AC 44113 EAS 9 17 C COUNTY BOROUGH OF EAST HAM. PUBLIC HEALTH DEPARTMENT. Annual Report of the Medical Officer of Health and School Medical Officer FOR THE YEAR 1933. 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 1933. recorders, ilford. EAST HAM CORPORATION. PUBLIC HEALTH COMMITTEE. Also Committee under Blind Persons Act, 1920, Sec. 2. *The Mayor (Alderman G. H. Manser, J.P.). *The Deputy-Mayor (Councillor J. W. Barton). *Alderman E. F. Markey (Chairman, Public Health Committee, Institutions and General Sub-Committee, and Maternity and Child Welfare Sub-Committee). *Councillor F. H. Edwards (Vice-Chairman). Alderman W. W. Bagot. Alderman C. W. Brading, J.P. *Alderman J. Brooks, J.P. *Alderman T. W. Burden. *Alderman Mrs. A. Taylor. Councillor G. W. Boultwood, J.P. Councillor W. T. Bush. *Councillor H. B. Harper, J.P. Councillor T. I. Lethaby, J.P. Councillor H. Restarick. Councillor A. Simons. Councillor Mrs. A. Warne. *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. Bagot (co-opted). Miss E. R. Davies (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 G. H. Manser, J.P.). The Deputy-Mayor (Councillor J. W. Barton). Alderman Mrs. B. Wilkens (Chairman). Alderman Mrs. A. Taylor (Vice-Chairman). Alderman J. Brooks, J.P. Alderman T. W. Burden. Alderman F. Webster. Councillor H. B. Harper, J.P. Councillor T. I. Lethaby, J.P. Councillor R. W. Moger. Councillor W. Thompson. 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. Rittebspack, Miss D. Gordon, C. L. Dubbin, A.C.I.S., G. H. GReen, C. J. Hayes. F. J. Kendall, A.R.San.I., Chief Clerk and Vaccination Officer. T. B. Clabk, 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 (to 10-2-33). Miss A. H. Bleaden (from 1-5-34). Assistant, Miss Sier (to 28-4-33). Miss M. E. Greenaway (from 13-2-33). Tuberculosis Dispensary Clerks: B. E. R. Hartley, A.C.I.S., Miss D. M. Greene. Tuberculosis Nurses: Miss L. E. Mallon, S.R.N., Miss E. E. Cook, S.R.N., Certified Midwife. Assistant Nurse: Miss A. Meadhubst. Nurse at Arragon Road 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. Health Visitors: Miss L. Barrett, S.R.N., Certified Midwife, Miss E. Hazelden, S.R.N., Certified Midwife, R.S.I. (Health Visitor's Cert.), Miss A. E. O'Leary, S.R.N., Certified Midwife, R.S.I. (Health Visitor's Cert.), Miss M. Preston, S.R.N., Certified Midwife, R.S.I. (Health Visitor's Cert.), Miss E. E. Roberts, S.R.N., Certified Midwife, Miss D. E. Skeggs, S.R.N., Certified Midwife, R.S.I. (Health Visitor's Cert.), Mrs. A. A. Woodman, S.R.N., M.R.San. I. (Health Visitor's Cert.), Certified Midwife (Senior). Matron of Isolation Hospital: Miss H. M. McLoughlin, S.R.N. Matron of Harts Sanatorium: Miss G. E. 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. Hillyabd, M.S.I.A., W. S. C. Tooby, A.R.San.I., M.S.I.A., W. J. Worley, A.R.San.I., M.S.I.A., W. H. Thurston, R.P., A.R.San.I., M.S.I.A. Senior Sanitary, Food and Shops Act Inspector, Inspector Contagious Diseases (Animals) Act: G. D. Lill, M.S.I.A. District Medical Officer and Public Vaccinator: L. F. A. Harrison, M.R.C.S., L.R.C.P. (to June, 1933). Assistant Medical Officers: J. Crawford, M.B., Ch.B., D.P.H. (M. and C.W. and General Public Health). 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. Deputy and Senior Assistant Medical Officer of Health: F. E. Bendix, M.R.C.S., L.R.C.P., L.D.S. (from 13-9-33). 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. (to 13-9-33). Malcolm E. Barker, M.R.C.S., L.R.C.P., D.P.H. (from 14-9-33). PART TIME. Tuberculosis Officer: Philip Ellman, M.R.C.P., M.R.C.S., M.D. (Laus.). Ophthalmic Surgeon (Maternity and Child Welfare Service): S. C. Reeve-Flaxman, M.R.C.S., L.R.C.P. Dentist (Maternity and Child Welfare Service): C. S. Neame, L.D.S., R.C.S. District Medical Officer: R. V. Brews, L.R.C.P., L.R.C.S., L.M. Medical Officer, Aldersbrook Homes: J. S. Greig, M.B., C.M. 5 Public Health Department, Town Hall, East Ham, E.6. May, 1934. To the Mayor, Aldermen and Councillors of the County Borough of East Ham. Mr. Mayor, Ladies and Gentlemen, I beg to submit the Annual Report on the health and sanitary circumstances of the Borough, together with the Report to the Education Authority on the work of the School Medical Service, for the year 1933. The Report is based on the "Circular as to the Contents and Arrangement of the Annual Report of Medical Officers of Health for 1933" issued by the Ministry of Health and, as directed, the information contained therein is limited to a record of alterations, improvements, and developments which have taken place during the year. I desire, firstly, to refer to Dr. W. Benton's eminent services to the Borough as Medical Officer of Health for the past twentytwo years, to express appreciation of his many achievements, and the admiration and gratitude of members of the staff for his example of energy and enthusiasm in the cause of public health. It is only by a complete survey of the service, as contained in the numerous reports presented by him during his long period of administration, that it is possible to assess the benefits conferred by the inauguration and extension of public health measures. These have resulted in a higher standard of physical wellbeing, and a marked diminution—in some instances a complete absence—of deleterious conditions which formerly menaced the health of the residents of the Borough. It will be my earnest endeavour to further such progress. The previous Report reviewed the public health work of the Council for a considerable period, and I have therefore omitted 6 many tables and much data and, in accordance with requirements, have confined my observations to the more important features and statistics of the year. Prominent among such is the opening of the new pavilion at Harts Sanatorium, a permanent well-equipped building which has not only proved of the greatest benefit to sufferers, but has afforded much satisfaction in regard to the Council's arrangements for the treatment of tuberculosis. The completion of the Nursery Block at the Children's Homes, Aldersbrook, marks a still further stage in the admirable work of this institution. The Domiciliary Medical Service Scheme for persons in receipt of Public Assistance was put into operation on 1st October, 1933, for a period of one year. The Scheme is outlined later in the Report and although it is too early to express any opinion as to its effectiveness or the desirability of continuing it, no serious difficulties have so far arisen. The extensions to the Infectious Diseases Hospital have proved of material benefit in the treatment of infectious disease, and permitted the admission of patients for whom provision did not formerly exist. The plans submitted to the Ministry of Health for a new Tuberculosis and Chest Clinic, and those to the Ministry and Board of Education for a combined centre for the use of the School Medical and Maternity and Child Welfare Services at Manor Park, will further the beneficial work respectively, of these Clinics. It is with pleasure that I take this opportunity of thanking the members of the Council for the confidence they have placed in me and for their help and consideration during a period of transition. I also wish to record my appreciation of the loyal support of the staff during my short term of office. I have the honour to be, Your obedient servant, Mahan Sanker 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 1933, 139,500. Number of inhabited houses (end of 1933) according to rate books (including tenements and shops), estimated 32,907. Rateable value at 31st December, 1933, £696,566. Sum represented by a penny rate, 1933, £2,811. 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 1,877 974 903 Birth rate per 1,000 of the estimated population 13.7. Illegitimate 45 23 22 Still Births 62 40 22 Rate per 1,000 total (live and still) births 31. Deaths 1,503 768 735 Death rate per 1,000 of the estimated population 10.7. Death from puerperal causes:- Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 2 1.00 Other puerperal causes 4 2.01 Total 6 3.01 Death rate of infants under one year of age:— All infants per 1,000 live births 45 Legitimate infants per 1,000 legitimate live births 43 Illegitimate infants per 1,000 illegitimate live births 133 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 6 Deaths from Diarrhoea (under 2 years of age) 13 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. It will be seen from these statistics that Cancer is responsible for the largest number of deaths from any one cause, although there is some reduction in comparison with last year. Heart disease and diseases of the circulatory system generally are accountable for much fatal illness in the middle and later decades, often the result of early rheumatic affections. The number of deaths from infectious and parasitic diseases calls for active propaganda as regards the prevention and early recognition of such illnesses. The severity and lateness of cases of Diphtheria admitted to hospital is a matter of some concern to the Council and the Medical Staff, and enquiries are generally made as to the reason for delay. In view of the fact that in the Press and elsewhere notices intimating that Diphtheria prophylaxis is offered in both the School Medical and Maternity and Child Welfare Departments, the serious nature of this illness is always before the public. Births. The number of births registered during the year was 1,922 as compared with 2,062 for the year 1932. The birth rate was, therefore, 13.7 or .8 less than that of the previous year. The decline in the birth rate is general throughout the country. The still-births numbered 62 a£ against 86 for 1932. Deaths. The number of deaths registered during the year was 1,503 as compared with 1,456 for the year 1932. The death rate was 10.7 or .5 greater than that of the previous year. Of this number 657 or 43.7 per cent. of the deaths occurred in various institutions. Sixty-two deaths of non-residents took place in East Ham. Although statistics indicate a slightly higher rate it is approximately the same as that of other years. East Ham is a healthy Borough and the low death rate is practically constant. 9 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 65-75 Years 75 Years and upwards 5.8 0.6 1.3 3.7 4.2 4.8 6.2 9.5 16.6 22.0 24.8 Infantile Mortality. The number of deaths of infants under one year of age was 87, equivalent to an infantile mortality rate of 45 as compared with 112 deaths and a rate of 54 for the year 1932. This is a commendable reduction in the loss of infant life and, to some extent, is a measure of the activity of the Child Welfare clinics. The rate compares favourably with that for England and Wales as a whole (64). Six deaths occurred amongst illegitimate children giving an infant mortality rate in this respect of 133—unfortunately a high figure in comparison with that previously given. Neo-Natal Mortality. This rate is obtained by estimating the deaths of infants under one month per 1,000 live births. It is a helpful guide in considering the value and extent of ante-natal influences and in furthering the work and scope of such clinics. The regular attendance of expectant mothers at the Centres and close association of these with Maternity Hospitals are factors which determine a low neo-natal mortality rate. The Neo-Natal mortality rates for the past 4 years are as follows:— 1930 25.1 1932 29.5 1931 26.8 1933 22.8 Maternal Mortality. The maternal mortality rate of 3.01 per thousand live and still births is slightly lower than the previous year (3.6). There is no doubt that regular and efficient ante-natal care does much to reduce the risk of fatal consequences of child bearing and this service is available to all mothers of the Borough. 10 The maternal mortality rates for East Ham as compared with England and Wales are as follows:— Puerperal Sepsis Other Causes Total England & Wales East Ham England & Wales East Ham England & Wales East Ham Per 1,000 Live Births 1.79 1.04 2.63 2.08 4.42 3.12 „ Total Births (Live & Still) 1.71 1.00 2.52 2.01 4.23 3.01 Population. All the rates per 1,000 of the population in this report are based on the Registrar-General's estimate of the population to the middle of 1933, viz.:—139,500, with the exception of the ward rates, which are based on the census returns. The figure for 1932 was 141,500. It will thus be seen that the population according to this estimate has declined by 2,000. 11 TABLE 1.—Birth Rate, Death Rate and Analysis of Mortality, 1933. Rate per 1,000 Population. Annual Death Rate per 1,000 Population. Rate per 1,000 Live Births. Percentage of Total Deaths. Live Births. Still-Births. All Causes. Typhoid and Para-typhoid Fevers. 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* 14.4 0.62 12.3 0.01 0.00 0.05 0.02 0.05 0.06 0.57 0.54 7.1 64 90.9 6.3 1.9 0.9 118 County Boroughs & Great towns including London † 14.4 0.67 12.2 0.00 0.00 0.06 0.02 0.06 0.08 0.55 0.49 9.4 67 91.0 6.0 2.5 0.5 132 smaller towns (estimated resident populations 25,00050,000 at census 1931) † 14.5 0.63 11.0 0.00 0.00 0.04 0.02 0.04 0.04 0.53 0.44 4.9 56 91.7 5.8 1.5 1.0 London * 13.2 0.45 12.2 0.00 0.00 0.02 0.02 0.08 0.08 0.51 0.58 11.6 59 88.3 6.3 5.4 0.0 East Ham * 13.7 0.44 10.7 0.00 0.00 0.00 0.03 0.04 0.15 0.35 0.54 6.7 45 88.0 7.0 5.0 0.0 * Rates based on Estimated Population to middle of year 1933. † Rates based on Estimated Population to middle of year 1932. TABLE 2. 13 Causes of Death in Age Groups, 1933. Cause of death. All ages. Deaths at different periods of life of residents whether occurring within or without the district. 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 65-75 years 75 years and upwards A.—Infectious and Parasitic Diseases 215 10 4 7 27 25 35 25 26 22 19 15 B.—Cancer and Other Tumours 228 — — — — 1 1 16 27 71 65 47 C.—Rheumatism, Diseases of Nutrition and of Endocrine Glands and other General Diseases 35 — — 1 3 3 2 1 5 5 9 6 D.—Diseases of the Blood and Blood-forming Organs 11 — — — 2 1 1 1 — 3 3 — E.—Diseases of the Nervous System and Sense Organs 120 2 1 1 4 3 3 8 7 16 37 38 F.—Diseases of the Circulatory System 390 2 — — 3 7 9 12 31 65 122 139 G.—Diseases of the Respiratory System 189 13 3 6 6 6 4 9 22 33 32 55 H.—Diseases of the Digestive System 84 15 — 2 4 5 4 5 9 16 18 6 I.—Non-Venereal Diseases of the Genitourinary System and Annexa 54 1 1 — — 2 3 2 5 11 14 15 J.—Diseases of Pregnancy, Childbirth and the Puerperal State 6 — — — — 1 4 1 — — — — K.—Diseases of the Skin and Cellular Tissue 7 1 — — 1 — — — 3 — — 2 L.—Diseases of the Bones and Organs of Locomotion — — — — — — — — — — — — M.—Congenital Malformations 9 6 1 1 1 — — — — — — — N.—Diseases of Early Infancy 37 37 — — — — — — — — — — O.—Old Age 42 — — — — — — — — 1 6 35 P.—Deaths from Violence 74 — — 2 5 8 7 13 8 8 8 15 Q.—Ill-Defined Diseases 2 — — — — 1 — — — — — 1 Totals 1,503 87 10 20 56 63 73 93 143 251 333 374 A.—Infectious and Parasitic Diseases. 1. Scarlet Fever 5 1 — 1 2 1 — — — — — — 2. Whooping Cough 6 3 2 1 — — — — — — — — 3. Diphtheria 22 — 1 4 17 — — — — — — — 4. Influenza 50 — — 1 1 1 2 7 9 6 11 12 5. Dysentery 1 — — — — — — — — 1 — — 6. Erysipelas 4 — — — — 1 — — — 2 — 1 7. Acute Poliomyelitis 2 — — — 1 1 — — — — — — 8. Encephalitis Lethargica 2 — — — 1 — — — — 1 — — 9. Cerebro-Spinal Fever 1 1 — — — — — — — — — — 10. Tuberculosis—Respiratory System 99 1 — — — 19 31 16 13 11 7 1 11. „ Central Nervous System 8 1 1 — 5 1 — — — — — — 12. „ Intestine and Peritoneum 1 — — — — — — — 1 — — — 13. „ Vertebral Column 2 — — — — — 1 1 — — — — 14. „ Lymphatic System 1 — — — — — — — 1 — — — 15. „ Genito-Urinary System 2 — — — — 1 — — 1 — — — 16. „ Disseminated 2 — — — — — — 1 1 — — — 17. Purulent Infection—Septicaemia 6 3 — — — — 1 — — 1 1 — 18. Mycoses 1 — — — — — — — — — — 1 B.—Cancer and other Tumours 19. Cancer, Malignant Disease—Buccal Cavity and Pharynx 13 — — — — — — — 5 4 2 2 20. „ „ „ Digestive Organs and Peritoneum 123 — — — — — — 4 9 40 44 26 21. „ „ „ Respiratory Organs 16 — — — — — 1 6 1 5 — 3 22. „ „ „ Uterus 9 — — — — — — — 1 4 4 — 23. „ „ „ Other Female Genital Organs 2 — — — — — — — — 2 — — 24. „ „ „Breast 24 — — — — — — 2 3 5 8 6 25. „ „ „ Male Genitourinary Organs 12 — — — — — — — 1 1 4 6 26. „ „ „ Skin 2 — — — — — — — — 1 1 — 27. „ „ „ Other or Unspecified Organs 17 — — — — — — 2 5 5 2 3 28. Non-Malignant Tumours 10 — — — — 1 — 2 2 4 — 1 C.—Rheumatism, Diseases of Nutrition and of Endocrine Glands, and other General Diseases. 29. Rheumatic Fever 11 — — — 3 2 1 — 3 — — 2 30. Chronic Rheumatism, Osteo-Arthritis 1 — — — — — — — — — — 1 31. Diabetes 16 — — — — 1 — — 1 4 7 3 32. Diseases of the Thyroid and Parathyroid Glands 5 — — — — — 1 1 1 1 1 — 33. Diseases of the Thymus 1 — — 1 — — — — — — — — 34. Other General Diseases 1 — — — — — — — — — 1 — D.—Diseases of the Blood and Blood-forming Organs. 35. Anaemia, Chlorosis 4 — — — — — — — — 1 3 — 36. Leukaemia, Aleukamia 7 — — — 2 1 1 1 — 2 — — E.—Diseases of the Nervous System and Sense Organs. 37. Encephalitis 2 — 1 — — — — 1 — — — — 38. Meningitis 4 1 — — 1 1 — 1 — — — — 39. Tabes Dorsalis (Locomotor Ataxy) 4 — — — — — — 1 — 1 1 1 40. Other Diseases of the Spinal Cord 4 — — — 1 — 1 — — 1 1 — 41. Cerebral Haemorrhage, Apoplexy, etc. 88 — — — 1 — 1 4 6 12 32 32 42. General Paralysis of the Insane 1 — — — — — — 1 — — — — 43. Other Forms of Insanity 2 — — — — — 1 — — 1 — — 44. Epilepsy 3 — — — — 2 — — — 1 — — 45. Infantile Convulsions (age under 5 years) 2 1 — 1 — — — — — — — — 46. Other Diseases of the Nervous System 7 — — — — — — — 1 — 3 3 47. Disease of the Eye and Annexa 1 — — — — — — — — — — 1 48. Diseases of the Ear and Mastoid Sinus 2 — — — 1 — — — — — — 1 F.—Diseases of the Circulatory System. 49. Pericarditis 2 — — — — — — — 1 1 — — 50. Acute Endocarditis 9 — — — 1 4 1 — 2 — — 1 51. Chronic Endocarditis, Valvular Disease 84 — — — 1 1 2 7 12 16 30 15 52. Diseases of the Myocardium 200 1 — — 1 2 3 4 12 25 66 86 53. Diseases of the Coronary Arteries, Angina Pectoris 21 — — — — — — 1 2 7 5 6 54. Other Diseases of the Heart 18 — — — — — 2 — — 6 4 6 55. Aneurysm 6 — — — — — 1 — 1 1 1 2 56. Arterio-Sclerosis 47 — — — — — — — 1 9 16 21 57. Gangrene 2 — — — — — — — — — — 2 58. Diseases of the Lymphatic System 1 1 — — — — — — — — — — G.—Diseases of the Respiratory System. 59. Bronchitis 74 3 — — — — — — 6 11 20 34 60. Broncho-Pneumonia 60 8 2 6 3 2 — 1 5 13 5 15 61. Lobar-Pneumonia 23 — 1 — 3 2 1 7 3 4 2 — 62. Pneumonia (not otherwise defined) 13 1 — — — 2 1 — 2 3 2 2 63. Pleurisy 2 — — — — — 2 — — — — — 64. Congestion and Haemorrhagic-Infarct of Lung, etc. 9 — — — — — — 1 4 — 1 3 65. Asthma 6 — — — — — — — 1 2 2 1 66. Other Diseases of the Respiratory System 2 1 — — — — — — 1 — — — H.—Diseases of the Digestive System. 67. Diseases of the Buccal Cavity, Pharynx, etc. 3 — — — 2 — — — — 1 — — 68. Ulcer of the Stomach or Duodenum 23 — — — — — 1 2 6 7 6 1 69. Other Diseases of the Stomach 2 — — — — — — — — — — 2 70. Diarrhoea and Enteritis (under 2 years) 13 13 — — — — — — — — — — 71. „ „ (over 2 years) 3 — — — — — 1 1 1 — — — 72. Appendicitis 13 — — 1 1 4 1 1 — 2 2 1 73. Hernia, Intestinal Obstruction 15 1 — 1 — 1 1 1 1 3 4 2 74. Other Diseases of the Intestines 1 — — — — — — — — — 1 — 75. Cirrhosis of the Liver 2 — — — — — — — — — 2 — 76. Other Diseases of the Liver 2 — — — — — — — — 1 1 — 77. Other Diseases of the Gall Bladder and Ducts 2 1 — — — — — — — 1 — — 78. Peritonitis (without stated cause) 4 — — — 1 — — — 1 1 1 — 79. Diseases of the Pancreas 1 — — — — — — — — — 1 — I.—Non-Venereal Diseases of the GenitoUrinary System and Annexa. 80. Acute Nephritis 1 — — — — 1 — — — — — — 81. Chronic Nephritis 30 — 1 — — — 2 2 3 5 9 8 82. Nephritis (not stated to be acute or chronic) 11 1 — — — 1 — — — 3 3 3 83. Other Diseases of the Kidney and Annexa 8 — — — — — 1 — 2 2 1 2 84. Calculi of the Urinary Passages 1 — — — — — — — — 1 — — 85. Diseases of the Bladder 2 — — — — — — — — — — 2 86. Diseases of the Prostate 1 — — — — — — — — — 1 — J.—Diseases of Pregnancy, Childbirth and the Puerperal State. 87. Abortion (not returned as Septic) 1 — — — — — 1 — — — — — 88. Puerperal Haemorrhage 2 — — — — — 1 1 — — — — 89. Puerperal Sepsis (not returned as postabortion) 2 — — — — 1 1 — — — — — 90. Other Accidents of Childbirth 1 — — — — — 1 — — — — — K.—Diseases of the Skin and Cellular Tissue. 91. Carbuncle, Boil 1 — — — — — — — — — — 1 92. Cellutis, Acute Abscess 4 — — — 1 — — — 3 — — — 93. Other Diseases of the Skin and its Annexa 2 1 — — — — — — — — — 1 M.—Congenital Malformations. 94. Congenital Malformations 9 6 1 1 1 — — — — — — — N.—Diseases of Early Infancy. 95. Congenital Debility 2 2 — — — — — — — — — — 96. Premature Birth 28 28 — — — — — — — — — — 97. Injury at Birth 2 2 — — — — — — — — — — 98. Other Diseases peculiar to Early Infancy 5 5 — — — — — — — — — — O.—Old Age. 99. Old Age 42 — — — — — — — — 1 6 35 P.—Deaths from Violence. 100. Suicide—By Solid or Liquid Poisons or Corrosive Substances 5 — — — — — — 1 1 2 1 — 101. „—By Poisonous Gas 5 — — — — 1 — 1 1 1 — 1 102. „—By Hanging or Strangulation 3 — — — — — — 1 1 1 — — 103. „—By Drowning 2 — — — — — 2 — — — — — 104. „—By Cutting or Piercing Instruments 3 — — — — — — — 1 1 1 — 105. „—By Jumping from High Place 1 — — — — — — 1 — — — — 106. „—By Other Means 1 — — — — — 1 — — — — — 107. Homicide 1 — — — — — — 1 — — — — 108. Attack by Venomous Animals 2 — — — — 2 — — — — — — 109. Accidental Absorption of Irrespirable or Poisonous Gas 1 — — — — — — 1 — — — — 110. Other Acute Accidental Poisoning (not by Gas) 3 — — 1 — — — — 1 — 1 — 111. Conflagration 2 — — 1 — — — — — — — 1 112. Accidental Burns (Conflagration excepted) 2 — — — — 1 — 1 — — — — 113. „ Drowning 2 — — — — — 1 1 — — — — 114. „ Injury by Cutting or Piercing Instruments 2 — — — 1 — — — — — 1 — 115. „ Injury by Fall, Crushing, etc. 36 — — — 4 4 2 5 1 3 4 13 116. Other and Unstated Forms of Accidental Violence 1 — — — — — — — 1 — — — 117. Violent Deaths of Unstated Nature (i.e., Accidental Suicide) 2 — — — — — 1 — 1 — — — Q.—Ill-Defined Diseases. 118. Cause of Death Unstated or Ill-defined 2 — — — — 1 — — — — — 1 15 TABLE 3.-Ward Distributionof Deaths, and Ward Death Rates, 1993. 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 — — — — — — — — — — — — 2. Measles — — — — — — — — — — — — 3. Scarlet Fever — 2 1 — — — — 1 — 1 5 5 4. Whooping Cough — 1 1 — — — -— 1 1 2 6 3 5. Diphtheria 3 3 1 3 1 — — 2 1 8 22 22 6. Influenza 6 6 8 5 2 4 3 7 2 7 50 12 7. Encephalitis Lethargica — — — 1 — — — — — 1 2 — 8. Cerebro-Spinal Fever — — — — — 1 — — — — 1 1 9. Tuberculosis of Respiratory System 11 7 8 12 6 10 14 9 7 15 99 40 10. Other Tuberculous Diseases 1 — 1 1 2 2 2 3 2 2 16 11 11. Syphilis — — — — — — — — — — — — 12. General Paralysis of the Insane, Tabes Dorsalis 1 1 — — — — 1 2 — — 5 2 13. Cancer 30 21 24 19 25 27 11 32 9 20 218 101 14. Diabetes 1 — 2 2 3 2 — 1 1 4 16 9 15. Cerebral Haemorrhage, etc. 9 10 7 13 4 6 12 13 6 8 88 49 16. Heart Disease 50 37 38 29 31 29 30 25 30 35 334 97 17. Aneurysm — 2 1 1 — — — — — 2 6 — 18. Other Circulatory Diseases 7 2 4 7 7 3 7 7 2 4 50 13 19. Bronchitis 11 6 6 14 7 4 5 12 1 8 74 14 20. Pneumonia (all forms) 12 8 8 7 8 5 7 18 5 18 96 35 21. Other Respiratory Diseases 2 — — 2 2 3 1 5 1 3 19 8 22. Peptic Ulcer 3 4 1 2 2 3 1 3 1 3 23 18 23. Diarrhoea, etc. (under 2 years) 1 2 1 1 — — 1 1 — 6 13 11 24. Appendicitis — — 2 1 1 3 — 2 1 3 13 12 25. Cirrhosis of Liver 1 — — — — — — — — 1 2 — 26. Other Diseases of Liver, etc. 1 — 1 — — 1 — — 1 — 4 1 27. Other Digestive Diseases 2 3 2 2 — 7 4 4 2 3 29 19 28. Acute and Chronic Nephritis 5 1 5 6 3 3 3 7 2 7 42 22 29. Puerperal Sepsis — — 1 — — — — — 1 — 2 2 30. Other Puerperal Causes — — 1 — — — — — 2 1 4 2 31. Congenital Debility, Premature Birth, Malformations, etc. 9 3 2 3 3 2 — 10 9 5 46 16 32. Senility 8 3 5 4 2 — 7 6 4 3 42 31 33. Suicide 4 — 1 2 1 3 1 3 1 4 20 7 34. Other violence 7 8 4 3 3 5 5 9 4 6 54 40 35. Other defined causes 4 10 9 14 7 12 14 14 4 12 100 54 36. Causes ill-defined or unknown — — — — — — 1 — 1 — 2 — Totals 189 140 145 154 120 135 130 197 101 192 1,503 657 Rates (Census population for Wards) 13.5 8.6 11.5 11.2 10.3 9.9 9.4 11.5 7.2 12.3 10.7 — 16 TABLE 4. Infant Deaths under One Year of Age, 1933. Cause of Death. Sex. Ages. Total under 1 year. Under 1 week.. 1-2 weeks. 2-3 weeks. 3-4 weeks. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Scarlet Fever M — — — — — — — 1 1 F — — — — — — — — — Whooping Cough M — — — — 1 — — — 1 F — — — — 1 — 1 — 2 Heart Disease M 1 — — — — — — — 1 F — — — — — — — — — Meningococcal Meningitis M — — — — — — — — — F — — — — — — — 1 1 Tuberculosis (all forms) M — — — — — — 1 — 1 F — — — — — — — 1 1 Bronchitis M — — — — 2 — — — 2 F 1 — — — — — — — 1 Pneumonia M — — — — 1 1 1 — 3 F — — — 1 2 3 — — 6 Other Respiratory diseases M — — — — — — 1 — 1 F — — — — — — — — — Diarrhoea, etc. M — 2 — — — 2 4 — 8 F — — 1 — 1 3 — — 5 Congenital Debility and Malformations, Premature Births. M 15 3 — 2 6 — 1 — 27 F 13 1 1 1 — — — — 16 Other defined causes M 2 1 — 1 1 — — 1 6 F — — — — 1 — 2 1 4 All causes M 18 6 — 3 11 3 8 2 51 F 14 1 2 2 5 6 3 3 36 Professional Nursing in the Home. (a) General, (b) Infectious Diseases. As set out in the report for 1931. Midwives. There is nothing further to add to the remarks published under this heading for the year 1931. Midwives Acts, 1902 and 1918. The number of midwives on the roll for 1933 was 50. Of this number 33 worked in connection with the Maternity Hospital and District Nurses' Home, Plaistow, and its branches, four at Sir Henry Tate Nurses' Home, Silvertown, three at the Kelvingrove Nurses' Home, Windsor Road, and 10 practised independently. 17 Summary of Visits Paid during 1933 by Nurses of Plaistow Maternity Hospital and District Nurses Home. Midwifery 500, Monthly 187, Hospital 341. Maternity and Nursing Homes.—Nursing Homes Registration Act, 1927. 1. Number of applications for registration Nil 2. Number of Nursing Homes on register 1 3. Number of orders made refusing or cancelling registration Nil 4. Number of appeals against such orders Nil 5. Number of appeals in which orders have been:— (a) Confirmed on appeal Nil (b) Disallowed Nil 6. Number of applications for exemption from registration Nil 7. Number of cases in which exemption has been:— (a) Granted Nil (b) Withdrawn Nil (c) Refused Nil Institutional Provision for Unmarried Mothers and Homeless Children. Already detailed in report for 1930. Ambulance Facilities. See report for 1930. The two ambulances operating from the Fire Station carried out the following work during 1933:— Cases conveyed to and from various hospitals 1,678 Accident cases 559 Illness cases 1,119 Journeys made 1,731 Miles run 13,911 18 East Ham cases removed by other ambulances:— Barking 15 Ilford 6 West Ham 19 Cases removed for other authorities:— West Ham 20 Barking 7 Laboratory Facilities. As detailed in last year's report, all specimens are now sent for examination to the East Ham Memorial Hospital. The number and nature of these examinations for 1933 are shown below:— Specimen. Number. Blood Sugar Estimation 5 Blood for Widal Test 3 Smears (Gonococci) 1 Mantoux Skin Test (Tuberculosis) 59 Swab (for Tuberculosis) 1 Faeces (for Tuberculosis) 6 Fluid from Chest (for Tuberculosis) 3 Sputa (for Tuberculosis) 1,163 Total 1,241 The same arrangements exist for the examination of swabs from the throat and nose as in previous years. The number of swabs examined at the Infectious Diseases Hospital and the Town Hall Laboratory:— Number. Positive. Negative. 3,545 178 3,367 Of the above total 1,267 were examined at the hospital, a much larger number than in former years. Legislation in Force. Legislation in force was printed in the report for 1932. 19 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 1933. Poor Law Medical Out-Relief. Consequent upon the retirement of Dr. L. F. A. Harrison, District Medical Officer, in June, 1933, the Public Assistance Committee considered the recommendations of the Minister of Health and British Medical Association in regard to other schemes for the provision of medical attendance to persons in receipt of out relief. The Council was the first County Borough to adopt a system whereby persons in receipt of public assistance would be permitted "open choice" of doctor. The Medical Practitioners of the district were invited to attend a meeting of the Public Assistance Committee at which the essential features of the scheme were discussed. It was proposed that a panel of practitioners willing to carry out such duties should be established on similar lines to that of the National Health Insurance. The patient upon first requiring medical attention would be permitted to select the name of a doctor on the panel as his medical attendant for the ensuing twelve months. A capitation fee of 10s. per annum (exclusive of medicines), payable in quarterly instalments, was agreed upon and the scheme was initiated on October 1st, 1933, for an experimental period of one year. Subsequently many practitioners accepted service under the scheme and apart from a few preliminary difficulties in regard to administration, the arrangement has worked exceedingly smoothly. The details of the scheme are submitted herewith. 20 COUNTY BOROUGH OF EAST HAM. Public Assistance Domiciliary Medical Service. Regulations governing Terms and Conditions of Scheme. The scheme shall come into operation on the 1st October, 1933. The regulations for the medical attention and treatment of Poor Persons referred to a Medical Practitioner shall be as follows:— The Medical Practitioner to visit and treat a patient whose condition so requires at any place in the Borough where the patient may at the time be; (The treatment which a practitioner is required to give to his patients comprises all proper and necessary medical services other than those involved in the application of special skill and experience of a degree or kind which general practitioners as a class cannot reasonably be expected to possess.) The Relieving Officer to issue a medical relief card (see Form (a)), and to insert thereon the name of the Medical Practitioner selected by the applicant. (A list of those available, including Surgery Hours, will be printed and exhibited at the Public Assistance Sub-Office, Arragon Road, East Ham.) The card to be countersigned and dated by the Medical Practitioner. The Medical Practitioner to " sign off " patient when recovered, and to return card to the Medical Officer of Health with his monthly return referred to below. The Medical Officer of Health to return cards to the Public Assistance Officer. The Medical Practitioner to attend and treat at the places, on the days, and at hours to be arranged to the satisfaction of the Council, any patient who attends there for that purpose, but to be permitted, with the consent of the Council, to alter the places, days or hours of his attendance, or any of them; to provide proper and sufficient surgery and waiting room accommodation for patients; to issue prescriptions for drugs and appliances, including cod liver oil and malt, to be signed by the practitioner with his own hand, but not to be written in such manner as to necessitate reference on the part of the person supplying the drugs or appliances to a previous prescription; Note.—The drugs, appliances, dressings, etc., recommended for patients on prescriptions shall be subject to the same regulations as govern the prescribing of these articles under the National Health Insurance Acts. to advise a patient whose condition is not within the scope of the practitioner's obligations, as to the steps to be taken to obtain that treatment; Note.—Ophthalmic cases should be referred to the Medical Officer of Health for reference to the Ophthalmic Surgeon, arrangements to be made by the Public Assistance Committee as to fee to be paid to the Ophthamic Surgeon for his services. Minor operations should be referred by Medical Practitioners to Hospitals. desiring a patient to be admitted to a Public Assistance Hospital or Institution, UNLESS THE CASE IS URGENT, to consult with the Medical Officer of Health (see Form (b) ), who will decide whether the case is one for admission or not; admission orders to be issued by the Relieving Officers. In cases of urgency the Medical Practitioner to be permitted to admit cases through the Medical Officer of the Institution concerned. In these cases the Public Assistance Officer to be notified at once on a form to be provided (see Form (c) ); 21 on the admission to an institution or hospital of any patient under his care, to supply the Medical Officer thereof, if required, with such information as may be in his possession as to the medical history of the case; in the event of a case arising of a patient who has been recommended by a member of the panel for hospital treatment, such recommendation having been approved by the Medical Officer of Health, and such patient refusing institutional treatment, to continue domiciliary treatment and report the case to the Medical Officer of Health, who will submit the same to the Public Assistance Committee for consideration ; to meet the Medical Officer of Health (or one of the Council's medical staff) when the latter so requires, for the purpose of examining, in consultation, any patient in respect of whom the practitioner has sought the advice of the Medical Officer of Health; to give to the Council, when required by them, any reasonable information respecting the case of any patient who is or has been under his care, and certify, in writing, on the request of the Council or of a Relieving Officer, or of the patient whom he is attending, the sickness of the patient, or other cause of his attendance on him; upon due notice being given, to afford to the Medical Officer of Health, or such other person as he may appoint for the purpose, access at all reasonable times to the practitioner's surgery or other place where the records are kept, for inspection of these records; to answer any enquiries of the Medical Officer of Health regarding any prescription issued by the practitioner and furnish such information as the Council or Minister may from time to time direct with respect to any cases of sickness or death amongst patients; in making entries in books, record papers, or other records, to employ the terms used in the volume prepared by a Joint Committee appointed by the Royal College of Physicians of London and entitled " The Nomenclature of Diseases"; to send to the Medical Officer of Health a monthly statement of patients attended (see Form (f) ), such statement to be circulated through the Public Assistance Officer to the Relieving Officers for their information; to keep clinical records of each patient similar to those kept by panel practitioners for panel patients (see Form (g) ). This record, if a patient changes his or her doctor, to be transferred to the new medical attendant; to have the right to refuse to accept a patient. He must, however, accept responsibility for the patient's treatment pending the submission of a report to the Medical Officer of Health and the decision of the Public Assistance Committee thereon ; to name to the Council some duly qualified medical practitioner who will, in case of his absence or other hindrance to his personal attendance, act in his place. Change of Medical Attendant. A patient, once choosing his or her medical attendant, shall not be allowed to change that attendant until 12 months thereafter. Capitation Fee. A capitation fee of 10s. per annum will be paid to the medical attendant by instalments at the end of each calendar quarter, the first instalment being payable at the end of the quarter in which the patient first receives treatment. Services of Nurse. Any medical practitioner requiring the Public Assistance District Nurse to call and attend to any patient, shall complete a requisition form for this purpose, the form to state:—Name, address, age, illness, assistance required (see Form (d) ). This form shall be sent to the Medical Officer of Health at whose office the nurse will visit at such times to be arranged to collect 22 the forms and carry out the instructions contained therein. The nurse will submit to the Medical Officer of Health a monthly return showing the daily number of visits paid. Extra Medical Relief. Recommendations for additional nourishment must be forwarded to the Relieving Officers (see Form (e) ), who will bring them to the notice of the next Relief Sub-Committee—the Relieving Officer in the meantime granting such "medical extras" on their own responsibility in cases of urgent necessity. Admissions to Special Institutions or Convalescent Homes. Where a medical practitioner recommends that a patient be sent either to a Convalescent Home or for treatment in a special Institution, he shall forward such recommendations to the Medical Officer of Health, who will examine such patient and forward a report to the Public Assistance Officer for submission to the Public Assistance Committee. TABLE 5. Public Assistance Domiciliary Medical Service. Statistical Return for 3 Months Ending 31.12.33. No. of individual patients. No. of attendances at homes. No. of attendances at Surgery. Total No. of attendances. No. of occasions medicines supplied without seeing patients. No. of recommendations for extra nourishment. 756 725 2,196 2,921 283 96 No. of cases urgently admitted to hospital 2 No. of applications to M.O. H. for hospital treatment 18 Public Assistance Nurse. (3 Months Ending 31.12.33.) No. of requisitions received for attendance of nurse 21 Total number of attendances at homes by nurse 337 District Medical Officers. No. of visits to homes of patients. No. of Patients seen at Public Dispensary. No. of prescriptions issued. Dr. Harrison (1) 2,300 2,892 2,320 Dr. O'Moore (2) 474 1,722 1,548 Dr. Brews (3) 314 *612 678 (1) Dr. Harrison's figures relate to period 1.1.33 to 31.5.33. (2) Dr. O'Moore's figures relate to period 1.6.33 to 30.9.33. Dr. Brews (3) 314 *612 678 *Visits to Surgery. 23 HOSPITALS. (a) Provided by Local Authority. New Pavilion—Harts Sanatorium. The need for additional and more suitable accommodation for observation and advanced cases at Harts Sanatorium has long; been advocated by the Council and it is a matter for congratulation that completion of the new permanent brick building was effected before the end of the year. The transference of many patients suffering from Pulmonary Tuberculosis in Public Assistance Hospitals was indicated in the Local Government Act 1929. The Council was anxious to comply with these requirements and by so doing afford direct facilities for treatment, and relieve Public Assistance Hospitals of this responsibility. With this provision the number of beds at Harts is increased from fifty-six to eighty. The building was opened by The Worshipful the Mayor (Alderman G. H. Manser, J.P.) on 28th October, accompanied by the Mayoress, the Chairman of the Public Health Committee (Alderman E. F. Markey) and members of the Council. Dr. Benton described the history of the Tuberculosis Scheme since its inception. The building was erected by direct labour under the supervision of the Borough Engineer (Mr. A. T. Bridgewater, F.S.I.) and the Chairman of the Works Committee (Alderman C. W. Brading, J.P.). The pavilion consists of male and female sections separated from one another by a duty-room and ward-kitchen. The female side has a ward containing eight beds, 4 two-bedded, and 4 onebedded cubicles whilst the male side consists of 4 two-bedded, and 4 one-bedded cubicles. Each part has bathrooms, lavatories, linenrooms, drying-room, locker-room, day-room, etc. The whole is centrally heated from a boiler-room situated below ground in the rear of the ward kitchen. Above the boiler-room are the X-ray and dark-rooms, both built in accordance with the recommendations of the National Physical Laboratory. Extending along the front of the whole of the cubicles, both male and female is a covered verandah, 9 feet wide, with two large 24 bays where bed-ridden patients can be wheeled when the climatic conditions are favourable. Much time and though were given to details of furniture and equipment, these as well as the interior fixtures being of the latest type. Every bed has wireless headphones and there are loudspeakers in each day-room. Additional equipment was also required for the laundry, kitchen, etc., and a refrigerator installed. Moreover, in order to accommodate the additional nursing and domestic staff it was necessary to convert the two wards on the first floor of the main building into bedrooms and furnish them accordingly. Nursery Block—Aldersbrook. The new Nursery Block at the Children's Homes, Aidersbrook, was opened on May 27th, 1933, in the presence of The Worshipful the Mayor of East Ham (Alderman G. H. Manser, J.P.) by Alderman T. W. Burden, Chairman of the Committee. The building is divided into three sections—ground floor: babies under 12 months, toddlers 1 to 3 years, and first floor, staff. Accommodation is provided for 90 infants under 3 years of age. It is impossible to give an adequate description of this building which is acknowledged by numerous visitors from all over the country and abroad to be the finest example existent of nursery provision on hygienic and potentially instructive principles. In addition to the usual wards, dormitories and offices of approved design and equipment, the nursery block contains isolation rooms for children recently admitted, sun-rooms, milk kitchens (for preparation of infants' milk foods) with sterilizers, bottle cleansing plant and refrigerator. The whole building is most tastefully decorated and the amenities all that could be desired for the care of these little ones. (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. New Pavilion, Harts Sanatorium. Nursery Block, Children's Homes, Aldersbrook. A Ward of the Nursery Block. Bottle Sterilising Room, Nursery Block. 25 Mental Hospital. Patients requiring treatment in mental hospitals have for many years been admitted to institutions under the jurisdiction of the Essex County Council. Owing to the need for additional accommodation the County Council was obliged to give notice to terminate these arrangements with East Ham, since when vacancies have been obtained at various mental hospitals throughout the country. The formation of the Joint Committee of the Corporations of the County Boroughs of East Ham and Southend, of which Councillor H. B. Harper, J.P., is Chairman, was the outcome of negotiations by these Authorities to provide facilities for the treatment of mental cases' from both areas. The magnitude of such a task with its numerous legal and other intricacies precluded the rapid development of any scheme, but the fact that the deliberations of the Joint Committee have reached an advanced stage in so short a time, affords the utmost satisfaction. The site at Runwell has been compulsorily purchased, and the plans for a new Mental Hospital embodying the " Villa " principle, which will permit of care and treatment upon the most modern and scientific lines, have been approved by the Joint Committee. It is anticipated that building will commence about the middle of 1934. Meanwhile, patients from East Ham are provided for in the following institutions :— TABLE 6. Disposition of East Ham Mental Patients on 31.12.33. Institution. Male. Female. Total. Brentwood 8 34 42 Colchester 1 36 37 Wells — 38 38 Gateshead 13 62 75 Powick, Worcester 69 10 79 Canterbury 34 — 34 Cotford, Somerset 9 — 9 Peckham House 29 29 58 Gloucester 29 10 39 Park Prewitt, Basingstoke — 20 20 Various Institutions 7 12 19 Totals 199 251 450 26 Smallpox. The treatment of cases of this disease is carried out, by arrangement, with the London County Council. East Ham Memorial Hospital. The number of beds remains the same, viz., 100. The following; figures are abstracted from the hospital report for 1933:— 1.—IN-PATIENTS. A. Number of Beds and In-Patients. Numbers in 1933. 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 1 .9 (iii) Other Causes — — (d) Average Daily Number Open during the year 99 99.1 (c) Average Daily Number Occupied during the year 92.5 91.8 2. Number of In-Patients in the Hospital at beginning of year 87 89 3. Number of In-Patients admitted during year 1,400 1,550 4. Number of In-Patients in the Hospital at the end of the year 95 87 5. Average number of days each Patient was resident (Ascertained by dividing the yearly total of daily counts, viz.:—33,765 by the number of Patients treated to a conclusion, i.e., (2)+ (3) —(4).) 24.3 21.6 6. Number of Patients admitted and discharged during the year who were resident for (i) only 1 day 98 202 (ii) 2 and 3 days 62 79 27 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. 1933 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. £ £ s. d. £ s. d. £ s. d. £ s. d. 1. Provisions (including Board of Officials) 3,184 13 2 2 5 9 14 2 2 3 9 2. Surgery and Dispensary 1,261 5 3 18 1 6 10 1 1 1 3. Domestic 2,786 11 7 2 0 0 11 7 1 15 11 4. Salaries and Wages (Maintenance) 5,498 l 2 9 3 19 0 1 2 8 3 10 2 5. Miscellaneous 470 1 11 6 9 1 11 6 1 6. Administration 676 2 10 9 9 2 9 8 5 Statistical Cost 13,875 2 17 6 9 19 4 2 19 11 9 5 5 7. Establishment:— Renewals and Repairs 185 9 2 8 1 3 3 11 8. Finance 1,004 4 2 14 5 3 9 11 7 Total Cost 15,064 3 2 5 10 16 5 3 4 11 10 0 11 *Average Cost per week found by dividing the amounts of Expenditure shown against each heading and total by the average number of In-Patients resident daily (No. 1(e) and A above) and dividing by the number of weeks in the year (viz., 52 1/7 or 52 2/7). †Average Cost per In-Patient found by dividing the amounts of Expenditure shown against each heading and total by the number of In-Patients treated to a conclusion during the year (Nos. 2 + 3—4 in A above). 2.—OUT-PATIENTS. A. Numbers. Numbers in 1933. Numbers in previous year. 1. Total number of new Out-Patients 10,006 9,380 2. Total number of Out-Patient Attendances 50,640 46,543 (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 3,239 2,964 (c) Number of Maternity Patients included in No. 1 above, attended at home — — (d) Number of Attendances on Maternity Patients included in No. 2 above — — 28 2.—OUT-PATIENTS—continued. B. Annual Expenditure on Out-Patients and Average Cost of each Out-Patient Attendance and of each Out-Patient. 1933 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) 361 1.71 8.66 1.68 8.32 2. Surgery and Dispensary 875 4.15 20.99 4.19 20.78 3. Domestic 201 95 4.82 1.23 6.11 4. Salaries and Wages (Maintenance) 1,495 7.08 35.86 6.62 32.83 5. Miscellaneous 122 58 2.93 53 2.63 6. Administration 132 .63 3.16 51 2.56 Statistical Cost 3,186 15.10 76.42 14.76 73.23 7. Establishment:— Renewals and Repairs 53 25 1.27 1.02 5.09 8. Finance 365 1.73 8.75 1.75 8.67 Total Cost 3,604 17.08 86.44 17.53 86.99 •Average Cost per Out-Patient Attendance found by dividing the amounts of Expenditure shown against each heading and total by the total number of Out-Patient Attendances (No. 2 in A above). †Average Cost per Out-Patient found by dividing the amounts shown against each heading and total by the total number of new Out-Patients (No. 1 in A above). 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 six patients were admitted during 1933. 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:— 29 TABLE 7. Cases Admitted to West Ham Corporation Public Assistance Institutions from East Ham. Institution. Chargeable on 31.12.32 Admitted during 1933. Born during 1933. Total. Discharged. Died. Transferred to other Instns. Chargeable on 31.12.33 Whipps Cross Hospital 168 1,442 — 1,610 1,065 238 189 118 Central Home 254 433 — 687 180 146 111 250 Forest Gate Hospital 119 182 117 418 253 14 20 131 Forest House and Cottages 41 19 — 60 5 — 16 39 Margate Home 4 10 — 14 10 — 2 2 As in previous years it has been impossible to obtain from the West Ham authorities detailed information regarding East Ham patients as desired by the Ministry of Health. 30 Aldersbrook Homes and Scattered Homes. I am indebted to Mr. Pitt Steele, Superintendent of the Children's Homes, Aldersbrook, for the following information:— Highest number chargeable during 6 months ending 30-6-33 565 6 months ending 31-12-33 556 Lowest „ „ „ 538 „ „ „ 520 In Receiving Homes on 1st January, 1933 311 1st July, 1933 323 „ Scattered „ „ „ 231 „ „ 229 542 552 In Receiving Homes 1st January, 1934 303 ,, Scattered „ „ „ 220 523 On 1st July, 1933, chargeability was apportioned as follows:— To the County Borough of East Ham 83 1st January, 1934 80 „ „ West Ham 317 „ „ 308 „ „ Essex County Council 152 „ „ 135 552 523 Average No. of admissions weekly—6 months ending 30-6-33 8.8 6 months ending 31-12-33 6.4 „ „ discharges „ „ 8.5 „ „ „ 7.6 Greatest No. of admissions on any one day—6 months ending 30-6-33 11 „ „ „ 8 Number of deaths in institutions— 6 months ending 30-6-33 0 „ „ „ 1* Number of children admitted from East Ham—6 months ending 30-6-33 40 „ „ „ 39 Number of children admitted from West Ham—6 months ending 30-6-33 129 „ „ „ 91 Number of Children admitted from Essex C.C.—6 months ending 30-6-33 71 „ „ „ 36 Transfers to Institutions (not under the control of the East or West Ham County Boroughs) 6 months ending 30-6-33 38 „ „ „ 11 Total No. of days maintenance—6 months ending 30-6-33 99,871 „ „ „ 97,106 Infants under 3 years on 1st July, 1933 47 On 1st January, 1934 57 Children over 3 and under 5 years on 1st July, 1933 63 „ „ „ 46 Children over 5 and under 8 years on 1st July, 1933 117 „ „ „ 98 Boys over 8 and under 14 years on 1st July, 1933 149 „ „ „ 126 Girls over 8 and under 14 years on 1st July, 1933 120 On 1st January, 1934 114 Boys over 14 and under 16 years on 1st July, 1933 31 „ „ „ 50 Girls over 14 and under 16 years on 1st July, 1933 25 „ „ „ 32 552 523 Accommodation—Beds Provided †Receiving Homes, on 1st July, 1933 371 On 1st January, 1934† 371 Scattered Homes „ „ „ 232 „ „ „ 232 603 603 31 Aldersbrook Homes and Scattered Homes—continued. No. of boys sent to situations during 6 months ending 30-6-33 11 6 months ending 31-12-33 10 No. of girls sent to situations during 6 months ending 30-6-33 6 „ „ „ 8 No. of boys returned from situations and since replaced, 6 months ending 30-6-33 1 and not yet replaced No. of girls returned from situations and since replaced, 6 months ending 30-6-33 2 1 6 months ending 31-12-33 0 No. of boys whose wages were subsidised since the last report (with the sanction of Ministry of Health)—6 months ending 31-6-33 0 „ „ „ 0 * East Ham. †Elizabeth Fry Lodge (60 beds) not opened. I am indebted to Dr. J. Sangster Greig, Medical Officer to the Children's Homes, Aldersbrook, for the following information :— September, 1933. Reports of the Medical Officer. As required by Articles 170 (13) and 179 (1) of the Public Assistance Order, 1930, I submit my half-yearly report for the period 1st January, 1933, to the 30th June, 1933. Health of the Children. The health of the children at the Aldersbrook and Scattered Homes continues to be most satisfactory and the small amount of sickness among the School children and the elder boys and girls continues to be a marked feature of the establishment. Infectious Diseases. There have been no epidemics. Sporadic cases of infection have occurred during the six months, viz.:—7 cases of Whooping Cough, 6 cases of Scarlet Fever, 2 each of Diphtheria and Mumps. In view of the large number of young children in residence and the still prevalent overcrowding in the Homes, these figures are very gratifying and are undoubtedly due in large measure to the speedy detection by the Staff of any illness among the children. The wave of Influenza affected many of the children in the early part of the year, but they were all nursed at Aldersbrook and no complications ensued. 32 Nursing. The nursing of the infants and sick children is highly satisfactory. The Matron and her staff continue to give the greatest care and attention to this branch of the work, and too much credit cannot be given to them for their unfailing energy and skill. The Nursery. The Nursery which was opened on the 27th May can be considered as the " last words " in establishments of this nature. It is replete with every requirement for the care and management of infants and young children. It has been designed and equipped with great care and forethought, no detail for the comfort, well being, and up to date feeding of the infants in the most hygienic surroundings has been neglected or forgotten. Supply of Medical and Surgical Requisites. The supply of medical and surgical requisites is adequate and complete. Deaths. No deaths have occurred during the past six months. Accommodation. I must again bring to the notice of the Committee that the Lodges at Aldersbrook and some of the Scattered Homes are still housing numbers in excess of the certified accommodation. The Elizabeth Fry Lodge is at the moment vacant and I understand from the Superintendent that he is pressing the Committee to re-open this for young children instead of adapting it for a Receiving Lodge. I must endorse his proposals as constant overcrowding may be harmful to the health of the children. Visiting, Examinations and Inspections. I and my Assistant made approximately 247 visits to the Aldersbrook Homes and 88 to the Scattered Homes. 240 children were thoroughly examined on admission and 220 on discharge. Minor operations were duly carried out and treatment given as required. In addition the usual routine medical examinations required by the Public Assistance Order have been carried out. 33 Twelve children, with the consent of their parents, were successfully vaccinated. The Dentist, Mr. C. F. Rose, has made the usual visits and inspections at Aldersbrook and the Scattered Homes, resulting in 126 children being treated for extractions, fillings, etc., anæsthetics being given by my Assistant when necessary. I should like to take this opportunity of expressing my appreciation of the help, consideration and courtesy shown me at all times by the Superintendent and Matron. January, 19.34. As required by Articles 170 (13) and 179 (1) of the Public Assistance Order, 19.30, I submit my half-yearly report for the half-year ended on the 31st December, 1933. Health of the Children. In the Aldersbrook and Scattered Homes the general health of the children is still very good. The fact of the children being almost immune from serious illness is very gratifying indeed. Infectious Diseases. There have been no epidemics during the period under review. Sporadic cases of infection have developed during the past six months as follows, viz.:—Whooping Cough 10, Scarlet Fever 7, Diphtheria 5, Mumps 1, Chicken Pox 1. These figures speak for themselves and much credit is due to the Staff for the detection of every illness at its onset, thereby undoubtedly reducing the number of infectious diseases, and minimising the danger of other illnesses. Nursing. The nursing of the infants and sick children is still of a very high standard. Every care and attention is given by the Matron and Nurses to these children, and the greatest credit is due to the Matron and her staff for their energy and skill. The Nursery. The Nursery which has been in operation during the past six months is fulfilling its expectations. The increased hygienic conditions which prevail have undoubtedly contributed to the improvement in the health and general appearance of the infants. 34 Supply of Medical and Surgical Requisites. The supply of medical and surgical requisites is adequate and complete. Deaths. One death occurred during the period under review. Accommodation. I understand that the Elizabeth Fry Lodge will be shortly ready for occupation and the numbers in excess in the other Lodges will thereby be reduced. Visiting, Examinations and Inspections. I and my Assistant made approximately 263 visits to the Aldersbrook Homes and 92 to the Scattered Homes. 166 children were thoroughly examined on admission and 210 on discharge. Minor operations have been duly carried out, and treatment given or ordered as required. In addition the usual routine medical inspections required by the Public Assistance Order have been performed. Eleven children, with parental consent, were successfully vaccinated. The Dentist, Mr. Rose, has made the usual visits and inspections at Aldersbrook and the Scattered Homes, resulting in 73 children being treated for extractions, fillings, scalings, etc., anæsthetics being given by my Assistant when necessary. 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 45 Soft Chancre 2 Gonorrhoea 128 Not Venereal 86 Total 261 Total attendances of all patients 11,228 Number of in-patients during 1993 166 Salvarsan substitutes—doses 634 35 Pathological Examinations. For or at the Centres— Spirochaetes 17 Gonococci 1,306 Wassermann 405 Others 1,654 Total 3,382 For Practitioners— Spirochaetes — Gonococci 3 Wassermann 28 Others 25 Total 56 During 1933 no East Ham patients were in residence under the Hostel Scheme. Mental Deficiency. The opening of South Ockendon Colony for Mental Defectives by the West Ham Corporation as mentioned in the last report has considerably eased the difficult situation of this Authority in recent years, in regard to the provision of institutional treatment for persons coming within this category. The Mental Defectives admitted to the Colony are mentally high grade in classification, and the object is to provide adequate training and instruction in suitable occupations, as well as an environment consistent with their happiness and physical wellbeing. Many slight cases are placed with suitable guardians. Low and medium grade defectives are accommodated at Forest Gate Hospital. 36 Clinics and Treatment Centres. These are shewn below and are all provided by the Council. TABLE 8. Clinics and Treatment Centres. Situation Purpose used Sessions Central Clinic, High St. School Special Clinics Monday, Wednesday & Saturday 9.30 a.m. „ „ Toddlers' Clinics Monday 9.30 a.m. Tuesday 2.0 p.m. Wednesday 9.30 a.m. „ „ Infant Welfare Monday 2.0 p.m. Thursday 9.30 a.m. „ „ Ante-natal Clinic Friday 9.30 a.m. „ „ Immunization Clinic Friday 9.30 a.m. Baptist Church Hall, Plashet Grove Infant Welfare Tuesday 9.30 a.m. Friday 2 p.m. North Woolwich Clinic, Fernhill St. „ „ Tuesday 2 p.m. St. George's Church Hall, Masterman Rd. „ „ Wednesday 2 p.m. Wesleyan Church Hall, Manor Park „ „ Thursday 2 p.m. Durban House, Katherine Road Tub. & Chest Clinic Monday and Wednesday (adults if not working) 2-3.30 p.m. Saturday (children only) 9.15-10.30 a.m. Thursday (adults if working) 6-7.30 p.m. Town Hall, East Ham General Clinic (minor ailments and observation cases Monday, Wednesday & Saturday 9 a.m. „ „ Immunization Friday 3 p.m. Wesleyan Church Hall, Manor Park General Clinic Tuesday & Thursday 9 a.m. North Woolwich Clinic, Fernhill St. „ „ Friday 2 p.m. Town Hall, East Ham Ear Clinic Thursday & Friday 2 p.m. „ „ Eye Clinic Tuesday, Thursday & Friday 9 a.m. „ „ Light Clinic Monday & Wednesday 2 p.m. Durban House, Katherine Road Dental Clinic By appointment. New Tuberculosis and Chest Clinic. The conditions under which this service is carried on at Durban House, Katherine Road, have long been a matter of concern to the Council. 37 The accommodation and facilities for investigation are totally inadequate to the proper performance of such important ameliorative and preventive work. Much thought has been given to the erection of a clinic on modern lines, and plans have been submitted to the Ministry for their consideration. North Woolwich. The facilities afforded by the Metropolitan Borough Council of Woolwich at the new combined treatment centre in Fernhill Street, North Woolwich, are more fully dealt with in the report to the Education Committee. The agreement entered into permits the use of this centre on two occasions per week for the purposes of a minor ailments school clinic, and one session per week for child welfare. The arrangement is proving most satisfactory and is convenient to the East Ham residents in the neighbourhood. MENTAL DEFICIENCY ACTS, 1913-27. The ascertainment and supervision of persons coming within the scope of these Acts has been carried out satisfactorily. Examination and certification, 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 9. VISITS. No. of reports— register, files, &c. Number of interviews Statutory Supervision Guardianship Institution Training Centre Friendly Care Total 1,127 134 113 111 170 1,655 991 82 38 TABLE 10. Particulars of Mental Defectives as on 1st January, 1934. (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 17 10 27 Aged 16 years and over 39 28 67 (2) On Licence from Institutions— Under 16 years of age 1 — 1 Aged 16 years and over 2 — 2 (b) (1) Under Guardianship (excluding cases on Licence)— Under 16 years of age 2 — 2 Aged 16 years and over 12 3 15 (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 — 1 1 3. Under Statutory Supervision 76 77 153 Of whom:— Awaiting removal to an Institution 3 6 9 4. Action not yet taken under any one of the above headings (a) Notified by Local Education Authorities (Sec. 2 (2)) — 2 2 (b) Mental Defectives in receipt of Poor Relief:— (1) Institutional— (a) In Public Assistance Institutions not approved under Sec. 37 — — - (b) In Institutions certified under the M.D. Acts (including those approved under Sec. 37):— (1) Cases "placed" under Sec. 3 — — — (2) Other Cases — — — (2) Domiciliary (c) Otherwise "ascertained" 1 5 6 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 39 2. Reported to the Local Authority from any reliable source but as to whom no action has been taken 4 3 7 3. Under Voluntary Supervision 21 25 46 Number of above Cases on the Registers of Occupation Centres:— Under Statutory Supervision 14 15 29 Under Voluntary Supervision 2 — 2 On Licence from Institutions — — — Under Guardianship 3 4 7 On Licence from Guardianship — — — DURING THE YEAR 1933. 1. (a) Number of instances in which Licence was granted during 1933:— 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 1933:— M. F. T. (1) To Institutions1 — 1 (2) To Guardianship— — — 2. Cases notified by Local Education Authorities (Section 2 (2)) during the year 1933:— Method of disposal. M. F. T. Sent to Institutions (by Order) — — — Placed under Guardianship (by Order) — — — Placed under Statutory Supervision 9 8 17 Placed in "Places of Safety" — — — Died or Removed from Area — 1 1 Action not yet taken— (a) In receipt of Poor Relief — — — (b) Others — — — Total 9 9 18 3. Of the total number of mental defectives known to the Local Authority:— (a) Number who have given birth to children during 1933:— (1) After marriage (2) While unmarried Nil Males. Females. (b) Number who have married during 1933 — — Training Centre. Many of those attending the Centre have responded to the teaching and guidance of the Superviser. By infinite patience, they have been taught to make fireside stools, clothes horses, book shelves, various kinds of baskets, trays, rugs, mats, linen 40 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. Good results are noticeable with some of the younger children and improvement in general behaviour, speech and concentration is apparent. The Annual Christmas Party and Exhibition of Work was held, the Mayor, the Mayoress and many of the Council being present. I am sure the members of the Corporation must have realised the valuable work that is done at this Centre. Miss Fooks retired on marriage in February last and Miss Bleaden was appointed Supervisor and commenced duties in May, 1933. TABLE 11. Statistics of Training Centre, 1933. 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 11 211 1,660 7.8 24 207 3,143 15.1 4,803 BLIND PERSONS ACT, 1920. The work of the East Ham Welfare Association for the Blind has resulted in steady progress. All activities on behalf of these sufferers have been well maintained and the Association records the hearty co-operation of the East Ham Council and the Education Committee in making an annual grant of £100 and providing facilities for recreation and entertainment. 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. Number of cases examined 34 Number of cases certified 26 41 In the following tables, the registration of the blind, ages at which blindness occurred, training and employment and occupations, as at 31.3.34, are set out:— TABLE 13. Welfare of the Blind.—Registration. .4s at 31/3/34. Age Period 0—5 Age Period 5—16 Age Period 16—21 Age Period 21—30 Age Period 30—40 Age Period 40—50 Age Period 50— 60 Age Period 60—70 Age Period 70— Total M. F. T. M. F. T. M. F. T. M F T. M F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. — 1 1 3 2 5 3 1 4 7 6 13 8 9 17 19 7 26 16 12 28 31 23 54 34 50 84 121 111 232 Ages at which Blindness occurred. Age Period 0—1 Age Period 1—5 Age Period 5—10 Age Period 10—20 Age Period 20—30 Age Period 30—40 Age Period 40—50 Age Period 50—60 Age Period 60-70 Age Period 70 Unknown M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F. T. M. F T M. F. T. 17 8 25 1 3 4 7 7 14 4 7 11 10 6 16 10 8 18 13 12 15 19 8 27 21 25 46 15 21 36 10 (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 (a) Home Workers (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. 3 6 9 4 1 5 10 3 13 17 10 27 4 — 4 — — — — — — 6 1 7 5 2 7 86 95 181 118 108 226 (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 Hoine Teachers Knitters Labourers Massage Mat Makers Musicians and Music Teachers Netting Makers Newsvendors Porters, Packers and Cleaners Poultry Farmers _ School Teachers straw Bagmakers Tuners Weavers Miscellaneous Total Mattress Makers Machinists Upholsterers Pan wiredrawn Hand Machine Within Institutions — 2 — — — — — — — — — — — — — — — — — 1 — — 1 — — — — — — — — 4 — 9 in approved Home Workers Schemes — — — — — 1 — — — — — — — — — — — — — 1 — — — — — — — — — — 3 — — 5 Others (not pastime Workers) 1 1 — — — 1 — — 1 — — 2 1 1 1 — 2 — — — — — — — — — — — — — — — 2 3 Totai. 1 3 — — — 2 — — 1 — — 2 1 1 1 — 2 — — 2 — — 1 — 1 — — — — — 3 4 2 27 43 TABLE 12. 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 ;ame. 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 — 1933 226 3,970 59 92 145 5 4,179 435 — 275 75 37 31 — 17 — 44 The Invalid and Children's Aid Association. The East Ham Branch of this Association was formed in 1923 and since its inception has worked in close co-operation with the Public Health Authority, Education Committee, and all institutions and voluntary agencies for the supervision and assistance of the invalid and crippled children in East Ham. It will be seen from the following statistics the extent to which the Association provides for the care and treatment of children referred by the Public Health Authority and Education Committee. The Association is to be commended upon the simplicity of its arrangements and the businesslike methods by which proper and adequate provision is afforded to these little sufferers. The work is not only valuable, it is indispensable to the residents of the Borough, and I desire to express my thanks to the Committee and to Miss H. Webber, the Secretary, for continued help. The following is abstracted from the Annual Report for the year 1933 :— Number of cases dealt with New cases 190 273 From previous year 5 Old cases 54 Referred for clothing 24 273 The 190 new cases were referred by :— Hospitals and Medical Practitioners 101 School Medical Officer 37 Tuberculosis Officer 28 Infant Welfare Centre 9 Parents, etc. 15 190 The types of new cases were as follows :— Tubercular and pre-tubercular 29 Rheumatism, heart and chorea 39 Anaemia and debility 25 Bronchitis and asthma 29 Malnutrition 8 Various 60 190 45 The 273 cases dealt with during the year have been assisted as follows :— Sent to Sanatoria, Convalescent Homes, etc. 174 Surgical appliances provided 56 Clothing granted 24 Extensions, visits, etc. 19 273 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. General. On reference to the table showing total cases notified of infectious diseases, 1910-33, it will be seen that there was a decrease in the notifications received of Scarlet Fever for 1933. The disease was somewhat more severe than that occurring the previous year, and complications were not infrequent. An increasing number of notifications in respect of persons suffering from Diphtheria was received during the year. Many of the cases were late in coming under treatment, and in some the infection appeared extremely virulent and less responsive to curative measures. No case of Scarlet Fever or Diphtheria was refused admission to the Infectious Diseases Hospital. The deaths from the seven principal zymotic diseases (Smallpox, Whooping Cough, Measles, Diphtheria, Diarrhoea, Scarlet Fever and Enteric Fever) during the year numbered 49, equivalent to a zymotic death rate of 0.3 per 1,000 population, a reduction of 0.1 in the death rate recorded for 1932. I am pleased to report that only one case of Smallpox has occurred within the Borough during the year. 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 D.A. 10.4.33 56 M. ? 1 No Infancy 46 Owing to the resignation of Dr. Harrison, Public Vaccinator, in June, Dr. O'Moore was appointed temporarily to the post and carried out the duties until the end of the year. It is obvious that on account of the low incidence of Smallpox within this Borough during the last few years the need for vaccination has not been so prominent in the minds of the public generally. Scarlet Fever. The number of notifications received during the year totalled 701, as compared with 779 for last year. Five deaths resulted from this cause. Of the total cases notified 556 or 79.3 per cent. received hospital treatment compared with 92.0 per cent. for 1932. Diphtheria. Cases notified numbered 180 as against 157 for 1932. Of this number 179 received hospital treatment, equivalent to 99.4 per cent., compared with 98.7 per cent. for the previous year. There were 22 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 1933, 526 infants and children have received three inoculations. VACCINATION, 1933. During 1933, the Public Vaccinator carried out the following vaccinations Number of successful primary vaccinations of children under one year of age 471 Number of successful primary vaccinations of persons one year and upwards 56 Total primary vaccinations 527 Number of successful re-vaccinations 63 47 The total number of inoculations performed has been 1,710, of which 84 were carried out by Private Medical Practitioners, 692 at the Maternity and Child Welfare Centre and 934 at the Town Hall Clinic. The following figures are intended to indicate the number inoculated and the age groups involved in the cases treated at the Town Hall Clinic, Maternity and Child Welfare Centre and by Private Medical Practitioners. 1. Town Hall Clinic. Total number of inoculations 934 Number inoculated three times 299 Number inoculated twice 11 Number inoculated once 15 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 4 23 20 35 41 50 35 32 27 18 12 14 7 7 123 162 40 2. Maternity and Child Welfare Centre. Total number of inoculations 692 Number inoculated three times 199 Number inoculated twice 9 Number inoculated once 21 In addition one child received 7 inoculations, 3 children 6 inoculations, 3 children 5 inoculations, and 4 children 4 inoculations. 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 13 46 51 28 36 11 12 9 3 10 4 5 5 7 174 45 21 240 3. Private Medical Practitioners. In addition to the above, during the same period 28 children have been inoculated three times by Private Medical Practitioners and the ages at which inoculation was performed were as follows ;— 48 Ages in years 1 2 3 4 5 6 7 8 9 10 11 12 13 14 and over No. inoculated 4 2 — 1 3 5 3 — 2 3 4 1 — — 10 13 5 28 N.B.—In considering the combined totals (1, 2 and 3), it will be noticed that 51.8 per cent. of the cases are in the age group 1-5 years, 37.1 per cent in the age group 6-10 years, and 11.1 per cent. in the group over 10 years. The Schick test for susceptibility to Diphtheria was performed during the year in 266 of the completed cases of which 251 proved negative. In 15 of the cases positive results were obtained. Enteric Fever. There were 5 cases notified all of whom were treated in hospital. There were no deaths. Erysipelas. Sixty-nine notifications of this disease were received during the year, 35 were treated in hospital and 4 died. Puerperal Fever. Seven cases were notified, 6 were treated in hospital and 2 died. Puerperal Pyrexia. There were 10 cases of this disease notified, 5 of whom received hospital treatment. No deaths were assigned to this cause. 49 table 14. Total Cases of Notifiable Diseases, 1910-1933. Disease. 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 Smallpox — — — — — — — — 3 1 10 — — — — — — — 17 25 70 51 13 1 Scarlet Fever 329 377 435 526 677 499 267 341 272 530 718 1,355 502 170 215 221 350 798 832 743 484 245 779 701 Diphtheria 142 121 72 258 319 204 225 279 273 451 426 309 198 160 128 246 337 464 669 578 473 196 157 180 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 5 Erysipelas 104 134 152 119 130 96 86 66 52 72 72 57 34 32 38 41 41 38 60 49 63 54 55 69 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 7 Puerperal Pyrexia Not Notif iable 11 11 12 14 6 23 10 Meningococcal Meningitis Not Notifiable 2 6 1 8 6 7 3 3 3 4 — 1 1 1 1 4 1 1 3 8 5 1 Encephalitis Lethargica Not Notifi able 4 5 7 — — 9 6 1 2 3 1 — — — 1 Ophthalmia Neonatorum Not Notifiable — 17 16 16 7 11 13 30 3 11 11 11 6 8 10 12 3 8 6 6 6 Ac. Polio Myelitis Not Notifiable 2 8 4 1 10 — — 3 1 — — 3 1 1 — 5 — 2 — 1 7 2 Ac. Polio Encephalitis Not Notifiable — — — — — — — — — — — — — 3 2 Dysentery Not Notifi able — — 1 — — — — — — — — — — — — Malaria Not Notifi able — — 1 — — — — — — — — — — 1 1* Measles Not Notifi able 1,650 1,404 1,538 Not Notifiable German Measles Not Notifi able 123 115 134 Not Notifi able Continued Fever — — — — — — — — — — — — — — — — — — — — — — — — Typhus Fever — — — 1 — — — — — — — — — — — — — — — — — — — — Pneumonia Not Notif iable 85 92 54 79 91 70 114 82 102 59 75 77 148 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 1,134 * Induced in an Institution. 50 TABLE 15. Prevalence of and Control over Infectious Disease.—Notified Cases for the 52 Weeks ending 30th December, 1933. 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 1 — — — — — — — 1 — — — — — 1 — — — — — 1 — Scarlet. Fever 701 2 141 328 139 42 34 13 2 — 52 94 93 73 50 49 55 94 57 84 556 5 Diphtheria 180 1 56 87 19 9 6 2 — — 16 32 12 16 12 18 16 16 15 27 179 22 Erysipelas 69 1 2 2 5 4 12 5 29 9 2 10 9 9 4 7 9 7 5 7 35 4 Puerperal Fever 7 — — — — — 6 1 — — — — 2 — — 1 1 2 1 — 6 2 Puerperal Pyrexia 10 — — — — 1 8 1 — — — — 1 4 1 2 1 — 1 — 5 — Pneumonia 148 4 12 9 2 13 33 37 28 10 16 21 22 28 10 14 9 10 10 8 88 96 Ophthalmia Neonatorum 6 6 — — — — — — — — — 3 — 2 — — 1 — — 2 — Meningococcal Meningitis 1 1 — — — — — — — — — — — — — 1 — — — — 1 1 Enteric Fever 5 — 1 1 1 2 — — — — — — 1 1 — 1 — — — 2 5 — Acute Polio Encephalitis 2 — 1 1 — — — — — — — — — — — — 2 — — — — 2 — Acute Polio Myelitis 2 — — 1 — 1 — — — — — — — — — 1 — 1 — — 2 2 *Malaria 1 — — — — — — — 1 — — — — — — 1 — — — — 1 — Encephalitis Lethargica. 1 — — — 1 — — — — — — — — — — — — — — — — — * Induced in an Institution. 51 TABLE 16. Disease. Cases. Vision Unimpaired Vision Impaired Total blindness Deaths Notified Treated At home Hospital Ophthalmia Neonatorum 6 4 2 5* — — — •Result of 6th case unknown. Parents removed from district to an address not ascertainable. CANCER. The total deaths from Cancer during; 1933 show some decrease over the number for the previous year, viz., 218 against 234, a decrease of 16 deaths. 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, 1933. Total deaths 218 Males 121 Females 97 Classification. Cancer (type not stated) 9 Carcinoma 199 Endothelioma 1 Epithelioma 2 Epulis (Malignant) 1 Mylomatosis 1 Sarcoma 5 Total 218 52 TABLE 17. 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 — — — — — — — — — — — — — — 5 — 3 1 2 — 2 — 12 1 Digestive Organs & Peritoneum — — — — — — — — — — — — 2 2 6 3 27 13 27 17 16 10 78 45 Respiratory Organs — — — — — — — — — — 1 — 4 2 — 1 2 3 — — 2 1 9 7 Uterus Other Female — — — — — — — — — — — — — — — 1 — 4 — 4 — — — 9 Genital Organs — — — — — — — — — — — — — — — — — 2 — — — — — 2 Breast — — — — — — — — — — — — — 2 — 3 — 5 — 8 — 6 — 24 Male GenitoUrinary Organs — — — — — — — — — — — — — — 1 — 1 — 4 — 6 — 12 — Skin — — — — — — — — — — — — — — — — 1 — 1 — — — 2 — Other or Unspecified Organs — — — — — — — — — — — — 2 — 2 3 2 3 1 1 1 2 8 9 Totals — — — — — — — — — — 1 — 8 6 14 11 36 31 35 30 27 19 121 97 53 REPORT ON THE WORK OF THE TUBERCULOSIS AND CHEST CLINIC, 1933. Dr. Philip Ellman reports as follows on the principal features of the work for 1933. Statistical. Notifications. The number of primary notifications of tuberculosis during the year 1933 was 249 as compared with 214 for the year 1932. Of these notifications in 43.07 per cent. tubercle bacilli were found in the sputum. This is a higher number of sputum positive cases than in 1932. It is of course important to get as small a number of infectious cases among the primary notifications as possible. The total number of notified cases on the Register of the Clinic on 31st December, 1933 was 947 (Pulmonary and Non-Pulmonary). Of these 326 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 (1925-1933) 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 1933 99 16 75 54 New Cases (including Contacts). The following are the comparative figures for 1932 and 1933. 1932. 1933. New Cases 511 504 Number proved, after complete investigation, to be tuberculous 32.1% 33.9% The remaining 66 per cent. have either no disease or have symptoms and signs which may so closely simulate tuberculosis as to justify the practitioner in making use of the services provided at the Clinic to establish a diagnosis. Attendances and Medical Examinations. 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 1933 4,051 3,360 The very large increase of both attendances and examinations for 1933 are specially noteworthy. It will be seen that the bulk of attendances are for the purpose of examination. Co-operation of General Practitioners in the Work of the Clinic during 1933. It has been calculated that during 1933 80.34 per cent. of new patients were sent with letters from their doctors (as opposed to the satisfactory figure of 74.5 per cent. in 1932), which goes to show the extent of the, co-operation of Practitioners in the work of the Clinic. It is to be hoped that with the advent of the New Clinic which should provide every facility for diagnosis and treatment, still greater use will be made of the Clinic by General Practitioners, who, it is always emphasised, are an integral part of the Scheme; so much so, that whenever possible, advantage is taken to encourage the fullest co-operation of the Practitioner in the active treatment of his patient. 55 A number of General Practitioners have attended in person during the year, whilst their patients have been examined at the Clinic. Some have seen for themselves and taken the greatest interest in the X-ray examinations of their patients, others see for themselves the radiograms, whilst others have actively participated in the specialised treatment of their cases by specific forms of therapy, e.g., Sanocrysin, Tuberculin, Insulin, etc. Such close co-operation is encouraged to the fullest extent, and this opportunity is taken of acknowledging this co-operation of many General Practitioners in the Borough. Consultations at Homes of Patients. During the year, 98 visits to patients who were too ill to attend the Clinic have been made to their own homes. In 53 of these cases the patient's own doctor was present, thus maintaining close contact. Co-operation with Specialised and General Hospitals. This continues as outlined in previous reports. With the advanced block in existence at the " Harts " Sanatorium little use is now made of the Whipps Cross Hospital, where formerly close co-operation w ith the Medical Superintendent existed. Acknowledgment is made of the help and courtesy received from the Staffs of the various Hospitals in the interests of the Council's patients. Industrial Disease of the Lungs. Among the many problems in differential diagnosis which inevitably arise, when, as we have seen, some 66 per cent. of the new cases prove to be non-tuberculous, serious industrial lung disease in asbestos workers—pulmonary asbestosis—is not infrequently seen. This condition was referred to in detail in the 1931 report. The cases then encountered were almost all pure cases of uncomplicated Asbestosis. However, since then, periodic observation has shown that the tuberculosis risk in Asbestosis, contrary to the earlier impressions of several observers, has to be seriously reckoned with. In our series several cases have, more 56 recently, developed a superimposed tuberculous infiltration, and all our cases of pure pulmonary Asbestosis have, from the beginning-, been kept under the closest possible scrutiny. We now consider that the phthisical risk in Asbestosis will probably prove to equal that in Silicosis. A case of modified Silicosis—Anthracosis— complicated by Phthisis, was also encountered in a South Wales Anthracite Collier. X-Ray Examinations of the Chest. The number of these examinations have increased by leaps and bounds, year by year, as the following figures show :— 1928. 1929. 1930. 1931. 1932. 1933. 29 97 302 352 454 533 (The figures for the last 4 years include screenings and films.) The examination of every new case is regarded as incomplete without, among other investigations, a very complete radiological examination. The correct interpretation of chest X-ray films demands the most perfect technique, and a poor film is worse than useless. The greatest possible attention has, therefore, to be paid to the quality of the radiogram, and subsequent radiograms for purposes of comparison concerning progress must be taken under precisely the same conditions. The Clinic has, unfortunately, through the untimely death of the Director of the Radiological Department of the Brompton Hospital, lost a never-to-be-forgotten friend. His courtesy and kindness to us and our patients can never be appraised. With the ever-increasing use which is being made of radiology in the diagnosis and treatment of chest disease, better and more complete radiological facilities near at hand will be inevitable. With the advent of the New Clinic the problem becomes even more acute. Acute Adolescent Phthisis. Acute fulminating pulmonary tuberculosis, particularly in young girls between 15 and 25, has become a very real problem in the country generally, and this Borough is no exception to the rule. 57 In a number of cases investigated, inadequate rest and unsuitable or inadequate nutrition appear to be among the predisposing causes. Many of these girls after completing a hard day's work return home to begin work of another kind by having to assist in the domestic needs of the home. Others indulge in social amusements, e.g., dancing to excess to a late hour, and are thereby prevented from obtaining adequate rest. It cannot be too strongly emphasised that adequate rest and a highly nutritious and wellbalanced diet are essential to the maintenance of good health and resistance, particularly at the adolescent period of life. Pulmonary Tuberculosis in Children. This condition is comparatively rare in children, although of course it can and does occur. The diagnosis of this condition is often made on slender or insufficient evidence. This is bound to result in disadvantage to these children in later life. Poor physique associated with malnutrition of course requires treatment, and this is obtainable through the School Medical Service. Particular attention has to be paid to contact cases of a positive sputum, but Tuberculous infection has to be carefully differentiated from clinically active disease, the latter demanding notification. X-ray examinations and positive or negative skin reactions to tuberculin may be of considerable help in diagnosis and are always fully utilised. The use of the Mantoux test was fully described in the 1932 report. There have been 50 Mantoux tests made in connection with the work of the Clinic during the year 1933. These tests were carried out at the East Ham Memorial Hospital. Prevention. The greatest danger for children is the patient with tubercle bacilli in the sputum living in the same household, particularly if overcrowding exists, and separation of the child from such sources of infection is urged on every possible occasion. The utilisation of the Grancher System, whereby healthy children of tuberculous patients are boarded out in the country, is made whenever possible. 58 Many children are sent to a School of Recovery by the School Medical Department, or to Convalescent Homes through the Invalid Children's Aid Association. The presence of Open-Air Schools (a) for delicate children, and (b) for tuberculous children not requiring residential treatment, would be of very material advantage. The Use of Thoracic Surgery in Treatment. Increasing use is being made of surgical collapse of the lung in the treatment of carefully selected cases. The operations of Phrenic Evulsion and Thoracoplasty in the hands of a specialised thoracic surgeon now present no more risk than any other major operations. It is essential, however, that the closest co-operation between the physician and thoracic surgeon should be secured in the interests of the patient. In connection with the work of the Clinic there have been 9 Thoracoplastic and 6 Phrenic Evulsion operations. During the year a young woman aged 30 years, who was almost moribund with advanced disease in the left lung complicated by advanced tuberculous laryngitis, has been saved by a thoracoplastic operation. Moreover, her larynx has healed and her voice has returned. She is shortly to go to the Papworth Colony, where it is hoped she will resume her work as a typist in a protected atmosphere. Specific Therapy in Treatment. The use of Sanocrysin, Insulin, Calcium and Tuberculin is utilised in selected cases often with great advantage. 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, 59 The treatment includes extractions, fillings, and dentures where necessary. Full use is made of these valuable facilities, often with considerable benefit to the patient on the principle that " a healthy mouth favours a healthy body." AFTER-CARE. After-Care Committee. The After-Care Committee has continued to do excellent work during the year. Its value in assisting necessitous cases makes the scheme more effective. Forty-one 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. To raise funds a Flag Day, which realised £29 18s., was held in October, and three Dances showed a profit of £3 12s. 5d. Contribution boxes at the Harts Sanatorium and Tuberculosis and Chest Clinic realised £3 19s. 3d. and £1 3s. 3d. respectively. Handicraft Class. It is hoped in the new Clinic to have an active class meeting regularly for those unfit for ordinary emplovment, and that the Committee will provide for the services of an Instructor, no success having been made in securing a voluntary instructor. The psychological effect in rendering some of these patients even partially self-supporting cannot help but react favourably on their physical condition. It is hoped also in the new Clinic to investigate, with the aid of a psychiatric social worker, the psychological factor in the origin and treatment of certain selected cases. The importance of the psychological factor in treatment was referred to in the 1932 report. We know how necessary it is during a lengthy illness like tuberculosis to keep mind and energy alive and fresh and to divert the patient's thoughts from the illness to useful things. The weeks and months that have to be sacrificed to 60 regain health should not be wasted. Again even when health is regained, idleness and want of mental occupation create an atmosphere of dissatisfaction with themselves and their surroundings and lead to fault finding and depression, thus bringing into play a factor that is definitely unfavourable to recovery, and the maintenance of recovery. Housing Accommodation for Tuberculous Patients. The home conditions of certain tuberculous subjects, on their return from sanatorium, soon begin to affect the value of their stay and excellent training which they have had at a sanatorium. The tuberculous subject must have a bedroom to himself, and there, at any rate, live a sanatorium mode of life. He should endeavour to make his bedroom his own little sanatorium, and to practice this routine during the period when he is not at work—often two-thirds of the day. Many tuberculous patients are quite unable to afford the cost of adequate accommodation. Others are unable to obtain suitable accommodation because they are known to be tuberculous. In the interest of prevention of disease to the non-tuberculous population, and in the interests of the affected tuberculous subject and his family, some special facilities for the impoverished tuberculous subject should be available, particularly where : (1) There is a sputum positive case. (2) Overcrowding cannot be remedied except by re-housing. In the long run this would prove to be a great financial saving. The Work of the Tuberculosis Nurses. The valuable work of the Tuberculosis Nurses both at the Clinic and at the homes of the tuberculous patients cannot be overemphasised. Limitation of staff prevents this work from being carried out to the full, but in the new Clinic it is hoped that this will be rectified. Colonisation. In some instances requests have been made by patients during the year asking to be allowed to colonise at the existing Village Settlements. 61 The protected lives they lead at such places as Papworth would enable them to live with their families in a protected atmosphere under constant medical supervision. Patients may live with their families and work under sanatorium conditions. The nature and hours of work are under the control of the Medical Director. The tuberculous subject is thus relieved of a considerable degree of anxiety and domestic worry, and is able thereby to maintain the progress originally made. It is of course essential to explain the whole principle of Colonisation to the patient so that anywrong impressions he may have, may be corrected before he enters a Colony. He is given to understand that unless he agrees to colonise permanently he is really wasting the Council's money. Nutritional Factor. The nutritional factor in a disease like pulmonary tuberculosis is equally important with the infective factor, and demands close attention. Impoverished nutrition means lowered resistance and extension of the disease. Close attention, therefore, has to be paid to the nutritional factor in all cases presenting themselves for treatment. It is essential that the patient should have a good appetite. The problem of loss of appetite in certain cases is one which may be set with difficulties and disappointments from the point of view of treatment. There are a large number of medicaments, yet not infrequently they prove to be of no avail. In the poorly nourished patient with little or no appetite and a feeble resistance, the use of Insulin in stimulating appetite has proved to be a factor of considerable importance. Where all the usual measures have failed, patients will often be found to be eating with a real appetite and gusto by this method. Its indications and contra-indications, however, are very definite and have to be strictly adhered to. I would once again wish to express my deep sense of gratitude to the Nurses and the Clerical Staff for their loyal and constant help and co-operation, which have played no little part in the successful working of the Clinic during the year. 62 TABLE 18. Return showing the work of the Tuberculosis and Chest Clinic, 1933. 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 62 45 2 2 8 9 9 4 70 54 11 6 141 (b) Diagnosis not completed — — — — — — — — 7 2 1 2 12 (c) Non-tuberculous — — — — — — — — 42 36 6 4 88 B.—Contacts examined during the year:— (a) Definitely tuberculous ... 9 12 3 4 — 1 — 1 9 13 3 5 30 (6) Diagnosis not completed — — — — — — — — 5 2 7 8 22 (c) Non-tuberculous — — — — — — — — 33 53 60 65 211 C.—Cases written off the Clinic Register as — (a) Recovered — 1 3 — 1 — 1 — 1 1 4 — 6 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Clinic Register as tuberculous — — — — — — — — 84 106 70 74 334 D.—Number of Cases on Clinic Register on December 31st, 1933 ;— (a) Definitely tuberculous 348 292 34 11 71 77 80 34 419 369 114 45 947 (b) Diagnosis not completed — — — — — — — — 12 4 8 10 34 63 1. Number of cases on Clinic Register on January 1st, 1933 945 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 33 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of " 86 4. Cases written off during the year as Dead (all causes) 75 5. Number of attendances at the Clinic (including Contacts) 4051 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 22 7. Number of consultations with medical practitioners :— (а) Personal 53 (б) Other 278 8. Number of visits by Tuberculosis Officers to Homes (including personal consultations) 98 9. Number of visits by Nurses or Health Visitors to Homes for Clinic purposes 4191 10. Number of (а) Specimens of sputum, &c., examined 931 (б) X-ray examinations made (inclusive of both film and screen examinations) 533 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 326 Number of Clinics for the treatment of Tuberculosis (excluding centres used only for special forms of treatment):— Provided by the Council 1 65 TABLE 19. PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1933 of all patients remaining on the Clinic Register ; and (6) 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 1929 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 Class T.B. minus Class T.B. plus j Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 T"otal 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 1 (a) Remaining on Clinic Register on 31st December. Disease Arrested Adults M. 21 3 4 — 7 2 1 1 — 2 2 1 1 — 2 4 1 — — 1 2 — 1 — 1 F. 9 3 3 — 6 2 — 1 — 1 2 — — — — 7 — — — — 5 — — — — Children 25 — — — — 1 — — — — 6 — — — 3 — — — — 4 1 — — 1 Disease not Arrested Adults M. 22 12 17 1 30 2 1 5 1 7 2 1 4 — 5 5 2 6 — 8 6 3 9 — 12 F. 17 8 16 3 27 3 1 3 — 4 1 — 3 — — 8 2 1 — 3 3 3 6 — 12 Children 9 — 2 — 2 3 — — — — 3 — — — — 3 — — — — 5 — — — — Condition not ascertained during the year 5 — 1 — 1 — — — — — — 1 — — 1 2 1 — — 1 1 — — — — Total on Clinic Register at 31st December 108 26 43 4 73 13 3 10 1 14 16 3 8 — 11 32 6 7 — 13 26 7 16 1 24 (b) Not now on Clinic Register and reasons for removal therefrom. Discharged as Recovered Adults M. 11 2 — — 2 1 — — — — 1 — — — — — — — — — — — — — — F. 14 1 — — 1 1 — — — — — — — — — — — — — — — — — — — Children 10 — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of or otherwise removed from Clinic Register 304 34 48 3 85 53 8 25 — 33 44 11 19 2 32 47 18 20 3 41 37 9 22 — 31 Dead Adults M. 37 5 49 27 81 9 2 24 12 38 5 3 26 11 40 10 1 23 9 33 3 3 19 16 38 F. 25 4 27 21 52 6 6 21 10 37 1 1 16 8 25 3 5 10 9 24 7 2 9 6 17 Children 5 — 1 1 2 1 — — 1 1 4 1 — — 1 1 — 1 — 1 — — — — — Total written off Clinic Register 406 46 125 52 223 71 16 70 23 109 55 16 61 21 98 61 24 54 21 99 47 14 50 22 86 Grand Totals 514 72 168 56 296 84 19 80 24 123 71 19 69 21 109 93 30 61 21 112 73 21 66 23 110 (a) Remaining on Clinic Register on 31st December. 1930 1931 1932 1933 Disease Arrested Adults M. 3 2 — — 2 1 — — — — — — — — — — — — — — F. 1 — — — — 1 — — — — — — — — — — — — — — Children 2 — 1 — 1 — — — — — — — — — — — — — — — Disease not Arrested Adults M. 9 7 9 2 18 8 4 10 — 14 19 7 26 — 33 26 7 34 7 48 F. 9 3 5 — 8 9 5 9 — 14 22 6 15 1 22 28 5 21 3 29 Children 5 — — — — 3 — — — 4 — — — — 12 — — — — Condition not ascertained during the year — 1 — — 1 — — — — — 2 — 1 — 1 — — — — — Total on Clinic Register at 31st December 29 13 15 2 30 22 9 19 — 28 47 13 42 1 56 66 12 55 10 77 (b) Not now on Clinic Register and reasons for removal therefrom. Discharged as Recovered Adults 1 M. — — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — — — Lost sight of or otherwise removed from Clinic Register 12 4 9 3 16 15 7 15 4 26 12 2 12 — 14 1 — 4 1 5 Adults M. 7 3 11 19 33 4 1 9 5 15 3 1 10 5 16 1 — 3 4 7 Dead F. 3 3 12 10 25 5 2 10 8 20 3 — 4 7 11 1 — 1 3 4 Children — — — 2 2 — — — — — 1 — 1 — 1 — — — — Total written off Clinic Register 22 10 32 34 76 24 10 34 17 61 19 3 27 12 42 3 8 8 16 Grand Totals 51 23 47 36 106 46 19 53 17 89 66 16 69 13 98 69 12 63 18 93 66 Table 20. NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1933 of all patients remaining on the Clinic Register; and (b) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the return relates. Previous to 1926 1926 1927 1928 1929 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 00Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Clinic Register on 31st December. Disease Arrested Adults M. 3 - 2 1 6 - — — 1 1 — — — 1 1 1 - — — 1 1 — 1 — 2 F. 4 - - 1 5 - 1 — — 1 — — — — — — — — 1 1 1 1 — - 2 Children 4 2 1 19 26 2 — — 2 4 1 1 — 3 5 1 — — 2 3 2 1 — 4 7 Disease not Arrested Adults M. 2 1 2 5 1 — 2 — 3 — — — — — 2 1 i — 4 1 — — 3 4 F. 6 — 2 — 8 — — - - — — - — — — — — — 3 3 — — — 1 1 Children 6 - 2 17 25 — 1 — 1 2 2 — 1 2 5 2 — — 5 7 4 3 — 11 18 Condition not ascertained during the year - - - 2 2 - - - - - - - - - - - - - - - - 1 — 1 2 Total on Clinic Register at 31st December 25 3 9 40 77 3 2 2 4 11 3 1 1 6 11 6 1 1 11 19 9 6 1 20 36 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 1 - - - 1 - - - - - - - - - - - - - - - F. 3 — 1 1 5 - - - 1 1 - - - - - - - - - - - - - - - Children 7 2 1 11 21 — — — 1 1 — — — — - — — — — — - — - 1 1 Lost sight of or otherwise removed from Clinic Register 52 9 18 87 166 10 2 6 13 31 6 1 2 9 18 — 1 5 12 18 5 — 3 9 17 Dead Adults M. 2 - 1 - 3 — — — - — - 1 — - 1 — — - — — — — — — — F 3 — — — 3 1 — — - 1 - — — — - 1 — — — 1 — — — — — Children 4 - - - 4 - - - - - - - - - - - - - - - - - - 1 1 Total written off Clinic Register 76 11 22 100 209 12 2 6 15 35 6 2 2 9 19 1 1 5 12 19 5 - 3 11 19 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 101 14 31 140 286 15 4 8 19 46 9 3 3 15 38 7 2 6 23 38 14 6 4 31 55 1930 1931 1932 1933 (a) Remaining on Clinic Register on 31st December. Disease Arrested Adults M. - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - Children 1 - 2 6 9 2 — — — 2 — — — — — — — — — Disease not Arrested Adults M. 1 1 — 2 4 — — — 2 2 1 — 1 1 3 2 1 2 3 8 F. — 2 1 3 6 — 3 2 1 6 4 1 — — 5 4 — 2 — 6 Children 1 1 1 6 9 1 — — 1 2 8 5 1 7 21 6 5 — 10 21 Condition not ascertained during the year 1 — — 2 3 1 - - - 1 - - - - - - - - - - Total on Clinic Register at 31st December 4 4 4 19 31 4 3 2 4 13 13 6 2 8 29 12 6 4 13 35 Transferred to Pulmonary - — — — — — — — — — — — — — — — — — — — (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 — 1 2 5 8 4 — 3 8 15 2 — 1 2 5 — 1 1 — 2 Dead Adults M. — — 2 — 2 — — — — — 2 — — — 2 — — — — — F. - - - - - - - - - - - - 1 - 1 - - - 1 1 Children - - - 1 1 - - - - - - - - - - - - - - - Total written off Clinic Register — 1 4 6 11 4 — 3 8 15 4 — 2 2 8 — 1 1 1 3 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 4 5 8 25 42 8 3 5 12 28 17 6 4 10 37 12 7 5 14 38 67 Dental Treatment of Uninsured Tuberculous Patients. The Council decided in 1932 that cases of uninsured persons attending the Tuberculosis and Chest Clinic and recommended for dental treatment should be dealt with through the local dentists, providing the fees charged did not exceed those provided for under the National Health Insurance Regulations. During 1933, seven such patients received dental treatment at the expense of the Council, after the financial circumstances of the families had been investigated. The following are the details:— Case No. Date Treatment. Cost £ s. d. 1 1.3.33 Two extractions 5 0 2 13.6.33 Thirteen Extractions, Upper Dentures (9) 4 18 6 3 13.6.33 Fifteen Extractions, Complete Upper and Lower Dentures 5 0 0 4 13.6.33 Fourteen Extractions, Complete Upper and Lower Dentures 5 15 0 5 6.7.33 Fourteen Extractions, Complete Upper and Lower Dentures 5 10 0 6 22.9.33 Seven Extractions and Stumps, Upper Dentures 3 0 0 7 29.12.33 Fifteen Extractions, Complete Upper and Lower Dentures 5 0 0 £29 8 6 “HARTS” SANATORIUM. Dr. Cheater reports as follows:— In 1933 the number of patients discharged was 108 (66 males, 38 females, 4 children). Of these 79 were insured (59 males, 20 females), and 25 non-insured (7 males, 18 females). Deaths 11 (included in the 108 above). Average duration of treatment 27.94 weeks. Number of patient days 21,336. Number of beds available at end of year, 80. Average number of beds occupied January 1st to October 23rd, 55.54 (99.2 per cent.). Average number of beds occupied October 23rd to December 31st, 70.94 (88.7 per cent.). 68 The immediate results of treatment are as follows:— 39 cases were discharged as "Quiescent." 58 cases were discharged as " Not Quiescent." Of the latter 48 (30 males, 17 females and 1 child) were "improved," and 10 (6 males and 4 females) were "not improved." Three of the children were non-pulmonary cases. The average duration of treatment for 1933 was approximately 7 weeks longer per patient than for 1932, this being due largely to the fact that in view of the completion of the new block more advanced cases were admitted than hitherto. When the new pavilion was opened in October all the East Ham cases of Pulmonary Tuberculosis then under treatment in Whipps Cross Hospital were transferred to "Harts," the number being 13 (5 males and 8 females). A considerable number of the patients had previous sanatorium treatment, 24 (16 males and 8 females) one period, 5 (3 males and 2 females) two periods, and 1 female three periods. The deaths numbered 11, and 4 of these occurred in the single cubicles after the new pavilion was opened, and it was strikingly noticeable not only what comfort the seclusion gave to patients and relatives, but also the immense psychological effect upon those more fortunate patients who were up and about, not to have fellow-sufferers dying in their midst. Apart from those cases transferred from Whipps Cross Hospital there were 22 patients admitted by ambulance in 1933, 15 from their homes and 7 from general hospitals. Speaking generally, those so admitted from their homes were acutely ill and advanced, whilst those from the hospitals were usually fairly early cases and derived the utmost benefit from sanatorium treatment. There can be no doubt that by removing advanced pulmonary cases from homes where housing conditions are inadequate and segregating them in a hospital-block as can now be done at "Harts," an appreciable effect will in due time be noticed upon the incidence of tuberculosis in East Ham. Up to the end of 1933 no action had been necessary to implement Section 62 of the Public Health Act, 1925, by which an advanced case can be compelled to enter an institution. 69 Artificial Pneumothorax. The number of refills in 1933 was 178 (approximately the same as in 1932). As mentioned in previous reports the lack of X-ray facilities on the spot is definitely hindering this useful method of treatment. It is to be hoped that now the requisite room has been built, the Council will see its way clear to provide the necessary apparatus, because there are many cases that cannot be transported to Buckhurst Hill and back, e.g., acute hæmoptyses, pleurisies, etc., for whom an X-ray examination is necessary to decide the form of treatment to be carried out. Bacteriology. The number of sputa examined in 1933 was 263 as compared with 251 in 1932. Again, this year "monilia" was found in two cases but as mentioned in my report for 1932, no definite deleterious effect was caused by this fungus, in fact it easily disappeared (as practically all fungi of this nature do) with appropriate treatment. Within the last year or two medical literature has contained numerous observations and opinions on the pathological significance of monilias found in sputa or obtained direct from the bronchi, and the concensus of opinion agrees with my previous remark that on the whole these fungi do not exert any appreciable detrimental effect upon the patients in whose sputa they are found. Several specimens of pleuritic effusion, urine, pus, etc., and two specimens of cerebro-spinal fluid from a case of tuberculous meningitis were examined microscopically. Six blood-sugar estimations were obtained in cases of diabetes mellitus in collaboration with the pathological department of the East Ham Memorial Hospital. The Complications met with and treated were as follows:— (a) Due directly to tuberculosis— Tubercular laryngitis 10, tubercular pleurisy 3, tubercular otitis media 1, abdominal tuberculosis 4, cervical glands 2, spinal caries 1, tubercular kidney 1, fistula 1, meningitis 1. 70 (b) Not directly due to tuberculosis— Pyorrhoea and dental caries 5, diabetes mellitus 2, bronchitis and emphysema 2, pneumokoniosis 1, boils and skin disease 2, epilepsy 1, etc. The recreational facilities for the patients continue to be numerous and varied. Towards the end of the year the billiard table was reconditioned and during the coming year it is proposed to convert the croquet lawn into a putting-green. Finally it is my pleasant duty to thank those members of dramatic societies who so kindly come during the winter months and give entertainments. Both patients and staff thoroughly enjoy their very good performances and look forward for days beforehand to each concert or play. TABLE 21. HARTS SANATORIUM.—Year ended 31st March, 1934. Expenditure. Cost per Patient per week. £ S. d. Salaries and Wages 2,802 17 1 Superannuation 99 0 7 Provisions 1,952 11 11 Disinfectants, Drugs and Appliances 114 0 8 Coal, Coke and Firewood 372 2 3 Electricity, Gas and Water 596 3 7 Furniture, Bedding and Linen 198 1 2 Uniforms and Dresses 83 0 6 Chandlery and Sundries 337 2 1 Crockery and Hardware 36 0 2 General Repairs 538 3 3 Garden Implements, Seeds, etc. 71 0 6 Printing, Stationery and Advertisements 41 0 3 Rent of Telephones 34 0 2 Rates, Taxes and Insurance 277 1 8 X-Ray Examinations 54 0 4 Installation of Automatic Telephone System 85 0 6 £7,689 46 8 71 TABLE 22. Number of Beds available for the Treatment of Tuberculosis on the 31st December in Institutions belonging to the Council. Name of Institution For Pulmonary Cases For NonPulmonary Cases Total Adults Children under 15 Adults Children under 15 The Harts Sanatorium, Woodford Green, Essex 78 2 — — 80 TABLE 23. Return showing the extent of Residential Treatment during the Year in Harts Sanatorium. In Institution on Jan. 1 (1) Admitted during the year. (2) Discharged during the year. (3) Died in the Institution. (4) In Institution on Dec. 31. (5) Number of definitely tuberculous patients admitted tor treatment Adults M. 35 74 62 4 43 F. 18 50 31 7 30 Children ... 3 2 4 - 1 Total ... ... 56 126 97 11 74 Grand Total 56 126 97 11 74 TABLE 24. 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 1 1 - 5 3 - 3 1 - 1 - - 10 5 - 15 Not quiescent 1 2 - 1 - - - - — 1 1 — 3 3 - 6 Died in Institution - - - - - - - - - - 1 - - 1 — 1 Class T.B. plus. Group 1. Quiescent 1 - - 3 - - - - - - - - 4 - - 4 Not quiescent — 1 - - - - - — - - - - - 1 — 1 Died in Institution - - - - - - - - - - - - - - - Class T.B. plus Group 2. Quiescent 1 1 - 7 2 - 3 1 - 1 - 1 12 4 1 17 Not quiescent 8 6 — 9 3 — 7 1 — 3 1 — 27 11 — 38 Died in Institution — — — — — — — 1 - - - - - 1 — 1 Class T.B. plus Group 3. Quiescent - - - - - - - 1 - - - - - 1 - 1 Not quiescent — 1 — 2 4 — 2 1 — 2 — — 6 6 — 12 Died in Institution 3 3 — 1 1 — — — — 1 — 4 5 — 9 Totals (pulmonary) 15 15 — 28 13 - 15 6 — 8 4 1 66 38 1 105 72 TABLE 24—continued. Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Grand Totals. Under 3 months. 3-6 months. 6-12 months. More than 12 months. Totals. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Non-Pulmonary Tuberculosis. Bones and Joints. Quiescent - - - - - - - - - - - - - - - - Not quiescent - - - - - - - - - - - - - - - - Died in Institution - - - - - - - - - - - - - - - - Abdominal. Quiescent - - - - - 1 - - - - - - - - 1 1 Not quiescent - - - - - - - - - - - - - - - - Died in Institution - - - - - - - - - - - - - - - - Other Organs Quiescent - - - - - - - - - - - - - - - - Not quiescent - - - - - - - - - - - - - - - - Died in Institution - - - - - - - - - - - - - - - - Peripheral glands. Quiescent - - - - - - - - - - - 1 - - 1 1 Not Quiescent - - 1 - - - - - - - - - - - 1 1 Died in Institution - - - - - - - - - - - - - - - - Totals (non-pulmonary) - - 1 - - 1 - - - - - 1 - - 3 3 73 74 TABLE 25. 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 (1) Admitted during the year. (2) Discharged during the year. (3) Died in the Institutions. (4) InInsti tutions on Dec. 31. (5) Number of definitely tuberculous patients admitted for treatment 1 Adults M. 43 82 69 5 51 F. 22 54 35 7 34 Children ... 35 27 27 — 35 Total ... ... 100 163 131 12 120 Grand Total 100 163 131 12 120 TABLE 26. 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 1933. Admitted during the year. Discharged during the year. Died in the institutions. In Institutions on Dec. 31, 1933. Number of patients suffering from pul- ary tuberculosis admitted for treatment Adults M. 6 29 22 11 2 F. 7 19 22 3 1 Chil- ... - 3 3 — — Total ... ... 13 51 47 14 3 Number of patients A suffering from nonpulmonary culosis admitted for treatment Adults M. 1 - 1 - - F. 2 2 4 — — dren ... 1 1 2 — — Total ... ... 4 3 7 — — Grand Total 17 54 54 14 3 TABLE 27. Return showing the immediate results of Treatment of definitely tuberculous patients discharged during the Year from Institutions approved for the treatment of Tuberculosis (including "Harts" Sanatorium) Classification on admission to the Institution. Condition at time of discharge. Duration of Residential Treatment in the Institution. Grand Totals. Under 3 months. 3-6 months. 6-12 months. More than 12 months. Totals M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. M. F. Ch. Pulmonary Tuberculosis. Class T.B minus. Quiescent 1 1 - 5 3 - 3 1 4 2 - 2 11 5 6 22 Not quiescent 1 2 — 1 - - - - - 1 1 — 3 3 — 6 Died in Institution — — — — — — — — — — 1 — — 1 — 1 Class T.B. plus. Group 1. Quiescent 1 - - 3 - - - - - - - - 4 - - 4 Not quiescent — 1 - - - - - - - - - - - 1 — 1 Died in Institution — — — — — — — — — — — — — — — — Class T.B. plus. Group 2. Quiescent 1 1 - 9 2 - 3 1 - 1 - 1 14 4 1 19 Not quiescent 9 7 — 10 3 — 7 1 — 3 1 — 29 12 — 41 Died in Institution — — — — — — — 1 - - - - - 1 — 1 Class T.B. plus. Group 3. Quiescent - - - - - - - 1 - - - - - 1 - 1 Not quiescent - 1 — 2 4 — 2 1 — 2 — — 6 6 — 12 Died in Institution 3 3 — 1 1 - - - - - 1 — 4 5 — 9 Totals (pulmonary) 16 16 — 31 13 — 15 6 4 9 4 3 71 39 7 117 75 TABLE 27—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 - 3 I 1 3 5 Not quiescent - - - - - - - - - - - - - - - - Died in Institution — — — — — — 1 — — — — — 1 — — 1 Abdominal. Quiescent - - - - - 3 - - 2 - - - - - 5 5 Not quiescent - — - - - - - - - - - - — — — — Died in Institution — — — — — — — — — — — — — — — — Other Organs. Quiescent - - - - - - 1 - - - - - 1 - - 1 Not quiescent — 1 - - - - - 1 - - - - - 2 — 2 Died in Institution — — — — — — — — — — — — — — — — Peripheral Glands. Quiescent - - - - - 1 - - 3 - - 7 - - 11 11 Not quiescent — — 1 - - - - - - - - - — — 1 1 Died in Institution — — — — — — — — — — — — — — — — Totals (non-pulmonary) — 1 1 — - 4 2 2 5 1 — 10 3 3 20 26 76 TABLE 28. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications, 1933. During the Period 1.1.33 to 31.12.33. 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. Pulmonary Males — 4 2 1 10 20 13 14 18 9 1 92 92 „ Females 2 3 2 2 12 13 17 11 2 4 2 70 72 Non-pulm. Males 1 — 5 3 2 1 2 1 1 — — 16 16 „ Females — 4 — 3 2 — 3 2 2 — 2 18 19 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 over Total cases. Pulmonary Males — — — — 1 — 3 6 5 1 3 19 ,, Females — — 1 - 1 1 12 3 — 2 — 20 Non-pulmonary Males — 2 2 1 2 — 1 — 1 — — 9 Females - 1 1 1 — 1 — — 1 — — 5 77 TABLE 28—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 7 — transferable deaths from Registrar General 6 4 Posthumous notifications 2 1 " Transfers" from other areas (other than transferable deaths) 21 9 Other sources if any (specify) (Merchant Seamen) 3 — Notification Register. Number of cases of Tuberculosis remaining at the 31st December, 1933, on the Registers of Notifications kept by the Medical Officer of Health of the County Borough Pulmonary Non-pulmonary Total Cases Males Females Total Males Females Total 485 365 850 169 139 308 1,158 Number of cases removed from Registers during the year by reason inter alia of:— 1. Withdrawal of notification 1 — 1 — — — 1 2. Recovery from the disease 3 1 4 2 — — 6 3. Death 58 36 94 6 5 11 105 78 TABLE 29. Notified Cases of Tuberculosis, 1933. Ages. Pulmonary. Abdominal. Meninges. Bones and Joints. Glands. Other Organs. Disseminated. All forms. Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Males Females Totals Under 1 year - 2 2 - - - 1 - 1 - - - - - - - - - - - - 1 2 3 1 and under 2 - - - - - - - - - - 1 1 - - - - - - - - - - 1 1 2-3 1 - 1 — 1 1 1 - 1 — 1 1 — 1 1 — — — - - - 2 3 5 3-4 1 2 3 - - - - 1 1 - - - - - - - - - - - - 1 3 4 4-5 2, 1 3 - - - - - - - - - - - - - - - - - - 3 1 4 5-10 2 3 5 1 - 1 1 - 1 1 1 2 3 - 3 - - - - - - 8 4 12 10-15 1 2 3 1 - 1 3 1 4 1 2 3 - - - - - - - 1 1 6 6 12 15-20 11 13 24 1 - 1 - 1 1 1 - 1 1 - 1 1 1 2 - - - 15 15 30 20-25 20 14 34 - - - - - - 1 1 2 - - - - - - - - - 21 15 36 25-35 16 29 45 - 1 1 - - - - 1 1 1 1 2 2 — 2 - - - 19 32 51 35-45 20 14 34 - - - - - - - 1 1 — - — 1 1 2 - - - 21 16 37 45-55 23 2 25 - - - - - - - - - 1 1 2 — 2 2 - - - 24 5 29 55-65 10 6 16 - - - - - - - - - - - - 1 - 1 - - - 11 6 17 Over 65 4 2 6 — - - — - — — 2 2 — - — — — — - - - 4 4 8 Totals 111 90 201 3 2 5 6 3 9 4 10 14 7 3 10 5 4 9 - 1 1 136 113 249 79 80 TABLE 30. Tuberculosis. New Cases and Mortality, 1933. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulm. Pulmonary. Non-Pulm. M. F. M. F. M. F. M. F. Under 1 year — 2 1 - — 1 1 — 1 — 5 years 4 3 2 5 — — 1 - 5 — 15 „ 3 5 11 5 — - 4 1 16 — 25 „ 31 27 5 3 10 9 — 2 25 — 45 „ 36 43 4 5 22 25 2 1 45 — 65 „ 33 8 2 3 21 8 1 3 65 and upward ,, 4 2 — 2 6 2 - - Totals 111 90 25 23 59 40 9 7 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths for the year was 1-7. REPORT ON WORK AT THE BOROUGH INFECTIOUS DISEASES HOSPITAL, 1933. A description of the reconstructed Hospital was given in the reports for 1931 and 1932, and it is therefore unnecessary to detail the many improvements that have been effected. It will be seen from Table 31 that varied types of cases have been admitted, and to those familiar with Isolation Hospital administration, it is apparent that only by the additional provision of cubicle accommodation has the segregation and treatment of such patients been possible. Apart from this consideration, the numerous instances in which separation for some minor complication, or mild infectious complaint is necessary, or again when some operative procedure is indicated, the use of the cubicle ensures more adequate and effective treatment. 81 Frequently some cubicles have served the requirements of a discharge block and have permitted the thorough and complete disinfection of patients prior to their return home. The number of patients received for treatment during the year was 794. In addition, 183 were in hospital at the end of the year 1932, giving a total of 977 patients resident during the year. Apart from the treatment involved, often urgent and insistent —the need for careful diagnosis upon admission—the numerous complications, many not sufficiently serious to endanger the life of the patient, but of the utmost importance as regards his future health—and finally the absolute necessity for a careful and complete overhaul prior to discharge—all these factors can be said to entail no little responsibility or devotion to duty. In addition, the anxiety of parents for their little ones, whether seriously ill or otherwise, cannot be allayed by a cursory interview. It will be seen that the scope and exigencies of the work are very considerable. Many cases of children admitted to hospital were found to exhibit upon bacteriological examination diphtheria or pseudo diphtheria bacilli in nasal secretions. It is difficult to estimate the significance of such bacteria— some may be extremely virulent, others much less so or avirulent —but the necessity for constant vigilance must be apparent. Children acting as carriers although showing no obvious symptoms of the disease, may infect others, with fatal results. With the object of eliminating such dangers, swabs from the nose and throat of each patient presented for discharge have been taken, as a routine measure, in the majority of cases. This has necessitated the culture and bacteriological examination of 1,267 swabs. Diphtheria. During the year 176 patients were admitted as compared with 156 for the previous year. Of this number, 133 were faucial, 12 laryngeal, 21 nasal, 10 faucial and nasal. Thirty-five patients remained under treatment at the end of the year 1932. 82 In four instances some other infectious disease was found to be present. Of the cases admitted for treatment, the number of deaths was 19, giving; a total death-rate for completed cases of 10.6 per cent, as compared with 8.8 per cent. for last year. Of the fatal cases, five were hæmorrhagic—a particularly fatal type of the disease. Many cases called for large amounts of antitoxin and 52 patients received from 50,000 to 144,000 units In many instances this was given intravenously in order to afford immediate benefit. As I have previously pointed out, many of the patients were late in coming under treatment and exhibited severe infection upon admission. In many instances, the infection was extremely virulent in type with rapid growth of membrane and profound toxaemia. Such cases are less responsive to treatment and in debilitated infants and children of grave import. Tracheotomy was performed in two cases. In toxic and febrile cases, antistreptococcic serum was administered in conjunction with diphtheria antitoxin, often with marked effect. The age incidence of the patients admitted was as follows:— Years 0-5 5-10 10-15 15+ Total 47 85 24 20 176 Scarlet Fever. The number of patients admitted during the year was 569 (including 16 cases where other infectious illness was found to be present) compared with 580 for 1932. 141 patients remained under treatment at the end of the year 1932. There were five deaths, the mortality rate being 0.9 per cent., as compared with 0.16 per cent. for the previous year. Seven mastoid and two myringotomy operations were performed by the Visiting Surgeon. All the patients recovered. Several patients exhibited a moderate degree of albuminuria. With one or two exceptions, all recovered completely with hospital treatment. 83 The number of patients treated with Scarlet Fever serum totalled 124, in 3 instances injections of mixed serum being- given. Severe or prolonged complications were as follows, viz.:— 34 cases showed marked double adenitis. 35 cases of rhinorrhœa profuse. 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 128 253 112 76 569 Measles and Complications. Nine patients were admitted during the year. All were severe cases with complications. No deaths resulted. By the admission of such cases some relief was afforded to Whipps Cross Hospital, and it must be acknowledged that had not institutional treatment been available, recovery might not have ensued. Whooping Cough. Fourteen cases of severe illness were admitted during the year—one death resulted from bronchial pneumonia. Typhoid Fever. Two cases of Paratyphoid' were admitted. Both recovered. Erysipelas. Ten cases were admitted for treatment during the year. No deaths occurred. 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. 84 Only those reacting negatively to the Dick test are permitted to commence duties in the scarlet fever wards. This occasionally necessitates delay in making use of the services of the nurse. Diphtheria prophylaxis is carried out before any member of the nursing staff is allowed in these wards. One nurse contracted Diphtheria, one Scarlet Fever, and one Diphtheria and Scarlet Fever. TABLE 31. Admissions, Discharges, etc., 1933—Borough Infectious Diseases Hospital. Disease. Remaining at end of 1932 Admitted during 1933. Discharged during 1933. Died during 1933. Remaining at end of 1933. Diphtheria 35 173 159 19 30 Diphtheria and Chicken Pox — 1 — — 1 Diphtheria and Impetigo — 1 — — 1 Diphtheria and Measles — 1 — — 1 Scarlet Fever 141 553 562 4 128 Scarlet Fever and Chicken Pox 1 2 3 — — Scarlet Fever and Diphtheria — 12 8 1 3 Scarlet Fever and Measles — 2 — — 2 Abscess of Neck — 1 1 — - Chicken Pox — 3 3 — — Croup — 1 1 — — Dermatitis — 1 1 — — Erysipelas — 10 9 — 1 Measles — 9 2 — 7 Pharyngeal Abscess — 1 1 — — Rubella — 1 1 — — Whooping Cough — 9 8 — 1 Whooping Cough and Complications - 5 4 1 — ? Diphtheria 1 3 4 — — ? Scarlet Fever 1 3 4 — — ? Typhoid — 2 2 — — Debility (Post Whooping Cough) 1 — 1 — — Marasmus 1 — 1 — — Measles and Complications 1 — 1 — — Tonsillitis 1 — 1 — —- 183 794 777 25 175 85 TABLE 32. BOROUGH INFECTIOUS DISEASES HOSPITAL. Year ended 31st March, 1934. Expenditure Cost per Patient per week £ s. d. Salaries and Wages 6,083 19 0 Superannuation 167 0 6 Provisions 3,256 10 2 Anti-toxin 571 1 9 Disinfectants, Drugs and Appliances 343 1 1 Coal, Coke and Firewood 880 2 9 Electricity, Gas and Water 1,148 3 7 Furniture, Bedding and Linen 231 0 9 Uniforms and Dresses 100 0 4 Chandlery and Sundries 603 1 11 Crockery and Hardware 81 0 3 General Repairs 882 2 9 Garden Implements, Seeds, etc. 65 0 2 Maintenance and Upkeep of Ambulances 563 1 9 Printing, Stationery and Advertisements 90 0 4 Rent of Telephones 53 0 2 Rates, Taxes and Insurance 344 1 1 Motor Vehicle Reserve ... 100 0 4 £15,560 48 8 THE WORK OF THE MATERNITY AND CHILD WELFARE DEPARTMENT, 1933. 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. 86 Infant Welfare Clinics. Attendances at Infant Welfare Clinics. Number of general Clinics held during the year 345 Number of individual children who attended the Clinics 4,640 Total number of attendances 31,483 Total number of children who attended the Clinic for the first time during the year:— (1) Children under 1 year 1,312 (2) Children between the ages of 1-5 years 399 Number of medical consultations at general Clinics 12,867 Number of medical consultations at special Clinics 1,136 Total number of visits to all Infant Welfare Clinics 32,619 The daily average attendances at the Clinics were as follows:— Central Clinic, Monday afternoon 84 Plashet Grove, Tuesday morning 76 North Woolwich, Tuesday afternoon 24 Masterman Road, Wednesday afternoon 101 Central Clinics, Thursday morning 93 Manor Park, Thursday afternoon 122 Plashet Grove, Friday afternoon 141 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 102.8, compared with 98.6 in 1932. During 1933, 4,640 children attended the centres, an increase of 663 on the previous year. The total attendance of infants from 0—5 increased from 31,335 in 1932, to 31,483 in 1933, an increase of 148 over 1932. 87 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. Clinics for the examination of " Toddlers "—children between the ages of two and five years—are held on Monday and Wednesday mornings and on alternate Tuesday afternoons. During 1933, 917 examinations were made. In cases where defects were found, the patients were transferred to the appropriate Specialist Service. A record of cases examined is transferred to the School Medical Service when the children enter school. Immunisation Clinic. The Immunisation Clinics of the Maternity and Child Welfare Service was continued throughout 1934. Forty sessions were held and 692 inoculations were made. 240 children were thus afforded protection by this means. The majority of children attending were given three injections of immunising fluid, and 199 cases were thus fully protected. Thirty-three additional attendances were made by 11 cases who showed some reaction to the initial doses, and who consequently received a longer course of smaller injections. In addition, 30 children, whose immunisation was not complete during the year, received 39 injections. 164 Schick tests were performed, and these cases attended once again for reading. Four cases were found to be still Schick positive after a normal immunisation course; they were given a second course of injections, and after testing, proved Schick negative. Tonsils and Adenoids. During 1933, 171 children received operative treatment, as compared with 207 in 1932. 88 Ringworm. No cases of Ringworm of the scalp were referred to the X-Ray Department for radical treatment. Dental Treatment. Mothers and children referred from the Maternity and Child Welfare Centres are treated by the School Dentist, two afternoons in each week being set apart for this purpose. 90 mothers and 311 infants were referred to the dental department during 1933. Ophthalmic Treatment. Ophthalmic defects requiring special treatment are seen at the special clinic each week by the School Ophthalmic Surgeon. During 1933, 51 cases were referred to the School Ophthalmic Clinic. Aural Treatment. Aural cases requiring special treatment are referred to the School Aural Surgeon. During 1933, 12 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. The statistics for 1933 are as follows :— Number of medical consultations ... ... 1,136 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. 89 All cases notified are visited by the Health Visitor as soon as possible after the doctor or midwife has ceased to attend. Advice is given with regard to the care, management, feeding and clothing of the child, and also the general health and care of the mother. Thereafter, periodic visits are made to the homes of infants during the first two years of life, and, as far as possible, at wider intervals during the next three years, up to the time when the child comes under the observation of the School Medical Service. The visits made by the Health Visitors during 1933 were 21,664. Visits to infants under one year of age 8,255 Visits to children over one year of age 12,358 Visits to Tonsils and Adenoid cases 136 Visits to Ante-natal cases, first visits 287 Visits to Ante-natal cases, revisits 94 Visits to Foster Mothers 315 Special visits not included in the above group 219 21,664 The Work of the Health Visitors in the Homes of the Borough. 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. 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) Ophthalmic Neonatorum (c) Puerperal Fever and Pyrexia. (d) Visits to Tonsils and Adenoid cases. (e) Pneumonia. (f) Infantile Diarrhoea. (g) Other special visits. 90 Still Births. The number of still births registered during the year was 62. The proportion of still births to live births was as 1 to 31. The still birth rate was 3.2 per cent. of the registered live births. On investigation into 57 of these still births it was found that in 54 cases the months of pregnancy at which the still births took place were as follows:— 7th month 4 8th month 14 9th month 36 No information 3 An analysis of the causes to which the still births were attributable will be found in the following table:— Malpresentation 1 Prolonged labour2 Excessive size of Foetus (including post maturity) 2 Contracted Pelvis 3 Placenta Praevia 1 Ante-partum haemorrhage 2 Albuminuria 4 Eclampsia 1 Spina Bifida 1 Breech presentation 9 Prematurity 11 Deformity 2 Causes unknown 18 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 332 Subsequent attendances 639 Total number of attendances 971 Average attendance of expectant mothers per session 19.04 Number of patients referred to Dental Clinic 58 91 The following- table gives an analysis of the pre-maternal cases found to be slightly or seriously abnormal— Contracted pelvis 5 Albuminuria 23 Hyperemesis gravidarum 5 Ante-partum hæmorrhage 3 Malpresentations 8 Cervicitis 6 Valvular disease of the heart 4 Varicose veins 12 Phlebitis 3 Hæmorrhoids 5 Anaemia 8 Bronchitis 4 Expectant mothers are visited by the Health Visitors in their homes and given advice regarding arrangements for confinement and general hygiene. During 1933, 381 visits were paid to expectant mothers. Maternity Accommodation. Under the provisions of the Maternity and Child Welfare Act, 1918, empowering Local Authorities to make arrangements for the institutional treatment of complicated midwifery cases, and for women whose homes are unsuitable for their confinements, 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 1933, three were referred to Queen Mary's Hospital, and 77 were admitted to Forest Gate Sick Home. Inspection of Midwives. Fifty midwives notified the Local Supervising Authority of their intention to practice within the Borough during 1933. Thirty-six visits of inspection were made by the Inspecting Medical Officer during the year. 92 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. During the year help was obtained in 179 cases as follows:— Mother— Ruptured perineum 38 Prolonged labour 29 Ante-partum hæmorrhage 5 Post-partum hæmorrhage 1 Retained placenta 16 Rise of temperature 19 Malpresentations 7 Extended breech 2 Other causes 40 157 Child- Prematurity and dangerous feebleness 8 Unsatisfactory condition of infant 7 Discharging eyes 1 Skin eruptions 2 Other causes 4 22 Puerperal Fever and Puerperal Pyrexia. Seven cases of Puerperal Fever and ten cases of Puerpera Pyrexia were notified during the year under the Regulations o 1926 and 1928. The Puerperal Fever case rate was 3.6 per 1,000 births and the Puerperal Pyrexia case rate 5.2 per 1,000 births. The death rate for Puerperal Fever was 1.00 per 1,000 births (live and still). 93 Maternal Mortality. There were six deaths associated directly with pregnancy. The Maternal Mortality rate was, therefore, 3.01 per 1,000 births (live and still) compared with 3.6 per 1,000 in 1932. Ophthalmia Neonatorum. During 1933, 6 cases of Ophthalmia Neonatorum were notified. For table giving result of treatment, see Table No. 16. 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 1933 was £2,378. 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. Children Acts, 1908-32. Administration of Part I of the Children Act. 1908, as amended by Part V of the Children and Young Persons Act, 1932. (a) Number of persons on the Register who were receiving children for reward at the end of the year, 32. (49 Registered Foster Mothers). (b) Number of children on the Register: (i) at the end of the year, 37. (ii) who died during the year, 1 (iii) on whom inquests were held during the year, 1. 94 (c) Number of Infant Protection Visitors at the end of the year who were: (i) Health Visitors, 7 (ii) Female, other than Health Visitors, — (iii) Male,— (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) of the Act of 1908, —. (e) Proceedings taken during the year: No. of Cases. Act and Section under which proceedings were taken. Nil (f) Number of cases in which the local authority has given a sanction during the year: (i) under (a) of Section 3 of the Act of 1908") (ii) „ (b) „ „ Nil (iii) „ (c) „ „ (g) Number of orders obtained during the year under Section 67 of the Act of 1932: (i) from a court of summary jurisdiction } Nil (ii) from a single justice Home Helps. The scheme for the provision of Home Helps approved by the Council on 14th July, 1931, has been in operation throughout the year. During 1933, 8 suitable applicants were registered as Home Helps and 15 applications were received for the services of Home Helps. CREMATORIUM. The City of London Cemetery, situated at Manor Park, contains and ideal Crematorium, and it is doubtful if the public realise that such provision exists in the vicinity of this borough. The advantages of the cremation of the dead over the system of burial in the ground are too well known 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, TABLE 33. METEOROLOGICAL RECORD—YEAR 1933. Rain Gauge 5-in. in diameter, placed 1 foot above ground, 15 feet above sea level. Temperature taken in the shade of a Stevenson's Screen, 5 feet from the ground. Months. Temperature of Air during the Month. Mean Temperature of Air. Rainfall. Highest Maximum. Lowest Minimum. Mean of All Highest. All Lowest. 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. January 54° 23° 42.2° 34.1° 38.2° 15 0.95 0.06 0.20 8th February 57° 25° 46.7° 36.0° 41.3° 13 1.54 0.12 0.49 11th March 64° 29° 54.5° 38.1° 46.3° 14 1.98 0.14 0.42 17 th April 71° 31° 58.6° 42.2° 50.4° 7 0.80 0.11 0.18 26th May 80° 42° 64.8° 47.6° 56.2° 12 2.21 0.18 0.50 28th June 84° 47° 71.0° 52.6° 61.8° 11 2.28 0.21 0.53 12th July 92° 53° 76.1° 58.1° 61.8° 11 1.66 0.15 0.41 16th August 92° 50° 77.6° 57.6° 67.6° 6 0.30 0.05 0.08 16th September 82° 43° 70.4° 53.9° 62.1 11 2.69 0.24 0.72 20th October 68° 33° 58.6° 46.5° 52 .6° 13 1.34 0.10 0.35 29th November 56° 32° 47.9° 39.2° 43.5° 14 0.99 0.07 0.22 15th December 45° 25° 38.0° 31.6° 34.8° 7 0.39 0.06 0.12 31st Means and Totals for the Year. 92° 23° 58.9° 44.8° 51.4° 134 17.13 0.13 0.72 20th Sept. The Rainfall for the Year was 6.58 ins. below, and the number of days on which rain fell 34 below the year 1932, at East Ham. 95 96 REPORT OF THE CHIEF SANITARY INSPECTOR ON THE WORK PERFORMED BY THE SANITARY INSPECTORS FOR THE YEAR, 1933. 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 1933. 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 274 single and 4 double 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. I am, Sir, Your obedient servant, GEORGE D. LILL. 97 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. One complaint was received during the year of water having an unpleasant taste and smell. A sample submitted for bacteriological analysis was certified satisfactory, and upon further investigation a broken service pipe was discovered. No further complaint has been received, since this defect was remedied. Rivers and Streams. On the eastern side of the Borough the River Roding and its backwater, 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 miles of 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 two residences in a cemetery. 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. 98 Sanitary Inspection of the Borough. The particulars of these inspections are set out in detail as follows:— TABLE 34. Inspections for the Year. Ordinary House-to-house Total January 564 557 1,121 February 436 586 1,022 March 524 761 1,285 April 457 437 894 May 544 703 1,247 June 528 508 1,036 July 456 310 766 August 457 420 877 September 593 373 966 October 593 426 1,019 November 683 349 1,032 December 838 98 936 Total for Year 6,673 5,528 12,201 Small Pox Contacts. In addition to the foregoing inspections, 120 special visits were paid in connection with small pox contacts. House-to-House Inspection. As I have stated on former occasions, special attention has been given to this branch of the work. The above table shows 5,528 house-to-house inspections for the year 1933, as compared with 5,908 for the previous year. At 70.77 per cent. of these visits sanitary defects were found, 99 TABLE 35. table Showing Inspections made in each Ward per Month. Month Manor Park Woodgrange Kensington Little Ilford Plashet Castle Central Wall End Greatfield South Total Ord. H. to H Ord. H. to H. Ord. H. to h. Ord. H. to H. Ord. H to H. Ord. H to H. Old. H. to H. Ord. H. to H. Ord. H. to H. Ord. H. to H. Ordinary House to House January 83 197 45 — 51 — 52 122 66 27 19 — 63 88 81 — 21 83 123 564 557 February 74 156 65 — 22 — 65 84 60 110 20 22 35 120 23 — 16 81 56 13 436 586 March 76 68 62 97 42 — 83 168 63 1 23 147 29 — 65 124 24 49 57 107 524 761 April 61 1 61 37 32 — 64 164 49 90 26 17 53 3 34 55 21 1 56 69 457 437 May 90 43 70 — 25 — 64 314 55 112 31 1 54 — 53 115 23 — 79 118 544 703 June 95 15 64 20 44 — 63 122 74 45 i3 55 28 — 36 141 21 6 70 104 528 508 July 97 32 74 1 34 — 64 114 73 82 25 6 23 9 15 34 19 — 32 32 456 310 August 70 19 53 1 21 — 44 80 47 24 18 107 34 — 76 86 23 — 71 103 457 420 September 78 20 65 — 34 57 59 119 59 27 33 20 63 — 89 59 35 17 78 54 593 373 October 84 1 68 16 56 80 70 97 49 78 50 — 54 — 59 75 22 — 81 79 593 426 November 82 47 72 5 36 100 82 12 75 16 79 55 76 — 64 57 17 — 100 57 683 349 December 95 — 84 — 74 — 102 46 100 — 71 18 83 — 88 1 44 — 97 33 838 98 985 599 783 177 471 237 812 1442 770 612 428 448 595 220 683 747 286 154 860 892 6,673 5,528 100 TABLE 36. Complaints Received for 1933. Manor Park Woodgrange Kensington Little Ilford Plashet Castle Central JWall End Greatfield South Total January 11 8 12 8 15 12 20 3 4 16 109 February 16 5 6 11 12 13 19 11 12 22 127 March 18 10 17 18 12 16 21 14 7 12 145 April 6 9 10 22 9 7 17 10 8 25 123 May 16 15 10 25 22 19 33 8 16 23 187 June 20 10 8 25 17 10 15 9 5 22 141 July 12 13 5 28 20 13 20 8 10 25 154 August 18 13 11 16 8 11 12 10 9 17 125 September 20 9 10 21 15 14 26 13 7 19 154 October 11 18 13 28 16 30 22 15 11 23 187 November 12 21 9 31 19 15 13 14 6 12 152 December 9 6 5 13 10 8 13 10 6 16 96 169 137 116 246 175 168 231 125 101 232 1,700 Nuisances. As a result of the inspections shown in the foregoing; tables 21,330 nuisances were discovered. A detailed list is given in the inset table, No. 47. To securc abatement the following- notices were served:— 1932. 1933. Preliminary 5,145 5,155 Statutory 807 1,221 5,952 6,376 101 Complaints. The following table shows the number of complaints received for the year as compared with the previous year:— TABLE 37. Year Written Oral Total 1932 401 1,111 1,512 1933 418 1,282 1,700 For detailed table see table on previous page. Notices Complied with during the year ended 31st December, 193:— TABLE 38. District No. 1 No. 2 No. 3 No. 4 No. 5 Total Complied 1,066 1,348 1,041 1,134 1,289 5,878 Rents Restriction (Notice of Increase) Act, 1923. Nineteen applications were made by tenants for certificates under this Act. One was granted. In 16 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. Of the remaining two, the necessary work was carried out under the Public Health Acts. Notices Outstanding at 31st December, 1933:— TABLE 39. District No. 1 No. 2 No. 3 No. 4 No. 5 Total Informal 121 185 200 243 264 1,013 Statutory 21 27 35 47 76 206 102 TABLE 40. Prosecutions under the Public Health Act for the Year 1933. Date. Situation of premises. Offence. Result. J anuary Bonny Downs Road Non-compliance with sanitary notice Work complied. Withdrawn 3s. 6d. costs March Katherine Road do. Work complied. Withdrawn 3s. 6d. costs March Welbeck Road do. Summons not served (incorrect address) March do. do. Summons not served (incorrect address) March Albert Road do. Work complied. Withdrawn 3s. 6d costs April Meanley Road do. Work complied. Withdrawn 3s. 6d. costs April do. do. Work complied. Withdrawn 2s. 6d. costs April do. do. Work complied. Withdrawn 2s. 6d. costs April do. do. Work complied. Withdrawn 2s. 6d. costs April do. do. Work complied. Withdrawn 2s. 6d. costs June Hubert Road do. Work complied. Withdrawn 2s. 6d. costs June Walton Road do. Work complied Withdrawn 2s. 6d. costs June Roman Road do. Work complied. Withdrawn 2s. 6d. costs June do. do. Work complied. Withdrawn 2s. 6d. costs 103 TABLE 40—continued. Date. Situation of premises. Offence. Result. June Roman Road Non-compliance with sanitary notice Work complied. Withdrawn 2s. 6d. costs June do. do. Work complied. Withdrawn 2s. 6d. costs June do. do. Work complied. Withdrawn 2s. 6d. costs July Lawrence Avenue do. *Work complied. Withdrawn 2s. 6d. costs July Walton Road do. *Work complied. Withdrawn 2s. (3d. costs July Lawrence Avenue do. *Work complied. Withdrawn 2s. 6d. costs October Bonny Downs Road do. Order to complete in 14 days. Fined 20s. October do. do. Order to complete in 14 days. Fined 20s. October Sheringham Avenue do. Work complied. Withdrawn 2s. 6d. costs October do. do. Work complied. Withdrawn 2s. 6d. costs October Eastbourne Road ... do. Work complied. Withdrawn 2s. Od. costs October do. do. Work complied. Withdrawn 2s. 6d. costs November Albert Road do. Work complied. Withdrawn 2s. 6d. costs November do. do. Work complied. Withdrawn 2s. 6d. costs 104 TABLE 40—continued. Date. Situation of premises. Offence. Result. November Albert Road Non-compliance with sanitary notice Work complied. Withdrawn 2s. 6d. costs November Goldsmith Avenue do. Work complied. Withdrawn 2s. 6d. costs November Lawrence Avenue do. Work complied. Withdrawn 2s. 6d. costs. Declaration fee, 2s. December Bonny Downs Road do. Adjourned to 18/1/34 December Central Park Road do. Adjourned to 4/1/34 *Declaration lee 5s. TABLE 41. Prosecutions under the Milk and Dairies Order for the Year 1933. Date. Offence. Result. June Unlawfully causing a bottle to be filled and closed at a place other than on registered premises Fined 10s. TABLE 42. Prosecutions under the Food and Drugs (Adulteration) Act, 1928, for the Year 1933. Date. Offence. Result. March Selling Chipalata Sausages containing preservative in the form of Sulphur Dioxide to the extent of 250 parts per million Dismissed (Case not proved) 105 Smoke Abatement. Three occurrences of factory smoke nuisance were observed during the year, two being from the same premises. In every instance the manager was cautioned by letter and the stoker verbally by the District Inspectors. 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 Ilford Recreation Ground 8 Manor Park Recreation Ground 10 Gooseleys Playing Fields 17½ 109½ There are also :— Wanstead Flats ... ... ... ... 96 Royal Victoria Gardens (North Woolwich) 9 2144 Wanstead Flats is an open unfenced space under the control of the City Corporation. The Royal Victoria Gardens is an enclosed park abutting on the River Thames and under the control of the London County Council, nine acres being in this Borough, and one acre in the Metropolitan Borough of Woolwich. 106 Cemeteries. The following is a list of the cemeteries in the Borough:— City of London, Manor Park, Woodgrange, Jews' Cemetery (Plashet), Jews' Cemetery (Greatfield), St. Mary the Virgin Churchyard, St. Mary Magdalene Churchyard, the total acreage being 278 acres. No complaint was received during the year of improper burials. Rag Flock Act. There are no premises in the Borough on which Rag Flock is manufactured. Of six samples taken from furniture upholsterers, two were found to be satisfactory, and four contained an excess of soluble chlorine. Upon further examination one of these was found not to be flock within the meaning of the Act. A second contained only a very slight excess of chlorine and no further action was taken. In the two remaining cases of formal samples procured one subsequently was certified as satisfactory, and legal proceedings were instituted against the vendor of the other. The defendant was allowed the benefit of the First Offenders Act. Public Water Closets and Urinals. There are 11 public conveniences in the Borough under the supervision of the Cleansing Superintendent of the Borough Engineer's Department. No complaint has been received during the year and they have been well maintained in a satisfactory condition. There are 34 Public Houses and Beer Houses in the Borough, the majority of which are well equipped with sanitary conveniences and with an occasional exception these are also well maintained. 107 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. TABLE 43. HOUSING STATISTICS. Number of new houses erected during the year:— (a) Total (including numbers given separately under (b)). (i) By the Local Authority — (ii) By other Local Authorities — (iii) By other bodies and persons 282 (b) With State assistance under the Housing Acts: (i) By the Local Authority — (a) For the purpose of Part II. of the Act of 1925 — 1. Inspection of Dwelling Houses during the year:— 1. (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 10,178 (b) Number of inspections made for the purpose 33,302 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 1 4. Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 7,654 108 2. Remedy of Defects during the year without Service of formal Notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 4,820 •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 8 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 7 (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 5,155 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 1,058 (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. 109 E.—Proceedings under Section 3 of the Housing Act, 1925 Nil. F.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925 Nil. Housing Act, 1930. Since the passing of the Act, the following four Areas in the Borough were declared to be Clearance Areas under Section (1) of the Act. CLAREMONT STREET: Nos. 1, 3, 5, 7, 9, 11, 13, 15, 17, 19, 21 and 23. FRANCIS STREET: 1, 2, 3, 4, 5, 6, 7, 8, 9 and 10. STOREY STREET: 1, 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 29, 31, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30 and 32. MARKET STREET: 98, 100, 102, 104, 106, 108, 110, 112 and 114. The Council decided that the most satisfactory method of dealing with the conditions in the areas was to purchase the lands and themselves secure the demolition of the buildings and to utilise the sites for re-housing. Claremont and Francis Street areas were purchased by negotiation at approximate site value. Negotiations for the acquisition of the Storey Street and Market Street properties were not successful, and the Council accordingly made Compulsory Purchase Orders and submitted the same to the Ministry of Health for confirmation. On the 11th October, 1933, a local enquiry into the Council's application for the confirmation of these Orders was held by the Ministry of Health, but up to the period covered by this report, the Ministry's decision had not been communicated to the Corporation. 110 (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 116 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. 4 for Grade A (Tuberculin Tested). 4 for Pasteurised. One Dealer's licence (Form B) was granted for the bottling of Grade A (Tuberculin Tested) Milk under this Order. One Pasteuriser's licence (Form C) was granted for the pasteurisation of milk under this Order. Supplementary licences (Form D) were granted for the Sale of Milk under this Order. — for Grade A. 2 for Grade A (Tuberculin Tested). 11 for Pasteurised. 1 for Grade A Pasteurised. 1 Certified 1ll BACTERIOLOGICAL EXAMINATIONS. Thirty-eight samples of Milk were procured for bacteriological examination, all of which were certified by the Counties Public Health Laboratories to comply with the bacterial standards of the respective grades. Twelve samples of Ice Cream were also submitted for bacteriological analysis, four of which were certified as being below the standard of purity usually obtainable. The vendors of these unsatisfactory samples were visited, and suggestions were made for improving the quality of their products. (ib) 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 1,228 notifications of intention to slaughter were received referring to:— Cattle 1,991 Sheep 1,619 Pigs 19,274 Lambs 4,385 Calves 448 27,717 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. 112 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 past 3 years). 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. Six parcels of various goods purchased from retail tradesmen were condemned, and the purchasers reimbursed on my certificate. One wholesale delivery was also condemned on submission by the retailer. 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. (c) FOOD AND DRUGS (ADULTERATION) ACT, 1928. Four hundred and forty-one samples were taken under the above Act, of which 101 were Milk. These were all submitted to Dr. Bernard Dyer, the Public Analyst for the Borough. Of the number 86 were taken formally, 79 of which were certified to be genuine. Details of the seven non-genuine samples are as follows:— 113 (i) A sample of Chipalata Sausages containing sulphur dioxide in the proportion of 250 parts per million. The summons issued was dismissed on the defendant's statement that a preservative notice was displayed in the shop. (ii) Two samples of Milk containing respectively 5 and 3 parts per cent. of added water. The second portions of these samples were inadvertently destroyed. Two further samples procured from the same vendor were adulterated with 4 and 2 parts per cent. respectively of added water. Summonses were laid but were not proceeded with on account of the defendant's declaration of bankruptcy. (iii) A sample of Whisky having a strength of only 36 degrees under proof. The case was reported to the Public Health Committee and a letter of caution was sent to the vendor. (iv) A sample of Ginger Wine which was certified as being not wine, but composed mainly of sugar and water. No proceedings were instituted as the manufacturer removed to an unknown address. Three hundred and sixty-five informal samples were taken, of which 355 proved to be genuine. Of the non-genuine:— (i) A sample of milk contained 17 per cent. added water and was submitted by a resident who suspected it had been adulterated after delivery. (ii) A sample of Quinine and Phosphorus Tablets certified as being deficient in all its ingredients. Correspondence with the manufacturers elicited that the prescription given was compounded without the sugar-coating on the tablets. In the absence of the coating the analysis proved in accord with the stated formula and no further action was taken. (iii) A sample of shredded suet containing 6 parts per cent. excess of flour. The manufacturers' suggestion that the excess adhesion was due to the suet having been shredded during hot weather, was accepted. (iv) Sausages containing preservative. (v) Milk containing 3 per cent. added water. (vi) Whisky having a strength of 36½ degrees under proof, 114 (vii) Ginger wine certified as not being wine in the real sense, but chiefly a mixture of sugar and water. Formal samples were procured in the four latter cases with results as outlined above. (viii) Rum having a strength of 37 degrees under proof. (ix) Gin having a strength of 38 degrees under proof. (x) Rum having a strength of 36¾ degrees under proof. In these three cases, formal samples were certified as free from adulteration. The following is a detailed list of the articles sampled:— TABLE 44. Acetum Ipecac 1 Almonds, Ground 2 Ammoniated Tincture of Quinine 1 Apricots, Dried 1 Aspirin Tablets 4 Beans, Baked 1 Beans in Tomato Sauce 1 Beef, Minced 1 Beef Extract, Fluid 1 Biscuits, Sultana 1 Bloater Paste 1 Brawn 2 Bread 3 Butter 42 Cabbage, Pickled 1 Cake 1 Camphorated Oil 2 Cascara Sagrada, Fluid Extract of 1 Cheese 1 Chocolates 1 Citrate of Magnesia 1 Cocoa 9 Cocoa Tablets 1 Coconut, Tinted 1 Coffee 5 Coffee and Chicory 1 Corned Beef 1 Cornflour 1 Cream 14 Cream, Tinned 1 Cream, All Sorts 1 Cream of Tartar 2 Currant Loaf 1 Custard Powder 2 Dandelion Coffee 1 Dripping 6 Fish Cake 1 Fish Paste 2 Flour 2 French Coffee 1 Fruit, Mixed 1 Fruit Sauce 1 Gentian 1 Gin 4 Ginger, Ground 2 Ginger Wine 2 Ginger Wine, Non-Alco- holic 1 Ginger Wine Essence 1 Glace Cherries 1 Glycerine, Lemon and Honey 1 Ham and Tongue Paste 1 Ham Roll 1 Health Salt 1 Herbs 1 Herrings in Tomato Sauce 1 Ice Cream 1 Indigestion Tablets 1 Jam, Apricot 1 Jelly, Grape 1 115 TABLE 44—continued. Jelly, Greengage 1 Jelly, Lemon 1 Jelly, Strawberry 1 Jelly, Wine 1 Kidney Soup 1 Lard 9 Lemon Crush 1 Lemonade Powder 1 Langues de Corderos 1 Lin Capsici B.P.C 1 Lion Sauce 1 Lung Syrup 1 Macaroni 1 Malt Extract and Cod Liver Oil 1 Malted Butterscotch 1 Margarine 14 Marmalade 1 Meat, Minced 2 Meat Pie 2 Milk 101 Milk, Condensed 2 Milk, Skimmed 1 Milk, Sterilized 2 Mincemeat 6 Mint Sauce 2 Mint Sauce Jelly 1 Mushroom Ketchup 1 Mustard 1 Nutmeg 1 Peas 4 Peas, Green 2 Peas, Split 1 Peas, Sweet Sugar 1 Peel, Mixed 1 Pepper 2 Pepper, White 2 Piccalilli 2 Pickles 1 Pilchards 1 Pineapple 2 Plums 1 Pork and Beans 1 Pork Pie 1 Prawn Paste 1 Quinine and Phosphorus Tablets 1 Raspberry Sherbert 1 Raspberryade 1 Rheumatic Tablets 1 Rice 2 Rum 4 Sage 1 Salmon 5 Salmon and Shrimp Paste 2 Sausage Roll 5 Sausages 9 Sausages, Beef 3 Sausages, Breakfast 1 Sausages, Cliipalata 2 Sausages, Picnic 1 Sausages, Pork 2 Sausages, Preserved 1 Saveloys 1 Slimming Tablets 1 Spice, Mixed 1 Sponge Cake 4 Steak and Kidney Pie 2 Suet 4 Suet, Beef 1 Sugar, Demerara 4 Sugar, Icing 1 Sugar, Pudding 1 Sugar, Yellow Crystal 1 Sulphur and Lime Juice Blood Tablets 1 Tapioca Flakes 1 Tea 14 Tinct. Lobeliæ 1 Tomato Ketchup 2 Tomato Sauce 1 Tomatoes, Tinned 1 Trex (a vegetable fat) 1 Veal and Ham Pie 1 Veal, Ham and Tongue Paste 1 Vinegar 1 Vinegar, Malt 5 Winter Pastilles 1 Whisky 16 Yorkshire Polony 1 Total 441 116 (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. TABLE 45. 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) 5 - - Workshops (including Workshop Laundries) 139 1 - Workplaces (other than Outworkers' premises) 25 — — Total 169 1 — 117 TABLE 46. 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 Acts:—* Want of cleanliness 4 4 - - Want of ventilation 1 1 - - Overcrowding — — - - Want of drainage of floors — — - - Other nuisances 6 6 - - Sanitary accommodation:— Insufficient — — - - Unsuitable or defective — — - - Not separate for sexes — — - - 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 11 11 - - * Including those specified in sections 2, 3, 7and 8of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. TABLE 47. 1 1 Q The Following is a Record in Detail of the Inspections made during the Year 1933:— 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.toH. Ord. H. to H. Ord. H.toH. Premises found in fair condition 589 183 302 53 304 94 298 568 362 222 194 126 225 49 262 188 140 46 232 87 2908 1616 Factory and workshop premises 29 ... 33 ... 3 ... ... ... 22 ... 12 ... 24 ... 22 ... 9 ... 15 ... 169 Outworkers'premises 10 ... 21 ... 21 ... 32 ... 25 ... 20 ... 30 ... 27 ... 19 ... 9 ... 214 ... Bakehouses 32 ... 26 ... 19 ... 12 ... 6 ... 11 ... 5 ... 1 ... 3 ... 14 ... 129 ... Dairies 13 ... 31 ... 11 ... 54 ... 9 ... 15 ... 4 ... ... ... 9 ... 14 ... 160 ... Slaughter-houses 497 ... 268 ... ... ... ... ... 324 ... ... ... ... ... ... ... ... ... 190 ... 1279 ... Unsound food 111 ... 200 ... 2 ... 2 ... 144 ... 3 ... 4 ... 1 ... 1 ... 118 ... 586 ... Urinals inspected 4 ... 2 ... 18 ... 10 ... ... ... 1 ... 14 ... 4 ... 2 ... 17 ... 72 ... Walls and ceilings dirty and dilapidated 35 156 73 43 41 49 111 463 80 272 68 217 100 111 79 360 45 71 173 611 805 2353 Yard paving dilapidated 6 53 20 14 5 7 18 52 17 32 8 46 40 42 22 153 9 11 27 145 172 555 No forecourt paving ... 5 1 4 1 3 ... 19 3 19 ... 7 1 1 2 7 1 4 1 20 10 89 Defective drains 7 2 4 ... 10 1 15 ... 9 ... 5 ... 22 ... 3 ... 1 ... 3 2 79 5 Defective w.c. traps 16 40 21 26 9 10 31 95 12 20 4 10 15 43 4 17 4 15 22 56 138 332 Soil pans foul and broken 9 31 12 10 7 6 18 33 6 18 9 10 24 48 7 49 ... ... 12 40 97 245 Defective Hushing apparatus 16 34 13 14 11 6 25 82 16 12 14 25 21 18 15 53 5 7 21 73 157 324 Defective vent pipes 5 35 6 19 7 8 13 61 5 6 5 11 9 12 10 24 ... 2 6 29 66 207 Rain water pipes and eaves gutters defective 23 68 39 18 22 38 54 288 23 54 18 59 64 107 49 217 18 29 70 248 380 1126 Roofs leaky 31 47 39 6 29 61 64 202 35 91 29 62 42 35 54 145 20 10 73 254 416 913 Dampness 40 111 36 16 25 19 155 198 35 68 28 73 48 24 49 45 14 26 107 348 537 928 Defective sink waste pipes 4 14 12 5 3 12 13 36 6 11 5 4 19 7 11 19 1 6 26 68 100 182 Drinking water improperly stored 6 55 7 33 1 ... 1 3 ... 1 1 9 1 6 4 13 3 ... 2 17 26 137 Defective brickwork 1 49 4 5 1 ... 4 24 12 49 6 66 29 51 25 189 9 24 39 358 130 815 Defective cement to yard gully 4 10 2 ... 2 15 4 39 6 41 8 22 17 18 9 80 7 35 21 140 80 400 Defective sashcords and windows 18 40 29 16 18 43 30 177 18 109 10 79 20 13 13 10 17 9 55 237 228 733 Insufficient underfloor ventilation 1 35 3 ... 2 12 8 63 6 33 3 26 10 35 6 69 4 2 6 47 49 322 Dilapidated floors 14 17 10 5 6 8 38 78 9 12 10 24 25 14 7 38 1 3 51 159 171 358 Accumulations 24 4 16 1 44 ... 50 8 10 ... 29 1 22 1 5 1 3 ... 37 2 240 18 Overcrowding ... ... ... 3 ... 2 2 1 ... 3 1 2 ... 3 ... ... 1 6 13 20 17 No dust bins 1 2 2 ... 3 2 8 24 ... 4 ... ... 1 ... 1 1 4 2 17 28 37 63 Defective stoves 10 49 12 3 22 7 36 110 28 78 16 82 27 7 25 26 7 6 44 1.42 227 510 Defective coppers 3 15 3 ... 9 4 9 58 9 42 4 37 15 6 13 21 3 3 26 93 94 2711 Animals improperly kept 1 ... ... ... 1 ... 2 ... ... ... ... ... 1 ... ... ... ... ... 3 ... 8 ... Factory smoke nuisance 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 3 ... Breaches of Bye-Laws and Regulations ... ... 4 ... 4 ... 9 ... 5 ... 4 ... 5 ... ... ... 1 ... ... ... 32 ... Other nuisances 173 268 167 81 88 18 220 353 127 218 107 249 277 165 229 657 67 70 344 819 1799 2898 Drains tested 40 ... 53 ... 49 ... 80 ... 7 ... 3 ... 33 ... 3 1 2 ... 1 ... 271 1 Inspections 985 599 783 177 471 237 812 1442 770 612 428 448 595 220 683 747 286 154 860 892 6673 5528 Total Inspections 1584 960 708 2254 1382 876 815 1430 440 1752 12201 COUNTY BOROUGH OF EAST HAM. EDUCATION COMMITTEE. Annual Report OF THE School Medical Offfcer FOR THE YEAR 1933. 122 EAST HAM EDUCATION COMMITTEE Councillor E. H. Thompson (Chairman). Councillor E. B. Hall (Vice-Chairman). Alderman G. H. Manser (Mayor). Alderman Mrs. A. Taylor. Councillor Mrs. A. Warne. Councillor Mrs. B. Wilkens. Alderman W. W. Bagot. Councillor R. W. Moger. Alderman W. Brading. Councillor A. H. W. Owen. Alderman T. W. Burden. Councillor J. J. Pope. Alderman E. F. Markey. Councillor H. Restarick. Alderman W. T. Newling. Councillor A. Simons. Councillor R. Bailey Councillor W. Thompson. Councillor W. T. Bush. Councillor T. W. Williams. Councillor F. Edwards. †Mrs. W. M. Knight. Councillor R. J. Fell. Mrs. L. A. Lethaby. Councillor H. B. Harper. *Miss L. Butcher. Councillor E. C. Howlett. Mr. F. T. Cowley. Councillor H. P. Jackson. Mr. E. J. Sullivan. Councillor T. I. Lethaby. ‡Alderman J. Brooks. *Resigned May, 1933. †Appointed September, 1933. ‡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. A dministrative and Clerical Staff: Chief Administrative Clerk: T. B. Clark. G. W. Friend (Senior). Miss F. E. Hales, Miss O. E. Griffin, Miss F. C. Wells and Miss J. M. Flynn. Dental Surgeons (full-time): C. S. Neame, L.D.S., R.C.S. (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. Deputy and Senior Assistant Medical Officer: F. E. Bendix, M.R.C.S., L.R.C.P., L.D.S. School Medical Officer: W. Benton, M.R.C.S.. L.R.C.P., D.P.H. (to 13/9/33). M. e. Barker, M.r.C.S., L.R.C.P., d.P.H. (from 13/9/33). 123 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 the 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, 1933. Dr. W. Benton was responsible for these duties until his retirement in September, by which time he had completed a period of more than 22 years' administration of the Service. The development and progress of School Medical work in East Ham since its inception was outlined in the report for 1932, and consideration of the many advancements and ultimate attainment of a high standard of supervision and physical well-being of the scholars, is a tribute to Dr. Benton's administrative ability and foresight. In order to avoid repetition and to condense the report, I have endeavoured, as far as possible, to confine the subject matter to the detailed work of the year under review. It will be seen that in most respects statistics indicate little change. There were 19,719 children on the School Roll as compared with 19,770 for the year of 1932 The number of routine and special cases of Elementary School children examined totalled 10,493, approximately the same as for the previous year. A complete medical inspection of all the scholars in the secondary schools has also been carried out. The steady growth and increasing requirements of such a service demand adequate accommodation for both clinical and administrative purposes, and it is a matter for congratulation that the combined centre for School Medical, Maternity and Child Welfare Clinics, at Manor Park—the plans of which have already passed the Council—is likely to materialise in the near future. I am pleased to report also that the arrangements entered into with the Woolwich Borough Council, by which accommoda- 124 tion is afforded to this Authority for the benefit of children residing in the East Ham (North Woolwich) area, provide the utmost satisfaction. The use of the modern clinic, electrically heated and lighted, with facilities for medical and dental treatment, is an asset to this Council's services. The accommodation afforded at the Central Clinic, however, on the second floor of the Town Hall building, continues to call for serious consideration. The congestion, overcrowding and poor ventilation of the waiting room, the necessity at times of permitting a number of mothers and children to be present in the clinic whilst treatment is being given to others, are matters the significance of which must be fully realised. The Clinic is in use during every available session throughout the week, and even under these circumstances does not meet the full demands of the service. In addition, administration is considerably handicapped by inadequate office accommodation. It must be acknowledged that progress and efficiency in the School Medical Service are dependent upon good working conditions, both in example and precept. 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. I have the honour to be, Ladies and Gentlemen, Your obedient Servant, MALCOLM BARKER, School Medical Officer. 125 1. STAFF. A list of the Staff of the School Medical Department will be found on page 122 of this Report. 2. CO-ORDINATION. Closer co-operation of the various health services of the County Borough has been fully discussed and advocated in previous reports, and there is little reason to doubt that such permits of a more accurate knowledge of the past history and physical condition of the patient, and a ready reference for further advice and treatment. This is not only essential in the interests of the individual, but prevents much overlapping and wastage of effort on the part of the staff. 3. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene. During the year 1933 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 the 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 1933. The figures for the year 1929 to 1932 are also given for comparison:— 126 COMPARATIVE STATEMENT OF WORK. 1929. 1930. 1931. 1932. 1933. Routine and Special Inspection (on School Premises) 9,763 8,325 10,351 10,458 10,493 Re-inspection 4,821 3,574 2,883 2,700 2,773 Consultations at Inspection Clinic 15,675 14,490 13,241 16,122 18,294 Number of Treatments at Clinic 18,517 16,967 15,180 12,819 13,636 General Cleanliness Visits to Schools 322 309 307 307 341 Nurses' Visits to Homes 3,824 3,479 3,081 3,078 3,124 Children Examined for Cleanliness 53,009 51,607 48,607 50,513 50,064 (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, 127 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 the report for 1930. It will be seen that the new classification of the Board of Education has been adopted, and that reference is now made to "Second Age Group" and " Third Age Group 128 FINDINGS OF MEDICAL INSPECTION. Group. NUMBER OF CHILDREN. Percentage of Children found to require Treatment. Inspected. Found to require Treatment. 1928 1929 1930 1931 1932 1933 1928 1929 1930 1931 1932 1933 1928 1929 1930 1931 1932 1933 Entrants 3,197 2,998 2,314 2,047 2,245 2,040 354 411 264 263 255 250 110.1 13.7 11.4 12.8 11.4 11.2 Second Age Group 2,424 2,208 2,207 1,987 2,028 2,006 291 316 237 217 240 230 12.0 14.3 10.7 10.9 11.8 12.4 Third Age Group 2,848 2,366 1,912 1,855 1,985 2,079 237 248 119 181 175 180 8.3 10.5 6.2 9.7 8.8 8.6 Totals 8,469 7,572 6,433 5,889 6,258 6,125 882 975 620 661 670 660 10.4 12.9 9.6 11.2 10.7 10.7 129 (a) Uncleanliness. The School Nurses have carried out 3 cleanliness surveys of all the children in the elementary schools during the year 1933. During the year the School Nurses made 50,064 examinations, as compared with 50,513 in 1932. Of this number 349 children showed vermin and many nits in the hair (321 in 1932), whilst 1,395 children showed only a few nits (1,637 in 1932). A greater number of Exclusion Certificates have been issued. Comparative table:— Year Number Examined Number with Nits Number with Head Vermin No. of Exclusion Certificates 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 1933 50,064 1,395 349 120 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 1 Nits. Many Nits and Vermin. Altmore S. Mixed 340 1 - Napier Infants 774 28 10 Avenue Infants 628 27 8 J. Boys 1147 22 10 J. Girls 884 49 24 S. Boys 994 9 - J. Boys 874 21 14 Plashet Infants 658 34 4 Brampton Infants 1326 21 2 J. Boys 1020 18 3 J. Girls 1371 33 2 S. Boys 888 5 1 S. Girls 870 19 — Salisbury Infants 715 30 - Castle Street R.C. Mixed 693 27 — J. Mixed 1087 30 3 Central Park Infants 802 19 3 S. Mixed 656 14 1 J. Boys 1214 13 — Sandringham Road J. Mixed 975 17 14 S. Boys 915 - — S. Mixed 934 5 2 Corn well Infants 1028 22 22 Sandrineham Central — 420 - 2 S Girls 1213 12 15 Shaftesbury Road Infants 1049 56 6 S. Boys 961 6 8 J. Girls 1042 74 1 Dersingham Mixed 814 16 16 S. Girls 758 - - Essex Infants 971 15 9 Shrewsbury Special 220 20 1 J. Boys 962 2 — Storey Street J. Mixed 507 37 11 S. Boys 648 1 — S. Mixed 854 33 7 Hartley Infants 693 18 3 Silvertown R.C. J. Mixed 471 30 10 J. Girls 613 38 — S. Mixed 781 34 11 S. Girls 898 32 1 St. Michael's R.C. Mixed 715 34 12 High Street Infants 376 9 1 St. Winefride's R.C. Mixed ... 801 11 20 Kensington S. Mixed 425 10 1 Vicarage Infants 1250 74 35 Infants 710 6 — J. Girls 1063 91 12 J. Girls 917 23 8 S. Girls 1048 35 10 S. Girls 659 14 1 Winsor J. Mixed 700 73 9 Lathom Infants 963 28 — S. Mixed 844 23 8 J. Girls 888 37 4 Grammar Schools — 400 - J. Boys 891 4 1 P.D.Cl'ss 12 — — Monega Infants . 802 28 1 Total 50064 1395 349 J. Boys 1110 6 2 S. Boys 780 1 — Per cent. in 1933 2.78 0.7 Myope 36 - - Per cent. in 1932 3.24 0.6 130 131 It will be noticed that the low incidence in the number of children suffering from uncleanliness of the hair and scalp is fairly well maintained. Few schools, however, show an entire absence of such conditions, and it must be agreed that those children who exhibit uncleanliness of this character are a menace to other classmates. Although much credit is due to the careful routine inspection of the staff, it is only by the teaching of hygiene and the efforts of all those associated in any way with the welfare of the children, either in or out of school, that such conditions of uncleanliness can be entirely eliminated. In addition to the service enumerated, a large number of children have been examined by the school nursing staff prior to their leaving for summer holidav camps or convalescence in other parts of the country. (b) Minor Ailments. As has been the case in former years, few minor ailments were discovered at routine medical inspection, owing to the vigilance displayed by teachers and nurses, and to the growing interest of parents in such matters. Such cases, frequently recognised in the early stages, have been immediately referred to one of the School Clinics. Chief Minor Ailments Discovered at Routine Medical Inspection. Discovered by Teachers and Nurses and sent to Clinic. 1932 1933 1932 1933 Scabies - - 15 17 Impetigo 13 6 206 193 Conjunctivitis 4 5 93 87 Blepharitis 11 2 32 30 Ear Disease 76 60 149 200 Ringworm (Scalp) - - 4 - Ringworm (Body) 3 13 38 (c) Tonsils and Adenoids. 3.93 per cent. of the children examined during the year were referred for treatment for "tonsils and adenoids," either separately or combined, as compared with 3.73 per cent. in the year 132 1932. Of these, much enlarged tonsils accounted for 1.08 per cent.; definite adenoids were present in 0.12 per cent., and the combined defect was diagnosed m 2.73 per cent.; the figures for 1932 were 1.19 per cent., 0.07 per cent., and 2.47 per cent., respectively. The percentage of children moderately affected and requiring to be kept under observation was 10.0, the corresponding percentage in 1932 being 12.1. In this case 9.5 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 11.6 per cent., 0.2 per cent., and 0.3 per cent., respectively in the year 1932. (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 3 5 8 Other forms of Tuberculosis 11 5 16 Totals 14 10 24 (e) Skin Disease and (f) External Eye Disease. The number of these cases still remains high. At medical inspections during the year 481 children were found to be suffering from skin affections (as compared with 450 in the year 1932). Cases of external eye disease also continue to show a high incidence, 126 in the year 1933 and 160 in the year 1932. (g) Vision. Only children with marked visual defect have been referred for treatment and these, including cases of strabismus, numbered 403. In addition there were 116 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. 152.) 133 (h) Ear Disease and Hearing. 0.1 per cent. of the children examined were found to be suffering from otitis media (0.2 per cent, in 1932.) The percentage of deaf children was 0.4, the corresponding- number for last year being 0.3. (i) Dental Defects. (See Report of Dental Surgeon on p. 153.) (j) Crippling Defects. Reference to Table III on page 158 will furnish information with regard to the occurrence of crippling defects in the area. 67 cases were discovered at routine medical inspection during the year. 6. INFECTIOUS DISEASES. The methods adopted for the detection and prevention of infectious disease in schools are generally known. It is necessary, however, to stress the importance of the early recognition of such illness, both as regards the spread of infection to other scholars, and also the detrimental effect upon the sufferer. This is particularly necessary in such an illness as Diphtheria, in which delay in treatment may have disastrous results. Scarlet Fever has been somewhat prevalent, attacking both parents and children. The importance of early and adequate treatment in this illness plays a great part in the prevention of complications, which is the precursor of chronic ear disease, glandular and heart disease. Measles was somewhat widespread during the latter part of the year, but no deaths resulted, unlike that experienced in many of the metropolitan areas. Some of the more serious cases were admitted to the Isolation Hospital for treatment. There were no contacts of cases of Small Pox amongst school children, and the incidence of the disease has been negligible. The statistics relating to protective immunization against Diphtheria are included in my report as Medical Officer of Health. 134 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. 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. 190 swabs were taken for this purpose, and the fact that three of these proved to be positive shows the great importance of this procedure. (b) In suspicious cases seen at the Clinics or Schools, 265 swabs were taken and 15 proved to be positive. 135 Table of the Chief Infectious Diseases, Showing the Monthly Incidence in Children of School Age. Month Measles Chicken Pox Whooping Cough Mumps Scarlet Fever Diphtheria January 3 5 5 7 47 11 February — 1 10 — 30 5 March 1 16 58 2 24 8 April 2 60 12 15 30 9 May 63 48 46 20 26 20 June 53 84 80 17 57 13 July August 3 7 12 5 47 11 September October 55 27 5 1 74 10 November 54 1 15 2 66 14 December 68 7 - — 49 8 Totals (774) 302 (239) 256 (188) 243 (141) 69 (471) 450 (95) 109 The totals in brackets are those for the year 1932 and are inserted for comparison. The return of cases of non-notifiable infectious diseases is not sufficiently accurate to indicate the prevalence of these illnesses amongst school children. 136 7. FOLLOWING UP. The arrangements for following up defects found at medical inspections were set out fully in previous reports, and these have been continued throughout. The School Nurses have paid 3,124 visits to the homes of children in whom defects were found at medical inspection, and for special investigation purposes. Of the 977 children referred for treatment, 726 or 74 per cent. have obtained treatment. The School Nurses have also paid 125 special visits to the Schools, and 21 visits to the Feeding Centres, and have undertaken 6 journeys in connection with the admission and discharge of children to Institutions. All children referred for the operative treatment of tonsils and adenoids (508) 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 the report fot 1922. 137 During the year 1933, 13,636 attendances were made for treatment at the various clinics, and there were 18,294 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. 162. (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 508 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 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: furthermore the East Ham Education Authority possess the services of a School Aural Surgeon to whom doubtful cases may be referred. (c) Tuberculosis. The arrangements for the treatment of Tuberculosis have been continued on the lines fully set forth in the 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. There were no cases of Ringworm requiring X-ray treatment. 138 (e) External Eye Disease. 126 cases (165 in 1932) of external eye disease were treated at the School Clinics. (/) Vision. During the year 1933 the Ophthalmic Clinic was held on six sessions per fortnight. 403 cases were referred for treatment in respect of visual defect during the year 1933 (of these 56 children with markedly defective vision had not been seen by the Ophthalmic Surgeon) and, including 62 cases awaiting treatment at the termination of the year 1932, 409 cases have been treated in the past year. In many cases a period of from three to four months intervenes between the discovery of the defect and attendance for treatment. Unfortunately it has not been possible to give an opportunity of attending the Ophthalmic Clinic to all the children with lesser degrees of visual defect. There were 116 cases discovered during the year, and it is hoped that these children will be dealt with as soon as the more urgent cases have been treated. A Sight-saving Class at Monega Road School was opened by the Education Committee in June, 1928, 18 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. 152.) (g) Ear Disease. During the year 1933, 83 Aural Clinic sessions were held. The total attendances at the Aural Clinic was 1,845, making an average attendance, at each session, of 22 patients. Ionisation treatment was carried out in 20 cases, 60 applications being made. No difficulty is experienced in obtaining admittance to hospital of patients suffering from acute mastoid disease, who require immediate operation. Arrangements, however, did not formerly permit of surgical treatment, without considerable delay, in those cases of "chronic" mastoid disease. This has now been rectified. The patients are admitted to Balaam Street Children's Hospital, the operations are performed by Mr. Ronald Savege, F.R.C.S., 139 and payment is made to the hospital authorities on a "per capita" grant basis, in respect of East Ham scholars sent to the hospital from 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. 151.) (h) Dental Defects. It has been pointed out on former occasions that one Dental Surgeon can deal satisfactorily and efficiently with a school population of 5,000. He should be able to give complete treatment to ail cases found to require attention as the result of the dental inspection of this number, and subsequently examine and treat all entrants and re-inspect and re-treat where necessary, at annual intervals, all the children previously dealt with. This is the only way to ensure freedom from oral sepsis and dental decay. (See also Report of Dental Surgeon, p. 153.) (i) Crippling Defects. In November, 1929, the Authority entered into an agreement with Queen Mary's Hospital, Stratford, in respect of a complete scheme for the treatment of orthopaedic cases. The treatment at the hospital includes operative, electrical and massage treatment, remedial exercises and the supply of surgical appliances, and is carried out under the direction of an orthopaedic surgeon. Payment is made to the Hospital Authorities on a per capita contribution basis in respect of East Ham scholars sent to the Hospital through the School Medical Service. All children referred by the Authority's Medical Officers to the Hospital for treatment are kept under observation at frequent intervals at one or other of the School Clinics, in order that the progress of the cases may be watched and recorded, and to ensure 140 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 1933, 15 out-patients have received treatment, the total out-patient attendances being 238. The highly satisfactory results achieved are due, in no small measure, to the efforts and keen co-operation of the responsible Orthopedic Surgeon. (j) The Light Clinic. A full account of the arrangements and methods adopted in regard to treatment by artificial light was included in previous reports. No variation has been made in connection with the methods described and very satisfactory results continue to be obtained. 141 SUNLIGHT FIGURES, 1933. DIAGNOSIS. Boys. Girls. Anæmia 8 17 Debility 52 52 Malnutrition 13 24 Bronchial Catarrh 13 18 Adenitis 11 18 Rheumatism – 5 Malnutrition and Anæmia 1 1 Malnutrition and Debility 2 1 Debility and Anæmia 6 4 Debility and Catarrh 2 2 Debility and Rheumatism I 1 Debility and Headaches — 2 Bronchial Catarrh and Anæmia — 4 Bronchial Catarrh and Malnutrition 2 1 Bronchial Catarrh and Asthma 1 — Bronchial Catarrh and Rheumatism 1 — Malnutrition and Rheumatism 1 — Malnutrition and Adenitis 1 4 Malnutrition and Worms — 2 Anæmia and Rheumatism 1 — Anæmia and Cough — 1 Pre T.B. 1 2 Under weight 3 2 Chorea 4 — Cough 2 8 Throat — 3 Sinus — 1 Rickets 3 — Bronchitis 4 1 Nerves 3 — Crippling due to Quiescent T.B. 1 — Suppurating Inguinal Gland — 1 Rachitis — 1 T.B. Glands 2 1 Gastro Enteritis 1 — Naso Pharyngitis 1 — Total 141 177 Number of children treated (general) 318 Number of children treated (local) 44 Number of attendances (general) 4,167 Number of attendances (local) 748 Total number of attendances (local and general) 4,915 142 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. A brief summary of the cases treated by general and local irradiation throughout the year is given on the previous page. The number of children recommended for treatment is so considerable that it is only possible to provide the minimum amount of irradiation. To obtain full benefit, visits should be more frequent, and the time of exposure to the beneficial rays gradually and systematically increased. In part, the effect of light treatment is to aid nutrition, improve physical well-being, and thereby increase resistance of the body to infection. In the case of children, this is mostly catarrhal in character. The amount of illness resulting from repeated attacks, the complications and deleterious effects which may ensue from susceptibility to repeated colds and catarrh, necessitate more adequate provision for such treatment. Statistics for 1933 show a still greater demand for sunlight therapy. 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. 143 (b) School Camps. The Education Committee sent 217 scholars to the East Cowes Holiday Camp during the year 1933, and in addition the following School Journeys were undertaken:— Brampton Senior Girls 29 Sandringham Central 50 Total 79 (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. Arrangements have also been made for the admission of children to the Russell-Cotes School of Recovery at Parkstone, St. Dominic's School of Recovery at Godalming, St. Mary's School of Recovery at Dover, and to the Institutions of the Invalid Children's Aid Association. The accompanying table (p. 25) gives particulars in connection with these children. The difficulty of providing satisfactory treatment for delicate, malnourished, debilitated and physically defective children, who in many cases require a change of air and the regulation and routine of a healthy life, has been overcome largely as the result of the keen activity of the Local Branch of the Invalid Children's Aid Association. Twenty-three children have been sent to Schools of Recovery, through this Association, by arrangement with the Local 144 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 36 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. SYNOPSIS OF CASES REFERRED TO EAST HAM I.C.A.A. BY SCHOOL MEDICAL SERVICE DURING 1933. Illness and Disability. Anæmia and Debility 19 Bronchial Catarrh 4 Sub-normal Nutrition 4 Cervical Adenitis 3 Post-Pneumonic Debility 1 Post Diphtheritic Debility 1 Post-Tonsillectomy Debility 1 Accident 1 Bronchitis 1 Rheumatism 1 Mitral Valvular Disease 1 Total 37 Action taken. Convalescence 36 Surgical Instrument 1 Total 37 145 Particulars of the number of Children who were resident in Schools of Recovery between 1st January and 31st December, 1933, and the periods of their stay between those two dates. School No. ok Months Totals 1 2 3 4 5 6 7 8 9 10 11 12 B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G Total Ogilvie — 7 1 — 2 2 2 2 3 2 2 7 2 1 — — 2 — 2 — — 1 4 22 20 42 I.C.A.A. (hqtrs.) 4 1 3 – 3 4 — 1 1 — 4 2 – – – – – – – – – – – – 15 8 23 St. Catherine's 1 — — 1 1 — 2 — 1 — — — — 3 1 — — — — 1 — — — 9 2 11 St. Dominic's 2 — 2 – – – – – – – 6 – 6 – – – – – 2 – – – 7 – 25 – 25 No. of Weeks 6 11 12 15 23 24 20 27 B. G. Total Russell-Cotes 1 — — 1 21 14 9 5 — — 3 1 — — 1 1 35 22 57 146 10. PHYSICAL TRAINING. Physical training has been continued on similar lines to those quoted in previous reports, and instruction in swimming has been conducted as heretofore. 11. PROVISION OF MEALS. During the year 224,350 meals were provided for children, as compared with 209,969 in 1932. 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. 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 1933 the number of parents who were present at the routine medical inspections was 4,935 (4,882 in 1932), that is, in 64.7 per cent. of the cases examined (61.8 per cent. in 1932). 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 147 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 65 were medically examined, reports and advice in each case being sent to the Secretary of the Education Committee. 16. CO-OPERATION OF VOLUNTARY BODIES. Reference to 9 (e) on page 143 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. Sixty-six 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 1933. The Inspectors have made 287 visits in regard to these cases and the following table indicates the work performed by the Society:— No. of Cases reported. No. of Cases obtaining treatment. No. of Cases still under supervision. No. of Cases where no action was taken after investigation. No. of Visits by Inspectors. 66 58 7 1 287 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. 17. BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. Physically Defective Children. Table III reveals the regrettable fact that 19 children suffering from physical defects are not receiving education owing to their being totally unfit to attend public elementary schools. 148 In addition it will be seen that 405 children, who are considered physically defective, are attending public elementary schools, and since suitable conditions are not available for all these cases it is not improbable that some 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 86 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. In addition to the 19 children who come within this category, there are 123 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 1933, the number of cases examined for purposes of the Mental Deficiency Acts, was 42 (56 in 1932). Of these 9 were classified as mentally deficient, and 31 as dull and backward, recommendations being made as shown in the following table:— Number examined 42 Classified as mentally deficient 9 10 Classified as morally deficient – Classified as imbeciles — Classified as idiots 1 Classified as dull and backward 31 Recommended for Special School 9 Decertified 1 149 Reference to Table III will show that the 89 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 are two secondary schools in East Ham, and tables relating to the work carried out in connection with these schools are appended. 20. CONTINUATION SCHOOLS. There are at present 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. Eleven boys have been specially examined in accordance with the Bye-laws, and these were found to be fit for employment. In addition, 3 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 considerable 150 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 1933 the following special medical examinations were made:— Teachers 5 Assistant Teachers 26 Student Teachers 16 Caretakers 3 Cleaners 17 Cook Attendants 3 MALCOLM BARKER, Medical Officer of Health and School Medical Officer 151 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 fifth annual report on the work clone in the Aural Clinic during 1933. Eighty-three clinics were held during the year, with a total attendance of 1,845. Sixty-two per cent. of the cases were, after treatment, discharged cured. I operated on 276 East Ham children for septic tonsils and adenoids, and in 7 cases of chronic mastoid disease. The statistical report is as follows:— Cases of Chronic Otitis Media 210 Discharged 144 Cases of Deafness 51 „ 23 Other Ear Cases 41 „ 33 Cases of Chronic Rhinitis 58 „ 33 Other Nose Cases 17 „ 9 Cases of Enlarged Tonsils and Adenoids 188 „ 109 Other Throat Cases 11 „ 8 I should like to take this opportunity of expressing my thanks to the medical, nursing and clerical staffs for their very efficient help. I have the honour to be, Sir, Your obedient Servant, RONALD SAVEGE. 152 REPORT OF THE OPHTHALMIC SURGEON. To the Medical Officer of Health for East Ham. Sir, I have the honour to present the annual report of the Eye Department for 1933. General Clinic. Number of new cases 591 Glasses prescribed 359 Glasses not necessary 232 Glasses obtained 359 Special treatment 72 Re-examinations 2,775 Discharged 195 Cysts treated at St. Bart's 8 Operations for strabismus (treated) 2 Baby Clinic. Number of new cases 66 Glasses prescribed 29 Glasses obtained 29 Special treatments 12 Re-examinations 256 Discharged 13 Lachrymal obstructions treated at St. Bart's 1 Myope Class. Number of pupils 18 The operations done at St. Bartholomew's Hospital by me were all successful. The sight-saving class did good work during the year. The School Medical Service and the optical and clerical staff have all given delightfully kind and efficient help at all times. I have the honour to be, Sir, Your obedient Servant, S. C. REEVE-FLAXMAN. 153 REPORT ON THE WORK DONE IN THE SCHOOL DENTAL CLINIC. To the School Medical Officer, County Borough of East Ham, Education Committee. Sir, I have much pleasure in submitting to you my report on the work done in the Dental Clinic for the year 1933. The age groups inspected have been those from 5 years to 11 years inclusive. All these children have been inspected once during the year and treatment offered where necessary, attendance being kept in strict rotation. The number of children inspected was 11,811 and the number referred for treatment was 8,133. To these figures must be added those cases of toothache and oral sepsis, referred by the School Medical Officers and Head Teachers, which number 332. All these cases are over 11 years of age and come under the heading of " specials." Details will be found in the following statistical table:— TABLE IV. Group V. Dental Defects. The dental inspection of school children is carried out so that each child is examined once a year. It sometimes happens that an inspection coincides with an epidemic when a large number of children are absent, then the absentees are inspected at some suitable future date. Inspection time is a good opportunity to talk to the children individually and try to obtain their confidence, especially those with very dirty and septic mouths. Two sessions per week are devoted to inspection. All treatment is carried out so that pain is almost eliminated. Teeth both temporary and permanent are filled when possible, and, in the case of sensitive permanent teeth, injections are given to make it painless. An injection is given for the extraction of most temporary teeth and some permanent teeth, except where sepsis is present, when gas is given for permanent teeth and local ethylchloride for temporary teeth. Sometimes a child is very nervous 154 of anything being done, then gas is given for all necessary extractions. One session per week is devoted to gas administration, when a doctor is in attendance. Regulation of teeth is carried out either by judicious extractions, or by making regulation plates to bring the teeth into proper alignment. Difficult cases are referred to dental hospitals, usually Guy's Hospital or the London Hospital. There is a general improvement in the teeth of the school children of East Ham. No. of Sessions devoted to Treatment. No. of Attendances. No. of Permanent Teeth. No of Temporary Teeth. Total No. of Ex tractions. 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. 95 218 664 337 44 1,069 184 1,406 228 57 138 84 Two sessions per week are devoted to the cases referred by the Medical Officers of the Maternity and Child Welfare Centres. Fillings are done when possible in both temporary and permanent teeth, and extractions are carried out by gas or local injection. I should like to thank my colleague, Mr. Hall, and the two dental nurses for their cordial co-operation and assistance during the year, and also the School Medical Officers, Nurses, Teachers and clerical staff. I have the honour to be, Sir, Your obedient Servant, (Signed) C. S. NEAME. 155 TABLE I. RETURN OF MEDICAL INSPECTIONS. A.—ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the prescribed Groups— Entrants 2,040 Second Age Group 2,006 Third Age Group 2,079 Total 6,125 Number of other Routine Inspections 1,420 B.—OTHER INSPECTIONS. Number of Special Inspections 2,948 Number of Re-Inspections 2,773 Total 5,721 156 TABLE II. A.—A Return of Defects found by Medical Inspection in the Year ended 31st December, 1933. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept underobservation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. (1) (2) (3) (4) (5) Skin Malnutrition 41 3 16 — Ringworm : Scalp — — — — Body — — 38 — Scabies — — 17 — Impetigo 6 4 193 — Other Diseases (Non- Tuberculous) 19 17 208 1 Eye Blepharitis 2 12 30 — Conjunctivitis 5 4 87 1 Keratitis – — — — Corneal Opacities 1 — 1 — Defective vision (excluding Squint) 208 82 135 22 Squint 19 11 41 1 Other conditions 5 9 80 3 Ear Defective Hearing 11 2 41 3 Otitis Media — — 13 — Other Ear Diseases 60 113 187 1 Nose and Throat Chronic Tonsillitis only 66 996 47 6 Adenoids only 5 24 8 2 Chronic Tonsillitis and Adenoids 156 35 131 3 [Other conditions 35 90 60 9 Enlarged Cervical Glands (Non- Tuberculous) 14 600 45 — 157 Table II.—(continued). (1) (2) _ (3) (4) (5) Defective Speech 2 6 7 5 Heart and Circulation. Heart Disease: Organic 9 20 9 4 Functional 1 78 6 2 Anæmia 30 43 42 3 Lungs Bronchitis 3 9 6 — Other Non-Tuberculous Diseases 40 51 85 8 Tuberculosis Pulmonary: Definite — — — — Suspected — — — — Non-Pulmonary : Glands — 1 — — Bones and Joints — 2 1 — Skin — — — — Other Forms — 1 — — Nervous System Epilepsy – 2 5 — Chorea 5 4 33 1 Other conditions 4 11 8 2 Deformities Rickets 3 5 – — Spinal Curvature 9 2 1 — Other Forms 6 9 10 3 Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 212 235 1282 70 B.—Number of Individual Children found at Routine Medicai. 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) Prescribed Groups:— Entrants 2040 250 12.2 Second Age Group 2006 230 11.4 Third Age Group 2079 180 86 Total (Prescribed Groups) 6125 060 10.7 Other Routine Inspections 1420 66 4.6 158 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Children Suffering from Multiple Defects. Information is only required of children suffering from any combination of the following types of defect :— Blindness (Not Partial Blindness). Deafness (Not Partial Deafness). Mental Defect. Epilepsy. Active Tuberculosis. Crippling (as defined in the penultimate category of the Table). Heart Disease. The actual combination of defects should be stated on a separate sheet, together with the type of school attended, e.g., in the case of a mentally defective epileptic child, the return should show whether the school attended is a school for mentally defective or for epileptic children. State here the number of children suffering from 1 Blind any combination of the above defects & M.D. No school Blind Children. A blind child is a child who is too blind to be able to read the ordinary school books used by children. Enter in this Section only children who are so blind that they can only be appropriately taught in a school for blind children. At Certified Schools for the Blind. At Public Elementary Schools. At Other Institutions. At no School or Institution. Total. 3 — — 1 4 Partially Blind Children. Enter in this Section only children who, though they cannot read ordinary school books or cannot read them without injury to their eyesight, have such power of vision that they can appropriately be taught in a school for partially blind. Children who are able by means of suitable glasses to read the ordinary school books used by children without fatigue or injury to their vision should not be included in this Table. At Certified Schools for the Blind. At Certified Schools for the Partially Blind. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — 27 6 — 4 37 159 Table III—continued. Deaf Children. A deaf child is a child who is too deaf to be taught in a class of hearing children in an elementary school. Enter in this Section only children who are so deaf that they can only be appropriately taught in a school for the deaf. At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 18 – — — 18 Partially Deaf Children. Enter in this Section only children who can appropriately be taught in a school for the partially deaf. At Certified Schools for the Deaf. At Certified Schools for the Partially Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. — — 1 — — 1 Mentally Defective Children. Feeble-Minded Children. Mentally Defective children are children who, not being imbecile and not being merely dull or backward, are incapable by reason of mental defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools but are not incapable by reason of that defect of receiving benefit from instruction in Special Schools for mentally defective children. This category includes only those children for whose education and maintenance the Local Education Authority are responsible, and should exclude all children who have been notified to the Local Authority under the Mental Deficiency Act. Details of such children should be given on Form 307M. At Certified Schools for Mentally Defective Children. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 84 3 2 — 89 Epileptic Children. Children Suffering from Severe Epilepsy. In this part of the Table only those children should be included who are epileptic within the meaning of the Act, i.e., children who, not being idiots or imbeciles, are unfit by reason of severe epilepsy to attend the ordinary Public Elementary Schools. 160 Table III—continued. For practical purposes the Board are of opinion that children who an subject to attacks of major epilepsy in school should be recorded as " severe ' cases and excluded from ordinary Public Elementary Schools. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 3 — – – 3 Physically Defective Children. Physically Defective children are children who, by reason of physical defect, are incapable of receiving proper benefit from the instruction in the ordinary Public Elementary Schools, but are not incapable by reason of that defect of receiving benefit from instruction in Special Schools for physically defective children. The exact classification of physically defective children is admittedly a matter of difficulty. Valuable information, however, will be obtained if School Medical Officers will record these defective children as accurately as possible under the selected sub-headings. A. Tuberculous Children. In this category should be placed only cases diagnosed as tuberculous and requiring treatment for tuberculosis at a sanatorium, a dispensary, or elsewhere. Children suffering from crippling due to tuberculosis which is regarded as being no longer in need of treatment should be recorded as crippled children, provided that the degree of crippling is such as to interfere materially with a child's normal mode of life. All other cases of tuberculosis regarded as being no longer in need of treatment should be recorded as delicate children. I.—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) At Certified Special Schools. At Public Elementary Schools.† At other Institutions. At no School or Institution. Total. 9 29 — 2 40 II.—Children Suffering from Non-Pulmonary Tuberculosis. (This category should include tuberculosis of all sites other than those shown in (I) above.) At Certified Special Schools. At Public Elementary Schools.† At other Institutions. At no School or Institution. Total. 19 57 2 7 85 † It is essential that tuberculous children who are, or may be, a source of infection to others should be promptly excluded from Public Elementary Schools. 161 Table III—continued. B. Delicate Children. This Section should be confined to 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. Such children should be included irrespective of the actual provision of Open Air Schools in the area, or of the practicability in present circumstances of sending the children to Residential Schools. At the same time it should be remembered that children should not be regarded as suitable for admission to an Open Air School unless the Medical Officer would be prepared to certify that they are incapable by reason of physical defect of receiving proper benefit from the instruction in the ordinary Public Elementary Schools. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 71 187 — — 258 C. Crippled Children. This Section should be confined to children (other than those diagnosed as tuberculous and in need of treatment for that disease) who are suffering from a degree of crippling sufficiently severe to interfere materially with a child's normal mode of life, i.e., children who generally speaking are unable to take part, in any complete sense, in physical exercises or games, or such activities of the School curriculum as gardening or forms of handwork usually engaged by other children. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 11 60 2 4 67 D. Children with Heart Disease. This Section should be confined to children whose defect is so severe as to necessitate the provision of educational facilities other than those of the Public Elementary School. At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 25 73 — 6 104 162 TABLE IV. Return of Defects Treated during the Year ended 31st December, 1933. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness, for which see Group VI.). 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 — – – Ringworm—Body 27 27 Scabies 14 14 Impetigo 193 — 193 Other skin disease 200 3 203 Minor Eye Defects (External and other, but excluding cases falling in Group 11.) 156 3 159 Minor Ear Defects 235 9 244 Miscellaneous (e g., minor injuries, bruises, sores, chilblains, etc.) 1255 96 1351 Total 2080 111 2191 163 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) 519 28 56 603 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) — — — – Total 519 28 56 603 Total number of children for whom spectacles were prescribed— (a) Under the Authority's Scheme 359 (b) Otherwise 28 Total number of children who obtained or received spectacles— (a) Under the Authority's Scheme 359 (b) Otherwise 28 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) (i) (ii) (iii) (iv) (i) (ii) iii) (iv) (i) (ii) (iii) (iv) 56 498 78 12 324 6 2 – 20 — 80 12 344 6 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids (iv) Other defects of the nose and throat. 164 Table IV.—continued. Group IV.—Orthopædic and Postural Defects. Under the Authority's Scheme. (1) Otherwise. (2) Total number treated. Residential treatment with education. Residential treatment without education. Nonresidential treatment at an orthopaedic clinic. Residential treatment with education. Residential treatment without education. Nonresidential treatment at an orthopaedic clinic. (i) (ii) (iii) (i) (ii) (iii) Number of children treated — — 15 — — 2 17 Group V.—Dental Defects. (1) Number of Children who were: — (i) Inspected by the Dentist— Age. Specials Grand Routine Age Groups. Total. 5 6 7 8 9 10 11 Total. 1525 1725 1813 1854 1940 2105 839 11811 332 11423 (ii) Found to require treatment 8133 (iii) Actually Treated 3181 (2) Half-days devoted to:— Inspection 104 Total 789 Treatment 685 (3) Attendances made by children for treatment 6908 (4) Fillings:— Permanent Teeth 1683 Total 2268 Temporary Teeth 585 (5) Extractions:— Permanent Teeth 850 Tota; 8561 Temporary Teeth 7711 (6) Administrations of general anaesthetics for extractions 474 (7) Other operations:— Permanent Teeth 481 Total 759 Temporary Teeth 278 Group I.—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 50,064 (iii.) Number of individual children found unclean 1,092 (iv.) Number of children cleansed under arrangements made by the Local Education Authority Nil. (v.) Number of cases in which legal proceedings were taken:— (а) Under the Education Act, 1921 Nil. (b) Under School Attendance Byelaws Nil. 165 TABLE I. RETURN OF MEDICAL INSPECTIONS. For the Year ended 31st December, 1933. SECONDARY SCHOOL. A.—ROUTINE MEDICAL INSPECTIONS. Number of Inspections in the prescribed Groups— Boys. Girls. Entrants — — Second Age Group — — Third Age Group 128 115 Total 128 115 Number of other Routine Inspections 268 301 B.—OTHER INSPECTIONS. Number of Special Inspections 22 9 Number of Re-Inspections 22 34 Total 44 43 166 TABLE II. SECONDARY SCHOOL. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1933. Defect or Disease. Routine Inspections. Special Inspections. No. of Defects. No. of Defects. Requiring Treatment. Requiring to be kept under observation, but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation,but not requiring Treatment. (1) (2) (3) (4) (5) B. G. B. G. B. G. B. G. Malnutrition — 1 — — — — — — Skin Ringworm: — — — — — — — — Scalp — — — — — — — — Body — — — — — — — — Scabies — — — — — — — — Impetigo — — — 1 2 — — — Other Diseases non-Tuberculous — — — 1 2 — 1 — Eye Blepharitis — — — 1 — — — — Conjunctivitis — — — — — 1 — — Keratitis — — — — — — — — Corneal Opacities — — — — — — — — Defective Vision (excluding Squint) 10 15 5 — — — — — Squint — 1 — — — — — — Other Conditions — — — — 2 — — — Ear Defective Hearing — 1 — — — — — — Otitis Media — — — — — — — — Other Ear Diseases — 2 — 9 1 — — — Nose and Throat Chronic Tonsillitis only 2 2 12 2 — — — — Adenoids only — — — — — — — — Chronic Tonsillitis and Adenoids — — — — — 1 — — Other Conditions 2 2 1 — — 2 — — Enlarged Cervical Glands (Non-Tuberculous) — — 3 1 2 — — — Defective Speech — — — — — — — — 167 Table II.—(continued.) (1) (2) (3) (4) (5) B. G. B. G. B. G. B. G. Heart and Circulation Heart Disease: Organic 1 1 2 — 1 — — — Functional — — 4 3 — — — — Anaemia — — 1 1 2 — — — Lungs Bronchitis — — — — — — — — Other Non-Tuberculous Diseases — — 1 1 — — — — Tuberculosis Pulmonary: Definite — — — — — — — — Suspected — — — — — — — — Non-Pulmonary: Glands — — — — — — — — Bones and Joints — — — — — — — — Skin — — — — — — — — Other Forms — — — — — — — — Nervous System Epilepsy — — — — — — — — Chorea — — — — — Other Conditions — 1 — 4 — — — — Deformities Rickets — — Spinal Curvature — 1 — 4 — — — — Other Forms — 6 1 20 — — — — Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 3 8 2 39 8 4 — — 3.—Number of individual children found at Routine Medical Inspection to Require Treatment (excluding Uncleanliness and Dental Diseases). GROUP. Number of Children. Percentage of Children found to require Treatment. Inspected Found to require Treatment. (1) (2) (3) (4) B. G. B. G. B. G. Prescribed Groups:— Entrants — — — — — — Second Age Group — — — — — — Third Age Group 128 115 5 10 39 8.6 Total (Prescribed Groups) — — — — — — Other Routine Inspections 268 301 6 20 2.2 6.6 168 TABLE IV. SECONDARY SCHOOL. Return of Defects Treated during the Year ended 31st December, 1933. TREATMENT TABLE. Group I.—Minor Ailments (excluding Uncleanliness). Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme Otherwise. Total. (1) (2) (3) (4) B. G. B. G. B. G. Skin— Ringworm—Scalp – — – — – — Ringworm—Body – – – – – – Scabies – – — — — — Impetigo 3 — — — 3 – Other skin diseases 2 2 — — 2 2 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 3 1 — — 3 1 Minor Ear Defects — — — — — — Miscellaneous (e.g.,minor injuries, bruises, sores, chilblains, etc.) 10 26 – – 10 26 Total 18 29 — — 18 29 169 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) B. G. B. G. B. G. B. G. Errors of Refraction (including Squint) 1 1 — 1 — — 1 2 Other Defect or Disease of the Eyes (excluding those recorded in Group I.). — — — — — — — — Total 1 1 — 1 — — 1 2 Total number of children for whom spectacles were prescribed— B. G. (a) Under the Authority's Scheme ... — 1 (b) Otherwise — 1 Total number of children who obtained or received spectacles— (c) Under the Authority's Scheme — — (d.) Otherwise — — Group III.—Treatment of Defects of Nose and Throat. NUMBER OF DEFECTS. Received Operative Treatment. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. (1) (2) (3) B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. B. G. (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 1 — — — 1 5 — — — — 1 — — — — — 1 — 1 — 1 5 — — (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and Adenoids. (iv) Other defects of the nose and throat. 171 INDEX. A. Abatement of Nuisances 100 Act—Blind Persons, 1920 40-43 Act—Children, 1908-32 93 Act—Housing, 1930 109 Act—Local Government, 1929 19 Acts—Mental Deficiency 37-40 Acts—Midwives, 1902-18 16 Act—Nursing Homes Registration, 1927 17 Act, Rents Restriction 101 Adenoids 87, 131, 137, 163, 169 After-Care Committee 59 Aldersbrook Homes 24, 30-34 Ambulance Facilities 17 Attendance Officers, Cooperation of 146 Ante-Natal Clinic 90 Artificial Pneumothorax 69 Artificial Sunlight 140 Aural Surgeon, report of 151 Aural Treatment 88 B. Bacteriology 18, 111 Bacteriological Examinations 111 Baths 146 Birth-rate 11 Births 8, 88 Births, Illegitimate 7 Births, Still 90 Blind Persons Act, 1920 40-43 Blind Children 147,158 Byelaws 105 Byelaws—Premises and occupations controlled by 105 C. Cancer 51-52 Cemeteries 106 Chief Sanitary Inspector— Report of 96-119 Children Act, 1908-32 93 Classrooms, Open Air 142, 143 Clinic, Ante-natal 90 Clinic, Artificial Sunlight 140 Clinic, Aural 151 Clinic, Dental 153 Clinic, Immunisation 46,47, 87 Clinics, Morning 88 Clinic, Ophthalmic 152 Clinic, School 136 Clinic, Toddlers' 87 Clinic, Tuberculosis and Chest 36 Clinics, Infant 86 Clinics and Treatment Centres 36 Closet Accommodation 97, 106 Committees 3, 122 Complaints of Nuisances 100, 101 Continuation Schools 149 Co-ordination 125 Crematorium 94 Cripples 133, 139, 161 D. Dairies 110 Day-Schools, Open air 143 Deaf Children 147, 159 Deaths 8 Death-rate, General 11 Death-rate, Infantile 9 Deaths, Causes of 13 Deaths, Infants 16 Deaths, in Wards and Rates 15 Dental Treatment 88, 133, 139, 153, 164 Dental Treatment — Tuberculous Patients 67 Dental Surgeons, Report of 153 Diphtheria 46, 81 Drainage and Sewerage 97 Dust Collection 97 E. Ear Diseases 24,133,138 East Ham Memorial Hospital 25 Education Committee 122 Employment of Children 149 Enteric Fever 48, 83 Epileptic Children 147, 159 Erysipelas 48, 83 Eye Diseases of Children 131, 138 F. Factories and Workshops 116 Following-Up 136 Food and Drugs 104-111 Food Inspection 110-115 Free Supplies of Milk 93 H. Harts Sanatorium 23, 67-73 Health Committee 3 Health Visitors 89 Home Helps 94 Homes, Aldersbrook and Scattered 30-34 Homeless Children 17 Hospital Accommodation 23 Hospital, Infectious Diseases 80-85 Hospital, East Ham Memorial 25 Hospital, Maternity 24 Hospital, Mental 24, 25 Hospital, Smallpox 26 Hospital, Whipps Cross 28 House-to-House Inspection 98 Housing Act, 1930 109 Housing Statistics 107-109 172 INDEX—continued. I. Illegitimate Births 7 Immunisation Clinic 46, 47, 87 Increase of Rent (Restriction) Act 101 Infant Deaths 9, 16 Infantile Mortality 9 Infectious Diseases Hospital 80-85 Infectious Diseases, Prevalence of and Control over 45-51, 133-135 Inspection of and Supervision of Food 110-115 Inspection, House-to-House 98 Inspection of School Children 125-133 Institutional Provision for Unmarried Mothers, Illegitimate Infants, etc 17 Institutions Controlled by West Ham 29 Invalid Children's Aid Association ... ... 44, 93, 144 L. Laboratory Work 18, 116 Legal Proceedings 102-104 Legislation in Force 18 Light Treatment 140 Local Government Act, 1929 19 M. Maternal Mortality 9, 93 Maternity and Child Welfare 85-94 Maternity and Child Welfare Committee 3 Maternity Homes and Hospitals 17,91 Meals, Provision of 146 Measles 83 Meat Regulations 111 Medical Examinations, Miscellaneous 150 Medical Officer of Health's Report 1-95 Medical Relief, Poor Law 19-22 Mental Defects, School Children 148 Mental Deficiency 35, 37-40 Mental Deficiency Committee 3 Mental Hospital 24, 25 Meteorology 95 Midwives 16, 91 Milk—Free Supplies 93 Milk (Special Designation) Order 110 Milk Supply 110 Minor Ailments 131,137 Mortality, Analysis of 11 N. Neo-natal Mortality 9 Noteworthy Causes of Sickness or Invalidity 8 Notices Served 100 Notification of Births 88 Nuisances Abated 100 Nuisances Discovered 100 Nursing Arrangements 16, 17, 22 Nursing Homes Registration Act, 1927 17 Nursery Schools 149 0. Open-air Education 142-145 Ophthalmia Neonatorum 51, 93 Ophthalmic Clinic 152 Ophthalmic Surgeon, Report of 152 Ophthalmic Treatment 88 Orthopaedic 24, 164 P. Parents, Co-operation of 146 Physical Features of Area 7 Physical Training 146 Playground Classes 142 Poor Law Medical Out Relief 19-22 Population 10 Premises and Occupations Controlled by Byelaws 105 Prevalence of Infectious Diseases 45-51 Prosecutions, Milk 104 Prosecutions, Public Health Act 102-104 Prosecutions, Sale of Food and Drugs Acts 104 Public Assistance Domiciliary Medical Service 19-22 Public Assistance Institutions 29 Public Health Committee 3 Puerperal Fever and Pyrexia 24, 48, 92 R. Rag Flock Act 106 Rateable Value 7 Refuse Removal and Disposal 97 Rents Restriction Act 101 Residential Schools 143-145 Ringworm 88 Rivers and Streams 97 S. Sanatoria 67-76 Sanitary Circumstances of the Borough 97 Sanitary Inspection of Borough 98 173 INDEX—continued. Scarlet Fever 46, 82 Scattered Homes 30-34 Scavenging 97 Schick Immunisation Clinic 46, 47, 87 School Attendance Officers Co-operation of 146 School Baths 146 „ Blind Children 147 „ Camps 143 „ Children, Blind, Deaf, Defective and Epileptic 147 „ Children, General Cleanliness 129, 164 „ Children, Minor Ailments 131 „ Children, Medical Inspection 126-133 „ Children, Physically Defective 160 „ Children, Dental 133, 139, 164 „ Children, Verminous Conditions 130-164 „ Continuation 149 „ Cripples 133, 139, 161 „ Exceptional Children 126, 147 „ Hygiene 125 „ Meals 146 „ Medical Officer's Report 121—169 „ Medical Service in Relation to Public Elementary Schools 125 „ Medical Treatment 136-142 „ Nursery 149 „ Open-air 142-145 Schools of Recovery 143-145 Schools, Secondary 149 Schools, Survey of 107 Sewage 97 Sickness or Invalidity, any Noteworthy Causes 8 Skin Diseases 132, 137 Slaughterhouses 112 Smallpox 26, 45, 98 Smoke Abatement 105 Social Conditions of Area 7 Special Enquiries 149 Special Schools 143-145 Staff 4, 85, 122, 125 Statistics 7 Still Births 90 Streams 97 T. Table, Birth-rate 11 „ Blind Persons 41,43 „ Cancer 52 „ Complaints Received 100, 101 „ Death Rate 11 „ Deaths, Causes of 13 Table, Deaths, Ward and Rates 15 „ Defective Vision and Squint 103 „ Dental Treatment 164 „ East Ham Memorial Hospital 26-28 Exceptional Children 158 „ Factories and Workshops Act 116 „ Food and Drugs Acts 114 „ Harts Sanatorium 70-73 „ Housing 107-109 „ Infant Deaths 16 „ Infectious Diseases, Notifiable 49 „ Infectious Diseases Removed to Hospital 50-84 „ Infectious Diseases in School children 135 „ Inspections for year 98 Inspections in Wards 99,119 Laboratory Examinations 111 „ Mental Defectives 37, 38,40 „ Mental Hospitals 25 „ Meteorology 95 „ Minor Ailments 131, 162 „ Ophthalmia Neonatorum 51 Public Assistance Institutions 29 Public Health Act Prosecutions 102-104 „ Record of Inspections 119 „ Sale of Food and Drugs Acts Prosecutions 104 „ School Children, Defects of 156-166 „ School Children Examined 155, 165 „ School Children Found to require Treatment 129, 157, 167 „ School Children, Treatment carried out 162-4, 168 „ Schools of Recovery 145 „ Secondary School Examinations 165-169 „ Sunlight Treatment 141 „ Throat and Nasal Defects 163 „ Tuberculosis Deaths 80 „ Tuberculosis and Chest Clinic 62-66 „ Tuberculosis Notifications 77-79 „ Tuberculosis, Residential Treatment 74-76 „ Vaccination 46 „ Verminous Condition of Schoolchildren 130 Teaching Staff, Co-operation of 146 174 INDEX—continued. Tonsils and Adenoids 87, 131, 137, 163, 169 Training Centre, Mental Defective 39 Treatment Centres 36 Tuberculosis 53-66, 132, 137, 160 Tuberculosis and Chest Clinic 36, 53-66 U. Unmarried Mothers 17 Urinals 106 V. Vaccination 46 Venereal Diseases 34 Vital Statistics, Extracts from 7 Vision 132, 138, 163, 169 Visits, Health Visitors 89 Visits, School Nurses 136 Voluntary Associations 44, 93, 144, 147 W. Wards, Deaths in and Rates 5 Water Supply 97 Whooping Cough 83 Workshops 116