07 0.06 0.32 0.53 6.6 65 91. 1 6.2 1.8 0.9 118 County Boroughsf & Great towns including London 15.4 0.70 11.08 0.00 0.00 0.11 0.01 0.08 0.07 0.28 0.48 8.9 69 91.3 5.9 2.3 0.5 126 smaller towns† (census populations 25,00050,000) 15.4 0.69 10.8 0.00 0.00 0.06 0.01 0.06 0.03 0.31 0.42 4.5 58 91.9 5.8 1.3 0.1 London † 14.2 0.51 12.3 0.00 0.00 0.19 0.02 0.8 0.07 0.27 0.53 12.6 66 89.4 6.2 4.4 0.0 East Ham * 14.5 0.60 10.2 0.01 0.00 0.07 0.01 0.04 0.13 0.14 0.60 8.7 54 91.2 6.5 2.3 0.0 •Rates based on Estimated Population middle of year 1932. † Rates based on Estimated Population middle of year 1931. TABLE 5.—Births in Wards and Rates. Wards. Total. Manor Park. Little Ilford. Woodgrange. Plashet. Kensington. Castle. Central. Wall End. Greatfield. South. Births in Wards 183 270 178 203 145 212 178 238 157 298 2,062 Rates (Census population forWards) 13.1 16.6 14.0 14.8 12.4 15.5 12.8 13.8 10.9 19.2 14.5 19 TABLE 6. Causes of Death in Age Groups, 1932. Cause of death. All ages. Deaths at different periods of life of residents whether occurring within or without the district. Under 1 yeas 1-2 years 2-5 years 5-15 years 15-25 years 25-35 years 35-45 years 45-55 years 55-65 years 65-75 years 75 years and upwards A.—Infectious and Parasitic Diseases 202 5 8 14 21 34 42 21 25 17 9 6 b.—Cancer and Other Tumours 244 1 — 1 3 1 4 21 44 73 60 36 C.—Rheumatism, Diseases of Nutrition and of Endocrine Glands and other General Diseases 30 - - - - 2 1 3 10 10 4 D.—Diseases of the Blood and Blood-forming Organs 8 - - - - - - 1 4 1 2 E.—Diseases of the Nervous System and Sense Organs 129 9 1 1 4 2 3 5 12 20 34 38 f.—Diseases of the Circulatory System 315 — — — 2 6 6 9 19 56 101 116 g.—Diseases of the Respiratory System 191 21 6 7 5 4 4 6 19 21 43 55 h.—Diseases of the Digestive System 79 18 2 1 3 3 6 7 9 12 13 5 i.—Non-Venereal Diseases of the Genitourinary System and Annexa 45 - 1 - 2 2 3 2 3 7 15 10 J.—Diseases of Pregnancy, Childbirth and the Puerperal State 8 - — — 2 5 1 - - - - K.—Diseases of the Skin and Cellular Tissue 1 - - - - - 1 - - - - - L.—Diseases of the Bones and Organs of Locomotion 5 - — 1 1 - - 1 - - 2 - M.—Congenital Malformations 9 9 — - - - -- - - - - - N.—Diseases of Early Infancy 47 47 - - - - - - - - - - O.—Old Age 54 — — — — — — — 1 2 7 44 P.—Deaths from Violence 86 2 — — 4 16 9 7 15 16 11 6 Q.—Ill-Defined Diseases0 3 - - - - - - - - 2 1 - Totals 1,456 112 18 25 45 72 84 81 154 237 306 322 A.—Infectious and Parasitic Diseases. 1. Typhoid Fever 1 - - - - - - - 1 — — — 2. Paratyphoid Fevers 1 - - - - - - - - 1 — — 3. Measles 10 2 4 1 2 1 - - - - - - 4. Scarlet Fever 2 — — — 1 — — 1 — — — — 5. Whooping Cough 6 3 2 — 1 - - - - - - - 6. Diphtheria 19 — — 6 11 1 — — — 1 — — 7. Influenza 21 — 1 — — 1 — 2 3 4 5 5 8. Erysipelas 4 - - - - - - - 2 2 — — 9. Acute Poliomyelitis 2 - — 1 — 1 — - - - - - 10. Encephalitis Lethargica 1 - - - - - - - 1 — — — 11. Cerebro-Spinal Fever 4 — — — — 2 2 — — — — — 12. Tuberculosis—Respiratory System 108 — — — 4 22 38 16 17 8 3 ~~~ 13. ,, Central Nervous System 10 — 1 6 1 2 — — — — - - 14. ,, Other Bones and Joints 1 - - - - - - - - - - - 15. ,, Genito-Urinary System 3 — . — — — 2 — — 1 — — - 16. „ Disseminated 2 — — — 1 1 — — — — — - 17. Purulent Infection—Septicaemia 5 - - - - - 2 1 — — 1 1 18. Syphilis 1 - - - - - - 1 — — — — 19. Mycoses 1 - - - - - - - - 1 - ~~~ b.—Cancer and other Tumours 20. Cancer, Malignant Disease—Buccal Cavity and Pharynx 17 - - - - - - - 3 4 7 3 21. ,, „ „ Digestive Organs and Peritoneum 117 - - - - - - 12 15 44 27 19 22. „ „ „ Respiratory Organs 19 — — — 1 — — 3 7 5 3 - 23. ,, „ ,, Uterus 11 - - - -- - - 2 2 4 3 — 24. ,, „ ,, Other Female 7 - - - - - - - 4 1 1 1 Genital Organs 25. „ „ ,, Breast 23 - - - - - 1 — 9 6 3 4 26. ,, ,, ,, Male Urinary Organs 13 - - - - - - - 1 3 5 4 27. „ „ ,, Skin 4- - - - - - - - - -— 2 2 28. „ ,, ,, Other or Unspecified Organs 23 1 — — 1 1 1 3 1 3 9 3 29. Non-Malignant Tumours 10 — — 1 1 ■— 2 1 2 3 - - C.—Rheumatism, Diseases of Nutrition and of Endocrine Glands, and other General Diseases. 30. Rheumatic Fever 3 — — — — 2 1 — — - - - 31. Chronic Rheumatism, Osteo-Arthritis 6 - - - - - - - 1 3 - 2 32. Diabetes 18 - - - - - - - - 7 10 1 33. Pellagra0 1 - - - - - - - 1 - - - 34. Diseases of the Thyroid and Parathyroid Glands 2 - - - - - - - 1 - - 1 D.—Diseases of the Blood and Blood-forming Organs. 35. Anaemia, Chlorosis 7 — - - - - - - -4 1 - 2 36. Leukaemia, Aleukamia 1 - - - - - - 1 - - - - E.—Diseases of the Nervous System and Sense Organs. 37. Encephalitis 2 2 - - - - - - - — — - 38. Meningitis 6 1 1 — — 1 1 1 — 1 - - 39. Tabes Dorsalis (Locomotor Ataxy) 2 - - - - - - - - — 2 - 40. Other Diseases of the Spinal Cord 3 - - - - - - 1 1 - 1 - 41. Cerebral Haemorrhage, Apoplexy, etc. 98 4 — — — — 1 2 9 16 29 37 42. General Paralysis of the Insane 3 - - - - - 1 1 1 — - - 43. Other Forms of Insanity 3 — — — — 1 — — 1 1 — - 44. Epilepsy 3 — — — 3 — — — — — - - 45. Infantile Convulsions (age under 5 years) 2 2 - - - - - - - - - - 46. Other Diseases of the Nervous System 6 — — 1 — — — — — 2 2 1 47. Diseases of the Ear and Mastoid Sinus 1 — — — 1 — — — — - -~ - f.—Diseases of the Circulatory System. 48. Acute Endocarditis 3 — — — — 1 — 2 — — — ~~ 49. Chronic Endocarditis, Valvular Disease 74 — — — 2 3 3 4 7 16 21 18 50. Diseases of the Myocardium 171 — — — — 2 3 2 6 22 55 81 51. Diseases of the Coronary Arteries, Angina Pectoris 9 — - - - - - - 1 4 3 1 52. Other Diseases of the Heart 13 - - - - - - 1 1 3 6 2 53. Aneurysm 8 — — — — — — — 1 4 2 1 54. Arterio-Sclerosis 32 — - - - - - - 3 6 14 9 55. Gangrene 3 — - - - - - — — — — 3 56. Diseases of the Veins (Varix, Haemorrhoids, Phlebitis, etc.) 1 — - - - - - - - 1 - - 57. Abnormalities of Blood Pressure 1 — - - - - - - - - - 1 g.—Diseases of the Respiratory System. 58. Diseases of the Larynx 1 1 - - - - - — — — - - 59. Bronchitis 62 4 — 1 — — — — 5 6 18 28 60. Broncho-Pneumonia 58 15 5 4 — 2 — 2 3 4 9 14 61. Lobar-Pneumonia 27 — 1 — 2 — 3 2 6 4 6 3 62. Pneumonia (not otherwise defined) 12 1 — 2 2 1 — — 1 1 2 2 63. Pleurisy 6 — — — 1 1 — - 2 ~~~ - 1 64. Congestion and Haemorrhagic-Infarct of Lung, etc. 65. Asthma 14 8 - - - - - - - - - - - - 1 1 1 - 3 2 6 2 4 3 66. Other Diseases of the Respiratory System 4 — — — — — 1 1 1 1 - - h.—Diseases of the Digestive System. 67. Diseases of the Buccal Cavity, Pharynx, etc. 1 — — — 1 — — — — — - ~~ 68. Ulcer of the Stomach or Duodenum 13 — — — — — 1 2 4 2 3 1 69. Other Diseases of the Stomach 1 1 — - - — — — — — - - 70. Diarrhoea and Enteritis (under 2 years) 18 16 2 - - — — — — — — — 71. ,, ,, (over 2 years) 2 — — — 1 — — — — — — 1 72. Appendicitis 15 — — 1 — 3 3 3 2 2 1 - 73. Hernia, Intestinal Obstruction 15 — — — 1 — 1 1 — 4 5 3 74. Other Diseases of the Intestines 1 — — — — — — — — 1 - 75. Cirrhosis of the Liver 5 1 — — — — — — — 3 1 - 76. Other Diseases of the Liver 1 — — — — — 1 — — — — - 77. Biliary Calculi 2 — — — — — — — 2 - - - 78. Other Diseases of the Gall Bladder and Ducts 2 — — — — — — — 1 — 1 - 79. Peritonitis (without stated cause) 3 — — — — — — 1 — 1 1 - I.—Non-Venereal Diseases of the GenitoUrinary System and Annexa. 80 .Acute Nephritis 4 — — — — 1 1 1 — — 1 1 81. Chronic Nephritis 11 — — — 1 1 2 — — 2 1 82 Nephritis (not stated to be acute or chronic) 19 — 1 — 1 — — 1 2 3 7 4 83. Other Diseases of the Kidney and Annexa 3 — — — — — — — 1 1 1 - 84. Diseases of the Bladder 5 — — — — — — — — — — 5 85. Diseases of the Prostate 2 — — — — — — — — — 2 - 86. Diseases of the Female Genital Organs 1 — — — — — — — 1 - - J..—Diseases of Pregnancy, Childbirth and the Puerperal State. 87. Puerperal Sepsis (Post-abortive Sepsis) 2 — — — — — 2 — — — — - 88. Puerperal Sepsis (not returned as postabortion) 3 — — — — 1 2 — - - - - 89. Puerperal Abuminuria and Convulsions 1 — — — — 1 — — — — — - 90. Other Accidents of Childbirth 2 — — — — — 1 1 — — ~~ - K.—Diseases of the Skin and Cellular Tissue. 91. Other Diseases of the Skin and its Annexa 1 — — — — — 1 — — — — — L.—Diseases of the Bones and Organs of Locomotion. 92. Acute Infective Osteomyelitis and Periostitis 3 — — 1 1 - - - - - 1 — 93. Other Diseases of the Bones 2 — — — — — — 1 — — 1 - M.-—Congenital Malformations. 94. Congenital Malformations 9 9 — — — — — — — — — - N.—Diseases of Early Infancy. 95. Congenital Debility 3 3 — — — — — — — — — — 96. Premature Birth 37 37 — — — — — — — — — — 97. Injury at Birth 3 3 — — — — — — — — — — 98. Other Diseases peculiar to Early Infancy 4 4 ~~ O.—Old Age. 99. Old Age 54 — — — — — — — 1 2 7 44 P.—Deaths from Violence. 100. Suicide—By Solid or Liquid Poisons or Corrosive Substances 3 - - - - - - 1 1 1 — - 101. ,, —By Poisonous Gas 12 — — — — 1 — 2 3 6 — — 102. ,, —By Hanging or Strangulation 4 - - - - - - 1 — 2 — 1 103. ,, —By Cutting or Piercing Instruments 2 - - - - 1 — 1 — — —• 104. ,, -—By Crushing 1 — — — — — — 1 — — — — 105. ,, -—By Other Means 1 - - - - - - - - - - — 106. Accidental Absorption of Irrespirable or Poisonous Gas 1 - - - - - - - - - - 1 107. Accidental Burns (Conflagration excepted) 1 - - - - - - - - - - — 108. ,, Mechanical Suffocation 2 1 1 — — — — 109. „ Drowning 5 - — — — 3 1 1 — — — — 110. „ Injury by Fall, Crushing, etc. 49 — — — 4 11 4 1 8 7 10 4 111. Other and Unstated Forms of Accidental Violence 3 - - - - - 1 — 2 — - - 112. Violent Deaths of Unstated Nature {i.e., Accidental Suicide) 2 1 - - - - - - - - 1 - Q.—Ill-Defined Diseases. 113. Cause of Death Unstated or Ill-defined 3 - - - - - - - 2 1 — 21 TABLE 7.—Ward Distribution of Deaths, and Ward Death Rates, 1932. Cause of death. Wards. Total. Deaths in Institutions. Manor Park. Little Ilford. Woodgrange. Plashet. Kensington. Castle. Central. Wall End. Greatfield. South. 1. Typhoid & Paratyphoid Fevers — — — — 1 — — — 1 — 2 2 2. Measles 1 2 — 1 1 2 — 1 — 2 10 5 3. Scarlet Fever — — 1 - - - - - 1 - 2 1 4. Whooping Cough 2 — — 1 — - 2 - 1 — 6 4 5. Diphtheria 3 1 — — 3 6 1 1 — 4 19 18 6. Influenza 2 1 1 2 2 1 9 2 - 1 21 4 7. Encephalitis Lethargica — — — — - - - - 1 — 1 1 8. Cerebro-Spinal Fever 1 — 1 — - 1 1 - - - 4 4 9. Tuberculosis of Respiratory System 8 9 10 9 7 16 14 16 7 12 108 55 10. Other Tuberculous Diseases 4 3 — 1 1 2 1 1 - 3 16 13 11. Syphilis — — - - 1 - - - - - 1 1 12. General Paralysis of the Insane, Tabes Dorsalis 1 1 - 1 - - - 2 - - 5 4 13. Cancer 21 23 17 22 23 25 21 38 19 25 234 110 14. Diabetes 1 1 1 3 2 1 3 4 2 - 18 8 15. Cerebral Haemorrhage, etc. 13 10 10 8 11 2 17 8 7 12 98 58 16. Heart Disease 40 26 32 33 25 28 22 33 14 17 270 86 17. Aneurysm 2 3 2 - - - - - — 1 8 4 18. Other Circulatory Diseases 4 2 5 6 4 3 5 2 2 4 37 15 19. Bronchitis 1 10 2 8 10 7 5 6 4 9 62 28 20. Pneumonia (all forms) 8 17 7 4 9 12 8 15 7 10 97 31 21. Other Respiratory Diseases 2 2 2 3 4 2 4 7 2 4 32 15 22. Peptic Ulcer 1 3 1 1 3 1 - 1 2 - 13 6 23. Diarrhoea, etc. (under 2 years) — 2 2 1 - 1 1 3 3 5 18 12 24. Appendicitis 1 2 2 — 2 1 2 2 — 3 15 15 25. Cirrhosis of Liver — — - - 1 1 1 - 2 - 5 3 26. Other Diseases of Liver, etc. — - 2 — 1 1 - - - 1 5 5 27. Other Digestive Diseases 3 1 2 - 4 1 5 4 — 3 23 18 28. Acute and Chronic Nephritis 5 4 4 2 1 3 4 6 3 2 34 21 29. Puerperal Sepsis 1 — — — 1 — — 2 — 1 5 5 30. Other Puerperal Causes — 2 — — — — — 1 — — 3 1 31. Congenital Debility, Premature Birth, Malformations, etc. 2 7 3 8 5 5 10 6 5 5 56 28 32. Senility 3 5 8 4 7 6 5 9 2 5 54 36 33 Suicide 1 3 4 2 1 2 1 4 2 3 23 8 34. Other violence 5 6 4 7 5 8 7 6 4 11 63 37 35. Other defined causes 14 11 10 8 11 7 9 7 3 5 85 53 36. Causes ill-defined or unknown — — — — — 1 — 2 — — 3 — Totals 150 157 133 135 146 146 158 189 94 148 1,456 715 Rates (Census population for Wards) 10.7 91 10.4 9.8 12.5 10.7 11.4 11.0 6.6 9.5 10.2 — 22 TABLE 8. Infant Deaths under One Year of Age, 1932. Cause of Death. Ages. Total under 1 year. Sex. 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 - - - - - - - - - f - - - - - 1 2 - 3 Measles M - - - - - - - 1 1 f - - - - - - - 1 1 Cancer, Malignant disease M - - - - - - 1 - 1 f - - - - - - - - - Cerebral Haemorrhage, etc M 1 1 - - - - - - 2 F — — — 1 — 1 — — 2 Bronchitis M — — — — — 2 1 — 3 F - - - - - - - 1 1 Pneumonia (all forms) M — — 2 — — 3 3 2 10 F — 1 1 — — 2 — 2 6 Diarrhoea, etc. M — 1 1 1 5 4 2 1 15 F - - 1 - - - - - 1 Other Digestive diseases M - - - - - 1 - - 1 F - - - - - - - - - Congenital Debility, Premature Births, Malformations, etc. M 25 4 3 2 2 1 1 38 F 8 5 1 — 1 3 - - 18 Other violence M 1 — — — — 1 - 2 F - - - - - - - - Other defined diseases M — — — — 2 1 3 F — — 1 — 1 1 1 — 4 All causes M 27 6 6 3 9 12 8 5 76 F 8 6 4 1 2 8 3 4 36 Professional Nursing in the Home. (a) General, (b) For Infectious Diseases. As set out in my report for 1931. Midwives. There is nothing further to add to my remarks in last year's report. Midwives Act, 1902 and 1918. The midwives on the roll for 1932, numbered 57. Of this number 39 worked in connection with the Maternity Hospital and District Nurses' Home, Plaistow, and its branches, three at the Sir Henry Tate Nurses' Home, Silvertown, two from the Kelvingrove Nurses' Home, Windsor Road, one from the Essex County Nurses' Training Home, Leytonstone, and 12 practised independently. 23 During- the year a prosecution was brought under the Midwives and Maternity Homes Act, 1926, ag;ainst a person acting as a midwife without being registered. After an adjournment, the defendant brought as a witness a medical practitioner, and the case was dismissed. Summary of Visits Paid during 1932 by Nurses of Plaistow Maternity Hospital and District Nurses Home. Midwifery 563, Monthly 200, Hospital 327. Maternity and Nursing Homes.—Nursing Homes Registration Act, 1927. 1. Number of applications for registration 1* 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 registration Nil 7. Number of cases in which exemption has been :— (a) Granted Nil (b) Withdrawn Nil (c) Refused Nil * Application withdrawn by person making the same. Under the Nursing Homes Registration Act, 1927, a nurse was prosecuted during 1932 for using her house as a Nursing Home without the same being registered. She was fined £20 (including costs). Institutional Provision for Unmarried Mothers and Homeless Children. Already detailed in my report for 1930. 24 Ambulance Facilities. See report for 1930. The two ambulances operating from the Fire Station carried out the following work during 1932 :— Cases conveyed to and from various hospitals 1,514 Accident cases 422 Illness cases 1,092 Journeys made 1,541 Miles run 13,896 East Ham cases removed by other ambulances :— Barking 16 Ilford 6 West Ham 19 Cases removed for other authorities :— West Ham 20 Barking 7 Laboratory Facilities. The same arrangements exist for the examination of swabs as in previous years. The number of swabs examined at the Infectious Diseases Hospital and the Town Hall Laboratory were as follows :— No. Positive. Negative. 2,001 114 1,887 Of the above total 236 were examined at the hospital. Facilities for the examination of other material were provided at several outside laboratories on behalf of the Council until the end of November, but on 1st December, 1932, an arrangement was commenced for all these specimens to be sent for examination to the East Ham Memorial Hospital Laboratory, at charges agreed upon by the Council. 25 The number examined is shown in the table below :— TABLE 9. Laboratory Examinations, 1932. Material Norfolk and Norwich Hospital Royal Institute of Public Health Counties Public Health Laboratories East Ham Memorial Hospital Charing Cross Hospital Total Blood Sugar Estimmation — — — 1 6 7 Blood (for Widal Test) — — 5 — — 5 Smears — — 2 — — 2 Hair (for Ringworm) — — 3 — — 3 Mantoux Skin Test (Tuberculosis) — — — 4 — 4 Urine (for Tuberculosis) — — 2 — — 2 Swab (for Tuberculosis) 1 1 — — — 2 Faeces (for Tuberculosis) 3 — — — — 3 Fluid from Chest (for Tuberculosis) — 1 — — — 1 Sputum 589 318 157 71 — 1,135 Totals 593 320 169 76 6 1,164 Legislation in Force. The legislation in force was printed in my last report. The following additions were made during 1932 :— Acts of Parliament applied to the Borough by order of Ministry of Health: Public Health Acts Amendment Act, 1907 ) Public Health Act, 1925 Parts VI. 2nd December, 1932. Bye-Laws, Regulations, etc. Fire Brigade. Local Government Act, 1929. A brief synopsis of the Council's administrative scheme as approved by the Ministry of Health was set out in the 1930 Report. No alterations or developments have taken place during 1932. 26 Poor Law Medical Out-Relief. The arrangements were set out in the 1930 Report. Since the transfer of this service to the Council the only change that has taken place is that prescriptions formerly dispensed by a dispenser are now given to the patients and dispensed by panel chemists. During the year under review Drs. Harrison and Brews, the District Medical Officers, carried out the following work :— No. of visits to homes of patients. No. of patients seen at public Dispensary. No. of prescriptions issued. Dr. Harrison 4,427 6,624 4,162 Dr. Brews 277 473* 591 *Visits to Surgery. HOSPITALS. (a) Provided by Local Authority, (b) Maternity, (c) Mental, (d) Orthopaedic, (e) Ear, Nose and Throat, (f) Puerperal Fever and Pyrexia, (g) Ophthalmia Neonatorum. There are no further comments to make on the Council's hospital arrangements under the above headings. Particulars were set out in previous reports. Building has commenced on the new Pavilion at Harts Sanatorium and it is to be hoped that this additional accommodation will be in use during the year 1933. TABLE 10. Disposition of East Ham Mental Patients on 31st December, 1932. Institution. Male. Female. Total. Brentwood 7 61 68 Colchester 1 48 49 Wells — 17 17 Gateshead 14 61 75 Worcester 70 10 80 Canterbury 34 — 34 Cotford 10 — 10 Peckham House 20 31 51 Gloucester 26 10 36 Various institutions 6 12 18 Totals 188 250 438 27 Smallpox. In March, 1932, the agreement with West Ham expired and an arrangement was made with the London County Council for the treatment of cases of this disease arising in the Borough. East Ham Memorial Hospital. The number of beds remain the same, viz., 100. The following figures are abstracted from the hospital report for 1932 1.—IN-PATIENTS. A. Number of Beds and In-Patients. Numbers in 1932. Numbers in previous year. 1. Beds :— (a) Complement at 31st December 100 100 (b) Average Daily Complement during the year 100 100 (c) Average Daily Number Closed during the year, owing to :— (i) Rebuilding or Extension Schemes — — (ii) Repairs, Redecoration, Cleaning or Infection .9 .1 (iii) Other Causes — — (d) Average Daily Number Open during the year 991 99-9 (e) Average Daily Number Occupied during the year 91.8 91.5 2. Number of In- Patients in the Hospital at beginning of year 89 92 3. Number of In- Patients admitted during year 1,550 1,710 4. Number of In- Patients in the Hospital at the end of the year 87 89 5. Average number of days each Patient was resident (Ascertained by dividing the yearly total of daily counts, viz. :—33,605 by the number of Patients treated to a conclusion, i.e., (2)-f(3) — (4).) 21.6 19.5 6. Number of Patients admitted and discharged during the year who were resident for (i) only 1 day 202 231 (ii) 2 and 3 days 79 158 28 1.—IN-PATIENTS—continued. B. Annual Expenditure on In-Patients apart from that on Outpatients ; Average Cost of each In-Patient per week ; and Average Cost of each In-patient. 1932 Previous Year. Expenditure on In- Patients (Pounds only). Average Cost of each In- Patient per week. Average Total Cost of each In- Patient. Average Cost of each In- Patient per week. Average Total Cost of each In- Patient. £ f s. d. f s. d. f s. d. f s. d. 1. Provisions (including Board of Officials) 3,398 14 2 2 3 9 14 3 1 19 8 2. Surgery and Dispensary 1,636 6 10 1 1 1 10 0 1 7 11 3. Domestic 2,784 11 7 1 15 11 11 6 1 12 1 4. Salaries and Wages (Maintenance) 5,448 1 2 8 3 10 2 1 2 2 3 1 9 5. Miscellaneous 469 1 11 6 1 2 1 5 11 6. Administration 654 2 9 8 5 2 11 8 0 Statistical Cost 14,389 2 19 11 9 5 5 3 2 11 8 15 4 7. Establishment :— Renewals and Repairs 302 1 3 3 11 9 2 2 8. Finance 898 3 9 11 7 4 3 11 9 Total Cost 15,589 3 4 11 10 0 11 3 7 11 9 9 3 2 .-OUT- PATIENTS. A. Numbers. Numbers in 1932. Numbers in previous year. 1. Total number of new Out -Patients 9,380 8,169 2. Total number of Out-Patient Attendances 46,543 38,271 (a) Number of Patients on books at the beginning of the year Not ascertainable Not ascertainable (b) Number of Casualty Patients included in No. 1 above 2,964 2,886 (e) Number of Maternity Patients included in — — No. 1 above, attended at home (d) Number of Attendances on Maternity Patients included in No. 2 above — — 29 2.—OUT-PATIENTS—continued. B. Annual Expenditure on Out- Patients and Average Cost of each Out- Patient Attendance and of each Out-Patient. 1932 Previous Year. Expenditure on Out- Patients (Pounds only). Average Cost of each Out- Patient Attendance. Average Total Cost of each Out- Patient. Average Cost of each Out- Patient Attendance. Average Total Cost of each OutPatient. £ Pence Pence Pence Pence 1. Provisions (including Board of Officials) 325 1.68 8.32 1.81 8.49 2. Surgery and Dispensary 812 4.19 20.78 3.66 17.16 3. Domestic 239 1.23 6.11 1.55 7.26 4. Salaries and Wages (Maintenance) 1,283 6.62 32.83 6.01 28.14 5. Miscellaneous 103 0.53 2.63 0.48 2.33 6. Administration 100 0.51 2.56 0.51 2.41 Statistical Cost 2,862 14.76 73.23 14.02 65.69 7. Establishment:— Renewals and Repairs 199 1.02 5.09 0.57 2.67 8. Finance 339 1.75 8.67 1.74 8.17 Total Cost 3,400 17.53 86.99 16.33 76.53 The agreement between this hospital and the Council, set out in detail in the 1930 Report, was renewed for a further period. Under this agreement five patients were admitted during 1932. Whipps Cross Hospital and Institutions Controlled by West Ham. The number of beds allocated on the user basis to East Ham has been shown in previous years. The following information has been kindly supplied by Mr. Armstrong, Public Assistance Officer :— 30 TABLE 11. East Ham Cases Admitted to Public Assistance Institutions. West Ham Corporation Institutions. Number chargeable on Number admitted to Total. Discharged. Died. Transferred to other Institutions. Number remaining on 31-12-30 31-12-31 31-12-31 31-12-32 1931 1932 1931 1932 1931 1932 1931 1932 31-12-31 31-12-32 Whipps Cross Hospital 110 149 1,328 1,352 1,438 1,501 889 946 201 184 199 203 149 168 Central Homes 282 273 487 425 769 698 199 150 149 193 148 101 273 254 Forest Gate Hospital 80 121 284 235 364 356 206 214 16 9 21 14 121 119 Forest House and Cottages 49 46 21 19 70 65 2 6 — 1 22 17 46 41 Margate Home — 10 19 21 19 31 8 24 — — 1 3 10 4 31 I have endeavoured to obtain further information from West Ham in tabular form showing the various diseases, etc., from which these patients suffered, but was again informed that it was impossible to abstract the details required. Aldersbrook Homes and Scattered Homes. Mr. W. Pitt Steele, Superintendent of these Homes, kindly supplied me with copies of his half-yearly reports for 1932, and the following information has been abstracted from these reports :— Highest number chargeable during 6 months ending 30-6-32 532 6 months ending 31-12-32 ... 542 Lowest ,, ,, ,, 498 ,, ,, ,, 509 In Receiving Homes on 1st January, 1932 292 1st July, 1932 284 „ Scattered „ „ „ 230 ,, ,, 231 522 515 In Receiving Homes 1st January, 1933 311 „ Scattered „ ,, ,, 231 542 On 1st July, 1932, chargeability was apportioned as follows :— To the County Borough of East Ham 81 1st January, 1933 83 „ „ West Ham 291 ,, ,, 318 ,, Essex County Council 143 ,, ,, 141 515 542 Average No. of admissions weekly—6 months ending 30-6-32 11 6 months ending 31-12-32 12 „ „ discharges „ „ 11 ,, ,, ,, 10 Greatest No. of admissions on any one day—6 months ending 30-6-32 13 ,, ,, ,, 16 Number of deaths in institutions— 6 months ending 30-6-32 0 ,, ,, ,, 0 Number of children admitted from East Ham—6 months ending 30-6-32 48 ,, ,, ,, 51 Number of children admitted from West Ham—6 months ending 30-6-32 143 ,, ,, ,, 184 Number of Children admitted from Essex C.C.—6 months ending 30-6-32 92 ,, ,, ,, 83 Transfers to Institutions (not under the control of the East or West Ham County Boroughs) 6 months ending 30-6-32 16 ,, ,, ,, 34 Total No. of days maintenance—6 months ending 30-6-32 93,458 ,, ,, ,, 97,355 Infants under 3 years on 1st July, 1932 29 On 1st January, 1933 38 Children over 3 and under 5 years on 1st July, 1932 50 ,, ,, 56 Children over 5 and under 8 years on 1st July ,1932 106 ,, ,, 124 Boys over 8 and under 14 years on 1st July, 1932 156 ,, ,, 159 32 Aldersbrook Homes and Scattered Homes—continued. Girls over 8 and under 14 years on 1st July, 1932 126 On 1st January, 1933 108 Boys over 14 and under 16 years on 1st July, 1932 35 ,, ,, 32 Girls over 14 and under 16 years on 1st July, 1932 13 ,, ,, 24 515 ,, ,, 542 Accommodation—Beds Provided :— Receiving Homes, on 1st July, 1932 300 On 1st January, 1933 311 Scattered Homes „ „ „ 232 ,, ,, 232 532 543 No. of boys sent to situations during 6 months ending 30-6-32 14 6 months ending 31-12-32 17 No. of girls sent to situations during 6 months ending 30-6-32 10 ,, ,, ,, 14 No. of boys returned from situations 6 months ending 30-6-32 2* ,, ,, ,, 1 No. of girls returned from situations 6 months ending 30-6-32 1* ,, ,, ,, 2† No. of boys whose wages were subsidised since the last report (with the sanction of Ministry of Health)—6 months ending 31-6-32 0 ,, ,, ,, 0 *For medical treatment. † For further training. Dr. J. Sangster Greig, Medical Officer to the Homes, in his half-yearly reports to the Committee, stated that the health of the children continued to be very satisfactory, but that many of the newly admitted children continue to require individual care and attention owing to their neglected condition on arrival. During the year there were outbreaks of measles and whooping cough amongst the children but no fatal cases occurred. During 1932 Dr. Greig and his Assistant paid 456 visits to Aldersbrook and 147 visits to the Scattered Homes. In addition to the ordinary routine medical examinations, 601 children were examined on admission and 518 on discharge. Minor operations were performed and treatment given as required. The Dentist, Mr. C. F. Rose, made the usual visits, and inspections at Aldersbrook and the Scattered Homes resulting in 213 children being treated for extractions, fillings, etc., anaesthetics being given by Dr. Greig's assistant when necessary. The ophthalmic treatment of these children is carried out by the Council's Ophthalmic Surgeon. 33 Venereal Diseases. The same facilities were available as in recent years for the treatment of these diseases, and from the official tables supplied by the London County Council the following figures are abstracted :— New Patients. Syphilis 47 Soft Chancre 2 Gonorrhoea 95 Not Venereal 98 Total 242 Total attendances of all patients 8,151 Number of in-patients during 1932 159 Salvarsan substitutes—doses 673 Pathological Examinations For or at the Centres— Spirochaetes 21 Gonococci 776 Wassermann 400 Others 1,174 Total 2,371 For Practitioners— Spirochaetes Gonococci 3 Wassermann 46 Others 35 Total 84 During 1932 no East Ham patients were in residence under the Hostel Scheme. Mental Deficiency. The difficult situation as regards institutional treatment for mental defectives eased considerably during the year with the opening of part of the new institution at Ockendon belonging to West Ham. The bulk of East Ham cases receiving treatment in the L.C.C. Institutions were transferred to Ockendon, as well as those on our long waiting list which were suitable. 34 Clinics and Treatment Centres. With the appointment of an additional Assistant Medical Officer the number of M. and C.W. clinics were extended, as shown below. Other clinics and treatment centres remained the same as detailed in my previous report. M. & C. W. Clinics. Situation. Purpose used. Sessions. Central Clinic, High St. Schools Special Clinic Monday—9.30 a.m. ,, ,, ,, Toddlers Clinic „ 9.30 a.m. ,, ,, ,, Infant Welfare „ 2.0 p.m. Wesleyan Church Hall, Manor park ,, ,, Tuesday—9.30 a.m. St. John's Church Hall, North Woolwich ,, ,, „ 2.0 p.m. Central Clinic, High St. Schools Special Clinic Wednesday—9.30 a.m. ,, ,, ,, Toddlers Clinic ,, 9.30 a.m. St. George's Church Hall, Masterman Road Infant Welfare ,, 2.0 p.m. Central Clinic, High St. Schools ,, ,, Thursday—9.30 a.m. Baptist Church Hall, Plashet Grove ,, ,, „ 2.0 p.m. Central Clinic, High St. Schools Ante-natal Friday—9.30 a.m. ,, ,, ,, Immunisation 9.30 a.m. Baptist Church Hall, Plashet Grove Infant Welfare „ 2.0 p.m. Central Clinic, High St. Schools Special Clinic Saturday—9.30 a.m. MENTAL DEFICIENCY ACTS, 1913-27. The ascertainment and supervision of persons coming within the scope of these Acts has been carried out satisfactorily. The examination of and certifying, in addition to the completion of reports and orders, occupies an important part of my duties. Miss Hicks, the Ascertainment and Supervising Officer, performed the following duties during the year under review :— TABLE 12. VISITS. No. of reports— register, files, &c. Number of interviews Statutory Supervision Guardian- ship Institution Training Centre Friendly Care School Cases Total 1,179 156 75 151 199 11 1,771 1,100 79 35 TABLE 13. Particulars of Mental Defectives as on 1st January, 1933. (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 18 8 26 Aged 16 years and over 36 29 65 (2) On Licence from Institutions— Under 16 years of age 1 — 1 Aged 16 years and over 2 1 3 (6) (1) Under Guardianship (excluding cases on Licence)— Under 16 years of age 2 — 2 Aged 16 years and over 12 4 16 (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 1 2 Aged 16 years and over — — — 3. Under Statutory Supervision 73 71 144 Of whom :— Awaiting removal to an Institution 3 3 6 4. Action not yet taken under any one of the above headings :— (a) Notified by Local Education Authorities (Sec. 2 (2)) — — — (6) Mental Defectives in receipt of Poor Relief :— (1) Institutional— (a) In Public Assistance Institutions not approved under Sec. 37 — — — (6) 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 36 2. Reported to the Local Authority from any reliable source but as to whom no action has been taken — 1 1 3. Under Voluntary Supervision 28 30 58 Number of above Cases on the Registers of Occupation Centres:Under Statutory Supervision 12 12 24 Under Voluntary Supervision 2 — 2 On Licence from Institutions — — — Under Guardianship 2 4 6 On Licence from Guardianship — — — DURING THE YEAR 1932. 1. (a) Number of instances in which Licence was granted during 1932 :— M. F. T. (1) From Institutions 1 — 1 (2) From Guardianship — — — (b) Number of instances in which cases on Licence have been returned to Institutions or transferred to Guardianship during the year 1932 :— M. F. T. (1) To Institutions — 2 2 (2) To Guardianship 2 — 2 2. Cases notified by Local Education Authorities (Section 2 (2)) during the year 1932 :— Method of disposal. M. F. T. Sent to Institutions (by Order) 3 3 6 Placed under Guardianship (by Order) — — — Placed under Statutory Supervision 8 9 17 Placed in " Places of Safety " — — — Died or Removed from Area 2 — 2 Action not yet taken— (a) In receipt of Poor Relief — — — (6) Others — — — Total 13 12 25 3. Of the total number of mental defectives known to the Local Authority :— (a) Number who have given birth to children during 1932 :— (1) After marriage — (2) While unmarried — Males. Females. (b) Number who have married during 1932 1 1 37 Training Centre. This year has clearly shown, in some cases, surprising results of the training given to mental defectives who have attended the Training Centre during the past four years. In their work and mental capacity they have responded to the teaching and guidance of their supervisors. By infinite patience, they have been taught to make fireside stools, clothes horses, book shelves, various kinds of baskets, trays, rugs, mats, linen cloths, underwear, knitted goods, etc., and the buyers of these articles have expressed surprise and satisfaction at the way these goods have been made and finished by the young men and women in attendance at the Centre. The good results with the younger children mentioned in my previous report have been maintained during 1932, and on my visits to the Centre I have particularly noticed the improvement in their general behaviour, speech and concentration. The Annual Christmas Party and Exhibition of Work was held, the Mayor, the Mayoress and many of the Council being present, and I am sure the members of the Corporation must have realised the valuable work that is done at this Centre. Miss Fooks, the Supervisor, retired on 17th February, 1933, on her marriage, and undoubtedly the Centre and those attending will miss her enthusiasm for the work and the patience she exercised with those under her charge. TABLE 14. Statistics of Training Centre, 1932. Morning Session—Males Afternoon Session—Girls and Juniors. Grand Total Attendances No on Register No. of Sessions held Total Attendances Average Attendance No. on Register No. of Sessions held Total Attendances Average Attendance 10 212 1,998 9.4 28 212 3,778 17 8 5,776 38 BLIND PERSONS ACT, 1920. The same arrangements under this Act as set out in previous reports still exist. The Council make a grant of £100 per annum to the East Ham Welfare Association for the Blind towards the cost of the work carried out by this Association. This organisation carries out splendid work amongst the blind resident in this area, and its activities were set out in my last report. Blindness is probably the most terrible physical affliction from which a person can suffer, and to an Association that lightens the burden of these sufferers, the practical thanks of the community should be given for the very excellent work they carry out. The Home Teacher and Visitor to the Blind, Miss Kingston, has carried out her duties with tact, sympathy and efficiency. The Council's Ophthalmic Specialist examines all new cases and certifies where necessary. 39 TABLE 15. Work of the Visitor to the Blind. Year. No. of technically Blind Persons on Register. No. of Visits to same. Daily. Evening. No. of Partially Blind Persons. No. of Visits to lame. Other Visits. Total Visits. No. of Lessons Given. Lessons Given in Cane Basket Work. Braille. Moon. Knitting. Crochet Wool Ball Work. Manual Straw- bag making. 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 — 1932 221 4,607 52 77 96 5 4,760 440 — 219 58 59 31 38 35 — 41 In the following tables, the registration of the blind, ages at which blindness occurred, training and employment and occupations, as at 31.3.33, are set out:- TABLE 16. Welfare of the Blind.— Registration. As at 31 /3/33. Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Total 0—5 5—16 16—21 21—30 30—40 40— 50 50—60 60—70 70— 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. — — — 2 2 4 2 1 3 9 7 16 11 8 19 17 9 26 15 12 27 29 23 52 25 46 71 110 108 218 Ages at which Blindness occurred. Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Age Period Un- Known 0—1 1—5 5—10 10—20 20—30 30—40 40—50 50—60 70— 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 15 8 23 2 3 5 8 6 14 4 7 11 9 6 15 9 7 16 14 26 20 9 29 17 25 42 11 17 28 9 (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) (j) (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. 9 6 15 4 1 5 12 4 16 25 11 36 2 — 2 — — — — — — 3 — 3 3 3 75 95 170 108 106 214 (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 T uners Weavers Miscellaneous Total Mattress Makers Machinists Upholsterers Pan Wiredrawn Hand Machine Within Institutions for the Blind — 2 — — — 3 — — — — — — — — — — — — — 1 — — 4 — — — — — — — — 5 — 15 In approved Home Workers Schemes — — — — — 1 — — — — — — — — — — — — — 1 — — — — — — — — — — 3 — — 5 Others (not pastime Workers) 1 1 — — — 1 — — 1 — — 2 1 2 1 — 2 — — — — 1 — — — — — — — — 1 — 2 16 Total 1 3 — — — 5 — — 1 — — 2 1 2 1 — 2 — — 2 — 1 4 — — — — — — — 4 5 2 36 43 INVALID CHILDREN'S AID ASSOCIATION (East Ham Branch). In this, my last report as your Medical Officer of Health, it again affords me great pleasure in commending the valuable work of this Association. In each of my Annual Reports since the formation of the East Ham Branch of the I.C.A.A. in 1923, I have felt compelled to add my thanks for the splendid efforts of this body in helping, advising, supervising and, if possible, curing the seriously invalided and crippled children of the poor. What more worthy object could a voluntary association set out to achieve than the above? It naturally follows that its work commends itself to all those engaged in Public Health. The following is abstracted from the Annual Report for the year 1932 :— Number of cases dealt with 265 New cases 160 From previous year 45 Old cases 60 265 The 160 new cases were referred by :— Hospitals and Medical Practitioners 81 School Medical Officer 37 Tuberculosis Officer 30 Infant Welfare Centre 9 Parents, etc. 3 The 265 cases dealt with during the year have been assisted as follows :— Sent to Sanatoria, Convalescent Homes, etc. 151 Surgical appliances provided 46 Food and Clothing Grants 17 Loan of Carriages, etc. 6 Extensions from previous year 45 44 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. General. On reference to the table showing total cases notified of infectious diseases 1910-1932, it will be seen that there was a very substantial increase in the notifications received of Scarlet Fever for 1932. Until the end of August the number of cases notified had been normal, but during the last four months of the year the disease became mildly epidemic, approximately 450 cases occurring during that period. It spread throughout the Borough from the North to the South, the two districts most affected being Manor Park and North Woolwich. Fortunately it was of a mild character. The deaths from the seven principal zymotic diseases (Smallpox, Whooping Cough, Measles, Diphtheria, Diarrhoea, Scarlet Fever and Enteric Fever) during the year numbered 57, equivalent to a zymotic death rate of 0.4 per 1,000 population. Smallpox. Again I am pleased to be able to report that the number of cases of this disease notified during the year under review had decreased from 51 (1931) to 13, and that all the patients suffered from the mild form of Smallpox experienced in recent years. The tabulated particulars of these cases are shown in the following table :— 45 TABLE 17. SMALLPOX, 1932. No. Initials. Date of Notification. Age Sex. Probable Source of Infection. No. of contacts traced and kept under observation. Secondary Cases in same house. State of Vaccination of Patient. 1 A.W.S. 6.2.32 48 M. Unknown 11 — Infancy 2 S.A.W. 15.3.32 45 F. Contact with missed case in same house 19 1 ,, 3 N.C. 15.3.32 8 F. Contact with West Ham Cases 7 — Not 4 E.W. 17.3.32 16 M. Contact with Case No. 2 4 See case No. 2 ,, 5 C E.W. 26.3.32 67 M. Unknown 5 — Infancy 6 J.A.G. 8.4.32 6 M. Contact with missed case in same house 4 — Not 7 C.P. 30.4.32 16 M. Unknown 10 1 ,, 8 R.P. 11.5.32 18 M. Contact with Case No. 7 6 See case No. 7 ,, 9 A.T. 15.5.32 52 F. Unknown 4 — Infancy 10 R.B. 17.5.32 7 mos. M. Contacts with missed East Ham case 10 — Not 11 H.A.E. 17.5.32 4 M. 12 E.V. 18.5.32 40 F. Contact with 'cases 10 & 11 7 — ,, 13 L.C.W. 18.7.32 11 M. Contact with missed case at same house 4 — " TABLE 18. Vaccination, 1932. No. of Births. Certificates of Primary Vaccination. Statutory Declarations. Certificates of Postponement. Certificates of Insusceptibility. 2.062 834 724 83 10 46 During 1932, the Public Vaccinator carried out the following vaccinations :— Number of successful primary vaccinations of children under one year of age 539 Number of successful primary vaccinations of persons one year and upwards 85 Total primary vaccinations 624 Number of successful re-vaccinations 35 The only observation I have to make on the working of the Vaccination Acts is that the number of conscientious objectors remains high. Scarlet Fever. The number of notifications received during the year totalled 779, the largest since 1928. As compared with the previous year —245—the number has trebled itself. Fortunately the disease was of a mild character, only two deaths resulting from this cause. 717 of the patients were treated in hospital or 92.0 per cent., compared with 69 per cent, for 1931. Diphtheria. Cases notified numbered 157, against 196 for 1931. Of this number 155 received hospital treatment, equivalent to 98.7 per cent., compared with 96 per cent, for the previous year. There were 19 deaths assigned to Diphtheria, equal to a case mortality of 12.2 per cent. There is no change in the arrangements for the supplying of anti-toxin as outlined in previous reports. Schick Immunization Clinic. During the year 1932, 269 infants and children have received three inoculations. The total number of inoculations performed has been 883, of which 69 were carried out by Private Medical Practitioners, 194 at the Maternity and Child Welfare Clinic and 620 at the Town Hall Clinic. 47 The following figures are intended to indicate the number inoculated and the age groups involved in the cases treated at the Town Hall Clinic, Maternity and Child Welfare Centre (from 21st October, 1932) and by Private Medical Practitioners :— 1. Town Hall Clinic. Total number of inoculations 620 Number inoculated three times 192 Number inoculated twice 14 Number inoculated once 16 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 12 15 9 14 25 19 31 25 23 13 12 12 11 1 75 111 36 222 2. Maternity and Child Welfare Centre. Total number of inoculations 194 Number inoculated three times 54 Number inoculated twice 12 Number inoculated once 8 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 10 14 21 8 7 5 3 1 2 1 — — 2 60 11 3 74 3. Private Medical Practitioners. In addition to the above, during the same period 23 children have been inoculated three times by Private Medical Practitioners, and the ages at which inoculation was performed were as follows :— Ages in years 1 2 3 4 5 6 7 8 9 10 11 12 13 14 and over No. inoculated — 1 3 2 8 4 1 1 1 — 2 — — — 14 7 2 23 N.B.— In considering the combined totals (1, 2 and 3) it will be noticed that 46.7 per cent, of the cases were in the age group 1 to 5 years, 40.4 per cent, in the age group 6 to 10 years, and 12.9 per cent, in the group over 10 years. 48 4. The Schick test for susceptibility to Diphtheria was performed during the year in 153 of the completed cases, of which 142 proved negative. In 11 of the cases, positive results were obtained and have subsequently received further injections of Toxoid-Antitoxin Mixture. Enteric Fever. There were seven cases notified and all these patients were treated in hospital. Two deaths resulted, equal to a case mortality of 28.5 per cent. Erysipelas. Fifty-five notifications of this disease were received during the year, 44 were treated in hospital and four died. Puerperal Fever. Four cases were notified and treated in hospital. There were five deaths, the reasons for more deaths than notifications are due to transferable deaths and death certificates indicating Sepsis, whereas the notifications stated Pyrexia. Puerperal Pyrexia. There were 23 cases of this disease notified, 19 of whom received hospital treatment. No deaths were assigned to this cause. ANTHRAX. An intimation was received from a neighbouring authority of a death from Anthrax. Shaving brushes from the same consignment as that used by the patient were found on examination to contain abundant colonies of Anthrax bacilli. Six of these brushes were traced to this Borough and were recovered and burnt in the Destructor. 49 TABLE 19. Total Cases or Notifiable Diseases, 1910-1932. Disease. 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Smallpox — — — — — — — — 3 1 10 — — — — — — — 17 25 70 51 13 Scarlet Fever 329 377 435 526 677 499 267 341 272 530 718 1,355 502 170 215 221 350 798 832 743 484 245 779 Diphtheria 142 121 72 258 319 204 225 279 273 451 426 309 198 160 128 246 337 464 669 578 473 196 157 Enteric Fever 19 56 13 19 21 5 7 9 2 15 10 7 4 3 5 9 7 2 7 2 3 8 7 Erysipelas 104 134 152 119 130 96 86 66 52 72 72 57 34 32 38 41 41 38 60 49 63 54 55 Puerperal Fever 6 6 8 8 4 4 1 2 1 6 6 5 3 5 5 5 5 4 8 9 10 4 4 Puerperal Pyrexia Not Notifiable 11 11 12 14 6 23 Meningococcal Meningitis NotNotifiable 2 6 1 8 6 7 3 3 3 4 — 1 1 1 1 4 1 1 3 8 5 Encephalitis Lethargica Not Notifiable 4 5 7 — — 9 6 1 2 3 1 — — — Ophthalmia Neonatorum Not Notifiable — 17 16 16 7 11 13 30 3 11 11 11 6 8 10 12 3 8 6 6 Ac. Polio Myelitis NotNotifiable 2 8 4 1 10 — — 3 1 — — 3 1 1 — 5 — 2 — 1 7 Ac. Polio Encephalitis... Not Notifiable — — — — — — — — — — — — — 3 Dysentery Not Notifiable — — 1 — — — — — — — — — — — Malaria ... Not Notifiable — — 1 — — — — — — — — — — 1 Measles ... Not Notifi able 1,650 1,404 1,538 Not Notifi able German Measles Not Notifi able 123 115 134 Not Notifi able Continued Fever — — — — — — — — — 1 — — — — — — — — — — — — — Typhus Fever ... — — — 1 — — — — — — — — — — — — — — — — — — — Pneumonia Not Notif iable 85 92 54 79 91 70 114 82 102 59 75 77 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 1,137 50 TABLE 20. Prevalence of and Control over Infectious Disease.—Notified Casks for the 52 Weeks ending. 31st December, 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 13 1 1 1 1 3 1 1 3 1 — 1 — 1 — 4 3 1 — 3 13 — Scarlet Fever 779 2 165 379 138 30 51 11 3 — 81 204 30 59 33 25 76 57 54 160 717 2 Diphtheria 157 3 34 69 29 10 10 — 2 — 16 21 3 9 6 35 19 16 12 20 155 19 Erysipelas 55 1 1 2 — 5 11 14 18 3 2 13 2 3 4 3 6 8 8 6 44 4 Puerperal Fever 4 — — — — — 2 2 — — — 1 — 1 — — 1 — — 1 4 5 Puerperal Pyrexia 23 — — — — 1 18 4 — — 3 3 1 4 — 3 3 4 1 1 19 — Pneumonia 77 4 8 11 1 5 15 12 12 9 13 18 6 17 1 7 4 1 3 7 53 97 Ophthalmia Neonatorum 6 6 — — — — — — — — — 2 — — — 1 — — — 3 2 — Meningococcal Meningitis 5 — 1 — — — 4 — — — 1 1 1 — — 1 1 — — — 5 1 Enteric Fever 7 — — 1 — 1 1 — 4 — — 1 1 — 1 1 — — 2 1 7 2 Acute Polio Encephalitis 3 — 1 1 — — 1 — — — 1 1 — — — — — — — 1 3 — Acute Polio Myelitis 7 — 7 — — — — — — — 1 2 — 1 — 1 — — 1 1 7 4 Malaria 1 — — — — — — — 1 — — — — — — — 1 — — 1 — 51 TABLE 21. Disease. Cases. Vision Unimpaired Vision Impaired Total blindness Deaths Notified Treated At home Hospital Ophthalmia Neonatorum 6 4 2 6 — — CANCER. The total deaths from Cancer during 1932 show a large increase over the number for the previous year, viz., 234 against 183, an increase of 51 deaths. On analysing the parts of the body affected and comparing them with the 1931 figures, it was ascertained that the increased number of deaths was spread over practically all those parts of the body as set out in the Cancer table that follows. Another interesting point is that more males died than females, which is unusual as far as Cancer is concerned. Propaganda has been carried out during the year on the same lines as previously, namely, by the issuing of circulars and advertisements in the local Press. It is not possible to state what use has been made by local sufferers of the increased facilities now provided in National Radium Centres. No investigations have been taken as set out in Circular 1136 of 31st July, 1930. Cancer Deaths, 1932. Total deaths 234 Males 119 Females 115 Classification. Cancer 18 Carcinoma 196 Epithelioma 5 Hypernephroma 1 Rodent Ulcer 2 Sarcoma 12 Total 234 52 TABLE 22. Cancer Deaths.—Parts of Body Affected. 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 — — — — — — — — — — — — — — 3 3 1 6 4 — 16 1 Digestive Organs & Peritoneum — — — — — — — — — — — — 10 2 5 11 29 15 13 14 4 14 61 56 Respiratory Organs — — — — — — 1 — — — — — 2 1 6 1 3 2 2 1 — — 14 5 Uterus ... — — — — — — — — — — — — — 2 — 2 — 4 — 3 — — — 11 Other Female Genital Organs — — — — — — — — — — — — — — — 4 — 1 — 1 — 1 — 7 Breast — — — — — — — — — — — 1 — — — 9 — 6 — 3 — 4 — 23 Male Genitourinary Organs — — — — — — — — — — — — — — 1 — 3 — 5 — 4 — 13 — Skin — — — — — — — — — — — — — — — — — — 2 — — 2 2 2 Other or Unspecified Organs 1 — — — — — 1 — — 1 — 1 2 1 1 3 5 4 1 2 13 10 Totals 1 — — — — — 2 — 1 — 2 14 6 15 28 41 29 33 26 13 23 119 115 53 SUMMARY OF THE WORK OF THE TUBERCULOSIS AND CHEST CLINIC SINCE ITS INCEPTION. Under the Public Health (Tuberculosis) Regulations, 1912, the then Municipal Borough of East Ham undertook the treatment of Tuberculosis at its Centre in Wakefield Street, under the direction of the Medical Officer of Health of the Essex County Council. When East Ham became a County Borough on the 1st April, 1915, I, as Medical Officer of Health of an autonomous area, was responsible for the treatment of this disease, and Dr. W. O. Pitts, who was appointed Tuberculosis Officer, continued to deal with cases at the Centre in Wakefield Street. Co-operation with the general practitioners continued to improve, with the result that more cases were being brought to the notice of the Tuberculosis Officer. In 1917 Dr. Pitts left the service, so that I, owing to war conditions, had to carry on as best I could. This state of affairs persisted until 1920, since when Dr. Barker, Dr. Cheater, Dr. Evans, and now Dr. Ellman have successively undertaken the duties. The premises in Wakefield Street became totally unsuited for the purpose, and in 1928 the Tuberculosis Clinic was moved temporarily to Durban House, Katherine Road. In the 1931 report attention was drawn to the urgent need of a new Clinic, with adequate accommodation and facilities for the complete adoption of all the recent advances in diagnosis. It now seems likely that this long felt want is nearer at hand. REPORT ON THE WORK OF THE TUBERCULOSIS AND CHEST CLINIC, 1932. Dr. Ellman reports as follows :— Notifications. The number of primary notifications of tuberculosis during the years 1920-1932 is shown in the following graph. 54 COUNTY BOROUGH OF EAST HAM. (Population 141,500.) Reduction in number of New Cases of Tuberculosis (Consumption) notified during the years 1920-1932. The graph shows a definite progressive tendency towards diminution. The number of notifications received is not necessarily a criterion of our position as regards tuberculosis. The principal point is the proportion of cases notified in the early and noninfectious stage of the disease. If a diagnosis, is made at this 55 stage, and treatment given, in a very large proportion of the cases the disease will become permanently arrested. In 27.2 per cent. of the 1932 notifications tubercle bacilli were found in the sputum. A large proportion of the remaining 72.8 per cent. of the cases were notified in the early and curable stage of the disease. Our work is, therefore, directed towards a decrease in the number of infectious cases amongst the primary notifications, and establishing a diagnosis of tuberculosis in the earliest stage of the disease. The total number of notified cases on the Register on 31st December, 1932, was 909 (Pulmonary and Non-Pulmonary). Of these 321 were definitely infectious cases, i.e., cases in which tubercle bacilli have been found in the sputum at some period of the illness. Deaths. The number of deaths (1925-1932) from Tuberculosis is shown hereunder. Pulmonary. Non-Pulmonary. Of Cases on the Clinic Register. 1925 132 25 98 1926 119 22 94 1927 118 19 91 1928 117 18 86 1929 124 5 93 1930 123 17 93 1931 100 15 74 1932 108 16 91 It will be observed that there is a tendency towards diminution of deaths from this disease. It is of interest to compare the death rates of pulmonary and non-pulmonary cases in East Ham as compared with the totals for England and Wales. 56 Death Rates per Million Living. England and Wales. East Ham. 1925 All Forms Respy. 1,038 833 1,102 926 1926 All Forms Respy. 961 771 989 835 1927 All Forms Respy. 972 791 961 828 1928 All Forms Respy. 928 755 947 821 1929 All Forms Respy. 959 793 905 870 1930 All Forms Respy. 898 739 982 863 1931 All Forms Respy. 896 742 807 702 The numbers show a progressive decrease, especially in the non-pulmonary cases. The use of Grade A Tuberculin tested milk and pasteurised milk is largely responsible for the very appreciable diminution in the incidence of non-pulmonary tuberculosis, and one hopes, very soon, for its complete extirpation. Attendances and Medical Examinations. The following is a list of the attendances and medical examinations for the last five years :— Total Attendances. Medical Examinations. 1928 2,398 1,935 1929 3,120 2,395 1930 3,796 2,434 1931 3,447 2,433 1932 3,836 2,788 Co-operation of Practitioners in the Work of the Clinic. It has been calculated that during 1932, 74.5 per cent. of new patients w ere sent with letters from their doctors, which goes to show the extent of the co-operation of practitioners in the work of the Clinic. For this to be complete to the fullest extent the Clinic must be adequately equipped, and every facility for diagnosis and treatment must be readily available. The aim of 57 the Clinic is to give the general practitioner every available facilityknown in modern medicine, to assist him in the early diagnosis and treatment of the disease. A diagnosis of the nature of the disease in those cases proved to be non-tuberculous with allied symptoms is surely also expected by the general practitioner, so that such cases may be referred to the correct channels for treatment. With the advent of a new Clinic this should certainly be possible. Consultations at Homes of Patients. During the year 92 patients who were too ill to attend the Clinic have been examined at their own homes. In 50 of these cases the patient's own doctor was present, thus maintaining close contact. Co-operation with Special and General Hospitals. This has continued as in former years. Great appreciation must be expressed at the help received from such specialised hospitals as the Brompton Hospital. The new Pathological facilities at the East Ham Memorial Hospital are greatly appreciated. The ready help and co-operation of the Pathologist is proving invaluable, and sputum results are now available with much less delay. Unfortunately the great demand on the X-ray department of the Hospital itself seriously restricts our X-ray work at the moment, but if provision is made in the new Clinic for our own X-ray apparatus, as should be the case, the X-ray work will be able to be developed more completely. It is again with very real pleasure that we have to record the constant help and co-operation of the late Medical Superintendent of the Whipps Cross Hospital. His resignation is much regretted, but the new Medical Superintendent is happily proving equally helpful and co-operative. 58 Problems in Diagnosis. The problems which present themselves at the Clinic in differential diagnosis have been outlined in previous reports. It must again be emphasised that at least 50 per cent. of new cases coming to the Clinic prove, after complete clinical, radiological and bacteriological examinations, to be nontuberculous. Among the common conditions that are particularly encountered which closely resemble pulmonary tuberculosis are :— 1. Cancer of the Lung (now increasingly common). 2. Bronchiectasis. 3. Heart Disease (especially mitral stenosis) with congestion of the lung. 4. In this Area Industrial Lung Disease—pulmonary asbestosis—an account of which was given in last year's report. We now know that Tuberculosis complicating pure Pulmonary Asbestosis is now not infrequent, several such cases having occurred in the Borough. Hence the necessity of keeping every patient with pulmonary asbestosis under the closest possible scrutiny. Several deaths from the disease have already occurred in the Borough. Special Methods in the Diagnosis and Treatment of Tuberculosis. X-ray Examinations in connection with the work of the Clinic. The following table shows the increased use that is being made of X-ray examinations year by year :— 1928. 1929. 1930. 1931. 1932. 29 97 302 352 454 The importance of X-ray examination in diagnosis and treatment was emphasised in last year's report. During the last 10 years more particularly, with modern apparatus for radiography at a distance of two metres, improved radiological technique, and facilities for almost instantaneous exposures (1/10th of a second or less), it has become possible to standardise the quality of 59 grams. The result is that when serial radiograms are required to enable one to watch the development of a lesion within the chest —an invaluable aid to the physician in assessing the results of treatment—it is now possible to repeat them under precisely similar conditions. The quality of the radiogram and the exact interpretation of abnormal shadows seen in a perfect picture are of fundamental importance, and of no less significance than a complete clinical examination. Moreover, a complete radioscopic " screening " examination, which must precede the taking of a film, and enables us to examine the chest from several angles, is of the greatest importance, and in routine contact work may not infrequently obviate the necessity of a film, with corresponding reduction of expenditure. From the figures shown it can be readily seen how increasing use is being made of this valuable aid in diagnosis and treatment. There is little doubt that year by year increasing use will be made of this procedure, and no tuberculosis scheme, which fails to provide full radiological facilities, can be regarded as complete. Such facilities are encouraged to the full by the Ministry of Health. It is to be hoped that with the advent of the new Clinic such modern radiological facilities will be available for the large number of patients passing through our hands. Examination of Sputum in Diagnosis. These examinations show very progressive signs of increase in number year by year. The necessity for the examination of a " valid " sample of sputum, which shall come from the chest and not from the back of the throat, is a matter of considerable importance, and printed instructions are supplied to all patients for supplying such a sample of sputum. Little reliance can be placed on the results of a single test, and hence repeated sputum examinations are made including, where necessary, in addition to the routine test, a concentrated " antiformin " test; for a sputum may be returned negative on several occasions and finally prove to be positive. 60 The use of the Intracutaneous Tuberculin Test (" Mantoux Test ") in Diagnosis. The use of the " Mantoux " test in diagnosis, especially in the diagnosis of intrathoracic tuberculosis in childhood, has of late become more stabilised. In consequence its use as a diagnostic aid has not been lost sight of in connection with the work of the Clinic. Whilst pulmonary tuberculosis of the adult type is rare in childhood, intrathoracic tuberculosis does occur, and is always a difficult problem. This test can undoubtedly be of help. Speaking generally a negative reaction to the " Mantoux " test is the rule up to two years of age. Should the reaction be positive in the first two years of life it may be assumed that we are dealing with an active case of tuberculosis. If, in addition, there is a history of contact with a case of tuberculosis, the diagnosis is certain. After the age of two or three years a positive reaction is not significant, and does not necessarily mean active disease. At the age of 14 it is generally assumed that the great bulk of children show a positive reaction. A positive reaction points to infection, and the degree of reaction is, in the majority of cases, a measure of the severity of the infection. A negative reaction in an ailing child, with few exceptions, may be taken to mean that tuberculosis is not the cause of the illness. Hence we see, despite its limitations, the value in diagnosis of this test, of which we are now making use at the Clinic. Thoracic Surgery in Diagnosis and Treatment. Brief reference was made to the increasing value of surgical methods in diagnosis, and especially as an adjunct to the routine treatment of pulmonary tuberculosis, 61 Such cases require very careful selection, and should only be dealt with by an expert Thoracic Surgeon. In this connection we have had the valuable help of the Surgeons to the Brompton Hospital, who have performed plastic operations on the chest on three patients, in order to collapse by surgical means (" phrenic evulsion " and " thoracoplasty ") cases which were unsuitable for an artificial pneumothorax. The Use of Insulin in the Treatment of Pulmonary Tuberculosis. A note should just be made on the use of Insulin in certain very selected cases of pulmonary tuberculosis without active disease, but with a marked disturbance of nutrition. In a few cases careful graduated doses of Insulin with the compensatory use of glucose has created such a marked improvement in appetite as to produce a pronounced increase in weight and resistance in the patient, with a corresponding improvement in the general condition. Importance of the Psychological Factor in the Treatment of Tuberculosis. This very important factor must never be lost sight of in this field of work. Mental hygiene and its relation to : (a) Physical improvement. (b) Mental placidity. (c) Increase of ability to become self-supporting is now fully appreciated. Tuberculosis is a disease peculiarly fitted through its long duration, disturbance of social relations, financial burden and segregation, to foster emotional stress, which in itself may be a precursor of tuberculosis. The importance therefore of mental re-education to instruct the patient in the mode of dealing with his emotional problems and tracing them to their source has to be encouragcd. A spirit of optimism, faith, courage and fortitude are undoubted factors of therapeutic importance, and such a spirit is encouraged wherever possible. 62 Prevention. The importance of the preventive side of our work is never lost sight of. Early diagnosis and early treatment of tuberculosis are vital in the interests of prevention. Emphasis is made of the importance of mouth sanitation and nasal hygiene, and this line of defence against infection. Patients are advised against the prevention of colds, to secure abundant fresh air, adequate rest, and pasteurised milk. It has been found that contaminated milk is sometimes the source of infection. The principles of hygienic discipline are fully explained to all patients, and the isolation of advanced cases is urged, particularly where there are children in the home. Again the importance of separating young children from an active tuberculous subject in the home is never lost sight of. In fact, it is now possible to adopt the Grancher System, whereby healthy children of tuberculous parents are boarded out in the country. Again, if a patient cannot obtain admission to sanatorium owing to having no one to look after the children, arrangements are made for the admission of the children to the Aldersbrook Homes. Contact Examination. Special attention continues to be paid to the contacts of notified cases of tuberculosis, and above all of the infectious type of case, and every contact case is given the opportunity of being examined at the Clinic. From the preventive point of view, however, as emphasised in the 1929 report, the adolescent type of contact must continue to command our very special attention, for it is they who are particularly liable to the virulent type of disease we speak of as " acute adolescent phthisis." Whilst all the school child contacts who, incidentally, are also under the School Medical Service, will be brought very readily for examination to the Clinic, unfortunately the young girl in her teens, who is subject to the greatest danger, can often only be got hold of with difficulty. Hence the appallingly high death rate from pulmonary tuberculosis, especially in young girls of 15-25. A complete examination of such contacts will enable us to diagnose the disease in the early stages when treatment is so beneficial, 63 Dental Treatment. Patients eligible for dental treatment are those who are unable to derive full benefit from their treatment for tuberculosis owing to oral sepsis. The Council provide this form of treatment for uninsured cases except for patients already covered by dental schemes of other bodies, e.g., school children and tuberculous pensioners, are excluded from benefit. For insured persons who are tuberculous, the approved societies make a contribution towards the cost of dental attention required. The treatment includes extractions, fillings, and dentures where necessary. After-Care Committee. The After-Care Committee has continued to do excellent work during the year. Thirty-three necessitous patients have been provided with clothing and bedding. The provision of bedding has enabled the patients concerned to sleep alone, thus acting as a preventive measure to the healthy members of the family. Repairs were carried out to a patient's artificial limb, and two patients (husband and wife) were removed into the country. To raise funds a Flag Day, which realised £16 16s. Id., was held in September; a Dramatic Performance kindly given by the Trevelyan Dramatic Club made £2 3s. 5d., and a Dance held in the Winter Hall in December showed a profit of £9 15s. lid. It is very much hoped that when the new Clinic is established, through the help of the After-Care Committee " A handicraft class " of selected patients, with a voluntary or even paid worker, may meet weekly or even fortnightly at the Clinic. The psychological effect, resulting from the ability of some of these patients to become even partially self supporting or useful, is incalculable. Adequate Housing Accommodation for Tuberculous Subjects. The difficult situation of many tuberculous subjects attending the Clinic, from the point of view of adequate housing 64 modation to enable them to continue the necessary after-care following sanatorium treatment, is a very real one. Whilst the solution is a difficult one, it would be a great advantage if some preference could be given to tuberculous subjects, especially where there is more than one case in the family, in securing new housing accommodation in the interests of public health. The Work of the Tuberculosis Nurses. The position was outlined in the 1929 report. I should be lacking in my duty were I not to express my deep sense of gratitude to the Nurses and the Clerical Staff for their ever ready help and constant co-operation, which have played no little part in the successful working of the Clinic. 65 TABLE 23. Return showing the work of the Tuberculosis and Chest Clinic, 1932. 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 68 37 2 — 3 9 9 10 71 46 11 10 138 (6) Diagnosis not completed — — — — — — — — 9 7 1 1 18 (c) Non-tuberculous — — — — — — — — 50 44 10 8 112 B.—Contacts examined during the year :— (a) Definitely tuberculous 8 13 2 1 — — — 2 8 13 2 3 26 (6) Diagnosis not completed — — — — — — — — 2 4 6 6 18 (c) Non-tuberculous — — — — — — — — 34 70 53 42 199 C.—Cases written off the Clinic Register as— (a) Recovered 8 7 2 — 4 2 — 1 12 9 2 1 24 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Clinic Register as tuberculous — — — — — — — — 87 129 69 58 343 D.—Number of Cases on Clinic Register on December 31st, 1932 (a) Definitely tuberculous 347 275 38 9 62 68 75 35 409 343 113 44 909 (b) Diagnosis not completed — — — — — — — — 11 11 7 7 36 66 1. Number of cases on Clinic Register on January 1st, 1932 1021 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 23 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of " 152 4. Cases written off during the year as Dead (all causes) 91 5. Number of attendances at the Clinic (including Contacts) 3836 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 26 7. Number of consultations with medical practitioners :— (а) Personal 50 (б) Other 381 8. Number of visits by Tuberculosis Officers to Homes (including personal consultations) 92 9. Number of visits by Nurses or Health Visitors to Homes for Clinic purposes 4577 10. Number of (a) Specimens of sputum, &c., examined 965 (b) X-ray examinations made 454 in connection with Clinic work. 11. Number of "Recovered" cases restored to Clinic Register, and included in A (a) and A (b) above — 12. Number of "T.B. plus" cases on Clinic Register on the 31st December 321 Number of Clinics for the treatment of Tuberculosis (excluding centres used only for special forms of treatment):— Provided by the Council X Provided by voluntary bodies — 67 TABLE 24. 67 PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1932 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.Plus) Group 1 Group 2 Group 3 Total (Class T.B plus) Group 1 Group 2 Group 3 Total (Class T.B plus Group 1 Group 2 Group 3 Total Class TB. Plus) | (a) Remaining on Clinic Register on 31st December. Disease Arrested Adults M. 31 2 3 — 5 2 1 — — 1 2 — 1 — 1 4 1 — — 1 F. 18 2 4 — 6 5 — 1 — 1 4 — — — — 7 — — — — Children 10 — — — — 1 — — — — 6 — — — — 5 — — — — Disease not Arrested Adults M. 31 12 22 2 36 3 2 5 1 8 3 3 4 — 7 8 3 6 — 9 F. 20 9 15 2 26 3 1 2 — 3 3 1 3 — 4 9 3 2 — 5 Children 8 2 — — 2 1 — — — — — — — — — 2 — — — — Condition not ascertained during the year 7 1 1 — 2 — — 1 — 1 — — — — — 3 1 2 — 3 Total on Clinic Register at 31st December 125 28 45 4 77 15 4 9 1 14 18 4 8 — 12 38 8 10 — 18 (b) Not now on Clinic Register and reasons for removal therefrom. Discharged as Recovered Adults M. 11 2 — — 2 1 — — — — 1 — — — — — — — — — F. 13 1 — — 1 1 — — — — — — — — — — — — — — Children 7 — — — — — — — — — — — — — — — — — — — Lost sight of or otherwise removed from Clinic Register 292 33 47 3 83 51 7 25 — 32 41 11 19 2 32 41 16 18 3 9 37 32 Dead Adults M. 35 5 45 27 77 8 2 23 12 37 5 3 25 11 39 10 1 22 F. 25 3 27 21 51 6 6 21 10 37 1 — 16 8 24 3 5 10 9 24 Children 4 — 1 1 2 1 — — 1 1 4 1 — — 1 1 — 1 — 1 Total written off Clinic Register 387 44 120 52 216 68 15 69 23 107 52 15 60 21 96 55 22 51 21 94 Grand Totals 512 72 165 56 293 83 19 78 24 121 70 19 68 21 108 93 30 61 21 112 1929 1930 1931 1932. (a) Remaining on Clinic Register on 31st December. Disease Arrested Adults M. 3 — 1 — 1 5 1 — — 1 — — — — — — — — — — F. 4 — — — — 2 — — — — — — — — — — — — — — Children 2 — — — — — — 1 — 1 — — — — — — — — — — Disease not Arrested Adults M. 9 2 16 1 19 8 9 15 2 26 13 5 18 1 24 26 9 35 4 48 F. 8 4 6 1 11 10 2 8 1 11 13 8 15 1 24 25 6 21 4 31 Children 5 — — — — 4 — — — — 4 — — — — 6 — — — — Condition not ascertained during the year 2 — — — — 3 1 1 — 2 — 1 — — 1 — — — — — Total on Clinic Register at 31st December 33 6 23 2 31 32 13 25 3 41 30 14 33 2 49 57 15 56 8 79 (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 28 9 18 — 27 10 4 6 3 13 9 3 9 4 16 5 1 5 — 6 Dead Adults M. 3 3 16 15 34 6 1 7 19 27 2 — 4 4 8 1 — 6 2 8 F. 7 2 8 6 16 3 3 9 9 21 5 2 7 7 16 2 — 1 3 4 Children — — — — — — — — 2 2 — — — — — 1 — 1 — 1 Total written off Clinic Register 38 14 42 21 77 19 8 22 33 63 16 5 20 15 40 9 1 13 5 19 Grand Totals 71 20 65 23 108 51 21 47 36 104 46 19 53 17 89 66 16 69 13 98 68 TABLE 25. 6f NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1932 of all patients remaining on the Clinic Register; and (b) the reasons for the removal of all cases written off the Register. tion 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 J oints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Clinic Register on 31st December. Disease Arrested Adults M. 4 1 2 8 15 1 — — 1 2 — — 1 — 1 1 — — 1 2 F. 3 — — 5 8 1 1 — — 2 — — — — — — — — 1 1 Children — — 1 5 6 1 — — 1 2 — 2 — 3 5 1 — — 1 2 Disease not Arrested Adults M. 5 — 3 6 14 1 — 2 — 3 2 — — 1 3 2 — 1 — 3 F. 6 1 1 5 13 — — — 1 1 — — — — — — 1 — 3 4 Children 7 1 1 12 21 — 1 — 1 2 1 — — 3 4 2 — — 5 7 Condition not ascertained during the year — — 2 2 4 — — — — — — — — 1 1 — — 1 — 1 Total on Clinic Register at 31st December 25 3 10 43 81 4 2 2 4 12 3 2 1 8 14 6 1 2 11 20 Transferred to Pulmonary 3 — 1 4 8 — — — — — 1 — — 1 2 — — — — — (b) Not now on Clinic Register and reasons for removal therefrom. Discharged as Recovered Adults M. 5 — 1 1 7 — — — — — — — — — — — — — — — F. 3 — 1 1 5 — — — 1 1 — — — — — — — — — — Children 7 2 1 11 21 — — — 1 1 — — — — — — — — — — Lost sight of or otherwise removed from Clinic Register 51 8 17 84 160 10 2 6 13 31 6 — 2 7 15 — 1 4 10 15 Dead Adults M. 2 — 1 — 3 — — — — — — 1 — — 1 — — — — — F. 3 — — — 3 1 — — — 1 — — — — — 1 — — — 1 Children 4 — — 4 — — — — — — — — — — — — — — — Total written off Clinic Register 75 10 21 97 203 11 2 6 15 34 6 1 2 7 16 1 1 4 10 16 Grand Totals of (a) and (6) (excluding those transferred to Pulmonary) 100 13 31 140 284 15 4 8 19 46 9 3 3 15 30 7 2 6 21 36 1929 1930 1931 1932. (a) Remaining on Clinic Register on 31st December. Disease Arrested Adults M. 2 — — 1 3 — — 2 — 2 — — 1 — 1 — — — — — F. 1 — — — 1 1 — — — 1 — — 1 — 1 — — — — — Children 1 — — 2 3 — — — 1 1 — — — — — — — — — 3 Disease not Arrested Adults M. 2 — — 1 3 1 1 1 2 5 1 — — — 1 2 — 1 — F. — 1 — 2 3 — 2 1 4 7 — 1 — 1 2 3 1 1 — 5 Children 3 3 — 16 22 1 2 2 13 18 3 — — 3 6 8 5 — 7 20 Condition not ascertained during the year 1 — 1 — 2 1 — — — 1 1 — — 1 2 — — — — — Total on Clinic Register at 31st December 10 4 1 22 37 4 5 6 20 35 5 1 2 5 13 13 6 2 7 28 Transferred to Pulmonary — — — — — 1 — 1 1 3 — — — — — — — — — — (ft) 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 4 — 3 8 15 — — — 4 4 3 — 1 8 8 1 — 1 1 3 Dead Adults M. — — — — — — — 2 — 2 — — — — — 1 — — — 1 F. — — — — — — — — — — — — — — — — — 1 — 1 Children — — — 1 1 — — — 1 1 — — — — — — — — — — Total written off Clinic Register 4 — 3 9 16 — — 2 5 7 3 — 1 4 8 2 — 2 1 5 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 14 4 4 31 53 4 5 8 25 42 8 1 3 9 21 15 6 4 8 33 69 "HARTS " SANATORIUM. History.—" Harts " was acquired by the East Ham Corporation on 31st January, 1919, previous to which it had been in private ownership. It consisted of a moderate-sized mansion, with stabling-, two lodges, a farm house and just under thirty acres of land. The larger rooms of the main building were converted into wards for female patients, whilst the smaller were utilised for administrative and staff purposes. A hut and six shelters were erected to accommodate male patients and also a dining hut for both sexes, whilst part of the stabling housed the electrical plant, etc., and alterations and adjustments were made for the laundry, dispensary, incinerator, etc. After being converted from a private residence into a public institution it was formally opened on October 16th, 1920, by the then Mayor, G. P. Dean, Esq., J.P., for the reception of 30 adult male patients, 19 adult female and two female children, a total of 51. The number of adult male patients was increased in October, 1927, when five new shelters were added, thus bringing the total up to 56 patients. In November, 1932, a commencement was made upon a new pavilion to contain 32 beds (20 female and 12 male) for advanced and observation cases. When that is complete the institution will accommodate approximately 80 patients, as a certain number of female beds now housed in the main building will be transferred to the pavilion and the rooms so vacated used for additional staff. Dr. Cheater reports as follows :— Report for 1932. Patients discharged, 126 (males 81, females 45). Of these 91 were insured (68 males and 23 females), and 35 non-insured (13 males and 22 females). Deaths 15 (included in 126 above). Average duration of treatment 20.26 weeks. Number of patient days 20,267. Number of beds available at end of year 56. Average number of beds occupied 55.37 (98.87 per cent.). 70 The immediate results of treatment are as follows :— 51 cases were discharged as " Quiescent." 60 cases were discharged as " Not Quiescent." Of the latter, 38 cases were " improved " and 22 " not improved." Out of the 126 cases discharged or died, 22 had previously had one course of sanatorium treatment, whilst 11 had been in more than once. The average duration of treatment for 1932 was approximately five weeks per patient less than in 1931. This was especially noticeable on the male side where, on account of the fear of unemployment, men had to go back to their work before the disease was quiescent. Phthisis, even when it has a good hold upon a person's lungs, causes no pain and perhaps the patient only notices a little inconvenience with shortness of breath on exertion, plus a slight, dry cough, and therefore feels he can return to work. He is probably the more anxious to do so, especially when it is a question of either keeping or losing his job. In such circumstances it is very difficult to convince a patient that he should continue treatment in the sanatorium. Those, however, who are more favourably situated, having light and suitable employment together with a considerate employer, are enabled to take full benefit from sanatorium treatment, and when discharged have an exceedingly good chance of continuing to remain fit and capable of sustaining the task of the family wage-earner. Nevertheless, it is a poignant fact that the question of how long a patient remains fit after deriving the utmost benefit from his stay in the sanatorium, is as much an economic as a medical problem, and in these stringent times it well may be that too close a pruning in expenditure in the direction of public health may store up a crop of untoward and perhaps unlooked-for troubles hereafter. In 1932 there were 18 patients admitted by ambulance (13 male and 5 female), 15 from general hospitals and 3 from their homes, compared with 8 so transferred in 1931. A number of these cases were seriously ill, suffering from advanced phthisis, and it will be a great improvement as regards nursing facilities and a relief to patients who are up and about, when the pavilion for advanced cases is available for the reception of such patients. 71 Artificial Pneumothorax. The number of refills increased from 151 in 1931 to 185 in 1932. In addition to these, on two occasions it was necessary to collapse a patient's lung as an " emergency operation " on account of severe haemoptyses. In connection with this method of treatment it is necessary to stress the importance of controlling its course by means of the X-rays. At the moment the patients have to be conveyed by ambulance to the Forest Hospital, Buckhurst Hill, an arrangement which worked satisfactorily when the amount of pneumothorax work was not so heavy. Now, however, the increase is such than an X-ray apparatus is urgently required at " Harts," moreover in addition to the collapse therapy treatment, X-rays are of great assistance in gauging the progress of ordinary uncomplicated cases, and in patients suffering from acute pleuritic effusions a radioscopic examination is essential before and after the operation of aspiration is performed, and the smallest ambulance journey is absolutely contraindicated. However, the new pavilion now in the course of erection contains an X-ray room and dark-room, constructed in accordance with the requirements of the National Physical Laboratory, so that when that is equipped with a suitable apparatus the difficulties now experienced will be obviated. Bacteriology. The number of specimens of sputum examined in 1932 was 251, compared with 236 in 1931. It was observed that three cases having tubercle bacilli present also contained the fungus " monilia," this however although of academic interest, was of no practical pathological significance and disappeared under appropriate treatment. Also a number of specimens of pus, fasces, urine, pleuritic effusions, etc. (the last two after centrifugalization), were examined microscopically, and six bloodsugar estimations were obtained in cases of diabetes mellitus. The Complications observed and treated were as follows :— (a) Those directly due to tuberculosis— Tubercular laryngitis 9 (3 died), pleurisy 2, tubercular kidney 3, abdominal tuberculosis 4, cervical glands 2, meningitis 1, epididymitis 1, " sanocrysin " nephritis 1, spinal caries 1. 72 (b) Not directly due to tuberculosis— Pyorrhoea and dental caries 18, skin diseases 2, gastritis 2, bronchitis 4, asthma 2, epilepsy 1, dysentery 1, otitis media 1, diabetes mellitus 2, hyperthyroidism 1, carbuncles 1. As mentioned previously, in November, 1932, the building of a new block for advanced and observation beds was begun. When completed this will convert the institution into what is designated a " Sanatorium-Hospital," which is the most suitable arrangement a Local Authority can adopt for the treatment of all cases of phthisis, " early," " intermediate " and " advanced." Dr. MacNalty of the Ministry of Health in his Report on Tuberculosis states that by " hospital treatment " is meant— " (a) observation of doubtful cases for the purpose of diagnosis or for determination as to their suitability for sanatorium treatment, (b) treatment of " acute " cases with considerable stitutional disturbance, with subsequent transference to the sanatorium section if they respond to treatment and become ambulant and afebrile, (c) short period treatment and education in hygiene of " intermediate " and " chronic " cases, and (d) isolation of dangerously infective and advanced cases." He also sets out the advantages of a combined institution which in short are, that the patient can be treated in all stages of the disease by the same medical attendant and be transferred from the hospital block to the sanatorium section or vice versa without delay so as to receive the most suitable form of treatment. This keeps before patients undergoing hospital treatment the prospect of making sufficient progress to be so transferred, and finally the hospital block being on the same site as the sanatorium it is economical in medical and nursing administration. In addition to these advantages the cubicles in the new pavilion at " Harts " will afford to patients and relatives a comforting privacy, both in the final stages of the disease and at the dissolution, and will prevent that spell of gloom which is cast over the other patients when a death occurs in an open ward. 73 In conclusion I wish to thank most heartily those companies of artistes who during the winter months so freely gave of their time and services to come to " Harts " and entertain us. They can rest assured that their efforts are highly appreciated both by patients and staff. TABLE 26. HARTS SANATORIUM.—Year ended 31st March, 1933. Expenditure. Cost per Patient per week. £ S. d. Salaries and Wages 2,545 17 5 Superannuation 68 0 5 Provisions 1,814 12 6 Disinfectants, Drugs and Appliances 145 1 0 Coal, Coke and Firewood 290 2 0 Electricity, Gas and Water 538 3 8 Furniture, Bedding and Linen 123 0 10 Uniforms and Dresses 45 0 4 Chandlery and Sundries 254 1 9 Crockery and Hardware 51 0 4 General Repairs 535 3 8 Garden Implements, Seeds, etc. 42 0 4 Printing, Stationery and Advertise ments 32 0 3 Rent of Telephones 34 0 3 Rates, Taxes and Insurance 246 1 9 X-Ray Examinations 44 0 4 £6,806 46 10 74 TABLE 27. Return showing the extent of Residential Treatment and Observation during the Year in Harts Sanatorium. In Institution on Jan. 1 Admitted during the year. Discharged during the year. Died in the Institution. In Institution on Dec. 31. (1) (2) (3) (4) (5) Number of definitely tuberculous patients admitted lor treatment Adults m. 34 82 72 9 35 F. 18 44 38 6 18 Children ... 1 3 1 — 3 Total ... ... 53 129 111 15 56 Grand Total 53 129 111 15 56 75 TABLE 28. 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. Totals. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Pulmonary Tuberculosis. Class T.B. minus. Quiescent 5 6 1 6 1 — 2 2 — — — — 13 9 1 23 Not quiescent 1 — — 1 — — — 1 — — — — 2 1 — 3 Died in Institution — — — — — — — — — — — — — — — — Class T.B. plus. Group 1. Quiescent 2 1 — 3 2 — — — — — — — 5 3 — 8 Not quiescent 1 — — — — — — — — — — — 1 — — 1 Died in Institution — — — — — — — — — — — — — — — — Class T.B. plus Group 2. Quiescent 3 1 — 5 4 — 6 1 — — — — 14 6 — 20 Not quiescent 7 6 10 4 6 — 1 — — 24 10 — 34 Died in Institution — — — — — — — — — — — — — — — — Class T.B. plus Group 3. Quiescent — — — — — — — — — — — — — — — — Not quiescent 6 2 — 5 2 1 4 1 1 13 9 — 22 Died in Institution 3 1 — 4 1 — — 2 — 2 2 9 6 — 15 76 TABLE 29. Return showing the extent of Residential Treatment during the Year in Institutions (other than poor law Institutions) approved for the Treatment of Tuberculosis (including Harts Sanatorium). In Institutions on Jan. 1 Admitted during the year. Discharged during the year Died in the Institutions . InInsti tutions on Dec. 31. (1) (2) (3) (4) (5) Number of definitely tuberculous patients admitted] for treatment ( Adults M. 39 93 79 10 43 F. 19 49 40 6 22 Children ... 21 32 18 — 35 Total ... ... 79 174 137 16 100 Grand Total 79 174 137 16 100 TABLE 30. 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 1932 Admitted during the year. Discharged during the year. Died in the institutions. In institutions on Dec. 31,1932. Number of patients suffering from pulmonary tuberculosis admitted for treatment Adults M. 6 27 21 6 6 F. 9 38 30 10 7 dren 2 4 3 3 — Total ... — 17 69 54 19 13 Number of patients suffering from nonpulmonary tuberculosis admitted for treatment Adults M. 1 2 2 1 F. 2 1 1 — 2 Children ... — 2 1 — 1 Total ... ... 3 5 4 — 4 Grand Total 20 74 58 19 17 77 TABLE 31 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. Ouiescent 5 6 2 6 1 — 2 2 2 — — 1 13 9 5 27 Not quiescent 1 — — 1 — — — 1 1 — — — 2 1 1 4 Died in Institution — — — — — — — — — — — — — — — — Class T.B. plus. Group 1. Ouiescent 2 1 — 3 2 — — — — — — — 5 3 — 8 Not quiescent 1 — — — — — — — — — — — 1 — — 1 Died in Institution — — — — — — — — — — — — — — — — Class T.B. plus. Group 2. Quiescent 3 1 — 6 4 — 7 1 — — — — 16 6 — 22 Not quiescent 7 7 — 10 4 — 6 — — 2 — — 25 11 — 36 Died in Institution 1 — — — — — — — — — — — 1 — — 1 Class T.B. plus. Group 3. Quiescent — — — — — — — — — — — — — — — — Not quiescent 6 2 — 5 2 — 1 4 — 1 1 — 13 9 — 22 Died in Institution 3 1 -— 4 1 — — 2 — 2 2 — 9 6 — 15 78 TABLE 31 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 — — — — — 1 — 4 2 — 4 6 Not quiescent — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — — — — Abdominal. Quiescent — — — — — — — 1 1 — — 1 — 1 2 3 Not quiescent — — — — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — — — — Other Organs. Quiescent — — — 1 — 1 — — — — — — 1 — 1 — Not quiescent — — — — — — — — — — — — — — — — Died in Institution — — — — — — — — — — — — — — — — Peripheral Glands. Quiescent — — — — — 1 1 — 1 — — 1 1 — 3 4 Not quiescent — — — — — — — — 1 — — 1 — — 2 2 Died in Institution — — — — — — — — — — — — — — — — 79 TABLE 32. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications, 1932. During the Period 3-1-32 to 31-12-32. Formal Notifications. Number of Primary Notifications of new cases of tuberculosis. Age periods. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 & over Total (all ages) Total notifications. 1 — 4 3 8 18 28 13 16 7 2 100 109 ,, Females — — 1 4 12 11 23 9 6 2 1 69 76 Non-pulm. Males — 3 9 4 2 4 2 — — — — 24 26 „ Females — 5 4 4 — 4 4 — — — — 21 21 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 2 — — 2 6 2 2 1 — 16 ,, Females — — 1 1 1 1 8 4 1 — — 17 Non-pulmonary Males — 3 — — — — 1 — — — — 4 „ Females — 1 1 1 2 — — 1 — — — 6 80 Notification Register. Number of cases of Tuberculosis remaining at the 31st December, 1932, on the Registers of Notifications kept by the Medical Officer of Health. Pulmonary Non-pulmonary Total Cases Males Females Total Males Females Total 506 359 865 162 124 286 1,151 Number of cases removed from Registers during the year by reason inter alia of:— 1. Diagnosis not confirmed by T.O. (withdrawal of notification) 11 8 19 — — — 19 2. Recovery from the disease 10 7 17 4 3 7 24 3. Death 64 56 120 9 6 15 135 TABLE 32—continued. The source or sources from which 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 7 2 Posthumous notifications — 2 "Transfers " from other areas (other than transferable deaths) 22 4 Other sources if any (specify) (Merchant Seamen) 1 — 81 TABLE 33. Notified Cases of Tuberculosis, l932. Pulmonary. Abdominal. Meninges. Bones and Joints. Glands. Other Organs. Disseminated. All forms. Ages. Males Females j 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 — — — — — — — — — — — — — — — — — — — — — 1 — 1 2-3 — — — — — — — — — — — — — — — — — — — — — 1 — 1 3-4 — — — — — — — 1 1 — — — — — — — — — — — — — 1 1 4-5 — — — — — — 1 1 2 — 2 2 — 1 1 — — — — — — 1 4 5 5-10 4 1 5 2 2 — — — 2 — 2 5 4 9 — — — — — — 13 5 18 10-15 3 4 7 1 1 2 — — — 1 1 2 2 2 4 — — — — — — 7 8 15 15-20 8 12 20 1 1 — — — — — — — — — — — — — — — 10 12 22 20-25 18 11 29 1 1 — — — — — — — 1 1 4 2 6 — — — 22 15 37 25-35 28 23 51 — — — — — — 2 2 4 — — — — 2 2 — — — 30 27 57 35-45 13 9 22 — — — — — — — — — — — — — — — — — — 13 9 22 45-55 16 6 22 — — — — — — — — — — — — — — — — — — 16 6 22 55-65 7 2 9 — — — — — — — — — — — — — — — — — — 1 2 9 Over 65 2 1 3 — — — — — — — — — — — — — — — — — — 2 I 3 Totals 100 69 169 4 2 6 1 2 3 7 5 12 7 8 15 5 4 9 — — — 124 90 214 82 TABLE 34. TUBERCULOSIS. New Cases and Mortality, 1932. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulm. Pulmonary. Non-Pulm. M. F. M. F. M. F. M. F. Under 1 year 1 — — — — — — — 1 — 5 years — — 3 5 — — 4 3 5 — 15 „ 7 5 13 8 1 3 — 2 15 — 25 „ 26 23 6 4 10 12 3 3 25 — 45 „ 41 32 2 4 26 28 — — 45 — 65 „ 23 8 — — 19 6 1 — 65 and upward ,, 2 1 — — 2 1 — — Totals 100 69 24 21 58 50 8 8 The ratio of non-notified deaths to total tuberculosis deaths for the year was 1—13. BOROUGH INFECTIOUS DISEASES HOSPITAL. It would appear opportune now that the hospital has been completed and many improvements effected in addition to rebuilding, to review the history of this Institution from its inception. The first Isolation Hospital was erected on land adjoining the Sewage Farm at Vicarage Lane about the year 1891, and consisted of a wood frame building covered with corrugated iron. This was used for cases of Smallpox, but owing subsequently to a decrease in this disease, it was made available for Scarlet Fever cases. At a somewhat later period, Clock House, High Street South, was obtained by the Council for the admission of Diphtheria patients. Also Rancliff House, which stood on ground now the Central Park, was used for patients suffering from Typhoid Fever. 83 In the year 1899, the present site consisting of 17½ acres was purchased at a cost of £9,768, and the Scarlet Fever Hospital removed from the Sewage Farm to this ground. It is interesting to note that during its reconstruction a large marquee put up to house the patients temporarily was blown down one windy March day and called for the services of the Fire Brigade and staff to deal with the catastrophe. At this time Roman Road was not completed and the entrance to the hospital was from Boundary Road. In 1902, galvanized iron and wood huts were erected for Diphtheria and Typhoid cases, and these were in use as acute and convalescent Diphtheria Wards until the recent reconstruction of the hospital. This building also provided other accommodation for medical officer, matron, stall', dining rooms, bedrooms and stores. In 1907, the first brick building (A) Block was constructed, comprising 26 beds on ground floor, recreation room on first floor, also laundry, stable and porter's lodge and mortuary. The entrance to Roman Road was made available. In l909, the original iron building removed from the Sewage Farm, was demolished and two permanent buildings erected, which consisted of one two-storey block (C and CA) for patients on ground floor, and bedrooms for staff, dining rooms, kitchen and annexes on first floor. Also the cubicle block (B) was provided to deal with cases of mixed infection. The doctor's bungalow was subsequently erected. A hut originally built as a quarantine house for Smallpox families was later used as a ward for the treatment of cases of Tuberculosis. All these buildings remained in use until the recent reconstruction which, with the new additional wards, has increased the hospital to its present size and state of efficiency, which was fully described in last year's report. In order to appreciate its present usefulness it is necessary to carry one's mind back to the time when, although extra provision for patients was increasing with the growth of the Borough, such was not in any way proportionate to its needs. 84 It is only recently that the number of beds considered adequate for the care of the infectious sick, namely, 1 per 1,000 of the population, has been available. REPORT ON WORK AT THE BOROUGH INFECTIOUS DISEASES HOSPITAL, 1932. Dr. Barker reports as follows :— The most striking feature of the work of the hospital during the past twelve months is the varied type of cases admitted for treatment. It must be acknowledged that this institution has increased its usefulness. In view of the fact that the accommodation has for some months during the year been taxed to its uttermost, it is perhaps a matter for thankfulness that such an epidemic as has occurred in the district did not take place during the period of rebuilding. Diphtheria. During the year, 153 patients were admitted to the hospital as compared with 191 for the previous year. Of this number, 129 were faucial, 5 laryngeal, 19 nasal and faucial. Sixteen patients remained under treatment at the end of the year. In six instances some other infectious illness was found to be present. Of the cases admitted for treatment, the number of deaths was 15, giving a total death-rate for completed cases of 8.8 per cent. as compared with 7.2 per cent. for last year. Except in the case of three patients, two of whom died from late diphtheritic paralysis, and one from pneumonia, death resulted within a few hours or days of admission. Six cases were hæmorrhagic—-a particularly fatal form of the disease. Many of the patients exhibited severe infection or were late in coming under treatment. 85 Lack of response to treatment was evident in many instances, due apparently to deficient nutrition and a lessened resistance owing to the economic situation, or again to the appearance of a severe type of infection, less amenable to the influence of antitoxin, which has been noted by many Authorities both in this country and abroad. Many cases called for large amounts of antitoxin and 25 patients received from 50,000 to 100,000 units. In many instances this was given intravenously in order to afford immediate benefit. In toxic and febrile cases, antistreptococcic serum was administered in conjunction with diphtheritic antitoxin. Severe complications of recovery cases were as follows, viz. :— Paralysis 2 Cardiac vomiting 3 Lobar Pneumonia 1 Myocarditis ... 7 The age incidence of the patients admitted was as follows :— Years 0-5 5-10 10-15 15 + Total 27 73 33 20 153 Scarlet Fever. The number of patients admitted during the year was 576, as compared with 160 for 1931, indicating an epidemic period. This is the largest number treated in hospital in any year, which was possible owing to the increased accommodation available. Twenty-three patients remained under treatment at the end of 1931. At first somewhat mild in type, this illness became more pronounced towards the latter end of the year and many cases showed marked toxicity and in some instances severe and prolonged complications. Four cases exhibited concurrent infectious disease. Of the total cases, 599, one death only resulted, that of a patient suffering from septic Scarlet Fever and Pneumonia, who died within twenty-four hours of admission. The mortality rate was 0.16 per cent., as compared with 0.5 per cent. for the previous year. 86 The number of patients treated with Scarlet Fever serum totalled 157, in 27 instances injections of mixed serum being given. Severe or prolonged complications were as follows, viz.:— 47 cases showed marked double adenitis. 5 cases of nephritis. 20 cases of severe otitis media. 43 cases of rhinorrhcea profuse. 4 cases of mastoid abscess (including two radical operations). Many minor and other operations under general and local anaesthesia were undertaken. The age incidence of the patients admitted was as follows:— Years 0-5 5-10 10-15 15+ Total 134 263 100 79 576 Measles and Complications. Seventy-nine patients were admitted during the year—in most instances, severe or complicated cases. Ten patients suffering from this illness remained under treatment at the end of 1931. Three deaths resulted from Broncho-Pneumonia, giving a mortality rate of 2.6 per cent. By the admission of such cases, some relief was afforded to Whipps Cross Hospital. It must be acknowledged that the mortality would have been considerably higher if institutional treatment and skilled nursing had not been available. Whooping Cough. Twelve patients were admitted, mostly severe cases, and three deaths resulted either from Convulsions or Broncho-Pneumonia. Typhoid. There were three cases of true Typhoid, one death resulting, and two cases of Paratyphoid which recovered. Erysipelas. Twelve cases were under treatment during the year. No deaths occurred. 87 General. All members of the nursing and domestic staff are medically examined and tested to ascertain their susceptibility to Diphtheria and Scarlet Fever by means of the Schick and Dick skin reactions. In those reacting positively immunization was offered. Three probationer nurses and one member of the domestic staff contracted Scarlet Fever during their first week and before immunization could be obtained. These cases occurred during the heaviest period of the epidemic and were due probably to mass infection and a more severe type of illness then prevalent. Several members of the staff succumbed to Influenza with fortunately no untoward results, apart from the inconvenience and disorganisation occasioned by depletion of such permanent staff. TABLE 35. Borough Infectious Diseases Hospital. Diseases. Remaining at end of 1931 mitted during 1932. Discharged during 1932. Died during 1932. Remaining at end of 1932. Scarlet Fever 23 576 457 1 141 Diphtheria 16 153 120 14 35 Diphtheria and Scarlet Fever 1 2 2 1 — ? Scarlet Fever — 5 5 — — ? Diphtheria — 2 1 — 1 Scarlet Fever and Complications — 1 — — 1 Scarlet Fever and Chicken Pox — 1 — — 1 Diphtheria and Whooping Cough — 1 1 — — Diphtheria and Pneumonia — 1 1 — — Diphtheria and Measles — 1 1 — — Tonsilitis — 1 — — 1 Whooping Cough and Complications 1 5 4 2 — Whooping Cough — 7 6 1 — Erysipelas 1 11 12 — — Debility following Whooping Cough — 1 — — 1 Enteritis — 2 1 1 — Pneumonia — 1 1 — — Chicken Pox — 1 1 — — Gonorrhœa — 2 2 — — Typhoid — 3 2 1 — ? Typhoid — 2 2 — — Marasmus — 2 1 — 1 Laryngitis — 1 1 — — Measles and Complications 10 79 85 3 1 52 861 706 24 183 88 TABLE 36. BOROUGH INFECTIOUS DISEASES HOSPITAL. Year ended 31st March, 1933. Expenditure Cost per Patient per week £ s. d. Salaries and Wages 5,697 18 11 Superannuation 134 0 6 Provisions 2,945 9 9 Anti-toxin 499 1 8 Disinfectants, Drugs and Appliances 331 1 1 Coal, Coke and Firewood 899 3 0 Electricity, Gas and Water 961 3 2 Furniture, Bedding and Linen 307 1 0 Uniforms and Dresses 132 0 5 Chandlery and Sundries 595 2 0 Crockery and Hardware 35 0 1 General Repairs 695 2 3 Garden Implements, Seeds, etc. 60 0 2 Maintenance and Upkeep of Ambulances 555 1 10 Printing, Stationery and Advertisements 126 0 5 Rent of Telephones 61 0 2 Rates, Taxes and Insurance 325 1 1 Motor Vehicle Reserve 50 0 2 £14,407 47 8 MATERNITY AND CHILD WELFARE. In submitting the report on the work of the Maternity and Child Welfare Department, a brief general account of its history and development is given below. Commencing in 1912 (under the Notification of Births Act, 1907, a voluntary measure), one health visitor was appointed, who had the assistance of one voluntary worker. In a few months six voluntary workers were enrolled and mothers were visited and invited by the Health Visitor to attend a weekly Clinic, opened in the Council's old offices in Wakefield Street. At the end of 1912, 472 mothers had enrolled their children on the Clinic register. 89 On the outbreak of war, Miss Kerr, the pioneer health visitor, volunteered for service and was accepted. In her place, the first fully qualified Health Visitor was appointed. By the end of 1915 —the Notification of Births (Extension) Act, 1915, a compulsory measure, was passed—the work had grown sufficiently to justify the appointment of two further Health Visitors. The district was divided up, extra Clinics were held at Wakefield Street, the services of the School Medical Officers being utilised twice weekly for medical examinations, and clerical assistance was rendered by the staff of the Public Health Department. During the war a great deal of work was undertaken by the health visiting staff in connection with the supply of food, e.g., dried milk, Virol, etc., and many cases were investigated and help obtained from the Prince of Wales Fund. To stimulate interest Baby Shows were organised, and funds obtained from a voluntary source to give teas to the mothers and children at the Town Hall, where an opportunity was afforded to demonstrate to the parents the necessity for proper clothing for infants, and sample garments were shown. In 1917 Measles was made notifiable and one Health Visitor was allocated to visit children suffering from this infection. During one epidemic in the Borough, 909 visits were paid in this connection. In 1918, the Maternity and Child Welfare Act came into operation, and the first full-time Medical Officer was appointed, together with two additional Health Visitors. A Centre was opened at the White House, Plashet Grove, and the Council was asked to undertake the supervision of two Day Nurseries in the Borough, which had hitherto been under the care of a Voluntary Committee. The medical inspection of these Nurseries was undertaken by the Assistant Medical Officer, and a Health Visitor was coopted on the Committee to advise regarding the proper clothing and method of feeding of the children attending. A grant was given towards the expenses by the Council. After the war the urgent need for Day Nurseries ceased and they were discontinued. In 1926, two branch Infant Welfare Clinics were opened, at North Woolwich and Manor Park. Also the supervision of Midwives, which had been carried out by a Health Visitor, was handed 90 over to the Medical Officer in accordance with the Ministry of Health Regulations. Prior to 1920, free milk was given to mothers and children at the discretion of the Medical Officer of Health. The Ministry issued a circular at this date granting free milk to nursing and expectant mothers and children up to five years of age, which was put into operation in this Borough. In 1922 this scale was revised and the age of children reduced by two years. In 1922 the Assistant Medical Officer resigned and no Medical Officer was appointed permanently for nearly a year, the work being carried out by temporary part-time Medical Officers at the Clinics, and the general administration overlooked by the Senior Health Visitor, under the supervision of the Medical Officer of Health. In 1923 another full-time Medical Officer was appointed, and the first full-time clerical assistant. Progress continued by arranging for the services of the School Dentist, Aural Surgeon, and for X-ray treatment for Ringworm. Arrangements were also made with Queen Mary's Hospital, Stratford, Balaam Street, and St. Mary's Hospital, Plaistow, and later with the East Ham Memorial Hospital, for operative treatment of Tonsils and Adenoids cases, payment being undertaken by the Council in those cases where the full cost could not be borne by the parents. In 1930 arrangements were made with Queen Mary's Hospital, Stratford, for the treatment of Orthopaedic cases. In 1926 a Sunlight Clinic was installed at the Town Hall for the treatment of children suffering from malnutrition, debility, rickets, etc., two sessions weekly being held. The treatment was carried out by the Senior Health Visitor, assisted by an additional Health Visitor, under the supervision of the Assistant Medical Officer. The Clinic was discontinued in 1931 owing to lack of accommodation. Special Morning Clinics were instituted for closer medical supervision of premature and ailing infants and backward and defective children, and a further Clinic was opened at St. George's Hall, Masterman Road, to serve the Greatfield area. The services of the Ophthalmic Surgeon were retained for one session weekly for the treatment of children suffering from eye troubles, and glasses were provided at reduced cost. 91 During this period two Health Weeks were held in the Borough, in which the Maternity and Child Welfare Department took a prominent part; demonstrations and lectures were given in the proper care of food and milk, and in the clothing of babies and children, and stalls displayed correct garments and articles for their use. In 1930, the White House site was required by the Education Authority, and the Maternity and Child Welfare Centre was removed to High Street Schools, thus making it necessary to open a further Clinic in Plashet Grove to serve the Plashet, Woodgrange and Kensington areas. In 1930 the work was increased when the Public Assistance Committee was formed, the supervision of Foster Children being undertaken by the Maternity and Child Welfare Department. In 1932 a second permanent Medical Officer for the Maternity and Child Welfare Department was appointed and the services of the part-time Medical Officer were dispensed with. Toddlers Clinics were then organised and one Immunisation Clinic weekly. It is interesting to note that, from one Health Visitor and one weekly Clinic, with a register of 472 babies in 1912, the Service, at the end of 1932, has expanded to include two full-time permanent Medical Officers, seven Health Visitors, one part-time St. John Ambulance Nurse, three Clerks, and a register of 3,977 children. THE WORK OF THE MATERNITY AND CHILD WELFARE DEPARTMENT, 1932. Dr. Maclaren reports as follows:— The work of the 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 at present consists of two Assistant Medical Officers, seven Health Visitors, three Clerks, and one St. John Ambulance Nurse who attends five Clinics per week. 92 Infant Welfare Clinics. There are seven 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 St. John Ambulance Nurse at five Clinics. Attendances at Infant Welfare Clinics. Number of general Clinics held during the year 339 Number of individual children who attended the Clinics 3,977 Total number of attendances 31,335 Total number of children who attended the Clinic for the first time during the year:— (1) Children under 1 year 1,429 (2) Children between the ages of 1-5 years 505 Number of medical consultations at general Clinics 12,858 Number of medical consultations at special Clinics 959 Total number of visits to all Infant Welfare Clinics 32,294 The daily average attendances at the Clinics were as follows:— Central Clinic, Monday afternoon 74 Manor Park, Tuesday morning 119 North Woolwich, Tuesday afternoon 28 Masterman Road, Wednesday afternoon 107 Central Clinic, Thursday morning 73 Plashet Grove, Thursday afternoon 88 Plashet Grove, Friday afternoon 131 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 98.6, compared with 86 in 1931. During 1932, 3,977 children attended the centres, an increase of 157 on the previous year. The total attendance of infants from 93 0—5 increased from 26,256 in 1931, to 31,335 in 1932, an increase of 5,079 over 1931. At the clinics special attention is paid to the education of mothers, individual instruction is given in general hygiene of childhood, correct methods of feeding and management of children. Mothers are encouraged to bring their children for periodical medical examination so that defects and incipient diseases can be treated in the early stages. Toddlers Clinic. A Clinic for the examination of "Toddlers"—children between the ages of two and five years—was commenced in October, 1932, and supplied a needed requirement in the Health Service of the Borough. Children attended on Monday and Wednesday mornings and on alternate Tuesday afternoons, and up to the end of the year 386 full examinations were made. In cases where defects were found, the patients were transferred to the appropriate Specialist Service. Diphtheria Immunisation Clinic. A weekly Clinic, held on Friday morning, was instituted in October, 1932, and during the last three months of the year 285 children attended. The procedure adopted was to give each child three weekly injections of Diphtheria Prophylactic and to Schick test the child after an appropriate interval. 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 1932, 207 children received operative treatment, as compared with 213 in 1931. Ringworm. No cases of Ringworm of the scalp were referred to the X-ray Department for radical treatment. 94 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. 93 mothers and 303 infants were referred to the dental department during 1932. 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 1932, 56 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. During 1932, 18 patients received treatment at the School Aural Clinic. Morning Clinics. Special clinics are held thrice weekly 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 Visitor from their district visits. Special morning clinics are held at:— The Central Clinic, High Street School, on Monday, Wednesday and Saturday at 9.30 a.m. The statistics for 1932 are as follows:— Number of medical consultations 959 95 Notification of Births. The Notification of Births Act, 1915, requires that all births be notified to the Medical Officer of Health within 36 hours of their occurrence. All cases notified are visited by the Health Visitor as soon as possible after the doctor or midwife has ceased to attend. Advice is given with regard to the care, management, feeding and clothing of the child, and also the general health and care of the mother. Thereafter, periodic visits are made to the homes of infants during the first two years of life, and, as far as possible, at wider intervals during the next three years, up to the time when the child comes under the observation of tfie School Medical Service. The visits made by the Health Visitor during 1932 were 20,277. Visits to infants under one year of age 7,458 Visits to children over one year of age 11,930 Visits to Tonsils and Adenoid cases 160 Visits to Ante-natal cases, first visits 218 Visits to Ante-natal cases, revisits 52 Visits to Foster Mothers 225 Special visits not included in the above group 234 20,277 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-school children in regard to defects. 4. Home visiting of foster children. 96 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 Diarrhœa. (g) Other special visits. Still Births. The number of still births registered during the year was 86. The proportion of still births to live births was as 1 to 24. The still birth rate was 4.1 per cent, of the registered live births. On investigation it was found that in 74 cases the months of pregnancy at which the still births took place were as follows:— 7th month 10 8th month 15 9th month 49 No information 12 An analysis of the causes to which the still births were attributable will be found in the following table:— Malpresentation 1 Prolonged labour 3 Excessive size of Foetus (including post maturity) 2 Contracted Pelvis 3 Placenta Praevia 2 Ante-partum haemorrhage 5 Albuminuria 2 Eclampsia 1 Spina Bifida 2 Breech presentation 20 Prematurity 10 Deformity 2 Causes unknown 33 97 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 231 Subsequent attendances 532 Total number of attendances 763 Average attendance of expectant mothers per session 15.8 Number of patients referred to Dental Clinic 67 The following table gives an analysis of the pre-maternal cases found to be slightly or seriously abnormal:— Contracted pelvis 6 Albuminuria 18 Hyperemesis gravidarum 3 Ante-partum haemorrhage 4 Malpresentation 7 Cervicitis 6 Valvular disease of the heart 5 Varicose veins 14 Phlebitis 2 Haemorrhoids 6 Anaemia 7 Bronchitis 2 Pulmonary tuberculosis 1 Dyspepsia 18 Constipation 32 It is satisfactory to note that during this year a very much larger number of cases attending the Ante-natal Clinic were sent by midwives. 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 1932, 270 visits were paid to expectant mothers. 98 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 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 1932, three were referred to Queen Mary's Hospital and 35 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. 57 midwives notified the Local Supervising Authority of their intention to practice within the Borough during 1932. 32 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. 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. 99 During the year help was obtained in 221 cases as follows :— Mother— Ruptured perineum 36 Prolonged labour 26 Ante-partum haemorrhage 13 Post-partum haemorrhage 3 Retained Placenta 9 Rise of temperature 34 Malpresentations 2 Extended breech 2 Inflammation of breasts — Phlebitis — Albuminuria 1 Other causes 60 186 Child- Prematurity and dangerous feebleness 10 Unsatisfactory condition of infant 4 Deformities 2 Discharging eyes 8 Still-birth 1 Skin eruptions 2 Other causes 8 35 Puerperal Fever and Puerperal Pyrexia. Four cases of Puerperal Fever and 23 cases of Puerperal Pyrexia were notified during the year under the Regulations of 1926 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 rate was 1.9 per 1,000 births and the Puerperal Pyrexia case rate 11.1 per 1,000 births. 100 The death rate for Puerperal Fever was 2.3 per 1,000 live births. Maternal Mortality. There were eight deaths associated directly with pregnancy. The maternal mortality rate was, therefore, 3.6 per 1,000 live births compared with 3.90 per 1,000 in 1931. Ophthalmia Neonatorum. During 1932, 6 cases of Ophthalmia Neonatorum were notified. For table giving result of treatment, see table No. 21. Ophthalmia Neonatorum includes all cases of inflammation of the eyes of new-born babies, however slight, coming on within 21 days after birth. Under the 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 1932 was £2,407. 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. 101 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 1932. Population of the area served by the Council : 142,800 (estimated middle 1931). 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, 2,062 ; (b) Still births, 86 ; (c) Total, 2,148 ; (d) By midwives, 796; (e) By doctors and parents, 1,352. Health Visiting. (i) Number of officers employed for health visiting at the end of the year:— (a) by the Council, 7. (b) by Voluntary Associations, Nil. (ii) Equivalent of whole-time services devoted by the whole staff to health visiting (including attendance at Infant Welfare Centres):— (a) in the case of Health Visitors employed by the Council, 7. (b) in the case of Health Visitors employed by Voluntary Associations, Nil. (iii) Number of visits paid during the year by all Health Visitors :— (a) To expectant mothers—First visits, 218 ; total visits, 270. (b) To children under 1 year of age—First visits, 2,008 ; total visits, 7,458. (c) To children between the ages of 1 and 5 years—Total visits, 11,930. Infant Welfare Centres. (а) Number of centres provided and maintained by the Council, 5. (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 18,592. (ii) By children between the ages of 1 and 5 years, 12,743. (d) Total number of children who attended at the centres for the first time during the year :— (i) Children under 1 year of age, 1,429. (ii) Children between the ages of 1 and 5 years, 505. (e) Total number of children who were in attendance at the Centres at the end of the year :— (i) Children under 1 year of age 1,104. (ii) Children between the ages of 1 and 5 years, 2,538. (/) Percentage of notified live births represented by the number in (d) (i), 69.3%. 102 Ante-natal clinics (whether held at Infant Welfare Centres or at other premises) :— (a) Number of clinics provided and maintained by the Council, 1. (b) Number of clinics provided and maintained by Voluntary Associations, Nil. (c) Total number of attendances by expectant mothers at all clinics during the year, 763. (d) Total number of expectant mothers who attended at the clinics during the year, 231. (e) Percentage of total notified births (live and still) represented by the number in (d) 10.7%. Number of women (if any) sent by the Council during the year to Maternity Institutions, 120. 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 2 (2) Pemphigus Neonatorum – (3) Puerperal fever 4 4 4 (4) Puerperal pyrexia 23 23 19 (6) Measles and german measles (in children under 5 years of age) Not Notifiable (6) Whooping Cough (do.) (7) Epidemic diarrhoea (do.) (8) Poliomyelitis (do.) 7 7 — 7 Home Nursing. (а) Number of nurses employed at the end of the year for the nursing of expectant mothers and children under 5 years of age, maternity nursing, or the nursing of puerperal fever : (i) by the Council, Nil. (ii) by Voluntary Associations, Nil. (б) Total number of cases attended during the year by these nurses, Nil. 103 Midwives. (a) Number practising in the area served by the Council for maternity and child welfare at the end of the year, 57. (b) Number (i) employed by the Council, Nil. (ii) directly subsidised by the Council, Nil. (iii) employed by Voluntary Associations, 45. (c) Number of cases during the year in which the Council paid or contributed to the fee of a midwife, Nil. Number of cases during the year in which medical aid was summoned by a midwife under Section 14 (1) of the Midwives Act, 1918, 221. 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, 5. (ii) from other causes, 3. lb) Number of these cases which died :— (i) at home, 2. (ii) in institutions, 6. Administration of Part I of the Children Act, 1908. (a) Number of persons receiving children for reward on the register at the end of the year, 46. (b) Number of children on the Register:— (i) at the end of the year, 64. (ii) who died during the year, 2. (iii) on whom inquests were held during the year, 1. (c) Number of Infant Protection Visitors holding appointments under Section 2 (2) at the end of the year who were:— (i) Health Visitors, 7. (ii) Female, other than Health Visitors, Nil. (iii) Male, Nil. (d) Number of persons (in addition to or in lieu of Visitors under (c) above) or societies authorised to visit under the proviso to Section 2 (2), Nil. (e) Proceedings taken during the year:— (i) Number of cases, Nil. (/) Number of cases in which the local authority has given a sanction during the year :— (i) Under (a) of Section 3, Nil. (ii) Under (b) of Section 3, Nil. (iii) Under (c) of Section 3, Nil. (g) Number of orders obtained during the year :— From a From the Local Justice Authority (i) Under (a) of Section 5 (1), Nil. Nil. (ii) Under (b) of Section 5 (1), Nil. Nil. (iii) Under (c) of Section 5 (1). Nil. Nil. 104 CREMATORIUM. Before writing " Finis " to this my last report, I would like to bring to the notice of the general public this most desirable method of the disposal of the dead. The City of London Cemetery, situated at Manor Park, contains an ideal Crematorium, and it is doubtful if the average public person realises the advantages of such provision. The advantages of the cremation of the dead over the system of burial in the ground are too well known for me to recapitulate them here. The Corporation of London have issued an admirable booklet entitled " The Garden of Rest," in which is described with full particulars both the Crematorium and the City of London Cemetery. The cost of cremation need no longer deter anyone from the disposal of the dead by such a method. PROPAGANDA. In conclusion, propaganda has been carried out as defined in previous years. 105 TABLE 37. METEOROLOGICAL RECORD—YEAR 1932. Rain Gauge 5.in. in diameter, placed 1.foot above ground, 15 feet above sea level. Temperature taken in the shade of a Stevenson's Screen, 5 feet from the ground. Months. Temperature of Air during the Month. Rainfall. Highest Maximum. I.owest Minimum. Mean of Mean Temperature of Air. 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 56° 23° 49.2° 38.7° 45.5° 14 1.38 0.09 0.52 6th February 48° 25° 43.0° 33.2° 38.1° 8 0.24 0.03 0.08 23rd March 55° 24° 48.8° 34.3° 41.5° 11 1.39 0.13 0.36 22nd April 64° 35° 52.6° 40.4° 46.5° 20 2.14 0.11 0. 27 14 th May 73° 35° 60.2° 46.6° 53.4° 19 3.79 0.20 0.61 9th June 80° 42° 67.8° 51.0° 59.4° 6 0.63 0.11 0. 39 30th July 83° 49° 71.0° 56.5° 63.8° 13 2.58 0.19 0. 69 25th August 95° 54° 75.8° 58.7° 67.3° 10 3.12 0.31 1..52 1st September 77° 42° 66.2° 52.0° 59.3° 19 2.03 0.11 0. 53 18th October 65° 34° 57.9° 44.8° 51.3° 24 5.05 0.21 1.00 23rd November 59° 34° 49.8° 41.2° 45.5° 14 0.90 0 .06 0.28 22nd December 56° 32° 47.3° 39.4° 43.4° 10 0.46 0 .05 0.12 2nd Means and Totals for the Year. 95° 23° 57.5° 44.7° 51.2° 168 23.71 0.14 1.52 1st Aug. The Rainfall for the Year was 2.08 ins. above, and the number of days on which rain fell 14 above the year 1931, at East Ham. 106 REPORT OF THE CHIEF SANITARY INSPECTOR ON THE WORK PERFORMED BY THE SANITARY INSPECTORS FOR THE YEAR 1932. To the Medical Officer of Health. Sir, In accordance with the Ministry of Health Regulations I beg to report on the sanitary work carried out by the Sanitary Inspectors during the year 19.32. The Staff of the Sanitary Section consists of one Assistant Sanitary Inspector, five district Inspectors, and myself. There are also one Disinfector and one Mortuary Attendant wholly engaged, and two men, as required, from the Engineer's department for drain clearing. I have again to report that with the exception of 188 new houses built there has been no material alteration in the sanitary circumstances of the Borough, most of the notes, therefore, are a reprint from the previous report. The tables are corrected to date, and form a summary of the monthly reports submitted to the Public Health Committee. As this is the last occasion upon which I shall have the honour of presenting the report on the work of the Sanitary Section of the Public Health Department to you as Medical Officer of Health of this Borough, which position you have held for upwards of twenty-four years, it is my pleasing privilege on behalf of the Sanitary Staff and myself to place on record our sincere appreciation of the unfailing courtesy and consideration we have at all times received at your hands. We wish you many years of healthy and happy life in which to enjoy your retirement from the Public Service. I am, Sir, Your obedient servant, GEORGE D. LILL. 107 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 River Roding Catchment Board. Drainage and Sewerage. Every house in the Borough is connected with the main drainage system with the exception of one residence in a cemetery. During the year under review a new sewer was laid from the Manor Way to the western boundary of the Borough, a distance of 3,800 feet, to pick up a small number of houses in the area and to provide for future development. 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. This work is carried out by the Cleansing Superintendent under the Borough Engineer's Department. The house refuse is collected once weekly, all of which is normally burnt in the Destructor. 108 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 397 615 1,012 February 361 667 1,028 March 355 477 832 April 447 568 1,015 May 411 435 846 June 381 624 1,005 July 481 375 856 August 460 358 818 September 540 305 845 October 622 551 1,173 November 552 479 1,031 December 665 454 1,119 Total for Year 5,672 5,908 11,580 Small Pox Contacts. In addition to the foregoing inspections, 276 special visits were paid in connection with small pox contacts. Lettings. Also 39 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 5,908 house-to-house inspections for the year 1932, as compared with 6,870 for the previous year. At 68.8 per cent. of these visits sanitary defects were found. 109 TABLE SHOWING INSPECTIONS MADE IN EACH WARD PER MONTH. Month Manor Park Woodgrange Kensington Little llford Plashet Castle Central Wall End Great field South Total Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H to H. Ord. H to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ordinary House to House January 55 93 47 97 61 92 58 36 29 15 176 35 19 25 26 102 39 7 397 615 February 39 143 36 51 18 119 60 — 27 56 22 77 42 116 29 — 31 105 57 — 361 667 March 54 126 34 46 31 110 52 — 30 78 21 — 40 41 18 — 24 75 51 1 355 477 April 69 80 51 82 31 57 54 72 41 51 41 63 29 59 32 — 32 70 67 34 447 568 May 83 — 52 41 40 124 35 8 23 25 36 113 35 20 29 — 20 96 58 8 411 435 June 97 123 46 60 22 143 32 — 29 12 23 82 30 59 40 — 24 123 38 22 381 624 July 78 20 43 66 51 75 66 — 32 — 18 89 56 98 42 — 28 2 67 25 481 375 August 60 91 49 9 18 2 57 — 53 29 35 36 42 67 59 — 28 64 59 60 460 358 September 69 54 53 7 24 8 88 — 61 49 30 73 36 16 93 22 16 23 70 53 540 305 October 83 104 84 12 40 63 109 — 55 101 33 72 36 44 47 72 27 45 108 38 622 551 November 77 151 51 5 27 — 89 85 72 42 34 60 27 84 32 — 19 28 124 24 552 479 December 73 131 66 24 48 — 89 67 89 6 47 77 63 83 58 1 43 — 89 65 665 454 837 1.116 612 500 411 793 789 232 548 478 355 918 471 706 504 95 318 733 827 337 5,672 5,908 110 COMPLAINTS RECEIVED FOR 1932. Manor Park Woodgrange Kensington Little llford Plashet Castle Central Wall End Greatfield South Total January 16 8 9 22 13 8 20 13 5 10 124 February 12 11 9 11 9 17 8 11 10 13 111 March 10 4 9 9 12 8 8 12 6 16 94 April 15 6 7 21 16 16 11 5 5 13 115 May 9 11 11 26 16 13 19 18 8 16 147 June 9 10 8 16 20 16 11 14 4 17 125 July 4 11 12 18 10 15 20 5 10 18 123 August 10 21 9 37 15 5 16 18 8 16 155 September 12 6 12 28 11 13 18 10 6 16 132 October 9 19 11 30 11 13 16 12 14 18 153 November 6 13 9 28 11 16 14 16 3 19 135 December 6 7 11 15 7 7 15 6 3 21 98 118 127 117 261 151 147 176 140 82 193 1,512 Nuisances. As a result of the inspections shown in the foregoing tables 20,576 nuisances were discovered. A detailed list is given in the inset table, page 127. To secure abatement the following notices were served :— 1931. 1932. Preliminary ... 5,865 5,145 Statutory 1,098 807 6,963 5,952 1ll Complaints. The following table shows the number of complaints received for the year as compared with the previous year :— Year Written Oral Total 1931 471 1,149 1,620 1932 401 1,111 1,512 For detailed table see table on previous page. Notices Complied with during the year ended 31st December, 1932 :— District No. 1 No. 2 No. 3 No. 4 No. 5 Total Complied 1,410 1,042 1,318 1,078 1,145 5,993 Notices Outstanding at 31st December, 1932 :— District No. 1 No. 2 No. 3 No. 4 No. 5 Total Informal 273 167 191 225 181 1,037 Statutory 39 33 57 55 96 280 Rents Restriction (Notice of Increase) Act, 1923. Ten applications were made by tenants for certificates under this Act. Three were granted, in one case it was found on investigation that the Rents Restriction Act was not applicable, 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. 112 PROSECUTIONS UNDER THE PUBLIC HEALTH ACT FOR THE YEAR 1932. Date. Situation of premises. Offence. Result. January Albert Road Non-compliance with Withdrawn January do. sanitary notice do. 3s. 6d. costs Withdrawn January do. do. 3s. 6d. costs Withdrawn January do. do. 3s. 6d. costs Withdrawn January do. do. 3s. 6d. costs Withdrawn January do. do. 3s. 6d. costs Withdrawn January do. do. 3s. 6d. costs Withdrawn February Telham Road do. 3s. 6d. costs Withdrawn 4s. 6d. costs February do. do. Withdrawn 4s. 6d. costs February Ranelagh Road do. Not served (accommodation address only) February do. do. Not served (accommodation address only) February ... Folkestone Road do. Withdrawn 3s. 6d. costs February ... Haldane Road do. Withdrawn 3s. 6d. costs March Bonny Downs Road do. Withdrawn 3s. 6d. costs March do. do. Withdrawn 3s. 6d. costs March do. do. Withdrawn 3s. 6d. costs April Albert 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 May St. Dunstans Road do. Withdrawn 4s. 6d. costs May do. do. Withdrawn 4s. 6d. costs May do. do. Withdrawn 4s. 6d. costs September Robert Street do. Withdrawn 3s. 6d. costs 113 PROSECUTIONS UNDER THE PUBLIC HEALTH ACT FOR THE YEAR 1932—continued. Date. Situation of premises. Offence. Result. September Robert Street Non-compliance with sanitary notice Withdrawn 3s. 6d. costs September do. do. Withdrawn 5s. 6d. costs September do. do. Withdrawn 3s. 6d. costs September do. do. Withdrawn 3s. 6d. costs September Eastbourne Road do. Withdrawn 4s. 6d. costs September do. do. Withdrawn 3s. 6d. costs September Shrewsbury Road do. Withdrawn 5s. 6d. costs November Walton 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 November do. do. Withdrawn 3s. 6d. costs November Whitehorse Road do. Withdrawn 3s. 6d. costs November Monega Road do. Withdrawn 4s. 6d. costs December Bonny Downs Road do. Withdrawn 3s. 6d .costs December Elizabeth Street do. Withdrawn 4s. 6d. costs December Grantham Road do. Withdrawn 3s. 6d. costs December do. do. Withdrawn 3s. 6d. costs December Lawrence Avenue do. Withdrawn 4s. 6d. costs December Tudor Road do. Adjourned to 10/1/33 114 PROSECUTIONS UNDER THE MILK AND DAIRIES ORDER FOR THE YEAR 1032. Date. Offence. Result. March Unlawfully causing a bottle to be filled and closed at a place other than on registered premises Fined £2 June do. do. do. Fined £2 September do. do. do. Fined £1 PROSECUTIONS UNDER THE PUBLIC HEALTH ACTS AMENDMENT ACT, 1007 (SECTION 85) FOR THE YEAR 1932. Date. Offence. Result. July Failing to keep separate books for the registration of applications from employers and servants Fined £1 July Failing to affix in some conspicuous place on the exterior of registered premises the words " Domestic Servants' Registry " Fined £2 PROSECUTIONS UNDER THE FOOD AND DRUGS (ADULTERATION) ACT FOR THE YEAR 1932. Date. Offence. Result. June Unlawfully and wilfully selling milk not of the nature, substance, and quality demanded by the purchaser Withdrawn Warranty Plea November Selling an article of food not of the nature, substance, and quality demanded, to wit, Whisky, 38½ degrees under proof Fined £5. Analyst's Fee 10s. 6d. Smoke Abatement. No complaint has been received during the year of a smoke nuisance from any of the few factories in the Borough. Two factories which had experienced some trouble with their boilers have now changed over to oil fuel. 115 In the large summary table appended hereto will be seen under item " smoke nuisance " that 31 nuisances have been scheduled. These refer entirely to smoke nuisances arising from defective kitchen ranges and other domestic stoves, which have been dealt with under Section 91 of the Public Health Act. 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 in the report for 1931. 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 llford 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 is an enclosed park abutting on to the River Thames under the control of the London County Council, nine acres of which are in this Borough, and one acre in the Metropolitan Borough of Woolwich. Cemeteries. The following is a list of the cemeteries in the Borough :— City of London. Manor Park. Woodgrange. 116 Jews' Cemetery (Plashet). Jews' Cemetery (Greatfield). St. Mary the Virgin Churchyard. St. Mary Magdalene Churchyard. With a total acreage of 278 acres. No complaint was received during the year of improper burials, but several complaints were received of defective fencing adjoining the gardens of dwelling houses of one cemetery, thus allowing children full view of the burial services. These fences are now being replaced by corrugated iron sheeting. Rag Flock Act. There are no premises in the Borough on which Rag Flock is manufactured. Of seven samples taken from furniture upholsterers, three were found to be satisfactory, and four containing an excess of soluble chlorine, were upon further examination found not to be flock within the meaning of the Act. Public Water Closets and Urinals. There are 11 public conveniences in the Borough under the supervision of tne 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 25 Elementary Schools, 2 Central Schools, and 2 Secondary Schools. 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 clean condition. 117 HOUSING STATISTICS. Number of new houses erected during the year :— (a) Total (including numbers given separately under (b) ). (i) By the Local Authority 32 (ii) By other Local Authorities — (iii) By other bodies and persons 156 (b) With State assistance under the Housing Acts : (i) By the Local Authority 32 (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) 9,884 (b) Number of inspections made for the purpose 9,884 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 4,556 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 5,133 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. 118 (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 5,145 (2) Number of dwelling houses in which defects were remedied after service of formal notices :— (a) By owners 860 (b) By Local Authority in default of owners Nil. C.—Proceedings 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 became operative 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. 119 F.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925 :— (1) Number of dwelling houses in respect of which Closing Orders became operative 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 became operative Nil. (4) Number of dwelling houses demolished in pursuance of Demolition Orders Nil. (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 122 registered premises for the sale of milk in the Borough. This number includes a few shops other than dairies where milk is sold. These premises have been periodically inspected and are maintained in good condition. Milk (Special Designation) Order, 1923. Dealers' licences (Form B) were granted for the Sale of Milk under this Order. 3 for Grade A. 5 for Grade A (Tuberculin Tested). 3 for Pasteurised. 120 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. 2 for Grade A (Tuberculin Tested). 11 for Pasteurised. 1 for Grade A Pasteurised. 1 Certified. BACTERIOLOGICAL EXAMINATIONS. Twenty-four samples of Milk were procured for bacteriological examination. Twenty of these samples were certified by the Counties Public Health Laboratories to comply with the bacterial standards of the respective grades. Of the remaining four samples, enquiries were instituted and subsequent samples were found to comply with the bacteriological standards of the prescribed grades. (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 1,027 notifications of intention to slaughter were received referring to :— Cattle 1,701 Sheep 1,976 Pigs 14,792 Lambs 2,961 Calves 172 Total 21,602 121 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 some years, has been found to work very satisfactorily. Slaughterhouses. Following is a list of slaughter-houses in the Borough :— Manor Way Farm, New Beckton. 319, Green Street. 167, Plashet Grove. 843, Romford Road (not used during 1932). 524, Romford Road. 737, Romford Road. 28, Station Road. Forest View Road. Food Supplies. The food supplies of the Borough are exceedingly good. As I stated in a former report, probably the fact that East Ham is within a few miles of the great central Food Markets of London to some extent accounts for this satisfactory condition. The standard of living has greatly increased in recent years, and the demand for a thoroughly good class article has been met by a great majority of shopkeepers stocking only foodstuffs of sound and reliable quality. It is very unusual to receive any complaint as to unsoundness. In no instance was it necessary to formally condemn any article of food sold by retail. A few wholesale parcels were condemned and the purchasers reimbursed on my certificate. The shops and markets are regularly inspected at least one evening in the week as well as during the day in the district Inspectors' routine work. 122 (c) FOOD AND DRUGS (ADULTERATION) ACT, 1928. Four hundred and seventy-four samples were taken under the above Act, of which 107 were Milk. These were all submitted to Dr. Bernard Dyer, the Public Analyst for the Borough. Of the number 112 were taken formally, 107 of these were certified to be genuine. Of the 5 non-genuine samples :— First. Milk : Adulterated with at least 10 per cent. added water. Summons issued. Warranty plea set up and sustained. Summons withdrawn. Second, Whiskey : 38½ deg. under proof. Summoned. Fined £5 and 10s. 6d. analyst fee. Third, Herrings in Tomato Sauce : Contaminated with grains of tin per lb. A letter was sent to the Wholesale firm who supplied this article, who, upon enquiry, found that the goods had been in stock over two years. The remainder of these tinned herrings were withdrawn. Fourth, Milk : Deficient in fat at least 41 per cent. All the circumstances of this case were reported to the Public Health Committee, and a letter of caution was sent to the vendor. Fifth, Milk : 2 per cent. added water. This vendor was also cautioned by letter. Three hundred and sixty-two informal samples were taken, of which 353 proved to be genuine. Of the non-genuine :— First, Gin : 39½ deg. under proof, subsequent samples were satisfactory. Second, Butter : Mixture of margarine and butter containing 80 per cent. of fat not derived from milk or cream. Third, All-spice : Consisted not of all-spice but of black peppercorns (no doubt an accidental substitution). Fourth, Herrings in Tomato Sauce : See note above. Fifth, Sweet Spirits of Nitre : Deficient in nitrous ether to the extent of 30 per cent., probably due to loss in keeping. Sixth, a sample of Milk from one of the Council's Institutions : Deficient in fat to the extent of 18 per cent. It was found upon investigation to be due to non-plunging of bulk supply. 123 Seventh, 8th and 9th, Whiskies: 36½ deg., 38 deg., and 39½ deg. under proof respectively. In all cases subsequent samples were found to be up to standard of quality demanded. The following is a detailed list of the articles sampled :— Ale 1 Ground Cinnamon 1 Ammoniated Tincture of Quinine 9 Ground Cloves 1 Ground Ginger 2 Anchovy Paste 1 Herrings in Tomato Sauce 2 Aspirin Tablets 12 Barley Sugar Sticks 1 Honey 1 Battenburgh Roll 1 Hydrogen Peroxide 1 Beer 2 Ipecacuanha Wine 2 Bitter Ale 2 Jelly 1 Black Currant and Glycerine Pastilles 1 Lard 20 Lemon Crystals 1 Boracic Powder 1 Lemon Fruit Crystals 1 Brawn 2 Lemonade Powder 2 Bread 1 Lemon Squash 1 Brompton Lozenges 1 Margarine 26 Broth Cubes 1 Meat Pattie 1 Butter 48 Meat Pie 2 Camphorated Oil 1 Milk 107 Castor Oil 1 Mincemeat 2 Cheese 3 Minced Meat (Raw) 2 Cheese Cakes 1 Minced Meat (Boiled) 1 Children's Cough Mixture 1 Minced Beef 5 Mince Pie 3 Coffee 6 Mince Slice 1 Coffee and Chicory 1 Mint Sauce •1 Condensed Milk 1 Mixed Herbs 1 Corned Beef 1 Mixed Pickles 1 Cornflour 1 Mustard Piccalilli 1 Cocoa 6 Oatmeal 1 Cream 9 Pitted Red Cherries 1 Cream of Tartar 3 Peas 1 Currant Loaf 1 Pepper 8 Currie Powder 2 Pepper (White) 3 Desiccated Cocoanut 2 Pork and Beans and Dill Water 3 Tomato Sauce 1 Dried Parsley 1 Pork Pie 1 Dripping 7 Raspberryade 1 Epsom Salts 1 Rice 4 Fish Paste 1 Rum 2 Flour 2 Rusk for Sausage Making 1 Flour (Wholemeal) 1 French Capers 1 Sal Volatile 3 Gin 4 Sausages 4 Green Peas 1 Sausages (Beef) 19 Ground Almonds 3 Sausages (Pork) 12 124 Sausages (Preserved) 1 Sugar (Yellow Crystals) 1 Skimmed Milk 2 Sweets 1 Skimmed Condensed Milk 1 Sweetened Cocoa 1 Sweet Spirit of Nitre 5 Soap Chips 1 Swiss Roll 1 Sodamint Tablets 1 Tea 6 Spice 2 Tinned Tomatoes 1 Sponge Cakes 13 Tomato Soup Squares... 1 Sponge Fingers 1 Tripe 2 Steak and Kidney Pie 1 Veal and Ham Pie 1 Sterilized Cream 1 Veal Stuffing 1 Sterilized Milk 1 Vinegar 1 Stout 1 Whisky 22 Sugar (Castor) 1 Sugar (Demerara) 1 Total 474 Sugar (Icing) 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. (1) Number of Inspections. (2) Written notices. (3) Occupiers prosecuted. (4) Factories (including Factory Laundries) 14 2 — Workshops (including Workshop Laundries) 75 4 — Workplaces (other than Outworkers' premises) 9 — — Total 98 6 — 125 DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. (1) Number of defects. Number of offences in respect to which prosecutions were instituted. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health A cts:—* Want of cleanliness 6 5 — — Want of ventilation 2 — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 17 7 — — Sanitary accommodation:— Insufficient — — — — Unsuitable or defective 8 5 1 — Not separate for sexes 1 1 — — Offences under the Factory and Workshop Acts: Illegal occupation of underground bakehouse (s. 101) — — — — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories & Workshops Transfer of Powers) Order, 1921) — — — — Total 34 18 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 of the Inspections made during the Year 1932:— DISTRICT No. 1 DISTRICT No. 2. DISTRICT No. 3. DISTRICT No. 4. DISTRICT No. 5. Manor Park Ward. Woodgrange Ward. Kensington Ward. Little Ilford Ward. Plashet Ward. Castle Ward. Central Ward. Wall End Ward. Greatfield Ward. South Ward. Total. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Premises found in fair condition 552 256 202 170 210 340 365 49 267 181 154 288 165 176 149 14 145 350 204 21 2383 1845 Factory and workshop premises inspected 21 ... 21 ... 8 ... 4 ... 10 ... 8 ... 10 ... 5 ... 5 ... 6 ... 98 ... Outworkers' premises inspected 11 ... 19 ... 43 ... 51 ... 28 ... 35 ... 32 ... 27 ... 29 ... 15 ... 290 ... Bakehouses inspected 26 ... 16 ... 14 ... 9 ... 11 ... 8 ... 4 ... 2 ... 2 ... 11 ... 103 ... Slaughter-houses inspected 431 ... 246 ... ... ... ... ... 196 ... ... ... ... ... ... ... ... ... 161 ... 1034 ... Dairies inspected 5 ... 17 ... 8 ... 41 ... 3 ... 8 ... ... ... ... ... 7 ... 3 ... 95 ... Urinals inspected 8 ... 2 ... 23 ... 13 ... 6 ... 3 ... 4 ... 1 ... ... ... 16 ... 76 ... Walls and ceilings dirty and dilapidated 46 425 53 142 47 83 155 131 69 238 74 489 92 340 82 54 51 222 241 251 910 2375 Yards improperly paved and dilapidated 13 102 8 54 ... 10 7 4 9 51 13 104 29 155 22 88 14 52 56 84 171 654 No forecourt paving 3 105 3 8 5 168 ... 1 6 40 3 64 7 77 3 ... 2 9 4 7 36 519 Defective drains 7 1 4 2 8 9 9 2 2 ... 10 ... 8 1 1 ... ... 1 6 ... 55 16 Defective w.c. connections 2 5 1 1 1 4 3 ... 1 ... ... 2 7 2 ... 1 ... 5 8 8 18 23 Defective w.c. traps 14 95 8 49 7 52 14 11 7 39 9 48 13 24 6 1 2 12 12 10 92 341 Defective flushing apparatus 11 101 8 30 16 21 22 9 7 20 12 34 15 42 15 14 4 27 28 18 138 316 Soil pans foul and broken 9 59 3 37 4 56 8 7 8 32 6 42 20 63 10 8 2 14 10 9 80 327 Defective vent pipes 6 75 5 30 5 70 11 8 2 23 2 19 6 37 5 9 2 18 6 6 50 295 Rain water pipes and caves gutters defective 21 220 30 58 35 97 69 50 25 81 26 135 58 213 57 35 20 127 90 105 431 1121 Rain water pipes connected to drain 164 ... ... ... ... ... ... 5 14 1 7 2 ... ... ... ... 1 1 ... 9 186 Roofs leaky 23 160 40 34 39 55 104 62 47 72 32 155 58 134 49 17 28 71 107 115 527 875 Defective sink waste pipes 6 38 5 15 2 19 12 11 4 15 10 22 16 50 6 6 3 19 28 24 92 219 Houses without water (Metropolitan Water Board) ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 1 Cisterns without covers ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Drinking water improperly stored 8 87 4 69 ... 1 2 ... 1 4 1 16 22 2 ... ... 9 7 1 25 159 Dilapidated floors 5 35 7 24 8 5 32 15 10 12 8 35 14 43 13 6 2 6 56 63 155 244 Insufficient underfloor ventilation 7 191 5 14 2 105 7 12 6 43 1 62 8 138 7 17 1 20 13 46 57 648 Dampness 29 195 43 50 49 65 85 42 28 78 40 119 49 68 43 5 18 92 124 189 508 903 Accumulations. 24 2 15 2 15 2 34 4 10 1 16 1 14 4 14 ... 7 2 13 3 162 21 Defective sashcords and windows 19 187 24 64 24 67 32 48 24 88 26 196 27 45 21 1 36 84 96 127 329 907 Overcrowding ... ... 4 1 2 ... 3 2 3 3 6 6 5 3 3 ... 1 2 13 7 40 24 Unsound food 95 ... 193 ... 2 ... 1 ... 82 ... 1 ... 6 ... ... ... ... ... 108 ... 488 ... No dust bins 3 2 3 5 ... 7 11 5 4 19 5 36 5 6 7 ... 5 18 24 11 67 109 Defective stoves 18 88 19 30 19 13 33 12 24 77 23 154 28 34 19 6 10 46 40 46 233 506 Defective coppers 3 51 5 20 8 7 24 6 9 33 14 87 13 30 14 1 4 41 61 51 155 327 Animals improperly kept 1 ... ... ... 2 ... 5 ... 3 ... 1 ... 1 1 8 ... 1 ... 4 ... 26 1 Temporary buildings found ... ... 2 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... Smoke nuisances 4 1 3 1 3 ... ... ... ... ... ... 5 7 ... ... ... 1 ... ... ... 24 7 Rear passages unpaved or undrained ... ... ... ... 29 ... 6 ... ... ... 1 ... 4 ... 2 ... ... ... 5 ... 47 ... Gipsies ... ... ... ... ... ... ... ... ... ... ... ... ... ... 69 ... ... ... 1 ... 70 ... Breaches of Bve-I.aws and Regulations 2 ... 3 ... 2 ... 5 ... 1 ... 1 ... 4 ... ... ... ... ... 1 ... 19 ... Other nuisances 110 742 124 278 72 79 169 58 110 270 123 570 163 442 140 67 104 352 363 476 1478 3329 Drains tested 68 ... 25 ... 33 ... 195 ... 13 ... 13 ... 27 2 25 ... 31 ... 28 ... 458 2 Inspections 837 1116 612 500 411 793 789 232 548 478 355 918 471 706 604 95 318 733 827 337 5672 5908 Total Inspections 1953 1112 1204 1021 1026 1273 1177 599 1051 1164 11580 COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Annual Report OF THE School Medical Officer FOR THE YEAR 1932. 130 EAST HAM EDUCATION COMMITTEE Councillor J.J. Pope (Chairman). Councillor E. H. Thompson (Vice-Chairman). Councillor T. W. Burden (Deputy-Mayor). Alderman Mrs. A. Taylor. *Councillor Mrs. A. Warne. Councillor Mrs. B. Wilkens. Alderman W. W. Bagot. Councillor E. Markey. Alderman G. H. Manser. Councillor R. W. Moger. Alderman H. N. Ridler. Councillor W. T. Newling. Alderman E. Shanahan. Councillor A. H. W. Owen. Councillor R. Bailey Councillor G. Pottinger. Councillor W. T. Bush. Councillor H. Restarick. Councillor G. J. Davies. Councillor W. Thompson. Councillor F. Edwards. Councillor T. W. Williams. Councillor R. J. Fell. Mrs. L. A. Lethaby. †Councillor C. F. H. Green. Miss L. Butcher. Councillor E. C. Howlett. ‡Mr. E. T. Andrews, B.A. Councillor H. P. Jackson. §Mr. F. T. Cowley. Councillor T. I. Lethaby. Mr. E. J. Sullivan. ||Alderman J. Brooks. * Resigned December, 1931. † Appointed December, 1931. ‡ Resigned July, 1932. § Appointed September. 1932. || 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 A dministrative 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. (England), A. E. Hall, L.D.S. (Liverpool). Ophthalmic Surgeon: S. C. Reeve-Flaxman, M.R.C.S., L.R.C.P. (Three sessions per week). Aural Surgeon: R. Savege, M.B., Ch.B., F.R.C.S.Eng., D.L.O. (Two sessions per week). Assistant Medical Officer: 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 work carried out in the School Medical Department of the County Borough of East Ham during the year ended 31st December, 1932. The year 1932 has witnessed the 25th anniversary of the School Medical Service (Sec. 13 I. (b) of the Education—Administrative Provisions—Act, 1907), and perhaps I may be forgiven for exhibiting some pride in the fact that I have been responsible for the administration of the Service, in East Ham, since its inception, and for a degree of sentiment in the knowledge that this 25th birthday coincides with my last complete year of office as your School Medical Officer. It would seem fitting and desirable that this report should contain a brief summary and comparative account of the growth and activities of the School Medical Service during the past quarter of a century. In the year 1909 the staff of the School Medical Service consisted of four officers: the Medical Officer of Health, a part-time Assistant Medical Officer (four sessions per week), a School Nurse, and one Clerk. At this time the only statutory obligation was the medical inspection of all children newly admitted to school and those who were entering upon their last year of school attendance. The Authority made no provision for medical or surgical treatment of any kind. Statutory obligations have steadily increased and now include the annual medical inspection of elementary school children in three age-groups, the medical inspection of all secondary school children each year, and the provision of adequate treatment for the defects discovered at medical inspection. To-day the staff of the School Medical Service numbers twenty-three. (See page 130 ) 132 The accompanying summary of work and the following brief details of the increase in the scope of the Service from year to year give an indication of steady development and very satisfactory progress:— 1910—Institution of arrangements for cleanliness inspections by the School Nurse. 1911—Opening of School Clinic at the Town Hall for treatment of minor ailments. Arrangements made for the re-inspection of children found to have defects. Appointment of Ophthalmic Surgeon (one session per week). Appointment of second School Nurse. 1913—Appointment of School Dental Surgeon (three sessions per week). 1914—Full-time Assistant School Medical Officer appointed. Appointment of third School Nurse. 1915—Second Clerk appointed. 1917—Branch School Clinics opened—North Woolwich and Manor Park. 1918—Appointment of fourth School Nurse. 1919—Full-time School Dental Surgeon appointed. 1920—Appointment of ear, nose and throat Surgeon (one session per week). Increase of School Nursing Staff to seven. Definite agreement with St. Mary's Hospital, Plaistow, for the operative treatment of enlarged tonsils and adenoids. Appointment of a third Clerk. 1921—Third Assistant School Medical Officer appointed. 1922—Re-organisation of the administration of the School Medical Service. Appointment of a Male Administrative Clerk. 1923—Opening of Shrewsbury Road Special School for Mentally Defective Children. Provision of places in Residential Schools and Schools of Recovery for Delicate and Physically Defective Children. 133 Clerical staff increased to four. Inclusion of Balaam Street Hospital and Great Ormond Street Hospital in the scheme for the operative treatment of tonsils and adenoids. 1924—Attendance of Ophthalmic Surgeon increased to two sessions per week. 1925—Orthopaedic scheme introduced—agreement entered into with the Balaam Street Children's Hospital. Arrangements made for the visitation, by the School Nurses, of all children after operations for the removal of tonsils and adenoids. 1927—Opening of Artificial Sunlight Clinic. Attendance of Ophthalmic Surgeon increased to three sessions per week. 1928—Opening of Special Class for Myopic Scholars at Monega Road School. 1929—Attendance of Aural Surgeon increased to two sessions per week. Commencement of ionization treatment in cases of ear disease. Appointment of second full-time School Dental Surgeon. Transference of Orthopaedic Scheme to Queen Mary's Hospital, Stratford. Opening of Immunization (Diphtheria) Clinic. Clerical staff increased to five. Reduction in medical staff consequent upon the fall in school population. 1930—Appointment of Chief Administrative Clerk to the Medical Services. 1931—Extract from Annual Report 1931—"The administration of the School Medical 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 Service. 134 The Service is hampered by the very inadequate and unsuitable accommodation which continues to hinder progress and improvement in our methods of ensuring the health and physical welfare of the school child." 1932—There were 19,770 children on the School Roll. The number of routine and special cases of elementary school children examined totalled 10,458 as compared with 10,016 in the year 1931 : a complete medical inspection of all the scholars in the Secondary Schools has also been carried out. There is no doubt that the extraordinary growth of our school medical work has been remarkable, but it is quite impossible to further overcrowd the Clinics and Office. The Central Clinic and Administrative Office, at the top of the Town Hall building, has undergone no extension since the year 1911, on the contrary, the accommodation has been reduced by one room, and the congestion and overcrowding is a matter for very serious consideration. This Clinic is in use during every available session throughout the week. The accommodation at the North Woolwich and Manor Park Clinics remains as it was in the year 1917, when Church Rooms were utilized as a temporary war-time measure. However, there appears to be some definite indication that more suitable premises will be available for these two branch Clinics in the near future. The provision of an up-to-date and properly equipped Central Clinic, with adequate Office accommodation, is a very urgent necessity. The Local Education Authority has reached the peak of that progress and efficiency in the Medical Service which it is possible to attain under present conditions of accommodation. For this reason my report for the year 1932 consists, for the most part, of statistical data. It is with feelings of confidence and satisfaction that I relinquish my position as School Medical Officer : the administration of the School Medical Service is firmly and efficiently established, the results obtained have more than justified the expenditure, and the vastly improved health and physical welfare of the scholars of East Ham are gratifying testimonies to the value of the Medical Inspection and Treatment of School Children. 135 I wish to express my appreciation of the keen interest and loyal co-operation of all the members of my staff. My sincere thanks are extended to the Teachers for their great help and courtesy, and to Mr. Thompson, the Secretary to the Education Committee, 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 that 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. 137 Summary of the Work Performed in the School Medical Service since its Inception. 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Medical Inspection Routine 3,623 2,520 4,652 4,657 4,905 7,881 6,845 3,543 4,011 4,749 5,872 6,520 10,445 6,569 7,687 6,459 8,705 8,993 6,480 9,679 8,973 7,567 7,311 7,726 Special 336 298 339 631 527 458 199 907 Nil. Nil. 645 872 3,898 3,252 3,869 3,129 3,489 3,660 3,885 3,984 3,877 2,538 2,705 2,732 Re-inspection Nil. Nil. 476 973 1,189 1,397 1,033 95 1,931 1,180 496 2,950 3,391 2,201 2,956 3,951 3,784 4,659 4,124 4,030 4,745 3,524 2,831 2,700 Medical Consultations at the School Clinics Nil. Nil. 1,275 3,801 5,626 5,885 4,591 4,915 4,338 3,099 2,462 6,961 5,831 6,113 10,982 13,080 13,445 14,575 13,530 16,533 15,675 14,490 13,241 16,122 Attendances for Treatment at School Clinics Nil. Nil. 800 2,914 2,815 1,737 3,457 7,050 5,900 3,091 5,788 11,017 8,422 8,036 16,616 18,319 18,665 15,810 14,873 19,140 18,517 16,976 15,180 12,819 Number of Children Inspected by School Dental Surgeons Nil. Nil. Nil. Nil. 3,215 910 1,718 1,250 2,284 2,583 3,523 6,844 11,224 10,624 9,664 9,192 9,270 9,665 9,911 10,033 13,053 13,800 13,471 12,164 Number of Children Treated by School Dental Surgeons Nil. Nil. Nil. Nil. 934 565 670 857 1,290 1,375 1,932 3,245 2,071 2,076 2,191 2,187 2,018 1,929 2,118 2,040 3,454 3,167 3,258 3,214 Number of Children Treated by School Oculist Nil. Nil. 131 308 355 474 612 446 619 759 750 526 542 605 522 685 890 762 656 688 565 557 626 594 Number of Children Treated by Aural Surgeon Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. 374 282 318 398 437 473 355 372 558 489 467 453 Cleanliness Inspections by School Nurses Nil. 1,142 24,014 23,386 22,983 15,209 13,372 21,475 22,308 37,742 46,733 60,394 49,452 65,464 62,207 57,936 58,090 58,683 58,588 55,351 53,009 51,607 48,607 50,513 Visits to Homes made by School Nurses 600 940 1,002 1,254 943 878 511 485 375 1,017 1,643 2,925 2,776 2,912 2,919 3,541 3,840 4,948 4,547 4,239 3,824 3,479 3,081 3,078 Attendances at the Light Clinic Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. Nil. 2,706 3,206 3,922 3,917 3,470 3,928 139 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. 3. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene. During the year 1932 a complete survey of the sanitary and hygienic conditions pertaining to all the schools of the Authority has been carried out. Reports upon matters requiring attention have been submitted month by month to the Committee. In most instances my recommendations have received careful consideration, and an endeavour has been made to remedy defects where possible, but a good deal remains to be done in connection with improvements in lighting, heating, ventilation and overcrowding of certain classrooms, and in regard to the provision of sufficient and satisfactory sanitary and cloakroom accommodation. 4. MEDICAL INSPECTION. The following is a synopsis of School Medical Work for the year 1932. The figures for the year 1928 to 1931 are also given for comparison:— 140 COMPARATIVE STATEMENT OF WORK. 1928. 1929. 1930. 1931. 1932. Routine and Special Inspection (on School Premises) 10,408 9,763 8,325 10,351 10,458 Re-inspection 4,061 4,821 3,574 2,883 2,700 Consultations at Inspection Clinic 16,533 15,675 14,490 13,241 16,122 Number of Treatments at Clinic 19,140 18,517 16,967 15,180 12,819 General Cleanliness Visits to Schools 274 322 309 307 307 Nurses' Visits to Homes 4,239 3,824 3,479 3,081 3,078 Children Examined for Cleanliness 55,351 53,009 51,607 48,607 50,513 (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. (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. 141 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 decrease 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 1930. 142 FINDINGS OF MEDICAL INSPECTION. Group. NUMBER OF CHILDREN. Percentage of Children found to require Treatment. Inspected. Found to require Treatment. 1927 1928 1929 1930 1931 1932 1927 1928 1929 1930 1931 1932 1927 1928 1929 1930 1931 1932 Entrants 2,468 3,197 2,998 2,314 2,047 2,245 244 354 411 264 263 255 9.9 11.1 13.7 11.4 12.8 11.4 Intermediates 1,295 2,424 2,208 2,207 1,987 2,028 133 291 316 237 217 240 10.3 12.0 14.3 10.7 10.9 11.8 Leavers 2,717 2,848 2,366 1,912 1,855 1,985 180 237 248 119 181 175 6.6 8.3 10.5 6.2 9.7 8.8 Totals 6,480 8,469 7,572 6,433 5,889 6,258 557 882 975 620 661 670 8.6 10.4 12.9 9.6 11.2 10.7 143 (a) Uncleanliness. The School Nurses have carried out 3 cleanliness surveys of all the children in the elementary schools during the year 1932. During the year the School Nurses made 50,513 examinations, as compared with 48,607 in 1931. Of this number 321 children showed vermin and many nits in the hair (273 in 1931), whilst 1,637 children showed only a few nits (1,438 in 1931). Comparative table:— Year Number Examined Number with Nits Number with Head Vermin No. of Exclusion Certificates 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 1932 50,513 1,637 321 76 144 TABLE VII. TABLE OF VERMINOUS CONDITIONS FOUND AT EXAMINATIONS FOR GENERAL CLEANLINESS. SCHOOLS. Dept. Number Exam'd. Few Nits. Many Nits and Vermin. SCHOOLS. Dept. Number Exam'd. Few Nits. Many Nits and Vermin. Avenue Infants 644 23 11 Napier Infants 1060 57 14 J. Girls 904 80 42 J. Boys 1439 15 4 J. Boys 915 30 20 S. Boys 724 7 2 Brampton Infants 1444 42 1 Salisbury Infants 701 27 — J. Girls 1287 36 4 J. Mixed 1091 35 3 S. Girls 756 6 — S. Mixed 530 13 — Castle Street R.C. Mixed 694 22 1 Sandringham Road J. Mixed 1073 14 8 Central Park Infants 901 16 1 S. Mixed 986 5 2 J. Boys 1240 10 2 Sandringham Central — 386 — — S. Boys 885 1 — Shaftesbury Road Infants 1012 43 3 Cornwall Infants 1153 75 10 J. Girls 1080 75 3 S. Girls 828 45 5 S. Girls 624 33 1 S. Boys 876 14 7 Shrewsbury Road Special 219 19 3 Dersineham Mixed 854 58 9 Storey Street Infants 527 51 5 Essex Infants 915 17 5 S. Mixed 965 43 9 J. Boys 1020 6 — Silvertown R.C. Infants 320 28 6 S. Boys 655 — — S. Mixed 722 24 12 Hartley Infants 801 14 1 St. Michael's R.C. Mixed 525 35 7 J. Girls 1008 61 5 St. Winefride's R.C. Mixed 776 37 12 S. Girls 698 30 1 Vicarage Infants 1266 67 22 High Street Infants 493 23 1 J. Girls 1108 95 27 S. Mixed 935 25 2 S. Girls 814 19 8 Kensington Infants 707 6 3 Winsor Infants 306 66 3 J. Girls 1086 16 26 S. Mixed 1195 — — S. Girls 594 9 4 Wakefield Central — 180 2 — Lathom Infants 1100 20 — J. Girls 914 40 — J. Boys 1029 5 — Monega Infants 950 25 — J. Boys 1094 12 — S. Boys 764 5 — Total 50513 1637 321 Myope 16 — — Per cent. in 1932 3.24 0.6 Per cent. in 1931 2.95 0.5 145 It will be noted that the low incidence in the number of children suffering from uncleanliness is fairly well maintained, and great credit is due to the School Nurses, whose untiring efforts have been entirely responsible for ensuring this diminished incidence in case 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, (6) 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 1931 1932 1931 1932 Scabies 3 — 11 15 Impetigo 11 13 232 206 Conjunctivitis 7 4 85 93 Blepharitis 2 11 41 32 Ear Disease 55 76 149 149 Ringworm (Scalp) — — 2 4 Ringworm (Body) 1 3 23 13 (c) Tonsils and Adenoids. 3.73 per cent. of the children examined during the year were referred for treatment for "tonsils and adenoids," either separately or combined, as compared with 4.6 per cent. in the year 146 1931. Of these, much enlarged tonsils accounted for 1.19 per cent.; definite adenoids were present in 0.07 per cent., and the combined defect was diagnosed in 2.47 per cent.; the figures for 1931 were 1.2 per cent., 0.2 per cent., and 3.2 per cent., respectively. The percentage of children moderately affected and requiring to be kept under observation was 12.1, the corresponding percentage in 1931 being 10.6. In this case 11.6 per cent. had moderately enlarged tonsils, 0.2 per cent. exhibited signs of the presence of adenoids, whilst 0.3 per cent. showed enlarged tonsils and adenoids of moderate degree, as compared with 10.0 per cent., 0.2 per cent., and 0.4 per cent., respectively in the year 1931. (d) Tuberculosis. The total number of cases of tuberculosis, occurring in children of school age, notified to the Medical Officer of Health during the year, was as follows:— Boys. Girls. Total. Pulmonary Tuberculosis 7 5 12 Other forms of Tuberculosis 13 8 21 Totals 20 13 33 (e) Skin Disease and (f) External Eye Disease. The number of these cases still remains high. At medical inspections during the year 450 children were found to be suffering from skin affections (as compared with 526 in the year 1931). Cases of external eye disease also continue to show a high incidence, 160 in the year 1932 and 154 in the year 1931. (g) Vision. Only children with marked visual defect have been referred for treatment and these, including cases of strabismus, numbered 609. In addition there were 123 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. 171.) 147 (h) Ear Disease and Hearing. 0.2 per cent. of the children examined were found to be suffering from otitis media. (0.3 per cent. in 1931). The percentage of deaf children was 0.3, the corresponding number for last year being 0.5. (i) Dental Defects. (See Report of Dental Surgeon on p. 173.) (j) Crippling Defects. Reference to Table III on page 178 will furnish information with regard to the occurrence of crippling defects in the area. 58 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 1932. Scarlet Fever and Measles show an increased incidence but that of Diphtheria continued to be low although the disease was very virulent in type. The bacteriological examination of swabs from the throats and noses of school children is carried out:— (a) Prior to the admission of children to Schools of Recovery, Convalescent Homes, etc., in order to ensure freedom from infection. 189 swabs were taken for this purpose, and the fact that two of these proved to be positive shows the great importance of this procedure. (b) In suspicious cases seen at the Clinics or Schools, 146 swabs were taken and 3 proved to be positive. (c) In cases where an undetected source of infection appears to be present in a class or school. 11 swabs were taken and none proved to be positive. 148 In regard to Small-pox there were three actual cases and six contact cases in children attending schools in the Borough. Seven 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. 149 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 278 10 39 69 12 6 February 208 13 13 22 19 3 March 203 25 21 18 23 8 April 30 24 37 9 32 16 May 28 12 6 5 12 1 June 25 42 21 3 30 7 July 3 26 24 3 30 5 August — — — — 20 1 September 2 5 19 4 64 6 October 2 30 1 2 90 18 November — 33 5 6 82 7 December — 19 2 — 57 17 Totals (170) 774 (344) 239 (168) 188 (194) 141 (140) 471 (89) 95 The totals in brackets are those for the year 1931 and are inserted for comparison. 150 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 3,078 visits to the homes of children in whom defects were found at medical inspection, and for special investigation purposes. Of the 978 children referred for treatment, 950 or 97 per cent, have obtained treatment. The School Nurses have also paid 118 special visits to the Schools, and 24 visits to the Feeding Centres, and have undertaken 15 journeys in connection with the admission and discharge of children to Institutions. All children, referred for the operative treatment of tonsils and adenoids (476), 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. Average attendance, 90. (2) General Clinic (Minor Ailments and Observation Cases), St. Michael's Institute, Manor Park—Tuesdays and Thursdays at 9 a.m. Average attendance, 62. (3) General Clinic (Minor Ailments and Observation Cases), North Woolwich—Mondays and Fridays, at 2 p.m. Average attendance, 27. (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—Thursdays 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. 151 During the year 1932, 12,819 attendances were made for treatment at the various clinics, and there were 16,122 attendances for consultation with 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. 181. (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 476 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. The widespread publication in the general Press of controversial matters in connection with the operation for the removal of tonsils and adenoids has resulted in increased opposition to advice given in regard to the need for the operation. The County Borough of East Ham, in common with many other Authorities, have a definite scheme in force whereby these operations are undertaken solely by Specialists in diseases of the ear, nose and throat. It is hardly feasible to suggest that these Surgeons would perform unnecessary operations, even taking into account the posibility that Assistant School Medical Officers might refer, to them, cases in which there was no indication for operative interference : furthermore the East Ham Education Authority possess the services of a School Aural Surgeon to whom doubtful cases may be referred. One can only regret the publicity given to this question, and retain the hope that the Board of Education will continue to insist upon this operative procedure being performed by Specialists in this branch of surgery. 152 (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 three children received this form of treatment during this year. (e) External Eye Disease. 165 cases (153 in 1931) of external eye disease were treated at the School Clinics. (/) Vision. During the year 1932 the Ophthalmic Clinic was held on six sessions per fortnight. 542 cases were referred for treatment in respect of visual defect during the year 1932 and, including 62 cases awaiting treatment at the termination of the year 1931, 594 cases have been treated in the past year. On the 31st of December, 1932, there were 50 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 360 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. 153 A Sight-saving Class at Monega Road School was opened by the Education Committee in June, 1928. 16 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. 171.) (g) Ear Disease. During the year 1932, 82 Aural Clinic sessions were held. The total attendances at the Aural Clinic was 1,622, making an average attendance, at each session, of 20 patients. Ionisation treatment was carried out in 25 cases, 109 applications being made; that is to say an average of 1.3 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. 170.) (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 attention as the result of the dental inspection of 5,000 children, 154 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. 173.) (») 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 1932, 17 out-patients have received treatment, the total out-patient attendances being 301. 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. No variation has been made in connection with the methods described and very satisfactory results continue to be obtained. 155 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 Hall premises : these are only available on two sessions per week, and considerable difficulty is experienced as the result of overcrowding in the waiting-room : it is impossible under these circumstances to insist upon the very necessary period of rest after treatment before the children leave the building. 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. 156 SUNLIGHT FIGURES, 1932. CONDITION. Boys. Girls. Anaemia 10 19 Debility 43 52 Malnutrition 16 24 Malnutrition and Anœmia 1 2 Malnutrition and Debility 1 1 Debility and Anaemia 10 7 Debility and Catarrh 2 2 Debility and Rheumatism — 1 Bronchial Catarrh and Anaemia 2 2 Bronchial Catarrh and Malnutrition 1 1 Bronchial Catarrh and Cervical Adenitis 1 — Adenitis 13 9 Rheumatism 1 6 Pretuberculosis 4 4 Asthma 1 — Underweight 6 2 Chorea 5 1 Cough 1 3 Throat 3 2 Sinus — 1 Gastritis 1 — Rickets 2 — Bronchial Catarrh 11 9 Bronchitis 6 3 Anaemia and Rheumatism 1 — Debility and Cough 1 — Underweight and Cough 1 — Nerves 2 — Aniemia and Cough 1 — Crippling due to Quiescent T.B. 1 — Malnutrition and Adenitis — 2 Knock Knee—Flat Feet — 1 Suppurating Inguinal Gland — 1 Total 148 155 Number of children treated (general) 303 Number of children treated (local) 32 Number of attendances (general) 3,478 Number of attendances (local) 570 Total number of attendances (local and general) 4,048 157 The daily use of the artificial light apparatus would be a great asset in our endeavours towards the prevention of ill-health and disease in early life, and the provision of specific accommodation would make this possible. A much larger waiting room is urgently necessary to enable the children to have a comfortable period of rest after treatment before they leave the building. 9. OPEN-AIR EDUCATION. (a) Playground Classes. In a few cases playground classes continue to be held occasionally. (b) School Camps. The Education Committee sent 203 scholars to the East Cowes Holiday Camp during the year 1932, and in addition the following School Journeys were undertaken :— Brampton Senior Girls 38 Essex Senior Boys 40 Sandringham Central 60 Total 138 (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. 158 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. 159) gives particulars in connection with these children. 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. Seventeen children have been sent to Schools of Recovery, through this Association, by arrangement with the Local Education Authority. In addition, the very courteous co-operation of the Association, with the Authority's Medical Officers, has secured open-air and convalescent treatment for 35 children of school age and for whom the Association has undertaken full financial responsibility. The facility and expedition with which the cases were dealt with reflects great credit upon the administration of the Local Branch of this Association. Particulars of the cases dealt with are as follows :— Debility 19 Anaemia 5 Bronchial Catarrh 6 Malnutrition 3 T.B. Spine (Quiescent) 2 In twelve of these cases clothing was supplied in order to enable the children to be admitted to a School of Recovery. 159 Particulars of the number of Children who were resident in Schools of Recovery between 1st January and 31st December, 1932, 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 Ogilvie 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 — — — 2 2 9 — — 6 3 1 — 4 2 1 1 1 1 — — — — 5 8 20 19 39 I.C.A.A. (hqtrs.) — 1 — — 3 1 3 2 — 1 3 — — — 2 1 — — — — — — — — 11 6 17 St. Catherine's — — — — 1 — 1 — — — 1 — — — 1 — 1 — — — — — — — 5 — 5 St. Dominic's 1 — — — 5 — — — 1 — 1 — 2 — 1 — 4 — — — — — 8 23 — 23 No. of Wkeks 11 12 15 23 24 26 Russell-Cotes 7 6 18 12 8 6 1 — 1 — 2 — — — — — — — — — — — — — 37 24 61 160 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 209,969 meals were provided for children, as compared with 151,024 in 1931. 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 1932 the number of parents who were present at the routine medical inspections was 4,882 (4,496 in 1931), that is, in 61.8 per cent, of the cases examined (50.3 per cent, in 1931). 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 161 Attendance Department has been fully discussed in previous reports. Many cases have been referred for special examination by the Attendance Officers on Form 21, and of these cases 78 wer,e 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 158 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. Seventy-three 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 1932. The Inspectors have made 234 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 34 28 6 Defective Vision 18 17 1 Torticollis 1 1 — Otitis Media 7 6 1 Dental Caries 2 2 — General Neglect 11 10 Improved — TOTAL 73 64 8 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. 162 17. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Physically Defective Children. Table III reveals the very regrettable fact that 33 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 289 children, who are considered physically defective, are attending public elementary schools, and since suitable treatment is not available for these cases it is not improbable that a number of them will ultimately join the ranks of the unfit. The present policy of the Local Education Authority, in regard to these children, is to increase the number of reservations in Residential Schools, and this is undoubtedly a sound proposition although progress is somewhat slow. In regard to the 95 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 33 children, who come within this category, receiving no education, and there are 125 children of this type who have been allowed to attend the ordinary elementary school under special conditions and with special precautions. Mentally Defective Children. During the year 1932, the number of cases examined for purposes of the Mental Deficiency Acts, was 56 (64 in 1931). Of these 12 were classified as mentally deficient, and 35 as dull and backward, recommendations being made as shown in the following table:— 163 Number examined 56 Classified as mentally deficient 191 20 Classified as morally deficient - Classified as imbeciles 7 Classified as idiots 1 Classified as dull and backward 35 Recommended for Special School 12 Excluded until age 7 1 Reference to Table III will show that the 95 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. Nine boys have been specially examined in accordance with the Bye-laws, and these were found to be fit for employment. 164 In addition, 8 school children were examined under the Regulations dealing with the employment of children at entertainments and certified fit for participation in such employment. 22. SPECIAL ENQUIRIES. Again the amount of work undertaken by the staff of the School Medical Service during the year has been so great that no time was available for satisfactorily carrying out any of the special inquiries suggested by the Chief Medical Officer of the Board of Education. 23. MISCELLANEOUS. During the year 1932 the follow ing special medical examinations were made:— Assistant Teachers 27 Student Teachers 8 Scholarship Candidates 202 Officers 1 Caretakers 8 Cleaners 14 Assistant Cook 1 W. BENTON Medical Officer of Health and School Medical Officer. 165 MEDICAL INSPECTION RETURNS. SECONDARY SCHOOL. TABLE I. RETURN OF MEDICAL INSPECTIONS For the Year ended 31st December, 1932. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections— Boys. Girls. Entrants — — Second Age Group — — Third Age Group 93 97 Total 93 97 Number of other Routine Inspections 288 293 B.— OTHER INSPECTIONS. Number of Special Inspections 20 13 Number of Re-Inspections 28 46 Total 48 59 166 TABLE II. SECONDARY SCHOOL. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1932. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation,but not requiring Treatment. (1) (2) (3) (4) (5) b. G. B. G. 13. G. b. G. Malnutrition — 2 — 2 — — — — Uncleanliness : See Table IV., Group V. - - - - - - - - Skin 'Ringworm Scalp - - - - - - - - Body Scabies - - - - - -- - - - - - - - - - - Impetigo 1 — - — 2 1 - — Other Diseases non-Tuberculous - 1 - 1 - 1 - - Eye Blepharitis - 2 - — 1 — - — Conjunctivitis - - - - - - - - Keratitis ... - - - - - - - - Corneal Opacities - - - - - - - - Defective Vision (excluding Squint) 18 33 9 1 3 2 _ Squint — — - - - - - - Other Conditions — — — 2 2 1 — — Ear Defective Hearing 2 1 Otitis Media Other Ear Diseases — 3 — 9 1 1 - — Nose and Throat Enlarged Tonsils only — — 16 7 - — Adenoids only — — — - — — - — Enlarged Tonsils and Adenoids 2 2 - - - - - - Other Conditions — 3 — — — 3 — — Enlarged Cervical Glands (Non-Tuberculous) — 1 7 — 2 — - — Defective Speech — — — — — — — — 167 Table II.—(continued.) (1) (2) (3) (4) (5) Teeth—Dental Diseases : See 1 able IV., Group IV. B. G. B. G. B. G. B. G. Heart and Circulation Heart Disease: Organic Functional - 1 2 2 — 1 — — Anæmia 1 \ 1 — - — — — lungs | Bronchitis - - - - - - - - Other Non-'l uberculous Diseases 1 1 - 1 — — — — Tuberculosis Pulmonary : Definite - - — — — — — — Suspected - - - - - - - - Non-Pulmonary : Glands Spine - - — - — — - - Hip - - - - - - - - Other Bones and Joints - - - - - - - - Skin - - - - - - - - Other Forms - - - - - - - - -Nervous System Epilepsy - - - - - - - - Chorea - - — — — — — — Other Conditions - 1 — — — — — — Deformities Rickets - - — — — — — — Spinal Curvature - 2 — — — — — — Other Forms - 10 — 8 — — — — Other Defects and Diseases 2 6 - 26 10 4 — - B.—Number of individual children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). GROUP. (1) Number of Children. Percentage of Children found to require Treatment. (4) Inspected (2) Found to require Treatment. (3) Code Groups :— B. G. B. G. B. G. Entrants - - - - - - Second Age Group - - - - - - Third Age Group 93 97 7 12 7.5 12.4 Total (Code Groups) 93 97 7 12 — — Other Routine Inspections 288 293 22 35 7.6 11.9 168 TABLE IV. SECONDARY SCHOOL. Return of Defects Treated during the Year ended 31st December, 1932. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness). Disease or Defect. (1) Number of Defects treated, or under treatment during the year. Under the Authority s Scheme (2) Otherwise. (3) Total. (4) B. G. B. G. B. G. Ringworm—Scalp — — - - Ringworm—Body - - - - - - Scabies - - - - - - Impetigo 2 1 — — 2 1 Other skin disease — 1 — — — 1 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 1 2 — — 1 2 Minor Ear Defects 2 6 — — - 6 Miscellaneous (e.g.,minor injuries, bruises, sores, chilblains, etc.) 16 24 3 3 19 27 Total 21 34 3 3 24 37 169 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 pr ictitioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. (D (2) (3) (4) (5) B. G. B. G. B. G. B. G. Errors of Refraction (including Squint) 1 4 2 2 — - 3 6 Other Defect or Disease of the Eyes (excluding those recorded in Group I.). - - - - - - - - Total 1 4 2 2 — — 3 6 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme 5 (b) Otherwise 4 Total number of children who obtained or received spectacles— (c) Under the Authority's Scheme 5 (d) Otherwise 4 Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received Operative Treatment. Received other forms of Treatment. (4) Total number treated. (5) Under the Authority's Scheme in Clinic or Hospital (1) By Private Practitioner or Hospital, apart from the Authority's Scheme. (2) Total. (3) B. G. B. G. B. G. B. G. B. G. 1 3 — 2 1 5 — — 1 5 170 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 fourth annual report on the work clone in the Aural Clinic during 1932. Eighty-two clinics were held during the year, with a total attendance of 1,622. Fifty-eight per cent, of the cases were, after treatment, discharged cured. The arrangements for operations by me on East Ham children in the Invalid Children's Hospital, Balaam Street, have continued to work satisfactorily, and during the year 1 operated on 296 cases of enlarged tonsils and adenoids, and on 4 cases of chronic mastoid disease. The statistical report of my Aural Clinic is as follows :— Cases of Chronic Otitis Media 193 Discharged 109 Cases of Deafness 26 „ 8 Other Ear Cases 41 „ 32 Cases of Chronic Rhinitis 65 ,, 37 Other Nose Cases 25 ,, 16 Cases of Enlarged Tonsils and Adenoids 146 ,, 88 My thanks are again due to the medical, nursing and clerical staffs for their very efficient help. I have the honour to be, Sir, Your obedient Servant, RONALD SAVEGE. 171 REPORT OF THE OPHTHALMIC SURGEON. To the School Medical Officer, County Borough of East Ham, Education Committee. Sir, I have the honour to present my report for 1932. General Clinic. Number of new cases 594 Glasses prescribed 361 Glasses not necessary 184 Glasses obtained 361 Special treatments 49 Re-examinations 2,586 Discharged 165 Cysts treated at St. Bart's 4 Squint operations advised 1 Baby Clinic. Number of new cases 64 Glasses prescribed 26 Glasses obtained 26 Special treatments 12 Re-examinations 250 Discharged 6 Obstructions treated at St. Bart's 9 Myope Class. Number of pupils 16 General Clinic. —A few of the treatment cases have been dealt with by me in Hospital. Only one operation for squint has been recommended. Baby Clinic.—Cases seen here have included a number of affections of the lachrymal system of the eye of varying' resistance to treatment. 172 Sight-saving Class.—This class continues to hold a useful place in the treatment of delicate eyes which have to be protected from over-work. The boys find it easier to be merry and bright possibly than the girls as the former take their oral lessons in the ordinary classes, which, unfortunately, the girls cannot. It appears that East Ham do particularly well by this uncommon arrangement, which removes some of the feeling of isolation these pupils have. The School Medical Service and the optical and clerical staff have all been most efficiently helpful. I have the honour to be, Sir, Your obedient Servant, S. C. REEVE-FLAXMAN. 173 REPORT ON THE WORK DONE IN THE SCHOOL DENTAL CLINIC. To the School Medical Officer, County Borough of East Ham, Education Committee. Sir, I beg to submit to you my report for the year 1932. The age groups inspected were from 5 years to 11 years inclusive. The number of children inspected was 12,164, and those referred for treatment were 8,709. The number of special cases, those referred by School Medical Officers, Nurses, and Head Teachers, was 204. These are children suffering from toothache or oral sepsis who do not come under the routine dental inspection. Statistical details will be found in Table IV., Group IV., Dental Defects. All the children in the routine age groups are inspected once a year, and those requiring treatment are notified to attend the Dental Clinic. When there is a depletion in the school attendance owing to epidemics such as influenza another inspection is carried out at a later date, for the sake of those who were absent on the first occasion. Dental inspection at school gives the dentist an opportunity of talking with the boys and girls individually, especially those whose mouths are neglected and in bad condition. A cheerful atmosphere at inspection tends to overcome the dread of the dentist and the dental chair. All work in the Clinic is carried out to give the little patients the minimum of pain. A local anresthetic is given for the extraction of all temporary teeth, and some permanent teeth, except those which are septic, and also for very sensitive cavities to be filled in permanent teeth. Septic temporary teeth are extracted by a local application of ethyl-chloride, except where the child is very nervous when nitrous-oxide is used. Septic permanent teeth are extracted under gas, to which one session per week is devoted, when Dr. Thomson attends as anaesthetist. Regulation of teeth is done, where possible, by judicious extraction, and regulation plates are made in a few cases. All bad cases are sent to Guy's or the London Hospital. 174 Some parents are very careful in seeing that their children's teeth are in a sound and healthy condition, and they take quite a lot of trouble about it. Every encouragement is given to them, and no pains are spared to explain any little point about which they are dubious. Unfortunately this type is in the minority, one wishes that the majority would realise the great importance to their children of having healthy mouths. The school-child can never be really healthy, and work as it should, if it has a mouthful of septic and dirty teeth, poisons are absorbed into the system, doing untold damage and impairing the working efficiency of the child. Maternity and Child Welfare Centre. Statistical details of the dental work done for the Maternity and Child Welfare Centres are shown in the following table:— No. of Sessions 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. 105 227 664 273 71 1,075 182 1,348 253 46 140 99 Two sessions per week have been devoted to the children under five and the mothers referred by the Maternity and Child Welfare Centres. Fillings are done wherever possible for the tiny children, and the necessary teeth extracted under a local anaesthetic. The mouths of a good number of the mothers attending the Dental Clinic are in a very septic and dirty condition, and although they have these teeth removed under gas, they attend once, and often we never see them again until some time in the future when they have a recurrence of toothache. If only these mothers would realise the benefit to their general health, and to the future health of their unborn children, in having clean healthy mouths, I am sure they would take a greater advantage of all that is offered to them. May I thank my colleague, Mr. Hall, and the two Dental Nurses, for their complete co-operation and help during the year. Also my thanks are due to the School Medical Officers, Nurses, Teachers, and Clerical Staff for their valued assistance. I have the honour to be, Sir, Your obedient Servant, CYRILS. NEAME. 175 TABLES GIVING SUMMING UP OF WORK OF SCHOOL MEDICAL SERVICE from 1st JANUARY, 1932, to 31st DECEMBER, 1932. PUBLIC ELEMENTARY AND CENTRAL SCHOOLS. TABLE I. RETURN OF MEDICAL INSPECTIONS. For the Year ended 31st December, 1932. A.—ROUTINE MEDICAL INSPECTIONS. Number of Code Group Inspections— Entrants 2,245 Second Age Group 2,028 Third Age Group 1,985 Total 6,258 Number of other Routine Inspections 1,468 B.—OTHER INSPECTIONS. Number of Special Inspections 2,732 Number of Re-Inspections 2,700 Total 5,432 176 TABLE II. A.—A Return of Defects found by Medical Inspection in the Year ended 31st December, 1932. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Defect or Disease. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Malnutrition 42 4 10 1 Uncleanliness: (See Table IV., Group V.) — — — — Skin Ringworm: Scalp — — 4 — Body 3 — 13 — Scabies — — 15 — Impetigo 18 10 206 — Other Diseases (Non- Tuberculous) 15 29 181 3 Eye Blepharitis 11 15 32 1 Conjunctivitis 4 3 93 — Keratitis — — 1 — Corneal Opacities — — — — Defective vision (excluding Squint) 259 77 283 29 Squint 27 16 40 1 Other conditions 2 7 72 — Ear Defective Hearing 5 5 27 — Otitis Media 3 1 21 — Other Ear Diseases 73 158 128 2 Nose and Throat Enlarged Tonsils only 94 1210 31 4 Adenoids only 3 17 5 1 Enlarged Tonsils and Adenoids 134 30 123 3 Other conditions 33 39 53 5 Enlarged Cervical Glands (Non- Tuberculous) 25 594 25 13 177 Table II.—(continued). (1) (2) (8) 4) (5) Defective Speech 4 24 8 5 Teeth—Dental Diseases (See Table IV., Group IV.) — — — — Heart and Circulation. Heart Disease: Organic 13 24 5 2 Functional 2 79 6 2 Anaemia 32 35 69 — Lungs Bronchitis 4 6 7 — Other Non-Tuberculous Diseases 30 57 79 6 Tuberculosis Pulmonary: Definite — — — — Suspected — — — — Non-Pulmonary: Glands 2 2 2 3 Spine — — — — Hip — 1 — — Other Bones and Joints — — — — Skin — 1 — — Other Forms — — 2 — Nervous System Epilepsy 1 4 2 Chorea 3 4 32 1 Other conditions 3 21 1 1 Deformities Rickets 3 8 1 1 Spinal Curvature 3 4 — 2 Other Forms 3 12 7 — Other Defects and Diseases 129 286 1105 no 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) Code Groups:— Entrants 2245 255 11.4 Second Age Group 2028 240 11.8 Third Age Group 1985 175 8.8 Total (Code Groups) 6258 670 10.7 Other Routine Inspections 1468 72 5.3 178 TABLE III. Return of all Exceptional Children in the Area during the Year ended 31st December, 1932. 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 Table), or Heart Disease — 1 1 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 10 13 23 At Public Elementary Schools 1 1 2 At other Institutions — — — 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 10 8 18 At Public Elementary 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 — 1 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 57 33 90 At Public Elementary Schools — — — At other Institutions 4 1 5 At no School or Institution 1 1 2 Notified to the Local Mental Deficiency Authority during the year. Feebleminded — — — Imbeciies — — — Idiots — — — 179 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 8 3 11 At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools — — — At other Institutions — — — At no School or Institution 4 2 6 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 — — — At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 18 14 32 At other Institutions — — — At no School or Institution 2 1 3 Tuberculosis of the peripheral glands. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 5 5 10 At Certified Residential Open Air Schools — — — At Certified Day Open Air Schools — — — At Public Elementary Schools 24 17 41 At other Institutions — 1 1 At no School or Institution 4 2 6 Abdominal tuberculosis 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 6 2 8 At other Institutions — 1 1 At no School or Institution 2 1 3 180 TABLE III.—continued. Boys. Girls. Total. 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 8 6 14 At other Institutions 2 — 2 At no School or Institution 1 — 1 Tuberculosis of other organs (skin, etc). At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board — — — At Public Elementary Schools — — — At other Institutions — — — At no School or Institution 1 — 1 Physically Defective. (contd.) 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 40 20 60 At Certified Day Open Air Schools — — — At Public Elementary Schools 99 65 164 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 2 3 5 At Certified Residential Cripple Schools 3 3 6 At Certified Day Cripple Schools 1 — 1 At Certified Residential Open Air Schools 1 1 2 At Certified Day Open Air Schools — — — At Public Elementary Schools 31 27 58 At other Institutions 1 1 2 At no School or Institution 4 2 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 — — — At Certified Residential Cripple Schools 1 — 1 At Certified Day Cripple Schools — 1 1 At Certified Residential Open Air Schools 10 13 23 At Certified Day Open Air Schools — — — At Public Elementary Schools 36 31 67 At other Institutions — — — At no School or Institution 3 4 7 181 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1932. 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 5 — 5 Ringworm—Body 21 — 21 Scabies 14 1 15 Impetigo 202 3 205 Other skin disease 200 10 210 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 185 2 167 Minor Ear Defects 165 8 178 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 1157 117 1274 Total 1929 141 2070 182 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) 545 13 70 628 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) — — — — Total 545 13 70 628 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme 361 (b) Otherwise 11 Total number of children who obtained or received spectacles— (a) Under the Authority's Scheme 361 (b) Otherwise 11 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) 375 21 386 78 474 183 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 1488 1774 1886 1849 2124 2141 902 12164 204 12368 (b) Found to require treatment 8709 (c) Actually Treated 3214 (2) Half-days devoted to:— Inspection 92 Total 790 Treatment 698 (3) Attendances made by children lor treatment 7078 (4) Fillings:— Permanent Teeth 16431 Total 2405 Temporary Teeth 7621 (5) Extractions:— Permanent Teeth 798 Total 8384 Temporary Teeth 7586 (6) Administrations of general anaesthetics for extractions 451 (7) Other operations :— Permanent Teeth 449 Total 728 Temporary Teeth 279 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 50,513 (iii.) Number of individual children found unclean 922 (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. 185 INDEX. A. Abatement of Nuisances 110 Act—Blind Persons, 1920 38-42 Act—Children, 1908 103 Act—Nursing Homes Registration, 1927 23 Acts of Parliament 25 Act, Rents Restriction 111 Adenoids 93 After-Care Committee 63 Aldersbrook Homes 31-32 Ambulance Facilities 24 Arragon Road Dispensary 26 Attendance Officers, Cooperation of 160-161 Ante-Natal Clinic 97 Anthrax 48 Artificial Pneumothorax 71 Artificial Sunlight 154-167 Aural Surgeon, report of 170 Aural Treatment 94 B. Bacteriology 24 Bacteriological Examinations 120 Baths 160 Birth-rate 17 Births 7, 95, 96 Births, Illegitimate 7 Births, in Wards and Rates 17 Births, Still 7, 96 Blind Persons Act, 1920 38-42 Byelaws 25 Byelaws—Premises and occu- potions controlled by 115 c. Cancer 51-52 Cemeteries 104, 115, 116 Census Population 11-16 Chief Sanitary Inspector— Report of 106-127 Children Act, 1908 103 Classrooms, Open Air 157 Clinic, Ante-natal 97 Clinic, Artificial Sunlight 154-167 Clinic, Aural 150 Clinic, Dental 1<93 Clinic, Immunisation 46-48, 93 Clinic, Mental Defectives 37 Clinic, Ophthalmic 171 Clinic, School 150 Clinic, Toddlers' 93 Clinic, Tuberculosis and Chest 53-68 Clinics, Infant 34, 93-94 Clinics, Morning 94 Clinics and Treatment Centres 34 Closet Accommodation ... 107 Committees 3, 130 Common Lodging Houses 115 Complaints of Nuisances 110 Continuation Schools 163 Co-ordination 139 Crematorium 104 Cripples 162 D. Dairies 119 Day-Schools, Open air 157 Deaths 8 Death-rate, General 7, 17 Death-rate, Infantile 7, 9, 17 Deaths, Causes of 19 Deaths, Infants 22 Deaths, in Wards and Rates 21 Dental Treatment 63, 94, 153 Dental Surgeons, Report of 173-174 Diphtheria 46, 84 Dispensary, Arragon Road 26 Drainage and Sewerage 107 Dust Collection 107 E. Ear Diseases 147, 153 East Ham Memorial Hospital 27-29 Employment of Children 163-164 Enteric Fever 48, 86 Epileptic Children 162 Erysipelas 48, 86 Eye Diseases of Children 152 F. Factories and Workshops 124-125 Following-Up 150 Food and Drugs 122-124 Food Inspection 119—124 Free Supplies of Milk 100 H. Harts Sanatorium 69-75 Health Committee 3 Health Visitors 95 Homes, Aldersbrook and Scattered 31-32 Homeless Children 23 Hospital Accommodation 26-31 Hospital, Infectious Diseases 82-88 Hospital, East Ham Memorial 27-29 Hospital, Maternity 26, 98 Hospital, Mental 26 Hospital, Smallpox 27 Hospital, Whipps Cross 29-30 House-to-House Inspection 108 Housing 117-119 Housing Statistics 117-119 186 INDEX —continued. I. Illegitimate Births 7 Immunisation Clinic 40-48, 93 Increase of Rent (Restriction) Act 1ll Infant Deaths 22 Infantile Mortality 7, 9, 17 Infectious Diseases Hospital 82-88 Infectious Diseases, Prevalence of and Control over 44-51, 147-149 Inspection of and Supervision of Food 119-124 Inspection, House-to-House 108, 127 Inspection of School Children 139, 140 Institutional Provision for Unmarried Mothers, Illegitimate Infants, etc. 23 Institutions Controlled by West Ham 29—30 Invalid Children's Aid Association 43, 100, 158-159, 161 L. Laboratory Work 24, 124 Legal Proceedings 112-114, 122 Legislation in Force 25 Lettings 108 Light Treatment 154-157 Local Government Act, 1920 25 M. Maternal Mortality 26 Maternity and Child Welfare 88-103 Maternity and Child Welfare Committee 3 Maternity Homes and Hospitals 98 Meals, Provision of 160 Measles 86 Meat Regulations 120 Medical Examinations, Miscellaneous 164 Medical Officer of Health's Report 1-105 Medical Relief, Poor Law 10-11,100 Mental Defects, School Children 162-163 Mental Deficiency 33-37 Mental Deficiency Committee 3 Mental Hospital 26 Meterology 105 Midwives 22-23, 98 Milk Free Supplies 100 Milk (Special Designation) Order 119 Milk Supply 119 Minor Ailments 145, 151 Mortality, Analysis of 17 N. Noteworthy Causes of Sickness or Invalidity 8 Notices Served 110 Notification of Births 95 Nuisances Abated 110 Nuisances Discovered 110 Nursing Arrangements 22 Nursing Homes Registration Act, 1927 23 Nursery Schools 163 O. Open-air Education 157 Ophthalmia Neonatorum 26, 51, 100 Ophthalmic Clinic 171 Ophthalmic Surgeon, Report of 171-172 Ophthalmic Treatment 94 Other Foods 120 Overcrowding 12 P. Parents, Co-operation of 160 Parks and Open Spaces 115 Physical Features of Area 7 Physical Training 160 Playground Classes 157 Poor Law Medical Out Relief 26 Population 11-16 Premises and Occupations Controlled by Byelaws 115 Prevalence of Infectious Diseases 44-51 Propaganda 104 Prosecutions, Milk 114 Prosecutions, Public Health Act 112-113 Prosecutions, Sale of Foods and Drugs Acts 114 Public Assistant Institutions 30, 76 Puerperal Fever and Pyrexia 26, 48, 99 R. Rag Flock Act 116 Rateable Value 7 Refuse Removal and Disposal 107 Rents Restriction Act 111 Ringworm 93 Rivers and Streams 107 S. Sanatoria 69-75 Sanitary Inspection of Borough 108 Scarlet Fever 46,85 Scattered Homes 31-32 Scavenging 107 Schick Immunisation Clinic 46-48, 93 187 INDEX—continued. School Attendance Officers Co-operation of 160-161 School Baths 160 „ Blind Children 162 „ Camps 157 „ Children, Blind, Deaf, Defective and Epileptic 162 „ Children, General Cleanliness 143-145 „ Children, Minor Ailments 145, 151 „ Children, Medical Examinations 139-147 „ Children, Physically Defective 162 „ Children, Dental 147, 153 „ Children, Verminous Conditions 143-145 „ Continuation 163 „ Cripples 147, 154 „ Exceptional Children 140 „ Hygiene 139 ,, Meals 160 „ Medical Officer's Report 131-183 ,, Medical Service in Relation to Public Elementary Schools 139 „ Medical Treatment 150-155 „ Nurses, Work of 143, 150 „ Nursery 163 „ Open-air 157 Schools of Recovery 157-158 Schools, Secondary 163 Schools, Survey of 116 Sewage 107 Sickness or Invalidity, any Noteworthy Causes 8 Skin Diseases 146, 152 Slaughterhouses 121 Smallpox 29-30, 44-45, 108 Smoke Abatement 114 Social Conditions of Area 7 Special Enquiries 164 Staff 4, 130 Statistics 7 Still Births 7, 96 Streams 107 T. Table, Births in Wards 17 „ Birth-rate 17 „ Blind Persons 39-42 ,, Cancer 52 „ Census Population 13-15 „ Complaints Received 110 „ Death Rate 17 „ Deaths, Causes of 19 ,, Deaths, Ward and Rates 21 ,, Defective Vision and Squint 182 Table, Dental Treatment 183 Exceptional Children 178-180 „ Factories and Workshops Act 124-125 ,, Foods and Drugs Acts 123-124 ,, Harts Sanatorium 73-75 „ Housing 117-119 „ Infant Deaths 22 ,, Infectious Diseases, Notifiable 49-50 „ Infectious Diseases Removed to Hospital 87-88 „ Infectious Diseases in School Children 149 „ Inspections in Wards 109 „ Laboratory Examinations 25 ,, Mental Defectives 35 ,, Mental Hospitals 26 ,, Meteorology 105 „ Minor Ailments 181 ,, Ophthalmia Neonatorum 51 ,, Public Assistance Institutions 30, 76 ,, Public Health Act Prosecutions 112-114 ,, Record of Inspections 127 „ Sale of Food and Drugs Acts Prosecutions 114 „ School Children, Defects of 176-177 „ School Children Examined 137, 140, 142, 175 „ School Children Found to require Treatment 142, 177 „ Schools of Recovery 159 „ Secondary School Examinations 165-169 „ Smallpox 45 ,, Sunlight Treatment 156 „ Throat and Nasal Defects 182 ,, Tuberculosis Deaths 82 „ Tuberculosis and Chest Clinic 65-68 „ Tuberculosis Notifications 79-82 Tuberculosis, Residential Treatment 74-78 „ Vaccination 45 ,, Verminous Condition of School Children 144, 183 Teaching Staff, Co-operation of 160 Tonsils and Adenoids 93, 145, 151 Training Centre, Mental Defective 37 Treatment Centres 34 Tuberculosis 53-82, 146, 152 Tuberculosis and Chest Clinic 53-68 188 INDEX—continued.. U. Unmarried Mothers 23 Urinals 116 Ultra-Violet Radiation 154-157 V. Vaccination 45, 46 Venereal Diseases 33 Vital Statistics, Extracts from 7 Vision 146, 152 Visits, Health Visitors 95 Visits, School Nurses 143, 150 Voluntary Associations 43, 100, 158-159, 161 W. Wards, Births in and Rates 17 Wards, Deaths in and Rates 21 Water Supply 107 Whooping Cough 86 Workshops 124—125